PARTICIPANT WORKBOOK

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Community Needs Assessment

Created: 2013

Community Needs Assessment. Atlanta, GA: Centers for Disease Control and Prevention (CDC), 2013.

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Table of Contents INTRODUCTION ……………………………………………………………………… 4

LEARNING OBJECTIVES ………………………………………………………………………………………… 4 ESTIMATED COMPLETION TIME ………………………………………………………………………………. 4 TARGET AUDIENCE ……………………………………………………………………………………………… 4 PRE-WORK AND PREREQUISITES ……………………………………………………………………………. 4 ABOUT THE WORKBOOKS …………………………………………………………………………………….. 5 ICON GLOSSARY ………………………………………………………………………………………………… 5 ACKNOWLEDGEMENTS …………………………………………………………………………………………. 5

SECTION 1: OVERVIEW OF COMMUNITY NEEDS ASSESSMENT …………. 6 INTRODUCTION …………………………………………………………………………………………………… 6 CHANGE TOOL AND WORKBOOK …………………………………………………………………………….. 8 OVERVIEW OF COMMUNITY NEEDS ASSESSMENT STEPS ……………………………………………… 8 PRACTICE EXERCISE #1 (10 MINUTES) ………………………………………………………………….. 11

SECTION 2: PLAN FOR A COMMUNITY NEEDS ASSESSMENT …………. 12 INTRODUCTION …………………………………………………………………………………………………. 12 IDENTIFY AND ASSEMBLE A DIVERSE COMMUNITY TEAM …………………………………………….. 12 DEVELOP A TEAM STRATEGY ………………………………………………………………………………. 13 IDENTIFY THE SCOPE OF THE ASSESSMENT …………………………………………………………….. 14 DEVELOP QUESTIONS TO ASK ……………………………………………………………………………… 17 SELECT SITES ………………………………………………………………………………………………….. 18 DETERMINE DATA COLLECTION METHODS OR USE EXISTING DATA ………………………………. 18 IDENTIFY KEY INFORMANTS TO CONTACT ……………………………………………………………….. 23 DOCUMENTATION ……………………………………………………………………………………………… 23 PRACTICE EXERCISE #2 (30 MINUTES) ………………………………………………………………….. 24 SECTION 3: KEY POINTS …………………………………………………………………………………….. 26

SECTION 3: REVIEW AND RATE THE DATA ………………………………… 27 INTRODUCTION …………………………………………………………………………………………………. 27 POLICY AND ENVIRONMENTAL STRATEGIES …………………………………………………………….. 27 DEVELOP A RATING SCALE …………………………………………………………………………………. 28 MAKING A TEAM DECISION ON RATINGS …………………………………………………………………. 31 SECTION 4: KEY POINTS …………………………………………………………………………………….. 32

SECTION 4: RECORD AND SUMMARIZE DATA …………………………….. 33 INTRODUCTION …………………………………………………………………………………………………. 33 RECORD DATA …………………………………………………………………………………………………. 33 SUMMARIZE DATA …………………………………………………………………………………………….. 35 SECTOR DATA GRID ………………………………………………………………………………………….. 36

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SECTION 5: KEY POINTS …………………………………………………………………………………….. 39

SECTION 5: CREATE A COMMUNITY ACTION PLAN ……………………… 40 INTRODUCTION …………………………………………………………………………………………………. 40 IDENTIFY ASSETS AND NEEDS ……………………………………………………………………………… 40 PRIORITIZE NEEDS ……………………………………………………………………………………………. 42 DEVELOP STRATEGIES ………………………………………………………………………………………. 43 PRIORITIZE STRATEGIES …………………………………………………………………………………….. 44 COMMUNITY ACTION PLAN ………………………………………………………………………………….. 46 SECTION 6: KEY POINTS …………………………………………………………………………………….. 48

CONCLUSION ………………………………………………………………………. 49 IMPLEMENTING THE ACTION PLAN AND SHARING PROGRESS ………………………………………. 49 TAKE HOME POINTS ………………………………………………………………………………………….. 50 WORKBOOK REVIEW …………………………………………………………………………………………. 50

RESOURCES ……………………………………………………………………….. 51 APPENDICES ……………………………………………………………………….. 52

APPENDIX A …………………………………………………………………………………………………….. 52 APPENDIX B …………………………………………………………………………………………………….. 53 APPENDIX C ……………………………………………………………………………………………………. 76

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Introduction LEARNING OBJECTIVES

After completion of the workbook, participants will be able to: • Plan for a community needs assessment by:

o Identifying a community team o Describing the scope of the assessment o Listing the questions to ask o Selecting sites o Determining data collection methods or sources o Identifying key informants

• Review and rate data collected from a community needs assessment.

