COMMUNITY ASSESSMENT
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COMMUNITY ASSESSMENT

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COMMUNITY ASSESSMENT

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1. COMMUNITY ASSESSMENT Community as Partner in Assessment

2. COMMUNITY ?People in relationship to others.? Hanchett ?...a social group determined by geographic boundaries and/or values and interests.? -Community can be defined in many ways. -Most any boundary will do for conducting an assessment. --may even be a community within a community (school or organization) -However, when deciding upon a multidisciplinary intervention, there must be a social structure to work with. When you intervene with a group (e.g. the AIDS group) who will you focus on. [keep in mind it is more effective to work with groups than individuals and more sustaining to empower others to intervene than to intervene for them]. Its the idea of promoting ?citizens? rather than ?clients? -Community can be a setting for care & a target of care. -Change in the community occurs at several levels. --cannot always expect the victim to change --public policy and sometimes the health professions must change as well --interventions, therefore, are not only aimed at the client, but at the family, friends and societal structures.-Community can be defined in many ways. -Most any boundary will do for conducting an assessment. --may even be a community within a community (school or organization) -However, when deciding upon a multidisciplinary intervention, there must be a social structure to work with. When you intervene with a group (e.g. the AIDS group) who will you focus on. [keep in mind it is more effective to work with groups than individuals and more sustaining to empower others to intervene than to intervene for them]. Its the idea of promoting ?citizens? rather than ?clients? -Community can be a setting for care & a target of care. -Change in the community occurs at several levels. --cannot always expect the victim to change --public policy and sometimes the health professions must change as well --interventions, therefore, are not only aimed at the client, but at the family, friends and societal structures.

3. Types of Communities Community of identifiable need Community of problem ecology Community of concern Community of political jurisdiction Community of solution Physical or phenomenological community - Explain what each of these communities mean. [Ask students] -Can you deal with more than one? -In the community you have defined, will there be more than one?- Explain what each of these communities mean. [Ask students] -Can you deal with more than one? -In the community you have defined, will there be more than one?

4. Essentials of True Partnership Power & legitimacy Mission statements Respect organizational autonomy Rooted in the community Commitment to partnership approach Clear expectations Written agreements Lack of coercion Open-mindedness, patience & respect are nurtured See page 100 for explanations, See page 100 for explanations,

5. Benefits of Community Partnerships Raise public consciousness about: health status available resources gaps in service delivery health behavior interventions

6. More benefits Promote shared vision on health goals and outcomes Encourage individuals and groups to use skills Activate citizens to participate in health-related decisions Help care providers focus on priority concerns of residents

7. Community Assessment Setting Boundaries special interest parish physical school geopolitical -Be thoughtful in setting boundaries that will allow you to collect adequate information and contain a community of solution. -physical boundaries may not allow you to collect meaningful health data (all people living in the flood plain) -school districts will give good information re children, but census tract information will be different. -special interest aggregates (HMOs) will have fairly decent problem data, but no community of solution. -In other words, be aware of the limitations of your data. Sometimes you can supplement it with other data, at other times you have to live with it.-Be thoughtful in setting boundaries that will allow you to collect adequate information and contain a community of solution. -physical boundaries may not allow you to collect meaningful health data (all people living in the flood plain) -school districts will give good information re children, but census tract information will be different. -special interest aggregates (HMOs) will have fairly decent problem data, but no community of solution. -In other words, be aware of the limitations of your data. Sometimes you can supplement it with other data, at other times you have to live with it.

