Ready or Not assessing and implementing change

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Ready or Not?assessing and implementing change

• Stephanie Jones
• Erica Ruck,
• Ovens and King Community Health Service

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Workshop Content

• Provide you with an understanding of community
  readiness and how this fits into Best Start at
  all levels - government, community, organisations
  and services, teams and groups.
• Work in groups to look at the readiness of your
  BS community

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What has this got to do with Best Start?
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Best Start has taken a community approach to
implementing changes within and for families

• place-oriented setting in local government
  areas
• driven by partnerships of local people and
  organisations
• BS in aboriginal communities with strong family
  and kinship networks

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But is the community ready?

To bring partners together to co-ordinate, plan
and deliver Best Start initiatives? To make
changes to its values, norms and goals that are
key to family and community well-being? To
re-orient services?
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Definition of Community Readiness
(adapted, Kumpfer, 1997)

• CR is the extent to which a group of individuals
  is adequately prepared to implement Best Start
• CR assessment is a process for measuring the
  characteristics of a community, its population,
  community leaders and service systems that can
  influence the success of Best Start

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AcknowledgesA. Every community is different

• Vary widely in their interest, ability and
  commitment to making changes (dependent on what
  they are)
• Level of community connection and networks
• Have different values, norms, hopes priorities
• Established communities may be much more
  practiced at working together- not so easy for
  newer or transient communities- with different
  populations

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B. Stages of change in a community
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Why increase community readiness?

• Comprehensive health promotion or change efforts
  are much more likely to have the desired impact,
  particularly when health professionals work with
  local citizens and community leaders
• Better allocation of resources and efforts
• Empower communities to deal with a whole range of
  issues
• More likely to change community norms and values

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Working with community readiness

• Erica will take us through how we can use
  identified criteria to assess the readiness of
  community groups to engage in public health
  initiatives, and to adopt different strategies
  depending on the level of readiness.

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Experience of measuring community readiness

• A particular issue or concern identified
• Interviews conducted with community members
• Measurement of readiness
• Potential strategies identified
• Community change

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Dimensions measured

• Community efforts (programs, policies)
• Community knowledge of efforts
• Leadership (aware active)
• Community climate (supportive)
• Community knowledge about the issue
• Resources for efforts (time, money, space)

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Stages of Community Readiness

• No awareness
• Denial/Resistance
• Vague awareness
• Preplanning
• Preparation
• Initiation
• Stabilisation
• Confirmation/Expansion
• High level of community ownership

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Working example-Suicide prevention project in
rural Victoria

• Community interviews were conducted-some
  individual and some focus groups
• Value to the community members
• Value to the worker
• Intervention strategies designed or confirmed

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Evaluation

• Second round of interviews evaluated progress
• -increase in preparedness to take action
• ? community leadership influence
• ? extent to which local resources
• available to support efforts
• Attribution to project not direct, but based on
  an a priori expectation of these changes,
  assuming a positive contribution to them is a
  reasonable conclusion

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Research

• Support from PHCRED Research Fellowship,
  Melbourne University School of Rural Health
• Conducted research into readiness with an
  organisation as the community
• Provided recommendations for how the organisation
  could move forward around a particular issue

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How is it useful?

• Acknowledges and engages community members
• Provides insight for worker/facilitator
• Guides choice of strategies that are more likely
  to be successful
• Provides data for monitoring change especially
  useful for evaluation and accountability
• May create change

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• Paradoxical Theory of Change
• (Arnold Beisser)
• Change occurs when one becomes what one is, not
  when one tries to become what one is not

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How can it be used?

• An assessment tool
• An evaluation tool
• A change measurement tool
• A planning tool

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• Stages of Readiness
• 1.No Awareness
• Issue is not generally recognized by the
  community or its leaders as a problem (or it may
  truly not be an issue)
• 2.Resistance
• At least some community members recognize that
  it is a problem, but there is little recognition
  that it might be a local problem.
• 3.Vague Awareness
• Most feel that there is a local problem, but
  there is no immediate motivation to do anything
  about it
• 4.Preplanning
• There is clear recognition that something must
  be done, and there may even be a committee.
  However, efforts are not focused or detailed.
• 5.Preparation
• Active leaders begin planning in earnest.
  Community offers modest support of efforts.
• 6.Initiation
• Enough information is available to justify
  efforts. Activities are underway
• 7.Stabilization
• Activities are supported by administrators or
  community decision makers. Staff are trained and
  experienced.
• 8.Confirmation Expansion
• Standard efforts are in place. Community members
  feel comfortable using services, and they support
  expansion. Local data are regularly obtained.
• 9.High Level of Community Ownership
• Detailed and sophisticated knowledge exists
  about prevalence, causes, and consequences.
  Effective evaluation guides new directions. Model
  is applied to other issues.

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WORKSHOP

• In your Best Start groups think about an issue
  and which domain it relates to
• Discuss at which stage of readiness your
  community may be at in relationship to this
  issue

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• After you have chosen the stage of readiness,
• Design some strategies
• Report back

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Contacts

• Stephanie Jones
• Stephanie.Jones_at_mh.org.au
• Erica Ruck
• Ovens and King Community Health Service
• rucke_at_ovensandking.org.au
• Or contact
• www.TriEthnicCenter.Colostate.edu