Structural Assessment of a Community Service Network 1 Leah Steimel MPH 1, Melissa Roberts MS 2, Daryl Smith MPH 1 1 University of New Mexico, Office of Community Affairs, 2 LCF Research

Background: Collaborative Planning Process 2 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 collaboration Public funding negotiated and MOU signed between UNM and Bernalillo County Coordination role (Hub) established and contracts with community agencies initiated. PATHWAYS Pilot program initiated

Background: PATHWAYS Mission Statement Connecting underserved county residents with health care & social service systems and supporting them as they navigate through them C OORDINATING services for underserved residents to achieve positive individual-level health outcomes A SSURING collaborative planning and improvement of our health care system in Bernalillo County 3

P ATHWAYS P RINCIPLES Measure Healthy Outcomes Intervention Confirm Evidence-Based Service Find and Engage at Risk Individual – Care Coordination

Connect & Confirm 5

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 6 Pathways Community-defined Outcomes

Healthcare and Social Support Systems 7 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

Community Network Some connections pre-existing 8 Main Street Hospital

Community Network Strong: very frequent interaction, established relationships Weak: infrequent, as needed 9 Main Street Hospital

Optimum Network Diverse participants Mutual respect, shared commitment Robust networks will have several paths for connections 10

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 11

PARTNER Tool Understand how organizations are connected attributes associated with connections 12 Illustration from PARTNER User Manual

Survey Questions -Value 13 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 OOOO 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. OOOO

Network Survey Implementation Early Fall Questions in survey Online Survey (PARTNER website/SurveyMonkey) Surveyed: ◦Navigators and administrators of participating Pathways organizations (current and past) ◦Administrators of partner organizations 14

Survey Responses 15 Navigator Survey Administrator Survey Total Partner Org. Pathways Org. Organizations invited to participate (N) Organizations responding (N) Organization Response Rate90.0%70.4%60.0%76.5% Individuals invited to participate (N) Individuals responding (N) Individual Response Rate63.9%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]

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 16

Perception of Network Outcomes 17 Correlation between Navigator & Administrator Responses = 0.72 Q6: Outcomes of this community network's efforts include (or could potentially include): (choose all that apply)

Perception Most Important Outcome Q7: Which is this community network‘s most important outcome? 18 Correlation between Navigator & Administrator Responses = 0.81

Success after 1 year Q8: How successful has this community network been at reaching its goals? 19 Correlation = 0.83

Pathways Network is Decentralized 20 Illustration from PARTNER User Manual 0%  Centralization Score  100% Score Navigators24.6% Administrators44.2% Combined30.6%

Trust between Network Members is Moderate to Strong 21 0%  Trust Score  100% Score Navigators62.9% Administrators61.5% Combined57.2% No TrustComplete Trust

Participating Pathways Agencies 22 Estimates of Trust in and Value of Other Organizations, Association with Connectivity

23 Navigator Responses – Interaction with other Participating Pathways Organizations

24 Navigator Responses – Interaction with other Participating Pathways Organizations

Participating Pathways Agencies Partner Agencies 25 Estimates of Trust in and Value of Other Organizations, Association with Connectivity Not the same story as with Navigators

Participating Pathways Agencies Partner Agencies 26

Future Directions Future Directions Health 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 27

Similar Other Community Projects Community Capacity Building to Reduce Health Disparities Project, Flint, MI Project to strengthen and empower community-based organizations as part of a collaboration of a health department, university, and other health care agencies in order to enhance community health infrastructure and improve overall health of community residents Institute for Social Capital, Charlotte, NC Coalition of university and community agencies and service organizations in the Charlotte/Mecklenburg area working in the domains of education, child welfare, health care, mental health, juvenile justice, law enforcement, and corporate and nonprofit management 28