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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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ath
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ys O
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Healthcare Behav Health Com Svcs Empl/Educ Legal Soc Svcs
Org
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ns
Res
po
nd
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to
th
e S
urv
ey
lo
Interaction Frequency Hou
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--P
ath
wa
ys O
rga
niz
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Healthcare Behav Health Com Svcs Empl/Educ Legal Soc Svcs
Healthcare
Org
aniz
atio
ns
Res
po
nd
ing
to
th
e S
urv
ey
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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Pa
thw
ays
Org
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iza
tion
s --
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Healthcare
Behav Health
Com Svcs
Org
aniz
atio
ns
Res
po
nd
ing
to
th
e S
urv
ey
Empl/Educ
Legal
Soc Svcs
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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athw
ays
Org
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Healthcare Behav Health Com Svcs Empl/Educ Legal Soc Svcs
Org
aniz
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espo
ndin
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the
Sur
vey
Interaction Frequency Hou
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--P
athw
ays
Org
aniz
atio
ns --
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-
Healthcare Behav Health Com Svcs Empl/Educ Legal Soc Svcs
Healthcare
Org
aniz
atio
ns R
espo
ndin
g to
the
Sur
vey
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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Pat
hway
s O
rgan
izat
ions
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Healthcare
Behav Health
Com Svcs
Org
aniz
atio
ns R
espo
ndin
g to
the
Sur
vey
Empl/Educ
Legal
Soc Svcs
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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