Community-based program design

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Community-based program design is a social method for designing programs that enables social service providers, organizers, designers and evaluators to serve specific communities in their own environment. This program design method depends on the participatory approach of community development often associated with community-based social work, and is often employed by community organizations. [1] From this approach, program designers assess the needs and resources existing within a community, and, involving community stakeholders in the process, attempt to create a sustainable and equitable solution to address the community's needs.

Contents

Similar to traditional program design, community-based program design often utilizes a range of tools and models which are meant to enhance the efficacy and outcomes of the program's design. The difference between traditional design and community-based design, when using these tools, is in the dynamics of the relationship between the designers, the participants, and the community as a whole. It evolved from the Charity Organization Society (COS) and the settlement house movements.

One advantage is a learning experience between a consumer and a social services provider. One disadvantage is a limited availability of resources. The models that can be used for it are:

History

Community practice in social work is linked with the historical roots of the profession's beginning in the United States. More specifically, the history of community-based social work has evolved from the Charity Organization Society (COS) and the settlement house movements. However, during the earlier half of the 20th century, much of this work targeted the mentally ill and focused on institutionalization. Not until the 1960s did the shift from institutions to communities, known as deinstitutionalization, [2] increase the emphasis on community-based program design. Community-based organizations and community-based programs burgeoned because of this. The poor conditions of mental health institutions and an increasing amount of research that illustrated the benefits of maintaining the relationships of the individuals served within the community surfaced to further the growth of community-based programs.

Although social work has been historically defined by these institutionalized and deinstitutionalized periods, informal community design programs have always existed. In fact, informal community-based programs predate human service applications of this approach. [1] In 1990, Bernice Harper illustrated this point in the book Social Work Practice with Black Families: A Culturally Specific Perspective in regards to African American communities, by writing that:

Blacks have always cared for the sick at home, yet it was never labeled 'home care.' Blacks have been dying at home and receiving care in the process, yet it was never called 'hospice care.' Blacks have relieved each other from the caring and curing processes, yet it was never seen as 'respite care.' Blacks have cared for each other in their homes, in their neighborhoods, and throughout their communities, yet it was never referred to as 'volunteerism.' [3]

Advantages and challenges

Advantages

Benefits of community-based program design include gaining insight into the social context of an issue or problem, mutual learning experiences between consumer and provider, broadening understanding of professional roles and responsibilities within the community, interaction with professionals from other disciplines, and opportunities for community-based participatory research projects. [4] Increased sustainability is an advantage of community-based program design. The program sustainability is ensured by the identification of solutions to problems based on existing resources accessible to all community members. Also, the involvement of local community leaders and local volunteers reinforce the sustainability of the impact of the program. [5]

Challenges

Some challenges of community-based program design are the limited availability of resources, propensity for high levels of staff turnover, the reliance upon unpaid volunteers, participant retention, and the evaluation of a dynamic task environment. [6] For the same reasons that sustainability is an advantage of this approach, utilizing limited available resources is a challenge. Based on free market principals and resource scarcity, programs often operate below pareto efficiency. [7]

Program design tools

A diagram of the social-ecological model Diagram of the social-ecological model.png
A diagram of the social-ecological model

Socio-ecological model

One model for program design is the socio-ecological model. This model enables an understanding of the factors that can influence a community. It demonstrates five levels of influence, which are the individual/intrapersonal, the interpersonal, the organizational/institutional, the community, and the policy. [8]

Logic model

Another common tool of program design that can be employed is the logic model. Logic models are a graphical depiction of the logical relationships between the resources, activities, outputs and outcomes of a program. [9] The underlying purpose of constructing a logic model is to assess how a program's activities will affect its outcomes. This model was first used as a tool to identify performance, but it has been adapted to program planning over time. [10]

Social action model

For community-based programs that seek to address macro-issues, the social action model may be utilized. The objectives of the social action model are to recognize the change around us in order to preserve or improve standards, understand the social action process/model is a conceptualization of how directed change takes place; and understand how the social action model can be implemented as a successful community problem solving tool. [11]

Evaluation

An emerging and growing practice of program design is program evaluation. Evaluation can be seen as a cycle which involves the ongoing systematic assessment of a community-based program by collecting data from it, reviewing the data, changing the program as the data recommends, and then collecting data again. Program designers often choose to incorporate evaluation into design in order to check program processes, determine impact, build a base of support, and/or justify replication/expansion. [12]

