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Houston Community Capacity Building Pilot Project

State: TX Type: Model Practice Year: 2018

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Houston Health Department
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Houston Community Capacity Building Pilot Project
1. Brief description of LHD--location, demographics The Houston Health Department (HHD) is the public health authority for Houston, Texas, the fourth largest city in the U.S., with an estimated 2016 population of 2.3 million, according to the U.S. Census Bureau. Established in 1840, HHD has grown to a department of 1,400 employees, and provides services for an increasingly racially and ethnically diverse population. Houston residents are 24.1% white (non-Hispanic): 44.8% Hispanic, 22.6% black, 7.4% Asian, and 1.1% other. Houston is also a large city, with 667 square miles of land area. 2. Describe the public health issue Fifty percent of health outcomes are due to social and economic factors, and the physical environment. Community safety, environmental quality, the built environment, education, employment, income, and family and social support all combine to be powerful influences on health (University of Wisconsin). These factors vary widely across the City of Houston. Houston neighborhoods that rank lower on social and economic factors frequently have high minority populations and worse health outcomes. HHD recognizes that the residents are uniquely positioned to identify and advocate for changes that will improve the health of their neighborhoods. To address health equity concerns by empowering neighborhood residents, HHD implemented the Community Capacity Building Pilot Project. This initiative teaches basic skills in assessment, planning, advocacy, evaluation and sustainability to assist people to take action in their communities (University of Kansas). To implement the project, HHD followed the CDC's Racial and Ethnic Approaches to Community Health (REACH) framework and the Community Action Model from the San Francisco Department of Public Health. 3. Goals and objectives of the proposed practice Goal 1: Empower Houston residents, especially those living in neighborhoods with health disparities, to advocate for their own health and for improvements in their communities. Objective 1. Conduct advocacy skills training in the three HHD service areas in Houston, with training located in neighborhoods with identified health disparities or health concerns, in Year 1. Objective 2. Provide opportunities for those who successfully complete the training to apply for mini grants to facilitate taking action in Year 1. Goal 2: Ensure that at least three mini-grant community projects are completed, with representation in all three HHD Service Areas. Objective 1. Evaluate mini grant applications and provide grant funding to at least three awardees by Year 1. Objective 2. Assist awardees as needed to ensure successful completion, including evaluation, of at least three community projects by Year 2. 4. How was the practice implemented/activities HHD began the process by reviewing community assessments that identified demographics and key health issues across Houston. Community area health profiles for the three HHD Service Areas (Areas A, B and C) were used as a basis for training. Two day training was conducted in each of the three areas, and included: Session 1 Overview & Community Health Profiles Community Building, Leadership and Collaboration Public Health and Social Determinants of Health Environmental Health & Emergency Preparedness Session 2 Government 101 Using Media to Help You & the Value of Social Media Applying for the Mini Grant Persons who completed the training were eligible to apply for a mini grant to impact a community need. Grant awards were made to those who met the grant criteria. HHD provided assistance as needed to ensure that the awardees were able to complete and evaluate their projects. 5. Results/outcomes (list process milestones and intended/actual outcomes and impacts. a. Were all of the objectives met? Yes, all objectives were met b. What specific factors led to the success of this practice? HHD adapted the evidence-based CDC REACH model and the San Francisco Community Action Model for this project. Both have been used successfully for several years. The training was tailored to each community. Neighborhood residents identified concerns where they lived. Funding was provided to assist residents to carry out projects to impact health concerns they identified. HHD provided assistance to grantees as needed to ensure that they successfully completed their projects 6. Public Health impact of practice Neighborhood projects were identified that were uniquely appropriate to assist their community. The projects were well attended and included mental health, environmental pollution, cancer prevention, nutrition, and emergency preparedness. Some classes were taught entirely in the languages of participants' home countries. Participants also benefitted from interventions, such as decreasing stigma of mental health concerns through group discussion, refugee support through participating in planting a community garden, and learning emergency preparedness that included a home an emergency kit. 7. Website for your program, or LHD. http://www.houstontx.gov/health/
1. Statement of the problem/public health issue Fifty percent of health outcomes are due to social and economic factors, and the physical environment. Community safety, environmental quality, the built environment, education, employment, income, and family and social support all combine to be powerful influences on health (University of Wisconsin). These factors are apparent in varying degrees in each community across the U.S. The residents in these communities are uniquely positioned to identify and advocate for changes that will improve the health of their neighborhood. Local residents often have ideas for how their community could be improved through physical changes such as installing walking trails, cooperative efforts such as coordinating patrol areas and times with local police departments, securing resources such as might come through advocacy with city government, or improving community awareness through training such as emergency preparedness. In many cases, however, they do not know how to organize their efforts in the community and move forward with impact. Community Capacity Building is a way of assisting people to take action in their home communities by providing needed skills in core areas, including assessment, planning, advocacy, evaluation and sustainability. This involves teaching and stimulating use of basic community competencies through methods such as workshops, webinars, and classes (University of Kansas). The Houston Health Department (HHD) has, for many years, been committed to working with local neighborhoods to empower residents to advocate for their own health and for improvements in their communities. Projects such as A.I.M. (Assessment, Intervention and Mobilization) and services provided by the 11 HHD Multi-Service Centers reach out into communities to contact residents, provide them with resources, and inform them about how to seek health improvements. The HHD Community Capacity Building project was designed to further this effort by (1) conducting advocacy skills trainings in the three HHD service areas in Houston, followed by (2) providing opportunities for those who successfully complete the training to apply for mini grants to facilitate taking action. 