Carson Research Consulting: Realize

Guest post by Thomas Kelly, Jr.
Vice President for Knowledge, Evaluation & Learning
Hawai?i Community Foundation

What are theories of change meant to do? As evaluators, we need to define what it is we are examining and measuring—naming outcomes, uncovering assumptions, describing cause and effect relationships, and articulating the pathway of change intended by the program implementers. This diagram of the logic and belief about how our efforts will achieve impacts is used to measure the progress of work, and to test the validity of what we really know about the world and our role in changing it.

We expect our theory of change to communicate the importance of the key concepts of the model, our ideas of interconnection and causality, and how we think we can respond to and change the many variables around us. This graphic boxes-and-arrows representation of our logic is one way of making a complex situation understandable, and helps us to more clearly see our individual roles amidst the confusion of many other actors and forces. http://www.theoryofchange.org/library/toc-examples/ (Please note: requires free registration.)

But in complex work like community and social change, involving many organizations and individual partners, theories are also important vehicles of communication intended to create a shared understanding of the values and intent of an initiative (Weiss, 1995). The structured and disciplined mapping of variables and relationships helps many evaluators and program implementers to focus and keep track of key elements. But it may still be insufficient to communicate to the many people who demand a simpler, yet more nuanced, representation of their point of view and their expectations for change.

Throughout my evaluation work in complex change programs and initiatives, I have logged many hours of conversations, discussions, and planning meetings, and what I have noticed most was that although the traditional graphical theory of change did help people focus on a few important elements of how change could be expected to happen, it did not help them understand the priorities, values, and complex interactions and relationships involved both in how their individual roles contributed to change, as well as the complex nature of change with positive and negative feedback loops and unintended consequences. As someone who has been involved in evaluations for more than 20 years, I now try to contain my own passionate enthusiasm for logic and theory and their usefulness and simply expect to be greeted by “matrix phobia,” glazed eyes, criticism of linear thinking, and outright hostility toward the abstract. Most people do not use language of “IF” and “THEN” and “SO THAT” naturally. What I hear more often is people describing what they meant not in mechanistic or engineered systems ways, but by using story, metaphor, and analogy to describe how they see change occurring, and why.

I have heard people describing complex interrelationships and change as the sun and planets with changing orbits, satellites and gravity, sunlight and growth, and even familiar old fables. Now some evaluators are embracing the importance of narrative, metaphor, and story, especially as it helps express and communicate within and across cultures (Davidson, 2010).

If one of the goals of using theory of change is to improve communication and increase the shared understanding of the enterprise, then what will it take for me to think less like an engineer and more like Aesop?

References

http://www.aspeninstitute.org/policy-work/community-change

Weiss, Carol Hirschon. 1995. “Nothing as Practical as Good Theory: Exploring Theory-based Evaluation for Comprehensive Community Initiatives for Children and Families.” In New Approaches to Evaluating Community Initiatives: Concepts, Methods, and Contexts, ed. James Connell et al. Washington, DC: Aspen Institute. http://www.eric.ed.gov/PDFS/ED383817.pdf

Metaphor as a tool to support insight. http://www.cleanlanguage.co.uk/articles/articles/19/1/Metaphors-of-Organisation-part-1/Page1.html

About the Author
Tom Kelly joined the Hawai?i Community Foundation in December 2012 as its new vice president for knowledge, evaluation and learning after 13 years managing evaluation at the Annie E. Casey Foundation in Baltimore. His work includes the building of internal and grantee evaluation and knowledge-building capacity, evaluation of policy advocacy and community capacity, and foundation performance and results measurement. He also led the evaluation of Casey’s 12-year, 10-city community change initiative Making Connections. Tom is a board member of GEO and the Dr. Barbara J. Sugland Foundation and is a graduate of Harvard College and The George Washington University.

by Taj Carson, PhD
Last week, we were talking to a prominent early childhood expert. We were trying to map out the pathways for children to develop good reading skills by the time they reached third grade (no small task). We had factored in instructional techniques, summer reading programs, and attendance initiatives, all of which have clear connections to literacy in school-aged children. In looking at the things that predict school success from birth to five years of age, however, it became a lot harder. Nutrition, health, whether there are books in the home; all kinds of things impact whether a child is ready to go to school.

