Chapter 3
Member Involvement and Retention  TOP

Introduction

CARE Act puts planning in the hands of groups broadly representative of the local community. In general, membership should be inclusive and as diversely representative as possible. This includes representatives from all populations directly impacted by HIV/AIDS and representatives from the broader health care community. The typical planning body is composed primarily of people directly involved with HIV/AIDS, either as consumers or providers of health care services. The more perspectives that are represented in the planning process, the better the chances that decisions will reflect community needs and be supported by participants and the broader community.

Multiple areas of expertise should be represented in the membership of a planning body. Examples include expertise in what it is like to live with HIV; expertise in how to deliver care and treatment programs to people living with HIV disease (PLWH); technical expertise in the health care planning activities required of the consortium including needs assessment, priority setting, comprehensive planning, resource allocation, and evaluation; and, expertise in group process.

A possible formula for membership recruitment and maintenance is: The better organized and operated, the easier it is to recruit new members and to retain current members. Members will feel that they are making a worthy contribution to an effective enterprise if the following holds true:

• The mission is clearly defined
• Policies and procedures are documented and agreed on by all members
• Tasks necessary to the mission are specified and pursued by the members themselves
• The committee structure allows all participants to understand their roles and responsibilities
• Meetings are conducted in a participatory, efficient, and timely manner, and
• The group acknowledges that everyone has an equally important contribution to make and that not everyone must be an expert in every aspect of the process.

Different Types of Participation  TOP

Some bodies distinguish between voting members and non-voting members. The latter are usually staff or board members of a lead agency or contracted service providers. Such entities feel that assigning voting privileges to these members could constitute a conflict of interest. Other groups allow only a designated number of voting members from each of the perspectives represented—consumer and provider. Additional representatives can participate as non-voting members. Finally, there are bodies that offer non-voting membership to people who cannot attend regularly, often for health reasons.

While the body guides planning locally, membership should not be a requirement to participate in planning. Nonmembers can contribute needed expertise through participation on selected committees, caucuses, and task forces and in surveys and focus groups to identify needs and service gaps. Some nonmembers with special expertise can be recruited to join in an advisory capacity, with limited duties. This has been used to involve experts, such as local physicians who may have limited time. They might be asked to review the needs assessment results and the draft comprehensive plan and give feedback.

Obstacles to Participation  TOP

Obstacles that can harm member participation include the following:

• Lack of clearly defined roles, responsibilities, and expectations for members. New members who are unclear about their role may become observers rather than participants. Further, potential new members may not continue because they do not know how to contribute or where they fit into the process.
• Lack of formal orientation and training. New members need to be oriented and all members need ongoing training in the skills required to perform their consortium duties. Without orientation, new members may feel discouraged because they do not understand what is happening. Without training, members who feel they cannot participate fully in all activities may simply attend meetings and observe. This dynamic sets up a situation where the process is dominated by a few members.
• Lack of knowledge of the formality and complexity of consortium processes. The primary tasks of the body—needs assessment, priority setting, comprehensive planning, resource allocation, and evaluation—are complex. To understand and participate in them requires a fairly high level of knowledge and training. Additionally, procedures used to enact business, such as parliamentary procedures and the relationships of committees to the full consortium, can be confusing to participants.
• Inaccessible meeting times or locations. Members who participate as part of their job requirements because they are employed in agencies related to the activities of the body tend to prefer meetings during their work days. Members who are employed outside of the HIV/AIDS field often find it difficult to attend meetings during the day and prefer evening meetings. Location of the meeting can also affect who attends. However, frequent changes of meeting times and locations can hurt attendance.
• A meeting process that is filled with conflict and does not seem productive. When meetings are badly run, overly long, and filled with anger and conflict, members tend to stop participating and then stop attending.
• Lack of administrative support. Many groups do not receive enough funding to pay for administrative support and the lead agencies often have to contribute these services. Members are often expected to volunteer large amounts of time to the process.
• Lack of consumer knowledge about policies and procedures to support their involvement. Sometimes, supports for consumers exist but they are unknown to new members. New members may be unfamiliar with expense reimbursement policies and uncomfortable asking about them. They may be unaware that child care or transportation assistance can be arranged. They may be unclear about access to office equipment such as a fax machine or copier, or secretarial support available to assist them in carrying out tasks. Further, new members may not understand how to ask for what they need. They may not know how to sustain their involvement should they be ill or unable to participate for a period of time.
• Lack of flexibility regarding participation. Membership policies and procedures often are rigid and inflexible and do not allow for alternates, proxies, or other types of participation (such as telephone hook-ups) necessary to encourage participation by consumers.
• Burnout and overcommitment. Sometimes members, including PLWH, are expected to serve on too many committees and take too much responsibility for tasks like reporting back to the community and recruiting new members. Some groups have unrealistic expectations of members and provide no opportunities for renewal and recognition.