2. What target population is affected by problem (please include relevant demographics)? The target population is Houston communities with identified health disparities or concerns, such as location in a food desert, nearby environmental pollution, lack of safe places for walking and other recreation, and/or high levels of poverty and chronic diseases. These identified neighborhoods often have high percentages of minority populations. a. What is the target population size? Approximately 22% of the Houston population, or 500,000 persons, live below the Federal Poverty Level. Neighborhoods with high levels of poverty were used as a general measure, as poverty is highly correlated with health disparities. b. What percentage did you reach? Approximately 500 persons were directly impacted by the training and grant projects. Many more were indirectly impacted, through hearing about the project in their neighborhood, supporting the project through volunteer time and/or donations, or helping to advocate for their community. While this is a small percentage of those who live in poverty and face health disparities, this was a pilot project. Since the project was well received in the neighborhoods, the scope is expected to be larger in the future. Funding has been secured to expand the program in the coming years. 3. What has been done in the past to address the problem? The Houston Health Department (HHD) has, for many years, been committed to addressing health disparities within the city, with services targeted to low-income and minority groups such as maternal and child health, family planning, immunizations, and HIV/STD screening and treatment. Additional projects to impact health equity include: Affordable Care Act (ACA) – leads partners in the Gulf Coast Marketplace Collaborative to provide outreach and enrollment assistance for the Affordable Care Act. AIM (Assessment, Intervention, Mobilization) – visits targeted low-income neighborhoods to collect data, provide links to services, and mobilize action. Project Saving Smiles – provides dental screenings and sealants for permanent teeth for approximately 10,000 high-need second graders in Houston area schools each year. Vision Partnership – holds vision screening events and provides glasses for approximately 10,000 low-income students in Houston area schools each year. 1115 Medicaid Waiver – conducts 15 programs that meet the HHS and CMS triple” aim criteria of a) improving population health 2) delivering better health care, and 3) reducing health system costs. My Brother's Keeper Houston (MBK Houston) – serves as the backbone organization for over 200 partners that are working to improve outcomes and provide second chances for men and boys of color. Community Re-Entry Network – re-integrates parolees with their families and communities and reduces recidivism. HHD also works with local neighborhoods to empower residents to advocate for their own health and for improvements in their communities. Projects such as A.I.M. and My Brother's Keeper involve partnerships with the targeted neighborhoods. Services provided by the 11 HHD Multi-Service Centers also reach out into communities to contact residents, provide them with resources, and inform them about how to seek health improvements. While many of these initiatives involve working closely with neighborhoods experiencing health disparities, they typically are driven by HHD-identified community needs. 4. Why is the current/proposed practice better? Many HHD projects have focused on improving health equity among the communities within Houston that show socio-economic risk factors. Generally, these projects are undertaken with community input. However, the HHD Capacity Building Program goes a step further, to empower community members to develop the ideas for projects needed by their neighborhoods and then take the lead in carrying out these projects. This approach has led to innovative projects uniquely designed for the community, with creative ways to approach and involve vulnerable groups. For example, in several cases, interventions were presented in the languages of the home countries of the target groups. 5. Is current practice innovative? How so/explain? a. Is it new to the field of public health Or a creative use of existing tool or practice: What tool or practice did you use in an original way to create your practice? (e.g., APC development tool, The Guide to Community Preventive Services, HP 2020, MAPP, PACE EH, a tool from NACCHO's Toolbox etc.) Yes, it is innovative, although not new to the field of public health. The project adapts the CDC REACH program, which uses evidence-based practices to provide guidance and grant funding to local communities across the U.S., to use by a local health department. The CDC REACH program has been effective in many different communities over several years, and has led to innovative and culturally-targeted interventions. The HHD project brings the REACH concepts to the neighborhood level, and empowers those who have never before carried out this type of project, to assist the communities in which they live. The project also incorporates the Community Action Model from the San Francisco Department of Public Health, but with innovative adaptations to better fit the Houston community and align with the Houston Health Department resources. 6. Is the current practice evidence-based? If yes, provide references (Examples of evidence-based guidelines include the Guide to Community Preventive Services, MMWR Recommendations and Reports, National Guideline Clearinghouses, and the USPSTF Recommendations.) Yes, the project is evidence-based. HHD has adapted the CDC REACH program for this project. The REACH program website lists evidence-based components of REACH, and those included in the HHD program include: Supporting community coalitions that design, implement, evaluate, and disseminate community-driven strategies to eliminate health disparities. Providing the infrastructure to implement, coordinate, refine, disseminate, and evaluate successful evidence- or practice-based approaches and programs in local communities. Supporting national organizations by sharing evidence and practice-based strategies and culturally based community practices to eliminate racial and ethnic health disparities. More information about the REACH program is available at https://www.cdc.gov/nccdphp/dnpao/state-local-programs/reach/. The San Francisco Community Action Model was developed more than 20 years ago to address disparities in health. Since that time, this model has been shown to be effective though multiple projects and evaluations (Hennessey-Lavery, Smith, Esparza, Hrushow, Moore & Reed, 2004; San Francisco Tobacco-Free Project, 2016). Some of the Community Action Model evidence-based activities used in the HHD project include: 1. Skill-based training, in which community advocates select the focus—adapted by HHD to include advocacy training, and community health profiles developed by HHD. 2. Action research, in which advocates define, design, and conduct a community diagnosis—adapted by HHD so that participants could discuss and define community needs in the classroom setting. 3. Analysis, in which advocates assess the results of the community diagnosis and prepare findings—adapted by HHD to allow each participant to determine a specific need in their home community. 4. Policy development, in which advocates select, plan, and implement an environmental change action and educational activities intended to support it—adapted by HHD to allow participants to write a mini grant application to address the need they identified. 5. Implementation, in which advocates seek to ensure that the policy outcome is sustainable—adapted by HHD to become the completion of grant-funded activities. The HHD project also serves to maintain local public health response to The Ten Essential Public Health Services national guidelines for public health departments by meeting two of the Essential Public Health Services: 3) Inform, educate, and empower people about health issues and 4) Mobilize community partnerships to identify and solve health problems.