• Summarize data by creating sector data grids. • Develop and prioritize strategies for improvement. • Create a community action plan that includes:

o Project period objective o Annual objective(s) o Activities needed to complete the objectives o Persons responsible for completing the activities, and o Estimated completion time

ESTIMATED COMPLETION TIME The workbook should take approximately 10 hours to complete.

TARGET AUDIENCE The module is designed for Field Epidemiology Training Program (FETP) residents who specialize in NCDs; however, you can also complete the module if you are tasked to evaluate a communicable disease surveillance system.

PRE-WORK AND PREREQUISITES Before participating in this training module, you must complete training in:

• NCD Data Sources

• Program Planning

• Prioritizing public health problems

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ABOUT THE WORKBOOKS You will read information about conducting a community needs assessment in the Participant Workbook. To practice the skills and knowledge learned, you will refer to the Activity Workbook and complete 4 exercises.

ICON GLOSSARY The following icons are used in this workbook:

Image Type Image Meaning

Activity Icon

Activity, exercise, assessment or case study that you will complete

Stop Icon

Stop and consult with your facilitator/mentor for further instruction

Resource Icon

A resource or website that may provide further information on a given topic

Tip Icon

Supplemental information, or key idea to note and remember

ACKNOWLEDGEMENTS Thanks to Shannon Griffin-Blake, PhD (Division of Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention) for sharing and explaining the CHANGE tool.

Thanks to Indu Ahluwalia, MPH, PhD (Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention) for reviewing this module and providing feedback and guidance.

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Section 1: Overview of Community Needs Assessment INTRODUCTION

What is a “Community?”

Communities are typically defined by a geographic area; however, they can also be based on shared interests or characteristics such as religion, race, age, or occupation. People within a community come from different backgrounds and have unique cultures, customs, and values. Utilizing this wide range of ideas and wisdom is critical to assessing the community needs and strategizing areas for improvement. Before you conduct a community needs assessment you should have a clear understanding of the different cultural groups within a community and how to best work with them to solve the community issues.

What is a Community Needs Assessment?

A community needs assessment provides community leaders with a snapshot of local policy, systems, and environmental change strategies currently in place and helps to identify areas for improvement. With this data, communities can map out a course for health improvement by creating strategies to make positive and sustainable changes in their communities.

Components of a Needs Assessment

The main outcomes of a community needs assessment are in 3 main categories: Policy Change, Systems Change, and Environmental Change.

Policy Change

This involves laws, regulations, rules, protocols, and procedures that are designed to guide or influence behavior. Policies can be either legislative or organizational. Policies often mandate environmental changes and increase the likelihood that they will become institutionalized or sustainable. Examples of legislative policies include taxes on tobacco products, provision of county or city public land for green spaces or farmers’ markets, regulations governing a national school lunch program, and clean indoor air laws. Examples of organizational policies include

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schools requiring healthy food options for all students, menu labeling in restaurants, and required quality assurance protocols or practices (e.g., clinical care processes).

System Change

This involves change that affects all community components including social norms of an organization, institution or system. It may include a policy or environmental change strategy. Policies are often the driving force behind systems change. Examples are implementing a national school lunch program across a region or provincial school system or ensuring a hospital system becomes tobacco free.

Environmental Change

This type of change relates to the physical, social, or economic factors designed to influence people’s practices and behaviors. Examples of alterations or changes to the environment include:

Physical: Structural changes or the presence of programs or services, including the presence of healthy food choices in restaurants or cafeterias, improvements in the built environment to promote walking (e.g., walking paths), the availability of smoking cessation services to patients or workers, and the presence of comprehensive school health education curricula in schools.

Social: A positive change in attitudes or behavior about policies that promote health or an increase in supportive attitudes regarding a health practice, including an increase in favorable attitudes of community decision makers about the importance of nonsmoking policies or an increase in nonacceptance of exposure to second-hand smoke from the general public.

Economic: The presence of financial disincentives or incentives to encourage a desired behavior including charging higher prices for tobacco products to decrease their use or the provision of nonsmoker health insurance discounts.

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CHANGE TOOL AND WORKBOOK

Resource

The community needs assessment process taught in this module is based on the Community Health Assessment and Group Evaluation (CHANGE) data- collection tool developed by CDC’s Healthy Communities Program within the Division of Community Health at the National Center for Chronic Disease Prevention and Health Promotion.1 The CHANGE tool was written primarily for communities in the United States interested in creating environments that support healthy living.

