2. Assessing Community Needs and Resources

The purpose of this section is to provide factual information about the county's population, economy, and health status. Reference data is included to give a meaningful background. The information is the basis upon which community leadership can undertake the planning process.

DEMOGRAPHIC ECONOMIC PROFILE

POPULATION TREND:

The population of the state of Kansas has grown at a steady rate since 1960. The projection for the period from 1990 to 2030 is for continued growth but at a slower rate: the population grew at an annual rate of 4.8 percent from 1980 to 1990, but is expected to slow to 2.1 percent by 2030. The northeast and southwest regions of the state are projected to have an increase in population, while the number of people living in the northwest and southeast regions are projected to decrease. The age profile of the population is also undergoing a significant shift. The proportion of the Kansas population 65 and over is projected to increase from 13.8 percent in 1990 to 20.3 percent in 2030, while the proportion of the population under 18 is projected to decline from 28.1 percent to 24.4 percent over the same period. In those counties where the population is growing slowly or actually decreasing, the proportion of older citizens can be expected to increase at a faster rate. This population and age shift is caused largely by the migration of young people with their children away from rural communities to urban areas.

The projections are based on a specific set of assumptions and will be valid only if the assumptions hold. The projections should be regarded as an estimate of the future population based on a continuation of current trends. The assumptions and the future population would be influenced by change such as natural disaster, war, epidemic, or the economy. It is particularly important to understand that the population trends in an area are influenced by the economic conditions in that area and that those conditions can be altered significantly by the population living in the area as well as by outside forces.

The population of Ottawa County has declined since 1940, and this trend is projected to continue. In contrast, the state population has grown steadily. The population of the county is homogeneous with respect to race/ethnicity. Of the total population, only 0.6% is from a minority group.

The rate at which the average age of the population is increasing is expected to become even more rapid. The trend toward a population that is growing older on average is very significant for health and human services planners.

Geography:

Ottawa County is located in the north-central region of the state and encompasses 721 square miles. The county is considered to be 100% rural with a population density of 7.8 people per square mile.

Ottawa County Hospital, with 30 beds, is located in Minneapolis. The closest large hospitals are 25 miles to the south in Salina. Tertiary care hospitals are located 111 miles to the south in Wichita and to the east 123 and 188 miles in Topeka and Kansas City, respectively.

ECONOMY:

The unemployment rate in Ottawa County is 3.7%. Nine percent of the population are below the poverty level, and 39% are below 200% of the poverty level. Nine percent of the population are eligible for Medicaid, and 7.2% are Medicaid recipients. Six percent receive food stamps, and 1.9% receive Aid to Families with Dependent Children (AFDC). These figures are approximately the same as the average of the other counties in the north-central region but are lower than for the state as a whole.

A preliminary review of employment in Ottawa County suggests that the health care industry is one of the larger employers and thus a significant segment of the economy. Additional employer information will be included in later sections.

Two measures of economic health are the strength index and the pull factor. The strength index is a measure of the economic prosperity of each of the 105 counties in Kansas. The index is derived from calculations using county wealth, personal income, and county employment for a period from July to June. The strength index for Ottawa County for 1992-93 was 2.32, placing the county 86th in a ranking of the 105 counties in the state. For all of the counties, the mean strength index was 2.55 and the median was 2.50. The counties ranged from a high of 4.62 (Johnson) to a low of 1.87 (Chautauqua).

The pull factor is an assessment of the strength of retail trade in a community. The factor is a measure of how well a community is attracting or losing business to other places. It is used to compare the magnitude of business activity in a county to the level of business activity in the state of Kansas on a per capita basis. A pull factor which is higher than 1.00 indicates that the community is attracting business on the whole, while a pull factor under 1.00 indicates that the community is losing business to other places. The period of time considered is from July to June.

The pull factor for Ottawa County for 1990 was 0.35, decreasing to 0.31 in 1994. These figures indicate that a significant portion of the population is going outside of the county to meet its retail needs. Of the 105 Kansas counties, only fifteen have pull factors greater than one. The counties range from a high pull factor of 1.71 (Seward) to a low of 0.25 (Wabaunsee).

SUMMARY:

Ottawa County has experienced a declining population that is typical for many of the rural counties of Kansas. The age of the population is shifting to include a higher proportion of older citizens. The rate at which the shift is taking place is greater than that for the state as a whole.

The indicators reflect an economy that is relatively lethargic. A significant portion of the retail business and thus the county wealth is leaving the area.

BACKGROUND:

Ottawa County received a grant from the Kansas Health Foundation to explore how health services might be improved. Part of this grant is designed to encourage community-based health promotion. The first step in this process involves identifying community health concerns. A small group of citizens developed a survey on community health issues encountered by Ottawa County citizens.

The survey was sent out to all households in the County (approximately 2,500). In addition, the survey was printed on an entire page of the local newspaper (circulation approximately 1,600). Surveys were hand-distributed to numerous sites in the County, including Senior Centers, business clubs (such as the VFW and Lions), at the local hospital and Emergency Medical Service site, and at a festival in Minneapolis, the county seat. The county has a population of approximately 5,500 persons. Citizens returned 593 surveys, for a response rate of 11%.

In the survey, people were asked to rate how important each issue was, and how satisfied they were with how the issue was being addressed in the County. An example question is included below:

Of people who filled out the survey, there was an 81% average rating on the importance scale. There was a 40% satisfaction rating (If all people gave it the lowest possible score, the satisfaction rating would be 0%). This rating of 40% is low compared to other issues on the survey.

Implications: Why are these aspects of the community (like recycling) considered to be problems? What might be done to work with others in the community to improve issues that are considered problems? Listening sessions around the community can help answer these and other important questions about the relative problems in Ottawa County.

Future Directions:
Using these data on the strengths and problems of community health issues in the County, citizens may wish to set up committees or task forces to address one or several of the most burning issues. Listening sessions will provide potential solutions to some of the problems. Task forces may wish to do more systematic "strategic planning" around some issues. Community citizens can be recruited to work on problems of most interest to them

 Relative Strenghts

Relative Problems

The Kansas Department of Health and Environment has set as one of its goals to assure access to complete public health services to all the citizens of Kansas. Public health services are listed below under three broad categories:

ENVIRONMENTAL AND SANITATION SERVICES 

• Well water and septic system inspections
• Restaurant inspections
• Licensing of child care facilities

PREVENTIVE SERVICES 

• Immunizations
• Communicable disease control
• Health screening
• Women's health services
• Women, Infants, and Children (WIC) program
• Periodic Screening, Diagnosis, and Treatment (EPSDT) programs

HEALTH PROMOTION AND EDUCATION SERVICES 

• School health services
• Acquired Immune Deficiency Syndrome (AIDS) education
• Community health fairs
• Environmental health education
• Community health assessment analysis and planning for health needs.