After talking for a while, our colleague sighed heavily–the kind of sigh that comes from spending years working on an issue, convening and serving on national panels, and looking for “a silver bullet”. She said that the more they looked at early childhood development programs and the younger the age group in question, the more basic the issues became… The earlier they went in the child’s life, the more the essential parenting behaviors seemed influential in building a developmental foundation, and the more they looked, the more alarmed they became as they found them to be missing. They worked with programs where they were telling people, “Pick up the baby. Look at the baby”. That phrase has been kicking around in my head all week. We’ve started using it around the office for any time you are working on the fundamentals, especially fundamentals that you assume are already in place.

This week, two excellent articles came out, adding a third element to the above phrase: “Talk to the baby”. The New York Times did a wonderful piece on the importance of talking to children, and an interesting new technology that measures how many words a child hears. We recently did a survey of 128 moms who receive home visiting services in Baltimore City, and for 26% of them, the TV is on in the home 24 hours a day. Unfortunately, words heard on television do not contribute to a child’s development. This is one of the reasons that the American Academy of Pediatricians advise against television exposure for children under two. If the TV is on, you are less likely to be talking to the baby.

What else do you think contributes to parents talking to, playing with, and reading to their children?

References:
The Power of Talking to Your Baby by Tina Rosenberg: http://opinionator.blogs.nytimes.com/2013/04/10/the-power-of-talking-to-your-baby/

Media and Children by the American Academy of Pediatrics:
http://bit.ly/Z6tT2k

by Tracy Dusablon

The Hospital Readmission Reduction Program is part of the Affordable Care Act, which has ignited heated debates both for and against the program. The program aims to improve quality of care and lower costs by reducing hospital readmissions for Medicare patients. To accomplish this, hospitals are essentially ‘dinged’ when patients are readmitted within 30 days of discharge, and these ‘dings’ turn into financial penalties for the hospitals. As it currently stands, the penalty is one percent of hospital payments, and is set to increase to three percent by 2015.

So, how are hospitals dealing with this new policy, which took effect in October 2012? To some extent, they may just be accepting the penalties, chalking it up to the expense of doing business. On a more constructive end, some hospitals are assisting patients with their social needs as they transition from hospital to home: providing instruction to patients on how to take their medicine, ensuring patient transportation for medical visits, and helping patients plan for the time when they leave the hospital. In Baltimore, for example, we learned that some hospitals are developing pilot programs to assist patients with chronic health issues to ensure that they stay healthy once they leave the hospital. And for some patients with significant social problems contributing to readmission, such as homelessness and poverty, there are additional resources such as “transition guides” and the like, who prepare patients for discharge and help stabilize patients once they leave the hospital.

(Image credit: Tim Lane, New York Times)

Of course, many argue that these services are beyond the scope of medical services. What do you think? Could the Readmissions Reduction Program lead the U.S. healthcare system on a path to further reform, where social and medical issues are addressed in a more integrated manner?

A New York Times article published on March 29th discussed the program and highlighted hospital concerns on these new rules. Critics of the program argue that it negatively affects hospitals serving large academic medical centers, those serving predominately low-income patients, and those treating the most severely ill. Authors of an article published in the New England Journal of Medicine (March 2013) stated that the readmission program could actually create “disincentives to providing care” to patients with greatest need. Because hospital mortality rates are not factored into the current program, it goes on to say that hospitals with higher mortality rates are able to report lower readmissions. Is this fair? How do you think this affects patient quality of care? What role can evaluation play here?

According to federal analyses, the program has reduced hospital readmissions and costs. However, risks for hospital readmission are multifaceted. The chief executive of the Robert Wood Johnson Foundation was quoted in the New York Times article saying “there isn’t a single magic bullet to fix everything”. Evaluation research is needed to help us better understand if the measures hospitals are taking are effective. It seems that much effort has been placed on outcomes without understanding the processes that lead to those outcomes.

References

New York Times article:
http://www.nytimes.com/2013/03/30/business/hospitals-question-fairness-of-new-medicare-rules.html?pagewanted=all&_r=0#comments

New England Journal of Medicine article:
http://www.nejm.org/doi/full/10.1056/NEJMp1300122

There is no need to skirt the issue—programs being evaluated have justifiable concerns around what an evaluation report may do to the future of their program. Now, if all stakeholders have been honest with themselves from the beginning, it won’t be entirely unexpected to learn that their program is or is not performing well. However, the evaluation report may be the very first time that the outcomes are displayed in such a concrete way. (We will assume that the evaluator meets all evaluation standards and provides a quality report; issues of ethics are for another post!)