This workbook teaches a similar approach to conducting community needs assessment as the CHANGE tool, but since this participant workbook is to be used globally we are providing some flexibility in the tool you choose to use. For example, after learning the process you may decide to create your own Excel spreadsheets to record and summarize data, or something similar in MS Word.

If you wish to use the CHANGE tool, you can download and modify (free of charge) the Excel spreadsheets at: http://www.cdc.gov/HealthyCommunitiesProgram

If you choose to order (free of charge) the CHANGE tool CD-ROM, you will also receive additional resources such as an Action Guide, an MS PowerPoint presentation template, and a policy brief or one-pager template. Please note that the Action Guide contains slightly different “action steps” than the ones in this workbook since the workbook is designed to be used with or without the CHANGE tool.

OVERVIEW OF COMMUNITY NEEDS ASSESSMENT STEPS There are different approaches to conducting community needs assessments. In this module you learn how to gather and assess data on community assets and determine areas for improvement. You will learn a process that involves these main steps:

1 Centers for Disease Control and Prevention. Community Health Assessment aNd Group Evaluation (CHANGE) Action Guide: Building a Foundation of Knowledge to Prioritize Community Needs. Atlanta: U.S. Department of Health and Human Services, 2010.

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This workbook explains steps 1, 3, 4 and 5 in detail.

Step 1: Plan for a community needs assessment • Identify and assemble a diverse community team

• Develop a team strategy

• Define community to assess (e.g., region, village)

• Identify community sectors to assess (e.g., health care, schools)

• Identify community components to assess (e.g., nutrition, tobacco)

• Develop questions to ask for each community component

• Select sites and number of sites to visit within each sector

• Determine existing data to use or methods for collecting new data Identify key informants to contact

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Resource

Step 2: Conduct the needs assessment For guidance on how to conduct a needs assessment (for example, how to prepare for and conduct interviews and focus groups), access the North Carolina Department of Health Community Assessment Guide Book at http://www.schs.state.nc.us/schs/data/databook/2002/GuideBook 2002.pdf.

Step 3: Review and rate the data • Develop a rating scale, and,

• Make a team decision on ratings.

Step 4: Record and review consolidated data • Enter the data,

• Total the data, and,

• Summarize the data.

Step 5: Develop a community action plan • Identify community assets and needs,

• Prioritize needs,

• Develop and prioritize strategies for improvement, and,

• Create an action plan for top priority strategies.

Tip

The focus of this workbook is on assessing a community’s strengths and weaknesses through mainly qualitative collection methods; however, it is still important to support those findings with quantitative data collection methods (e.g., vital statistics, hospital records) to assess the health status of a community; for example, identifying prevalence and incidence of NCDs.

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PRACTICE EXERCISE #1 (10 MINUTES)

Activity

Instructions:

1. Complete this exercise individually.

The community needs assessment can yield information about different types of change strategies in the community: policy, systems or environmental. Systems changes can either be policy or environmental. Match the examples in the first column of the following table with the appropriate category. Mark your responses. The first one has been done for you as an example.

Example of types of strategies in a community- Law requiring schools to provide healthy food options for students

 Policy Environmental

Walking paths at a work site Policy Environmental

Higher prices for alcohol Policy Environmental

Smoking cessation programs for government employees

Policy Environmental

Food labeling Policy Environmental

2. Review your responses with a colleague. Then check the answers with those in Appendix A.

Stop

Let the facilitator or mentor know you are ready for the group discussion.

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Section 2: Plan for a Community Needs Assessment INTRODUCTION

Planning for a community needs assessment is just as critical as conducting the actual assessment. You need to ensure you have the right people to help out and that you have identified the logistics and content of the assessment, what data to collect, how to collect the data and from whom.

In this section you will learn how to plan for a community needs assessment, in particular how to:

• Identify and assemble a diverse community team

• Develop a team strategy

• Identify scope of assessment

• Develop questions to ask

• Select sites

• Determine data collection methods

• Identify key informants

IDENTIFY AND ASSEMBLE A DIVERSE COMMUNITY TEAM Representation from diverse sectors of the community is critical to successful team work and enables easy and accurate data collection and assessment. All members of the community team should have an active role in the assessment process from developing questions to identifying data collection methods to use. This process also ensures the community team has equitable access to and informed knowledge of the process, thereby solidifying their support.

Identifying 10-12 individuals is recommended to ensure the size is manageable, allow for adequate representation of different perspectives, and to account for attrition of members. Include representatives of different stakeholder groups.

