Bridging the Gap
Needs assessments provide vital insights into rural communities' well-being.
By Jessica Rosencrans on
It has been said that if you've seen one rural community, you've seen one rural community. Although rural areas are often grouped together, there is immense diversity among what rural looks like around the U.S. Some rural communities might be highly agricultural, while others may be defined by mining, logging, fishing, or a multitude of other industries.
With such diversity attributed to rural areas, it is critical for local healthcare facilities to have a thorough understanding of their community and service area. Community Health Needs Assessments (CHNAs) were designed for just that.
As the term suggests, a CHNA is a systematic process involving the community to identify and analyze community health needs. This process provides a way for communities to prioritize health needs and to plan and act upon unmet needs. Back in 2010, the Affordable Care Act mandated that Critical Access Hospitals (CAHs) must conduct a CHNA once every three years. Likewise, public health units must conduct a CHNA once every five years to gain or maintain accreditation.
An 11-Step Process
Although CHNAs are a required aspect of a CAH's operational duties, the organization conducting the assessment gains much more from the process besides a checked box.
A CHNA consists of a 11-step process, one that takes nearly 18 months from start to finish – a substantial undertaking. The core component of the CHNA is a community survey, customized for each individual community, to elicit responses on the strengths of the area and where improvement can be made. Throughout this timeline, the CAH – often in partnership with a local public health unit and other healthcare facilities – will facilitate planning sessions, community meetings, and key informant interviews, and launch a promotional campaign for the CHNA.
The Center for Rural Health (CRH), located within the University of North Dakota School of Medicine & Health Sciences, offers North Dakota CAHs assistance in completing their CHNA as part of their services. CRH is on-call as a helping hand: visiting each community to coordinate meetings, presenting data once the survey has been completed, and assisting in identifying the top needs of the community.
The nice thing about completing a CHNA is getting the results on what the current needs of your community are. The important part comes after.
Holly Long, project coordinator with CRH, works closely with communities during the CHNA process. She travels across North Dakota to be present for the two community meetings; once to introduce the community to the needs assessment process and to conduct key informant interviews, and a second time after the survey has been completed to present the results.
"There are things you find out in a CHNA that you might not have expected," she said. "The nice thing about completing a CHNA is getting the results on what the current needs of your community are. The important part comes after – what happens because of the report."
Implementing Action
After the CHNA report is compiled, the CAH has five months and fifteen days to complete an implementation plan to address the top community needs identified by the assessment.
For instance, Coal Country Community Health Center (CCCHC) and Sakakawea Medical Center, located in Beulah and Hazen, respectively, have been working with CRH and their local public health units and long-term care facilities to complete their several CHNAs for over a decade.
"Our collaborative CHNAs and corresponding implementation plans have resulted in significant improvements in both the delivery of healthcare services, but also in addressing workforce challenges to meet the needs of our communities," Chastity Dolbec, director patient care and innovation at CCCHC, shared.
Although
CHNAs are conducted by healthcare facilities, the most
pressing community needs aren't always directly related
to healthcare services. One of the top needs identified
in a previous CHNA for CCCHC was access to daycare
resources for essential workers. As a result of this
finding, eight businesses in Mercer County collaborated
to create Energy
Capital Cooperative Child Care, an enterprise
operated out of a vacated church in Hazen. Since its
opening in 2017, daycare services have not been listed as
a community need in subsequent Coal Country reports.
CCCHC has also implemented a variety of programs regarding concerns about depression and anxiety in youth and adults in the region. Increased access to behavioral health services, such as universal screening, have been implemented at local healthcare organizations. The school districts also became involved in the effort, with the Beulah, Hazen, Center, and Killdeer school districts implementing the IMPACT (Integrating Mental Health, Physical Health, And Continuity of Care Together) Program to provide on-site behavioral health services.
"It is vital for our rural healthcare organizations to receive input and feedback from our area residents, in combination with county and state level healthcare data, to better target and individualize our approach in meeting those identified needs," said Dolbec. "Specific information about our communities provides our organizations the opportunity to tailor community health improvement plans that will address and produce improved healthcare outcomes."
Ever-Evolving Needs
Jamestown Regional Medical
Center (JRMC) has also worked with CRH to complete
their CHNAs. Access to specialty care was identified as a
need in the area, and JRMC responded in kind. The
hospital has recruited a range of specialists to bring
essential services, including orthopedics, obstetrics and
gynecology, advanced wound care with hyperbaric oxygen
therapy, and podiatry directly into the community. JRMC
also partnered with Sanford Health to
offer comprehensive cancer care locally.
"This approach not only alleviates the need for extensive travel – reducing both time and cost burdens for patients – but also enhances the quality and continuity of care by allowing patients to receive specialized treatments in a familiar, community-centered environment," said Trisha Jungles, vice president and chief nursing officer at JRMC. "By providing these services close to home, JRMC is supporting better health outcomes and making high-quality care more accessible to all."
JRMC has also addressed other fronts, establishing key partnerships with local providers to expand mental health services and introducing wellness programs, health education workshops, and fitness initiatives to promote physical activity.
Our efforts have not only addressed immediate needs, but also strengthened our infrastructure to support the evolving health requirements of our community.
"These initiatives have been well-received by the community, and we have seen positive outcomes in patient satisfaction, access to care, and overall health engagement," Jungles said happily. "Our efforts have not only addressed immediate needs, but also strengthened our infrastructure to support the evolving health requirements of our community."
Empowering a Community
With CHNAs being so impactful to rural communities, Long is very proud of the work that she does. "The information we are working with is extremely valuable to these communities," she said. "We try to make the CHNA process as easy and streamlined as possible for the organizations we work with."
"The CHNA process is collaborative and comprehensive," stated Jungles. "Working with CRH provides us with expertise in rural health research and analysis, ensuring that our CHNAs are thorough and tailored to our region. CRH also helps facilitate engagement with community members and stakeholders, which is essential for gathering authentic and representative input."
Dolbec agreed, explaining how CHNAs
are vital for rural communities in "identifying health
disparities and unique health challenges, including
access to needed services in the rural communities we
collectively serve."
"Our local healthcare organizations are very grateful for the assistance and resources provided by CRH over the past decade in identifying unique healthcare needs and challenges of our rural communities," She smiled.
The collaborative nature of CHNAs, in addition to being a distinguishing characteristic, is perhaps one of the most critical features to the process's success.
CHNAs are not only a tool for identifying needs, but also a way to engage and empower our community.
"CHNAs are not only a tool for identifying needs, but also a way to engage and empower our community," said Jungles. "They offer residents a voice in shaping local healthcare priorities and foster a sense of shared responsibility for community health."
is the communication specialist with the Center for Rural
Health at the University of North Dakota School of
Medicine & Health Sciences in Grand Forks.
