Getting clean, inside and out

A key step of social marketing is understanding your target audience, the people you want to adopt your desired behavior. Second to that is understanding the midstream audience, the people your target audience trusts, who can serve as messengers of your campaign.The target audience in the first phase of our Trash Free Baltimore campaign is not going to come to a community meeting. We can't just teach them that litter is bad; they know that, but they have little motivation to do anything about it. So our job is to go where they are.We learned in focus groups that a lot of them are working through recovery from substance abuse. They are trying to be involved parents. They are trying to find and keep jobs, and they are going to church. Some have spent time in prison and are adjusting to being back home. That's our road map for where to go, to find the people they trust.We've begun a wonderful relationship with Institutes for Behavior Resources, in Baltimore's Old Goucher neighborhood. They provide treatment for drug addiction, including methadone, as well as wraparound health services. Their patients visit regularly, even daily, for treatment and counseling. The patients feel deeply connected to the clinic, and to each other. IBR's director of REACH Health Services, Vickie Walters, says that some patients offer to help clean up the building and sidewalk outside when they know visitors are coming.We are working with Vickie, Dr. Yngvild Olsen, and the clinical team at IBR and REACH to develop tools for counselors and patients to use to encourage adoption of picking up litter. We're providing counselors with information to talk about litter in their sessions with patients--that patients can feel a sense of accomplishment and connection to neighbors by picking up litter outside their homes. Counselors will describe picking up litter as a form of self-care, a key part of the recovery process. Meanwhile, with our friends at Baltimore Clean Corps, we are training block captains around the city to notice when new people are taking action to clean up outside their homes, and thank them, providing important positive reinforcement and a sense of community.This direct outreach will be supported by posters in the clinic, reminding people to pick up. Finally, the Central Baltimore Partnership and nearby community associations will distribute window signs to businesses and residents to encourage everyone to participate, and help everyone feel like they are on the same team. They are even planning a spring cleanup with local residents and clinic patients to give the neighborhood a deep clean.While we assess litter levels, the clinic is going to look at health outcomes. Do patients who adopt the behavior have more success in their treatment?We are talking to several other clinics about the campaign and how to get involved. We're also working to build relationships with family support services, job resource centers, dialysis centers, faith-based organizations, and other partners that serve as mentors in the community. We are so grateful to all the clinics for their interest in this novel approach, and can't wait to see how it works!