Municipal health policy development, planning and implementation: addressing youth risk factors through participatory governance.
Subject: Public health (Analysis)
Task forces (Analysis)
Health planning (Political aspects)
Health planning (Reports)
Administrative agencies (Health policy)
Authors: Tataw, David Besong
Rosa-Lugo, Bernardo, Jr.
Pub Date: 03/22/2011
Publication: Name: Journal of Health and Human Services Administration Publisher: Southern Public Administration Education Foundation, Inc. Audience: Academic Format: Magazine/Journal Subject: Government; Health Copyright: COPYRIGHT 2011 Southern Public Administration Education Foundation, Inc. ISSN: 1079-3739
Issue: Date: Spring, 2011 Source Volume: 33 Source Issue: 4
Topic: Event Code: 970 Government domestic functions
Product: Product Code: 8000120 Public Health Care; 9005200 Health Programs-Total Govt; 9105200 Health Programs; 8000310 Health Planning NAICS Code: 62 Health Care and Social Assistance; 923 Administration of Human Resource Programs; 92312 Administration of Public Health Programs
Geographic: Geographic Scope: Switzerland Geographic Code: 4EXSI Switzerland
Accession Number: 250033487
Full Text: BACKGROUND

Introduction

In 1988, the Institute of Medicine (IOM) issued a report entitled "The Future of Public Health," This report echoed the resurgence on the international scene of the concept and practice of citizenship participation in municipal governance; and recognized the shift from expert dominated health planning to participatory community health planning. In the report, IOM called for public health policy development and practice to be evidence-based, to involve citizens' participation, should be advanced through partnerships, and should be based on cooperative relationships with grassroots organizations. The IOM report was directed at Local Public Health Agencies (LPHA)/Local Public Health Departments (LPHD). Like much of urban public health literature, the IOM report failed to acknowledge the public health functions of municipal authorities which do not have designated public health agencies under their jurisdiction.

As urban public health problems have increased in number and intensity within the years, cities without Public Health Departments have developed innovative community oriented strategies to address public health problems facing youths. Examples of intractable urban health problems affecting youths are gang violence, academic failure, substance use, and favorable attitudes towards antisocial behavior. The Pomona Youth and Family Master Plan (YFMP) was developed to address three community identified and prioritized youth risk factors, including community disorganization, academic failure, and favorable attitudes towards antisocial behavior.

The YFMP is a textbook example of research-based municipal participatory health policy development, planning and implementation. This case study outlines and analyzes the unfolding of the policy process from problem to policy decisions, to the development of a municipal master plan and the ultimate actualization of The Pomona Youth and Family Master Plan. Implications for policy making and implementation, community health partnerships and the concept of citizenship are also discussed.

The Pomona Youth and Family Master Plan (YFMP)

The Pomona Youth and Family Master Plan (YFMP) is a road map for the positive development of Youths and Families in Pomona, California. The plan emerged from decades of frustration with intractable community problems such as gang violence, poor academic achievement, teen substance use, and high rates of teen pregnancy. The formal planning process for this municipal master plan was initiated on February 28, 2005 through the adoption of City Council Resolution No. 2005-13.

The city council resolution adopted The Community That Cares (CTC) strategy as the organizing framework to guide the planning and implementation of a municipal Master Plan for Youth and Families. The CTC focuses on tested and effective programs, policies and practices that address pre-determined priority risk factors by increasing protective factors. The CTC process is a five-step evidence driven strategic planning process that includes: 1) Preparing Community Board Readiness, 2) Assessing Risk and Protective Factors, 3) Identifying Resources and Gaps in Services, 4) Identifying Best Practices Programs, Strategies and Policies, and 5) Developing an Evaluation plan. The Plan that emerged was developed through a partnership between the city government and the Pomona Unified School District(PUSD) working in collaboration with other community stakeholders including faith-based organizations, businesses, institutions of higher learning, community based organizations, chamber of commerce, and the youth of the city. The process included a needs assessment, community analysis of the data, prioritizing of the risk factors, and development of a plan to address three selected priority factors including community disorganization, academic failure, and favorable attitudes towards antisocial behavior.

The Pomona Youth and Family Master Plan is comprised of the following Community Action Components: Community Mobilization; Establishment and Fostering of Collaboration and Partnerships involving service providers and Pomona Youth ; Development, Enhancing, and Co-ordination of existing programs and services that address the selected three priority risk factors; Resource Brokerage; and Community-Based Participatory Evaluation Research to implement the evaluation plan. The final plan was developed and implemented through a process that integrated policy development; collaborative and participatory planning; and organizational development.

Outcomes

Pomona Youths and Families who participate in the Youth and Family Master Plan will realize the following outcomes:

* Reduced community disorganization reported by 8th, 10th, and 12th grade students as measured on the Pride Risk and Protective Factor Questionaire and other evaluation instruments.

* Reduced academic failure reported by 8th, 10th, and 12th grade students as measured on the Pride Survey Risk and Protective Factor Questionaire and other evaluation instruments.

* Reduced Favorable Youth Attitudes toward Antisocial Behavior reported by 8th, 10th, and 12th grade students as measured on the Pride Survey Risk and Protective Factor Questionaire and other evaluation instruments.

Social Context of Individual Risk

The tendency for health professionals to individualize risk has perpetuated the idea that risk is individually determined rather than socially determined. Yet, contextual or multilevel factors are critical in community health outcomes (Reppucci et al.1999) because individual health and psychological empowerment is not only affected by personal characteristics but also by the characteristics of the group people belong to (Diez-Roux, 1998); by the social system in which they operate (Mckinlay, 1995); or the organizational climate they find themselves in (Mcmillan et al.1995).

Citizenship and Participatory Governance

The character of citizenship and participatory governance are important factors that shape the social context that affects community health outcomes. Democratic participation has recently gained prominence in urban politics (Marshall, 1964) but the notion can be traced to the Greek city-states, where it was believed that every citizen should be allowed to participate in decision-making. The political rights of citizens entail the entitlement of individuals to participate in their governance, through rights, which are associated with systems of democracy (Prior et al. 1995, Republic of South Africa, 2000, Abram & Cowell, 2004). Citizen participation is not only an integral part of community development(Abbott, 1996); but it democratizes planning, and promotes social justice by allowing all citizens, especially disadvantaged groups to influence policy making at the city level (Imparato & Ruster, 2003, Souza, 2003 ); and is considered a crucial component in the provision of basic needs, efficiency , and self-reliance (Cox & Sinclair, 1996).

