Wellness is a measure of an individual's physical, mental and social health…[it] is more than the absence of disease; it is the ability of people and communities to reach their best potential in the broadest sense. The village is a setting for health, the place where people engage in daily activities in which environmental, organizational, and personal factors interact to affect health and well-being. CYCHI E/D RFP, 3/99.

• Provide a comprehensive evaluation of processes, outcomes, and impacts of the Initiative;
• Design and implement a dissemination plan;
• Assist TCWF with establishing objectives and baseline indicators;
• Provide community collaboratives with timely feedback to increase effectiveness;
• Engage Initiative participants in the process of evaluation/dissemination;
  developing a participatory design that actively involves program participants at all levels.
  

In the planning phase, Imoyase designed an evaluation strategy that emphasized the formation of site-specific evaluation teams and the collection of process data, community assets, and immediate activity outcomes to assess the overall planning process. In the participatory model, each planning site collaborated in the design and implementation of evaluation activities via site evaluation teams, staff and community input.

In contrast to planning, the implementation phase marked the full-scale execution of a multi-component wellness village plan that integrated academic support, mentoring and community health projects. These plans were intended to result in environmental transformation and improved community health. For the implementation phase, with the participatory model intact, Imoyase constructed a new evaluation strategy that emphasized the (1) assessment of outcomes within and across wellness villages, (2) an evaluation of the Initiative Support Process, and (3) an evaluation of the overall Initiative''s theory of change. Points two and three led to a widening of the evaluation lens during the implementation phase to include not only the activities of the wellness villages but also the technical support activities of the Initiative Support Grantees and the Initiative's own structure and logic model.

Each of the villages operated within a three-component structure to organize efforts to improve community health.

Community Health Projects: Community designed health promotion activities and programs intended to transform community environments and thereby positively affect community health.

Community Mentors Program: Programs designed to provide children and youth with mentoring experiences and the chance to work with adults on community service projects that promote health and enhance the environment.

Academic Support Program: Partnerships between wellness villages and local institutions of higher education designed to increase understanding, capacity and social capital around health issues in the community.

CYCHI is grounded in the community-based health promotion paradigm. Community- based health promotion strategies, diverse as they are, usually fall into one of two categories: (1) programs that have as their main objective(s) the prevention of specific diseases, illnesses, and symptoms and (2) community development projects with an objective to promote specific health outcomes (Mittelmark, 1999). CYCHI falls under the latter approach. Programs of this nature focus on building community capacities to mount and manage different kinds of health promotion programs or to improve the basic foundations for a thriving community.

Lessons Learned

As previously mentioned, Imoyase's evaluation of The Children and Youth Community Health Initiative (CYCHI) delineated a host of valuable lessons learned from the Initiative, especially lessons relevant to policy-makers, foundations, and community-based organizations. Our forthcoming handbook, When Youth Thrive, We All Thrive!, delineates, in detail, those lessons. For example, some of the valuable lessons include:

• Communities Know Best
• Youth Have Vision/Energy to Transform Communities
• Culture Matters
• Investing in Personal/Institutional Relationships Is Key

Communities Know Best
Residents understand what works in their communities—what they need, how others will feel about it, and how to get things accomplished. As one Jordan Downs staff member said, CYCHI "tried to get as close as possible . . . to getting the residents' perspective, full definition, full contributions, of what community health was."

Policy-makers should realize that communities can define health in meaningful ways, and make the time to solicit community input on programs from the earliest planning stages. What do service recipients really want? What do they need to make that happen? What are barriers and how can they be overcome? The culture of 'doing with' must replace the culture of 'doing for' or 'doing to.' When residents are active partners in community health, rather than just carrying out something imposed on them from outsiders, they truly embrace the message and care about results.

Foundations can build-in the time and funding to support a community design process for all grants involving community-based issues. Linking results to the places where people live extends their energies beyond the personal into the communal.

Community-based organizations can take seriously their role as community spokespeople and organizers, leaving individual agendas at the door and working together for a common goal.

Youth Have Vision/Energy to Transform Communities
Young people often recognize opportunities that adults will not consider or immediately discount; they're not as willing to accept the negative aspects of 'how things are.' An organic rather than a formal relationship with youth in leadership positions can give them room for self-directedness, exploration, and creativity. The process can feel risky to many adults, but CYCHI youth rose to the challenge, forming the backbone of village planning and activities throughout the Initiative. And, because they and their families will live with the changes brought about, they are very invested in being effective.

A leadership role also changes individual outlooks. "In giving [youth] the freedom to make decisions and act, they were able to improve themselves, not just their community," said a Chinatown staff member. "So, their grades got better, relationships with family members got better, attitudes got better. When youth are empowered, they really do change for the better." By the same token, adults found hope in youth commitment to the project and their willingness to work for the community.

Policy-makers can recognize that youth engagement is a key factor on all levels of community change.

Foundations can incorporate leadership development for youth into community-based grants, realizing that extra support is necessary. "Because the focus of the wellness village was community health, our youth program had that focus also," said one Chinatown staff member. "But we didn’t expect to get as involved in their personal development . . . When we work with youth it’s hard to avoid. . . . These are people who are still finding themselves and developing mentally and physically."

