Collective impact: multidisciplinary, collaborative practice

by Ellyn Satter, Registered Dietitian and Family Therapist

Giving parents consistent messages is critical. Achieving that consistency requires public health and clinical broad cross-sector coordination. Isolated interventions by individual organizations leaves parents confused and immobilized by conflicting messages and contradictory courses of intervention. 

Large-scale social change requires broad cross-sector coordination

In another newsletter, County-obesity Prevention – Speaking with One Voice, Carol Danaher tells you about the Satter division of responsibility in feeding (sDOR) based Santa Clara County Childhood Feeding Collaborative. This issue builds on that newsletter. We all understand the importance of giving parents consistent messages, and in today’s funding world, there is a new awareness of public health and clinical partnerships. However, I only realized the full implications of the Childhood Feeding Collaborative initiative when I read Kania and Kramer’s article, Collective Impact. To quote them, “large-scale social change requires broad cross-sector coordination, yet the social sector remains focused on the isolated intervention of individual organizations.”¹ This is a splendid, encouraging, accessible article that I highly recommend your reading. However, as I plow through it, I find myself longing for a metaphor to help me get my head around this complex and overwhelming topic. So, here goes:

Perspective: The story of six blind men and an elephant

This is probably a totally misandristic statement, but it seems to me that if it had been six blind women, they would have talked it over and gotten their act together before they committed themselves!

When I started social work graduate school, I heard this story in about every second class: Six blind men are asked to determine what an elephant looks like by feeling different parts of the elephant’s body. The blind man who feels a leg says the elephant is like a pillar; the one who feels the tail says the elephant is like a rope; the one who feels the trunk says the elephant is like a tree branch; the one who feels the ear says the elephant is like a fan; the one who feels the belly says the elephant is like a wall; and the one who feels the tusk says the elephant is like a pipe. (This is probably a totally misandristic statement, but it seems to me that if it had been six blind women, they would have talked it over and gotten their act together before they committed themselves!) Be that as it may . . .  Now let us imagine that each of those blind men is, in reality, an agency, each dedicated to doing programming addressing their particular part of the elephant. The agencies compete for funding, so in any funding cycle, emphasis is placed on one or another part of the elephant’s anatomy.

The moment of truth: that elephant isn’t looking so good

This goes on for a few years (fortunately, elephants live quite a while) until the people in these agencies, who really do care quite a lot about elephants, step back and say, “you know, that elephant isn’t looking so good. I wonder what the problem is.” They care enough for their elephant, in fact, that they are each willing to set aside their own interests and look for a solution. The leaders of the organizations (it has to be the leaders or it won’t work) have many meetings, and finally they agree on a set of guidelines for what the elephant needs to be well and healthy. They don’t stop there. Each agency identifies what it can do best on behalf of the elephant, they set up a method for keeping track of their combined efforts, they find ways to communicate with one another, and they agree to cooperate in getting funding. Since keeping it all together is so much work, they set up another agency to do it. Then they approach funders, who have sat in on some of the meetings, to support the process by paying for the new agency (supporting infrastructure is unusual in the funding world) and providing money for the whole shebang. At long last, they are off and running.

Before long the elephant in all its parts looks better and is healthier than ever before

The moral of the story? If you live long enough, you can make use of the most arcane things you learn in graduate school. For a far better, and in fact remarkable, example of collective impact, consider Carol Danaher’s story, of the Santa Clara County Childhood Feeding Collaborative, Speaking with One Voice, in newsletter and webinar. 

Addendum: In the Kania and Kramer article,¹ “Shape Up Somerville” is a control-based approach to child overweight that is inconsistent with sDOR and entirely different from the Santa Clara County program. 

To learn more about Speaking with One Voice, Satter’s Division of Responsibility-Based (sDOR), County-Wide Intervention with Child Obesity or to view of a recording of the webinar, click here.