Participatory Community Health Planning

Participatory governance leads to citizenship participation in community health and creates opportunities for citizens to be part of conceptualization, planning, implementation and evaluation of community health programs (Aston et. al.2009; World Health Organization (WHO), 2003). Participation leads to empowerment (Kretzman and McKnight (1993) and stimulates critical consciousness and trusting relationships (Freire, 1970). Participatory governance can also trigger policy development and systems change (Rose, Gomez, & Valencia-Garcia (2003); and ensure that local ownership and consensus are obtained, interagency coordination is established, and all stakeholders, not just proprietary interests, are involved in policy development and planning (Penner, 1994). A participatory approach also creates long term sustainability as youths who participate in community programs grow up to be civically-engaged adults (Borden & Seri do, 2009), therefore, a dual focus on youth and community development contributes to peace building and the disruption of cycles of violence (Wessels & Monterio, 2006).

Conceptual Framework

The Pomona Youth and Family Master Plan are framed within four intersecting conceptual elements. The first is a multilevel approach (Reppucci ET al.1999; Dawes & Donald, 2000) that views individual risk as mediated by micro and macro-level transactions with agents such as family, peers, community groups, and wider institutions. The second is the concept of citizens' participation which involves everyone in community decision making including youths, vulnerable populations, adults, politicians, and other stakeholders. By merging multilevel analysis with involvement of all stakeholders in the social system, element one and two together underscore the role of a dynamic social context in youth empowerment. The third element is a social disruption analysis borrowed from a post war analysis (Higson-Smith&Killian, 2000) which views conflict and crisis as having a destabilizing influence on multiple social levels. The Fourth is a Risk and Protective Factors Approach. This epidemiologically-based risk reduction approach provides a natural framework for planning and managing comprehensive prevention activities at the community level (Arthur et al., 1996; Arthur & Blitz, 2000). By collecting and prioritizing epidemiologic data on risk and protective factors at the community level, preventive interventions may target prioritized factors and program resources focused on specific geographic areas with the most prevalent risk factors (Hawkins, 1992, 1999). This two prong approach to prevention; community action of reducing risk and promoting positive social development is actualized via the Communities That Care (CTC) strategy for preventing adolescent problem behavior (Hawkins & Catalano 1992). The Pomona Youth and Family Master Plan adopts the Communities That Care strategy as its planning framework. The Communities That Care (CTC) strategy besides facilitating the risk reduction approach is well aligned to the other three elements above because it is evidenced based, uses multilevel analysis, is participatory, and focuses on tested and effective programs, policies and practices that address pre-determined priority risk factors. The CTC approach can be applied to a variety of problem behaviors, including substance abuse, delinquency, teen pregnancy, and violence and is intended to involve key community leaders in identifying and prioritizing risks and resources, developing a plan, and monitoring ongoing action and implementation. The driving force behind program development and implementation in the CTC approach is a community board that should include representatives from different professional, citizen, and advocacy constituencies. The Pomona YFMP's four conceptual elements which are actualized through the CTC strategy address the key IOM recommendations for public health policy development and practice (1988): evidence-based, citizens' participation, partnerships, and cooperative relationships with grassroots organizations.

COMMUNITY AND PLANNING SETTING

Founded in 1888, the city of Pomona has a population of 164,140; and a land area of 22.84 square miles. Pomona is afflicted by high levels of poverty, prevalence and intensity of childhood disease burden, low academic performance, intractable gang violence, high teen pregnancy, teen substance abuse, low levels of health prevention resources and, barriers to access to care. The city of Pomona population statistics and the Pomona Unified School District student statistics are shown in Table one below. Table Two shows substance use statistics in the Pomona Unified School District

Racial and ethnic breakup of the city is as follows: 69% of Latino/Hispanic, 11% White, 10% Asian, 9% African American, and 1% are from other ethnic groups. There is a 9.9% unemployment rate in Pomona; 22% poverty rate; 45% of the residents do not have a high school diploma; only 12.8 % have a college degree ( US 2000 Census, Pomona General Plan 2006).

The city of Pomona has 56,972 Children who are 19 years and under or 34.5% of the population. There were 900 juveniles on criminal probation as of January 2005. As of 2003, Pomona ranked number 1 in gang homicides in San Gabriel Valley Region of Los Angeles County. About 10% of the children do not have health insurance; 46% are teen mothers; and prevalent diseases include heart disease, cancer, diabetes, and childhood obesity (California Department of Health Services, 2005, Pomona General Plan, 2006)

The Pomona Unified School District (PUSD) reports a student population of 31,817 with 49% or 15,630 in 6th to 12th grade. The student ethnic composition is as follows: Hispanics 80.1%, African Americans at 6.9%, Whites 6.4%, Asian/Pacific Islander/Filipino 6.4%, 6.3%. Forty-five percent of PUSD students are English Language Learners; high school dropout rate of 29% is the 4th highest in California; 3/4 of students qualify for the compensatory education program; and 51.7% qualify for free or reduced lunch. Substance use by grade for 8th, 10th, and 12th grades is as follows: Alcohol: 8th-23% ,10th-41.6%, 12th-46.4%; Marijuana: 8th- 8.1%, 10th-14.6%, 12th-18.8%; Crystal Meth: 8th-3.3%, 10th-4.9%, 12th-3.6%; Cocaine: 8th-1.8%, 10th-3.0%, 12th-3.6%; and Tobacco: 8th-8.5%, 10th 13.4%, 12th-17.7%(PUSD Pride Risk Factor Survey, 2005)

PROGRAM PLANNING

The Program planning component of this paper describes the emergence of youth and gang violence as a policy problem on the city agenda, the planning process to seek solutions to the problem, and community intervention components developed to address the problem of youth and gang violence in Pomona.

From Problem to Policy Solutions

Gang Violence in Pomona: In April of 2004, a 16 year old youth under the influence of "crystal methamphetamine" shot and killed a California Highway Patrol Officer in Pomona, allegedly trying to gain entry into the oldest and biggest Mexican gang in Pomona. The shooting of the officer is part of the intractable problem of gang violence and deviant youth behavior in Pomona. The shooting of the police officer pushed Pomona's youth problem high up the city's agenda. The city had already started work on developing solutions for youth problems but the crisis environment created by the shooting forced the city to create an additional path way to developing a municipal solution to the problem of youth and gang violence. Due to the crisis, the city formed a Gang Task Force that would recommend solutions to youth and gang violence in Pomona. The task force encompassed the City of Pomona as the lead institution, the Pomona Unified School District, the Pomona Police Department, Pomona Chamber of Commerce, Institutions of higher learning, Pomona Valley Hospital Medical Center, Los Angeles County Fairplex, Pomona youth, community residents, and numerous Faith Based and Community Based Organizations serving youth and families in the City of Pomona.