Community-based organizations can understand that youth have competing priorities: school, jobs, social life. Young people need to get excited about programs—'catch the vision,' feel ownership about designing and carrying them out—to bring in and extend their networks of friends.

Culture Matters
Without appropriate linguistic skills, helping people can be difficult, as medical students with limited Spanish in Wellness Village 92701 found out during home-to-home immunizations. T.E.A.M. Chapman made sure that translators were available for exhibits during its four community health fairs. Interns in Chinatown were required to speak Cantonese. Andrew Hill needed staff fluent in Spanish as well as staff fluent in Vietnamese.

Culture is a matter of ethnicity and language, certainly—but it's much more than that. The ability of staff to grasp subtleties of their communities' cultures was just as important as their ability to speak the appropriate language.

• Andrew Hill staff understood the unrealistic expectations that Vietnamese parents had of American school systems, i.e., that students would learn discipline as well as academics (as in Vietnam); this realization stimulated more parents to become more involved with their children's education.
• In Wellness Village 92701, the licensed clinical psychologist who provided mental health services exhibited such expertise and such a culturally appropriate approach that many families asked—and even demanded—to be part of Family Wellness Plans.
• The Alliance of Adults and Youth embedded a spiritual component into every part of its work, honoring the definition of wellness within Native American culture.
• In Jordan Downs, a deep familiarity with that community, its challenges and aspirations proved essential. As one youth put it, "[The staff] grew up here so they know what we’re going through. They have most of the same goals that we want to get accomplished." Staff also understood the importance of gaining confidence of influential people in the community, however unorthodox their positions.

Cultural concerns also affected program design. "The most important part about introducing a new program in a community is to make it culturally competent," a Chinatown report to The California Wellness Foundation stated, "which could mean discarding, or at least adapting, the traditional model." This was particularly true of the mentoring component of the Initiative, which originally used a one-on-one mentorship model that was inappropriate for most communities. Group, peer, and family mentoring programs were very successful as well as those that were task-specific.

Policy-makers can be aware of diverse cultures within their constituencies and make sure that community experts—who 'speak the language,' literally and metaphorically—are involved in outreach efforts.

Foundations can be open to alternative evaluation processes and to programs with less-than-traditional designs, depending on the communities involved.

Community-based organizations know what works with the people they serve and can articulate and advocate for culturally-appropriate approaches.

Investing In Personal/Institutional Relationships Is Key
Personal relationships were at the heart of community-building efforts throughout wellness villages. Lead agencies may have had sterling reputations (which certainly were valuable), but the bottom line for trustworthiness and accountability was nearly always at the individual level.
When people have similar experiences and a chance to know one another—because they put on an event together, or watch their kids dance, or go to the same exercise class—they begin to trust each other. The result is a network of positive social ties that bring individuals and neighborhoods together.

But, that investment takes time and isn't easy. Many villages found that sustained, personal, face-to-face interaction was necessary before parents were comfortable with their children participating in village activities, or before they joined in themselves. "I didn’t become discouraged", said one Wellness Village 92701 staff member, "but I did focus [on] going and visiting the families . . . and making sure that they knew who I was. That made the whole situation a little less stressful for [them], to think that 'They're going to take my kids and I don't even know who they are'. Now, they trust me."

Where social isolation was the norm, as with T.E.A.M. Chapman, some extra effort was needed. "People were willing to spend time to build relationships with one another," one staff member there related. "[It] was very brave for a couple of our board members to spend the night with the team for that camping trip. That was all about wanting to build relationships. So people aren't like 'that old guy' or 'that young kid,' they are people, and they have common experiences. They just work together a lot better."

Common experiences can heal rifts, too. Tribal and kinship members, often at loggerheads regarding difficult political and personal factions, found a safe place to put those conflicts aside in celebrating the work of young people of the Alliance of Adults and Youth. "I didn't think I'd ever see some of those people together in the same place and not fighting," said one youngster.

But, relationships are dynamic. Staff turnover in many villages, sporadic involvement of volunteers, and youth graduating and moving away all contributed to an ongoing need to keep everyone informed, to constantly communicate, and build/rebuild connections. Some wellness villages also created extensive institutional linkages, which brought significant resources and valuable support to the work, but took time to nourish and often added layers of red tape.

Participation levels and personnel changes at partnering organizations led, in some cases, to disappointment and lack of follow-through on program components. Or, as captured by a Lincoln Park report, "Contracts are no substitute for commitment and compassion."

Policy-makers can understand that mandating involvement of stakeholders in any given effort will mean little without the opportunity for them to form relationships, listen to and work out differences, and commit to a common vision and goal.

Foundations can provide resources for ongoing team-building, outreach, and relationship-building efforts during community-based grant cycles.

Community-based organizations can consider sharing programs at a more individual level—within neighborhoods or even buildings within large complexes—and encourage personal visits or small house meetings to get input and feedback from residents.