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 the social-ecological model, which provides a framework for program design, the logic model, which is a graphical depiction of logical relationships between the resources, activities, outputs and outcomes of a program, the social action model, whose objectives are to recognize the change around a community 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, and program evaluation, which involves the ongoing systematic assessment of community-based programs.

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

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. In both the public and private sectors, stakeholders often want to know whether the programs they are funding, implementing, voting for, receiving or objecting to are producing the intended effect. While program evaluation first focuses around this definition, important considerations often include how much the program costs per participant, how the program could be improved, whether the program is worthwhile, whether there are better alternatives, if there are unintended outcomes, and whether the program goals are appropriate and useful. Evaluators help to answer these questions, but the best way to answer the questions is for the evaluation to be a joint project between evaluators and stakeholders.

The United Nations defines community development as "a process where community members come together to take collective action and generate solutions to common problems." It is a broad concept, applied to the practices of civic leaders, activists, involved citizens, and professionals to improve various aspects of communities, typically aiming to build stronger and more resilient local communities.

Adaptive management, also known as adaptive resource management or adaptive environmental assessment and management, is a structured, iterative process of robust decision making in the face of uncertainty, with an aim to reducing uncertainty over time via system monitoring. In this way, decision making simultaneously meets one or more resource management objectives and, either passively or actively, accrues information needed to improve future management. Adaptive management is a tool which should be used not only to change a system, but also to learn about the system. Because adaptive management is based on a learning process, it improves long-run management outcomes. The challenge in using the adaptive management approach lies in finding the correct balance between gaining knowledge to improve management in the future and achieving the best short-term outcome based on current knowledge. This approach has more recently been employed in implementing international development programs.

Health human resources People acting to improve health outcomes

Health human resources (HHR) – also known as human resources for health (HRH) or health workforce – is defined as "all people engaged in actions whose primary intent is to enhance positive health outcomes", according to World Health Organization's World Health Report 2006. Human resources for health are identified as one of the six core building blocks of a health system. Human resources for health include physicians, nursing professionals, pharmacists, midwives, dentists, allied health professions, community health workers, social health workers and other health care providers, as well as health management and support functions personnels like cleaner, guard etc. who add important values as part of the wider health systems so that enhance the delivery of essential healthcare services effectively and efficiently. Effective health system functioning highly demand well trained health services managers, medical records and health information technicians, health economists, health supply chain managers, medical secretaries and others.

Participatory management is the practice of empowering members of a group, such as employees of a company or citizens of a community, to participate in organizational decision making. It is used as an alternative to traditional vertical management structures, which has shown to be less effective as participants are growing less interested in their leader's expectations due to a lack of recognition of the participant's effort or opinion.

Community-based participatory research (CBPR) is a partnership approach to research that equitably involves community members, organizational representatives, researchers, and others in all aspects of the research process, with all partners in the process contributing expertise and sharing in the decision-making and ownership. The aim of CBPR is to increase knowledge and understanding of a given phenomenon and to integrate the knowledge gained with interventions for policy or social change benefiting the community members.

Community organization or Community Based Organization refers to organization aimed at making desired improvements to a community's social health, well-being, and overall functioning. Community organization occurs in geographically, psychosocially, culturally, spiritually, and digitally bounded communities.

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.

Participatory rural appraisal

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 based on the observation that in any community there are people whose uncommon but successful behaviors or strategies enable them to find better solutions to a problem than their peers, despite facing similar challenges and having no extra resources or knowledge than their peers. These individuals are referred to as positive deviants.

Participatory development communication is the use of mass media and traditional, inter-personal means of communication that empowers communities to visualise aspirations and discover solutions to their development problems and issues.

Logic model 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.

Participatory planning

Participatory planning is an urban planning paradigm that emphasizes involving the entire community in the community planning process. Participatory planning emerged in response to the centralized and rationalistic approaches that defined early urban planning work. It has become a highly influential paradigm both in the context of traditional urban planning, and in the context of international community development. There is no singular theoretical framework or set of practical methods that make up participatory planning. Rather, it is a broad paradigm which incorporates a wide range of diverse theories and approaches to community planning. In general, participatory planning programs prioritize the integration of technical expertise with the preferences and knowledge of community members in the planning process. They also generally emphasize consensus building and collective community decision making, and prioritize the participation of traditionally marginalized groups in the planning process.

Theory of change

Theory of Change (ToC) is a methodology for planning, participation, adaptive management, and evaluation that is used in companies, philanthropy, not-for-profit, international development, research, and government sectors to promote social change. Theory of Change defines long-term goals and then maps backward to identify necessary preconditions.

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.

International Institute of Rural Reconstruction, also known as IIRR is a non-profit organization that helps empower rural communities by making them self-sufficient. By offering programs across health, education, environment and livelihood, its goal is to have rural communities take charge of their own success. The organization has delivered programs to more than 40 countries in Asia, Africa and Latin America and directly impacted the lives of over 5 million people as of 2019.

Community food security (CFS) is a relatively new concept that captures emerging ideas about the central place of food in communities. At times it refers to the measure of food access and availability at the community level, and at other times to a goal or framework for place-based food systems. It builds upon the more commonly understood concept of food security, which refers to food access and availability at an individual or household level and at a national or global level. Hamm and Bellows (2003) define CFS as “a situation in which all community residents obtain a safe, culturally acceptable, nutritionally adequate diet through a sustainable food system that maximizes community self-reliance and social justice” (p. 37). CFS involves social, economic, and institutional factors, and their interrelationships within a community that impact availability and access to resources to produce food locally. It takes into account environmental sustainability and social fairness through measures of the availability and affordability of food in that community relative to the financial resources available to purchase or produce it.

Jean J. Schensul is a medical anthropologist and senior scientist at The Institute for Community Research, in Hartford, Connecticut. Dr. Schensul is most notable for her research on HIV/AIDS prevention and other health-related research in the United States, as well as her extensive writing on ethnographic research methods. She has made notable contributions to the field of applied anthropology, with her work on structural interventions to health disparities leading to the development of new organizations, community research partnerships, and community/university associations. Schensul’s work has been dedicated to community-based research on topics such as senior health, education, and substance abuse, among others.

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. Retrieved 16 May 2017.
  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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