Anthropological Model

The community-based program design is a method utilized in the field of applied anthropology. In the mid to late 20th century, anthropologists focusing on research program design discovered that excluding the desire, input, and commitment of local communities and people (for which problems were being attempted to be solved) would be unsuccessful and unsustainable without some type of community-based methodology. [13] Additionally, there are examples, from the past 20 years, of social scientists like anthropologists utilizing collaborative strategies with the communities that they research and study to introduce ideas that can enact change at the individual level and even on a global scale. [13] Applied anthropologists use the community-based model to help indigenous groups recognize and construct their individualized "theories of need and change" and even help these groups accumulate the various forms of capital required to address those needs, including financial resources, and political support. [13] When conducting community-based research, it is imperative that an anthropologist establish a definition of the community they will be working with by identifying the community members and stakeholders of such said community and provide justification or clear reasoning for the defined community group. [14]

An example of the anthropological model can be found within the field of medical anthropology and the work conducted by medical anthropologist Paul Farmer. In 1998, Farmer and his colleagues developed a community-based model of care in order to provide free and comprehensive HIV treatment in impoverished areas of Haiti. The winning key strategy that Farmer and his contemporaries developed out of the community-based model was the use of community health workers, who would check on patients at their own homes to make sure patients were taking their medications correctly and regularly. [15] Due to Paul Farmer's success of the medical community-based program design in Haiti, Farmer and his colleagues were invited to duplicate their efforts in Lima, Peru in order to combat drug-resistant tuberculosis; and, subsequently, the Clinton Foundation leaned on Farmer's organization Partners in Health to support medical efforts in the government of Rwanda. Partners in Health was able to rebuild the government's local infrastructure by building new hospitals and health centers and introduced low-cost medicines and therapies through the use of community health workers. [15]

See also

Related Research Articles

Medical anthropology studies "human health and disease, health care systems, and biocultural adaptation". It views humans from multidimensional and ecological perspectives. It is one of the most highly developed areas of anthropology and applied anthropology, and is a subfield of social and cultural anthropology that examines the ways in which culture and society are organized around or influenced by issues of health, health care and related issues.

Program evaluation is a systematic method for collecting, analyzing, and using information to answer questions about projects, policies and programs, particularly about their effectiveness and efficiency.

Community psychology is concerned with the community as the unit of study. This contrasts with most psychology, which focuses on the individual. Community psychology also studies the community as a context for the individuals within it, and the relationships of the individual to communities and society. Community psychologists seek to understand the functioning of the community, including the quality of life of persons within groups, organizations and institutions, communities, and society. They aim to enhance the quality of life through collaborative research and action.

<span class="mw-page-title-main">Community health</span> Field of public health

Community health refers to non-treatment based health services that are delivered outside hospitals and clinics. Community health is a subset of public health that is taught to and practiced by clinicians as part of their normal duties. Community health volunteers and community health workers work with primary care providers to facilitate entry into, exit from and utilization of the formal health system by community members as well as providing supplementary services such as support groups or wellness events that are not offered by medical institutions.

<span class="mw-page-title-main">Participatory action research</span> Approach to research in social sciences

Participatory action research (PAR) is an approach to action research emphasizing participation and action by members of communities affected by that research. It seeks to understand the world by trying to change it, collaboratively and following reflection. PAR emphasizes collective inquiry and experimentation grounded in experience and social history. Within a PAR process, "communities of inquiry and action evolve and address questions and issues that are significant for those who participate as co-researchers". PAR contrasts with mainstream research methods, which emphasize controlled experimentation, statistical analysis, and reproducibility of findings.

Community-based participatory research (CBPR) is an equitable approach to research in which researchers, organizations, and community members collaborate on all aspects of a research project. CBPR empowers all stakeholders to offer their expertise and partake in the decision-making process. CBPR projects aim to increase the body of knowledge and the public's awareness of a given phenomenon and apply that knowledge to create social and political interventions that will benefit the community. CBPR projects range in their approaches to community engagement. Some practitioners are less inclusive of community members in the decision-making processes, whereas others empower community members to direct of the goals of the project.

Asset-based community development (ABCD) is a methodology for the sustainable development of communities based on their strengths and potentials. It involves assessing the resources, skills, and experience available in a community; organizing the community around issues that move its members into action; and then determining and taking appropriate action. This method uses the community's own assets and resources as the basis for development; it empowers the people of the community by encouraging them to use what they already possess.

Case management is a managed care technique within the health care coverage system of the United States. It involves an integrated system that manages the delivery of comprehensive healthcare services for enrolled patients. Case managers are employed in almost every aspect of health care and these employ different approaches in the control of clinical actions.

