In 2000, The California Endowment and The Rockefeller Foundation launched the California Works for Better Health (CWBH) initiative to test the theory that improving the consistency and quality of employment among people with multiple disadvantages in the labor market could also improve their health. CWBH brought together grantee agencies in four California regions — Fresno, Los Angeles, Sacramento, and San Diego — to form collaboratives that were charged with raising the level and quality of employment in targeted communities. Community-based organizations (CBOs) were chosen in each region to carry out the activities that were expected to lead to more and better jobs for workers with multiple disadvantages in the targeted California communities.

The initial vision of the CWBH funders was an effort of eight to ten years and a scale and scope that included a significant commitment to learning through evaluation. The CWBH concept in the four California regions was approved by the two foundation sponsors at a budget eventually totaling about $20 million including $1.4 million for evaluation and an additional $2.5 million for technical assistance and management services. Two phases were anticipated: a three-year first phase of planning and development and a 5- to 7-year implementation phase with outcome measurement.

CWBH unfolded as an extraordinarily complex effort to change community conditions that featured many levels of planning and decisionmaking, shifting goals over time, and an evaluation attempting both micro-level documentation and macro-level measurement while expectations and activities were under development and undergoing revision. The final design and implementation of the initiative and, consequently, the design and implementation of the initiative’s evaluation research, were significantly different from the initial vision because: 1) CBOs serving multiple, non-contiguous neighborhoods or city-wide populations were selected to participate in the site collaboratives, which made it unrealistic to expect measurable neighborhood effects of CWBH; and 2) the timeframe for Phase II of the CWBH initiative was scaled down from seven to five years, and then to three years, shifting sites’ attention to job placements as the central objective (away from health improvements).

The CWBH initiative as implemented between 2000 and 2006 was not a true test of its starting hypotheses, given the major changes in scope and focus over its first four years and major difficulties experienced by the sites and the initiative partners in carrying out essential elements of the initial vision. As a result, most of the changes that the initiative was aiming to effect were visible only in limited areas and, overall, compared to the initial vision, outcomes were disappointing. Among the key outcome findings were:

• Job placement rates by CWBH collaborative agencies ranged from 17.5 to 39.3 percent, rates that were mostly below average for similar populations served by non-CWBH employment and training providers, although CWBH agencies did succeed in reaching multiply-disadvantaged workers and sometimes filled niches in local workforce investment programs that were important to these groups.



• Wages for CWBH individuals placed in jobs were above minimum wage, but below local "living wage" targets, and the evaluation was not able to collect universal data on job benefits. Occupational data that was collected suggests that CWBH individuals placed in jobs were "moving up," but definitive evidence is not available.



• The four CWBH sites had varying levels of success in working together. Two sites — Fresno and Sacramento — developed relatively effective regional collaboratives. In the two other sites, the structural barriers to collaboration, some introduced by CWBH, and the divergent capacities and agendas of the participating agencies, hindered the development of true region-wide efforts.



• Policy and system changes attributable to CWBH activity were very limited. There are a few stories of strengths in this area, but also evident is the lesson that limited-duration interventions should not expect local agencies to go up against their "bread and butter" funders by undertaking policy/system change advocacy against those entities.

Site-level findings reflected the diverse origins of the community agencies selected to participate in CWBH, their partnerships with their local Workforce Investment Agencies (WIAs), and the employment-related needs of their constituencies. For example, in the Fresno region, there was a preexisting collaboration among workforce agencies, both public and nonprofit, that gave the CWBH initiative a boost, even though employment conditions were very difficult. This site succeeded in connecting clients to vocational training and placed about one-quarter of participants in jobs, but fell short in its efforts to secure a municipal "first-source" hiring agreement, and did not succeed in harnessing the skills and enthusiasm of the local residents who were trained for leadership and advocacy.

The Los Angeles CWBH collaborative theory built on previous successful efforts to organize and advocate for better jobs and working conditions for disadvantaged workers, based in part on better access to job training, and it involved several of the CBOs that had led those efforts. This strategy produced mixed results, as the experienced CBO members of the collaborative pursued their own agendas and new collaborative members were recruited to provide employment services that they had no experience with. Overall, the Los Angeles CWBH site had a job placement rate of less than 20 percent, the lowest rate of the four CWBH sites.

Sacramento’s CWBH involved public agencies and CBOs with long histories of collaboration and cooperation, and a policy orientation toward serving disadvantaged workers within the constraints of a national WIA system that did not make that easy. While the site had limited success in cementing hiring agreements and increasing the number of "healthy jobs," this site helped very disadvantaged clients make progress in terms of the placement rate (39 percent, the highest among the four CWBH sites), diversifying and improving occupations, improving placements with benefits, and job retention. The results of resident leadership efforts were disappointing, however.

San Diego’s CWBH site, focused on the job difficulties of people in two neighborhoods heavily impacted by the problems of Mexican immigrants, many of whom were undocumented, brought together CBOs connected to the targeted population with advocacy/policy development organizations working on strategies for tying very active downtown development activity to improvements for workers in downtown businesses and low-income residents of downtown neighborhoods. One strand of this employment improvement strategy was through the existing system of public services for the unemployed and underemployed in the neighborhoods that were anticipated to be affected by downtown development. During the data collection period of the CWBH initiative, San Diego’s job placement rate was under 25 percent.

CWBH faced many of the challenges that had been experienced in foundation-initiated community improvement projects since the mid-1980’s — particularly the difficulty of stimulating community-driven processes of change that fit within the funder’s overall agenda and timeframe for seeing results. Often, arriving at community consensus about how to proceed is more complicated and time-consuming than funders anticipate, as is expanding the local capacity to carry out agreed-upon plans. Money is not enough. It needs to be supplemented with expertise that is well-matched to local institutions and carefully coordinated with the overall vision of the change agenda and process. In the middle of foundation-initiated community change initiatives, the funders often experience a crisis of confidence, pressed between Board of Trustee questions about measurable outcomes and the realities of community-based planning and implementation. CWBH came to just such a juncture, at which the funders scaled back their expectations and support. As a result, while CWBH offers local implementation stories of interest, the overall theory of leveraging employment to improve public health was not truly tested.