In urban areas, these types of services have traditionally been performed by public health departments. In smaller rural communities, services such as clinical services, health screening, women's health, EPSDT, immunizations, and the like, are often carried out in the primary care clinic. While the regulatory, educational, and planning components of the public health mission are the domain of the public health department, the entire community should be a part of the planning and decision-making process concerning these activities.

This model assumes that economies of scale are the primary variable in service delivery and does not take into consideration factors such as geography or the ability (or necessity) to perform traditional public health department functions through alternative mechanisms. In rural areas, which do not have a large population base, these alternative mechanisms are often critical.

OTTAWA COUNTY SERVICES:

The Ottawa County Public Health Department provides a range of public health services. This agency is tax supported and located in Minneapolis. The Public Health Department employed a total of 15 people in 4.1 full time equivalent positions in 1994. In addition to the services provided by employees, some services are offered through contract. The services which are provided are listed in Table 21.

Utilization:

Table 21 Public Health Visits by Program

The department made a total of 4,906 visits in the last fiscal year. The largest program was school health with 2,027 visits, followed by Adult Health visits at 1,715. The age break down of those who have used public health services (excluding home health) is listed in Chart 3.

With the exception of its school health service, this department primarily serves the very young and the elderly in the county.

The Public Health Department is primarily funded through public sources: over 50 percent of its 1994 revenue came from a single mil of county funds and over 20 percent from grants, many of which come from state and federal programs. The sources of funds are listed in Table 22.

Table 22 1994 Ottawa County Public Health Department Revenue and Visits by Payor 

Table 22 also shows how local tax dollars support the services of the Public Health Department. As federal and state sources of grant funds become more difficult to obtain, this department will depend to an even greater extent on local dollars to provide needed services.

WHAT WE LEARNED FROM THE DATA:

• Next to School Health, Adult Health visits constitute the second most frequent type of patient care for the Ottawa County Public Health Department.
• With the exception of School Health, this agency primarily serves the very young and the elderly in the county.
• Over 50% of the 1994 revenue for the health department came from public funds in the form of the county mil levy.
• 20% of the 1994 revenues came from grants - many of which also come from the state and federal governments.
• The only other source of funds for this agency in 1994 was the Medicaid program and what fees could be collected from clients who were not covered by categorical grants or the Medicaid program.

WHAT WE LEARNED FROM COMMUNITY INTERVIEWS:

• The Ottawa County Public Health Department was commended for its services and the caring attitude of its personnel. This was particularly evident in the communities outside Minneapolis.
• The health department was described by other providers as cooperative and in need of additional resources.
• The Hospice program of the health department was described as an important community resource.
• Ottawa County is under served with rural water districts, which means many of the rural residents are on private wells.
• Some areas of the county are remote and distant from access to health services - they are only served by the health department.
• The county has a high teenage pregnancy rate.
• Low income families that are not eligible for public funds do not access care when they should and when they do, the care they need is more costly.
• Broaden the county-wide immunization program to more sites in smaller communities.
• Medicare certification for Hospice is very important for the community.
• More information on AIDs prevention and care including a support system for those people in the community caring for AIDs patients is needed.
• Develop an immunization tracking system so records in various immunization sites can be coordinated (i.e., MD Offices and the Health Department).
• Dispel the myth that the Health Department is part of SRS.
• Community education on immunizations and adequate nutrition for kids is needed.
• The pregnancy issues of unmarried or adolescent women need to be addressed.
• Unsafe water supplies and improper septic waste disposal are threats to the local system of health care.

HEALTH STATUS INDICATORS:

Knowledge of the current health status of the community is the first step in identifying health problems and developing a plan to deal with those problems. There are many measures or indicators of health status. Some are based on occurrence of disease, some on lifestyle choices, and others on behavioral outcomes. What follows is a compilation of selected health status indicators for Ottawa County. While the data in this section is the most recent available, it is often dependent upon information collected as long five years ago. Care must be exercised in evaluating the data because the numbers in each category are often quite small and a small change can make a relatively large change in the percentages. Reference indicators for the state of Kansas are included to provide a comparative perspective. A process that will track these and other benchmarks is critical to an ongoing community health assessment and planning program.

Table 1

Percentage of All Births to Single Teens

Table 2

Percentage of Babies Born with Low Birth Weights

Table 3

Live Birth Rate per 1,000 Population

Table 4

Percentage of Kindergartners Fully Immunized by Age 2

*School did not participate this year

Table 5

Percentage of Children in Poverty

 Table 6

Death Rate per 1,000 population

 Table 7

Alcohol-Related Traffic Accidents and Safety Belt Non-Use

Table 8

Cause of Death Ranked By Rate per 100,000

During the period of the above ranking, Ottawa County had the 13th highest age adjusted average death rate in Kansas.

Morbidity for infections diseases is illustrated in Table 9. In order to make comparison possible, the diseases are reported by incidence rate per 100,000 people, based on the average number of cases per year between 1987 and 1991.

Table 9

Incidence of Infectious Diseases, 1987-1991

BEHAVIORAL HEALTH RISK

As humans our behavior vitally affects the status of our health. In 1990 the Center for Disease Control published the following list of factors contributing to death before the age of seventy five:

Lifestyle: 51%
Environment: 20%
Human Biology: 19%
Health Care System: 10%

The way in which we chose to live (that is, lifestyle) has an important role in determining the length and quality of life. The Kansas Department of Health and Environment has done a study of Kansans that focused on a number of factors which are recognized to be of high risk. A part of the study determined the percentage of the population of the state who have these risk factors:

Table 10

Percentage of Population with Selected Risk Factors

While the study was not county-specific, the information does take on greater significance when the five leading causes of death in Ottawa County are considered. Physical inactivity, obesity, smoking, hypertension (high blood pressure), and high blood cholesterol all contribute to heart disease. The chance of developing coronary heart disease is twice as high for people who are physically inactive as for those who are active (i.e., exercise for 20 minutes 3 times a week). Both smoking and obesity increase a person's risk of developing coronary heart disease; in fact, smokers are two to three times more likely to developing heart disease than non-smokers. The relationship of smoking to cancer and lung disease is well recognized. Cerebrovascular disease is closely related to hypertension, and smoking also affects the health of the blood vessels of the brain. The use of alcohol and the non-use of safety belts are often associated with unintentional injury.

A common characteristic of all the factors in Table 10 is that they can be modified. Community programs designed to bring about or assist individuals with changing these factors are increasingly common. A reduction in the number of people with these risk factors could be expected to have a positive affect on individual and community health. Bringing about such a change is an appropriate consideration for health care planners.