Ways to Encourage Participation  TOP

The following actions can help encourage participation:

• Formal membership plan
• Orientation of new members
• Ongoing training for all members
• Clear roles and responsibilities
• A culturally sensitive environment
• Flexibility about meeting times, locations, and participation requirements
• PLWH participation as a priority
• Creativity in finding solutions to administrative support needs
• Action to prevent burnout and sustain member commitment
• A membership removal process.

Formal Membership Plan

Member recruitment and retention can be better tracked and analyzed by creating a formal membership plan that addresses (1) representation, (2) diversity (key occupational, geographic, demographic, and social characteristics representative of the area and population served by the body) and (3) recruitment and selection of members.

Representation means including different perspectives, such as the following:

• Consumers, including PLWH and their families and significant others
• Other CARE Act Titles, and
• Community leaders, including neighborhood leaders
• Community-based organizations, including those serving various ethnic communities, other health issues, and community action agencies
• Gay/lesbian/bi-sexual and transgender organizations
• AIDS service organizations
• Medical providers, including hospitals, health departments, HMOs, private medical and dental groups, medical societies, primary care clinics, community and migrant health centers, home health agencies, hospices, and nursing associations
• Health planners and evaluators
• Public health professionals, such as epidemiologists and prevention staff
• Mental health providers, including mental health clinics, crisis centers, substance abuse treatment programs, and private counselors
• Social and support service providers, including social service departments, adoption agencies, food banks and emergency relief agencies
• Housing providers, including housing authorities, long-term care facilities, homes for PLWH, and homeless shelters
• Programs that address needs of formerly incarcerated populations
• Programs that enhance access to care and treatment, including Medicaid, clinical trials, sexually transmitted disease clinics, and tuberculosis prevention/treatment services
• Business people, including small business owners, and executives of corporations
• Educational institutions, including schools, colleges, technical schools, and professional schools
• Religious leaders, including rabbis, priests, ministers, and others
• Policymakers, including elected city, county, and State officials
• Law enforcement and correctional officers, attorneys and judges
• Media, including advertising, print, radio, television, and cable
• Youth services, including runaway and homeless youth shelters, teen clinics, youth organizations, and community centers
• Women’s services, including family planning, rape, and domestic violence programs
• Family-centered caregivers, and
• Other (e.g., vocational rehabilitation services, client assistance programs (CAPs) and disability community organizations).

Diversity should be based on population characteristics including the following:

• Geography, including neighborhoods in urban areas and counties or communities in rural areas;
• Gender, including transgender
• Sexual orientation, including heterosexual, homosexual, bisexual, and transgender
• Ethnocultural background, including the various ethnic and cultural communities within the consortium area
• Risk for HIV, including injection drug users, men who have sex with men, and persons with hemophilia, and
• Physical ability, including hearing-challenged and sight-challenged persons.

A process for recruitment and selection of members may include answers to the following:

• What nominations process will be used?
• How will members be recruited?
• How do nonmembers become members, and what are the criteria for membership?
• What are the requirements to maintain membership?
• What training will be available to consortium members to help them recruit new members?

Each of these questions is addressed in greater detail in the Appendix at the end of this chapter.

Orient New Members

Orientation of new members helps them understand procedures and prepare to participate actively. Well-planned orientation and training activities demonstrates the value the group places on new member participation. Orientation activities might include the following:

• An initial orientation prior to each new member’s first meeting should cover their roles and responsibilities as members, the annual work plan, and timeline for activities and topics to be addressed at the next meeting. A new member Orientation Manual or Packet might include:
  • Overview of the Ryan White CARE Act
  • History and the mission statement
  • Bylaws, policies, and procedures
  • List of services provided
  • Chart of the committee structure
  • List of members including addresses and phone numbers (prepared according to the wishes of the membership)
  • Member and committee job descriptions
  • Reimbursement procedures
  • Current comprehensive plan (which should include the results of the needs assessment, priority setting process, resource allocation process, and previous year’s evaluation), and
  • Other pertinent information.

  The orientation manual should not be used as a substitute for an interactive orientation. Written materials should be compiled and adapted as necessary to accommodate the language preferences and literacy levels of new members.

