Ready or Not?assessing and implementing change

Stephanie Jones

Erica Ruck,Ovens and King Community Health Service

Workshop Content1. 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.

2. Work in groups to look at the readiness of your BS community

What has this got to do with Best Start?

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

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?

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

Acknowledges:A. 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

Stages of

Change

DiClemente& Prochaska‘Individual Readiness’ (1982)

Warren‘Group Readiness’

(1978)

1 Pre-contemplation stage-minimal awareness of the problem and therefore little desire to change

Stimulation of interest-recognition of need

2 Contemplation stage-awareness but no commitment to action

Initiation-development of problem definition and alternative solutions

3 Preparation stage-recognition of the problem and exploration of options

Legitimization-local leaders accept the need for action

4 Action stage-implantation of proposed changes in behaviour

Decision to act-development of specific plans involving community members

5 Maintenance stage-consolidation and relapse prevention

Action-implementation

B. Stages of change in a community

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

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.

Experience of measuring community readiness A particular issue or concern identified Interviews conducted with community

members Measurement of readiness Potential strategies identified Community change

Dimensions measured1. Community efforts (programs,

policies)2. Community knowledge of efforts3. Leadership (aware & active)4. Community climate (supportive)5. Community knowledge about the issue6. Resources for efforts (time, money,

space)

Stages of Community Readiness1. No awareness2. Denial/Resistance3. Vague awareness4. Preplanning5. Preparation6. Initiation7. Stabilisation8. Confirmation/Expansion9. High level of community ownership

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

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

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

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

Paradoxical Theory of Change(Arnold Beisser)

“Change occurs when one becomes what one is, not when one tries to become what one is not”

How can it be used? An assessment tool

An evaluation tool

A change measurement tool

A planning tool

Stages of Readiness1.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.ResistanceAt least some community members recognize that it is a problem, but there is little recognition that it might be a local problem.3.Vague AwarenessMost feel that there is a local problem, but there is no immediate motivation to do anything about it4.PreplanningThere is clear recognition that something must be done, and there may even be a committee. However, efforts are not focused or detailed.5.PreparationActive leaders begin planning in earnest. Community offers modest support of efforts.6.InitiationEnough information is available to justify efforts. Activities are underway7.StabilizationActivities are supported by administrators or community decision makers. Staff are trained and experienced.8.Confirmation & ExpansionStandard efforts are in place. Community members feel comfortable using services, and they support expansion. Local data are regularly obtained.9.High Level of Community OwnershipDetailed and sophisticated knowledge exists about prevalence, causes, and consequences. Effective evaluation guides new directions. Model is applied to other issues.

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

After you have chosen the stage of readiness,

Design some strategies

Report back

Contacts: Stephanie Jones

Stephanie.Jones@mh.org.au Erica Ruck Ovens and King Community Health

Servicerucke@ovensandking.org.auOr contact

www.TriEthnicCenter.Colostate.edu