nuts and bolts #2 conducting the needs assessment

Nuts and Bolts #2Nuts and Bolts #2

Conducting the Needs Conducting the Needs AssessmentAssessment

ObjectivesObjectivesParticipants will be able to:Participants will be able to:Understand the key aspects of a needs Understand the key aspects of a needs

assessment and be able to plan and assessment and be able to plan and implement a needs assessmentimplement a needs assessment

Make recommendations based on the Make recommendations based on the findings of the needs assessmentfindings of the needs assessment

Identify the key aspects of school Identify the key aspects of school nurses, parents/guardian, and nurses, parents/guardian, and confidentiality in school-based health confidentiality in school-based health care servicescare services

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What is a Community Needs What is a Community Needs Assessment?Assessment?

An accurate appraisal of the current An accurate appraisal of the current situation (strengths, concerns, and general situation (strengths, concerns, and general conditions) of a community’s populationconditions) of a community’s population

A collection of secondary and first hand A collection of secondary and first hand information and data from a wide range of information and data from a wide range of relevant sources and audiencesrelevant sources and audiences

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What is a Community Needs What is a Community Needs Assessment?Assessment?

A process for:A process for:identifying needs and resources in a identifying needs and resources in a community community determining gaps between what a determining gaps between what a situation is and what it should besituation is and what it should beestablishing prioritiesestablishing priorities

An opportunity to paint a picture of the An opportunity to paint a picture of the conditions in a community and sharpen your conditions in a community and sharpen your perceptions of the critical issues children perceptions of the critical issues children and families faceand families face

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Why Identify Needs and Why Identify Needs and Resources?Resources?

Better understand the community in which Better understand the community in which you will be workingyou will be working

Become aware of needs and concerns you Become aware of needs and concerns you never knew aboutnever knew about

Locate hidden strengths or underutilized Locate hidden strengths or underutilized resources that could be developedresources that could be developed

Document needDocument need

Make sure future actions are aligned with Make sure future actions are aligned with expressed community needsexpressed community needs

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Why Identify Needs and Why Identify Needs and Resources?Resources?

Garner greater support and involve more Garner greater support and involve more people in subsequent actionpeople in subsequent action

Give voice to individuals in the community Give voice to individuals in the community who have not traditionally been solicited for who have not traditionally been solicited for commentcomment

Convince outside funders and supportersConvince outside funders and supporters

Make decisions based on priorities and Make decisions based on priorities and documented needsdocumented needs

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Planning and Implementing the Planning and Implementing the AssessmentAssessment

Step 1:Step 1: Involve stakeholdersInvolve stakeholders

Establish working group to guide the Establish working group to guide the planning and implementation of planning and implementation of Community Needs Assessments Community Needs Assessments

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Step 2:Step 2: Determine the Objectives and Determine the Objectives and Outcomes of the AssessmentOutcomes of the Assessment

What are you really interested in knowing? Your What are you really interested in knowing? Your questions will flow from this.questions will flow from this.

What is your vision? How will you use the What is your vision? How will you use the information obtained?information obtained?

Which issues, questions, and behaviors are of Which issues, questions, and behaviors are of particular interest?particular interest?

What don’t you know about these issues? What What don’t you know about these issues? What questions do you need to answer?questions do you need to answer?

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Step 3:Step 3: Identify secondary data sourcesIdentify secondary data sources

Find out what outside resources can be used Find out what outside resources can be used

What public reports exist (examples of What public reports exist (examples of sources: census data, vital statistics, CPS sources: census data, vital statistics, CPS reports)reports)

– Have other studies been done?Have other studies been done?

Are there experts in the community who can Are there experts in the community who can help you?help you?

