Community Assessment and Engagement PDF

Community Assessment and Community Engagement PPN 302 Class 7  Before doing a community assessment consider: What is Health? “The extent to which an individual or group is able, on the one hand, to realize aspirations and satisfy needs; and on the other hand, to change or cope w...

Community Assessment and Community Engagement PPN 302 Class 7  Before doing a community assessment consider: What is Health? “The extent to which an individual or group is able, on the one hand, to realize aspirations and satisfy needs; and on the other hand, to change or cope with the environment. Health is, therefore, seen as a resource for everyday living, not an object of living; it is a positive concept emphasising social and personal resources, as well as physical capabilities”. A balance between physical, social, and spiritual dimensions Protect-----Promote----Prevent  Defining Need and Capacity Problem/need/issue identification Influenced by DOH/resources, issues of inequity & social injustice Capacity identification What resources, real & potential strengths are present? Before doing a community assessment consider: What is community? A collective of people who live in a defined geopolitical boundary/work, play and pray in a space A collective of people who share common values and concerns The way people think about and organize their social relationships The formation of community identity is based on the contexts of the relationships and the interests of the members Always remember: community is not a‘coherent’ and ‘fixed’ entity – collective actions and conflicts exist side- by-side  Before doing a community assessment consider: What is a healthy community? Clean, safe physical environment  Committed local government Peace, equity, social justice  Healthy public policies Adequate access to basic and fundamental resources  Respect for diverse voices and Adequate access to health and perspectives healthcare resources  Wide public participation in Opportunities for learning & skill decision making development  Strong local cultural and spiritual Strong mutually supportive relationships and networks heritage  Diverse and vital economy Before doing a community assessment, consider: The purpose of the assessment The target population - How has it been defined? The social and/or geopolitical boundaries of the community The community composition What are the community demographics? Have they changed or remained constant? The Characteristics of the community Who are the gatekeepers and stakeholders of the community? The approaches or techniques that will be used Degree of political support The time frame for assessment Available resources to carry out the assessment The costs and benefits of the assessment Before beginning a community assessment-- Self reflection Reflect on: Your current knowledge of the community Your current credibility with the community Your own role in the assessment process The limits of what you can realistically accomplish Your biases, assumptions, expectations Your existing community connections and how these might affect the assessment The pre-assessment information you need before you begin  What’s missing in this picture? What discourse does this picture produce? NSE 31 Fall 2011 What is a community assessment? A process of gathering, analyzing and reporting information about the needs and the capacities or strengths that are also currently available in your community meet those needs. Part of a complex process of identifying & responding to problems, needs, & issues affecting populations. Process: Determines and address the health of the community NSE 31 Fall 2011 A Community Health Assessment: Basic Steps 1 2 3 Gather Analyze Prioritize Data Data Setting gathering interpretati priorities (existing on Resource data) Needs evaluation Data identificatio generation n (creating NSE 31 Fall 2011  Why Community Assessments? To learn more about population of interest (i.e., who's affected by a health issue). To identify community wants/needs, assets To identify challenges of overall quality of life To set priorities To anticipate trends and issues that may affect the implementation of your program. To apply the principles of equity and social justice in practice  Why Community Assessment? Health Equity and social justice Framework of Community Assessment: Involving community members in determining the goals of the assessment process Focusing not only on needs but on identifying & building on community strengths/capacity Making empowerment of people a central goal of the assessment process Achieving health equity and social justice Critical social theory Social determinant framework  Who is involved in a community assessment? Done in collaboration with the community, in order to develop strategies to improve the health and quality of life of the community Involves community members & health professionals - often differing but complementary perspectives > purpose clearly defined > available resources identified > adequate resources to complete the assessment ensured Who do we need to consider: Gatekeepers & Stakeholders Stakeholders: Anyone & everyone who has an interest in/stake in the community and community process Gatekeepers The person, people or institutions that hold the power to let you in or keep you out  Assessing Community needs and Capacities Physical environment Socioeconomic environment Income and social status Employment and working conditions Social supports and networks Diversity and social inclusion Recreation Education Health and Social services Transportation Communication Government and politics  Assessing Community needs