SUMMARY 

These indicators suggest that Ottawa County is an area where the health risks are somewhat lower than the health risks in the state as a whole. The health risks present are to a great extent those associated with an aging population. Behaviors which have a significant influence on health risks are amenable to modification. Designing programs to modify these behaviors offer health and human services planners one of the best opportunities.

The United Way of Wyandotte County conducted a Needs Assessment. They began this by describing their community (Wyandotte County). Secondary sources of data that informed their assessment included data from the U.S Census of Population and Housing and data from the Kansas City Business Journal. They determined the percentage of population by age group, race and ethnicity, per capita income, and percentage of households by income groups. They then compared these data figures with five other counties in the Kansas City Metropolitan area.

The needs assessment ultimately identified 11 different areas of concern to Wyandotte County residents. These identified issues included abuse, neglect, support for families, basic needs, basic skills, and child youth and development. For each of these concern areas they used various methods to measure the problem, such as surveys, secondary data, and small group forums. For the issue area of abuse, neglect, and support for families, the United Way began characterizing the level of the problem. This was done by using the "Metro Kansas City: The Status of Children in the Five-County Area Report Card" to determine the number of reports of child abuse and neglect for three previous years. The next step was to measure the community's perception of the problem. They then measured the community's perception of the problem by administering a Needs Assessment Survey, in which they had community members rate both the importance of these issues and their satisfaction that the community was addressing those issues effectively. Following the survey, the United Way conducted neighborhood focus group discussions. The United Way divided the community into four geographic areas and residents were invited to attend. The residents chose topics to discuss and made potential suggestions for solutions. The United Way also gathered primary data through a service providers' forum, in which they gathered information from 60 members of the Wyandotte County Social Service Alliance regarding gaps in service and potential solutions.

All of this information was compiled into briefs for each issue area.

ISSUE BRIEF 

Abuse, Neglect, and Support for Families and Individuals

SUMMARY

Wyandotte County residents are concerned about abuse, neglect, and support for families and individuals. In general the number of reports of child abuse and neglect cases has declined slightly in Wyandotte County. Issues related to abuse, neglect, and support for families and individuals were rated "important" to "very important" by respondents to a needs assessment survey, who were in general "neutral" to "unsatisfied” with how the issues were being addressed in the community. Discussions with community members and service providers indicated that abuse, neglect, and support for families and individuals are associated with families "falling through the cracks." Participants noted that counseling is expensive and underutilized, and adults lack support to parent effectively. Potential solutions suggested by community members and service providers included providing help in the home, providing support and information to families through churches and hotlines, and providing information on available resources.

NEIGHBORHOOD FOCUS GROUP DISCUSSIONS:

Focus Groups were conducted to gather community feedback on the 11 broad issues addressed by the Needs Assessment Survey. The meetings were held in four areas of the County: South Wyandotte County, Northeast Wyandotte County, Bonner Springs/Edwardsville, and West Wyandotte County. Participants selected a few of the 11 issues for in-depth discussion.

DIMENSIONS OF THE ISSUE:

Abuse, neglect, and support for families and individuals was selected as a topic for discussion at the Bonner Springs/Edwardsville and the West Neighborhood Focus Groups. Participants explored a wide range of issues related to abuse, neglect, and support for families and individuals. Section IV of the Needs Assessment Report lists all dimensions discussed.

A few dimensions of the issue discussed included:

• Adults lack support to parent effectively; Abuse is a growing problem;
• Families "fall through the cracks";
• Counseling is expensive and underutilized;
• Both physical abuse and mental abuse are a problem.

POTENTIAL SOLUTIONS:

Focus Group participants also discussed a wide range of potential solutions to the problem of abuse, neglect, and support for families and individuals. Section IV of the Needs Assessment Report lists all potential solutions discussed.

Some selected comments from the discussion of potential solutions included:

• Provide help in the home
• Provide programs that allow families to work and be successful
• Provide support and information to families through churches and hotlines
• Provide information on available resources

SERVICE PROVIDERS' FORUM:

A Service Providers' Forum gathered information from approximately 60 members of the Wyandotte County Social Service Alliance on issues from the Needs Assessment Survey. Participants selected four issues for in-depth discussion. Participants represented a variety of human service organizations from County, State, and private sectors. Participants discussed the dimensions of each problem, and gaps in service, and were asked to posit solutions regardless of how much money they would cost. Many ideas were explored in the Forum. Section V in this report provides a complete list of the ideas generated. Participants at the Forum discussed abuse, neglect, and support for families and individuals in Wyandotte County and explored gaps in services. The issues raised were similar to those discussed at the Focus Groups.

A few highlighted problems and gaps in services included:

• No flexible round-the-clock crisis management
• Lack of cultural-language-specific service providers
• No long-term graduation of services to help families become fully independent

A few of the potential solutions discussed included:

• Intensive case management services;
• Training in how to negotiate red tape and bureaucracy.

Community asset mapping identifies strengths within the community. In south Chicago, the Institute for Policy Research developed an assets map of the Grand Boulevard neighborhood to identify strengths within the community. They began by collecting written materials about local organizations, including newspapers, newsletters, and membership and contact lists. They then interviewed local leaders in multiple sectors to help add to the list of organizations and associations. They also conducted a block-by-block field survey that identified additional organizations and specific geographic characteristics that were used to divide the community into areas for their phone interview/survey.

Ultimately, this yielded a list of assets within the Grand Boulevard neighborhood mapped by organizational type, function(s), community activities implemented, and willingness to engage with future community building and economic development activities.

VOLUNTARY ASSOCIATIONS IN LOW-INCOME NEIGHBORHOODS: AN UNEXPLORED COMMUNITY RESOURCE 

INTRODUCTION

There is great concern in the United States about the current and future health of civil society. While definitions of civil society are diverse, almost all analysts include local citizens' associations as a vital expression of civil society and civic culture. Recently there have been studies and reports indicating a decline in civil society measured by associational membership These studies represent the conclusions drawn from data that are aggregated and reported by central sources. They do not include data regarding those associations that are not connected to central data collection systems. In order to better understand the actual current status of associational life, as well as the functions they perform, we need to begin by gathering primary data at the local level. This report summarizes a recent exploration of the nature and extent of the associational life of the Grand Boulevard community on Chicago's South Side. In addition, the project surveyed a representative sample of those citizens' associations' leaders concerning their current activities and their willingness to undertake further specific community building and economic development activities. These explorations focus on associations because they are the naturally existing community organizations for empowering individuals and mobilizing their capacities. Quite simply, an association is a group of citizens working together. It is an amplifier of the talents, resources and skills of individual community members. It is clear that any community-based effort to solve problems must begin by recognizing the creative power of a community's formal and informal associations

