The purpose of the project described herein was to develop a coalition of faith communities to recruit volunteers for a home-delivered meals programme serving homebound older adults under the auspices of the Meals on Wheels (MOW) programme in Jefferson County, Alabama, USA. The MOW programme is a home-delivered nutrition service federally subsidized through the US Administration on Aging. Employed and volunteer staff seek to ensure that older adults, especially those who are most vulnerable, have meals that meet at least one-third of their dietary needs once per day for five days per week. The programme is administered through the National Aging Services Network and implemented by fifty-six state units, 655 area Agencies on Aging, 243 Indian Tribal organizations and over 500 000 volunteers(1). Throughout the USA, there are long waiting lists in some neighbourhoods; and the current economic crisis that affects these services, including volunteer participation, places homebound older adults in those neighbourhoods at even greater nutritional risk.
Particularly in the Greater Birmingham area of Alabama, where the project was designed, there are long waiting lists. In 2006 when the current project was initiated, 181 300 meals were delivered to recipients living along sixty routes within the city and surrounding Jefferson County, but there were still over 400 people on waiting lists who were not being served. Persons on waiting lists were concentrated in nineteen routes (five to seventy-five individuals in each), and these routes were concentrated in chronically poor inner-city neighbourhoods with almost exclusively African-American populations and high rates of crime. The city of Birmingham, Alabama, was ranked sixth in the nation in 2006 for metropolitan crime rates based on data released by the Federal Bureau of Investigation(Reference Morgan and Morgan2).
Data collected by the Bureau of Labor Statistics(3) on formal volunteering activities showed that: (i) white Americans volunteer at rates higher than African-Americans; (ii) persons are more likely to volunteer within their own communities; and (iii) African-Americans are more likely to volunteer in informal settings. MOW is a formal programme which has found recruitment of volunteers to be difficult. The programme draws from a base of primarily white volunteers who are fearful of real and perceived crime that is concentrated in African-American neighbourhoods in the underserved areas in Birmingham. These volunteers frequently request to serve in neighbourhoods outside Birmingham that are located in their own neighbourhoods. The focus of our work was on recruiting African-American volunteers from informal volunteer settings, namely faith communities, to volunteer within their broader community in partnership with the local MOW programme.
The community collaboration literature provides compelling evidence that community organizations, such as MOW, can effectively work with groups different from themselves, like faith communities, to enhance service provision in various contexts. However, previous initiatives have had limitations. In a comprehensive review of this literature, Jones et al.(Reference Jones, Crook and Webb4) summarize these omissions, including: ‘the type of training needed to prepare staff and members of organizations for participating in the collaborative process, and different management models and practices to determine which forms of governance system achieve the best results’ (p. 41). One aspect of our work focuses on these key components important in building partnerships within communities, specifically on offering training that allows collaborators to collectively decide upon their own form of governance.
Homebound older adults’ poor access to food in urban neighbourhoods combined with limited resources of the local MOW programme prompted the development of a theoretically based approach to address the problem. The use of social capital resources in and between faith communities, the physical capital of food offered by MOW, the intellectual capital seen in the organizational skills of the University of Alabama at Birmingham (UAB) team and the economic capital extended by the funding agency, Lucille Beason Trust, all were a fruitful combination for meeting some of the nutritional needs of older adults in a vulnerable neighbourhood through the Support Team Network approach.
Innovativeness of the approach
A Support Team approach that had been developed and successfully implemented at The 1917 Clinic (an interdisciplinary clinic specializing in the treatment of HIV/AIDS at UAB), as well as elsewhere, was adapted for use to develop a coalition of different faith communities in one neighbourhood to recruit volunteers for the MOW programme(5, Reference Stevens, Lancer and Smith6). As defined by the Support Team Network, Support Teams are a ‘group of persons organized to provide practical, emotional, and spiritual support to persons with health concerns or other special needs’ with four guiding principles: (i) do what you can, (ii) when you can, (iii) in a coordinated way, and (iv) with a built-in support system(5).
Support Teams can be organized into one of four models designed to address different individuals or groups with varying needs. The Basic Model focuses on helping one person or family to meet a variety of needs. The Mission Model focuses on helping several people or families address a common need (such as delivering meals to multiple homebound older adults). A Facility Model focuses on multiple persons residing in one place to meet specialized needs on site. A Peer Model focuses on the needs of each team member who has a common illness or shared connection.