• A formal procedure should introduce and welcome new members at meetings. Attending a full-membership meeting for the first time can be overwhelming and confusing, especially if there is no mechanism to acknowledge and integrate new members.
• Debrief with new members after their first meeting.
• Establish a mentor or “buddy” system. Assigning a current member to be a “buddy” to a new member, for at least three months, helps new members feel welcome, learn about individual member perspectives, and become comfortable with the processes and interactions of the group.
• Train to address individual needs. For example, address the problem of burnout, helping new members make realistic time commitments and avoid becoming overcommitted.
• Sensitize all members to the importance of consumer input.

Provide Ongoing Training for All Members

Continuing education and training opportunities promote constructive working relationships among members, reward members for their time and effort, develop members’ knowledge and skills related to HIV disease and organizational functioning, and advance the work of the group. The following educational opportunities can be useful for members:

• Strategic planning retreats
• Trust-building and team-building workshops
• Conflict-management workshops
• Training on comprehensive planning, priority-setting methodology, using data and statistics to plan, and evaluation methodology
• HIV/AIDS informational topic sessions (e.g., antiretrovial therapies)
• Workshops on roles and responsibilities of consortium members, and
• Development of skills for facilitation and chairing a successful meeting.

Clearly Outline Roles and Responsibilities

Clear information will enhance functioning, including clearly defined roles and responsibilities; policies and procedures that are as simple as possible and available to all members in writing; and written definitions of all operating concepts. Use agreed-upon ground rules for all meetings. Conflict of interest and grievance policies and procedures should, at a minimum, be defined and distributed in writing to all members.

Further, CARE Act-specific activities require a high degree of definition to be successful. To illustrate, all services provided should be clearly defined before the needs assessment process begins. Establishing such definitions up-front is critical to the priority setting process, the resource allocations process, the comprehensive plan, and the evaluation process.

Create a Culturally Sensitive Environment

Never assume that there is only one way to conduct business of the group. The effort is a collaboration of many different people, all of whom bring their own expectations and backgrounds to the table. A formal process governed by parliamentary process and Robert’s Rules does not necessarily work in all environments. As needed, modify and create procedures for doing work that meet the needs of most members, promote full participation and high levels of productivity, and create a comfortable atmosphere that is inviting to new members.

Be Flexible about Meeting Times, Locations, and Participation Requirements

Meeting times, locations, and requirements for participation should be revisited on a regular basis. The group changes as new members join, older members leave, members die, and the requirements of the epidemic change. Many groups report changes in their PLWH participation as greater numbers of consumer members return to work or become employed. They have been forced to change their meeting times accordingly. Some are only meeting as a full body on a quarterly basis and rely more and more on committee functioning to complete the operational tasks. Some use consumer and service provider caucuses to review the work of the full group and provide input but do not require caucus members to participate in general membership meetings. The key is flexibility and taking the time to develop a process that works best.

PLWH Participation is a Priority

The following approaches will help assure PLWH participation:

• Develop a formal PLWH membership plan.
• Provide supports for PLWH members with limited physical capacity or special needs.
• Demonstrate respect for PLWH member input and recognition of contributions by paying attention to what PLWH say, insisting on an atmosphere of mutual respect, encouraging everyone to participate, and maintaining an orderly process.
• Seek PLWH representation on all committees at the same level as on the consortium.
• Develop a formal leadership development training program for PLWH.
• Have policies and procedures that allow PLWH to participate in different ways, predicated by the changes in their health status.
• Directly address grief and loss within the membership.

Be Creative in Meeting Administrative Support Needs

Take the time to assess administrative support requirements and resources available to meet them. Do not assume some members will volunteer to do all the work or that the lead agency will automatically agree to donate those services.

First, discuss administrative requirements and develop an administrative budget with the State grantee and their lead agency (if they have one). If the administrative cap is inadequate to meet administrative needs, alternative resources need to be found. There are many creative solutions to the barrier of administrative support. Some groups recruit specific people or entities to make targeted contributions, such as small business owners willing to donate postage for mailing minutes as a sole contribution to the process. Others rely on local universities, colleges, or trade schools to provide interns to assist with the administrative tasks, such as taking meeting minutes. Some even use interns to write their applications. In other areas, groups from adjoining regions have combined their administrative allocations and contracted with a staff person to provide administration to multiple groups.

