In this assignment, we will zoom out to a larger concentric circle and consider the health of the entire community. On a larger scale, this impacts the health of those within it and creates the context for this group of people and what types of facilitators and barriers to health they have collectively.
Communities are unique, just as individuals are unique, and if we are going to be effective as health providers, we need to understand the community our patients live in; at least enough to make recommendations that make sense and to provide culturally safe care.
If we live in the community we serve, then this comes naturally. If we do not, then it takes much more effort on our part, to gain that understanding (and we are much more likely to make mistakes). This is one reason why culturally concordant care leads to improves patient health outcomes.
We can use the same stages of health promotion that we used for an individual, but apply it on the community level:
- Assessment
- Planning
- Intervention
- Evaluation
Fortunately, we will not be responsible for performing a Community Health Needs Assessment (CHNA), since this is a very complex task.
We will, however, ask you to find the one that exists for the community you live in, or that is nearest to you for this assignment. If you work or plan to work as an APRN in a different community from your own, you may choose to use that one. You will search for and find the CHNA to use for this assignment, and become familiar with it.
This will provide several benefits for you. First, you will get to know the health status of your community better, and second, you will learn more about the process of assessing community health. Additionally, you will learn how to go about planning, creating interventions, collaborating with partners, and evaluating efforts.
Keep in mind that this assignment is meant to be an introductory to community assessment. We will cover a lot of ground quickly and we realize that we could go deeper with this. The goal is to make sure that as APRNs and leaders in the field, you are able to access data, interpret it, and formulate evidence-based recommendations to help your community.
Hot tip: If you find that you love community health, consider that this could be a nursing specialty area for you. Many nurses and APRNs find that they love working on a larger scale, such as in community or public health, especially if policy work is your cup of tea, you will want to consider working in these broader fields.
Assignment Objectives
- Identify the stages of health promotion as they pertain to a community health assessment and implementation plan.
- Assess and identify health disparities amongst vulnerable populations according to community data reports.
- Recognize community interventions, agencies, and policies when advocating for vulnerable populations.
- Identify community partners and consider effective ways to collaborate to meet community health goals.
Community Health Needs Assessment
The information in your local hospital’s CHNA should help you complete this assignment.
· Click here to learn about the CHNA and what hospitals are required to include
· Then Google search for your local hospital's CHNA latest report
· If you do not have a local hospital system or can’t locate a CHNA report, use this link to find the closest one to you. (You can also copy and paste: https://data.cms.gov/provider-data/dataset/xubh-q36u ).
ASSESSMENT
|
City and State: |
|
|
Zip Code: |
|
|
Name of the hospital used: |
|
|
Year of assessment (use most recent): |
|
|
Link for the CHNA report used (make sure this link is accessible to faculty/people outside of the organization): |
Top 3 health needs identified:
|
Top 3 Health Needs |
|
1. |
|
2. |
|
3. |
Top 3 healthcare disparities/inequities (if not explicit, infer from your community needs and list them):
|
Top 3 Healthcare Disparities/Inequities |
|
1. |
|
2. |
|
3. |
Based on the data you’ve gathered above, name 3 vulnerable populations that you are likely to care for:
|
Vulnerable Populations |
|
1. |
|
2. |
|
3. |
What social determinants of health could be contributing to the identified health needs and healthcare disparities? Identify 3 per need based on economics, environment, education, race, religious minority, cultural minority, cognitive load, access to food, transportation, etc.
|
Top 3 Health Needs |
Social Determinant of Health 1 |
Social Determinant of Health 2 |
Social Determinant of Health 3 |
|
1. |
|||
|
2. |
|||
|
3. |
Historical Context
Use the table below to answer the following prompts:
· What Indigenous communities first lived on the land where your community resides? Use: https://native-land.ca/
· Briefly (2-3 bullet points) describe one historic event that had a lasting impact on your community (i.e., closing of an industry that was a major employer; a natural disaster; red lining; wave of immigration or migration). Does this event continue to impact the health of the community today?
· Are there any historical events that community members are particularly proud of?
|
Indigenous community(ies) that first lived on the land: |
|
|
One impactful historic event (2-3 bullet points to describe): |
|
|
Continued impact? How so? |
|
|
Historical event(s) community takes pride in: |
Access To Care
Local Transportation
· What are the options for local transportation, and can people access healthcare facilities through public transportation? Buses, Trains, Subways, Taxi, Uber, etc.
· How much does public transportation cost?
