What is the most common type of intervention used to improve a communitys health?
Learn how to identify and choose a particular program or a way of doing something that has the potential to effectively address the issues in your community. Show
The West Perry Youth Initiative (WPYI) has completed a careful assessment of youth issues involving all sectors of the community. The findings were revealing: kids and other community members alike were concerned and frightened by the number of kids who brought weapons to school, and by the number of violent incidents that most youth encountered daily. The initiative therefore has identified youth violence prevention as the area it most needs to address. So far, so good. But a problem identified is not the same as a problem solved. Everyone knows that you can't just wave a magic wand and make youth violence in the community disappear. It's a complex issue that involves kids, parents, schools, the police, the community's finances, community attitudes, the availability of weapons - far too many things for the WPYI to address all at once. The initiative and the community have to choose an intervention that will work. One way to deal with this issue is to look at what other communities have done to try to prevent youth violence. But the question then becomes "How do we know that a particular model will have the effect we're looking for?" WPYI has some choices here:
This chapter is about finding out what kinds of practices and interventions are possible, choosing what's appropriate for your purposes and your community, and adapting it to the particular needs and character of your community and target population. In this opening section of the chapter, we'll discuss how to tell whether a practice or intervention is one that has a chance of fulfilling your purposes. What is a promising practice or intervention?Promising practices and interventions are that those that have the potential to effectively address the issues of concern in your community. They are usually (though not always, as we'll see) things that seem to have worked elsewhere, as judged by standards that make sense for your community and your issue. What's the difference between a practice and an intervention?A practice is a particular way of doing things. It may encompass a whole program or it may simply refer to a single method or a way of looking at things. Inoculating infants against particular diseases at particular ages because that time schedule seems to provide them the greatest protection is an example of a practice. Another is barring - or not barring - access to homeless shelters to people who are actively under the influence of alcohol or drugs. An intervention is usually a whole program or initiative meant to achieve an overall result. In the first example above, for instance, the practice is inoculating infants at specific ages. The intervention chosen to carry out this practice would probably be an integrated program of making contact with the mothers of infants, providing incentives to get their children inoculated, following up to make sure that the children were getting other health care, etc. In the situation of the homeless shelter, the practice of barring those actively under the influence would be part of a larger intervention package: making contact with homeless people, particularly in cold or nasty weather, providing a warm and safe place to sleep, and perhaps offering such other services as job training and placement. The practice of excluding users would be aimed toward assuring the physical safety and psychological comfort - and the return - of others who needed the intervention. Practices are the tools that interventions use to get the job done. Sometimes a whole intervention may be considered a practice. An adult literacy or job training program, for instance, might be seen as a necessary practice in the context of a larger initiative to eliminate poverty in a community. A drug treatment program with several components might be seen as a single practice if it is accepted that the program needs all those components and a given structure in order to work. Untried practices and interventionsPromising practices and interventions may also be untried, but based on something solid. Sometimes, there is no model for what you want to do, or at least no satisfactory one. In that case, there are places to look for ideas.
New practices and interventions have to start somewhere. Sometimes they start from entirely new ideas or new perceptions of an issue. You may be in a situation where that's appropriate. One caution, however: there are few ideas that are totally new. If you do have a new idea, check around and see if it or something similar has been tried before. If it has, you may be able to get some suggestions about to how to make it work and how to avoid pitfalls. Where do you find out about existing promising practices or interventions?The discussion above, of course, brings up the question of where to look for promising practices and interventions. There are a number of possibilities, and the ideal is to use as many of them as you can. The best strategy for learning about promising practices and interventions is to find and contact directly the programs or initiatives using the practices or interventions you're interested in. Some sources of information about promising practices and interventions: Networking.Talk to everyone you know. Directors and staff from other agencies, coalition members, and others may know about things happening in the area, or even state- or nationwide. They may be able to provide introductions, or at least information so that you can contact programs or initiatives and learn about what they're doing. The Internet.The Internet grows by millions of sites a year. Once you develop good search skills, you can find nearly anything. Libraries.Public libraries are open to all. Private colleges and universities may let you use their libraries, even if you have no connection to the institution. If you've attended the institution, you may be eligible for alumni privileges. In many states, public colleges and universities grant regular privileges to state residents. Much of the material referred to above resides in libraries, and librarians can be extremely helpful in finding what you're looking for. They're persistent and knowledgeable, they often enjoy the search itself, and they get satisfaction from being able to help. State and national advocacy and professional organizations.These organizations often give awards for best practices, or document them in journal articles and at conferences. The journals are usually available in libraries, either public or academic, and often on the Internet as well; conference proceedings are often posted on the Internet. You can contact the organization to find out what's available. International, state and federal agencies.UNESCO, the U.S. Council of Mayors, HUD, and others often have listings of "best practices" in