Section 6. Using Outreach to Increase Access

• What is outreach?

• When is outreach needed?

• What are some common methods of outreach?

• How do you implement outreach?

Creating a useful program or service does not guarantee that the people who could benefit from it will be able to find, access, trust, or use it.

A community health clinic, for example, may provide high-quality services but still reach only a small portion of eligible residents if its hours are inconvenient, transportation is limited, people do not know the clinic exists, information is not available in relevant languages, or previous experiences have made community members hesitant to use the service.

Situations like these highlight an important distinction between making a program available and making it meaningfully accessible.

Outreach can help bridge that gap. Sometimes this means bringing information or services directly into communities. In other cases, it means building relationships, working through trusted community partners, helping people navigate services, or learning from community members about barriers that organizations need to address.

Rather than describing people as "hard to reach," it can be more useful to ask why an organization has not yet connected with them. The challenge may lie in communication, service design, transportation, cost, trust, accessibility, eligibility requirements, or other conditions that can be changed.

What is outreach?

Outreach includes a wide range of activities that connect people with information, services, resources, opportunities, and one another. Effective outreach often takes services or information beyond an organization's usual setting and into places, networks, and communication channels that community members already use and trust.

Outreach can include:

• Providing sterile syringes, safer-use supplies, overdose prevention information, and connections to health services in places that are accessible to people who use drugs
• Bringing mobile screening or health services to rural communities where access to health facilities is limited
• Demonstrating correct child car-seat installation at community events or other places families regularly visit
• Sharing condoms, sexual health information, and information about confidential health services in places where young people can access them comfortably
• Training community health workers, peer educators, or other trusted community members to provide information and help people connect with services
• Helping people complete applications, understand eligibility requirements, schedule appointments, or navigate complex systems
• Holding listening sessions or meeting people in community settings to better understand barriers, strengths, priorities, and experiences

The type and extent of outreach should reflect the purpose of the initiative and the priorities, circumstances, and preferences of the people and communities involved.

Outreach may be used to:

• Deliver services, resources, or products directly in accessible community settings
• Share useful information and support people in developing knowledge or skills
• Work with community health workers, peer educators, navigators, or other trusted community members who can connect people with information and resources
• Build relationships and connections among community members, organizations, and systems
• Learn directly from community members and use what you hear to improve programs, services, policies, and outreach strategies

When is outreach needed?

Outreach can be especially important when people experience barriers to traditional services or when organizations have not developed strong relationships with the communities they hope to serve.

Outreach is commonly used with older adults, people living in rural communities, people experiencing homelessness, people who use drugs, immigrant and refugee communities, people with disabilities, communities that have experienced discrimination or disinvestment, and others who may face barriers to conventional service systems.

These communities should not be treated as inherently difficult to reach. Instead, examine whether existing systems, locations, hours, communication methods, eligibility requirements, costs, or institutional relationships make services difficult to access.

If you're unsure whether outreach would help, consider:

• Who currently uses your program, and whose perspectives or participation may be missing?
• Have you asked community members how they prefer to receive information, services, and support?
• Are there differences between who could benefit from the program and who is actually using it?
• What barriers may be limiting participation?
• Are aspects of the program itself contributing to low participation?
• Which community organizations, leaders, or networks already have trusted relationships with the people you hope to engage?

Many programs have historically been designed around the experiences, schedules, communication styles, and resources of people who already have relatively easy access to services. When communities differ in language, culture, income, disability, transportation access, work schedules, family responsibilities, or other circumstances, a program designed around only one set of experiences may unintentionally exclude people.

Surveys, interviews, focus groups, listening sessions, community advisory groups, observation, and ongoing relationships with community organizations can help you understand these differences. Whenever possible, involve community members not only as sources of information but also as partners in designing the response.

For people to make meaningful use of a program, service, or resource, they generally need to:

• Know that it exists and understand what it offers
• See it as relevant, trustworthy, respectful, and useful
• Be able to access it physically, financially, technologically, linguistically, and practically
• Feel welcome and able to participate without unnecessary stigma, discrimination, or administrative burden

If one or more of these conditions is missing, outreach may help -- but outreach should not automatically be used to persuade people to accept a service that does not meet their needs. Sometimes the appropriate response is to change the program itself.