· Are there any discount programs for low-income women/pregnant individuals to access transportation to healthcare visits?
|
Options for local transportation to clinics/hospital: |
|
|
Average cost of transportation to nearest clinic/hospital: |
|
|
Discount programs/aid available? If so, what kind? Insert N/A if not applicable. |
Health Insurance
|
Did your state participate in Medicaid Expansion? |
Yes/No |
|
Can people access the healthcare.gov marketplace for low-cost insurance in the community? |
Yes/No |
|
If so, what’s the lowest costing plan available when accessing healthcare.gov for your state? Insert N/A if unable to view plans; do not insert your personal data. Definitions for reference: · Monthly premium x12 months: The amount you pay to your insurance company each month to have health insurance. · Deductible: How much you have to spend for covered health services before your insurance company pays anything (except free preventive services) · Copayments and coinsurance: Payments you make to your health care provider each time you get care, like $20 for a doctor visit or 30% of hospital charges. · Out-of-pocket maximum: The most you have to spend for covered services in a year. After you reach this amount, the insurance company pays 100% for covered services. |
|
|
How long does Medicaid coverage remain in place after birth? |
|
|
What is the percentage of uninsured people in your state or community? // Use https://www.countyhealthrankings.org/ and enter your zip code // Scroll down to “Additional clinical care” and click the + button to see additional information |
PLANNING
Environmental Conditions and Disaster Plan
· Use 1-2 websites to gather information for this section (maximum of 2). Try searching for the key phrase: “ disaster preparedness plan” + your city (i.e., disaster preparedness plan Louisville).
Use the table below to answer these prompts:
· What are 2 local environmental conditions or emergencies that might impact access to care and how? (i.e., poor road conditions or lack of road systems; regular flash flooding)
· What agency handles public health emergencies/ pandemic preparedness? Note this might not be the same as the agency that handles environmental disasters.
· What is your community’s disaster communication plan in the event of an emergency? (i.e., how are people notified of an impending emergency)
|
Website(s) used (max 2): |
1. |
2. (optional) |
|
1-2 local environmental conditions or emergencies that might impact access to care and how? |
1. |
2. (optional) |
|
What agency/agencies handle public health emergencies/pandemic preparedness? |
1. |
2. (optional) |
|
Disaster communication plan: |
1. (insert website/social media link) (wireless emergency alert – phones) |
2. (optional) |
INTERVENTION
Recommendations for Health Equity
What health services could an APRN provide support or advocate for to help vulnerable communities in your area? Identify 3 in the table below.
Partnerships are an essential part of implementing any public health plan. Who would you partner with? What sectors are involved?
Think BIG. What is a policy that could impact this intervention?
You can use your CHNA to see if there are recommendations for interventions in the Community Health Implementation Plan (CHIP) if yours has one.
The County Health Ranking & Roadmaps at https://www.countyhealthrankings.org/ also has great resources for taking action/interventions as well as partnerships.
POLICY: Include a link to a current policy (preferably local/state), policy issue/brief, or an idea for a policy you have that is not currently in place. Provide a brief synopsis of it.
|
Intervention for vulnerable communities (list 3): |
Who would you partner with? What partner organizations could you collaborate with? |
What sectors should be involved? (i.e. healthcare, public, private, etc.) |
Describe what policies currently are or could impact this intervention? (1-3 bullet points) |
|
1. |
|||
|
2. |
|||
|
3. |
EVALUATION
How are you hoping these interventions would make an impact on your community? Who decides what success would look like in your community? Be sure to consider perspectives of patients and direct impact on them, not just “statistical” success.
How would you evaluate if your proposed interventions are working? (i.e., survey of a specific population, data collection and analysis – be specific of what type of data, etc.)
|
Proposed intervention (one per column) |
Example: free diabetes medication for patients with type 2 diabetes |
(replace with intervention 1) |
(replace with intervention 2) |
(replace with intervention 3) |
|
Examples of what success for this intervention would look like (list 2-3 bullet points): |
· Improved labs (glucose, HgbA1c) · Improved consistency or compliance with taking medication |
|||
|
Method of evaluation (i.e., data collection, surveys, testing, etc.): |
· Testing: reduction of HgbA1c in patients in the county · Survey: patient reports greater adherence to taking meds |
Rev. 9/24
SUMMARY
Well done! Now that you’ve completed an introductory level community assessment, fill in the summary table below. This will help you see the big picture of what you’ve accomplished.
|
ASSESSMENT |
PLANNING |
INTERVENTION |
EVALUATION |
|
Top 3 Health Needs |
List who would you collaborate with to address this? |
One recommended intervention for vulnerable population(s) |
Method of evaluation for the intervention |
|
1. |
|||
|
2. |
|||
|
3. |