THE SURVEY SITE: THE GRAND BOULEVARD COMMUNITY 

Grand Boulevard is a low-income neighborhood on Chicago's South. A community of about 36,000 residents, Grand Boulevard is 99 percent African-American. In 1989,82 percent of children in the neighborhood lived in families with a cash income below the poverty line. (Nationally, 17.1 percent of children live in poverty) Median family income, at $8,371 in 1989, was less than a third of median income for the city of Chicago ($30,707). The 1989 income figure represents a 30 percent decline in family income, after adjusting for inflation, since 1979. The shifting of manufacturing employment out of Chicago and the growth of the suburbs have hastened the decline of the community .The unemployment rate increased from 24 percent to 34 percent during the eighties. Between 1970 and 1990, Grand Boulevard's population halved, and, in the same period, almost 10,000 housing units were lost. Much of the community's population lives in high-rise public housing. The loss of population and housing stock, and the concentration of high-rise public housing, impose strains in addition to those of poverty. Grand Boulevard residents, despite these depressing economic figures, have organized to rebuild their community The community is the home of creative and vigorous community organizations, and is part of an ambitious economic development scheme, the Mid-South Plan, to reinvigorate that part of Chicago.

DATA COLLECTION METHODS 

This study inventoried local citizens' associations which were defined as face-to-face local organizations whose essential work is done by members who are unpaid. An association of this type might have a small paid staff, i.e., pastor, organizer, or choir director. However, the primary work of the group is carried out by the citizen members rather than professional or paid workers. This definition excluded from the survey, therefore, local not-for-profit and governmental agencies as well as businesses. "Mapping" Grand Boulevard '8 associational life involved a range of methods, of which four primary approaches proved most productive. The process began by gathering all of the written materials that could be found, including items from newspapers and newsletters, as well as membership and contact lists from local institutions, and from both public and nonprofit groups. The second step involved more than 45 interviews with local community , civic, religious, governmental and political leaders. During these discussions, leaders were asked to edit the existing inventory and to add groups not yet listed. A block-by-block field survey of the Grand Boulevard neighborhood then yielded both more specific associations, as well as a working map of the neighborhood 's distinct characteristics such as patterns of public and private housing and differences in residents' income levels. Finally, using this working map in Grand Boulevard, 100 stratified phone surveys were conducted asking residents to add groups to the inventory. The telephone survey targeted residents of four different subsections of Grand Boulevard, asking them about the associations in which they were involved as well as the issues and activities that interested them. The four subsections included public housing (both high- and low-rise); senior citizen housing (both public and private); an area of concentrated single-family homes; and a section containing a mixture of rental units and smaller single-family residences. The survey uncovered many new groups in each section of the neighborhood, as well as some interesting variations in the types (not the numbers) of groups with which residents in each area are affiliated. (Middle-income residents, for example, were much more likely to belong to associations outside the neighborhood than were lower income people).

AN ASSOCIATIONAL MAP OF GRAN BOULEVARD

Though no list of a community's associations can ever be regarded as complete, the inventory of Grand Boulevard's associational life represents at least an indicative snapshot of the neighborhood in 1995. In all, some 319 associations were located in Grand Boulevard. Only a few of those associations were of the very informal, unnamed kind. Further interviews conducted by local residents might well have uncovered more of these less visible groups. Nevertheless, the number and variety of associations uncovered in Grand Boulevard is significantly larger than most residents or experts expected. What kinds of groups make up the associational life of Grand Boulevard? They are so diverse that it is hard to generalize. There are 71 religious congregations of various sizes and denominations. Beyond these, the groups range from those which are very small and informal -e.g., unnamed associations, such as a group of seniors meeting regularly to discuss neighborhood improvement, a group of adults and children gathering regularly around an artist who teaches them - to those that involve hundreds of people and even employ minimal staff- e.g., Alliance of Congregations Transforming the South Side (ACTS), or the Mid-South Planning Council.

One way of categorizing the 319 groups is depicted on the "Associational Map of Grand Boulevard" (Table 1). The map identifies ten different clusters of groups in the community, and provides an introduction to the ways in which citizens in Grand Boulevard organize their energies and commitments. The Associational Map reflects also the particular nature of the Grand Boulevard community. The ubiquity of public institutions, for example, has spawned a large number of associations whose tasks include advising and/or assisting schools, parks, public housing developments and the police. The large number of religious congregations, and of associations connected to local churches reflects the importance of religious institutions in the life of Grand Boulevard.

Table 1

Grand Boulevard Associational Inventory
Total Number of Groups: 319

Grand Boulevard's Associations: What Might They Do?
The database of local associations created by the mapping process which includes their addresses, phone numbers, and names of leaders allows community leaders to build relationships with the local associations, and to explore ways in which they can contribute to building the community.

To facilitate that process further, the second part of this inquiry involved designing, testing and administering a survey aimed at discovering: What functions these neighborhood associations currently fulfill; Which associational activities have already affected the wider community; and What kinds of community economic development and more broadly defined community building activities associations would be willing to undertake.

The interviews probed past experience, current activity and potential future activities in three major areas:

• Providing Mutual Care Through Work on "Neighborhood Projects"
• Addressing Issues in the Community
• Contributing to Economic Development

A random sample of 23 leaders of the associations were engaged in the survey. These interviews revealed a rich and varied set of current involvements, many of which have impacted the community's life. More than half of the groups surveyed, for example, report having worked on "neighborhood projects," including those supporting youth, senior citizens and families, and those aimed at beautifying the neighborhood, and at improving neighborhood health and safety. Many of these projects represent the associations' experience entering into relationships that provide help, support, and mutual care to those in need. However, many fewer association leaders reported that their groups had already been involved in working on neighborhood issues, as opposed to mutual care projects. Whether teen pregnancy, child abuse, drug abuse, domestic violence, youth groups, or issues facing people with disabilities or those who had been in prison -these pressing issues have not, for the most part, engaged the efforts of local associations.

In a parallel result, an extensive set of questions aimed at discovering how local associations might have been involved in direct economic development activity or in supporting the vitality of the local economy or in job training and placement, revealed very little previous activity. But what the surveys do reveal, in question after question and category after category, is the consistent willingness of the association's leadership to seriously consider doing more. As concrete potential activities were put before them, the answer heard most often by the interviewers was, "Well, we've never done that before, but we'd certainly be willing to try." The following four tables summarize the local leaders' responses regarding the present and potential community-building functions of their groups in the areas of Mutual Care (Table 2), Job Placement / Training (Table 3), Local Economy (Table 4), and Neighborhood Challenges (Table 5).

Table 2

Table 3

Table 4

Table 5

BACKGROUND 

Lack of employment opportunities for people with disabilities continues to be a significant problem, especially in rural communities. Self-employment and small business development often can be the only viable employment option for people with disabilities in rural areas, but these areas also often lack economic development support. The Rural Community Economic Development Project was developed to address employment issues of people with disabilities through rural economic development while exploring the leadership roles that people with disabilities and rehabilitation professionals might take in the process. Phase 1 of the project involved a community assessment of two rural areas of eastern Utah and northern Vermont.