Nutrition, Physical Activity, and Obesity
1. Goal(s) and objectives of practice Goal 1: Empower Houston residents, especially those living in neighborhoods with health disparities, to advocate for their own health and for improvements in their communities. Objective 1. Conduct advocacy skills training in the three HHD service areas in Houston, with training located in neighborhoods with identified health disparities or health concerns, in Year 1. Objective 2. Provide opportunities for those who successfully complete the training to apply for mini grants to facilitate taking action in Year 1. Goal 2: Ensure that at least three mini-grant community projects are completed, with representation in all three HHD Service Areas. Objective 1. Evaluate mini grant applications and provide grant funding to at least three awardees by Year 1. Objective 2. Assist awardees as needed to ensure successful completion, including evaluation, of at least three community projects by Year 2. An additional priority was to maintain local public health response to The Ten Essential Public Health Services national guidelines for public health departments by meeting two of the Essential Public Health Services: 3) Inform, educate, and empower people about health issues and 4) Mobilize community partnerships to identify and solve health problems. Within the larger goals stated above, the project also had short-term capacity building outcomes for the participants. These included: Increased knowledge of: Health issues and information sources Community organizing Building support Priority health issues Grant writing process Engagement Increased self-efficacy for: Developing community improvement projects Seeking/asking for funding and making a case Interacting with policy makers (city government) Creating implementation plans and budgets Implementing community health improvement projects Measuring changes Achievement of these short-term outcomes was anticipated to lead to the mid-term outcome of increased community empowerment, which facilitates better health outcomes in the community in the long-term. --------------------------------------------------------------------------------------------------------------------------------- 2. What did you do to achieve the goals and objectives? a. Steps taken to implement the program Step 1. Planning the Project The Houston Health Department (HHD) Community Capacity Building Pilot Project was planned to use information from the locally developed Community Health Profiles, political contacts, skills training, and other resources to assist residents in Houston communities to evaluate and improve the conditions that impact health in their communities. This effort began in 2015 with envisioning the project, and was led by the HHD Office of Planning, Evaluation & Research for Effectiveness (OPERE). The HHD project was designed to assist community members, especially in low-income areas, to learn skills that will help them: Organize community efforts and residents to take steps to improve their locale Learn how to advocate for community improvements Become confident and feel empowered to carry out community improvement efforts The project was also intended to be useful for long-term HHD departmental goals. For example, completion was planned so the full report will be available as a resource prior to next Houston Community Health Improvement Plan (CHIP) due date. Another priority was to maintain local public health response to The Ten Essential Public Health Services national guidelines for public health departments. After reviewing a number of models, the HHD team decided to use the CDC Racial and Ethnic Approaches to Community Health (REACH) as the overall framework (CDC Division of Nutrition, Physical Activity and Obesity) and the Community Action Model (Hennessey-Lavery, Smith, Esparza, Hrushow, Moore & Reed, 2004) for some of the program components and the plan to operationalize the project. Both models were adapted to fit the HHD Capacity Building Program. The REACH program was developed by the Centers for Disease Control and Prevention (CDC) in 1999 to reduce racial and ethnic health disparities across the U.S. Through the REACH program, CDC awards grants to local groups to carry out culturally appropriate programs to address a wide range of health issues. Key minority groups are targeted to benefit from REACH activities based on documented disparities such as higher rates of heart disease, obesity and diabetes. The CDC REACH program began in 1999 and has since assisted numerous communities across the U.S. to decrease barriers and improve health outcomes for high risk groups. REACH grants have been successfully implemented in the Houston area, so the HHD team was familiar with the goals and methods. HHD used the REACH concept of providing training, funding and guidance for projects that are aligned with local community culture and needs to develop the HHD Community Capacity Building Program. To implement the HHD Program, HHD took the role of providing the training in community health and advocacy, and then funding grant projects tailored to each applicant's Houston community. The HHD program did not target specific minority groups, but did locate the training in largely minority and lower income communities across Houston, where the program was anticipated to have the greatest potential for positive impacts. To develop the components of the HHD program and address disparities in health, HHD chose the Community Action Model from the San Francisco Department of Public Health to serve as a reference model. This model has been used extensively since 1996 by the San Francisco Department of Public Health in public health practice settings to build capacity in the community organizations or community leaders. HHD determined that the Capacity Building Program would take place across three years, and would build skills on the individual, organizational and community levels. Step 2. Vendor Selection In December of 2015, HHD issued a Scope of Services for Community Health Training and Leadership announcement seeking vendors to engage the residents of Areas A, B and C, conduct the training, and manage the mini grant application process. A local public affairs and communications firm with 20 years of public health experience was selected to reach out to community members, develop the curriculum, teach the classes, and award the mini grants, with HHD approval of the various plans. The comprehensive curriculum was to include: The impact of the Houston Health Department in the community Community building Social determinants of health Environment and health Planning and implementing community health neighborhood projects Interacting with decision makers Step 3. Recruitment HHD and the contracted vendor used several methods to reach interested community members in the three Areas. Among these were: A flyer, developed to advertise the training to the communities Outreach to 44 local businesses, apartment complexes, libraries, community centers, and parks to provide information about the training and flyers. Contacts included 15 Starbucks locations. Social media contacts including: Facebook—Invitations were shared on the fan pages for Areas A, B, and C. Over 1,000 personal contacts received the invitation. Twitter—Shared the invitation with over 1,200 followers. The League of Women voters shared the invite with 800 followers. Emails to partners, including the Office of International Communities, Mi Familia Bota (Latino Emerging Leaders Program), Spring Independent School District, and FIEL (a Houston non-profit supporting