Eddy and Berry (2009) recommend following a simple heuristic. Essentially, the evaluator determines if the factors leading to program closure are flexible or immutable. If the factors are flexible then the evaluator can recommend changes to overcome those factors and improve the program; however, if they are immutable then program closure is recommended (one reason being to uphold the evaluator’s professional responsibility to the public). How do you think a program would feel about this approach?

In some cases, though, it is not the evaluator’s role to recommend program closure. In these situations, the evaluator can still follow the heuristic to identify program strengths and weaknesses. Suggestions about how to address the weaknesses can also be provided, which may help stakeholders determine whether or not to continue with the program.

Ending a program is, at minimum, not enjoyable and can have unpleasant radiating effects. However, when people are receiving services it is critical they have access to quality programs that actually meet their needs. It’s not enough for them to have access to a program that’s well-run but doesn’t meet its stated outcomes. Those individuals running a well-run, but ultimately ineffective, program may not want to see it go, but doing so opens up the possibility for new opportunities that may better accomplish everyone’s needs and goals.

Resource:
Eddy, R.M. & Berry, T. (2009). The evaluator’s role in recommending program closure: A model for decision making and professional responsibility. American Journal of Evaluation, 30, 363-376.

The role of the evaluator is much like that of Peter Brand in the movie Moneyball (based on the book by Michael Lewis, a favorite author of mine). Peter Brand’s role as an economics whiz kid— hired by the Oakland A’s— was to help them figure out how to win. Using meaningful statistics, Peter and the General Manager Billy Beane, helped turn the game of baseball on its head by looking at data in a new way. Similarly, evaluators are charged with identifying and measuring the ‘bottom line’ of non-profit services from a social impact perspective. We have seen an explosion of businesses and non-profits talk about the use of data (like they do in Moneyball). But before anyone thinks about the analysis of data, we (as evaluators) have the responsibility to help organizations collect, use, and analyze data. I often feel like I need to wave the yellow (or red!) flag that you need to understand the data PROCESS before diving in to talk about the measurement of outcomes. The data that are produced and consumed by non-profits are only as good as the intent put into the process and the quality controls around that data.

My colleagues and I talked about this recently at a congressional briefing in Washington, DC that highlighted the need for a developmental approach to evaluation— one we use on Elev8 (http://www.elev8kids.org/ ). Instead of diving directly into outcomes, we thought about how to approach data and data collection to get a grasp on the implementation of services FIRST. For the full description of how we did this, go to http://www.elev8kids.org/node/609.

In terms of process, whether you are a single agency measuring outcomes or you work collaboratively across agencies, there are key steps to get the data collection process off the ground (from engaging staff to training to sustaining the work). If you saw Moneyball, you know that some of the Oakland A’s staff (including the coach at the time) struggled with a new approach to evaluating players that relied on being data driven. This is no different than what we are seeing in the non-profit sector. In Collective Ideas to Collective Impact, a new guide published by nFocus Solutions and authored by me and Chelsea Farley, we discuss this as well as other key tenets of the work: http://www.nfocus.com/company/collective-ideas-to-collective-impact.
So my hope is that before getting caught up in the world and excitement of measuring impacts, you take a step back. As Michael Lewis, author of Moneyball says, “People operate with beliefs and biases. To the extent you can eliminate both and replace them with data, you gain a clear advantage.” Just make sure it is good and appropriate data!

About Meridith: Meridith Polin is a senior consultant with McClanahan Associates and previously served as program director at Public/Private Ventures. She is the evaluation project manager for Elev8 – a multi-agency community schools model with 20 sites nationwide. Polin also provides management oversight, evaluation technical assistance and training to a variety of initiatives focused on education, out-of-school time and criminal justice. Polin presents across the country on performance management, including presentations at the University of Pennsylvania, the United States Department of Labor and the American Evaluation Association. Her previous experience included her tenure as the director of research and evaluation at Citizen Schools and also direct service work with youth. She is a co-author of Using Data in Multi-Agency Collaborations: Guiding Performance to Ensure Accountability and Improve Programs. Polin earned her B.S. in business administration from Boston University and her M.S. in community resources and development from Arizona State University. Contact Meridith at mpolin@mcclanahanassoc.com.

Carson Research has had an exciting and productive 2012, and we’re thankful for our clients, friends, families, and evaluation colleagues, who were an integral part of our successes this year!