Outreach to increase access

Some access barriers can be addressed through changes in program design. If clinic hours conflict with people's work schedules, for example, evening or weekend hours may improve access.

Outreach may also help address transportation barriers by bringing services into community settings, providing transportation assistance, coordinating rides, offering mobile services, or using virtual options when appropriate.

If childcare responsibilities make participation difficult, organizations might offer childcare, allow children in appropriate settings, provide family-friendly scheduling, or work with community partners that can provide support.

Language access may involve qualified interpreters, translated materials, bilingual staff, community health workers, accessible digital content, and plain-language information. Ask community members which communication approaches work best rather than assuming one method will meet everyone's needs.

Outreach to strengthen trust, relevance, and participation

When people are hesitant to use a service, avoid assuming that the problem is simply a lack of understanding or an attitude that needs to be changed.

Ask why people may be reluctant. Previous discrimination, poor treatment, confidentiality concerns, immigration concerns, cost, stigma, inconvenient hours, cultural mismatch, inaccessible facilities, complex eligibility rules, or a belief that the service does not meet their needs may all affect participation.

Outreach can create opportunities to listen to these concerns and make changes. Communication campaigns may still be useful when people lack accurate information, but they should be based on what community members actually want to know and should not substitute for improving a service that is difficult to use or trust.

Incentives can sometimes reduce practical barriers or encourage initial participation, but they should not be used to pressure people into services or decisions. Participation should remain voluntary and informed.

Outreach to increase awareness

Sometimes people simply do not know that a service exists or that they are eligible to use it. In those situations, outreach can focus on making information easier to find and understand.

Do not assume that newspapers, television, websites, social media, or any other single communication channel reaches everyone. People get information through many sources, including family and friends, schools, workplaces, health professionals, neighborhood organizations, faith communities, community health workers, libraries, service organizations, messaging apps, social media, and local events.

Work with community members to identify trusted messengers and effective communication channels. Organizations may need to use several approaches to reach people with different levels of internet access, literacy, language proficiency, disability access, schedules, and relationships with institutions.

What are some common methods of outreach?

Once you've decided outreach may strengthen your effort, choose methods that fit your goals and the community context.

Common approaches include:

• Outreach that brings services, resources, or products directly into accessible community settings
• Outreach that shares information, builds skills, or helps people navigate services, often through community health workers, peer educators, or other trusted messengers
• Outreach that strengthens relationships and connections among community members and organizations
• A combination of outreach strategies that provides services, shares information, reduces barriers, builds relationships, and connects people with resources

These categories overlap. Effective outreach often combines several approaches and changes over time based on what community members and outreach workers learn.

Outreach to deliver services or resources

Outreach may involve bringing health and human services directly to places where people already live, work, learn, gather, or receive other services. Examples include mobile health clinics, home visiting programs, school-based services, neighborhood resource events, street outreach, and telehealth when it is accessible and appropriate.

This approach can be especially helpful when people face transportation barriers, limited service availability, inflexible schedules, cost, disability access barriers, unstable housing, or lack of nearby providers.

Outreach services are often used in rural communities, neighborhoods with limited access to health and social services, Tribal communities, and communities affected by disinvestment. They may also support people experiencing homelessness, people who use drugs, older adults, young people, people with disabilities, and others when conventional service locations are not accessible or responsive to their circumstances.

Bringing services into a community should not mean offering a lower-quality version of care or support. Outreach services should maintain appropriate standards for privacy, safety, accessibility, informed consent, cultural responsiveness, and quality.

Outreach to share information, build skills, and support navigation

Informational outreach can range from brief communication about available resources to ongoing education, skill building, navigation, and peer support.

For example, a public health department working to prevent pregnancies among adolescents and sexually transmitted infections might partner with schools and youth organizations to provide age-appropriate education about sexual health, consent, contraception, healthy relationships, and available confidential health services.

Additional outreach might include providing information through social media, youth centers, libraries, community events, or other places young people use. Condoms and other prevention resources might also be made available in accessible and confidential ways.

Community health workers, peer educators, navigators, and similar community-based roles can be especially valuable because they often bring strong relationships, cultural and linguistic knowledge, and firsthand understanding of the systems people are trying to navigate.