immigrants and students). Fifty-four community members responded and enrolled in the two day training. Step 4. Training The classes were held in HHD Multi-Service Centers located in Areas A, B and C during the summer of 2016. Each Multi-Service Center was located in an area of Houston with neighborhood concerns, such as location in a food desert, nearby environmental pollution, lack of safe places for walking and other recreation, and/or high levels of poverty and chronic diseases. Third Ward, Kashmere, and Sunnyside Multi-Service Centers were the training sites. The two-day training was held over two consecutive Saturdays. Training Session 1 Module A: Overview & Community Health Profiles Module B: Community Building, Leadership and Collaboration Module C: Public Health and Social Determinants of Health Module D: Environmental Health & Emergency Preparedness Training Session 2 Module E: Government 101 Module F: Using Media to Help You & the Value of Social Media Module G: Applying for the Mini Grant Many outside speakers were invited to provide perspectives on the modules, and the classes involved much interaction between instructors and students, and also between students. Step 5. Mini Grants for Communities The persons who completed both days of the 2016 Civic Leadership Summer Session (Community Capacity Building Workshop) were eligible to apply for a mini grant that would benefit their community. The Houston Health Department determined that three mini grants would be made available in each of the three Areas (A,B,C). For each area, either three grants (each up to $1,000) or one grant (up to $3,000) would be provided. Grants at the $1,000 level could be submitted by an individual, but the $3,000 grants would need to represent a team. The mini grant application asked the applicants to consider whether the project can realistically be done, if it fills an important community need, and how it will improve the health of the community. The grants were asked to provide project aims, a project overview, a timeline, a reasonable budget, and an evaluation plan. The applications were due several weeks following completion of the training sessions. These dates were August 8, 2017 (Area A), August 15 (Area B), and August 29 (Area C). Six applications for mini grants were received from the three areas. Of these, two were team projects and four were applications by an individual. The topics for the mini grants addressed a range of interventions to help local communities. Topics included: An educational forum for Spanish-speaking individuals and families to help those with mental illness find resources and combat the negative stigma surrounding mental illness. An educational series on environmental pollution taught for neighborhoods close to the Houston Ship Channel and refineries, to understand local environmental threats and how to report them to City of Houston officials through the 3-1-1 help line. An education event designed for Hispanic residents with limited English proficiency and who may follow traditional Hispanic health care practices, to learn the importance of cancer screening. Establishing a community garden for African refugees such as Somali and Congolese, to provide food and a sense of their homeland where many were farmers. The project also hoped to decrease suicide among this group through creating a sense of community. Training seniors in preparedness to cope with disasters such as flooding and power outages. An asset mapping project designed to assess the lack of grocery stores in the Fifth Ward, with the goal of encouraging more businesses that provide healthy grocery stores and restaurants to locate in the area, and to eventually establish a local Chamber of Commerce. The applications requested amounts from $900 to $3,000. Applications were rated according to the following criteria: 1. This project can be realistically done. 2. This project identifies an important community need. 3. This project makes a real difference in the community. 4. This project improves the health of the community. 5. The timeline for completion looks realistic. 6. The budget appears reasonable. (Up to $1,000 for an individual and up to $3,000 for team) 7. If applicable, there is a plan to continue the project when the mini grant runs out. 8. This is an idea that has been proven successful before or is based on evidence. 9. There is a plan for evaluating project's success. 10. FIVE ADDITIONAL BONUS POINTS: This project addresses environmental health or emergency health preparedness. The reviewers found positive aspects of all the grant applications, and the applications addressed needs in some of the areas with the highest levels of poverty in Houston. Therefore, the team decided that all six applications would be funded. Funding ranged from $900 to $1,500. Letters were mailed to notify applicants of their awards in mid-November, 2016. All six projects decided to accept the approved cash amount and complete their projects. Project proposals were: Project 1. It's Okay to Not be Okay Council Districts B, H, I Health Service Areas A & B A bilingual mental health awareness program, aimed at taking away stigma of mental illness. Target Denver Harbor, Fifth Ward and East End. Project Leaders: Griselda Gallardo, Gabriela Salazar, Diana Wakasugi Award: $1,200 Project 2. Toxic Trespass-Knowing Your Environment Council Districts B & I Health Service Area B An environmental justice training program targeted to Clinton Park & Pleasantville communities to learn about oil and chemical exposure. Project Leaders: Bridgette Murray and Achieving Community Tasks Success-fully (ACTS) Award: $1,500 Project 3. Cancer Prevention Education Forum Council District F Health Service Area C One-time symposium aimed toward those with little or no English proficiency and likely to follow traditional Hispanic healthcare practices, in the Southwest Alief area. The symposium will address cancer prevention. Project Leaders: Heladio Ibarguen and The Cascajal Foundation Award: $1,000 Project 4. Garden of Hope Council District J Health Service Area C Create a gardening project and mental health education event to address growing mental health concerns in the refugee community in the Gulfton area. The garden will raise fruits and vegetables from refugees' native countries to remind them of their homelands, and foster a sense of community. Project Leaders: Omar Osman, Azeb Yusuf, and the Somali Bantu Community of Greater Houston Award: $1,500 Project 5. Sunnyside Senior SAFE Program Council District D Health Service Area A Provide an environmental health, safety and disaster education informational forum and emergency kits to 100 seniors in the Sunnyside area. Project Leaders: Della Banks and Dela Productions Award: $1,500 Project 6. Get A.M.P.E.D. About Fifth Ward (Asset Mapping Project and Economic Development) Council District B Health Service Area B Collect information to identify the need for more healthy food options and hold Call to Action meetings with community members, with plans to collaborate with others to develop a Chamber of Commerce in Fifth Ward. Project Leader: Kathy Phipps Award: $1,000 On January 10, 2016, the grant awardees were invited to a Houston City Council meeting to be recognized and receive certificates from At-large Council members for their successful grant applications. Four of the six awardees were able to attend. The mayor, Sylvester Turner; Council members Amanda Edwards and David Robinson; the HHD Director, Stephen Williams; other members of the City Council; and the audience recognized their achievements in service of their