programs they fund. These may be on the Internet (see Resources for several listings), in government publications, or available in print from the agencies themselves. Foundations and other private funders.These funders also may list best practices, or may simply describe projects they fund. Many of these lists and descriptions are also on the Internet, in libraries, or are available from the funders themselves. Academia.Local colleges and universities may have researchers looking at just what you're concerned with, or know others who are. Furthermore, there may be graduate students who'd like to work with you on a project. They're often paid by university grants, and if they want to evaluate or document what you do for a master's or doctoral thesis, you might get not only their expertise, but also some other free services. Start by contacting the university department most closely connected to the work you do - education, environmental science, psychology, public health, etc. Word of mouth from the community.Clergy, members of service clubs (Rotary, Kiwanis, etc), and members of the business community all may have knowledge through their networks of intervention models elsewhere. In addition, other community members, including members of the target population, may know of successful programs or initiatives similar to the one you want to start. How do you identify a true promising practice or intervention?Once you've looked at a number of "best practices" and talked to some folks about their programs, how do you decide what really works, and what might work for you? First, you need to determine what the best practices you've been looking at are best practices for. Then, the question is what criteria do you use to identify best practices and interventions. In other words, how do you know they actually work? Finally, what are some of the common elements of successful practices and interventions, elements that you can incorporate into whatever you decide to do? Best practice for what?Particular best practices may or may not be relevant to your goals. Many organizations, agencies, or government departments identify best practices as those which solve a specific problem or treat a specific condition. Thus, a best practice in child and family services might be one that targets child abuse, and reduces it drastically through increased vigilance and enforcement by child protective workers. These practices and interventions are certainly vital - no one would deny the need to reduce child abuse as quickly and drastically as possible - but they often fail to address the underlying causes of the issue. Another type of best practice focuses on prevention. In the case of child abuse, for instance, a "best practice" preventive intervention might include the vigilance and enforcement, but would also address the issue on other levels. These might include counseling for the abused child; parent counseling for abusers; widely available parenting skills courses, particularly for those at risk of abusing their children; the establishment of parenting groups; family fun activities, to encourage parents to enjoy their children; and an attempt, through school programs, media ads, and other avenues to change community attitudes that accept child abuse. Finally, there's a type of best practice that promotes certain behaviors, attitudes, or causes. Again, this type of practice or intervention looks to root causes of problems and issues, but approaches them from a positive angle. It asks people to do something, rather than to stop doing something. Campaigns promoting condom use and safe sex as a defense against AIDS are an example. They don't suggest that everyone should stop having sex (unlikely in any case), but rather that they should adopt some behaviors that will protect them from risk. Many health programs have switched from disease prevention to health promotion, emphasizing taking positive steps to maintain and improve current and long-term health through daily attention to diet, exercise, stress, and other health-related factors. As you look for best practices, you should be clear about what kind of practices and interventions you're interested in (and have the resources for). Are you intending to run a treatment program, which addresses the manifestations of a particular problem or issue? Are you, instead, planning a prevention program, through which you'll try to address and change the root causes of the problem or issue? Or will you sponsor a promotion program, which approaches the issue from a positive standpoint? Being clear about the direction you choose will help you decide which among many best practices or promising interventions might work for you.
There's another element to the question of what a best practice is meant to do: what is the real problem or issue that your community needs to address? Criteria for identifying best practices and interventionsThere are essentially two ways you can look at a practice or intervention: quantitatively and qualitatively. The quantitative view uses numbers to analyze and understand the impact of particular practices or interventions on their target populations. These numbers may be used in simple or complex ways. They could merely state the number of people served, or the number who accomplished something specific. They can be used to make simple comparisons that point up what seems to have happened as a result of what's been done. Or they can be used in statistical analysis, to try to draw complex conclusions about the effects of a program.
Although these numbers may not always mean much (as Mark Twain said, "There are lies, damned lies, and statistics."), even simple numbers can be an indication of how well a practice or intervention is working. If the number of people a program serves keeps growing, and if most of those people stay in the program long enough for the program to have some effect, the chances are good that it's doing something positive. The growth of a health or human service program usually means that the word on the street is that it's a good thing. The fact that people stay in it usually means that they're getting what they need.
Quantitative analysis is generally considered objective, and a good indication of whether anything has happened as a result of a program. More often than not, it is what public funders and public officials demand as "proof" of the effectiveness of their use of taxpayers' money. Unfortunately, quantitative analysis by itself often fails to prove anything one way or another, even when it seems to.
Qualitative analysis looks at what actually happens when a particular practice or intervention is used. It can include anything from anecdotes and snapshots (in words or actual pictures) to a painstaking analysis of trends and actions over a long period of time. A psychologist's records are a qualitative analysis, for instance, as are most essays by historians, literary and art critics, and political scientists.