In 2003, the City of Pomona reactivated the Pomona Youth Commission as the official Pomona Youth Advisory Committee consisting of 15 high school teens selected by the Mayor and individual Council members. The youth Commission, after studying existing Youth Master Plans, recommended a Youth Master Plan based on the Community That Cares strategy. Simultaneously, in 2004, the Gang Task Force Steering Committee held 3 community meetings and produced 5 subcommittee reports. Participants at the community meetings were recruited from the 6 council districts through the city website, flyers sent to resident's homes and the local media. The Mayor's Gang Task Force renamed the Youth Master Plan as the Youth and Family Master Plan and recommended the development of a Youth and Family Master Plan in Pomona.

Municipal resolution to create a youth and family master plan: On February 28, 2005, the Mayor and City Council adopted Resolution 2005-13 declaring its commitment to "Establishing a comprehensive process based on the Community that Cares Prevention operating system of engaging all members of the community and its leaders who have a stake in promoting positive youth development in the City of Pomona" and, "Endorsing the development of a Youth (and Family) Master Plan [and] a process that is inclusive and based on collaboration; focuses on preventive measures; is supported by proven research; is specific to community needs; and one that will be sustainable."

The YFMP steering committee: The Mayors' Gang Task Force transitioned into the Planning Steering Committee of the Pomona Youth and Family Master Plan after the city council adopted resolution No 2005-13 for developing a Youth and Family Master Plan. A Communities that Care Consultant was retained to guide the Pomona community through a CTC model prevention strategic plan. The consultant guided the community through the following processes:

* Strategic Consultation encompassing Key Leaders' Orientation-for up to 50 participants , Community Board Orientation--for up to 30 participants, Community Assessment Training--for up to 25 participants, Community Resources Assessment Training--for up to 25 participants, Community Planning Training--for up to 30 participants, and Community Plan Implementation Training--for up to 30 participants;

* Technical Assistance Services;

* Needs Assessment/Data Collection;

* Creation of a Youth Master Plan.

On Nov 20, 2006 the City Council approved the Final Draft of the Youth and Family Master Plan and created the Community Board with their role and function to oversee the implementation of the plan. The Community Board became a special committee of the City of Pomona to act in an advisory capacity governed by the Brown Act of California.

The Planning Process

The planning process was guided by a community that cares consultant and included the steps below.

Needs assessment: The pride survey risk and protective factors instrument was used to collect baseline data on youth protective and risk factors in order to identify and prioritize youth risk factors. To establish the resource gap in Pomona, a community resource assessment was also completed.

Protective and risk factor assessment: The CTC assessment process included the collection and analysis of data about community specific levels of risk and protective factors. The purpose of the community assessment was to identify those risk factors that are the greatest contributors to adolescent substance abuse, delinquency, teen pregnancy, school dropout and violence. Its purpose is also to facilitate community consensus on a targeted number of priority risk factors that can become the focus of community action.

Information on risk and protective factors was collected through the Pride Survey Risk and Protective Factor Questionaire. In November of 2005, the Pride Survey was given to 6,000 PUSD students in grades eight, ten, and twelve, and 3967 surveys were completed.

The Pride Protective Risk Factor survey was given under the auspices of a passive permission approach whereby parent permission was not needed at the 8th, 10th and 12th grades. Time was a critical element for expediting this survey due to increase public pressure on Policy and Institutional Leadership to create a plan to reduce gang violence. The confidentiality of the students responding to questionnaires was protected because the students were not allowed to write their names on the questionnaires.

It is hard to say if there might have been an incentive to exaggerate behavior from some of the youths who responded. Based on anecdotal information from informal conversations, many non gang youths trying to survive in their gang infested community, will assume behavior that is consistent with gang affiliation and support. Also there are a significant number of youths who do not align themselves with gangs or get involved in violence even though they may experience risk factors.

Also, geographical divisions might explain the 1/3 non-response to the survey. There are stark differences among Pomona neighborhoods. Some are infested with gangs while other neighborhoods are very wealthy and do not experience gang activity. Philips Ranch and Ganesha Hills are two examples of neighborhoods where professional, and often time's wealthy families live in stark difference to Sin Town in East Pomona or South Pomona. Youth from these wealthier communities normally do not view themselves as being part of the Pomona environment and might not respond to the survey.

The Pride Survey measured twenty risk factors and five protective factors separated in 4 critical domains: Community, Family, School, Peer and Individual. In addition, the survey measured 30-day and annual use of 14 drugs, including alcohol and tobacco, and prevalence of eight other antisocial behaviors, such as carrying a handgun or attacking someone with intent to harm. The Survey data was compared to the national norm for risk and protective factors. The national norm for both protective and risk factors is 50. Because risk factors increase the likelihood

that young people will become involved in problem behaviors, it is desirable to have a score below the national norm for risk factors. Protective factors act as buffers against risk for young people so it is desirable to have a score above the national norm for protective factors.

The community used the assessment data to select 3 priority risk factors as the basis of the Youth and Family Master Plan. Six community forums were held in February 2006 to solicit community input in prioritizing the risk factors. Over 300 community residents including the youths attended the forums and provided input on the top three risk factors. Community Residents were recruited by an open outreach that included teams going door to door in each district with door hangers' invitations, city website announcements, School District sending out invitation flyers, local media, and invites sent to approximately 39,000 households in Pomona. Youth represented 30% of community forum attendees as recorded by sign in sheets at all the forums.

The YFMP Gang Taskforce assessment subcommittee with support from the youth involvement committee facilitated the prioritization of risk factors for Pomona. The selection of the priority risk factors was informed by assessment data as well the experience and perception of community residents. Selecting a risk factor was not simply a matter of looking at the data and selecting those risk factors with the highest scores. Rather the community was encouraged to prioritize factors that have high scores and resonate with the needs and concerns of community members. Risk factors prioritization was undertaken by the Gang Taskforce steering committee and at 6 community forums. Both the steering committee and the community forums selected the same three priorities. The selected priority risk factors included: community disorganization, academic failure, and favorable attitudes towards antisocial behavior. Community Disorganization means that young people do not feel that the adults in their community are working together to solve the problems impacting their lives. Academic Failure shows that students do not see themselves as succeeding academically. Students rate themselves as perfuming worse than most students in their class or similar grade levels. Favorable Youth attitudes Toward Antisocial Behavior means that young people accept and condone antisocial behavior such as skipping school, getting into fights, running away from home, persistently lying, using illegal drugs or alcohol, stealing , vandalizing property, engaging in aggressive or violent behavior towards other individuals, and violating school rules, home rules or local criminal laws.