communities. The project leader and trainers, and representatives of the HHD Multi-Service Centers were also in attendance. Follow-up at Six and Eight Months Six months after the awards were announced, a follow-up assessment showed that four projects were completed and two were partially complete. At eight months, five projects were complete. Community participation and feedback showed the projects to be well received, and assessed as providing important education and resources to the communities. The five completed projects were placed in consideration for supplemental funding to repeat their projects at least once within three months, based on additional potential funding from HHD. The following summary describes each project and the associated outcomes in detail. Each project team submitted a final report as a part of their deliverables. Final Project Summaries Project 1. It's Okay to Not be Okay Project Leaders: Griselda Gallardo, Mayra Rivera, Gabriela Salazar, Diana Wakasugi Status: Complete Outreach: Radio stations, newspapers, social media, announcements at churches, and flyers in the community and passed out door-to-door. Program: It's Okay to Not be Okay – three 30 minute sessions on Depression, Bipolar/Schizophrenia, and Support Systems. Speakers and an introductory video were presented for each session, and information booths were available. Speakers, all local mental health professionals: -Rob Arteaga, LPC – Depression -Sergio Aguirre, School-Based Counselor – Schizophrenia/Bipolar -Adrian Yam, LPC – Support Systems and Coping Date: February 11, 2017 Location: Denver Harbor Multi-Service Center Participation: 86 attendees Evaluation: 55 completed surveys. The majority viewed mental health issues in a negative way prior to the event. After the event, the majority no longer saw mental health concerns as negative. Project 2. Toxic Trespass—Knowing Your Environment Project Leaders: Bridgette Murray and Achieving Community Tasks Success-fully (ACTS) Status: Complete Outreach: Flyers to households in Clinton Park and Pleasantville. Reminders were sent to all attendees at the introductory sessions who expressed interest in the training session. Training Sessions: Toxic Trespass—Knowing Your Environment Introductory meetings were one hour, to provide an overview of local environmental issues for the two communities near industrial areas in east Houston. The four-hour training session followed with in-depth information about EPA measures, toxic health impacts, citizen response and disaster planning. Speaker: Bridgette Murray, trained by Riki Ott, Marine Toxicologist Date: Introductory meetings on January 11 and January 14. Training session on February 18, 2017. Location: Introductory meetings at St. Matthew Baptist Church in Clinton Park and Judson Robinson Sr. Park in Pleasantville. Training session at Spirit of Life Ministries. Participation: Clinton Park Introductory—53; Pleasantville Introductory—33; Training Session—15. Evaluation: 46 evaluations were completed at the various sessions. A majority indicated the topic is relevant in their community. Many expressed a desire to learn more. Attendees commented that the trainings very informative, interesting, and eye-opening. Project 3. Cancer Prevention Education Forum Project Leaders: Heladio Ibarguen and The Cascajal Foundation Status: Project completed. The team conducted a 3-hour symposium to help persons with little or no English proficiency learn about cancer prevention. Outreach: 3000 flyers were distributed Symposium: How to Prevent Cancer, provided in Spanish Speakers: Lizette Rangel MPH, MD Anderson Cancer Center—Physical activity and cancer prevention Ms. Lozano, cancer survivor—Personal experiences with cancer and cultural/language barriers Yanneth Rivera MPH, CHES, MD Anderson Cancer Center—Preventing and recognizing skin cancer Ana Paula Correa Refinetti, MD, MD Anderson Cancer Center—Preventable cancers and healthy choices to lower cancer risk Date: January 21, 2017, 9:00 am to 12:00 pm Location: Sharpstown Community Center, 6600 Harbor Town Dr., Houston, TX 77036 Participation: 86 community members attended, along with 15 Casajal Foundation members. Evaluation: 100% were satisfied or very satisfied that (1) the information they were given contributed to their knowledge about cancer, and (2) the forum was well organized and helpful. Project 4. Garden of Hope Project Leaders: Omar Osman, Azeb Yusuf, and the Somali Bantu Community of Greater Houston Status: Project completed. 1. Part One—the Mental Health Forum Outreach: Flyers and communications to the Somali-Bantu Community of Greater Houston Forum: Mental Health for Refugees. The forum was presented in English and interpreted in their language by the Center Director. Speaker: Elizabeth Mesfin, LPC, a local mental health professional, conducted the workshop. The information was translated by Omar Osman, the Somali-Bantu Community Executive Director. Ten community groups were sponsors for the event. Date: February 18, 2017 Location for the forum: HHD Southwest Multi-Service Center, 6400 High Star Drive, Houston, TX 77074 Participation: 28 participants Evaluation: The participants indicated interest in the program and were engaged in learning. 2. Part Two—Planting the Gardens The group was given four plots of garden space at the Southwest Multi-Service Center. The project used the expertise of the City of Houston horticulturalist and one of their own volunteers who is familiar with gardening and plants native to their country. Outreach: Participants at the Mental Health Forum in February were told about plans for the garden and were encouraged to participate. In addition flyers describing the planting event were distributed through the Somali-Bantu Center. Garden Planting: Garden supplies were purchased and the garden blocks and soil were installed in May, 2017. The project refugee participants came together to plant tomatoes, okra, green beans, and dragon cayenne in June. Date: Planting on June 3, 2017 Location: Southwest Multi-Service Center Participation: 20 – most were attendees of the Mental Health Forum in February and members of the Somali-Bantu Community. Project 5. Sunnyside Senior SAFE Program Project Leaders: Della Banks and Dela Productions Status: Complete Outreach: Social media; flyers in libraries, multi-service centers and small businesses; announcements on TV-PSA; interview on local talk show Great Day Houston. Training Session: Senior Safe Program with topics on emergency preparedness for seniors Speakers: John Carter, John Productions, Host -Suzanne Terry, Houston Area Agency on Aging -Melanie Manville, Houston Office of Emergency Management -Raul Castillo, City of Houston Health Department, Emergency Preparedness -Ms. Flora, Alzheimer's CITNA Research Community Support: Multiple community groups contributed to publication of the event and provided donations such as water. Date: February 11, 2017, 11:00 am to 2:00 pm, with a follow-up session for seniors who could not attend on February 16, 2017. Location: Sunnyside Multi-Service Center, with a follow-up session at the Senior Residence home of Anna Dupree. Participation: 82 participants; the seniors were aged 50 to 90 in the Sunnyside area. Each received a free Emergency Disaster Kit containing a flashlight, first aid kit, poncho, water and emergency information from local agencies that address emergency preparedness (AAA, Office of Emergency Management, Houston Health Department). Evaluation: Participants were very interactive with the speakers and expressed appreciation for the information provided. They completed a survey that