Take Action to Prevent Burnout and Help Sustain Member Commitment

Sustaining commitment and enthusiasm is challenging. All organizations experience an ebb and flow of involvement. Thus, it is important to bring in new members on an ongoing basis. They bring new energy and fresh perspectives. It is also important to rejuvenate existing members. Methods to sustain member commitment include the following:

• Acknowledge people for their contributions and give them positive feedback on an ongoing basis by thanking members at meetings, honoring them at special events, developing an awards program, or featuring members in newspaper or newsletter articles. Celebrate accomplishments at an annual social event.
• Provide opportunities for continuing education, training, leadership development, and growth-promoting activities.
• Effective meetings also help to keep members involved. Start by mailing out an agenda and a packet of background information needed for decision making at least one week before the meeting. Specify when the meeting will begin and end. Start and adjourn on time. The meeting facilitator or leader should ensure that discussion does not stray from the agenda and that the discussion leads to an agreed-upon course of action on all items that require decisions.
• Consider scheduling time for optional socializing and networking immediately before or after the meeting. For some people, these opportunities represent a critical reason to remain involved.

Have a Membership Removal Process

Once criteria for membership have been established, adopt a process for removing members who no longer meet the criteria or who violate the rules. To discourage attempts at removal based solely on personality conflict, the removal process must be fair, impartial, and clearly spelled out. Use the following four steps, which are drawn from standard organizational personnel policies:

Step #1. Written notification to the member about the violation. This notice should specify actions necessary to correct the violation and the time frame within which the corrective action must occur. It is typically written by the principal leader or designee (e.g., the chair of the membership committee).

Step #2. A meeting to mediate a solution between the member or members and the principal leader or leadership such as the Executive Committee.

Step #3. Mediation and conflict resolution facilitated by an outside expert. This action should be taken if the member or members refuse to pursue a solution with the leadership.

Step #4. A motion to remove the member if all attempts at mediation fail. The motion should be introduced to the membership committee or the full membership, with complete written documentation of all prior steps taken. Removal usually requires a two-thirds vote of the members.

APPENDIX A  TOP

Recruitment and Selection Process

Address the following questions in the process that is established:

• What nominations process will be used?
• How will members be recruited?
• How do nonmembers become members? (What are the criteria for membership?)
• What are the requirements to maintain membership?
• What training will be available to consortium members to help them recruit new members?

What Nominations Process Will Be Used?

An open nominations process might include the following minimum standards:

• Be described and announced before the nominations process begins.
• Specify the membership criteria being sought to ensure that membership:

  (1) Includes the legislatively required positions (membership categories)
  (2) Reflects the epidemic of HIV disease in the EMA
  (3) Reflects the geography of the EMA
  (4) Reflects any other locally determined membership needs, and
  (5) Incorporates conflict of interest requirements.

• Be publicized, including advertisements in local HIV publications, notices to service providers, press releases, and other community announcements.
• Inform nominees of:

  (1) The time commitments involved in serving on the planning body
  (2) Conflict of interest standards, and
  (3) HIV disclosure requirements.

• Use a nominations form to:

  (1) Collect information about the nominee’s characteristics, experience, and background, with specific attention to legislatively mandated membership categories and the characteristics of the local epidemic of HIV disease
  (2) Include an open-ended response category for nominees to describe their experience
  (3) Provide information to potential members about time commitments and other demands of planning body membership, meeting schedules, HIV disclosure requirements, and the conflict of interest standard, and
  (4) Provide a written description of the nominations process.

  Establish a representative nominations or membership committee that reviews all nominations.

How Will Members Be Recruited?

Methods for recruiting consortium members include:

• Direct mailings to other organizations’ mailing lists and current members’ own personal mailing lists. To maintain confidentiality in conducting recruitment, take steps such as using unmarked envelopes.
• Have consortium members telephone potential members who belong to targeted groups and work with them to become members of the consortium. This may include a type of mentoring or buddy program where members agree to pick up potential members and drive them to meetings and work with them to help them understand the process.
• Consortium members can engage in collaborative community networking. Consortium members should attend other organizations’ meetings and promote membership on the consortium in their public venues or where speakers are allowed. Some consortia are developing speakers bureaus not only to provide education about HIV/AIDS and the consortium funded services, but also to advertise and promote consortium membership.
• Use newspapers and newsletters. Consortium meetings should be regularly advertised in local newspapers and member organizations’ newsletters.
• Distributing flyers and brochures at various locations certainly promotes the consortium but has seen little direct success when used as the only technique for recruiting members. When used in conjunction with other techniques, flyers and brochures can promote the consortium membership, but are used most widely to promote the consortium’s funded services. Flyers and brochures should be translated into all the major language groups of populations targeted both to receive services and to become consortium members.
• Multiple methods can be used to target consumer/PLWH involvement. Examples include outreach to service providers and individual staff who serve clients with HIV/AIDS to identify non-affiliated PLWH nominees. (Non-affiliated refers to consumers who do not have a potential conflict of interest, meaning they have no financial or governing interest in funded agencies.) Coalitions of PLWH can also be contacted.