Community resource assessment: Based on the identified priority risk factors, the Resource Assessment Subcommittee of the Gang Taskforce inventoried current programs and resources in the city of Pomona which address one or more of the priorities. The goal of the resource inventory is to identify what programs currently operating in the community addresses each of the priority risk factors and to identify gaps in the current community resource capacity. A youth and Family Master Plan Resource Assessment Survey was completed by 82 program providers and the results were compiled into a resource data base. Based on the resource inventory, the steering committee identified gaps in community resources related to each priority, as well as system-wide gaps.

Gaps in resources affecting Community Disorganization included the following : lack of programs in south Pomona, lack of culturally appropriate programs for Asian-Americans and African-Americans; lack of neighborhood leadership development; lack of youth driven programs, lack of stable funding; shortage of neighborhood-based programs; lack of affordable housing; Resource gaps affecting academic failure include the following: shortage of spots for preschool, shortage of programs to help parents promote their child's academic success; lack of a welcoming environment for all students in schools; lack of access to technology; shortage of parent support groups; lack of training for intervention staff on safe school/healthy families grants; inadequate student counseling; inadequate library resources, barriers to access to secondary electives; inadequate neighborhood based educational programs; lack of support programs for struggling African American and Asian American students; lack of understanding of the culture of poverty by school staff; lack of coordination of /collaboration among existing resources and providers; lack of faithful implementation of programs for youth and families; lack of career ladder programs.

Resources gaps associated with favorable attitudes toward antisocial behavior included the following: Shortage of tested effective programs in schools or for families for this risk factor; lack of gang prevention programs beyond the Southside of Pomona; highest risk kids get labeled; inadequate prevention/intervention programs; inadequate family and community programs; inadequate gang prevention programs for girls; and inadequate support for families.

Tested effective programs: An identified gap across all three priorities was the lack of tested effective programs to address the priorities. Tested effective programs are programs that have been rigorously evaluated and deemed to be successful in reducing noted outcomes and measures. The Pomona Youth and Family Master Plan use the youth pro-social developmental strategy (CTC) as the paradigm for defining tested effective programs. Programs operating within the CTC paradigm as used in the YFMP, will have the following attributes: seek to build healthy beliefs among children and youth; establish clear standards; build bonding, attachment and commitment to families, schools, communities and their peer group; nurture individual characteristics by providing skills, opportunities and recognition in families, schools, community and peer group to individual children and youth.

YFMP Community Intervention Components

Based on the prioritized risk factors and resource gap analysis, the Youth and Family Master Plan included the following Community Action Components: Community Mobilization; Establishment and Fostering of Collaboration and Partnerships involving service providers and Pomona Youth ; Development, Enhancing, and co-ordination of existing programs and services that address the priority risk factors; Resource Brokerage; and Community-Based Participatory Evaluation Research .

Community mobilization: will ensure that the stake holders are involved in the decision making and implementation of the Youth and Family Master Plan. Through this program component leadership opportunities for youth and residents are made available. This includes active recruitment of community organizations to participate in the activities of the YFMP, organizing community wide events, participating in the organization and implementation of community wide events. Another aspect of community mobilization is the dissemination of information about the YFMP using all available media including local newspapers, television stations, city and school events, community fares, and online. The Leadership of the Community Board is responsible for community mobilization.

Establishment and fostering of collaboration and partnerships involving service providers and pomona youth and their families: This involves maintenance and strengthening of communication, cooperation, collaboration and leadership among providers and families. There is regular communication with key stakeholders about the progress towards achieving the goals of the YFMP. This process is guided by the Communities That Care strategy.

Development, enhancing, and co-ordination of existing programs and services that address the priority risk factors: In this program component, a taskforce identifies and recommends solutions to access barriers to youth and family programs and services including neighborhood-based services and /or adequate transportation to help youth and families' access services. The YFMP also works with program and service providers to ensure that their services rise to the level of tested effective practices. The Community Board ensures that collaboration and technical assistance is primarily offered to programs and services whose work affects the three prioritized risk factors.

Resource brokerage: The YFMP facilitates the availability of, and access to youth and family resources impacting community disorganization, academic failure, and favorable attitudes towards anti-social behavior. This is done through creating a centralized digital or physical resource center, facilitating neighborhood resource outlets, and partnering or supporting efforts by community organizations or individuals to bring additional resources to Pomona. The resource centers or outlets are staffed by trained community volunteers and staff. All information provided through the resource centers or outlets is current and up to date in order to meet the changing needs of Pomona residents. A centralized Physical and digital Center provides space for local providers and local groups to publicize activities and workshops related to the goals of the Youth and Family Master Plan.

Community-based participatory action research: The goal of Collaborative Community Based Research is to ensure neutral and rigorous evaluation of the work carried out under the Youth and Family Master Plan. The YFMP calls for the creation of measurable outcomes for effective and tested programs. Programs should be evidence-based and subjected to rigorous and regular evaluations which will act as feedback loops for program effectiveness and improvement. The Plan also calls for the use of shortcomings discovered through evaluation research as opportunities for improvement; and successes should be standardized and shared with other municipalities and communities facing similar challenges to Pomona. To this end, the community partners with researchers to carry out evaluation and other investigations within the framework of the Youth and Family Master Plan. The Master Plan's priority risk factors of community disorganization, academic failure, and favorable attitudes towards antisocial behavior will define the areas of inquiry to be carried out by the evaluation team.

IMPLEMENTATION

The implementation of the Pomona Youth and Family Master Plan (YFMP) has been possible because of good governance, volunteers, a network of partners and collaborators, and many policy actions taken by the City of Pomona and the Pomona Unified School District (PUSD) Board to facilitate the implementation of the YFMP. The implementation involved integrating policy actions, plan roll out, and organizational development.

