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Community Arts in Healthcare Program PlanningAdapting Community Health Program Planning Models to the Arts in Healthcare

JILL SONKESHANDS ARTS IN MEDICINEUF CENTER FOR THE ARTS IN HEALTHCARE

+Arts in Healthcare is a diverse, multidisciplinary field dedicated to transforming the healthcare experience by connecting people with the power of the arts at key moments in their lives.

This rapidly growing field integrates the arts, including literary, performing and visual arts and design, into a wide variety of healthcare and community settings for therapeutic, educational and expressive purposes.

Society for the Arts in Healthcare, 2009

+ A rich body of research defines benefits, including:

• shorter hospital stays

•reduced need for medications

• increased employee retention

• more effective communication of health information

Findings demonstrate that integration of the arts into healthcare:

• helps to cultivate a healing environment

• supports the physical, mental, and emotional recovery of patients

• fosters a positive environment for caregivers Sonke et al., 2009

Rural CommunitiesHigher rates of mortality are caused by preventable illnesses, including:

• obesity

•heart disease

•diabetes,

•infant and maternal death

•lower respiratory diseases

•suicide

Poor health literacy accounts for a general lack of health-supporting behaviors and utilization of healthcare (Thomas, 2006; USDA, 2009)

Rural CommunitiesSignificant factors in rural health disparities:

• urban bias in health policy

• poverty

• limited access to healthcare

• rural culture

Social determinants of health, including rural culture itself, represent 50-60% of the

overall influence on health outcomes in rural communities (Evans, 2004)

Franklin County, Florida• One of the state’s largest counties at 545 square miles

• 12,257 residents

• 18% of those individuals living below the poverty level (compared with 12% in the state)

• Median annual income of $26,756 (compared with $47,804 in the state)

• One hospital within a 60-mile radius with 25 beds (including rehab/swing and emergency department beds) and an average daily census of 5-6 patients

• One Federally Qualified Health Center (of 285 in the state)

• Strong arts community due to tourism

Sources: Florida Department of Health (2009) and US Census Bureau (2009)

+A Basic (and insufficient) Program Planning Sequence

1.Needs Assessment

2.Clarify Goals and Objectives

3.Develop an Intervention

4.Implement the Intervention

5.Evaluate the Results

+ Background Information

There is no perfect model

Use one or find what fits/adapt elements from various models

Remember the importance of responding to local populations, conditions, needs, culture, and resources

Three F’s of program planning that can help with selecting the appropriate model Fluidity - steps are sequential Flexibility - adapt to needs of stakeholders Functionality - useful in improving health outcomes

+Program Planning Models PRECEDE-PROCEDE

MATCH

CDCynergy

SMART

MAPP

APEX-PH

Healthy Communities (USDHHS)

The Communication Model (NCI)

Healthy Plan-IT (CDC)

+Social Marketing

•Social marketing seeks to influence social behaviors not to benefit the marketer, but to benefit the target audience and the general society

•Used extensively in international health programs, especially for contraceptives and oral rehydration therapy, and is being used with more frequency in the United States for topics such as drug abuse, heart disease and organ donation

•A good fit for Arts in Healthcare given its creative nature

• Weinreich Communications: http://www.social-marketing.com/index.html

Needs Assessment

A systematic process of asking questions, comparing answers, and making informed decisions about what to do next to improve human or organizational performance

a systematic process to guide decisions-making

provide justification for decisions before they are made

provide a systemic perspective for decision-makers

allow for interdisciplinary solutions for complex problems

offer a replicable process that can be used over and over again

Focuses partners on shared understanding of issues and shared goals

http://www.needsassessment.org/

Needs Assessment

Maslow’s Hierarchy of Needs:

Needs Assessment

Normative Need

The existence of standards or norms

Perceived Need

What people think their needs are or feel their needs to be

Expressed Need

The level of “attempts” that have been made to meet needs/the number of people who have attempted to get help

Relative Need

The gap between the level of services available in the community compared to those in similar communities or geographic areas

Types of Needs Assessment

Extrapolating from existing data (normative needs)

Using resource inventories/community maps (normative needs)

Using service statistics from social services or human services agencies (expressed need)

Conducting a social survey (perceived need)

Holding a public forum (expressed need)

Community Mapping

Identifying and understanding the “geography” of community resources in a particular area

Serves as a basis for partner cultivation

Inclusive in nature

Sustainability

Sustainability – factors influencing routinization

resource stabilization – identification/commitment of human, financial, and other resources

risk-taking - balance between exploitation of recognized activities and the exploration of new activities (builds confidence)

Incentives - benefits outweighing costs for those involved in planning and managing

adaptation of activities - the incremental adjustment of activities according to circumstances

objectives fit – the level to which the program’s objectives fit with the values of the organizations and individuals involved

transparent communication - helps program planners maintain a focus on a common purpose, increases trust and resource sharing, and allows members to discuss and resolve program challenges

sharing of cultural artifacts - a means through which programs and organizations adapt to each other and encourage routinization

integration of rules - the program’s rules are integrated into the rules of the participating organizations

Pluye et al, 2005

Sustainability – guidelines for external organizations developing programs

fund projects in existing agencies with some capacity to support them and to provide the expertise needed for carrying out the many facets of sustainability

fund smaller scale projects that have local resources involved in order to build ownership of the project among local stakeholders

identify, work with, and strengthen local champions to provide the leadership and knowledge of local organizations needed to sustain the project over time

encourage planning for sustainability early in a project’s life cycle

Scheirer, 2005

Meaning

According to Viktor Frankl (1959), meaning is:

• a universal human phenomenon that reflects an attitude or idea that people have about their reality

• the primary motivational force in humans • the ultimate goal of human life

Self-transcendence, Frankl

an inherent characteristic of being human that leads to feelings of self-confidence and the discovery of new purpose and meaning

We self-transcend in three primary ways:

by giving to the world creatively

by being receptive to the world and others

by choosing how to face adversity and find meaning

Self-Transcendence – defined…The expansion of one’s awareness or boundaries:

intrapersonally (sense of wholeness within self),

interpersonally (connectedness to others and the environment)

temporally (connectedness to future and past situations)

transpersonally (connectedness to something greater than the self)

Reed, 2003

Moving beyond the known boundaries of the self to achieve a broader perspective, which in turn helps one discover or make new meaning.

Coward, 1993

The expansion of one’s conceptual boundaries inward through contemplative or introspective activities and outward through a heightened concern for the welfare of others.

Vaughan, 1985

Reed’s Model of Self-transcendence

Appreciative Inquiry Study of Weems Arts in Medicine Program (Sonke, 2009)

Seven themes emerged in the analysis as primary categories:

Meaning

opportunities to help others

benefits to others

sense of community

recognition of health benefits

self-transcendence

diversity (the functional coming together of diverse populations)

Summary of Findings (grounded theory):

program stakeholders can have experiences that lead either to self-transcendence or directly to meaning;

through enhanced self-understanding, purpose and insight, self-transcendence leads to meaning;

meaning, with its seven identified facets, leads to sustainability by producing excitement, commitment, collaboration; and routinization; and

enhanced conditions for sustainability lead to continued involvement in the program.

Thus, if a program can produce meaning, with or without self-transcendence, it has greater potential to be sustained over time.

Sonke, 2009

I value the sense that I am helping people feel better… The difference that one person can make in another person’s life… It drives me.

Weems Arts in Medicine Program Participant