8. Community Assessment Determine information needs collect data generate missing data Both methods are essential in all eight categoriesBoth methods are essential in all eight categories

9. Community Assessment Wheel -can be used to asses any community regardless of size. Generally assess the core first and then the individual sub-systems -Your text contains outlines for data collection in each sub-system -some sections do not apply to all communities, or only marginally -other more important data may be added depending on the community -can be used to asses any community regardless of size. Generally assess the core first and then the individual sub-systems -Your text contains outlines for data collection in each sub-system -some sections do not apply to all communities, or only marginally -other more important data may be added depending on the community

10. Ways to get community data Analyze census tract and vital statistics data Attend community meetings (PTA, citizen groups, etc) Conduct windshield survey Attend Board of Health meeting or other policy-focused meeting Shop in district to determine cost of essentials

11. More ways to get data Identify location of community resources: clinics recreational facilities churches schools shopping areas Make field visits with community workers Participant-observation

12. Community Assessment Data Gathering demographic data vital statistics institutional data Demographic (age, sex, SES, racial distribution) Vital statistics (births, deaths, morbidity and mortality data) Community Institutions (services provided, manpower, etc.)Demographic (age, sex, SES, racial distribution) Vital statistics (births, deaths, morbidity and mortality data) Community Institutions (services provided, manpower, etc.)

13. Core Data History Demographics Age & sex Ethnic distribution Vital statistics births deaths age leading causes Library, historical society, census, planning board, chamber of commerce Local and state health department Census Bureau Note that values, beliefs and cultural influences cannot be found in a library. One must get out intothe community. -first drive through the area (all of it!) --eat lunch in the neighborhood. --go to church there --attend a support group --hang out and watch patterns of congregation.Note that values, beliefs and cultural influences cannot be found in a library. One must get out intothe community. -first drive through the area (all of it!) --eat lunch in the neighborhood. --go to church there --attend a support group --hang out and watch patterns of congregation.

14. Community Assessment Determination of Meaning Ask Listen Understand -Not as easy as it sounds. Why? Perception. -There are statistical methods that can be applied to numerical data. (can this statistic be trusted) -What do you do with opinions and perceptions. Are they biased? How can you tell? -What is validity and reliability in the analysis of opinion. -You must spend an appropriate amount of time grappling with the data.-Not as easy as it sounds. Why? Perception. -There are statistical methods that can be applied to numerical data. (can this statistic be trusted) -What do you do with opinions and perceptions. Are they biased? How can you tell? -What is validity and reliability in the analysis of opinion. -You must spend an appropriate amount of time grappling with the data.

15. Physical Environment Analogous to the Physical Examination Inspection observe Auscultation listen Vital signs climate, terrain, life signs Systems review social systems, businesses, hangouts Lab studies almanac, census, surveys See page 187See page 187

16. Health & Social Systems Services inside and outside of the community fees, hours patterns of services (new or discontinued services) resources (personnel, space, budget) statistics (number of users) accessibility, acceptability of services Sources of data: chamber of commerce, interview facility staff, administration, talk to patients in the waiting room., obtain annual report, United Way directory. Check out both private and public health services Include long term care and home health agencies plus quality of emergency services. Dont forget to check out individual churches and alliances of churches.Sources of data: chamber of commerce, interview facility staff, administration, talk to patients in the waiting room., obtain annual report, United Way directory. Check out both private and public health services Include long term care and home health agencies plus quality of emergency services. Dont forget to check out individual churches and alliances of churches.

17. Economics Financial characteristics of households median household income per capita income % in poverty Labor force characteristics % employed or unemployed occupational categories technical service etc may be able to observe number of high rise office buildings or underground (street economy) also of interest is % of families in poverty and % of female headed households.may be able to observe number of high rise office buildings or underground (street economy) also of interest is % of families in poverty and % of female headed households.

18. Safety & Transportation Protection Services: police, fire, sanitation, air quality Transportation: Private & public Crime patterns in the neighborhood. presence and effectiveness of neighborhood watch programs, # of homes with smoke alarms. placement of fire stations and patterns of removal or establishment of firehouses. Bus routes, why some lines are discontinued and some established and the impact on residents. Water quality?? Esp in south part of the county animal protection laws, enforcement and patterns of dog bitesCrime patterns in the neighborhood. presence and effectiveness of neighborhood watch programs, # of homes with smoke alarms. placement of fire stations and patterns of removal or establishment of firehouses. Bus routes, why some lines are discontinued and some established and the impact on residents. Water quality?? Esp in south part of the county animal protection laws, enforcement and patterns of dog bites

19. Politics & Government Form of Government (official) Voting patterns Political involvement Other sources of power business organizations C.O.P.S. ?gray panthers?