Examples of types of stakeholders to include on the community team are: • Law enforcer

• Faith leader

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• Hospital administrator

• Community health worker

• School principal or headmaster (of primary school or university)

• Neighborhood council representative

• Civic leader

• Local advocates

• Local business leader

• Local health practitioner

When your community team is assembled you should clearly define the purpose of your community team, capacity of team members and their organizations, identify potential barriers to success, and plan for overcoming any obstacles. Ensuring adequate funding to support the community team’s efforts is critical to the success of the project.

DEVELOP A TEAM STRATEGY After you have assembled your team you will meet to develop a team strategy. This involves, at a minimum:

• Defining goals for the needs assessment

• Defining how the data collected will be used (e.g., to influence policy makers, to support new programs, to support new changes in service delivery or policies)

• Determining the timeline for the assessment (e.g., 3 months, 6 months)

• Determining roles and responsibilities of team members

• Assigning tasks based on skills and available resources

• Identifying how decisions will be made

• Selecting a method or tool for conducting the needs assessment (e.g., CHANGE tool, customized Excel spreadsheets, MS Word worksheets)

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IDENTIFY THE SCOPE OF THE ASSESSMENT In this step you will determine the scope of your community assessment. During this process, your team should define “community” and then keep this definition the same throughout the needs assessment.

A community needs assessment should focus on: • a selected community as defined by the team, such as a region or

neighborhood

• sectors within that area, such as health care and work sites

• community components to assess within each sector, such as nutrition, chronic disease management and tobacco use

Define the Community to Assess The community team will decide what community to assess. Previously established areas (e.g., school districts, city limits) may be helpful, but the community team will define its own community. As the community team decides on the area to assess, it should consider starting with a smaller geographic area or segment of the population. It might be easier to attain greater impact with a smaller sized community than a larger one within the first year.

Identify Community Sectors to Assess Within the community identified, your team will determine which distinct parts or sectors of the community to assess. Examples of community sectors are:

Community-At-Large Sector: includes community-wide efforts that impact the social and built environments such as food access, tobacco- free policies, walkability or bikeability, and personal safety.

Community Institution/Organization (CIO) Sector: includes entities within the community that provide a broad range of human services and access to facilities such as childcare settings, faith-based organizations, senior centers, health and wellness organizations, colleges and universities.

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Health Care Sector: includes places people go to receive preventive care or treatment, or emergency health care services such as hospitals, private doctors’ offices, community clinics, or health posts. Work Site Sector: includes places of employment such as agriculture, manufacturing, private offices, restaurants, retail establishments, and government offices. School Sector: includes all primary and secondary learning institutions.

Identify Community Components to Assess Within each sector, you should identify which components of the community to assess. Choose ones that the community team believes are most important and relevant to evaluate and that will lead to the most useful recommendations for improvement. For example, you may want to assess demographics, statistical data of a population such as age, income, education level, type of work site/health facility/school. For each sector, you will determine which demographic factors that you want to assess. For example, in some sectors, you might collect information on whether the population using the institution is from an urban or rural setting. You will also assess whether each sector has the policies and systems in place to evaluate risk and to help those in that system to engage in health promoting behavior. Part of this assessment may include who provides leadership and how and assessing who are the successful change agents.

Policies, Systems and Environments • Physical activity: the policy, systems or environmental change

strategies in place that support physical activity. For example, does the sector assess patients’ physical activity as part of a written checklist or screening used in all routine office visits? Does it provide access to public recreation facilities? Does it promote stairwell use?

• Nutrition: the policy, systems or environmental change strategies in place that support nutrition. For example, does the sector ensure that healthy food preparation practices (e.g., steaming, low fat, low salt, limited frying) are always used? Does it implement a referral

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system to help patients access community-based resources or services for nutrition?

• Tobacco Use: the tobacco control-related change strategies in place. For example, does the sector institute a tobacco-free policy 24/7 for indoor/outdoor public places? Does it ban tobacco vending machine sales? Does it provide access to a referral system for tobacco cessation resources and services?

• Chronic disease management: the policy, systems or environmental change strategies in place that support managing chronic diseases and its related risk factors. For example, does the sector provide chronic disease self-management education to individuals identified with chronic conditions or diseases? Does it implement a referral system to help patients access community- based resources or services for chronic disease? Does it promote chronic disease prevention?

• After school: the policy, systems or environmental change strategies in place that support after school activities. For example, does the school ensure appropriate active time during after-school programs or events? Does it institute healthy food and beverage options during after school programs?

• Leadership: the policy, systems or environmental change strategies in place that relate to the management of the community. For example, does the sector participate in community coalitions and partnerships? Does it reimburse employees for preventive health or wellness activities? Does it finance public parks/sports facilities?

• Legislative / Legal Environment

o District: the policy, systems or environment change strategies that are in place at the school district level. For example, does the district ban tobacco advertising on school proper

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