PROJECT STRUCTURE 

The Research and Training Center on Disability and Rural Communities developed the Rural Community Economic Project in response to the lack of employment opportunities for people with disabilities living in rural communities. The Project worked with a community in Emery County, Utah to build the capacity of state vocational rehabilitation agencies and also to build skills of people with disabilities to identify business development and employment opportunities. The project took place in two phases: Phase 1, community assessment, and Phase 2, in which the recommendations from the assessment process were put into practice.

During Phase 1, the Utah State Vocational Rehabilitation (VR) Program regional office played an active role in the project. The VR contact identified project leaders, organized the Community Advisory Panel, and served as a community liaison. Two local people with disabilities were identified and trained as project leaders, and they, in turn, recruited and trained four additional people to conduct the assessments. These six individuals formed the Study Team that conducted the community assessment.

During the assessment process, the Community Advisory Panel provided knowledge and credibility to the project. The council consisted of elected officials, business owners, agency representatives, and other interested citizens. They interfaced with the community regarding the assessment process to provide validity and provided feedback to the Study Team during and after the assessment process.

Describe the makeup and history of the community to provide a context within which to collect data on its current concerns

Emery County had a population of 10,892 at the time of the assessment and nine principal towns including the county seat. The rural area has diverse landscapes including mountains and desert areas. Historically, the economy was built on ranching, agriculture, and coal mining used for power generation. At the time of the assessment, coal mining, coal transport, power generation, and transmission dominated the local economy, and the unemployment rate was 8% with 3,218 residents in the workforce.

This information was gathered from the county Chamber of Commerce website and census data. Interviews and conversations with community members added more insight. The formal assessment process involved in-person interviews with local business owners. The National Institute on Disability and Rehabilitation Research funded the Study Team who completed the assessment process.

Information was collected using an interview process that revealed tremendous strength in the history and heritage of the local people. The assessment also revealed strength in the natural environment, which is not only beautiful, but contributes to the productivity and job base for the people such as mining in the mountains and open farmland for agriculture and ranching. The problems include the up-and-down cycles of the local economy prompted by periods of lay-offs and hiring at local power plants and mines.

DESCRIBE WHAT MATTERS TO PEOPLE IN THE COMMUNITY 

To gather information for the community assessment portion of the project, a total of 59 locally owned business owners were interviewed. Because the project purpose is economic development, the focus of the assessment was on business owners. The Study Team asked business owners about community strengths and sources of pride that could contribute to economic development as well as specific concerns and obstacles to economic development.

Using the "Guidebook for Citizen Involvement to Create and Expand Businesses in Rural Communities," the Study Team asked the following questions to determine what mattered to the residents of Emery County:

• What makes residents proud of Emery County?
• What are the strengths of Emery County that could contribute to its economic development?
• What are the strengths of Emery County's physical infrastructure?

Residents and business owners reported being proud of the beautiful natural environment, rich Indian and pioneer heritage, and small town lifestyle. They stated that this rural, small town lifestyle contributes to strong families and high quality of life.

Other strengths related to economic development included:

• Expansive, beautiful landscape
• Natural resources, including agriculture, coal, etc.
• Human resources, namely hard working people
• Strong infrastructure related to power production
• Recreation opportunities
• Nearby interstate and rail lines
• Low cost of living.

Some expressed concerns included a lack of transportation to this isolated region and the high cost of gas. Concerns relating to economic development involved competition from outside the area. Business owners reported that major businesses are not hiring locally, and many local residents were not shopping locally. The negative attitude of community members was also a major concern. Business owners cited defeatist attitudes, apathy, lack of communication, and resistance to change as barriers to economic development efforts.

Interviewees thought the attitudes of community members could be addressed through education and increased awareness among community members about the benefits of economic development activities. Creating ways to get community members involved in economic development so that they see the benefits was suggested as a possible solution to this concern.

DESCRIBE WHAT MATTERS TO COMMUNITY STAKEHOLDERS 

Community stakeholders involved in the project included the Emery County Economic Development agency, Vocational Rehabilitation, Chamber of Commerce, and local businesses. These stakeholders wanted to know the concerns of local businesses related to economic development and their perceived barriers. Though business owners were the focus of the assessment, other stakeholders were informally interviewed and included in the assessment process.

The community stakeholders hoped that economic development would help people with disabilities become self-employed. They wanted to see expanded businesses and economic development that would benefit everyone in the community. Economic stability for the community was a major concern to the stakeholders.

COMPILE AND DESCRIBE THE EVIDENCE SUGGESTING THAT IDENTIFIED ISSUES SHOUL BE A PRIORITY 

The assessment process identified numerous issues with the most relevant being the economic stability of the community. Numerous anecdotes and perceptions about the lack of jobs resulting from changes in the mining and power production industry also surfaced, as did comments on competition from outside communities and the political environment.

To look at data regarding economic stability, it was necessary to obtain unemployment rates over time and see how these unemployment rates corresponded to events that impacted the economy. [JS1]

DESCRIBE BARRIERS AND RESOURCES FOR ADDRESSING THE IDENTIFIED ISSUES 

Business owners described several barriers to business expansion, many of which relate to the employment difficulties. These barriers included:

• Competition for labor from outside businesses
• Limited capital
• Land use restrictions
• Small population
• Recent economic downturn
• Transportation costs
• Lack of interest in development of the ?South End? of town
• Political climate

The resources for addressing the problem included the natural environment, low cost of living, quality of life, and hard-working residents. Other community assets, which developed from or were strengthened by this project, included the Community Advisory Panel, the Vocational Rehabilitation program, and the Study Team.

As a part of the assessment process, the Study Team also developed a list of 32 new or existing businesses with potential for development or expansion. They were grouped as "most viable," "have potential," or "would face significant challenges." Only five were identified as facing significant challenges. This list was presented to the community at a public event as part of the final report and recommendations from the assessment. The listed "viable" and "potential" business opportunities served as a starting point for economic development for Emery County, which led to Phase 2 of the project.

In Phase 2, the Community Advisory Panel expanded in response to the recommendations and created what would become the governing body for the South Eastern Utah Small Business Investment Fund. In short, this fund was used to develop 79 small businesses that, in turn, created 192 jobs over just a three-year period. The project shows tremendous potential to remain strong and continue to produce economic growth in the community. [JS2]

[JS1] Are there other data that suggest economic problems or consequences of the e.g., higher rate of violence, poverty?

[JS2] What does the community itself have to offer? Money, expertise, retired leaders, community college?