The CRC Team, 2012

Of all the developments that have taken place, one of the most noticeable is the growth of our team, and the diversification of our skill set that has come along with our new team members.

Looking towards the New Year, we’d like to share how each CRC staffer chose to complete the following statement:

Next year, I plan to enhance my evaluation skills by….

Jill: learning more about state-of-the-art evaluation and data visualization strategies.

Sheila: improving my data visualization skills.

Leslie: making more time to stay up-to-date on the latest evaluation research.

Matthania: working on tasks that will expose me to new and relevant research.

Mandi: more readily applying my academic knowledge of evaluation to the practical, real world uses.

Taj: continuing to explore ways for my clients to use technology to have better access to their data and evaluation findings.

Jackie: increasing my knowledge of Excel.

Kathy (not pictured): improving my grant skills.

(We would also like to take this opportunity to thank departing staffer Jenn Prichard for her many contributions to our team this year. Good luck, Jenn, in all of your future pursuits!)

Wishing you a prosperous New Year and the very best for your own evaulation efforts in 2013!

Taj & the CRC team

p.s. Please consider following us on facebook! For a short time only, by doing so you can win lunch with an evaluator. See http://tinyurl.com/cdq9nnp for details.

It’s already the end of November, and we’re entering that time of year when people are inclined to look back and reflect on the events of the previous months. At CRC we are not quite ready to reminisce about all of 2012 just yet, but before November ends we do want to revisit an important event for us that occurred a few weeks ago. At the end of October, some of the CRC staff flew out to Minneapolis to attend the American Evaluation Association conference (and to see our first snowfall of the season!).

If you follow CRC on twitter and/or facebook*, you already know that CRC was busy at this year’s AEA! Leslie and Taj (on behalf of Jenn, too pregnant to fly) presented Using an Adaptive Research Design in the Evaluation of a Community Schools Program: Initial Findings of the Implementation and Evaluation Of Elev8 Baltimore, and as the leadership of Baltimore Area Evaluators they helped to coordinate a tweetup of East Coast evaluators. Taj also provided her insights to other evaluators at Meet the Pros: Intermediate Consulting Skill Building Self-Help Fair. Sheila was extremely busy with intensive all day workshops, and was social networking like mad on CRC’s behalf. Yet somehow she still had time to meet and pick the brain of AEA President Rodney Hopson.

Collectively, our group had other fortuitous meetings with colleagues and various evaluation celebrities, enjoyed networking with fellow data snobs from the East Coast and beyond, and came away with some valuable lessons learned.The title and theme of the 2012 conference was Evaluation in Complex Ecologies Relationships, Responsibilities, Relevance:

Evaluation takes place in complex global and local ecologies where we evaluators play important roles in building better organizations and communities and in creating opportunities for a better world. Ecology is about how systems work, engage, intersect, transform, and interrelate. Complex ecologies are comprised of relationships, responsibilities, and relevance within our study of programs, policies, projects, and other areas in which we carry out evaluations.

This theme is extremely relevant to the work that CRC does with our clients– of diverse types, scale, and needs. Here are a few notable take-aways for three of us:

Sheila:

One of the programs that Sheila attended was a day-long Logic Modeling workshop. From this workshop she gleaned that:
1. A little logic modeling goes a long way
2. Logic models make program theory clear, not true

She also picked up some new pointers about data visualization:
1. Strive to make things clear
2. Simplicity enhances clarity
3. Have a single message
4. A picture is worth a thousand words: They provide a medium for explaining thought and feeling

Leslie:

Karen Kirkhart, the discussant for Fiona Cram’s plenary (titled, Taking a walk on the Wild Side: Some Indigenous Perspective on Valuing Complexity, Sustaining Relationships, Being Accountable for Responsibilities and Making Things Relevant), provided intriguing parting questions that we should ask ourselves when doing evaluation in complex or diverse populations:

1. How does our own privilege filter what we see and understand?
2. How do we come to know what we don’t know – to see what has previously been invisible to us or gone unnoticed?

Leslie found question 2 to be particularly thought-provoking.

Jill:

Jill was pleased to learn more from evaluator Donna Mertens, who she had previously met at the International Congress of Qualitative Inquiry. From Donna’s Transformative Mixed Methods Evaluation AEA workshop, she took away that:

1. Doing contextually-sensitive mixed methods program evaluation that serves the goals of social justice for the population served AND meets the needs of funders is challenging but not impossible.