The quantitative analysis of the program seemed to show that there were fewer violent incidents and that more kids were being given the skills to avoid violence if they chose to. The qualitative analysis showed that more than a simple reduction in violent incidents was taking place. In fact, kids were using the skills they had been taught, and the whole climate of violence was changing. Using both the quantitative and qualitative data makes it possible to see that the program seems to be changing youth attitudes toward violence, which is likely to have a far greater long-term effect than merely reducing the number of incidents through enforcement or increased awareness. The lesson here is that the combination of quantitative and qualitative analysis is what's likely to give you the best picture of reality, and make it possible to identify a promising practice or intervention. That's not the end of the lesson, however. Let's go back to that program in the box above that seems to serve a small number of people extremely well. What can we learn from that example? If we make the standards for a "best practice" too strict, we're apt to reject some possibilities that may have potential. Remember, things work differently in different places and in different circumstances. If your standards are "nothing but the Mercedes," you'll never buy that Subaru that can get you home in the snow while your Mercedes is spinning its wheels in the parking lot.
When you look for promising practices and interventions, start by casting a wide net. Something that works only adequately in another community may be dynamite for yours, with a little tweaking. By the same token, something that works well someplace else may not be appropriate for you. Another element of your search should be finding out what didn't work. You may have a terrific idea with a hidden flaw that has already been discovered elsewhere. Or there may have been an attempt to do something similar in your community before, with disastrous results because of a cultural factor. Knowing your history can save you vast amounts of time, energy, and frustration. It's one of the most important criteria for assessing promising practices and interventions. General characteristics of a successful programOne way to approach the search for promising practices and interventions is to look at the general elements of programs that seem to work. Lisbeth Schorr, in her book Common Purpose: Strengthening Families and Neighborhoods to Rebuild America (New York: Anchor Books, Doubleday, 1997), discusses what works in improving outcomes specifically for children and families. She identifies "Seven Attributes of Highly Effective Programs":
In addition to Schorr's seven attributes, there are two more that might be added:
All of these nine attributes might apply to a program of any sort: how do they help you sort out promising practices for what you want to accomplish? In fact, these general characteristics are some of the promising practices you need to pay the most attention to. They provide an overall structure for a program that works. How you decide to approach your specific issue should depend on the needs of your community, what the target population is comfortable with and will respond to, a participatory planning process, the talents and skills of your staff, etc. The nine attributes here paint a picture of a program that is responsive, flexible, egalitarian, collaborative, well-managed, competent, aware of context, supportive of staff members and their development, and committed for the long term to a clear mission. If you can adopt these general characteristics, the chances are your intervention will do well. To make it the best it can be, it's necessary to find - or create or adapt - the specific practices and/or interventions that are right for your community. How do you choose the particular practice or intervention that's right for your community?All of these steps assume community involvement, ideally in both planning and implementing an intervention.
In the rest of this part of the section, we'll concentrate on finding and choosing the appropriate practice and intervention for your community. Difficulties in finding practices or interventions you can use:One possibility, of course, is finding the best program around and simply copying it exactly in your community. That should be fairly simple to do, shouldn't it? Actually, no... it's not. Copying - replication is the term that's most often used - doesn't always work well. Lisbeth Schorr, again, has some ideas on this subject:
Keys to success in replicationJust as there are difficulties in replicating successful programs, there are also some factors that will help replication work. They depend largely on characteristics of the original intervention (the first six of these are also from the work of Lisbeth Schorr):
Elements of successful replications of effective programsJust as there are factors in the programs themselves, there are also elements in the replication process that lead to successful replication. Some elements of successful replications:
In SummaryChoosing a promising practice or intervention for your purposes may not be a simple matter. What works in another community may not work in yours, and it may be difficult to actually determine how a particular successful intervention operates. There are, however, some general elements that good programs seem to have in common:
In addition to these general characteristics, there are some factors that identify successful replications. They include the adaptation of program features to local needs and cultures; backing by an intermediary organization; an understanding of the importance of the community and human context of the work; judging of success by individual and community outcomes; and a focus on root causes. The process of choosing may be difficult, but it doesn't have to be a crapshoot: if you follow the guidelines in this section, and listen to the voices of the community and the target population, you can help to transform your community. Which interventions are most commonly used by public health?Common types of interventions include screening programs, vaccination, food and water supplementation, and health promotion. Common issues that are the subject of public health interventions include obesity, drug, tobacco, and alcohol use, and the spread of infectious disease, e.g. HIV.
Which of the following is the most common type of intervention used to improve the health of a community quizlet?Which of the following is the most common type of intervention used to improve the health of a community? Offering health education and screening programs.
What is a community intervention?Community-based interventions refer to multicomponent interventions that generally combine individual and environmental change strategies across multiple settings aiming to prevent dysfunction and to promote well-being among population groups in a defined local community.
What is the best technique to assess a community's health quizlet?A healthy community is one in which residents are happy with their choice of location and exhibit characteristics that would draw others to the location. Thus, the best way to determine the health of the community is to talk to those living in it.
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