Governance

The Youth and Family Master Plan is led by a Community Board which is made up of the city of Pomona, community members, and institutions of higher education, businesses, the school district, universities, youth advocates and many other entities interested in Pomona. The YFMP is facilitated by the City of Pomona Community Services Department and the Community Board leadership.

The community board: The Community Board is a combination of the Implementation Steering Committee and the Executive Advocacy Committee. The Board is comprised of residents, youth, community leaders, and those who provide prevention and youth development services to Pomona's youth and families. Membership is defined in the policies and procedures developed by the Community Board and included the voting rights and equitable representation of member organizations. Board membership is open to any individual or organization willing to invest in the empowerment of youth and families in Pomona. Active membership is maintained by the number of consecutive meetings as recorded by sign in sheets at the general and special working committees of the Community Board. An informal setting allows for inclusive entry into the Community Board meetings for new membership and visitors.

The Board meets on a monthly basis and is responsible for the overall implementation of the Youth and Family Master Plan. Other responsibilities of the Community Board include, but are not limited to, sharing and disseminating information regarding programs and resources and maintaining a centralized resource center. The Community Board serves as the governing body and has the authority to approve activities, programs, and funding proposals recommended by the subcommittees, task forces and ad hoc committees.

Advocacy group: The goal of the Executive Advocacy Group is to support the implementation of the Youth and Family Master Plan by providing support for capacity building and sustainability of the plan, and organizing the social capital resources of the major institutions in Pomona to focus on the plan. This group is made up of community stakeholders representing the fields of business, education, and government. These members are committed to bringing resources that support the sustainability of the YFMP.

Subcommittees, task groups and ad hoc working groups: Much of the volunteer staff work of the YFMP Community Board is carried out in standing and ad hoc committees. The role of the sub committees, task groups and adhoc working groups is to ensure that the goals and objectives of the YFMP are being met. Responsibilities for these groups include but are not limited to: implementing programs and services, developing policies and procedures, identifying gaps or needs for programs, making recommendations, conducting community activities and leveraging or identifying funding sources.

Maintenance subcommittee: The maintenance subcommittee is responsible for the review of task force recommendations based on the CTC model and to make recommendations to the Community Board. The Maintenance subcommittee conducts outreach and trains new Board members on roles and responsibilities; develops Bylaws and Articles of Incorporation for the establishment of a non-profit component of the YFMP; acts as a conduit for information among the subcommittees, task groups and the Community Board; conducts an organizational strategic planning process to solidify goals and objectives; and conducts an annual summit for resource information gathering.

Evaluation subcommittee: The Evaluation subcommittee is responsible for developing the tools and guidelines necessary for an evaluation process. This subcommittee also identifies appropriate data to be collected to measure the suggested indicators of progress not measured by the Pride Risk and Protective Factor Questionaire and develops and implements a plan for collecting needed data.

Funding subcommittee: The funding subcommittee is responsible for the identification and leveraging of funding sources to support programs and activities identified and supported by the Community Board. This committee is also being responsible for writing grants, collecting and maintaining a catalog of funding source information.

Task groups: There are three task groups. Promoting Academic Achievement Task Force (PAA) which is responsible for addressing the academic failure risk factor; The Active Community Empowerment Task Force (ACE) which is responsible for addressing the community disorganization risk factor; and The Favorable Attitudes toward Anti-Social Behavior Task Force which is responsible for addressing the favorable attitudes toward antisocial behavior risk factor. These task groups receive requests and make recommendations based on the risk factor, goals and objectives, and alignment to the CTC model.

Pomona youth leadership network: The youth leadership network recruits youths and ensures youth leadership group representation at the Community Board, Sub Committee and Task Force meetings. The Pomona Youth Leadership Network is facilitated by the Pomona Youth Advisory Committee and represents all major youth leadership groups in Pomona.

Adhoc working groups: Adhoc/working groups will consist of members from all task groups and subcommittees and participation is voluntary. These groups may be called at anytime on an as needed basis to examine, evaluate, identify, or coordinate programs and activities to ensure there is CTC model compliance under the YFMP.

Volunteers

A volunteer program is critical to the effective implementation of the YFMP. About 90 percent of the Plan's work is done through volunteers drawn from universities, businesses, community organizations and from Pomona citizen advocates. Volunteers staff the Community Board and the different standing and ad hoc sub committees. Student volunteers participate through internships, service learning programs and through the Pomona Youth Leadership Network.

Network of Partners and Collaborators

Partnership: The YFMP was initiated, developed and implemented through a strategic alliance between the City of Pomona and the Pomona Unified School District.

Collaborators: The YFMP relies on a network of collaborators encompassing hospitals, universities, youth and family service providers, community based organizations, businesses, industry, and individual citizens. These collaborations are a critical ecological factor as the YFMP creates an environment that supports community organization, academic success, and favorable social behavior among youths and families in Pomona.

Policies enacted to support the creation and implementation of the YFMP

The following formal policies were enacted by both the Pomona City Council and Pomona Unified School District Board to support the implementation and sustainability of the YFMP.

* In 2005, the City of Pomona adopts a resolution to offer bids and a resolution to hire Wong and Associates to conduct Communities that Care strategic prevention planning process in order to develop a Youth and Family Master Plan

* In 2005, the City of Pomona adopts a Resolution to financially support the Youth and Family Master Plan with $100,000 budget

* In 2005, the City of Pomona adopts a Resolution to adopt the YFMP Implementation Strategy and establish the Community Board

* In 2005, the City of Pomona adopts a decision to hire a Youth and Family Services Manager to work with the Community Board

* In 2006, the city of Pomona adopts a resolution to shift the City of Pomona Community Services Culture and local institutions as they commit to the structural processes of the YFMP Community Board operating system.

* In 2006, YFMP Community Board proposes and the city adopts rules and procedures making the YFMP Community Board a special committee of the City of Pomona with oversight of the YFMP.

* In 2006 the city selects and adopts several tested effective programs including Strengthening Families and Across Ages.

* In 2006 the City of Pomona adopts and develops the Pomonafamilyresources.org web based resource data services.

* In 2007, the City of Pomona financially supports training and implementation of the Strengthening Families and Across Ages changing the priorities of the City of Pomona Community Services.

* In 2007, the City adopts the Multi Housing Crime Free Ordinance. (The Crime Free Multi-Housing Program is a crime prevention program designed to reduce crime, drugs, and gangs on apartment properties.

* In 2007, the Pomona Unified School District passes a resolution to support and partner with the City of Pomona on the Youth and Family Master Plan.

