DPET was developed between 2005 and 2009, when the US Centers for Disease Control and Prevention (CDC) and its partners ran nine public engagement projects on influenza vaccine priorities, pandemic planning, and other issues. The model is distinctive in its inclusion of citizens-at-large and key stakeholders.
Problems and Purpose
Prompted by the controversy over vaccines and autism and the concern it reflected in some segments of the US population, a new model for actively engaging citizens-at-large and representatives of stakeholder organizations was developed. The purpose of the new model, named “Decision-focused Public Engagement Table” (DPET), was to better inform difficult, values-laden vaccine policy decisions, potentially earn support for them, and build a better, more trusting relationship between the CDC and the public.
According to the National Coalition for Dialogue and Deliberation (NCDD), there are four major purposes for using the techniques that are at the heart of public engagement. They are (1) to learn more about people or issues, (2) to resolve conflicts, (3) to influence public decisions, and (4) to act collaboratively to solve problems. Using the DPET model, the nine projects in this report were decision-focused, that is, conducted for the purpose of helping to better inform and potentially influence decision makers on public policy issues. Secondary purposes were to increase support for the final decisions made and to enhance trust between citizens and government.
Beginning in 2005, the DPET model or modified versions of it were used in nine public engagement projects that initiated by CDC and/or the National Vaccine Program Office at the Department of Health and Human Services, the parent Department for the CDC.
One of these nine projects was a grant program to six state health departments to assess the feasibility of the DPET model at the local level.
Origins and Development
These projects were initiated “top-down” by government agencies and/or a non-governmental organization (NGO) seeking consultation from the public on pending decisions, as opposed to being organized at the grassroots level by citizens interested in solving a problem or stimulating government to act on a problem. The subject area was chosen by the government, not the public.
Participant Recruitment and Selection
- Target number of 100 citizens-at-large
- Participants selected from the four geographic segments of the population
- Participants representative of their area by age, race, and sex
- Normally 20-30 stakeholders from approximately 10 key sectors of interest
- Includes agency or sponsor’s staff persons as stakeholders
How it Works: Process, Interaction, and Decision-Making
Problem Solving Stage: Problem solving includes: (1) problem identification or definition, (2) gathering information about or determining the causes of the problem, (3) designing or finding options to address the problem, (4) discussing pros and cons of the options, (5) weighing the options for a solution, (6) choosing a best solution, (7) implementing the chosen solution, and (8) evaluating an implemented solution.
In these decision-focused public engagement projects, the focus was on obtaining the public’s contributions to the discussing, weighing, and choosing stages. These stages are closer in sequence to the final decision, thereby increasing the potential for the participants to have more direct and traceable influence over the final choice made by decision makers. It was also assumed that this type of work on the part of the participants would have positive implications for the level of satisfaction participants might experience, and for the accountability of decision-makers.
Choice of Publics: Early on in any consultation exercise, sponsors need to make a decision about what publics they wish to engage. The most fundamental choice is whether to include citizens-at-large with no recognized interests, or stakeholders who are representatives of organizations with recognized interests. The choice made with the DPET model was to include both the general public and the stakeholder public. This decision made it more difficult to achieve agreement on a single public perspective to be conveyed to the sponsoring organization, but was thought to have the advantage of providing advice that was more fully considered.
Mandates: The agencies implementing this model were not mandated by law to involve citizens in their decision making process. All of the topics placed on the table for public engagement were chosen voluntarily by the sponsors. This feature was included with the assumption that it would increase the degree of commitment by the sponsors to consider the advice received from the public.
Governance Level: Also, since the CDC is a federal agency and the Association of State and Territorial Health Officials (ASTHO) represents all state health departments in the US, these projects were carried out (with one exception) as national-level projects with the goal of assisting in the work of a federal agency or non-governmental organization with nationwide responsibilities. Such projects have unique elements not found to the same degree at the community level, such as challenges in motivating citizens to participate or in achieving adequate representation.
Commitment Level: Finally, the DPET model was initially proposed for ongoing public engagement with creation of a standing agency infrastructure. In practice, these projects were carried out on an ad hoc basis project by project. Creating a standing support infrastructure has implications for the kind and quality of resources and expertise that would be available for individual projects and the amount of training required.
Working Definition
The definition of decision-focused public engagement used to guide each of these projects was “The practice by which the agency or sponsoring organization very actively involves members of the public-at-large and/or representatives of stakeholder organizations in group dialogue and deliberation sessions to better inform and possibly shape the agency or organization’s final policy decisions.”
The Decision-focused Public Engagement Table (DPET) Model
With the working definition of decision-focused public engagement described above, the DPET model had the following key features:
- A focus on undecided policy choices
- Inclusion of representative groups of both stakeholders and citizens-at-large
- Linkage with government decision makers
- Neutral facilitation
- Presentation of balanced information from credible sources
- Frank dialogue and genuine deliberation
- Reaching some form of group judgment or agreement
- Synthesis of the results as the “public perspective” on the pending decision
- Feedback to the participants
Participants:
- Target number of 100 citizens-at-large
- Participants selected from the four geographic segments of the population
- Participants representative of their area by age, race, and sex
- Normally 20-30 stakeholders from approximately 10 key sectors of interest
- Includes agency or sponsor’s staff persons as stakeholders
Meetings:
- Four day-long dialogue and deliberation sessions for citizens
- Stakeholders meet twice separately from the citizens-at-large, once before and after
- Stakeholder meeting activities similar to those for citizens-at-large
- Stakeholders can provide initial input in framing issues and designing process
- Some stakeholders participate as observers at the larger citizens’ meetings
- One or two citizens invited from each area to attend final stakeholder meeting
Information presented:
- Participants in general session hear an oral presentation in easy to understand language
- Effective, non-condescending expert/lecturer presents the minimum amount of unbiased information needed to have an informed discussion of the issue at hand
- Opportunities are given to ask questions about the factual information presented
- Subject matter experts are on hand to answer questions but not to participate directly in the discussions
- Booklet summarizing the key facts needed to have the conversation is presented in a user-friendly fashion
- A discussion guide summarizing the choices faced is presented to the participants for use during small group table discussions and large group exchanges.
Dialogue and deliberation:
- Neutral facilitation is provided
- Participants in small groups listen respectfully, exchange experiences and viewpoints, and deepen their understanding of the issue on the table
- Participants in general session listen and consider the views expressed by participants of other small groups and seek clarifications where necessary
- Participants weigh the alternative courses of action brought forth at the meeting
- Participants as a group vote or otherwise make their preferences known.
- Opportunities are given for participants to react to the group findings and to introduce modifications if needed and agreed to by the group.
Influence, Outcomes, and Effects
Product and closure:
- Stakeholders consider citizen-at-large input, develop their own views, and synthesize the viewpoints into the “societal perspective” on the decision being placed on the table.
- Agency or sponsor participants convey results to key decision makers.
- Decision makers provide feedback about the final decision to participants