Our project was a hybrid model that combined elements of the Mission and Peer Models to create a meal delivery route for one vulnerable neighbourhood. To the extent that the focus was on addressing a common need of several people, the project adopted a Mission Model. By recruiting faith communities and parishioners from within the neighbourhood to be served to become members of the Support Team, and because they had a shared bond of residing in the same community, we used a Peer Model. Particularly innovative about our approach was that we relied upon several faith communities, thus several Support Teams, to fulfil a single mission.
Theoretical basis
As noted by Rimer and Glanz(Reference Rimer and Glanz7), theory is foundational for developing effective community-based programmes. Support Teams have their theoretical base in key tenants of social capital, which is the resources accessible to individuals through their engagement in various community and social relations that can be drawn upon to produce some beneficial outcome(Reference Lin8–Reference Bourdieu12).
Social capital that exists within communities may affect the well-being of its members by increasing access to services and amenities that exist there and by enhancing psychosocial processes through the provision of emotional support in trusting social environments. Social capital is a property of individuals, small groups, communities or even larger entities(Reference Portes10, Reference Macinko and Starfield13). Most important for the development of Support Teams are elements of social capital at the community level, where social networks provide the necessary condition to facilitate coordinated actions of group members(Reference Putnam, Leonardi and Nanetti14, Reference Lin15). Benefits accrue thereby to individuals as the result of membership within the larger community. This access to and use of embedded resources is contingent on one’s placement within social networks wherein that placement may increase or decrease one’s likelihood of having a given quantity or quality of resources.
The purpose of the present project was to design and evaluate a theoretically driven community-based project designed to increase volunteer participation in serving MOW clients. Here we report on the Support Team model that was used, wherein existing social capital among religious organizations, and social networks within those organizations, was joined with a local MOW programme to create a sustainable meal delivery route to vulnerable homebound older adults.
Methods
The goal of the project was to evaluate the impact of a training intervention for churches and parishioners in a single community and for MOW staff as a delivery mechanism for social capital that could effect positive change in a MOW delivery route.
Setting
During the autumn of 2006, the authors worked with the Jefferson County, Alabama, MOW staff to identify those areas that were the most underserved by the MOW programme. One neighbourhood was targeted as the site for implementation of the project because of its lengthy waiting list and distinctive history of never having a volunteer-based route. This neighbourhood was situated in the city of Birmingham, Alabama, which is 73·5 % African-American, 24·1 % white and 2·4 % other ethnicities. The neighbourhood chosen had 96 % African-American people, and individuals aged 60 years and above comprised 23 % of the population there.
Sample
A list of neighbourhood faith communities was obtained from a minister who is part of the UAB African-American HIV Faith-Based Initiative and the fourth author; he suggested that we contact the pastors of six faith communities, including his own, to participate in the project. These six faith communities and their congregants were already celebrating Lenten services together and participating in ministries within their own churches that prepared meals for a nearby homeless shelter. They were also actively searching for a common mission that would enable them to come together to serve others within their own neighbourhood. The impetus for the churches coming together was driven by the pastors of the churches (who lived in the same neighbourhood and were of similar age) and members of the churches (many of whom knew each other and wanted to participate in more fellowship together). The third and last authors contacted and met with the pastors of the six faith communities to present the Support Team project to them. These pastors were enthusiastic about the opportunity and went back to present the idea to their congregations.
The group represented African Methodist Episcopal, Baptist (two), Catholic, Christian Methodist Episcopal and United Church of Christ denominations. The faith communities were all nearly exclusively African-American, with perhaps one white member in a couple of the churches, and ranged in size from approximately 200 to 500 members. The ‘Black Church’ has historically played a significant role in aiding individuals not just in their spiritual journey, but in their physical and social development as well, particularly in the South. Johnston and Klandermans(Reference Johnston and Klandermans16) argue it is the spiritual unity parishioners feel that motivates them for both collective action and identity in their community. This is not just the case in one or a few denominations, but it is characteristic across denominational lines within African-American congregations(Reference Barnes17).
Protection of human subjects
The University of Alabama at Birmingham’s Institutional Review Board reviewed the study protocol and granted expedited review. No special approval was required from any church hierarchy.
Intervention
A single training session was held in November 2006, in one of the faith community facilities, to approximately fifty volunteers from the six faith communities. The training consisted of an overview of the Support Team concept, led by the second author, and included discussion of the four guiding principles: (i) do what you can, (ii) when you can, (iii) in a coordinated way, and (iv) with a built-in support system. Emphasis was placed on how to create opportunities for individual volunteers to participate while allowing them flexibility in their commitments, how to create an environment where decisions and activities of the group would be self-supporting and how to keep organizational meetings to less than one 59-minute meeting per month in which volunteers share the responsibility to communicate, educate and coordinate with each other. Important boundaries for Support Team members and MOW clients were discussed; these included the importance of not giving money, medicine or medical care (including advice) to anyone. Next, the MOW Program Coordinator and Volunteer Coordinator provided information on the rules of the programme and the expectations of volunteers and conducted background checks and volunteer registration. These staff also made themselves available for future, ongoing assistance. Finally, in the training session, the last author described some possible ways in which the faith communities and volunteers might organize themselves. In this initial training session, the form of governance of this collaborative effort began to unfold as training occurred and was ultimately determined by the members themselves.