Community health workers can help people:

• Find and understand available services
• Navigate health, social service, education, or benefits systems
• Communicate with organizations and providers
• Understand health information
• Identify practical barriers and possible solutions
• Connect with resources and community support
• Share feedback that can help organizations improve their services

Community health workers should be treated as skilled members of the workforce, not simply as convenient messengers. Programs should provide appropriate training, supervision, compensation, support, and opportunities for leadership.

Community-based health outreach

In many Spanish-speaking communities, promotores and promotoras de salud have helped connect people with health information and services through trusted community relationships. Similar community health worker models are used in many communities and cultures.

These approaches are most effective when community health workers have meaningful input into program design, are adequately trained and supported, and can bring community concerns back to institutions rather than functioning only as one-way messengers.

Outreach to strengthen connections between people and organizations

Outreach can also create relationships that expand access to education, mentoring, employment, health care, recreation, civic participation, and other opportunities.

This often involves working through trusted institutions and networks such as schools, youth organizations, libraries, community centers, faith communities, neighborhood groups, cultural organizations, workplaces, or other community-based organizations.

Example: College access and mentoring outreach

A university might partner with local middle schools and community organizations to connect students from communities historically underrepresented in higher education with college mentors.

Students could receive tutoring, explore academic and career interests, visit campus, participate in cultural or recreational activities, learn about financial aid and admissions, and talk with mentors about the transition to college.

Families could be included through information sessions, campus visits, and opportunities to ask questions about college costs, financial aid, academic expectations, disability services, housing, and other concerns.

The program would be strongest if students, families, schools, and community partners helped shape the activities rather than the university deciding by itself what participants need.

Combining outreach approaches

Comprehensive outreach efforts often combine awareness, navigation, direct services, community partnerships, and follow-up.

Consider a program designed to help people enroll in health coverage. Outreach workers might first share information through trusted community organizations, schools, health centers, and local events. They could then help eligible participants complete applications, understand documentation requirements, address enrollment problems, and learn how to use their coverage.

Effective navigation should build people's understanding and ability to use systems without implying that confusion about a complex system is a personal failure. Outreach workers can help participants understand their options while also identifying administrative problems that organizations and agencies should simplify.

How do you implement effective outreach?

The following principles can be adapted to many health promotion, human service, education, and community development efforts.

Guidelines for effective outreach

• Meet people where they are -- physically, socially, culturally, and in terms of their priorities
• Treat people with dignity and respect
• Listen to community members and involve them in shaping the outreach
• Build trust and relationships over time
• Communicate without stigmatizing the people or communities you hope to engage
• Offer information and services in a variety of accessible locations and at times that fit people's schedules
• Make information clear, useful, accessible, and easy to understand
• Provide language access through qualified interpretation, translated materials, bilingual staff, and other appropriate approaches
• Follow up consistently without pressuring people to participate
• Protect privacy and explain clearly how personal information will be used
• Reduce practical barriers such as transportation, childcare, cost, disability access, technology access, and complicated enrollment procedures
• Use community feedback to improve the service itself, not only the outreach strategy

Planning and implementing effective outreach

Depending on the nature of your initiative and the type of outreach needed, consider the following steps.

Determine the purpose and methods of outreach for your initiative.

Be clear about what you hope outreach will accomplish. Are you trying to increase awareness, provide direct services, reduce barriers, strengthen trust, connect people with resources, learn from community members, or accomplish several of these goals?

Determine staffing needs.

Outreach staff should have the skills, relationships, training, and support necessary for the work. People who live in or have strong relationships with the communities involved may bring valuable cultural knowledge, language skills, lived experience, and understanding of local resources and barriers.

At the same time, don't assume that someone automatically understands every member of a community simply because they share an identity or live in the same neighborhood. Outreach workers still need training, support, clear roles, and opportunities to learn from community members.

Outreach workers may need preparation in areas such as:

• Communication and active listening
• Cultural humility
• Disability accessibility
• Language access
• Trauma-informed approaches
• Privacy and confidentiality
• De-escalation and personal safety when relevant
• Community resources and referral systems
• Documentation and data privacy
• Boundaries and informed consent

Organizations should also support outreach workers through fair compensation when outreach is paid work, appropriate supervision, manageable workloads, opportunities for professional development, and meaningful involvement in program decisions.