How Do Nonmembers Become Members, and what are the criteria for membership?

Following are ways for an individual to become a member. More than one of these processes might be used:

• Application
• Appointment
• Invitation to join
• Following attendance at multiple consecutive meetings
• Volunteering
• A member commitment statement (see sample membership commitment statement at the end of this chapter), and
• Meeting specific criteria determined by the consortium.

Criteria for membership may require the following of individual members:

• Agreement with the mission of the consortium
• Belonging to a targeted population
• Representing a targeted agency
• Being recommended by other members, and/or
• Having experience with HIV/AIDS.

What Are The Requirements To Maintain Membership?

Members may be required to do the following to maintain their membership:

• Participate on committees
• Regularly attend full consortium meetings
• Stay below an agreed-upon number of unexcused absences from consortium meetings
• Participate in special projects, and/or
• Comply with consortium policies and procedures.

What Training Will Be Available to Members
to Help Them Recruit New Members?

All members have an investment in new member recruitment and should be encouraged to participate in recruiting new members. The most successful recruitment technique identified by consortia across the country is the personal connection of asking someone directly to join. The best way to recruit a potential member on the importance of the group’s work is for someone with a prior personal connection to meet with him or her.

When meeting with a prospective member, do the following:

• Explain the mission and goals of the consortium
• Connect on a personal level by explaining why they joined
• Describe why the potential member is needed and the specific contribution they can make
• Candidly estimate the time commitment
• Be clear about what is expected; go over the membership commitment statement , if one is used (see the sample at the end of this chapter)
• Explain the membership selection process
• Explain the member orientation process
• Give the potential member time to consider membership, and
• Follow up with a telephone call to assess the candidate’s interest and answer any questions.

SAMPLE MEMBERSHIP COMMITMENT STATEMENT

Statement of Individual Consortium Member’s Responsibilities

I, _______________________________________________, do hereby commit to:

General Expectations

1. Know the Consortium’s mission, purpose, programs, and services. Continually work to develop and implement strategies, goals, policies, and procedures that promote the Consortium’s mission.

2. Work to attract new members who can make significant contributions to the work of the Consortium and reflect the diversity of the community and the HIV/AIDS epidemic.

3. Fulfill commitments made, willingly undertake special assignments, and consider serving in leadership positions.

4. Avoid prejudiced judgments on the basis of information received from individuals and urge those with grievances to follow established policies and procedures for grievances within the Consortium. (All matters of potential significance should be called to the attention of the Consortium’s leadership.)

5. Stay informed and follow the trends in the HIV/AIDS epidemic.

Meetings

1. Prepare for and participate in Consortium meetings and committee meetings.

2. Ask timely and substantive questions at Consortium and committee meetings consistent with my conscience and convictions, while supporting the majority decision on issues decided by the Consortium.

3. Maintain confidentiality of the Consortium’s sessions and speak for the Consortium only when authorized to do so.

4. Suggest agenda items periodically for Consortium and committee meetings to ensure that significant policy-related matters are addressed.

Avoiding Conflicts

1. Serve the HIV/AIDS community as a whole rather than only serving a special interest group, constituency or service provider. (It is very important that all the various perspectives of the HIV/AIDS epidemic be represented and participate in discussions. Ultimately, all Consortium members need to make final decisions for the good of the entire community.)

2. Avoid even the appearance of a conflict of interest that might embarrass the Consortium and jeopardize the credibility of the funds allocation process. Disclose any possible conflicts to the Consortium in a timely fashion.

3. Maintain independence and objectivity and do what a sense of fairness, ethics and personal integrity dictate even though not necessarily obliged to do so by law, regulation or custom.

4. Never accept (or offer) favors or gifts from (or to) anyone who is funded by the Consortium or does business with the Consortium.

Fiduciary Responsibilities

1. Exercise prudence with the Consortium’s decisions regarding allocation of CARE Act Title II funds. I understand that we are the stewards of these public funds and our decisions about how to spend them must be made in a fair, impartial and informed way.

2. Faithfully read and understand the Consortium’s financial statements and budgets and otherwise help the Consortium fulfill its fiduciary responsibility.

Further, I personally commit to:

(For example: accomplish a specific task, sit on certain committees, take responsibility for certain functions of the Consortium, or take a particular leadership role.)





Signed: ___________________________________________ Date: _____________