Community Health Needs Assessment
Can you imagine having only the clothes on your back, no transportation, no money, no job, no state issued identification with health issues and only a seven day supply of medication? This is a reality for those who are re-entering back into society from incarceration. It is challenging for Community Health Needs Assessment (CHNA) initiatives to include this population in determining community health priorities but it is extremely important.
(Woods et al., 2013) reports:
addressing prison reentry is an essential strategy to address health disparities and increase health equity. Any intervention focusing on health for these communities must consider the role of incarceration in the observed differences in morbidity and mortality. Furthermore, increasing the health of formerly incarcerated men can positively affect the health of the communities to which they return.
When re-entrants have medical issues and find themselves with no resources it affects our communities in various ways. One way is that re-entrants feel they have no option other than to go to the Emergency Room of local hospitals to meet their non-emergency medical needs. (Moskop, 2010) states, "Commentators over the years have decried the provision of nonurgent medical care in the ED, describing this practice as a “misuse” of hospital EDs and attributing several negative consequences to it, including crowding, increases in the cost of medical care, and reduction in its quality."
Designing and implementing a CHNA is important to our community to collectively identify priority health needs through collaborative data collection, analysis, strategies, to achieve the greatest sustainable positive impact possible, especially for the underserved population, the social or economic disadvantaged. (Swain, 2016-2017) states, "social or economic disadvantage also affects the ability to access clinical care, as well as the quality of care received."
The most recent CHNA for the Charleston, SC Tri-County area was performed in 2019. This was performed by "Healthy Tri-County (HTC), a multi-sector regional initiative powered by Trident United Way in partnership with MUSC Health and Roper St. Francis Healthcare (Core Partners) to improve health in Berkeley, Charleston and Dorchester counties in South Carolina through collective impact" (Tri-County Health Landscape 2019 Community Health Needs Assessment Report, 2019). This CHNA did not mention re-entry population nor transitional housing population of which housing a large number of re-entrants.
It is important to select and use appropriate research methods to capture both quantitative and qualitative data. states, Engaging community members through a process is vital to the success of the CHNA. Since each community varies, there is no one size fits all approach. The recommended research type as defined and described by (Applying Principles of Community-Based Participatory Research to Your Program 2015) is what is recommended and is described below:
Community-Based Participatory Research (CBPR) is a research methodology which includes the participation of those who are affected by the issue or problem being studied for the dual purpose of creating knowledge and social change. CBPR recognizes and appreciates the unique strengths and resources each partner brings to the “research table.” Consequently, all research partners are treated equitably through a collaborative research approach. Research questions are formed with the community rather than on or about the community to combine knowledge with actions that improve community health. Research then becomes a partnership between academics, community-based organizations, and community members rather than a process where study participants act as subjects for the sole purpose of institutional knowledge gain.
Notes: Please note that this blog has been created in response to a Purdue Global University Community Health Care Assessment assignment which has brought to light this issue.
Applying Principles of Community-Based Participatory Research to Your Program. Health Outreach Partners. (2015, September 30). https://outreach-partners.org/2011/10/01/applying-principles-of-community-based-participatory-research-to-your-program/.
Health Research & Educational Trust. (2016, June). Engaging patients and communities in the community health needs assessment process. Chicago, IL: Health Research & Educational Trust. Accessed at www.hpoe.org
Moskop, J. C. (2010, June 1). Nonurgent Care in the Emergency Department: Bane or Boon? Journal of Ethics | American Medical Association. https://journalofethics.ama-assn.org/article/nonurgent-care-emergency-department-bane-or-boon/2010-06#:~:text=Major%20problems%20purportedly%20associated%20with,and%20reduced%20quality%20of%20care.
Swain, G. (2016-2017). How does economic and social disadvantage affect health? Retrieved from https://www.irp.wisc.edu/publications/focus/pdfs/foc331a.pdf
Tri-County Health Landscape 2019 Community Health Needs Assessment Report. (2019). Visual Infonomics Group. Charleston. https://muschealth.org/-/sm/health/about-us/growth/f/chna-report.ashx?la=en
Woods, L. N., Lanza, A. S., Dyson, W., & Gordon, D. M. (2013, May). The role of prevention in promoting continuity of health care in prisoner reentry initiatives. American journal of public health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3698835/.