Power of the people
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By Katie Vincent
Fran Butterfoss, PhD, was worried.
The year was 1993. The United States had come through a measles epidemic in the 1980s and was armed with new approaches to protect public health. To prevent future outbreaks, the Centers for Disease Control and Prevention had issued grants to six cities — including Norfolk — to improve immunization rates of infants and preschool-aged children. A professor in EVMS’ Division of Community Health and Research, Dr. Butterfoss encountered regular resistance among parents and caregivers in Hamptons Roads to the CDC initiative. And no wonder. As Dr. Butterfoss understood, many minority families distrusted the medical community — in part because of the painful legacy of the United States Public Health Service’s Syphilis Study at Tuskegee. Misinformation was rampant.
Dr. Butterfoss knew that to turn public opinion, she needed to engage help from the community and put a human face on the importance of immunizations. The idea led to something big. The Consortium for Immunization of Norfolk’s Children, the original CINCH, held its first meeting January 29, 1993. The coalition of about 30 local health leaders was tasked with learning what kept parents from vaccinating their kids and how to remove those barriers.
“We started with many phone calls and visits to community organizations, with focus groups and door-to-door interviews of about 6,000 households,” says Dr. Butterfoss, who served as the founding Director of CINCH. Such grassroots efforts, typically associated with political or social justice issues, represented a new approach to solving a health crisis.
Thirty years later, CINCH is still going strong. The group’s longevity has proven Dr. Butterfoss right: A team of health professionals in Hampton Roads that speaks directly with community members and listens to their stories can yield practical solutions to curb a major health issue. That radical tactic — and the vow to do it again and again — set the foundation for a robust village committed to supporting Southeastern Virginia families on their health journeys.
Pilot program
During their initial outreach, CINCH workers learned that many people didn’t realize kids needed immunizations prior to grade school as their physicians didn’t press the issue. In addition to their mistrust around vaccines, some families thought they couldn’t afford shots; many described grueling logistics with bus transfers and long wait times with multiple children in tow.
Community members also voiced a laundry list of health and safety concerns that kept them up at night. “We promised them if this vaccination project succeeded, we would expand it to all children in the area, and we would do a major child-health assessment to prioritize other issues,” Dr. Butterfoss says.
Extensive advertising, parent and physician education, work with the transit authority, reviews of physician records and reminder phone calls helped immunization rates rise by 17 percent within two years.
Bigger, broader goals
Following the immunization project, CINCH leaders kept their word, expanding their footprint to all cities in Hampton Roads and changing the acronym to represent the Consortium for Infant and Child Health. They’ve focused on issues such as obesity, asthma, injury prevention, health disparities, special needs and health insurance coverage. Their work has led to policy changes, safer playground equipment, bicycle paths through underserved communities, nutritional guidelines for aftercare facilities and breastfeeding accommodations in the workplace.
Collaboration made these and other accomplishments possible.
“What sets CINCH apart is the wide variety of community stakeholders involved with our work, as well as our focus of inviting to and valuing diverse voices in the coalition,” says Amy Paulson, an Instructor in EVMS Pediatrics and CINCH’s Executive Director since 2006.
In addition to hospitals, doctors, managed care organizations and public health experts, CINCH engages with schools, churches, city government, community organizations, such as the YMCA and The Up Center, public housing and advocacy groups like Moms Demand Action. Today, CINCH has 425 partners.
“The issues we’re tackling would be insurmountable without community partnerships,” says Sara Rothenberg, MPH, a fellow EVMS Pediatrics Instructor, and since 2018, CINCH’s Assistant Director.
Much of CINCH’s work involves aligning with people doing positive work and disseminating the efforts to a broader audience.
“CINCH avoids duplication of efforts,” says Beth Parker, a CINCH member since 2019 and Assistant Director of Minus 9 to 5, an EVMS initiative that supports parents from pregnancy through their child’s fifth year. “When we see overlap, we pool our knowledge and resources to enhance that particular area of focus.”
This deliberation has become even more important since COVID as many CINCH partners have been spread thin.
“We have to be very efficient, focused and action-oriented, so we best engage very busy partners in ways that make the most of their time and contributions,” says Paulson.
Additionally, CINCH leans heavily on community insight to understand what initiatives have real impact. Rather than relying on a few experts to come up with a plan, “tapping into the power of people gets results that are much more effective and meaningful,” Paulson says.
From its inception, CINCH operated as a group where every volunteer’s voice had equal weight, a value that inspires Matt Herman, Director of EVMS’ M. Foscue Brock Institute for Community and Global Health and CINCH member since 2008. “So often, people in positions of power like government officials or physicians get all the attention,” he says. “But community residents’ opinions are just as important.”
Next steps
Part of seeking partners’ perspectives means acknowledging when to pivot. In September 2022, CINCH launched its latest strategic plan.
“Our leadership team reviewed the landscape change COVID created,” says Rothenberg. “What came out of it was a renewed interest in mental health.”
This ranges from fostering social-emotional awareness with toddlers to addressing risky behavior in teenagers, as well as identifying
warning signs for depression and suicide. It’s a mission that taps experts from all stages of childhood development.
Reinvention has been key to CINCH’s survival.
“Most coalitions only last a few years, so I was a bit nervous making that initial promise,” says Dr. Butterfoss. “Thirty years is a remarkable longevity, and it’s really come down to CINCH’s willingness to evolve and stay relevant for the Hampton Roads community.”
Watch a video celebrating 30 years of CINCH.
Pictured at top: Today CINCH is led by Executive Director Amy Paulson (right) with Assistant Director Sara Rothenberg.