indicated a need for this type of program and information. Future plans: Based on the positive response of this program, two additional sessions were scheduled for March, 2017. The Senior Safe team also agreed to participate in upcoming emergency preparedness activities with the Houston Health Department. Project 6. Get A.M.P.E.D. About Fifth Ward (Asset Mapping Project and Economic Development) Project Leader: Kathy Phipps Status: Partially completed. A survey was developed and the Asset Mapping for Fifth Ward was completed. One community presentation was held. However, there was a mix-up on the place, and the community meeting was poorly attended. Follow-up presentations are to be held in the community and with Houston Health Department staff, but these have not been completed. Outreach: Invitations distributed Presentation: Community Discussion on Fifth Ward Asset Mapping Outcomes Date: February 28, 2017 Location: Victual Parlor, 4300 Lyons, Houston TX Participation: One community member attended Evaluation: N/A Continuation of Mini Grants The five mini grant projects were successfully completed and were evaluated positively by the impacted communities. Four of these projects reached out to HHD to request continuation funding so their projects could be continued. The HHD team agreed that the results of these projects were impressive and in August, 2017, agreed to provide continued limited funding to allow the projects to conduct at least one more event or training. --------------------------------------------------------------------------------------------------------------------------------- 3. Any criteria for who was selected to receive the practice (if applicable)? Any member of the community was welcome to participate in the Capacity Building Training. The classes were held in three HHD Multi-Service Centers located in areas of Houston with high percentages of minority and low-income populations, and also with neighborhood concerns, such as nearby pollution or lack of recreational resources. Locating the training in areas with health concerns and disparities helped to ensure that those attending were residents of neighborhoods that were most likely to benefit from their newly developed advocacy skills and projects. --------------------------------------------------------------------------------------------------------------------------------- 4. What was the timeframe for the practice? Planning Period – 2015 Develop the plan for the HHD Capacity Building Program. Issue a Scope of Services for Community Health Training and Leadership announcement to select a vendor to provide the training and oversee the mini grant selection and implementation. Project Year 1—2016 Select the vendor. Train community leaders in Houston Areas A, B, and C to advocate for health issues to improve the community, especially regarding environmental hazards and chronic disease. Conduct training sessions with a variety of speakers and activities to teach and stimulate the use of basic community competence, such as how attendees can advocate for community improvements. Provide those who successfully complete the two-day training with an opportunity to apply for mini grant funding for a project tailored to improve the health of their community. Evaluate the mini grant applications and select for funding the projects that meet the required standards, such as cultural fit for the community, positive impact on community needs, and an evaluation component. Provide funding to the awardees. Ensure that grant funded projects are initiated by the end of year 1. Serve as a resource for funded projects with technical assistance as needed. Project Year 2—2017 Finalize completion of the mini grant projects. Provide technical assistance and resources if needed and appropriate. Ensure that each project completes a final report. Secure additional funding to allow successful community projects to continue their efforts with a second round of mini grants. Complete the second round of mini grant activities by the end of year 2. --------------------------------------------------------------------------------------------------------------------------------- 5. Were other stakeholders involved? What was their role in the planning and implementation process? The planning process was undertaken by the Office of Planning, Evaluation and Research for Effectiveness in the Director's Office at HHD. Once the vendor selection was completed, the vendor took a major collaborative role. The vendor has been a well-respected public health advocacy group in the Houston area and collaborator with HHD for many years. Many stakeholders were involved. As the Capacity Building classes were developed, the vendor, as an agent of HHD, involved Houston City Council members, local media specialists, experts on public health and emergency preparedness, and other resources. The training was publicized in cooperation with over 40 partners including Empowerment Community Center, Starbucks, and Texas Southern University. Additional collaborators, such as MD Anderson Cancer Center and St. Matthew Baptist Church, came on board to provide presenters, training sites, or other volunteer support during the mini grant projects. These efforts were essential as HHD worked with the projects and their supporting organizations to ensure successful implementation of their community activities. b. What does the LHD do to foster collaboration with community stakeholders? Describe the relationship(s) and how it furthers the practice goal(s) Nearly all of HHD programs and projects involve community stakeholders. For example, the Bureau of HIV/STD and Viral Hepatitis has a community advisory board to provide input for the program. The Bureau of Dental Health works with many local elementary schools to ensure that low-income second graders have oral exams and sealants. The department's AIM projects (Assessment, Intervention and Mobilization) are invited into communities to go door-to-door to contact residents about their health status and resources. The 11 HHD Multi-Service Centers provide community outreach and resources, and provide space for partner activites such as Houston Community College ESL classes and the YWCA Senior Program. Each of these and similar projects involve meetings and coordination with interested community stakeholders. These community relationships are central to continuing the capacity building efforts. --------------------------------------------------------------------------------------------------------------------------------- 6. Any start up or in-kind costs and funding services associated with this practice? Please provide actual data, if possible. Otherwise, provide an estimate of start-up costs/ budget breakdown. Direct Costs were: $49,999 for the training contractor and expenses -Staffing: Project Manager and Program Developer: $18,299 Trainers (3 FTE): 16 hrs. x $150/hr. x 3 sites = $7,200 Assistant/Data Entry: $2,400 -Program Expenses: Sites Rental/Maintenance: $2,000/site x 3= $6,000 Refreshments: $10/pp x 30 x 4 sessions x 3 sites= $3,600 Supplies & Materials: $30/pp x $10 x 3 sites= $900 Printing/copying: $1,000 x 3 sites= $3,000 Translation (Spanish, Vietnamese & Chinese)$15/pp x 30 x 3= $1,350 Stipends for Interpretation Services by Partners $100/session x 4 sessions x 4 partners= $1,600 Appreciation Gifts for Speakers (as appropriate) $25 x 6 x 3= $450 Miscellaneous: $500 SUBTOTAL EXPENSES: $47,000 Overhead: 10%= $4,700 $7,700 for funding the mini grants In-kind Costs were primarily HHD staff salary costs for overseeing the project and completing the evaluation.