20. Communication Formal Newspapers Radio Telephone service Informal bulletin boards, posters, telephone poles newsletters, ?unofficial? neighborhood papers Dissemination How do people get information? Dissemination: -word of mouth -mail -radio or TVDissemination: -word of mouth -mail -radio or TV

21. Education Educational status years of school completed enrollment by type of school language spoken Educational sources types of schools % of attendance, graduation resources and services offered Principals can be wary of giving out a lot of information -teachers and school nurses can be good sources -sometimes PTA officers -also 3rd party reviews of performance --stats on TAAS tests.Principals can be wary of giving out a lot of information -teachers and school nurses can be good sources -sometimes PTA officers -also 3rd party reviews of performance --stats on TAAS tests.

22. Recreation Types of facilities parks, hiking trails, picnic areas, etc. established by whom? state of repair citizen involvement in programs church involvement in recreation

23. Community Assessment Community Diagnosis Prioritize Problems Begin Planning Process

24. Community Development: Some considerations Relationships between institutions and community groups. The choice of some groups over others. Making private troubles public issues. Institutional programs in community settings. Self reliance vs self sufficiency Relationships: that are more equitable in power-sharing. Community development does not proceed unless some power is transfered. How does one choose the groups to help? What are the power relationships that affect these choices. (17% of services going to the most needy, the rest going to middle class. ?social justice) Support groups look in. This must eventually turn out to facilitate policy development and sociopolitical change not simply moving programs into communities. It involves examining existing power relationships..both can coexist (p.97) Self reliance works to create relationships that foster negotiations for what a group needs. The myth of self-sufficiency seeks to assist groups in providing all that is necessary from their own resources.Relationships: that are more equitable in power-sharing. Community development does not proceed unless some power is transfered. How does one choose the groups to help? What are the power relationships that affect these choices. (17% of services going to the most needy, the rest going to middle class. ?social justice) Support groups look in. This must eventually turn out to facilitate policy development and sociopolitical change not simply moving programs into communities. It involves examining existing power relationships..both can coexist (p.97) Self reliance works to create relationships that foster negotiations for what a group needs. The myth of self-sufficiency seeks to assist groups in providing all that is necessary from their own resources.

25. Case Study Develop short and long term plans to combat violence Form task force Identify key informants Analyze existing data Obtain qualitative data How will community attitudes impact this?

26. Primary Prevention of Violence Conduct risk assessment to identify population Develop community awareness campaign Involve community members/leaders Educate aggregates Advocate for limits to drugs and weapons

27. Secondary Prevention of Violence Get statistics on murder, suicides, crimes against persons Refer victims to support groups Support enforcement of legal sanctions Screen for depression and refer Work with populations to reduce substance abuse Facilitate peer development

28. Tertiary Prevention of Violence Conduct follow-up assessment for relapse Coordinate follow-up therapy of victims to break cycle Collaborate to establish support groups to educate perpetrators of violence Advocate for shelters Collaborate for ongoing treatment of victims and perpetrators

29. SE San Antonio Community Assessment Amanda Flagg, EdM, BSN, RN Kathy Linn, MN, RN Carlo Piraino, BSN, RN

30. Community Description Rich History Semi-rural Poor Contrasting sections Gang infested and run down Older, well kept, and relatively safe

31. Census Tract 1413

32. Community Demographics- Total population 5,996 Total number of households 2,023 Total number of families 1,545 Number of disabled 21-64 yrs 985 31.7% of 21-64 yrs disabled

