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+ Community Arts in Healthcare Program Planning Adapting Community Health Program Planning Models to...
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Community Arts in Healthcare Program PlanningAdapting Community Health Program Planning Models to the Arts in Healthcare
JILL SONKESHANDS ARTS IN MEDICINEUF CENTER FOR THE ARTS IN HEALTHCARE
+Arts in Healthcare is a diverse, multidisciplinary field dedicated to transforming the healthcare experience by connecting people with the power of the arts at key moments in their lives.
This rapidly growing field integrates the arts, including literary, performing and visual arts and design, into a wide variety of healthcare and community settings for therapeutic, educational and expressive purposes.
Society for the Arts in Healthcare, 2009
+ A rich body of research defines benefits, including:
• shorter hospital stays
•reduced need for medications
• increased employee retention
• more effective communication of health information
Findings demonstrate that integration of the arts into healthcare:
• helps to cultivate a healing environment
• supports the physical, mental, and emotional recovery of patients
• fosters a positive environment for caregivers Sonke et al., 2009
Rural CommunitiesHigher rates of mortality are caused by preventable illnesses, including:
• obesity
•heart disease
•diabetes,
•infant and maternal death
•lower respiratory diseases
•suicide
Poor health literacy accounts for a general lack of health-supporting behaviors and utilization of healthcare (Thomas, 2006; USDA, 2009)
Rural CommunitiesSignificant factors in rural health disparities:
• urban bias in health policy
• poverty
• limited access to healthcare
• rural culture
Social determinants of health, including rural culture itself, represent 50-60% of the
overall influence on health outcomes in rural communities (Evans, 2004)
Franklin County, Florida• One of the state’s largest counties at 545 square miles
• 12,257 residents
• 18% of those individuals living below the poverty level (compared with 12% in the state)
• Median annual income of $26,756 (compared with $47,804 in the state)
• One hospital within a 60-mile radius with 25 beds (including rehab/swing and emergency department beds) and an average daily census of 5-6 patients
• One Federally Qualified Health Center (of 285 in the state)
• Strong arts community due to tourism
Sources: Florida Department of Health (2009) and US Census Bureau (2009)
+A Basic (and insufficient) Program Planning Sequence
1.Needs Assessment
2.Clarify Goals and Objectives
3.Develop an Intervention
4.Implement the Intervention
5.Evaluate the Results
+ Background Information
There is no perfect model
Use one or find what fits/adapt elements from various models
Remember the importance of responding to local populations, conditions, needs, culture, and resources
Three F’s of program planning that can help with selecting the appropriate model Fluidity - steps are sequential Flexibility - adapt to needs of stakeholders Functionality - useful in improving health outcomes
+Program Planning Models PRECEDE-PROCEDE
MATCH
CDCynergy
SMART
MAPP
APEX-PH
Healthy Communities (USDHHS)
The Communication Model (NCI)
Healthy Plan-IT (CDC)
+Social Marketing
•Social marketing seeks to influence social behaviors not to benefit the marketer, but to benefit the target audience and the general society
•Used extensively in international health programs, especially for contraceptives and oral rehydration therapy, and is being used with more frequency in the United States for topics such as drug abuse, heart disease and organ donation
•A good fit for Arts in Healthcare given its creative nature
• Weinreich Communications: http://www.social-marketing.com/index.html
Needs Assessment
A systematic process of asking questions, comparing answers, and making informed decisions about what to do next to improve human or organizational performance
a systematic process to guide decisions-making
provide justification for decisions before they are made
provide a systemic perspective for decision-makers
allow for interdisciplinary solutions for complex problems
offer a replicable process that can be used over and over again
Focuses partners on shared understanding of issues and shared goals
http://www.needsassessment.org/
Needs Assessment
Maslow’s Hierarchy of Needs:
Needs Assessment
Normative Need
The existence of standards or norms
Perceived Need
What people think their needs are or feel their needs to be
Expressed Need
The level of “attempts” that have been made to meet needs/the number of people who have attempted to get help
Relative Need
The gap between the level of services available in the community compared to those in similar communities or geographic areas
Types of Needs Assessment
Extrapolating from existing data (normative needs)
Using resource inventories/community maps (normative needs)
Using service statistics from social services or human services agencies (expressed need)
Conducting a social survey (perceived need)
Holding a public forum (expressed need)
Community Mapping
Identifying and understanding the “geography” of community resources in a particular area
Serves as a basis for partner cultivation
Inclusive in nature
Sustainability
Sustainability – factors influencing routinization
resource stabilization – identification/commitment of human, financial, and other resources
risk-taking - balance between exploitation of recognized activities and the exploration of new activities (builds confidence)
Incentives - benefits outweighing costs for those involved in planning and managing
adaptation of activities - the incremental adjustment of activities according to circumstances
objectives fit – the level to which the program’s objectives fit with the values of the organizations and individuals involved
transparent communication - helps program planners maintain a focus on a common purpose, increases trust and resource sharing, and allows members to discuss and resolve program challenges
sharing of cultural artifacts - a means through which programs and organizations adapt to each other and encourage routinization
integration of rules - the program’s rules are integrated into the rules of the participating organizations
Pluye et al, 2005
Sustainability – guidelines for external organizations developing programs
fund projects in existing agencies with some capacity to support them and to provide the expertise needed for carrying out the many facets of sustainability
fund smaller scale projects that have local resources involved in order to build ownership of the project among local stakeholders
identify, work with, and strengthen local champions to provide the leadership and knowledge of local organizations needed to sustain the project over time
encourage planning for sustainability early in a project’s life cycle
Scheirer, 2005
Meaning
According to Viktor Frankl (1959), meaning is:
• a universal human phenomenon that reflects an attitude or idea that people have about their reality
• the primary motivational force in humans • the ultimate goal of human life
Self-transcendence, Frankl
an inherent characteristic of being human that leads to feelings of self-confidence and the discovery of new purpose and meaning
We self-transcend in three primary ways:
by giving to the world creatively
by being receptive to the world and others
by choosing how to face adversity and find meaning
Self-Transcendence – defined…The expansion of one’s awareness or boundaries:
intrapersonally (sense of wholeness within self),
interpersonally (connectedness to others and the environment)
temporally (connectedness to future and past situations)
transpersonally (connectedness to something greater than the self)
Reed, 2003
Moving beyond the known boundaries of the self to achieve a broader perspective, which in turn helps one discover or make new meaning.
Coward, 1993
The expansion of one’s conceptual boundaries inward through contemplative or introspective activities and outward through a heightened concern for the welfare of others.
Vaughan, 1985
Reed’s Model of Self-transcendence
Appreciative Inquiry Study of Weems Arts in Medicine Program (Sonke, 2009)
Seven themes emerged in the analysis as primary categories:
Meaning
opportunities to help others
benefits to others
sense of community
recognition of health benefits
self-transcendence
diversity (the functional coming together of diverse populations)
Summary of Findings (grounded theory):
program stakeholders can have experiences that lead either to self-transcendence or directly to meaning;
through enhanced self-understanding, purpose and insight, self-transcendence leads to meaning;
meaning, with its seven identified facets, leads to sustainability by producing excitement, commitment, collaboration; and routinization; and
enhanced conditions for sustainability lead to continued involvement in the program.
Thus, if a program can produce meaning, with or without self-transcendence, it has greater potential to be sustained over time.
Sonke, 2009
I value the sense that I am helping people feel better… The difference that one person can make in another person’s life… It drives me.
Weems Arts in Medicine Program Participant