Following the training and in subsequent telephone conversations, email correspondences and face-to-face meetings, six volunteer teams began serving the chosen neighbourhood on 2 January 2007. These are described in the Results section.
To provide recognition for volunteer services, on 13 March 2007 a brunch was hosted at one of the faith community’s facilities; approximately twenty-five volunteers attended. The purpose of the brunch was to offer appreciation and support to the volunteers from both UAB faculty and MOW staff. This opportunity was also used to provide booster training and encouragement, based on the Support Teams approach to team organization. In April and May of 2007, UAB faculty worked with a staff writer from The Birmingham News to write an article on the project. This article appeared in the 9 May 2007 edition of the newspaper. Publication of this article had two intended goals: (i) to recognize the efforts of the faith community volunteers; and (ii) to inspire other like-minded faith communities and organizations to engage in similar activities.
Of additional note, the project received financial support from the Lucille Beeson Trust which is administered by a large church located in a wealthy, predominantly European-American community outside Birmingham. The support this grant offered was directed at providing initial training to both the church pastors and parishioners and the staff at the Jefferson County MOW office, and to evaluate the success of the programme one year following its creation. The only stipulation of the Trust was that we share details regarding the Support Team approach with relevant parties so that the approach could be replicated if found to be successful. Money for food delivery came from the Administration on Aging and was available to the local MOW office regardless of this Support Team approach to delivery.
Results
The project resulted in the creation of one volunteer route comprising six congregations that served sixteen homebound older adults. Each of the congregations provided a volunteer team to serve on the route. The faith communities that came together were from five different denominational backgrounds, and each of them worked under the guidance of the Volunteer Coordinator from the MOW office to ensure that the project goals were being met and that MOW policies and guidelines were being followed. Four of the faith communities took responsibility for staffing the route once per week, and the other two faith communities shared the remaining day.
The goal of the pastors after putting in a call for volunteers was to recruit two committed and two substitute members from each church, for a total of twenty-four members. This goal was met with the majority of volunteers being retirees, several of whom were newly retired and who were seeking to engage in productive and meaningful activity. There was also one husband and wife team who were members of different churches.
Consistent with the self-management emphasis of the Support Team approach, the faith communities adopted unique structures for volunteering. For example, one structure involved all members of the volunteer team from a single faith community going out together to deliver all sixteen meals. Another structure involved members of the volunteer team from a single faith community dividing into smaller groups of four, each assuming responsibility for only one day of the month to deliver meals to all clients. Another structure involved all members of a volunteer team from a single faith community delivering meals each week, but dividing up the route so that each group delivered a third of the meals.
Evidence that supports replication
MOW staff estimated that, during the initial year the programme was up and running, over 2000 meals were served to sixteen homebound older adults because of this Support Team application. The programme remains vibrant today, and the administrative office of MOW indicated that they were very comfortable with the process of initiating Support Team Networks after having coordinated them under the guidance of UAB faculty and staff. At the completion of the pilot project, the Volunteer Coordinator had identified another community that was in need of volunteers and employed the Support Team Network tools for staffing another. Additionally, the Volunteer Coordinator submitted an article to the local Jefferson County Office of Senior Citizens Services Newsletter highlighting the programme in an effort to recruit volunteers. During the Lenten season of 2010, nearly 4 years after the route began, the Volunteer Coordinator requested that the churches consider adding more clients to their existing route. The churches are currently contemplating how this would be possible and are considering seeking out additional volunteers. Of additional note is that three of the congregations have had new pastors and the collaboration between congregations continues.
Discussion
In using the Support Team model for MOW, several components were essential and necessary, and for the purpose of replicating the model, they are noteworthy. First, the goal was to build upon pre-existing social capital and networks that already existed in the community to support a common goal. The elements of capital that were already in place included the Office of Senior Citizens MOW programme and the faith communities in the community selected for the Support Team model. These separate organizations, which seemingly had nothing in common, were brought together for a single mission. The faith communities had already been sharing Lenten services and hosting joint gatherings for their congregations. Thus, we were able to take advantage of partnerships that already were in place.
