Community Service Project Evaluates Adding a Health and Safety Component
From 1995 to 1997, the Woodrow Wilson National Fellowship Foundation, Princeton, N.J., carried out a planning project to incorporate a specific focus on health into the National School and Community Corps program funded by the national service program (AmeriCorps).
The National School and Community Corps is active in 65 elementary, middle, and high schools in Philadelphia. It has 245 members, ranging in age from 18 to 83, whom it has enlisted for mentoring, tutoring, managing after-school activities, and providing other support to families and youth in their neighborhoods.
In working with parents, Corps participants frequently encounter a variety of health issues, such as failure to obtain or take medication, which they are not prepared to handle.
- Through a consultant the National School and Community Corps developed a report that provided a blueprint for a new initiative that was to build on the organization's accomplishments in Philadelphia and elsewhere.
The report concluded that Corps members have the opportunity and ability to add health to the work they are already doing for children and their families in Philadelphia's distressed schools and neighborhoods, and that adding health to their current mission was a feasible goal.
The Corps secured funding from the Philadelphia schools to field a health team to augment the efforts of corps members.
The Robert Wood Johnson Foundation (RWJF) supported the project with a $39,233 grant between September 1995 and October 1997.
The National School and Community Corps (NSCC) was one of 400 community service projects funded under AmeriCorps, the national service program. It was considered to be among the top 25 projects nationally. It was active in 65 schools and communities in Philadelphia where it enlisted about 245 members, ranging in age from 18 to 83, who provided mentoring, tutoring, after-school supervision, and providing other support to families and youths. It planned to expand to include schools in New York City and Wilmington.
In working with parents, NSCC participants frequently encounter a variety of health issues they are ill equipped to handle. For example, substance abuse may be one of the primary barriers limiting efforts to strengthen parent participation in schools. Yet, youth working in the program have had no training on how to address this issue. Specific training for NSCC participants about how to address health issues was thought to improve the effectiveness of the project, while also focusing greater community attention on health issues.
At the time of the RWJF grant, future federal funding for AmeriCorps was uncertain, jeopardizing the effort to integrate health into the community service initiative. The House of Representatives had eliminated funding for the program and Senate support was also weak.
This grant provided funds to the Woodrow Wilson National Fellowship Foundation to hire a consultant who developed a plan for "adding health" to the ongoing work of the NSCC and to assess its feasibility. The basic concept behind the effort was that the high quality of relationships built between corps members and community members could form the basis around which a variety of health interventions could be planned and implemented.
During the project, the grantee planned to:
- Conduct research and a thorough literature review.
- Conduct additional site visits and interviews to assess targets and opportunities for adding health to the NSCC mission, complete an inventory on other health-related ventures in the district, and develop a preliminary list of shared health priorities.
- Explore strategies to recruit and train corps members and to ensure quality assurance.
- Coordinate with other initiatives of the Corporation for National Service, the federally funded volunteer effort that provided funding to NSCC.
These activities were to lead to a detailed plan for further funding that would:
- Refine the concept of community service workers as intermediaries.
- More sharply refine the health objectives to be achieved and a strategy for selecting health priorities.
- Propose an innovative strategy for corps member selection, training and quality assurance.
- Recommend a series of activities to connect urban and suburban interests to achieve health.
- Propose an evaluation plan.
- Develop a specific strategy to promote continuity.
- The research and literature review concluded that most strategies to improve access to care focus on structural barriers to care in the health care system (such as a lack of health insurance), but neglect certain relational barriers that prevent people from obtaining access (such as cultural differences). NSCC outlined seven important needs that are essential to the success of projects to improve access to care and health. These include:
- Breaking down attitudinal barriers.
- Spreading the word regarding the benefits of certain treatments and care.
- Reaching out to those who are socially isolated.
- Legitimizing outreach efforts by others.
- Representing and explaining needs of community residents to providers.
- Touting the tangible benefits of service.
- Providing skill-based interventions.