DESCRIBE THE MAKEUP AND HISTORY OF THE COMMUNITY TO PROVIDE A CONTEXT WITHIN WHICH TO COLLECT DATA ON ITS CURRENT CONCERNS. 

Costa Rica is a small Central American country. It is a democratic republic with a strong constitution. The country is run by a president, 2 vice presidents, a 15 member cabinet, and a Legislative Assembly. Nobel Peace Prize winner, Óscar Arias, has held office for 4 years. Costa Rica has managed to avoid much of the violence that is prevalent in the rest of Central America and, as a result, has been viewed as an example of political stability in the region. It was the first country in the world to constitutionally abolish its army. There have been only two short periods of violence in the region since the late 19th century. Although the country has no military it does maintain domestic Police and armed National Guard forces for internal security.

Costa Rica is, for the most part, an agricultural country; however, it has achieved a standard of living that is fairly high. The economy has been expanding for Costa Rica, partly because the Government implemented a seven year plan of expansion in the high tech industry. The central government offers tax exemptions for those who are willing to invest in the country. High levels of education among its residents make the country an attractive investing location. Autonomous state agencies enjoy considerable operational independence; they include the telecommunications and electrical power monopoly, the nationalized commercial banks, the state insurance monopoly, and the social security agency.

Costa Rica is bordered by Nicaragua, Panama, the Caribbean Sea, and the North Pacific Ocean. The country is approximately half the size of Ireland, and encompasses several islands. The country is highly recognized and praised for its national park system: a developed and progressive system which stresses ecotourism. Costa Rica protects over 25% of its national territory within national parks.

In 2005, Costa Rica had an estimated population of 4,016,173 persons. Most people in Costa Rica are mestizo to various degrees, though there is also a large unmixed European minority, which is primarily Spanish. These two groups account for a combined 94% of the population. Some 3% of the population is of black African descent, and another 1% is composed of ethnic Chinese. The indigenous population today numbers less than 1%, or around 29,000 individuals.

DESCRIBE WHAT THE MATTERS TO PEOPLE IN THE COMMUNITY.

In low- to middle-income countries and regions, the majority of road deaths are among pedestrians, passengers, cyclists, users of two wheelers, and occupants of buses and minibuses. The thing that matters most to community members is safety for themselves and for their families. The community members realize the growing public health problem with traffic safety and recognize the current traffic laws, practice, education, vehicles, and road conditions as a threat to their well-being.

DESCRIBE WHAT THE MATTERS TO OTHER COMUNITY STAKEHOLDERS.

Organizations from the governmental, civil society, and private sectors are all involved in road traffic safety in Costa Rica. The Consejo de Seguridad Vial (COSEVI - National Road Safety Council) is the main national organization addressing road safety issues. The Minister for Public Works and Transport is the President of the Council. The Council has four executive departments: traffic engineering, road safety education, traffic police, and public transport. These people are in charge of ensuring the safety of their citizens. As the economy of Costa Rica continues to grow, the people in charge feel it necessary to take the proper steps needed to promote public health and improve conditions so that the citizens of Costa Rica are safe. This desire includes coming together in collaborative teams to plan interventions that will make widespread change and allow for safer roads.

COMPILE AND DESCRIBE THE EVIDENCE SUGGESTING THAT IDENTIFIED ISSUES SHOULD BE A PRIORITY.

Road crash injury is, for the most part, preventable and predictable, and yet it remains one of the leading causes of death around the world. It is the ranked number 2 in age groups 5-14 and 15-29, and number 3 in age group 30-44. These three groups alone suffer at least 718,500 deaths a year from road traffic injuries. The fatalities cause by road traffic injuries are only the beginning, and do not include all the loss of human and societal resources.

Rapid motorization, which often accompanies rapid economic development, is a major contributing factor to increasing road traffic injury risk.  In countries that see rapid economic growth like Costa Rica, there are larger stretches of vulnerable road than in higher-income countries. In many developing nations, though vehicle use has greatly increased, most people still walk or bicycle to work. Those traveling in motorized vehicles are often bus passengers or motorized two-wheeler riders. Vehicles are also less safe in developing nations. Buses are often second-hand imports from wealthier countries and lack up-to-date safety features. Passenger cars tend to be older and do not have air bags, collapsible steering columns, or other crash-protective features. In addition, vehicles are not as well maintained in developing countries. Another factor is poor road and land-use planning. This often leads to a deadly mix of high-speed through traffic, heavy commercial vehicles, MTWs, pedestrians, and bicyclists on developing-country roads. Accommodations for vulnerable road users, such as sidewalks and bicycle lanes, are rare in developing countries.

In Costa Rica, traffic crashes and their consequences are clearly a public health problem. The economic cost of traffic crashes to the country amounts to almost 2.3% of the gross domestic product. There were 68,804 road crashes in 2002, accounting for 673 fatalities and 2,783 serious injuries. 64,797 road crashes were responsible for 668 fatalities, and 2,914 serious injuries in 2001. In 2000, there were 13,507 light injuries, 2,562 serious injuries and 670 fatalities in the 59,496 road crashes that occurred.

Traffic accidents are the leading cause of violent deaths, the leading cause of death in the 10–45 years age group, and the third leading cause of years of life lost due to premature death.

DESCRIBE THE BARRIERS AND RESOURCES FOR ADDRESSING THE IDENTIFIED ISSUES (S).

A big barrier to success is that, in most countries, current road safety efforts fail to match the severity of the problem. Often in developing countries, residents are at a much higher risk of sustaining road traffic injuries. These people are also at a higher risk of death when a crash does occur. This is because developing countries have inadequate trauma systems and are often unable to care for crash victims. In Costa Rica, the highest crash risks are actually for the pedestrians and cyclists. This is because the modern traffic system often forgets to make provisions for other road users because it was set up primarily for motorized vehicles.  In particular, young drivers or riders are at higher risk for crash involvement. Men, especially young men, are more likely than women to be in a road crash.

Drivers drive too fast, overtake others at wrong places, drink and drive, and ignore road signs and rules. Estimates show that the cost of road accidents corresponds to almost one percent of Costa Ricas GNP each year. And, as an increasing number of people are buying cars, the problem is growing.

The population of Costa Rica is roughly 4 million, with 900,000 vehicles, and a road network of 29,000 km only 9000 km which are surfaced, and only 20% of these roads are in a satisfactory state of repair.

As a result of then recognized importance of finding a solution to this problem in Costa Rica, there have been interventions set in motion to promote road safety and make it a desirable behavior. A national road safety plan, aimed at reducing the mortality rate by 19% during the period 2001–2005, is being implemented, providing for action in the fields of traffic laws, police surveillance, education, infrastructure, and research.