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Planning and Implementing the Planning and Implementing the Assessment Assessment (cont)(cont)

Step 4: Choose your approach/ Step 4: Choose your approach/ approaches for gathering newapproaches for gathering newinformationinformation

Most common approaches:Most common approaches: Key informant interviewsKey informant interviews

Focus groups Focus groups

Public forumsPublic forums

SurveysSurveys

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Planning and Implementing the Planning and Implementing the Assessment Assessment

When making your choice of approach, When making your choice of approach, take into account:take into account:Purpose of the studyPurpose of the studyAmount of time you have and number of people Amount of time you have and number of people

assisting youassisting youAvailable resourcesAvailable resourcesSize and characteristics of target populationSize and characteristics of target populationRelationship you have with target populationRelationship you have with target population

“The quality of information about a community is only as good as the technique or combination of techniques used. A single technique may be too narrow; using too many techniques may be costly in terms of time and dollars. Different techniques are appropriate for different needs. Analyze the situation and then weigh the advantages and disadvantages. Sometimes a combination of techniques will provide a more reasonable picture.” (Butler and Howe, 1980)

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Key Informant InterviewsKey Informant Interviews

PurposePurpose = to collect information from those in = to collect information from those in the community who are in a prime position to the community who are in a prime position to know the needs facing the community know the needs facing the community

How to implementHow to implement = compile a list of = compile a list of participants, create protocol, make participants, create protocol, make appointments (either telephone or in-person), appointments (either telephone or in-person), gather data, identify common themesgather data, identify common themes

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Key Informant InterviewsKey Informant Interviews

AdvantagesAdvantages Easy and not expensiveEasy and not expensive Can discuss confidential issues more readilyCan discuss confidential issues more readily Establishes rapport and trust with communityEstablishes rapport and trust with community Permits clarification of issues and ideasPermits clarification of issues and ideas

DisadvantagesDisadvantages May be difficult to schedule May be difficult to schedule May provide a biased perspectiveMay provide a biased perspective Only represents perceptions – not hard dataOnly represents perceptions – not hard data Personal relationships may influence outcomesPersonal relationships may influence outcomes Should be combined with other methods because may not Should be combined with other methods because may not

represent whole communityrepresent whole community

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Focus GroupsFocus Groups

PurposePurpose = = to collect information from those in the to collect information from those in the community who are in a prime position to know the community who are in a prime position to know the needs facing the community needs facing the community

How to implementHow to implement = = compile a list of participants, compile a list of participants, decide on location, create protocol, invite participants decide on location, create protocol, invite participants (think about food and baby sitting if necessary), use (think about food and baby sitting if necessary), use facilitator and documenter, organize and identify facilitator and documenter, organize and identify common themescommon themes

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Focus GrouFocus GroupspsAdvantagesAdvantages

Easy and not expensiveEasy and not expensive Establishes rapport and trust with community Establishes rapport and trust with community

membersmembers Permits clarification of issues and ideasPermits clarification of issues and ideas Easily combined with other techniques Easily combined with other techniques

DisadvantagesDisadvantages May provide biased perspectivesMay provide biased perspectives Only represents perceptions – not hard dataOnly represents perceptions – not hard data Sharing opinions and views in a group setting may Sharing opinions and views in a group setting may

be inhibitingbe inhibiting Should be combined with other methods because Should be combined with other methods because

may not represent whole communitymay not represent whole community

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Purpose Purpose = elicit information from a wide range = elicit information from a wide range of residents in a series of public meetingsof residents in a series of public meetings

How to implementHow to implement = develop list of invitees, = develop list of invitees, create list of questions, select strategically create list of questions, select strategically located venue (use different sites and hold at located venue (use different sites and hold at different times), publicize, use facilitator and different times), publicize, use facilitator and documenter, identify common themesdocumenter, identify common themes

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Advantages:Advantages: Get opinions from a wide range of peopleGet opinions from a wide range of people Promotes active involvement, community awareness, Promotes active involvement, community awareness,

and buy-inand buy-in Inexpensive, quick picture of communityInexpensive, quick picture of community

