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Structural Assessment of a Community Service

Network Leah Steimel MPH 1, Melissa Roberts MS 2, Daryl Smith MPH 1

1 University of New Mexico, Office of Community Affairs, 2 LCF Research

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Background:Collaborative Planning Process

Need identified by community organizations & CHWs: health navigators for uninsured

  Pathways model introduced and working group formed

   

Collaborative planning takes place to design overarching goals and adapt model to local needs - Over 35 organizations - 5 month facilitated process - Strong focus on collaborationPublic funding negotiated and MOU signed between UNM and Bernalillo County

      Coordination role (Hub) established and contracts with community agencies initiated.

PATHWAYS Pilot program initiated

2006 2007 2008 2009  

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Background:PATHWAYS Mission Statement

• Connecting underserved county residents with health care & social service systems and supporting them as they navigate through them

• COORDINATING services for underserved residents to achieve positive individual-level health outcomes

• ASSURING collaborative planning and improvement of our health care system in Bernalillo County

PATHWAYS PRINCIPLES

Measure Healthy Outcomes

Intervention Confirm Evidence-Based Service

Find and Engage at Risk Individual – Care Coordination

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Connect & Confirm

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1. People in Bernalillo County will self report better health

2. People in Bernalillo County will have a health care home

3. Health and social service networks in Bernalillo County will be strengthened and user friendly

4. Advocacy and collaboration will lead to improved health systems

PathwaysCommunity-defined Outcomes

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Healthcare and Social Support Systems

Setting (facilities, resources, personnel)• Location• Size• Operations• Leadership

STRUCTURE

PROCESS

OUTCOMES

Care/services for health/social welfare: • Inform, educate, and empower community members• Diagnose/investigate problems and hazards• Mobilize community partnerships to identify and solve problems

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Community Network Some connections pre-existing

Main Street Hospital

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Community Network•Strong: very frequent interaction, established relationships• Weak: infrequent, as needed

Main Street Hospital

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Optimum Network

Diverse participantsMutual respect, shared commitmentRobust networks will have several

paths for connections

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Network Survey

PARTNER: Program to Analyze, Record, and Track Networks to Enhance Relationships [Copyright © 2010 University of Colorado Denver]

Funded by Robert Wood Johnson Foundation

Designed with following goal: to gather data on how organizations work together to achieve improvements in population health

Mix of standard and modifiable questions

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PARTNER Tool

Understand• how

organizations are connected

• attributes associated with connections

Illustration from PARTNER User Manual

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Survey Questions -Value

Asked with respect to a particular organization:

Not at all

A small amount

A fair amount

A great deal

How valuable is this organization/program/department's power and influence* to achieving the overall mission of this community network? *Example: holds a prominent position in the community; shows strong leadership

O O O O

How valuable is this organization/program/department's level of involvement* to achieving the overall mission of this community network? *Example: strongly committed; active in the partnership; gets things done.

O O O O

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Network Survey Implementation

Early Fall 201117 Questions in surveyOnline Survey (PARTNER website/SurveyMonkey)Surveyed:

◦Navigators and administrators of participating Pathways organizations (current and past)

◦Administrators of partner organizations

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Survey Responses

Navigator Survey

Administrator Survey

Total Partner

Org.Pathways

Org.

Organizations invited to participate (N) 20 27 10 17

Organizations responding (N) 18 19 6 13

Organization Response Rate 90.0% 70.4% 60.0% 76.5%

Individuals invited to participate (N) 36 27 10 17

Individuals responding (N) 23 19 6 13

Individual Response Rate 63.9% 70.4% 60.0% 76.5%

Months responding individual with organization (Mean (SD) [Min, Max] )

15.0 (9.7)[3,26]

38.6 (32.0)[1,120]

53.4 (41.3)[14,120]

29.9 (22.9)[1,71]

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Survey Analysis

Reviewed results separately ◦Navigators◦Administrators◦Combination

Combination:If representatives from an organization responded to both surveys, took maximum value of response, otherwise, used values for response

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Perception of Network Outcomes

Correlation between Navigator & Administrator Responses = 0.72

Q6: Outcomes of this community network's efforts include (or could

potentially include): (choose all that apply)

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Perception Most Important Outcome

Q7: Which is this community network‘s most important outcome?