- Through site visits and interviews NSCC found four approaches to adding health to corps members' activities and the plan discussed the way each succeeded or failed to address the seven important needs. The potential strategies included:
- The Opportunistic Approach adds health during what are called teachable moments opportunities for doing something that was not planned or predicted.
- The Strong Opportunistic Approach seeks to identify a range of specific opportunities and to develop a capacity for specific interventions and results.
- The Dedicated Service Approach is a way of describing a more formal, fixed, and established set of services and interventions. It can be distinguished from the two opportunistic approaches because it would look like a traditional function or area.
- The Reciprocal/Advocacy Approach describes a strategy that would more formally link existing or emerging providers of services with those who need them.
- Using these approaches, NSCC developed a comprehensive model for adding health to the service mission of corps members. The model has five principal elements:
- Recruit and add a health specialist to each school team to enhance NSCC's capacity to add health within a school, to serve as a mentor to other team members, and to be primarily responsible for coordination with other school health initiatives.
- Convert all NSCC members from health bystanders to actors or agents to improve the health of the children they serve. Each school team would select a health objective (or group of objectives) to be added to the school site plan.
- Develop formal arrangements with managed care providers for reciprocal/advocacy functions.
- Implement the Adding Health Network, an interactive training and mentoring strategy that promotes quality and accountability and measures achievement of desired outcomes. Expand on the current training program toward the development of an interactive network to support assistance and development.
- Implement strategies to enhance continuity, secure alumni participation, and promote understanding and support by outsiders.
- Interviews with current corps members and others found that it is feasible to add health to corps members' general repertoire of skills so that corps members become agents of health. They identified the range of health needs where corps members could have an impact. These included:
- Ensuring that all children had appropriate immunizations.
- Managing common illnesses.
- Addressing concerns about sex, pregnancy, and sexually transmitted diseases.
- Addressing concerns about drugs and alcohol.
- Increasing awareness about violence and its psychological consequences.
- Increasing awareness of poor nutrition (particularly over consumption of sugar).
- A strategy was developed to secure mentoring, supervision, and quality assurance without building a large training bureaucracy through the application of new networking technology. The Adding Health Network would link each site, the training and supervisory personnel within the NSCC, selected community providers and school (nurses and other) officials, and cooperating mentors. It would provide opportunities for on-line mentoring through the development of a moderate listserve.
- An evaluation plan was developed. The investigators proposed to measure the outcome of the project by:
- Selecting a set of experimental schools where the project would be implemented and a set of control schools with no NSCC activity and equivalent access to health services.
- Conducting baseline assessments of the incidence and prevalence of health issues, diseases, conditions, interventions, and services.
- Mounting the program in the experimental schools, emphasizing in all schools the cultivation of trusting relationships.
- Measuring and comparing results between the experimental and control schools.
- A strategy for stability and continuity was developed. The plan called for entering into agreements with local health care agencies and HMOs and developing a contingent of NSCC alumni who would remain active in the community.
There was no dissemination of grant products outside of reports to the Foundation.
AFTER THE GRANT
A proposal for a grant to implement the proposed model was not funded by the Foundation primarily because of concerns about the ability of the project, if implemented, to achieve significant measurable outcomes. The grantee has not sought other funding to implement the project, but it did secure funds from the Philadelphia schools to field a six-member health team to augment the work of NSCC corps members. Before the grant ended, AmeriCorps received its largest federal appropriation in years and enjoys bipartisan support in Congress, which benefits NSCC in its overall mission.
GRANT DETAILS & CONTACT INFORMATION
Strengthening a Community Service Project's Capacity to Improve Health and Safety
Woodrow Wilson National Fellowship Foundation (Princeton, NJ)
Dates: September 1995 to October 1997
Martin S. Friedman
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Books and Reports
"Adding Health" to the Work of the National School and Community Corps. Princeton, N.J.: Woodrow Wilson National Fellowship Foundation, 1996.
Report prepared by: Alison Schwartz
Reviewed by: Richard Camer
Reviewed by: Molly McKaughan
Program Officer: Rush L. Russell