<span class="mw-page-title-main">Participatory rural appraisal</span> Process in international development

Participatory rural appraisal (PRA) is an approach used by non-governmental organizations (NGOs) and other agencies involved in international development. The approach aims to incorporate the knowledge and opinions of rural people in the planning and management of development projects and programmes.

Positive deviance (PD) is an approach to behavioral and social change. It is based on the idea that, within a community, some individuals engage in unusual behaviors allowing them to solve problems better than others who face similar challenges, despite not having additional resources or knowledge. These individuals are referred to as positive deviants.

Participatory GIS (PGIS) or public participation geographic information system (PPGIS) is a participatory approach to spatial planning and spatial information and communications management.

<span class="mw-page-title-main">Logic model</span> Method of depicting causal relationships

Logic models are hypothesized descriptions of the chain of causes and effects leading to an outcome of interest. While they can be in a narrative form, logic model usually take form in a graphical depiction of the "if-then" (causal) relationships between the various elements leading to the outcome. However, the logic model is more than the graphical depiction: it is also the theories, scientific evidences, assumptions and beliefs that support it and the various processes behind it.

<span class="mw-page-title-main">Participatory planning</span> Decentralized, whole community-based urban design process

Participatory planning is an urban planning paradigm that seeks to involve the community of an area in the urban planning of that area. It's a way for communities to work together to identify and address problems and to create a plan to achieve a desired socio-economic goal. Participatory planning emerged in response to the centralized and rationalistic approaches that defined early urban planning work.

Normalization process theory (NPT) is a sociological theory, generally used in the fields of science and technology studies (STS), implementation research, and healthcare system research. The theory deals with the adoption of technological and organizational innovations into systems, recent studies have utilized this theory in evaluating new practices in social care and education settings. It was developed out of the normalization process model.

Community-based monitoring (CBM) is a form of public oversight, ideally driven by local information needs and community values, to increase the accountability and quality of social services such as health, development aid, or to contribute to the management of natural resources. Within the CBM framework, members of a community affected by a social program or environmental change track this change and its local impacts, and generate demands, suggestions, critiques and data that they then act on, including by feeding back to the organization implementing the program or managing the environmental change. For a Toolkit on Community-Based Monitoring methodology with a focus on community oversight of infrastructure projects, see www.communitymonitoring.org. For a library of resources relating to community-based monitoring of tropical forests, see forestcompass.org/how/resources.

<span class="mw-page-title-main">Theory of Change</span> A theory of how a social policy or program is thought to work

A theory of change (ToC) is an explicit theory of how and why it is thought that a social policy or program activities lead to outcomes and impacts. ToCs are used in the design of programs and program evaluation, across a range of policy areas.

The PRECEDE–PROCEED model is a cost–benefit evaluation framework proposed in 1974 by Lawrence W. Green that can help health program planners, policy makers and other evaluators, analyze situations and design health programs efficiently. It provides a comprehensive structure for assessing health and quality of life needs, and for designing, implementing and evaluating health promotion and other public health programs to meet those needs. One purpose and guiding principle of the PRECEDE–PROCEED model is to direct initial attention to outcomes, rather than inputs. It guides planners through a process that starts with desired outcomes and then works backwards in the causal chain to identify a mix of strategies for achieving those objectives. A fundamental assumption of the model is the active participation of its intended audience — that is, that the participants ("consumers") will take an active part in defining their own problems, establishing their goals and developing their solutions.

Participatory evaluation is an approach to program evaluation. It provides for the active involvement of stakeholder in the program: providers, partners, beneficiaries, and any other interested parties. All involved decide how to frame the questions used to evaluate the program, and all decide how to measure outcomes and impact. It is often used in international development.

Empowerment evaluation (EE) is an evaluation approach designed to help communities monitor and evaluate their own performance. It is used in comprehensive community initiatives as well as small-scale settings and is designed to help groups accomplish their goals. According to David Fetterman, "Empowerment evaluation is the use of evaluation concepts, techniques, and findings to foster improvement and self-determination". An expanded definition is: "Empowerment evaluation is an evaluation approach that aims to increase the likelihood that programs will achieve results by increasing the capacity of program stakeholders to plan, implement, and evaluate their own programs."