Second, we believe that the success of building quick and effective partnerships for programmes like this Support Team Network-facilitated MOW outreach model was enhanced by connections between existing persons in the community who have a strong rapport and mutual trust with those who are being called to action. Thus, we relied upon a key minister from one of the faith communities, the fourth author, to introduce us to pastors from the other faith communities. A key tenant of social capital is trust between members of a social network. This trust must extend to those involved in developing or facilitating any coordinated activities and, in this case, that proved to be true.
For implementing the programme, social support was also a key element, and this was evident in the individuals within faith communities and between faith communities. The individuals within faith communities were able to support each other by unifying together around a single outreach mission project so that no one person’s resources would be exhausted. Further, the different faith communities in the neighbourhood were linked together so that no one faith community would be burdened with the MOW outreach. This added an additional dimension that built upon the Support Team approach, such that individuals within congregations were linked together with this common mission of meal delivery through the MOW programme and congregations within the community were linked together in the same way, but at an organizational level; and the faith communities had a common concern and commitment to work together to improve their community.
Of an additional and non-trivial note, this project was supported financially by the Lucille Beeson Trust which is administered by a more affluent faith community from a different town. This faith community extended ‘bridging social capital’ to a poor urban neighbourhood by offering support outside its boundaries. In extending this capital outward, they created an opportunity for faith communities in the neighbourhood to engage in ‘bonding social capital’ to help others within their communities, with the goal of potentially helping members of their own congregations(Reference Putnam, Leonardi and Nanetti14).
As noted previously, white Americans volunteer at higher rates than African-Americans in formal programmes(3) and this may have been a reason why predominantly African-American neighbourhoods lacked sufficient volunteers for staffing MOW routes, a reason for intentionally working to staff these neighbourhoods. Researchers have found that food collection, preparation and distribution are common activities in which volunteers participate, and that frequently their motivation for volunteering was simply someone asking for their help(3). Indeed, we found that simply informing potential volunteers of the need in their community for MOW volunteers and asking for their help was sufficient for drawing their support. In fact, the faith communities we approached were searching for a mission that they could be involved in together, and feeding others was something that all could identify with easily.
Also previously noted, prior community collaboration initiatives have been limited by not adequately addressing the training needed for preparing participants for their tasks and by not adequately determining which forms of governance achieve the best results(Reference Jones, Crook and Webb4). The present study brought together three different stakeholders – the UAB faculty and staff, the Jefferson County MOW staff and the faith communities – for both training and governance. To work together, trainings were held that allowed for flexibility, thereby creating an environment in which the most effective governance was achieved. Because training involved extensive explanation of the elements of the Support Team Network models, the faith communities were able to adopt a common structure with enough flexibility that allowed them to create their own internal structures. Of note is that even though models are prescriptive and rational, it is necessary that they be flexible and moveable within certain bounds in real-life settings. This philosophy proved to be successful.
In conclusion, the project described herein is significant because, increasingly, organizations like the Robert Wood Johnson Foundation and the National Institutes of Health are supporting initiatives that encourage translational research. As noted by Stevens and colleagues(Reference Stevens, Lancer and Smith6) who also used a Support Team approach: ‘Translational research requires partnerships between intervention developers (commonly academically based researchers); service providers (public and private care providers); and the community that will be served by the project’. The present research is translational research in the sense that the scientific underpinnings of social capital were applied in the context of local public and private organizations in efforts to improve the health and well-being of community members. In this spirit, we implemented a theoretically based, Support Team model built upon the principles of social capital to create a single MOW delivery route in an underserved neighbourhood. We speculate that this model or one similar might be used successfully in other community-based projects as well.
Acknowledgements
This work reported herein was supported by the Lucille Beeson Trust, which is administered through the Canterbury United Methodist Church in Mountain Brook, Alabama. The authors of this paper have no financial or other conflicts of interest. All authors have read and approved the manuscript. Additionally, all authors have contributed substantially to (i) conception and design or interpretation of data and (ii) drafting the article or revising it critically for important intellectual content. The authors thank the administration and staff of the Jefferson County Council on Aging, particularly Director George Graham and Volunteer Coordinators Amy Johnson and Alma Moore and Program Director Diane Heath, for their participation in this project. Furthermore, they are grateful to the pastors and parishioners of Thirgood Memorial CME Church, St. Paul AME Church, Tabernacle Baptist Church, First Congregational Church UCC, Greater Temple Baptist Church and Our Lady Queen of the Universe Catholic Church, who worked together on this project.