Correlation between Navigator & Administrator Responses = 0.81

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Success after 1 year

Q8: How successful has this community network been at reaching its

goals?

Correlation = 0.83

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Pathways Network is Decentralized

Illustration from PARTNER User Manual

0% Centralization Score 100%

Score

Navigators 24.6%

Administrators 44.2%

Combined 30.6%

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Trust between Network Members is Moderate to Strong

0% Trust Score 100%

Score

Navigators 62.9%

Administrators 61.5%

Combined 57.2%

No Trust Complete Trust

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Participating Pathways Agencies

Estimates of Trust in and Value of Other Organizations, Association with Connectivity

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lolo -------------------------------------------------Pathways Organizations ------------------------------------------------

Organizations Respondents said they Interacted With

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

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1 4 4 2 5 2 4 2 5 4 5 3 4 4 3 3 42 3 2 3 3 2 3 2 3 5 3 2 2 2 2 2 3 34 1 4 6 1 2 1 1 5 1 1 5 5 1 1 2 55 5 4 4 2 1 5 3 5 1 3 2 4 4 3 1 26 4 3 4 4 3 4 3 5 5 1 3 2 1 2 2 47 5 5 5 4 5 5 5 8 Housing 2 3 3 2 1 2 1 4 3 2 2 3 2 2 1 39 10 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 411 1 1 1 1 1 1 1 1 5 1 1 1 1 1 1 112 4 4 4 3 1 1 1 1 4 1 2 3 4 6 1 113 4 3 1 1 5 6 1 2 4 1 3 2 1 3 1 314 4 4 3 4 4 2 1 1 3 1 5 4 4 3 1 415 5 5 4 1 3 3 5 3 5 1 5 1 1 5 1 416 4 4 4 1 4 1 4 1 1 4 5 4 4 4 1 117 3 2 4 3 1 2 1 2 5 1 1 2 1 2 2 118 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 --

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1 Never/Only Non-network related 2 Yearly 3 Quaterly 4 Monthly 5 Weekly 6 Daily

Navigator Responses – Interaction with other Participating Pathways Organizations

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-------------------------------------------------Pathways Organizations ------------------------------------------------Organizations Respondents said they Interacted With

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

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1 4 4 2 5 2 4 2 5 4 5 3 4 4 3 3 42 3 2 3 3 2 3 2 3 5 3 2 2 2 2 2 3 34 1 4 6 1 2 1 1 5 1 1 5 5 1 1 2 55 5 4 4 2 1 5 3 5 1 3 2 4 4 3 1 26 4 3 4 4 3 4 3 5 5 1 3 2 1 2 2 47 5 5 5 4 5 5 5 8 Housing 2 3 3 2 1 2 1 4 3 2 2 3 2 2 1 39 10 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 411 1 1 1 1 1 1 1 1 5 1 1 1 1 1 1 112 4 4 4 3 1 1 1 1 4 1 2 3 4 6 1 113 4 3 1 1 5 6 1 2 4 1 3 2 1 3 1 314 4 4 3 4 4 2 1 1 3 1 5 4 4 3 1 415 5 5 4 1 3 3 5 3 5 1 5 1 1 5 1 416 4 4 4 1 4 1 4 1 1 4 5 4 4 4 1 117 3 2 4 3 1 2 1 2 5 1 1 2 1 2 2 118 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 --

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Healthcare

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1 Never/Only Non-network related 2 Yearly 3 Quaterly 4 Monthly 5 Weekly 6 Daily

Navigator Responses – Interaction with other Participating Pathways Organizations

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Participating Pathways Agencies Partner Agencies

Estimates of Trust in and Value of Other Organizations, Association with Connectivity

Not the same story as with Navigators

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Participating Pathways Agencies Partner Agencies

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Future DirectionsHealth and social service networks in Bernalillo County will be strengthened and user friendly

Sustain and improve levels of mutual trust, value among organizations

Identify critical, but weak links and strengthen them

Measure: ◦network strength ◦accessibility/use◦health outcomes

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