ADDING THE METRICS TO MEASURE IMPACT Asset-Based Approaches to Community Development Deborah Puntenney, Ph.D. Northwestern University, ABCD Institute 1

ABCD Principles:  Asset-based (built on positives, strengths, opportunities),  Relationship driven (centered on people in the neighborhood working together), and  Place based (locally focused). ABCD Practices:  Asset mapping (finding all the good things), and  Asset mobilizing (connecting the good things for positive purposes). Asset-Based Community Development (ABCD) 2

ABCD—Perspective Matters EMPTY GLASS: COMMUNITIES ARE FULL OF PEOPLE WITH NEEDS AND DEFICIENCIES FULL GLASS: COMMUNITIES ARE FULL OF PEOPLE WITH IDEAS, SKILLS, AND CAPACITIES WHERE YOU LOOK DRIVES WHAT YOU SEE 3

SIX TYPES OF COMMUNITY ASSETS Actors:  Skills and talents of LOCAL PEOPLE.  ASSOCIATIONS–the network of relationships they represent.  INSTITUTIONS, agencies, and professional entities. Context:  PHYSICAL ASSETS and infrastructure–land, buildings.  ECONOMIC ASSETS–local economy, productive capacity.  CULTURAL ASSETS–ways of knowing, ways of being. ABCD—Types of Community Assets 4

The most community role. An advocate connects the community’s vision and the policies that support the vision or get in the way, advocating positive change. Actor/producer is a critical role for a resident. An actor/producer is a fully engaged individual who helps define and implement community ideas as part of sustainable change. Participant is an entry-level community role. A participant is someone who gets involved, but leaves the defining the vision and developing ideas to others. An advisor can have little power and the role can be an empty one. Authentic advisors have decision-making power. Some people have been victimized, but the role of victim can also be a choice; a victim will never have power. VICTIM ADVISOR CHANGE ADVOCATE ACTOR PRODUCER PARTICIPANT Empowering Co-Producers of Health 5

Neighborhood Health Status Improvement Initiative Launched by the Greater Rochester Health Foundation in 2008 Supports communities to organize residents around the social determinants of health Assumes residents must be at the table for sustainable change Long-term funding; long- term goals Uses an ABCD, grassroots approach Provides evaluation coaches to communities CBPR used to create logic model for outcomes and measures Ongoing measurement builds as projects gain sophistication 6

Neighborhood Health Status Improvement Initiative Current Neighborhood Health Status Improvement grantees Community characteristics from a needs perspective HOPE–Rochester Our Town Rocks–Dundee STEPS– Ovid/Interlaken/Lodi SOAR–Clyde/Savannah High poverty Large health disparities Low income Poor health outcomes 7

MANY factors influence health outcomes.  Good health not solely the result of genetics and good medical care  In County Health Rankings model, physical, social, economic factors represent about 50% of explanatory factors that drive health outcomes.  Health care and health behaviors explain the other 50%. What Drives Health Outcomes? 8

ABCD APPLICATION IN NHSII GRANTS  Assessment (finding assets).  Planning (engaging assets for different roles).  Doing (mobilizing assets toward plan implementation). THREE QUESTIONS:  What can we do ourselves (local assets)?  What can we do with some help and support (partnerships)?  What is it really someone else’s job to do (policy)? Asset-Based Community Development in the NHSII Grants 9

Our 0pportunities for better health begin where we live, work and play Place Matters — NHSII pays attention to the physical, social, and economic environments Authentic neighborhoods Resident- driven Grassroots Asset-based Partnerships 10

NHSII Logic Model and Measures 11

Change in Environment, Exposures, & Experiences Change: Social: Social cohesion, civic engagement, and collective efficacy Physical: Clean, safe and healthy neighborhood living conditions Economic: Opportunities for self sufficiency, learning, and jobs Cultural: Prevailing community norms, customs, and processes Measures, 1-2 years of implementation: Outputs: e.g., activities undertaken, participants involved Outcomes: E.g., Number of blocks in neighborhood that showed no evidence of trash, debris, or litter increases [block observations]. E.g. Sense that residents can have a positive influence on their community increases [survey]. E.g., Degree of comfort with neighbors increases [survey]. 12

Change in Attitudes, Feelings, and Understanding Change: Hope for the future Feelings of cohesiveness and connection Feeling safe Feeling empowered, capable, and in control Feeling different health and lifestyle choices are possible Measures, 3-6 years of implementation: Outputs: e.g., activities undertaken, participants involved Outcomes: E.g., Percentage of residents that feel it is safe for kids to play outside increases [survey]. E.g. Percentage of residents that feel they can count on neighbors increases [survey]. Percentage of residents that feel the neighborhood is improving increases [survey]. 13

Change in Behavior Change: Nutrition Physical activity Substance abuse Tobacco use Educational attainment Employment Measures, 3-6 years of implementation: Outputs: e.g., activities undertaken, participants involved Outcomes: E.g., Percentage of residents that eat no fruits/vegetables decreases [survey]. E.g. Percentage of residents that do not smoke increases [survey]. Percentage of residents that participate in physical exercise for 5 or more days in the past week increases [survey]. 14

Change in Medical Conditions that Precede Disease Change: Obesity High blood pressure High cholesterol Stress levels Low birth weight babies Elevated blood lead levels in children Measures, years of implementation: Outputs: e.g., activities undertaken, participants involved Outcomes: E.g., Percentage of residents that are obese decreases [survey]. Percentage of residents that are overweight decreases [survey]. E.g. Percentage of residents told they have high blood pressure decreases [survey]. Percentage of babies born with low birth weight in neighborhood decreases [survey]. 15

Change in Health Status Change: Angina/coronary heart disease Diabetes Stroke Asthma STDs HIV/AIDS Measures, years of implementation: Outputs: e.g., activities undertaken, participants involved Outcomes: E.g., Years of potential life lost decreases relative to Monroe County [YPLL]. E.g., Percentage of residents that report their health status as excellent or very good increases [survey]. 16

How the Evaluation is Conducted Evaluation coaches work with residents, project teams, and ABCD TA starting in the planning year to define outputs and outcomes in the short-, medium-, and long-term. Evaluation coaches work with project teams to design data gathering instruments for project tracking, and design and implement their baseline data gathering protocol. Evaluation coaches work with project teams to implement ongoing data gathering, and share data with the community. Protocols include observation, surveys, focus groups, key informant interviews, and monitoring. Evaluation coaches work with project teams, ABCD TA, and Program Officer to use results to revise both individual projects and the overall funding NHSII program. Evaluation coaches help develop reports, articles, presentations using the findings for individual projects, and all projects collectively. 17

Evaluation Partners Ann Young, AGTY Partners, and Eileen Flanagan are contracted by the foundation to work on the long-term evaluation. Evaluation coaches have worked with project teams to identify secondary data sources specific to each project; these include: City of Rochester and Rochester Police Department Finger Lakes Health Systems Agency Dundee Central School District Yates Economic Development Commission Keuka Housing Council Evaluation coaches work with the Greater Rochester Health Foundation to develop data sharing relationships with: New York State Department of Health Monroe County Department of Public Health Yates County Department of Health Finger Lakes Health Systems Agency 18

Evaluation Challenges Finding data sources that provide neighborhood level data. Getting agreement from data sources to share. Getting agreement from data collectors to add neighborhood level questions. Maintaining ownership across the community, i.e., not creating “survey fatigue.” 19