Disadvantages:Disadvantages: Requires good leadershipRequires good leadership Opinions limited to those who attendOpinions limited to those who attend Lots of advance planningLots of advance planning May generate more questions than answersMay generate more questions than answers May create unrealistic expectationsMay create unrealistic expectations

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SurveysSurveys

PurposePurpose = = collect information from a wide range of collect information from a wide range of respondentsrespondents

How to implementHow to implement == find or create carefully find or create carefully developed instrument and administer through a developed instrument and administer through a sampling procedure (may be face to face, personal sampling procedure (may be face to face, personal distribution and collection, self-administered in a group, distribution and collection, self-administered in a group, telephone, mailed), analyze resultstelephone, mailed), analyze results

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SurveysSurveys

AdvantagesAdvantages Best approach for eliciting attitudes of broad range Best approach for eliciting attitudes of broad range

of individuals of individuals Data usually valid and reliable Data usually valid and reliable

DisadvantagesDisadvantages Costly and requires time and expertiseCostly and requires time and expertise Needs carefully selected tool and sampling Needs carefully selected tool and sampling Subject to misinterpretationSubject to misinterpretation Individuals may hesitate to answer questionsIndividuals may hesitate to answer questions

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Planned Approach to Community Action (PATCH)Planned Approach to Community Action (PATCH)– developed by CDCdeveloped by CDC– effective model for planning, conducting, and evaluating effective model for planning, conducting, and evaluating

community health promotion and disease prevention programscommunity health promotion and disease prevention programs– Used by diverse communities in US and other nations to address Used by diverse communities in US and other nations to address

health concerns health concerns – PATCH Guide for local coordinator has sample surveys and data PATCH Guide for local coordinator has sample surveys and data

collection toolscollection tools– Web siteWeb site www.cdc.gov/nccdphp/path/index.htm

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Step 5: Implement PlanStep 5: Implement Plan

Collect secondary dataCollect secondary data

Collect primary data (conduct interviews, focus Collect primary data (conduct interviews, focus groups, surveys, etc)groups, surveys, etc)

Analyze secondary and primary dataAnalyze secondary and primary data

Summarize findingsSummarize findings

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Step 5: Implement PlanStep 5: Implement Plan

Prepare report Prepare report

Share with working group, interpret data and Share with working group, interpret data and develop recommendations together develop recommendations together

Present to external stakeholders as neededPresent to external stakeholders as needed

Create action planCreate action plan

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Review Anytown’s Needs Review Anytown’s Needs Assessment DocumentAssessment Document

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Project Work Plan and Design Project Work Plan and Design Example from Chicago SBHCExample from Chicago SBHC

Convened a planning committee of key community Convened a planning committee of key community stakeholders who met regularly to oversee and stakeholders who met regularly to oversee and guide the process guide the process

Gathered existing dataGathered existing dataU. S. Census Bureau (2000)U. S. Census Bureau (2000)Chicago Health and Health Systems Project Chicago Health and Health Systems Project

(CDPH 2006)(CDPH 2006)Healthy Albany Park Assessment (2004)Healthy Albany Park Assessment (2004)Illinois State Report Card (2004 – 2005)Illinois State Report Card (2004 – 2005)CPS School Profile (2004 – 2005CPS School Profile (2004 – 2005))

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Project Work Plan and DesignProject Work Plan and Design

Collected new dataCollected new data Conducted fifteen stakeholder interviews with Conducted fifteen stakeholder interviews with

school administrators, school personnel, school administrators, school personnel, school nurses, and external partners working school nurses, and external partners working in schoolsin schools

Conducted a focus group with community Conducted a focus group with community providers providers

Analyzed findingsAnalyzed findings

Drafted initial recommendationsDrafted initial recommendations

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Make RecommendationsMake Recommendations

Based on Needs Assessment Based on Needs Assessment FindingsFindings

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Select the SchoolSelect the School