and Capacities Health status: morbidity, mortality, life Community structure: expectancy Demographic composition: proportion of Emotional/mental: quality of life or members in terms of age, sex, ethnicity, mental health indices etc. Social: social capital, or trust indices; Economic distribution: income, self-report sense of belonging, crime education, employment, housing types, rates, etc. etc. Community cohesion: levels of Community infrastructure: collaboration, social networks, etc. Access to services: transportation, Community capacity: The strengths, health & social care, recreational resources, & problem-solving abilities of facilities, etc. a community --services and other Service use patterns: who uses what resources provided by local agencies services and how often. Types of Community Assessments Environmental Scan Problem Investigation Resource evaluation Needs assessment  Environmental Scan Broad overview of a community to see “what’s what” Environmental scan/windshield survey “look, listen and watch” at different times, days  Consider:  The appropriateness of an environmental scan for the identified purpose of the assessment  What it can/cannot tell you  How your own assumptions and expectations might affect the assessment process  Ethical issues & factors related to SDoH, equity & social justice in the assessment process & analysis  Problem investigation Does the identified problem truly exist? What is the extent of the problem and how does it manifest?  Consider:  Who has identified the problem & how it is framed  Power dynamics in the community overall and in the identification of the problem  Solutions that are being suggested and by whom  How your own assumptions and expectations might affect the process  Ethical issues & factors related to determinants of health, equity & social justice  Resource evaluation Evaluating existing resources and services Examining if resources meet identified needs; if they are appropriate to the demographics Often done when service use has changed Consider:  Whether the issue is about services/resources, shifting demographics or something else  Implications of the social, political &/or economic realities on the potential for change  Who is advocating for change and issues of power  Influence of your own assumptions and expectations on the process  Ethical issues & factors related to determinants of  Needs Assessment Is there a ‘need’? Is something missing Assessing ‘needs’ vs. ‘wants’ Often looks at resource/service allocation  Think about:  Whose needs are being expressed (whole/sub-group?)  Whether these are needs vs. wants  Where to begin – do you need to begin big or can you start with a smaller issue?  The power dynamics that must be considered  How your own assumptions and expectations might affect the process  The ethical issues & factors related to determinants of health, equity & social justice that must be considered  Defining community needs Identify issues that has been described as needs in your area Types of needs: Normative need: determined by experts through professional analysis Felt need: what people say they need Expressed need: felt need turned into action, e.g., number of names on a waiting list for service Comparative need: comparing services or resources of one area to another similar area.  Situational Assessment The phrase “situational assessment” is now used rather than the previous term “needs assessment.” This is intentional. The new terminology is used as a way to avoid the common pitfall of only looking at problems and difficulties. Instead it encourages considering the strengths of and opportunities for individuals and communities. In a health promotion context, this also means looking at socio-environmental conditions and broader determinants of health. (Region of Waterloo, 2009, p. 11)  Gathering Data Literature Previously conducted community surveys National, and local policy documents Demographic and epidemiologic data Participant observation Key informants Surveys (caution here… who answers these.. Who cannot?… literacy, Focus groups Town hall meetings 1: 1 conversations  Obtaining data: Factors to consider History of the community Perception of community by both CHN & community Population/demographics of community Physical environments (including rural, suburban, urban setting) Socioeconomic environments Education & healthy child development Culture & religion Health & social services Governance and politics Use Existing Data Quantitative: population statistics and health status reports - Municipal - Provincial and - Statistics federal Canada planning agencies - Canadian - Environmental - Social Institute for Canada planning Health - Public health councils Information reports - United Way of (CIHI) - Scientific Greater journals Toronto - etc. NSE 31 Fall 2011  Generating Data Qualitative: - - Public Windshield Quantitative or meetings / bike - Mailed - Open surveys surveys forums - - Telephone - Key Neighbourh surveys informants ood walks, etc. - Web - Focus surveys groups - ObtainingEnvironmen ‘Informed’ Consent tal scan NSE 31 Fall 2011  Analyzing the data What is the interplay between data sources? Do different sources support or contradict one another? What are the primary issues that need to be addressed and what tells you so? What capacities exist within the community? What challenges exist? Do you have all the data you need or is something missing?  