* In 2008 the City of Pomona Implements Strengthening Families Across Ages which is a tested effective program.

* In 2008 the city of Pomona passes a resolution to develop 7 Community Resource Centers in individual districts across the City.

EVALUATION PLAN

The YFMP is implementing a pre post quasi experimental evaluation design. Data is collected to measure the desired outcomes for the three prioritized risk factors including community disorganization, academic failure, and favorable attitudes towards antisocial behavior. Three instruments have been adopted for use in the evaluation process: The pride survey risk and protective factors questionnaire, the general event questionnaire, and the program level survey instrument. The event survey and the program level survey questionnaires have been developed by the evaluation team. The risk and protective factors instrument has been widely used by evaluators of adolescent programs and has been successfully validated (Hawkins, Arthur, catalano, 1995, 1997). There is both a community level evaluation as well as a program level evaluation.

Community Level evaluation is carried out as follows: The pride survey risk and protective factor questionnaire was used to collect baseline community level data. It will be used every two years to measure youth outcomes at the community level including Community Disorganization, Academic Failure, and Favorable Attitudes towards antisocial behavior. Community level outcomes are also been tracked through bi-annual focus groups and key informant interviews of a cohort of parents. The focus groups and key informant interviews will explore parents/guardians perceptions of changes in Community Disorganization, Academic failure, and Favorable Youth Attitudes towards Antisocial Behavior. The evaluation team also tracks all purposeful activities initiated by the YFMP and its partners, which contribute positively to prioritized risk factors. In addition, the evaluation team tracks activities initiated by other entities not affiliated with the Youth and Family Master Plan that can contribute to an understanding of the prioritized risk factors above. Financial resources coming into the City to support activities that will alleviate the risk factors identified above are also been tracked. Other data at the community level that will be continuously tracked include juvenile crime statistics, adolescent related homicides, teen pregnancies, truancy rates. Community level administrative or trend data is entered in a data base developed and retained by the evaluation team.

Event evaluation: An event effectiveness survey instrument is used to evaluate the effectiveness of each event/activity organized or facilitated by the YFMP using a general survey questionnaire of no more than 10 items.

Program Level evaluation will involve the evaluation of all programs initiated by or supported by the YFMP Board for program integrity, effects on the three priority risk factors, evidence of program effectiveness and best practices. The program level instruments will also assess programs for compliance with the YFMP tested effectiveness standards.

DISCUSSION

The Pomona Youth and Family Master Plan was successfully planned and implemented in conformity with the recommendations of the Institute of Medicine for public health policy development and practice (1988). The development and implementation of the plan involved an integration of policy making, collaborative and participatory planning, organizational development, and participatory implementation. The participatory planning methodology based on the Community That Cares (CTC) organizing principles provided an opportunity for the most disadvantaged youths and families to participate in resolving their most pressing health, academic, and economic problems. Within the past two years a Community Board has been formed, committees created and staffed, policy and procedures developed and implemented. Through the Plan, Pomona has seen digital and physical resource centers, community collaborations, and numerous city-wide activities implemented. The Pomona Youth and Family Master Plan is now a high profile institution in Pomona and has become the main infrastructure for community development and youth empowerment in Pomona. The YFMP has given voice to the powerless, and acts as the Pomona town hall were people from different geographic regions, different socioeconomic classes, and different cultural backgrounds come to discuss and resolve matters of common interest. The YFMP meetings are also a forum for youths to share their views and disagree without resorting to violence.

IMPLICATIONS FOR POLICY MAKING AND IMPLEMENTATION

The creation and implementation of the Pomona Youth and Family Master Plan is a contribution to public health policy making, citizenship, community-based participatory research alliances, and policy/program implementation.

Policy Making Institutions and Process:

The Pomona YFMP policy making process departs from dominant policy making models in the United States. Neither the power elite models (Domhoff, 1990) nor the pluralist models (Dahl, 1956) can explain or describe policy making in the Pomona Youth and family master plan. The YFMP participatory character certainly defies Schattsneider's (1960) construction of a policy process which excludes the lower class and policy solutions which are dominated by "upper class accents." The YFMP policy development process did not involve pluralist factions with competing alternatives and had no overwhelmingly dominant elite groups as proponents of the power elite models would argue. The two policy groups in the YFMP policy process (The Youth Commission and The Mayor's Gang Taskforce); both recommended a Municipal Master Plan as a solution to the Youth gang problems of Pomona. Furthermore, the steering committee of the Gang Taskforce selected the same priority risk factors as the community forums. There was a focus on evidence and a general desire to achieve the best results for the people of Pomona based on the evidence.

Also, the YFMP enabling policies were made at the level of a municipal government which does not have a Public Health Department. This underscores the role of municipal entities with or without formal Public Health Departments, in the public health policy making process and public health practice. Recognized decision making points for public health policy in the literature and professional settings are federal and state institutions or Local Health Departments.

Democratic Participation

Most American scholars and governmental entities think of citizens in the limited sense of legal and political rights gained as a native born or naturalized person. The Pomona YFMP takes the concept of citizenship further. Citizen in the YFMP extends to all community members including all who reside in the city, work in city, worship in the city or just have interest in the city. It covers the entire spectrum of the public, from documented to undocumented immigrants and from natural to naturalized citizens. In the YFMP context, a citizen is anyone who is touched or wants to affect the intractable youth problems of community disorganization, academic failure, and favorable attitudes towards antisocial behavior.

Character of the Alliance

The YFMP is also a Community-Based Participatory Research Alliance. It is unique in the sense that the relationship is initiated by the City government, defined by the community, led by community, and based in the community. In its formation and implementation, the YFMP exhibits key characteristic that scholars have associated with successful collaborations and partnerships: synergy, effective leadership, and the creation of a focused alliance function in the participating organizations (Lasker Weiss, Miller ,2001, Weiss, Anderson, Lasker, 2002, Dyer, Kale, Singh, 2001). Both the City government and the Pomona Unified School District have community service departments specifically assigned to oversee community alliances. These units act as focal points for learning and for leveraging feedback from the alliances and capturing the attention of senior management. Community Service Departments in both the City and the School District systematically establish processes to articulate, document, codify and share alliance know-how within the organization and with the community. Senior management support is demonstrated through the dedication of city and school district resources to the Youth and Family Master Plan and organizational commitment is evidenced in enabling resolutions and ordinances adopted by the Pomona School District and the City of Pomona .