1. What did you find out? To what extent were your objectives achieved? Please re-state your objectives. The project showed the ability of community residents to design and implement creative projects that uniquely addressed needs where they lived. The HHD staff and contractor noted how much the grantees were able to achieve with minimal funding, and how well received the projects were in the communities. The HHD team agreed that HHD staff alone would not have had the knowledge, relationships, or credibility to implement similar activities in these communities. The HHD-community partnerships developed an impact far beyond what was initially expected. All objectives were successfully completed. Goal 1: Empower Houston residents, especially those living in neighborhoods with health disparities, to advocate for their own health and for improvements in their communities. Objective 1. Conduct advocacy skills training in the three HHD service areas in Houston, with training located in neighborhoods with identified health disparities or health concerns, in Year 1. Objective 2. Provide opportunities for those who successfully complete the training to apply for mini grants to facilitate taking action in Year 1. Goal 2: Ensure that at least three mini-grant community projects are completed, with representation in all three HHD Service Areas. Objective 1. Evaluate mini grant applications and provide grant funding to at least three awardees by Year 1. Objective 2. Assist awardees as needed to ensure successful completion, including evaluation, of at least three community projects by Year 2. 2. Did you evaluate your practice? Yes, the project was evaluated at several points: during the training, during each mini project, and at the end of the project to assess completion of the initial goals and objectives. All goals and objectives were successfully completed. a. List any primary data sources, who collected the data, and how (if applicable) Pre- and post-test scores were collected at the beginning and end of the training sessions. The pre- and post-tests were designed and administered by HHD staff with Master's Degrees in Public Health. Primary data collected by the grantee projects was designed by the leaders of those projects, with HHD input as requested, and collected by the grantee project teams from participants at the project events. b. List any secondary data sources used (if applicable) N/A c. List performance measures used. Include process and outcome measures as appropriate. The evaluation was conducted at several points along the project. During the training, a pre- and post-tests were completed by the participants. Then, each project conducted an evaluation of the effectiveness of their community intervention. And, finally, the overall project was evaluated according to completion of the initial goals and objectives. 1. Pre- and post-tests during the training The evaluation was conducted by a pre- and post-test completed by the Civic Leadership Summer Series 2016 participants. The evaluation included demographic information, and an assessment of each participant's awareness of community health-related issues and their confidence in taking action to advocate for improvement in health concerns in their community. Demographic Information Demographic information was collected on 27 of the participants. The largest group of participants (17) described themselves as black. The education level was higher among participants than the community at large, with over half reporting they had completed four years of college. Fifty-six percent were employed. Age groups ranged across the spectrum from teenage to 65+. Racial/ethnic group: 2 = White 17 = Black 2 = Hispanic 1 = Asian American Pacific Islander 1 = American Indian 4 = Other Highest education level: 1 = 9th to 12th grade 3 = High school graduate 1 = Trade school 7 = 2 years of college 1 = 3 years of college 14 = 4 years of college Employment: 15 = employed 2 = In school 1 = Employed and school 4 = Retired 5 = Not employed Age groups: 1 = Less than age 20 1 = 20-24 years 6 = 25-29 years 2 = 30-34 years 4 = 35-39 years 2 = 40-44 years 2 = 45-49 years 2 = 50-54 years 1 = 55-59 years 4 = 60-64 years 2 = 65 and above Training Evaluation Class participants were given a pre- and post-test to assess their awareness of issues related to their neighborhoods, and their level of confidence in taking action on these issues. Seven participants completed the pre- and post-tests in Area A, nine in Area B, and nine in Area C. The evaluation addressed two general topics: 1. Awareness--of neighborhood health concerns: Questions about awareness of local health issues addressed health concerns, community building and organizing, role of community leadership, social issues that impact health, environmental factors, the role of media in addressing community health issues, the process of planning community health projects, the process of implementing community health projects, how to build consensus and support in the community to address local issues, how to engage with community stakeholders to address neighborhood issues, and how to use social media to address local issues. 2. Level of Confidence--in addressing neighborhood concerns: These questions asked how confident participants were in doing activities to advocate for their neighborhoods, including discussing health issues of concern with others, initiating /organizing community building, taking a leadership role in addressing community issues, discussing social issues that impact health, discussing environmental concerns, advocating for community issues, using media to address community health issues, planning community health-related neighborhood projects, building consensus and support in the community to address issues, engaging community stakeholders, using social media, and communicating examples of neighborhood projects. Questions were ranked on a scale of 1 to 5, with 1 = not at all aware or not at all confident, and 5 = extremely aware or extremely confident. Students showed significant improvements in both awareness and confidence at the end of the training, compared with their initial scores. While improvement was seen in every question on the post-test scores, participants showed the most gains on the scale of 1 to 5 for the following questions: Awareness: The process of planning community health neighborhood projects (increase from 2.84 to 4.44 = 1.60 points higher) The process of implementing community health neighborhood projects (increase from 2.92 to 4.40 = 1.48 points higher) How to build consensus and support In the community to address issues of my neighborhood (increase from 3.08 to 4.44 = 1.36 points higher) How to engage with community stakeholders to address issues of my neighborhood (increase from 3.16 to 4.44 = 1.28 points higher) Confidence in taking action: Use media in addressing community health issues (increase from 3.80 to 4.56 = 0.76 point higher) Plan community health related neighborhood projects (increase from 3.84 to 4.56 = 0.72 point higher) Build consensus and support in the community to address issues of my neighborhood (increase from 3.80 to 4.56 = 0.72 point higher) The following summary shows the average scores of all participants. Pre- and Post-Test Results Combined 1. Question: Level of Awareness Average Pre-Test Score = 44.64; Average Score per Question = 3.53 Average Post-Test Score = 57.72; Average Score per Question = 5.51 2. Question: Confidence in Taking Action Average Pre-Test Score = 54.84; Average Score per Question = 3.93 Average Post-Test Score = 63.16; Average Score per Question = 4.52 The following summary shows the change from pre- to post-test in each of the three Service Areas. While Area A participants reported slightly greater awareness of neighborhood health concerns, and confidence in taking action to address these concerns, participants in all Areas reported improved ability to recognize and address neighborhood health concerns. Pre- and Post-test Results for Area A, Area B and Area C 1. Question: Level of Awareness Area A Average Pre-Test Score per Question = 48.86; Average Post-Test Score per Question = 61 Average Pre-Test Score per Question = 3.81; Average Post-Test Score per Question = 4.74 Area B Average Pre-Test Score per Question = 40.89; Average Post-Test Score per Question = 56.89 Average Pre-Test Score per Question = 3.14; Average Post-Test Score per Question = 4.38 Area C Average Pre-Test Score per Question = 45.11; Average Post-Test Score per Question = 56 Average Pre-Test Score per Question = 5 ; Average Post-Test Score per Question = 4.34 2. Question: Confidence in Taking Action Area A Average Pre-Test Score per Question = 58.29; Average Post-Test Score per Question = 65.29 Average Pre-Test Score per Question = 4.16; Average Post-Test Score per Question = 4.66 Area B Average Pre-Test Score per Question = 51.11; Average Post-Test Score per Question = 63.22 Average Pre-Test Score per Question = 3.65; Average Post-Test Score per Question = 4.52 Area C Average Pre-Test Score per Question = 55.89; Average Post-Test Score per Question = 61.44 Average Pre-Test Score per Question = 4.03; Average Post-Test Score per Question = 4.42 Overall, the community participation and feedback from this capacity building project indicate that those who participated gained confidence and other useful skills that were put to use to improve their communities. Participants expressed appreciation for the education and opportunities provided to them through this project, and noted that these efforts at community improvement would not have taken place without the support of the Houston Health Department. d. Describe how results were analyzed. Demographics were collected from participants and totaled. The class pre- and post-tests were analyzed by comparing average pre-test scores with average post-test scores on the test items. Scores were also organized to reflect results in the Service Area where each class was taught. e. Were any modifications made to the practice as a result of the data findings? While no modifications were made during the training and projects, the evaluation findings of this pilot project did help to ensure future funding of this project. The evaluation results will be used in designing the next years of the project. Informal feedback from students in the classes was used by the vendor and instructors to improve the training for future classes conducted during the pilot project.