<span class="mw-page-title-main">Cultural competence in healthcare</span> Health care services that are sensitive and responsive to the needs of diverse cultures

Cultural competence in healthcare refers to the ability for healthcare professionals to demonstrate cultural competence toward patients with diverse values, beliefs, and feelings. This process includes consideration of the individual social, cultural, and psychological needs of patients for effective cross-cultural communication with their health care providers. The goal of cultural competence in health care is to reduce health disparities and to provide optimal care to patients regardless of their race, gender, ethnic background, native languages spoken, and religious or cultural beliefs. Cultural competency training is important in health care fields where human interaction is common, including medicine, nursing, allied health, mental health, social work, pharmacy, oral health, and public health fields.

References

  1. 1 2 Delgado, Melvin (1999). Social Work Practice in Nontraditional Urban Settings. Oxford University Press. doi:10.1093/acprof:oso/9780195112481.001.0001. ISBN   9780195112481.
  2. ↑ Tausig, Mark; Janet, Michello; Sree, Subedi (2004). A sociology of mental illness. Pearson. p. 188. ISBN   9780131114784. OCLC   636608234.
  3. ↑ Harper, Bernice Catherine O (1990). "Blacks and the health care delivery system : challenges and prospects". In Logan, Sadye Louise; Freeman, Edith M; McRoy, Ruth G (eds.). Social work practice with Black families: a culturally specific perspective. New York: Longman. ISBN   978-0801300127. OCLC   18909442.
  4. ↑ Mudarikwa, Ruvimbo Sharon; Mcdonnell, Jacqueline A.; Whyte, Susan; Villanueva, Elmer; Hill, Robyn A.; Hart, William; Nestel, Debra (2010-12-01). "Community-based practice program in a rural medical school: Benefits and challenges". Medical Teacher. 32 (12): 990–996. doi:10.3109/0142159X.2010.509417. ISSN   0142-159X. PMID   20874029. S2CID   28904608.
  5. ↑ M, Sternin; J, Sternin; D, Marsh (1998). "Designing a community-based nutrition program using the hearth model and the positive deviance approach: A field guide" (PDF). Save the Children: 17.{{cite journal}}: Cite journal requires |journal= (help)
  6. ↑ O'Neil, Margaret E.; Fragala-Pinkham, Maria; Ideishi, Roger I.; Ideishi, Siobhan K. (2012-05-01). "Community-based programs for children and youth: our experiences in design, implementation, and evaluation". Physical & Occupational Therapy in Pediatrics. 32 (2): 111–119. doi:10.3109/01942638.2012.668089. ISSN   1541-3144. PMID   22483374. S2CID   41033620.
  7. ↑ Lewis, Michael Anthony; Karl, Widerquist (2002). Economics for social workers : the application of economic theory to social policy and the human services. Columbia University Press. ISBN   9780231116862. OCLC   47805132.
  8. ↑ Healthy Teen Network (March 2015). "Increasing Our Impact by Using a Social-Ecological Approach" (PDF). pp. 1, 2–3. Retrieved 10 May 2017.
  9. ↑ McCawley, Paul F. (n.d.). "The Logic Model for Program Planning and Evaluation" (PDF). University of Idaho Extension: 1. Retrieved 24 February 2014.{{cite journal}}: Cite journal requires |journal= (help)
  10. ↑ Coffman, Julia (January 1999). "Learning From Logic Models: An Example of a Family/School Partnership Program". Harvard Family Research Project. para. 3. Archived from the original on January 23, 2009. Retrieved 16 May 2017.{{cite web}}: CS1 maint: unfit URL (link)
  11. ↑ Zastrow, Charles (January 27, 2009). The practice of social work : a comprehensive worktext. Brooks/Cole Publishing Company. p. 284. ISBN   9780495599708. OCLC   800460168.
  12. ↑ "Evaluating your community-based program" (PDF). American Academy of Pediatrics. 2013. p. 7. Archived from the original (PDF) on June 26, 2016. Retrieved May 9, 2017.
  13. 1 2 3 Schensul, Jean J.; Trickett, Edison (2009). "Introduction to Multi-Level Community Based Culturally Situated Interventions". American Journal of Community Psychology. 43 (3–4): 232–240. doi:10.1007/s10464-009-9238-8. PMID   19387821. S2CID   154037.
  14. ↑ "Supplementary file 14. Differential isoform usage plots". doi: 10.7554/elife.30860.037 .{{cite journal}}: Cite journal requires |journal= (help)
  15. 1 2 Chu, Louise (2012-10-23). "Global Health Pioneer Paul Farmer Touts Community-Based Health Care Model to Combat Infectious Diseases". UCSF.edu. Retrieved 2020-10-31.
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