Participatory Implementation Model

Policy implementation literature is broadly separated into two major categories or models of analysis. The top-down school of thought and the bottom-up school of thought. Several authors have tried to bridge the theoretical gap between the top downers and the bottom top models. Matland (1995), arguably, made the most significant contributions to our understanding of policy implementation by advancing a framework of analysis that reconciles the two major perspectives above by focusing on the theoretical significance of ambiguity and conflict in policy implementations. Hanks (2006), introduced the partnership model of implementation which gave a significant role for the policy target in the implementation process and even foresaw community and family participation in the implementation process. The Pomona Youth and Family Master Plan (YFMP) was implemented within a participatory implementation approach which is described below. The participatory approach distinguishes itself from all three models above by bringing all the stakeholders into the entire policy continuum, from formulation to implementation. In the participatory implementation approach, the policy and implementation settings are tightly coupled and move in and out of the different phases of the policy making process. While there is means and goal clarity, the form of each individual project from the different micro partner organizations is ambiguous though, it must meet the tested effectiveness standards of the macro policy and implementation settings of the YFMP. Table three below compares the three models above to the Participatory implementation approach that emerged from YFMP.

Top downers focus on the authoritative power of statutes to the exclusion of pre statutory factors in their conception and prescription of the implementation process. Top down theorist call for consistent and clear policy goals (Van Meter and Van Horn, 1975), limited number of actors (Pressman and Wildavsky, 1983), limits to the extent of change necessary(Van Meter and Van Horn, 1975; Mazmanian and Sabatier, 1983), and place implementation responsibility in an agency sympathetic with the policy's goals(Van Meter and Van Horn 1975, Sabier 1986). Top downers also see implementation as a purely administrative process with Weberian purity and not tainted by political factors.

Bottom-top models believe that a good understanding of implementation can only be arrived at by looking at policy from the perspective of the target population and service providers(Berman, 1978, Hjern and Porter (1981); Hjern (1982); Hjern and Hull(1982);Hull and Hjern (1987); and Lipsky (1978). Bottom Top models identify macro and micro implementation levels. At the macro level central organizations devise a program while at the micro level local organizations implement the program. The shape in which policy is implemented is determined by local factors. Implementation flexibility at the local level or at the level of service providers is very critical if policy implementation is to succeed (Palumbo, Maynard-Moody, and Wrigh, 1984).

Matland (1995) presents the ambiguity/conflict model which analyzes the ambiguity and conflict levels of policies to determine which of the differing models in the literature illustrate a particular implementation process. Matland draws from the rational and bureaucratic models of decision making to demonstrate the centrality of conflict and ambiguity in the implementation process. Matland (1995) in his conflict/ambiguity model presents a matrix that provides the type of implementation process, the central principle determining outcomes for this kind of implementation process, and an example of policy that fits this category. The following aspects of each perspective are described: the central principle underlying the factor that would have the greatest influence on the implementation outcome; a description of the implementation process with emphasis on implications for policy ambiguity and conflict; a discussion of the expected pitfalls; and the appropriateness of top-down or bottom-up approaches as a depiction of the process. Matland's matrix includes administration implementation, political implementation and experimental implementation conditions.

Administrative Implementation involves low policy ambiguity and low policy conflict. The central principle in administrative implementation is that outcomes are determined by resources. The process is compared to a machine and the machine is the central authority. This process fits a top down model. Political Implementation involves low policy ambiguity and high policy conflict. Here actors have clearly defined goals but dissention occurs because these clearly defined goals are incompatible. Conflict can also occur over means. The central principle in political implementation is that implementation outcomes are decided by power or bargaining. This variety fits the more sophisticated top down power models that recognized political factors in the implementation process. Experimental Implementation involves high policy ambiguity and low policy conflict. The central principle driving this type of implementation is that contextual conditions dominate the process. Outcomes depend heavily on the resources and actors present in the micro implementing environment. In decision-making terms, this type of implementation condition closely parallels a "garbage can" process with streams of actors, problems, solutions, and choice opportunities combining to produce outcomes that are hard to predict. Experimental implementation defines cases where preferences are problematic and technology is uncertain. The crucial element is which participants are active and what is their intensity of participation? Policies with both means and goals unclear fall into the experimental category. Policies with clear goals but unclear means also fall in the experimental category.

The classic implementation models discussed above do not give participants any decision-making role in putting programs in place. Hanks (2006) provides an alternative model that could be responsive to communities and families. This model creates space for a partnership between the provider and policy target in the Special Supplemental Nutrition Program for Women, Infants, and Children program that is locally implemented. Program targets collaborate with public health experts and politicians in cycles of learning and doing. All partners are expected to change attitudes and behaviors as they learn from each other. In this partnership model, program targets are expected to accept more responsibility to improve their own health status.

All the models described above, frame policy as something that occurs exclusively in a federal-state-local intergovernmental hierarchy. They seem to ignore horizontal intergovernmental and community collaborations at the municipal level. There is also a separation between the policy and implementation settings. Actors do not move from one setting to another. While the bottom top models recognize policy setting influences on the implementation environment, they basically see the two settings as separate and distinct and elevate the role of the implementation setting above the formulation setting. The partnership implementation model focuses on the micro level and proposes a relationship improvement approach which operates within a provider-patient framework. It foresees community and family involvement in the implementation of policy at a micro level but does not clearly demonstrate or explain how the community and family would get involved.

The YFMP followed a participatory implementation approach which falls in the experimental implementation component of Matland's matrix but it is neither a top-down nor bottom-up model. The participatory approach does not separate policy from the implementation settings. Structural relationships between the two settings are horizontal and involve both local governments and community actors. Actors move from one setting to another, the settings get in and out of the policy/program implementation phases. All stake holders including the policy/program targets participate in the formulation and implementations phases of the program.

Equal participation of all stakeholders is critical in the participatory model. The experimental implementation variety in the ambiguity/conflict matrix, reveals a potential for an actor's intensity of participation and activity to dominate the process. This might limit equal input into the implementation process from stake holders who are limited by time and geographical proximity to the implementation setting. In a low income and multiracial minority community such as Pomona California, equal participation by all groups and all government agencies is critical to acceptability of the implementation process and the continuous support of the program. The YFMP ensures equal participation of stake holders through a conceptual , planning and implementation model that is structured for collective reliance on evidence and tested methods as well as collective judgment of the evidence using diverse experiences of stakeholders.

