1. Ready or Not? assessing and implementing change Stephanie Jones Erica Ruck, Ovens and King Community Health Service

2. Workshop Content 1. Provide you with an understanding of ‘community readiness’ and how this fits into Best Start at all levels - government, community, organisations and services, teams and groups. 2. Work in groups to look at the readiness of your BS community

3. What has this got to do with Best Start?

4. Best Start has taken a community approach to implementing changes within and for families ‘place-oriented’ setting in local government areas driven by partnerships of local people and organisations BS in aboriginal communities with strong family and kinship networks

5. But is the community ready? To bring partners together to co-ordinate, plan and deliver Best Start initiatives? To make changes to its values, norms and goals that are key to family and community well-being? To re-orient services?

6. Definition of Community Readiness (adapted, Kumpfer, 1997) CR is the extent to which a group of individuals is adequately prepared to implement Best Start CR assessment is a process for measuring the characteristics of a community, its population, community leaders and service systems that can influence the success of Best Start

7. Acknowledges: A. Every community is different Vary widely in their interest, ability and commitment to making changes (dependent on what they are) Level of community connection and networks Have different values, norms, hopes & priorities Established communities may be much more practiced at working together- not so easy for newer or transient communities- with different populations

8. Stages of Change DiClemente& Prochaska ‘Individual Readiness’ (1982) Warren ‘Group Readiness’ (1978) 1Pre-contemplation stage-minimal awareness of the problem and therefore little desire to change Stimulation of interest- recognition of need 2Contemplation stage-awareness but no commitment to action Initiation-development of problem definition and alternative solutions 3Preparation stage-recognition of the problem and exploration of options Legitimization-local leaders accept the need for action 4Action stage-implantation of proposed changes in behaviour Decision to act- development of specific plans involving community members 5Maintenance stage-consolidation and relapse prevention Action-implementation B. Stages of change in a community

9. Why increase community readiness? Comprehensive health promotion or change efforts are much more likely to have the desired impact, particularly when health professionals work with local citizens and community leaders Better allocation of resources and efforts Empower communities to deal with a whole range of issues More likely to change community norms and values

10. Working with community readiness Erica will take us through how we can use identified criteria to assess the readiness of community groups to engage in public health initiatives, and to adopt different strategies depending on the level of readiness.

11. Experience of measuring community readiness A particular issue or concern identified Interviews conducted with community members Measurement of readiness Potential strategies identified Community change

12. Dimensions measured 1. Community efforts (programs, policies) 2. Community knowledge of efforts 3. Leadership (aware & active) 4. Community climate (supportive) 5. Community knowledge about the issue 6. Resources for efforts (time, money, space)

13. Stages of Community Readiness 1. No awareness 2. Denial/Resistance 3. Vague awareness 4. Preplanning 5. Preparation 6. Initiation 7. Stabilisation 8. Confirmation/Expansion 9. High level of community ownership

14. Working example- Suicide prevention project in rural Victoria Community interviews were conducted-some individual and some focus groups Value to the community members Value to the worker Intervention strategies designed or confirmed

15. Evaluation Second round of interviews evaluated progress -increase in preparedness to take action ▪ community leadership influence ▪ extent to which local resources available to support efforts Attribution to project not direct, but based on an a priori expectation of these changes, assuming a positive contribution to them is a reasonable conclusion

16. Research Support from PHCRED Research Fellowship, Melbourne University School of Rural Health Conducted research into readiness with an organisation as the “community” Provided recommendations for how the organisation could move forward around a particular issue

17. How is it useful? Acknowledges and engages community members Provides insight for worker/facilitator Guides choice of strategies that are more likely to be successful Provides data for monitoring change – especially useful for evaluation and accountability May create change

18. Paradoxical Theory of Change (Arnold Beisser) “Change occurs when one becomes what one is, not when one tries to become what one is not”

19. How can it be used? An assessment tool An evaluation tool A change measurement tool A planning tool

20. Stages of Readiness 1.No Awareness Issue is not generally recognized by the community or its leaders as a problem (or it may truly not be an issue) 2.Resistance At least some community members recognize that it is a problem, but there is little recognition that it might be a local problem. 3.Vague Awareness Most feel that there is a local problem, but there is no immediate motivation to do anything about it 4.Preplanning There is clear recognition that something must be done, and there may even be a committee. However, efforts are not focused or detailed. 5.Preparation Active leaders begin planning in earnest. Community offers modest support of efforts. 6.Initiation Enough information is available to justify efforts. Activities are underway 7.Stabilization Activities are supported by administrators or community decision makers. Staff are trained and experienced. 8.Confirmation & Expansion Standard efforts are in place. Community members feel comfortable using services, and they support expansion. Local data are regularly obtained. 9.High Level of Community Ownership Detailed and sophisticated knowledge exists about prevalence, causes, and consequences. Effective evaluation guides new directions. Model is applied to other issues.

21. WORKSHOP In your Best Start groups; think about an issue and which domain it relates to Discuss at which stage of readiness your ‘community’ may be at in relationship to this issue

22. After you have chosen the stage of readiness, Design some strategies Report back

23. Contacts: Stephanie Jones Stephanie.Jones@mh.org.au Erica Ruck Ovens and King Community Health Service rucke@ovensandking.org.au Or contact www.TriEthnicCenter.Colostate.edu