1. Lessons learned in relation to practice Several lessons were learned during the course of this project, including: Locating the training in target communities with identified disparities worked well. The presentations and question-answer periods with local City Council and other officials were especially well received by the participants. While the team explained the grant application form during the training classes, many participants also needed 1:1 assistance and examples to successfully complete the application. Students knew in general the community issue they thought needed attention, but had difficulty narrowing the focus so that issue could be successfully addressed. For those not exposed to research, technical assistance was needed to define and develop a plan that could succeed using available resources and within the time limits for the project. It was important for the HHD team to be available to grantees through the projects, to help them overcome barriers. An example of this was the Garden of Hope project. The project team wanted to create a community garden for Somali-Bantu refugees, but did not have a garden site available and struggled to find a site. The HHD team was able to help them gain a garden site at one of the nearby Multi-Service Centers, at an unused space near a parking lot. Recognition by the mayor was meaningful to both the mayor and the participants. Not all projects could be helped to completion. One project was nearly finished, but the project leader was not able to finish, and did not stay in communication with the HHD team. The project could benefit from adding additional populations. In particular, community youth were identified as an important target population. Future projects will include a focus group for community youth to better understand their needs and perspectives, and will design the Capacity Building training to benefit them. 2. Lessons learned in relation to partner collaboration (if applicable) Increased communication and coordination with the Multi-Service Centers staff may have increased recruitment efforts and attendance. 3. Did you do a cost/benefit analysis? If so, describe. A formal cost/benefit analysis was not done. However, an informal estimate shows that an initial investment for the training and grant funding of: $57,699 = Total for the pilot project ($49,999 for the training contractor and expenses and $7,700 for funding for mini grant projects). Approximately 500 persons were directly impacted by the training and grant projects. Many more were indirectly impacted, through hearing about the project in their neighborhood, supporting the project through volunteer time and/or donations, or helping to advocate for their community. Thus, the cost for the number directly impacted would be $58,140/500 = $116 per person, and the cost for those indirectly impacted would be much lower. These numbers compare favorably with other community development projects. 4. Is there sufficient stakeholder commitment to sustain the practice? a. Describe sustainability plans Yes, local grant funders have stepped up to sustain the practice. New funding will support expansion of the Capacity Building Program for three additional years. In September of 2017, the HHD Houston Health Foundation was awarded $272,000 in grant funds from the local Episcopal Health Foundation. The Houston Health Foundation will work closely with the HHD Office of Planning, Evaluation & Research for Effectiveness (OPERE) to carry out the grant activities. The grant funds will continue the Civic Leadership Training, and this time will target youth and young adults in two of the mayor's designated Complete Communities: Acres Homes and Gulfton. The Complete Communities Initiative works to revitalize Houston neighborhoods that are historically under-resourced, diverse, have a base level of community engagement, and face challenges. The project will assist these two neighborhoods with civic engagement and advocacy. This future project will use focus groups to design the training for the community and the target population of youth. Approximately 60%-75% of the Capacity Building training will remain the same as in the 2016-2017 project, and the remainder will be developed based on input from the focus groups. The project will include: Recruitment of young men and boys of color in the target areas Civic Leadership training sessions Mini grants made available to those who complete the training sessions Support for the awarded capacity building projects Evaluation The initiative will be carried out in three phases over three years. Year 1 – Phase 1: Planning, recruitment of participants, training sessions Year 2 – Phase 2: Review mini grant applications, determine funding, project implementation Year 3 – Phase 3: Evaluation, grantee presentations to City Council and Complete Communities, final reports, sustainability planning With this additional funding, the HHD Capacity Building project will expand to bring civic leadership skills and resources to two targeted neighborhoods. The funding will allow HHD to extend the Capacity Building program an additional three years, an important step in sustaining this successful project. Coordination with other initiatives HHD, in partnership with a local non-profit (Dia de la Mujer, DML), recently received Federal funding to conduct trainings among young men and boys of color to become certified behavioral health trained community health workers. The HHD community capacity building effort will coordinate and build upon the activities of the DML-HHD grant to train young men and boys of color, thus leveraging additional resources for a similar population. References 1. University of Wisconsin Population Health Institute. County Health Rankings & Roadmaps 2014. Available at www.countyhealthrankings.org. 2. University of Kansas Center for Community Health and Development. Community Toolbox website. University of Kansas, Lawrence, Kansas. Available at https://communityhealth.ku.edu/services/ctb. 3. CDC Division of Nutrition, Physical Activity and Obesity. Racial and Ethnic Approaches to Community Health (REACH). Available at https://www.cdc.gov/nccdphp/dnpao/state-local-programs/reach/index.htm. 4. Hennessey-Lavery SH, Smith ML, Esparza AA, Hrushow A, Moore M, Reed DF. The community action model: A community-driven model designed to address disparities in health. Am J Public Health. 2005 April; 95(4): 611–616. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449228/. 5. San Francisco Tobacco-Free Project. Community action in public health policy: Lessons learned from twenty years of community capacity building in San Francisco through the Community Action Model. 2016 April. Available at www.sftobaccofree.org.
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