Consider:  How your own biases, assumptions, expectations and social location can affect your analysis  How determinants of health and issues of equity/social justice play into your analysis How does community engagement fit with the Community Nursing Process?? What is Community Development? Involves members of a community collectively participate in identifying health issues, set priorities, develop interventions and implement them. It is both a process embarked on, and an outcome, of many and various processes and strategies that are purposefully initiated – and sometimes occur more naturally or spontaneously - towards enhancing the experience of people living in communities.  Community Engagement Different health promotion lenses have different assumptions about: o Role of the CHN o Role of community members o Level and extent of community engagement/participation Different HP lenses involve different power dynamics & relationships to notions of ‘empowerment’ & capacity building Consider:  Why is it important to make explicit the assumptions underlying your approach? Community participation There are different levels of citizen participation, and each level has different degrees of power/control Degrees of citizen power, degrees of tokenism, non- participation Community Engagement  Power and Empowerment: Integral to community engagement Think about one experience when you What comes to mind felt ‘empowered’ and when you hear the one experience when word “power”? you felt Where is your own ‘disempowered’. What made these individual & different? collective power? What does it mean to be ‘empowered’?  Individual empowerment does not occur in isolation Remember: none of us can ever exist independent of others. Empowerment occurs at multiple interconnected levels: Individual (intra- psychological and interpersonal) Organizatio Community nal / Society Community Empowerment: greater than the sum of its parts Community empowerment is both a process and an outcome Process: empowering interactions and actions within the community and in relation to broader society Outcome: the community achieving an increased level of capacity to take control of their health challenges and advocate for equity Key features of community development Underpinned by principles of community empowerment & adult education Addresses social determinants of health Capacity rather than needs based model Collective decision-making Social justice, equity and shared power Community development is both a process & an outcome Community development is both a process & an outcome  Key Assumptions Community Development Participation in one’s community is a basic tenet of democracy Responsibility to participate is integral to the notion of ‘citizenship’ Communities can best identify their own issues, needs and capacities and must be central to the process of change Notion of working ‘with’ rather than ‘for’ communities  Community Development Community is supported in a process of: Identifying health needs/issue/concerns Setting community-relevant priorities, goals and objectives Identifying and building on existing strengths to develop increased capacity & confidence Identifying internal and external resources Building and supporting collaborative relationships Developing and implementing relevant strategies to address issues Evaluating the process  Community Development as an Outcome Community development can lead to:  Increased community capacity  New relationships, connections, skills, social cohesion, etc….  Increased sense of community  Increased self-esteem, sense of individual & community competence, personal supports, autonomy  New services/programs  Modification of existing services/programs  Institutional/legislative reform Central to community Development Focus remains on the community Relevant to & respectful of community contexts and realities Involves seeking out, listening to and hearing multiple voices Building community vs. creating divisions Consensus vs. “taking power”/conflict Focus on sustainability & self reliance Community capacity and empowerment are central Congruent with assumptions of primary health care Challenges to community development Participation Timing Complexity Geography Realistic appraisal of what is possible Avoiding rhetoric and ensuring that CD does not replace government responsibility Realities of ‘empowerment’  Challenges for the CHN involve in community development Competing demands related to: Time Accountability/tensions between community and CHN role Boundary tensions Power Working together with communities” versus “working for communities” or “doing to communities”  Maintaining Boundaries What does the CHN need to think about when working “with” the community? Hint: CHN is NOT the expert! How can a CHN maintain professional boundaries as a ‘”member of the group” E.g. – should the CHN attend community social events Should the CHN be a member of community Facebook or other social media groups How does the CHN navigate the role when a community wants to go in directions that are outside a CHN scope of practice References Arnstein, S. (1969). A ladder of citizen participation. Journal of the American Institute of Planners, 35:4, 216-224, DOI: 10.1080/01944366908977225 Reyes, D., & Meyer, K. (2020). Identifying community priorities for neighborhood livability: Engaging neighborhood residents to facilitate community assessment. Public Health Nursing, 37(1), 87-95. Martinez, L. S., Rapkin, B. D., Young, A., Freisthler, B., Glasgow, L., Hunt, T.,... & Battaglia, T. (2020). Community engagement to implement evidence-based practices in 19 the HEALing Communities Study. Drug and Alcohol Dependence, 217, 108326. Yiu, L. (2020). Community nursing process. Chapter 13 in L. L. Stamler, L. Yiu, A. Dosani, J. Etowa and C. Van Daalen-Smith (Eds.) Community health nursing: A Canadian perspective (5th ed.). Toronto: Pearson Prentice Hall.