Effective Expansion Planning: Using Community Resources and Fostering Community Development

The Affordable Care Act (ACA) has created many opportunities and monetary incentives for existing community health centers (CHC’s) to expand primary health care services and to build, expand, and improve their facilities. Overall, the Affordable Care Act will allocate $9.5 billion over five years to expand services at community health centers and $1.5 billion to support construction and renovation projects.[1] By 2015, CHC’s are going to be expected to more than double the number of patients they serve, reaching an estimated 40 million patients with comprehensive primary care services.[2] Effective expansion planning will be critical to the ensuring that these goals are met.  

Effective expansion projects take full advantage of existing community resources. Community resources can include other health and social service organizations, community leaders, students, coalitions, churches—any asset within a community that can be utilized to support and enhance expansion planning activities. At their best, expansion projects also foster meaningful community development.  Community development includes efforts that build “the capacity of people to work collectively in addressing their common interests.”[3]  Health centers can promote development on a community-wide level through expansion activities that engage and empower community members as active partners.  Outreach programs can be a particularly valuable health center resource to assist with these efforts.

This article explores how effective expansion planning can use community resources and foster  community development in order to expand access to care for underserved populations. This article also highlights three examples of health center expansion projects and how outreach programs played a role.

 

Incorporating Community Members and Resources into Expansion Planning

Expansion projects should not take place in isolation from the community that is served by the health center. Overlooking the opinions and experiences of community members can result in unwanted, unneeded, or culturally unresponsive services.  Here are three steps that will help to incorporate community voices, feedback and resources into expansion planning:

1. Conduct a needs assessment. Make sure to assess the need for expansion activities in your community.  Needs assessment methods can include surveys, interviews, focus groups, community forums, observation, and the use of existing data. Depending on the scope of the expansion, the needs assessment could be a large, formal process or something more informal.  For information on how to conduct a needs assessment, see: http://web.outreach-partners.org/resources/outreachconnection/77

2. Identify and incorporate existing community resources. Brainstorm a list of resources within your community relevant to expansion planning activities. Resources could be an individual person, place, or business, including other social service providers, hospitals, universities, volunteers, churches, faith-based organizations, city officials, media outlets and funders. Invite representatives from other organizations to a meeting to discuss the expansion project. Connecting with community resources can provide you with potential supporters and collaborators. It can also foster community development by building the capacity of all organizations involved and strengthening services to best meet the needs of the community.

3. Develop an expansion plan. Before embarking on any expansion project, develop a solid plan. Take into account the voices of clinic staff, consumers, and community members affected by the planned expansion.

   • Shared goals and objectives: Develop shared goals and objectives to direct the focus of the expansion. Base them on the results of the needs assessment findings and other observations regarding the need for expansion activities.  Shared goals and objectives can be developed during a strategic planning process or a staff meeting. But remember to involve community stakeholders in this development process!

   • Timelines, roles and responsibilities:  Once you have conducted a needs assessment and developed goals and objectives, establish a timeline and staff roles and responsibilities for the expansion project. Creating a workplan for each staff member that lays out their responsibilities can be helpful.

There are several ways that health centers can remain accountable to community members throughout the duration of a project:

• Ensure that community members are included in every step along the way, beginning with the needs assessment and seeking feedback at the conclusion of the project.
• Invite community members to share their opinions on what services are needed and to propose solutions and approaches toward addressing needs.
• Share the results of the needs assessment with community members through community forums.
• Seek input and feedback from consumers and other community members once an expansion project is completed through patient satisfaction or other types of surveys.  Use this feedback to modify any activities that are not responsive to community needs.

 

Outreach and Expansion Activity Examples

Outreach can play a vital role in supporting expansion activities and promoting community development. Outreach workers:

• are well connected to the community
• understand cultural issues, health beliefs, and specific barriers to accessing care
• can take the time to build and maintain trusting relationships
• understand how the system of care works in your health center and in the community
• most likely already have strong connections and an awareness of existing resources

HOP has identified three specific examples of expansion projects submitted by outreach programs at health centers for our annual Innovative Outreach Practices Report.

1. Program or site expansion. Health centers can expand by developing the scope of their programs, or by adding more sites. In 2003, Panhandle Community Services (PCS) in Gering, Nebraska, initiated the Southwest Nebraska Migrant Study in an attempt to identify health needs and barriers within the farmworker community.  Based on the results of the study, PCS altered the Migrant Program’s goals and outreach activities. PCS also applied for an Expanded Medical Capacity grant from the Bureau of Primary Health Care. This grant allowed PCS to expand beyond a migrant voucher program. In addition, their use of Geographic Information Systems (GIS) Technology improved their ability to reach out to farmworkers. They placed an outreach worker in an area in high need and added a Mobile Health Clinic to serve remote locations identified through GIS.

2. Service expansion. Health centers can expand by offering more or different types of services. In 2006, outreach staff at the Farmworker Health Program of Appalachian Regional Healthcare System (ARHS) in Watauga, North Carolina, conducted focus groups to better understand farmworkers’ perception of mental health. Based on the results of the focus groups, ARHS outreach staff collaborated with local university students to offer new mental health services including mental health and alcohol abuse education, culturally-appropriate music therapy, and a cultural exchange program.

3. Population served expansion. Health centers can expand by serving new, emerging, or other underserved populations within their area.  In the late 1990’s, Kansas Statewide Farmworker Health Program (KSFHP) in Topeka, Kansas noticed an influx of Low-German speaking Mennonites from Mexico in their community.  After conducting a needs assessment, KSFHP received a medical expansion grant in 2004 to provide culturally and linguistically responsive services to this emerging population. KSHFP now has a trilingual staff and offers outreach and enabling services specifically designed to serve Low-German-speaking farmworkers.

By incorporating community members and community resources into the process of expansion planning, health centers can empower and engage populations to become active participants in expansion activities and promote community development. Outreach can also play an important role by seeking out and incorporating community members and resources throughout all stages of expansion planning. 

 

Additional Resources:

To learn more about how to identify and connect with existing resources within your community, please visit:

• The Community Tool Box:  “Identifying Community Assets and Resources.” http://ctb.ku.edu/en/tablecontents/sub_section_main_1043.aspx
• USA.gov: “Community Resources.”  http://www.usa.gov/Citizen/Topics/Family-Community.shtml
• Health Outreach Partners: “Outreach Reference Manual, Chapter 2: Maximizing Your Resources.” http://www.outreach-partners.org/resources/orm

To learn more about the expansion projects described in this article, please visit Health Outreach Partners’ Innovative Outreach Practices Report Database at: http://www.outreach-partners.org/resources/iop.