33. Community Demographics- 459 female-headed households 22.7% of female-headed households Median family income $38,494 324 families below poverty level 21.0% of all families below poverty level

34. In the beginning?

35. The Interview Process Nursing Staff at SE Baptist Hospital Management Staff at SE Dialysis clinic Area Primary Care Physicians and Specialists School District Nurses School Principals Councilman Segovia Management at University Clinic SE CNO, CFO & CEO at SE Baptist Hospital

36. Initial Concerns Lack of available Healthcare & insurance for patients Need for low cost, comprehensive primary care clinic with Mental Health Need for Preventive Medical & Dental Care Clinic Need for Specialty Physicians Need for Health Education Poverty based priorities

37. Initial Diagnoses Progressive health problems related to lack of consistent primary health care Knowledge deficit related to the lack of understanding of disease processes and secondary to the inability to focus on health issues.

38. Additional Diagnoses Inadequate social support systems Inadequate coping skills Increased stress Lack of physical exercise of children Potential for inadequate parenting skills Potential for increased number of accidents

39. Where do we go from here?

40. Literature Review Those with less education were less likely to have access to medical care Low-income individuals living in areas with more federally funded community health centers had better access to health care Higher income & low unemployment were associated with increased primary care utilization

41. Literature Review Uninsured patient access to primary care decreased ER visits Providing free health care to very low-income individuals does not guarantee they will use it. Educating individuals of the need for routine, continuous care would increase use.

42. Focus Group Selection Patients in the SE Baptist ER Patients in the Urgent Care Clinic at University Clinic SE Area Pastors

43. Saturday Night in the ER.

44. Concerns No place for kids to play Police just pick on me They won?t give me my drugs Why didn?t you provide Budweiser

45. Views of their healthcare system As long as I can get to work I am OK I only need to go to the Dr. if I am hurting The ER provides really good care here

46. Friday morning at the Clinic I am healthy as long as I can work My regular Dr. is downtown, but I am too sick to get there. All patients were being seen for acute illnesses or complications of chronic conditions

47. Lunch with Hospital staff No Specialty Care on this side of town Improve employment opportunities Better wages Health insurance Improved Quality of Medical/Nursing care at hospital

48. Additional Needs Improved disabled transportation services VIA bus availability Adult Daycare Satellite Specialty care clinics Affordable (Government funded) child daycare

49. Putting it all together

50. Revised Diagnoses Lack of knowledge of the importance of preventive care and the role of the primary health care provider Lack of recreational facilities Lack of specialized health care in the local area Potential for increased violence and criminal activity

51. Now what? The community as a whole is in need for a transition in its approach to healthcare Prevention needs to be emphasized to transform priorities from a reactive approach to a proactive approach.

52. The New Deal

53. Goals and Objectives Promote the importance of health prevention and screening Consistent / routine follow up visits for monitoring of chronic conditions Increase self care Increase awareness of available community resources

54. The Plan $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ Grant Money

55. What would we spend it on? Educational material Patient Education Material Laptops Staff Education Material Staff CNS Staff RNs

56. Strategies for Educating Community about Health Needs Elicit perspectives through focus groups Share assessment data with culturally diverse groups Conduct a health fair Write a health column Place information on bulletin boards

57. The REAL Plan CNS role Educate community Manage the grant Supervise the staff RNs Conduct needed research to justify future use and improve health promotion activities Healthcare intermediary for community members / organizations

58. The REAL Plan Staff RN role Teach self-care strategies to patients Provide healthcare information / counseling at the point of care

59. The Book ?Take Care of Yourself: The Complete Illustrative Guide to Medical Self-Care? (D. M.Vickery & J.F. Fries )

60. Did we do a good job? Was there a decrease in the use of non-urgent visits in the SE Baptist Hospital ER? Was there a decrease in urgent visits seen at University Clinic SE? Are local physicians seeing a decreased rate rate of complications? Is there a decrease in the number of admissions r/t chronic diseases?


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