Furthermore, policy formulation and implementation is not just an opportunity to learn but rather a learning process because stake holders are trained in tested methods and participate in the data collection and prioritizing of risk factors. Therefore, all actors collectively discover the evidence and decide how to use the evidence in shaping community remedies for youth problems.

Goals are clear but the prioritization of risk factors is flexible and not predetermined. The implementation process is structured and standardized but the form of individual programs is ambiguous and flexible. The YFMP policy goals are clear, evidence based, and designed through tested methods using rational processes and organizational structures, yet priorities are not predetermined and are collectively selected based on community experience and quantitative evidence. Also, implementation at the community wide level is structured but the individual organizational programs are not defined except that they must meet the tested effectiveness standards of the YFMP.

OBSTACLES AND THEIR RESOLUTIONS

The two main obstacles to the formulation and implementation of the YFMP were the existence of entrenched traditional approaches to fighting youth violence and the lack of leadership and knowledge in the community or governmental agencies to lead the needed transformation. There was therefore so much infighting and disagreements on strategy or goals.

Traditional Gang Approaches: The first major obstacle was to overcome the traditional approaches that were frequently used to address gang violence prevention and antisocial youth behavior. In Pomona, this meant that no population survey was used, local entities just implemented programs that were not tested effective, and there was no strategic collaboration or sharing of resources among entities. At best, the historical approaches in Pomona were based on guesswork, collaboratives that met to talk about themselves, relying on popular myths for approaching gang prevention/intervention work and reactionary use of suppression to appease public opinion.

The second major obstacle was the lack of agency and community leaders who truly studied, understood and had experience with implementing a public health approach to the problem of community violence. In all the arenas: city, school and community, there were no clear consensus on specific, tested effective models for reducing gang involvement and violence. There was a clear absence of technical language to truly describe, analyze and evaluate approaches that were implemented, or were presently in operation or for suggesting future "best practices" approaches. While the early initiation of the Mayor's Gang Task Force was able to leverage political involvement, the major obstacle was how to convene a strategic collaborative among the already dueling programs, organizations and institutions in Pomona. New leadership, methodology and approaches needed to be recognized and new training needed to be implemented to increase the knowledge of all participants on tested effective public health approaches. This constituted the major change of culture for the Pomona community that was locked in territorial divides, mistrust of leadership and disregarded community participation.

The participatory, evidence based, and learning dimensions of the planning and implementation phases of this program were very important in resolving the above obstacles that plagued both the planning and implementation processes. Since most stakeholders were on the table from the beginning, it was difficult for them to later oppose the plan. Also, because actors were trained in the methods which they then used to evaluate the scientific evidence, the process made them grow in knowledge and the necessary leadership skills needed for long term participatory implementation of the Pomona Youth and Family Master Plan.

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DAVID BESONG TATAW

Indiana University, Kokomo

BERNARDO ROSA-LUGO JR

The Community Wellness Partnership of Pomona
Table 1:
City of Pomona Statistics, 2006

Land Area                          22.84 square miles
Population                         164,140
Hispanic                           69%
White                              11%
Asian/Pacific Islander/Filipino    10%
African American                   9%
Other                              1%
Unemployment Rate                  9.9
Percent on Poverty                 22
Percent with High School           65
  Diploma
Percent with College Degree        12.8
Children                           56,972 (34.5%)
Number of Juveniles on criminal    900
  probation (2005)
Percent of Uninsured Children      10%
Teen Mothers                       46%
PUSD student population            31,817
PUSD Hispanics                     80.1%
PUSD African Americans             6.9%
Asians                             6.4%
English Learners                   45%
High School Drop out               29%
Compensatory Education             75%
Reduced Lunch                      52%

Table 2:
PUSD Substance Use (Pride Risk Factor Survery, 2005)

Grade        Alcohol   Marijuana    Crystal    Cocaine   Tobacco
                                    Meth

8th Grade    23%        8.1%        3.3%       1.8%       8.5%
10th Grade   41.6%     14.6%        4.9%       3%        13.4%
10th Grade   46.4%     18.8%        3.6%       3.6%      17.7%

Table 3:
The YFMP Participatory Implementation Approach Compared
To Three Major Implementation Models

Variables         Top Down                Bottom Top

Goals             Goal Clarity            Goal ambiguity

Number of         Limited Actors          Many actors in
Actors                                    varying
                                          implementation
                                          contexts

Degree of         Limited Change          Extensive
Change                                    change

Attitudes         Sympathetic             Implementers
towards Policy    Implementation          adopt policy to
                  Agency                  local context

Policy and        Policy-                 Formulators in
Implementation    implementation          macro
settings          dichotomy with          environment
                  policy setting          formulate
                  dominant in the         programs but
                  implementation          implementers in
                  process.                micro
                                          environments
                                          are dominant in
                                          the
                                          implementation
                                          process.

Structural        Vertical                Vertical
relationship      process/relationship.   relationships
between Policy    Policy level higher     between macro
and               than implementation     and micro
Implementation    levels                  environments.
environments

Autonomy          No implementers         Implementers
                  autonomy and no         autonomy and
                  flexibility             flexibility

Means             Means Clarity           Means
                                          ambiguity

Conflict          High Conflict           Low Conflict

Learning          No Learning             Learning
                                          opportunity but
                                          not required

Variables         Partnership         YFMP
                  Model               Participatory
                                      Approach

Goals             Goal ambiguity      Goal Clarity

Number of         Limited Actors      Inclusive of all
Actors            (provider-          stake holders
                  target)

Degree of         Extensive           Extensive
Change            change              Change

Attitudes         Implementers        Sympathetic
towards Policy    adapt policy to     implementers
                  beneficiary needs   who are also
                                      formulators

Policy and        Focus on Micro      Policy and
Implementation    Level,              implementation
settings          addressing the      in the same
                  role of             continuum, not
                  beneficiary in      linear and fluid.
                  the                 Same actors
                  implementation      participate in
                  process.            both
                                      formulation and
                                      implementation

Structural        Vertical            horizontal
relationship      relationships       relationships
between Policy    between macro       among local
and               and micro           governments
Implementation    environments        and community
environments

Autonomy          Implementers        Implementers
                  autonomy and        autonomy and
                  flexibility         flexibility

Means             Means               Means
                  ambiguity           ambiguity

Conflict          Low Conflict        Low Conflict

Learning          Learning central    Structured
                  to                  Learning.
                  implementation      Stakeholders
                  process             are trained and
                                      rely on proven
                                      science to
                                      formulate and
                                      implement
                                      policy
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