ElementaryElementaryMiddle or Junior High Middle or Junior High K-8K-8High SchoolHigh SchoolAlternative School Alternative School Pre-school Pre-school

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Select the Service Delivery Strategy Select the Service Delivery Strategy and Modeland Model

Service and Staffing OptionsService and Staffing Options Collaborative PartnershipsCollaborative Partnerships The role of the school nurseThe role of the school nurse Policy and ProceduresPolicy and Procedures Referral NetworksReferral Networks Delivery of ServiceDelivery of Service Parental Consent/Parental InvolvementParental Consent/Parental Involvement Integration of the school-based health center with Integration of the school-based health center with

existing school and community resourcesexisting school and community resources Confidentiality IssuesConfidentiality Issues

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Services to Consider for Services to Consider for All Grade LevelsAll Grade Levels

Primary Care including Primary Care including biennial risk biennial risk assessmentassessment

ImmunizationsImmunizations Health EducationHealth Education Physical ExaminationsPhysical Examinations Mental HealthMental Health Laboratory ServicesLaboratory Services MedicationsMedications

Nutrition CounselingNutrition Counseling Vision, Hearing, and Vision, Hearing, and

Dental ScreeningDental Screening Social Services Social Services Chronic Disease co-Chronic Disease co-

management management Specialty Care Specialty Care

ReferralsReferrals

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Services at the MS and HS LevelsServices at the MS and HS Levels

Pregnancy testingPregnancy testing

STD testing and treatmentSTD testing and treatment

Reproductive health careReproductive health care

Group counseling to address issues such as Group counseling to address issues such as sexual abuse, depressionsexual abuse, depression

Individual mental health counseling Individual mental health counseling

HIV testing and/or counselingHIV testing and/or counseling

Referral for family planning Referral for family planning

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The Role of the School NurseThe Role of the School Nurse

Maintain school nurse mandated functions Maintain school nurse mandated functions (vision and hearing screening, (vision and hearing screening, immunizations, special ed, etc.)immunizations, special ed, etc.)

Member of school-based health team Member of school-based health team

– Identify students for school-based health center Identify students for school-based health center servicesservices

– Provide follow-upProvide follow-up

– Reach out to parentsReach out to parents

– Serve as a liaison between the school-based Serve as a liaison between the school-based health center and school staff health center and school staff

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Parental/Family Consent / Family Parental/Family Consent / Family EngagementEngagement

The majority of SBHCs have a parental/guardian The majority of SBHCs have a parental/guardian consent policy. consent policy.

Consent form should include:Consent form should include:

– Services to be offeredServices to be offered

– Statement about confidentiality /HIPAAStatement about confidentiality /HIPAA

– Billing issuesBilling issues

– Statement about the relationship between the Statement about the relationship between the sponsoring organization and any collaborators sponsoring organization and any collaborators including the school district including the school district

Review state statutes regardingReview state statutes regarding age of consent for age of consent for various health care servicesvarious health care services

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ConfidentialityConfidentiality

Confidential versus nonconfidential Confidential versus nonconfidential services services

Access to confidential servicesAccess to confidential services

Release of informationRelease of information

Providing follow-up information to school Providing follow-up information to school personnel and outside agenciespersonnel and outside agencies

Informing students of confidentiality Informing students of confidentiality procedures and limits of confidentiality procedures and limits of confidentiality

Needs AssessmentNeeds Assessment

Helps you determine where you are at, Helps you determine where you are at, existing resources and gapsexisting resources and gaps

Paints a picture of the school, the Paints a picture of the school, the community, the environmentcommunity, the environment

Helps you determine what the model Helps you determine what the model needs to be and the types of servicesneeds to be and the types of services

Necessary to make a solid plan for Necessary to make a solid plan for implementationimplementation

nuts and bolts #2 conducting the needs assessment

Documents

expressed community

different needs

needs assessmentidentify

documented needs

workingbecome aware

assessment contstep

underutilized resources

different techniques