Choose physical and virtual spaces carefully.

If outreach uses a physical office or community site, consider whether the space:

• Is near public transportation or otherwise reasonably easy to reach
• Is accessible to people with disabilities
• Provides private space for conversations when privacy is needed
• Feels welcoming, respectful, and appropriate to the community
• Can accommodate children and family needs when appropriate
• Provides language, communication, sensory, and other accessibility supports

If outreach is offered online or by phone, consider internet and device access, accessible technology, privacy, language, digital literacy, and whether people have a safe and confidential place to participate.

Plan your services or activities.

Develop strategies and action plans using principles for effective program design. Preparation may include:

• Developing clear procedures and accessible information for outreach workers and participants
• Establishing protocols for referrals, privacy, safety, follow-up, and situations that require additional support
• Coordinating with other organizations and services to reduce duplication and make referrals easier for participants
• Creating ways for participants and community members to provide feedback about the outreach process

Consider potential partners.

Outreach is often stronger when organizations work with partners that already have trusted relationships and relevant knowledge. Partnerships should be mutually beneficial and should respect the expertise, time, and resources that community organizations contribute.

Depending on your initiative, partners might include:

• Community leaders and resident-led organizations
• Faith and spiritual communities
• Hospitals and emergency departments
• Health centers and clinics
• Medical practices and their clinical, administrative, and billing staff
• Pharmacies
• Organizations that help people navigate insurance and medical billing
• Public health and community health programs
• Home health and visiting nurse organizations
• Schools, counselors, nurses, family engagement staff, and student-support programs
• Childcare centers and family, friend, and neighbor care networks
• Housing organizations, tenant groups, and housing authorities
• Courts, public safety agencies, and community-based violence-prevention programs when relevant to the initiative
• Local businesses and employers
• Local, state, and national organizations that provide related services or advocacy
• Shelters, workforce programs, adult education programs, food-access organizations, and other community-support programs
• Local news outlets, community media, social media networks, and other communication partners
• Current or former participants who choose to share their experiences and recommendations

Expand outreach thoughtfully.

New outreach efforts may benefit from starting with existing relationships, learning from early experiences, and then expanding into communities or partnerships where the organization has fewer established connections.

For example:

Beginning with established relationships

• Conduct an outreach activity with a community organization that already knows and trusts your program
• Provide information or referral training to other programs within your organization

Building new partnerships

• Offer a listening session, training, or information session with a school, health provider, neighborhood organization, or community service agency
• Participate in joint outreach with another organization

Developing relationships in communities where you have fewer connections

• Build relationships with community leaders, resident groups, and organizations you do not already know and ask what kind of collaboration would be useful
• Meet with organizations that already conduct outreach to learn from their experience and identify opportunities to coordinate rather than duplicate their work

Make the most of your outreach.

Outreach can fail even with significant resources if organizations do not understand the barriers people experience or if the service itself does not respond to community priorities.

Ineffective outreach may use the wrong language, communication channel, location, messenger, schedule, or format. It may also focus so heavily on delivering a message that it leaves little room to listen.

People may encounter information several times and through several trusted sources before deciding whether a service is relevant to them. Use consistent communication and appropriate follow-up, but avoid overwhelming or pressuring people.

Evaluate outreach regularly. Ask not only, "Did we reach more people?" but also:

• Who did we reach, and who is still being missed?
• Did people find the outreach respectful, useful, and accessible?
• Did outreach reduce barriers or simply increase awareness of a service that remains difficult to use?
• What did community members tell us should change?
• Are our partnerships reciprocal and sustainable?
• Are outreach staff adequately supported?

In Summary

Outreach can be the foundation of a community initiative or one part of a larger strategy for improving health, well-being, access, and participation.

Effective outreach is not simply about finding better ways to persuade people to use a service. It begins with understanding the people and communities involved, listening to their priorities and experiences, identifying barriers, building trust, and examining whether the service itself needs to change.

No single approach works in every community. Outreach should be adapted to local relationships, culture, language, accessibility needs, resources, communication preferences, and community strengths.

Strong outreach meets people where they are, works through trusted relationships, provides useful and accessible information and services, follows up respectfully, and creates ways for community members to influence the programs and systems intended to serve them.