Every day in a small village in central Ghana, she crosses a river to reach her subsistence farm on the other side.  She climbs up a dirt hill out of the water and soon forgets about her traverse across as her wet feet dry in the sun.  She spends the day farming okra until it is time to make the journey back home when she once again crosses the river and directly trudges through the water.  She spends the evening caring for her large family and sweeping dirt out of her home, but she is very tired while she works.  She knows something is not right; she knows her fatigue, bloody urine and diarrhea, and fever are resulting from her walk through the river.  She cannot afford to not walk through the river, and her village cannot afford to build a bridge.  Every day she and many others in the community are knowingly affected by the chronic disease schistosomiasis, caused by a parasitic flatworm, as they walk through the river.  This condition started to change once a massive intervention occurred in the community.

In 2003, researchers from the Department of Family and Preventive Medicine at the University of Utah were asked to assess and recommend health interventions in the community of Barekuma, a village in Ghana, West Africa. According to Dr. Steve Alder, a lead investigator, “We started out with the idea we would go in and fix things (the typical approach that is often taken), but we realized quickly that was not going to work.”  The initial assessment vision rapidly evolved into a participatory evaluation process that extended beyond the outside researchers to rely on local experts, local interpreters, village chiefs and elders, leadership counsels, community members, and researchers and physicians from the neighboring hospital and university.  Dr. Alder reflected, “We had a very receptive village, a capable village, and an enlightened leader, Chief Nana Kwasi Tabiri—it was that combination of circumstances that took us from what would have been an unfortunate path to take initially to a much better approach that I am now convinced represents the way this type of work should be done almost exclusively.”  Now, the “basic thrust of the community development projects is to build upon the self-reliance of communities and look to see ways in which we can capitalize on resources that are there and access resources that aren’t there with the specific focus of reducing health disparities.”  The outcome of this collaboration was the Barekuma Collaborative Community Development Project (BCCDP), a partnership that views the community as a unit, is of mutual benefit to partners, creates a space for co-learning, fosters intervention sustainability, and builds on existing strengths and resources (Duncan).  The project impacts a cohort of approximately 40,000 rural village residents within Barekuma and its surrounding villages.

The project began with a needs assessment that involved community members in the decision-making process so the interventions would reflect the priorities of the community members, and would incorporate the beliefs and cultural etiologies of the community members.  In earlier interventions, prior to the BCCDP presence, standpipes, were introduced to replace drinking water from the river and wells.  Standpipes are freestanding pipes which provide a communal source of clean drinking water.  Barekuma used the standpipes while water was free, but when a small fee was introduced, community members rejected the water and rationalized the refusal by saying the water was poisoned. If a community assessment was done prior to the project, instead of merely postulating community needs, they would have discovered the importance of wells to community members and would have learned to incorporate changes that enhanced existing wells.  Implementing standpipes has been beneficial in other impoverished rural areas, but did not meet the community needs of Barekuma because of the way they were implemented without interacting with the community.

Prior to researchers from the Department of Family and Preventive Medicine at the University of Utah implementing and evaluating interventions, a community assessment was developed that included several elements: census and demographic information, physical exams, water and sanitation analysis, focus group and community member interviews, and a disease cluster map of the community. Community assessment is a continual process whereby the changing needs of the community are evaluated. The researchers had not anticipated the need for economic and agriculture components, but due to the information community assessments yielded, these have become integral components of the intervention. Over the course of four years, the project has defined a variety of community needs and priorities. Methodologies for key learning involved both the collection of quantitative data in the form of GPS disease cluster mapping, medical exams, and malaria rapid test kit use and qualitative data in the form of focus group and individual interviews. Challenges in focus group interviews included women answering in unison reflecting a collective culture and a hesitance to answer questions of a sensitive nature.  This challenge was ameliorated by augmenting focus group responses with individual interviews.  Women were found to be key players in the health of the villages so they were the main population targeted in focus group interviews. Questions in a variety of areas assessed breastfeeding, immunizations, health priorities, health beliefs, finance, and food security. A direct priority that was identified through the interviews was to increase sanitation, and flush toilets were subsequently built. Listening sessions and meetings with community elders identified satisfaction and experience of the intervention and additional community priorities.

It became evident that the health of the community was complex and multifaceted.  Women were sometimes sick with malaria three times a year, which impacted their ability to bring income to their families and therefore limited their opportunity to provide nutritious foods. This cyclical process was penetrated by practices such as the creation of microfinance projects, a fruit plantation that took the village beyond subsistence farming, and altering local wells to prevent standing water and increase water quality. With income from the orange plantation, the community hopes to build a bridge to reduce the prevalence of schistosomiasis from walking through the river.  Future activities for the area are to provide a field site for community trials to expand the research base, implementing the Integrated Management of Childhood Illness (IMCI) scheme, and scaling up and adapting the intervention to other villages in West Africa.  IMCI is World Health Organization’s “integrated approach to child health” that “promotes the accurate identification of childhood illnesses in outpatient settings, ensures appropriate combined treatment of all major illnesses, strengthens the counselling of caretakers, and speeds up the referral of severely ill children” (WHO).  Dr. Alder said of the process, “We experienced growth pains, but now having gotten through those, we are really positioned well to not only do this in Ghana but to take the framework with appropriate tailoring to other countries.” Because the project involved local community members and addressed pertinent community needs, the project has increased sustainability and now is moving toward efforts to make the BCCDP a completely Ghanaian led project.

For others engaging in similar participatory research and intervention projects, Dr. Alder recommends being “very self-reflective before engaging in the process of truly what strengths or weakness one would have to offer to that type of a setting, to be able to recognize where the community, academic, or other expertise comes together, and to look at the many examples of successes and failures to find where to begin.”

RESOURCES:

Alder, S. Telephone interview. 23 Oct. 2007.

Duncan, M. "Using Community Based Participatory Research to Develop Effective Health Interventions in Rural Ghana." Global Health Education Consortium. 16 Feb. 2007. University of Utah Department of Family and Preventative Medicine. 10 Oct. 2007. Using Community Based Participatory Research to Develop Effective Health Interventions in Rural Ghana.

Integrated Management of Childhood Illness. World Health Organization. 2005. 06 Dec. 2007.

A University-School System Partnership to Assess Middle School Health Program
American Journal of Health Studies 19(3) 2004

Brian F. Geiger, Ed.D.
CindyJ. Petri, Ph.D.
Carol Barber, MA.

Abstract: University health education faculty assisted an urban school system in a southeastern state to plan and conduct an assessment of the school health program in three middle schools. A School Health Subcommittee was formed that included administrators, teachers, school nurses, parents, student, and representatives from nonprofit agencies. The Subcomminee activated three middle school wellness teams to identify program strengths and areas for improvement during the 2003-04 school year.

