Conclusion: Opening Possibilities
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MAPP's striking flexibility is evident in these case studies of community health planning. First, MAPP is useful in different stages of development, from the start-up phase in Nebraska, to the planning and redirection phase in Florida and Washington, to the more operational phase in Tennessee. Second, MAPP is useful for departments structured in different ways, from a free-standing county health department in Washington, to a state-supervised county health department in Florida, to a multicounty health department in Nebraska, to a state-run regional health office in Tennessee. Third, MAPP's flexibility is reflected in the different types of communities it serves, from mostly white areas struggling with economic change in Washington and Tennessee, to a largely black and growing county in Florida, to a largely Latino and elderly district in Nebraska. Fourth, MAPP works well regardless of the particular public health challenges facing local health departments. Nebraska emphasized the need for basic services, Florida paid special attention to HIV/AIDS and school health, Washington gave priority to obesity among youth, and Tennessee was influential in addressing healthcare coverage for indigents. Fifth, MAPP fits various time frames. It can be enacted rapidly, in only nine months (as in Nebraska) or more slowly, over several years (as in Tennessee). Washington's Sue Grinnell says that the process should never actually end, but rather become part of an ongoing planning and evaluation process. Sixth, MAPP fits diverse leadership styles, including those of business-minded Becky Rayman in Nebraska, activist Edgar Morales in Florida, the logical Sue Grinnell in Washington, and earnest Carlos Yunsan in Tennessee. Collaborations The stories further demonstrate that MAPP easily meshes with other planning or quality improvement approaches, such as the Sterling criteria in Florida, Community Diagnostics in Tennessee, and both Pathways 2020 scenario planning and asset-based community development in Washington. MAPP works best when the local instrument of the National Public Health Performance Standards is used within MAPP—as done in Florida, Washington, and Tennessee. These projects incorporated broad community participation: 38 agencies in Nebraska, 30 in Florida, and 160 agency respondents in Washington. In Tennessee, the unique rolling assessment approach—where each of the four types of MAPP assessments was focused on a single county in the region—and a partnership with the University of Tennessee produced great "bang for the buck." Tennessee also demonstrated the utility of the dialogue method of "thinking together." Although the MAPP process typically culminates with the creation of a series of committees working to achieve separate goals, the Florida experience shows that these committees can best succeed by coordinating their efforts. The Florida case also demonstrates how MAPP can help when responding to a near-crisis, in this instance, an announcement that the county had the state's highest HIV/AIDS rate among blacks. MAPP's influence is twofold. It reverberates communitywide, showing communities the importance and the possibilities of mobilizing to improve public health. At the same time, it gives focus to health department staff, as noted by both Larry Lee, administrator of the St. Lucie County Health Department in Florida, and Carlos Yunsan, director of health promotion for East Tennessee. In particular, MAPP greatly enhances grant development, as Rayman and Grinnell found. These stories will show many local and state health departments and community organizations whether MAPP is likely to open similar possibilities and enable similar successes for them. |