2. Bringing all evaluation stakeholders to the table together is a worthwhile aim, but must be done with sensitivity to issues of power, privilege, and history.

If you were unable to go to Minneapolis, we hope that you take away something form our take-aways. More visual take-aways for you to enjoy are viewable on our Picasa page: https://picasaweb.google.com/116313125623568026879/CRCAEA2012#

Hope to see many of you at next year’s AEA conference in Washingotn, DC!

*Find us on facebook and twitter!
https://www.facebook.com/CarsonResearchConsultingInc
https://twitter.com/CarsonResearch

An article by Lehn Benjamin in the September 2012 issue of the American Journal of Evaluation explored the extent to which existing outcome measurement frameworks are aligned with the actual activities performed by nonprofit staff to ensure positive outcomes for their clients.

Benjamin’s analysis of numerous measurement guides revealed that existing outcome measurement frameworks focus primarily on program activities completed and the changes in the users as a result of those program activities. This highlights, rather overwhelmingly, that outcome measurement often misses important aspects of staff work, namely the direct activities they do with clients. It is this frontline work that is essential for helping staff build relationships in their communities that are paramount to positive program outcomes. Unfortunately in many cases this does not fully capture the work of frontline staff, which in turn increases the likelihood of mischaracterizing nonprofit performance.

Research shows other possible reasons for a disconnect between outcome measurement frameworks and the frontline work of non-profit staff, including:

1) Funding requirements that force nonprofits to collect data that are only necessary for reporting to donors rather than collecting data that will be useful for internal development (Christensen & Ebrahim, 2006, Cutt & Murray, 2000, and Ebrahim, 2005).
2) Performance measurement frameworks that do not take into consideration the role of nonprofits in client engagement, particularly frontline work (Knutsen & Brower, 2010, and Smith, 2010).
3) The fact that outcome measurement as a standardized framework conflicts with the experimental nature of nonprofit work (Hwang & Powell, 2009).
4) The idea that nonprofits may not have the capacity to adequately measure outcomes (Botcheva, White, & Huffman, 2002 and Carman & Fredericks, 2008).

Given the above limitations, what can evaluators do to ensure outcome measurement better captures nonprofit performance? Benjamin’s article offers three main recommendations for evaluators. He suggests that they:

1) Develop guidance tools that help nonprofits measure frontline activities critical to achieving positive program outcomes
2) Create tools that help nonprofits incorporate relationship building activities into their performance measurement systems
3) Further examine how the adoption and assimilation of current outcome measurement frameworks have shaped the work that nonprofits do as well as the consequences of using poor measurement frameworks

In conclusion, Benjamin suggests that in order to fully understand nonprofit performance, evaluators must redefine outcome measurement to include a broader conception of nonprofit work, which will in turn help nonprofits achieve their desired outcomes.

Blog post by: Sheila Matano, Research Analyst, CRC

References:
Christensen, R., & Ebrahim, A. (2006). How does accountability affect mission: The case of a nonprofit serving immigrants and refugees. Nonprofit Management & Leadership, 17, 195–209.
Cutt, J., & Murray, V. (2000). Accountability and effectiveness evaluation in nonprofit organizations. London, England: Routledge.
Ebrahim, A. (2005). Accountability myopia: Losing sight of organizational learning. Nonprofit and Voluntary Sector Quarterly, 34, 56–87.
Knutsen, W. L., & Brower, R. S. (2010). Managing expressive and instrumental accountabilities in nonprofit and voluntary organizations: A qualitative investigation. Nonprofit and Voluntary Sector Quarterly, 39, 588–610.
Smith, S. R. (2010). Nonprofits and public administration: Reconciling performance management and citizen engagement. The American Review of Public Administration, 40(2), 129–152.
Hwang, H., & Powell, W. W. (2009). The rationalization of charity: The influences of professionalism in the nonprofit sector. Administrative Science Quarterly, 54, 268–298.
Botcheva, L., White, C. R., & Huffman, L. C. (2002). Learning culture and outcomes management practices in community agencies. American Journal of Evaluation, 23, 421–434.
Carman, J. G., & Fredericks, K. A. (2008). Nonprofits and evaluation: Empirical evidence from the field. In J. G. Carman & K. A. Fredericks (Eds.), Nonprofits and evaluation. New directions for evaluation (119; pp. 51–72). San Francisco, CA: Jossey-Bass.

