Medical College of Wisconsin
Medical College of Wisconsin Medical College of Wisconsin
Physician Patient
Psychiatry and Behavioral Medicine

The Advancing Behavioral Health Initiative Learning Community

Over the course of the past eight years, the Advancing a Healthier Wisconsin Endowment (AHW) supported a Learning Community for the 10 behavioral health coalitions to support skill building, peer support, expert training, and collaborative work. The paper “Funding the Long Game in Collective Impact” (PDF) shares some of the initial lessons and experience.
ABHI Learning Communities_Intro Photo

Year One (2016-2017): Building the Learning Community

During year one, the Learning Community met monthly and focused on:

  1. Developing their goals, strategies, and metrics for the next seven years;
  2. Learning best practices in collective impact for building effective coalitions; and
  3. Building a supportive peer community.

Year One Goals and Challenges


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Goals and Challenges

The ultimate goal of the year was for the coalitions to complete their proposal for years two through eight with a strategy developed using Results-Based Accountability (RBA). They built their plans step-by-step, incorporating data from their communities; evidence-based practices from other communities; community engagement; racial equity and inclusion; coalition building; defining the authority, responsibilities, and accountability of coalition roles; and other practices. By the end of the year, with feedback and support from their peers and the Endowment, each coalition completed their seven-year proposals. All were funded.

There were a few challenges during the first year. First, using an RBA process on mental health was challenged by the lack of regularly collected community-wide data to be able to measure progress on population change. For example, census data on mental health is available every three years and the Youth Risk Behavior Survey is administered bi-annually, but data is not shared by all schools. This made establishing population-level results and metrics - that could be used to guide progress and coordination of their coalitions - more difficult, and the development of their strategies took longer than expected.

Another challenge faced was integrating the work of a sovereign Native American nation with other communities. Some of the models and approaches used conflicted with their traditions and cultural practices. Early on, AHW made the decision that practicing equity meant meeting the tribe where they are and finding ways to bridge and adapt the process to support their region. The program benefited from their participation and impact. The design originated with an Arc of Learning (PDF) that guided the curriculum our first year.

Years Two through Four (2017-2019): Peer Support and Collaboration

During years two through four, the Learning Community met quarterly, visiting a different community each session for 1.5 days that enabled the coalitions to do three things:

  1. Update peers and get feedback on the progress of their strategies and coalitions;
  2. Dive more deeply into the host coalition’s experience, innovations, and lessons; and
  3. Provide responsive training and support to issues or needs identified by the community.

Years Two through Four Goals and Challenges

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Goals and Challenges

For example, when visiting the Southwest Wisconsin coalition’s site for two days in October of 2018, the following was done:

  • Participated in a gallery walk, viewing five slides from each coalition that summarized their progress and challenges, leaving feedback on post-it notes, then debriefing themes, lessons, and opportunities for collaboration in the large group;
  • Learned from a panel of farmers and an expert from the UW Extension about how the shifting agricultural economy has impacted mental health in the region;
  • Learned the SW coalition’s approach to ECPR (Emotional CPR) training and provided feedback on its implementation;
  • Learned how the SW site has adapted language and built relationships with feed dealers, mechanics, and others close to farmers to be able to identify signs of depression and appropriately refer farmers to places that can help them;
  • Developed systems change priorities for their sites after a workshop on “The Water of Systems Change;”
  • Learned and provided feedback on the La Crosse coalition’s Resilient and Trauma-informed Community Framework;
  • Engaged with author and professor John McKnight about using an Asset-Based Community Development approach to consider community building as a solution to behavioral health and community engagement to support development and implementation of solutions; and
  • Explored, provided feedback to, and considered partnership with the Tri-Counties on their website to engage and support youth and families. ABHI Wireframe 2018-10 (PDF)

The Learning Community also designed and hosted two statewide summits to share lessons with others in the field and work on statewide systems change priorities. There were many examples of peers visiting each other’s sites, collaborating on projects, and supporting each other in other ways as a result of the relationships built in the Learning Community. Topics such as motivating and managing coalitions, meeting design and facilitation, policy and systems change, racial equity and inclusion, and fundraising and development were revisited over time as requested.

Years Five and Six (2020-2022): Covid

The pandemic had many impacts on the Learning Community:

  1. The coalitions’ progress was halted as partners closed offices and shifted priorities;
  2. Many coalitions worked closely with or were housed in health departments whose work was diverted to Covid response;
  3. Many coalitions partnered closely with schools that were closed; and
  4. Mental health needs became more widespread and acute.

Years Five and Six Goals and Challenges

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Goals and Challenges

During the pandemic, the Learning Community met virtually to use a Triage Tool (PDF) to determine what work (1) continues to be a priority; (2) is a new priority because of the pandemic; (3) is paused and will resume when crisis is “over;” and (4) should be honored and let go. Scenario planning (PDF) was also introduced to help groups explore different combinations of trends and test how their strategies may need to adapt to different conditions in the near future.

The coalitions used these tools to adapt their strategies, re-shape their coalitions, and find new ways to engage partners. The Learning Community shared their changes and adaptations with each other, leveraged the reduced stigma of mental health to educate communities about resources, worked to achieve and retain systems changes that improved access and quality of services, and utilized virtual tools to engage communities and meet their needs.

The Learning Community did not meet in person again until December 2022. During the three virtual years, sessions were typically held on Zoom and were scheduled from 9-10:30 a.m. and 11 a.m-12:30 p.m. each day for three consecutive days. Sites were invited to identify topics for sessions, lead discussions, and share tools and continue conversations about topics for Phase Three, like funding their coalitions and sustaining their impacts.

Years Seven and Eight (2023-2024): Phase Three and Beyond

The third phase of the project was defined as the “sustainability phase.” During this phase, the Learning Community was conducted with two virtual sessions and two in-person sessions, where the coalitions visited the last two communities to learn about their work. The sessions also focused on:

  1. Creating an “open space” for Learning Community members to self-organize around topics and themes of interest to them;
  2. Adapting their work to post-pandemic conditions; and
  3. Preparing sites to sustain the programmatic and systems change impacts of their work.

Years Seven and Eight Goals and Challenges


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Goals and Challenges

One topic that emerged from this phase was the challenge of political divisions in many communities that have made public health, mental health support (especially for youth), and diversity, equity, and inclusion controversial topics. While behavioral health outcomes in society - especially for youth - became worse and the stigma of mental health was reduced during the pandemic, the ability to serve that growing need faced opposition rooted in misinformation and emotion that created a new, unexpected barrier to impact. Each session included a guest speaker or peer-led conversation on the topic.

As groups have grappled with whether their projects will sustain, sunset, or be handed off to other partners, Strategic Choice Structuring (PDF) was often introduced as a way to work through fork-in-the-road decisions which many groups found helpful.

Many members have described this as the most powerful professional development experience of their careers. It demonstrates the importance of investing in these types of communities, especially in person. The learning and sharing across sites was often more impactful than the expert presentations and workshops. Doing collective impact work is often herding cats, stepping back to step forward, and facing complex challenges across issues, systems, and partners. Having a place to learn skills, sort out and work through challenges with empathetic peers, and learn from others’ similar practice was critical to each coalition’s success.

Helpful Resources