In 2007, the Richland County Public Health Department conducted a survey process to evaluate the overall health, safety, and wellness of Richland County residents.  They used an approach called Mobilizing Action through Partnership and Planning, or MAPP. The community assessment looked at social circumstances, environmental conditions, economic development, and county/city growth policies.

DESCRIBE THE MAKEUP AND HISTORY OF THE COMMUNITY:

First, demographic and other statistical information was collected about the physical health of the Richland County residents: Community Health Assessment.

A County Windshield Survey was also conducted. AmeriCore*VISTA members were taken on car tours of each town in Richland County guided by two residents from each town. Discussion topics included health, environment, youth, seniors, local business, housing, protection, transportation/road conditions, and safety. City of Sidney Windshield Survey.

DESCRIBE WHAT MATTERS TO PEOPLE IN THE COMMUNITY:

Several methods were used approaches were taken to learn about the broad array of issues that matter to people in the community.

• A County Telephone Survey was conducted by the University of Montana’s Bureau of Business and Economic Research, which contacted a random sampling of residents. The topics chosen by area groups for this survey included local housing, business, volunteerism, and the importance of a local school system to their community. Richland County Telephone Survey.
• To assess the views of youth, the young people of the community were given a chance to voice their opinions on what they liked and what they would change about their communities. They used a methodology called PhotoVoice. Youth were given disposable cameras and asked to take photos of the positive areas of their community and the areas that needed improvement: Richland County PhotoVoice slideshow.
• The views of the elderly were also assessed. Focus groups were formed to address senior citizens’ accessibility to physical activity. Seniors were asked to comment on what forms of exercise were currently available to them, what barriers existed that prevented physical activity, and what changes and programs they would like implemented in the future. Richland County Senior Focus Group.
• Written surveys were given out to Richland County residents inquiring about their views on various environmental health topics. The top concerns that surfaced from this survey were: Illegal drugs and alcohol use, road safety and unsafe drivers, crime and domestic violence, oil/gas development, water and air quality, and the quality of medical facilities. Environmental Health in Richland County.
• Finally, a Local Public Health System Assessment was conducted using the Local Public Health System Performance Assessment Instrument. This instrument evaluated the performance and implementation of ten essential services that the community should do: monitor health status; diagnose and investigate health problems; inform, educate and empower people; develop policies and plans; link people to needed personal health services; assure a competent workforce; evaluate effectiveness, accessibility, and quality of services; and research for new insights and innovative solutions. These ten essential services are guidelines for the optimal performance of the public health system. Richland County Local Public Health System Assessment.
• In an effort to look to the future, a Forces of Change assessment was performed by members of the organization in charge of this effort, the Communities In Action Steering Committee. This was a brainstorming activity that looked at potential forces of change in the community and the potential threats and opportunities created from each change. Some examples of these factors include political or legislative changes, demographic shifts, or changes in availability of natural resources. Richland County Forces of Change Assessment.

RESULT FROM THESE ASSESSMENTS INDICATING THE PRIORITIES OF THE RESIDENTS OF RICHLAND COUNTY:

Housing needs: Statistics indicate that housing in Richland County has become scarce since the beginning of the oil boom in 2001 due to the influx of transient workers employed in the oil fields. Of those who responded to the telephone survey, 85% said there is not enough housing in Richland County.  Many responders also indicated that the “wrong type” of housing is available, as most of the housing units in the county are single family residences.  The EPHT report states that there are waiting lists for all apartment complexes in the county, and that many families and individuals are living in hotels or motels until permanent housing becomes available.  As the oil boom occurred a year after the most recent census, taken in 2000, most data on this subject is outdated.

Water quality: The County Windshield Survey reported that drinking water is of “fair” to “poor” quality and that bleach and water softener must be added to make the water clean and useable. An exception to this is the town of Lambert, where a new water system was recently installed; water quality here is reported as “very good.” Residents wonder if the water in the county is being regularly monitored and by whom. This is especially a concern because of the recent oil and gas development in the area. Currently, the aquifer along the Yellowstone River, which is the source of the local water supply, is being studied along with water samples from Sidney and Fairview.

Illegal drugs and alcohol abuse: The Environmental Health Assessment and the County Telephone Survey both rated illegal drugs and alcohol abuse as the number one concern among residents of Richland County. Findings, however, show that illegal drug use may not be as prevalent as the public perceives.  The Montana Board of Crime Control reports that the percentage of drug offenses relative to the fluctuating county population has actually decreased since 1998.  According to a 2004 study, marijuana was used more frequently than stimulant drugs, but for 8th and 10th graders, marijuana was used to a lesser degree than the state average. Twelfth grade results were on par with the state average.  Alcohol, on the other hand, affects a large percentage of the population, including among youth under the age of 18. In 2004 it was reported that 66% of youth binge drink (i.e., the consumption of 5 or more drinks per sitting), 78% said they had tried alcohol within the past 30 days, and 94% said they will be a lifetime user of alcohol.

DESCRIBE THE BARRIERS AND RESOURCES FOR ADDRESSING THE IDENTIFIED ISSUES:

The Richland County Health Department directly assessed barriers and resources through the Forces of Change assessment, in which “threats posed” and “opportunities created” were identified for each factor or trend. One identified trend was the increasing amount of truck traffic on the highways due to the oil boom.  This posed a threat, because these conditions were harsh on the roads, creating wear and tear which in turn caused automobile accidents. A potential opportunity resulting from this trend was a reason to lobby the federal government for money for highway maintenance.  Another trend was the increasing use of methamphetamines within the community.  This led to the threat of increased crime and drug addiction.  It created the opportunity to increase law enforcement infrastructure and making resources available for meth users who wanted help quitting. A third trend was the increase in internet accessibility in the community. This threatens local business in the downtown areas of Richland County, as people have access to many the same goods online. However, while this access to other goods may harm businesses, it is also a benefit for the people who can now buy products that were previously not obtainable. Additionally, the internet allows access to higher education that is not available locally. Richland County Forces of Change Assessment.

SELECT AND STATE THE PRIORITY ISSUE (OR ISSUES ) TO BE ADDRESSED BY THE GROUP:

A team of community representatives was formed into the Community Environmental Health Assessment Team, or CEHAT, to guide and facilitate the Environmental Health Assessment. This group recommended some priorities for action and action steps: llegal drugs, alcohol abuse, and domestic violence; water quality; quality of medical facilities; oil and gas development; and unsafe drivers. Environmental Health in Richland County.

These recommendations are a good way to start narrowing down the community’s top concerns. However, these recommendations do not take into account the information from the other seven assessments and may not accurately affect information collected in these other ways. Now that a list of concerns has been compiled, Richland County residents must decided which issues are most critical for the community to address. Only then will the community be able to formulate goals and strategies for success, and then finally put the plan into motion.