Use of an evaluation’s findings (i.e., lessons learned) and process use (i.e., evaluation use that takes place before lessons learned are generated and feedback initiated) are two of the clearest, simplest examples of the uses for evaluations. (Fleischer and Christie (2009) offer other examples, but recognizing they don’t have clear definitions, they won’t be discussed here.) By now there is much agreement that there is a great deal of useful information generated during the evaluation process itself, information that could increase involvement and learning.

Instituting practices that foster involvement in the evaluation process will lead to increased evaluation use, right? This idea seems to be common sense, but why is it that common sense concepts are often hard to implement or forgotten all together?

I’d offer that often common sense ideas sound reasonable but may still a bit too abstract to be used. For these ideas to go from abstract to implementation, some preliminary questions may arise and should be answered, including:
1) Does process use play a role in my outcomes (e.g., through learning)?
2) How is each stakeholder going to use the evaluation?
3) Is the evaluator going to be in charge of involving the stakeholders and
facilitation?

Fleischer and Christie’s (2009) study found that nearly three quarters of evaluation participants thought nonuse of evaluation findings was a concern. They felt that a lack of understanding and transparency about the evaluation process made it difficult for people to place much value in the results. Stakeholders would reject findings based on personal beliefs and values rather than on the data that came out of the evaluation.

Creating understanding and a transparent evaluation process takes resources and planning, not to mention the requirement that key stakeholders need to regard evaluation use as a priority. Clearly evaluation use is important to any evaluation. Therefore concepts should be explicit from the beginning so the evaluator can properly orchestrate the dissemination of varying reports to the correct users. For example… you have a program with an overall anticipated outcome of reducing youth’s recidivism. The funders and directors of the program are going to be especially interested in the primary findings, while those implementing the program and working more intimately with the families may be more interested in knowing more of the process use outcomes.

This approach doesn’t mean generating numerous lengthy reports and seeing dramatically increased costs as a result. It just involves more planning and organization in the beginning, requires a timeline for disseminating key pieces of information to relevant stakeholders throughout the program, and breaking a larger report down into manageable chunks for dissemination to certain stakeholders, depending on the needs they identified at the beginning of the evaluation.

Breaking a topic or a request into manageable chunks can help clarify what is involved and promote evaluation use.

Resource: Fleischer, D.N., & Christie, C.A. (2009). Evaluation use results from a survey of U.S. American evaluation association members. American Journal of Evaluation, 2, 158-175.

I must admit I’m excited about today’s post. Not because it gives us an excuse to indulge ourselves in a lot of unfocused social media (e.g. facebook, LinkedIn, or Twitter) fun, but because of the opportunities and uses these tools can provide program evaluators. Not only have these platforms have provided us, as evaluators, with greater ease in gleaning resources (such as through the American Evaluation Association’s facebook page) and communicating with clients and colleagues (via Twitter and our local evaluators’ LinkedIn group), but we’ve begun to see programs’ use of these platforms as an important piece of their evaluation “stories”.

Social media allows for connections that are rapid and have the potential for wide dissemination. It isn’t easy to envision programs advertising their services through social media, but it is a new option that should be considered. Programs could offer additional support to their clients through social media, and the use of social media by clients and other stakeholders could even serve as a marker of program success (or failure).

The evaluation of social media as a possible tool is becoming much more widespread in the private sector, as companies realize that it allows them to interact efficiently with their customers and with wide impact. For example, if a company sees a negative post on Twitter related to them or to their product, they can address it quickly and with the added benefit of all who follow them, and the person who posted the original comment, see it. Some companies use facebook to connect with their customers and offer them the chance to engage intimately and regularly with the company on all sorts of topics. Did you know that even Marshmallow Peeps have their own facebook page?

We’re seeing these days that it is possible for social media to be used effectively in the public sector, addressing issues ranging from public health to transportation. Case-in-point are the multiple Twitter streams maintained and frequently updated by the Centers for Disease Control. But, for widespread, effective use to occur at the program level, we must take into consideration realities such as confidentiality, program clients’ ability to access social media, and program staff’s potential lack of time to keep up with the sometimes fast-paced management of social media.

Our aim is not to have you hop blindly on the social media “bandwagon,” but rather to get you thinking creatively about the possibilities of using social media in your organization, as it fast becomes the new approach to marketing. How can you implement some social media into your organization?