Community development can be defined - as it is - in many different ways. A definition I like using for community development is, "A plan of action involving operating principles (broader determinants of health, mutual respect, implementation focus, and community capacity), and various processes (community health status assessment and community discussion groups). This strategy is intended to achieve the goal of health status improvement. By-products may include enhanced relationships and resources."

Communities, organizations and individuals have utilized community development strategies to:

• Increase awareness and build support for the health issues

• Increase awareness and build support for existing health resources, and health improvement activities

• Create the forum for dialogue to explore the opportunities for health system level collaboration, and relationship development

• Instill a sense of hope that health issues could be addressed (particularly among patients), and that the community leaders and local health providers understand and support an improved health model

• Gather strategy components for improving health status and the health system (i.e., recruitment and retention or providers, and community awareness of and requirements for a community health center)
  

Proceedings from community development activities have been used to:

• Re-convene community leaders, providers and consumers to share results and continue community dialogue

• Engage in team building exercises

• Build relationships between agencies and organizations

• Incorporate information into an already existing community health status improvement initiative

• Organize a community coalition to address issues raised

• Increase awareness of community health issues and community health status improvement activities

Some outcomes and benefits realized by communities that have engaged in community development activities include:

• national recognition for local/regional collaborative efforts around health status improvement;

• insight about the role and function of, and resources available through federal, state and local state partners; and

• increased knowledge, and strengthened relationships.

How to get started?

Define the purpose for your community development strategy. This purpose will drive the roles, expectations, tasks, time lines and resources required to implement the remaining steps. Purposes for community development strategies have included, among others: to develop partnerships and strategies that can address the needs of uninsured persons; to determine how existing resources can be used to expand access to primary care services for minority or non-English speaking populations; or to build relationships with state or federal resource holders who have mandates to address health service needs in vulnerable populations, such as migrant farm workers, or those infected and affected by HIV/AIDS.

After defining the purpose, the first step in the community development process I utilize is for you to create a list of people who will participate in the site visit community discussions. As we discussed on the telephone, have fun with this and engage other people and institutions to assist you increasing this list and establishing meeting locations (serve as co-inviters and co-hosts). ATTACHMENT 1 lists types of persons we want to talk with, but the specific individuals need to be identified by you and others who know the players in your environment. After you make your initial list, I will review it with you in a conference call. At this time, we'll determine together if the right mix of individuals has been identified.

After this conference call, the next step is to contact each person that has been identified, share the purpose of the site visit, and extend an invitation to participate in a community meeting that is part of the site visit. You can contact potential invitees by letter, telephone and/or fax; but regardless of the type of initial contact, everyone should receive an introductory letter explaining the visit and why they are invited to participate. ATTACHMENT 2A is a sample letter for this purpose. At this point, I would recommend setting up a database (paper or electronic) that lists all persons who are contacted (a sample format has been provide as ATTACHMENT 2B).

Meetings Agendas and schedules for a two-day visit have been developed for your consideration (ATTACHMENT 3A ), along with sign-in sheet (ATTACHMENT 3B).

In the introductory letter, persons are asked to contact a coordinator in your community (you or Cathy) to set up a time when they can participate in a community meeting. [Note: The database of people contacted can be used to keep track of who has responded; follow-up phone calls to persons who do not contact you to participate is an important follow up step that should be included if possible.] When they RSVP, respondents should be given a time that they can participate in a group discussion.

I use the following rules of thumb when scheduling community discussions:

• community leaders are typically interviewed or part of a discussion over a breakfast or lunch;

• other community health and human services providers can typically meet at late morning or mid-afternoon;

• community representatives are easiest to recruit for an early evening;

• groups are most effective when they have between 20 and 30 people attending.

Where do these interviews and discussions happen? Conference and meeting rooms at your facility, or at sites within your community, can be reserved; community sites that are safe and accessible, such as public libraries and places of worship with meeting space, can also be used. I recommend finding these spaces before the official scheduling begins, so that when persons RSVP, specific locations for the meeting can be given to them.

As you will see in the proposed site visit schedule, specific times have been designated for briefing sessions; these are formal processing sessions with the site visit team, and they are a time to discuss what is being learned in the site visit process. The site visit coordinator, and any one else appropriate are welcome to participate in these sessions.

In addition to your time, administrative support and creativity, we would ask that you contribute to this process whatever creature comforts can be afforded for the discussion groups: the breakfasts and lunches, as well as coffee and/or snacks for the morning and afternoon sessions, if supported financially by your facility, would be helpful. If this is not possible, we can discuss other arrangements. Also, I would like to have use of a portable flip chart stand, flip chart pads, flip chart markers (Sanford Round Tips work the best), and masking tape to record and display community discussion participants responses.

In addition ATTACHMENT 4, a sample press release, which can be modified for use prior to, during or after the community development site visit process.

We will also be collecting health data that exists in Community as part of this process-- that is, information that can help us understand the community context. Usually -- a real manageable option -- is a copy of the most recent health assessment (for your county) and something from the chamber of commerce gets the job done. The focus here is on the community discussions more so than the secondary data, but we still need some "picture" of the community.

ATTACHMENT 5 details the types of data typically collected from a community prior to a site visit. I will work with you and others in the community to obtain the information that is required, and establish a methodology that bests accommodates organization and tabulation of data (e.g., fax or e-mail responses). A list of these data indicators and variables can be viewed in the NEW DATA (Excel file format) attachment and may be easier to organize for this particular site visit.

The meeting schedule (once finalized), and the community information will be organized into a Briefing Packet prior to the site visit. The packet will serve as the project team's guide to the multi-day event. Once this document is complete, the site visit set-up process is concluded.

For your review, ATTACHMENT 6 is included. This is the general Community Discussion Group Summary Analysis "outline" that will be used to construct the summary analysis report. Depending on the nature of the site visit - purpose, on-site findings, etc., the outline may change to accommodate.

A TIME, RESOURCE AND CALENDAR document is also included that addresses time and resource commitments for the community discussion group process, as well as a generic calendar that outlines the process from start to finish.