Improving Services: Overview of Developing and Improving Community Services
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WHAT DO WE MEAN BY DEVELOPING AND IMPROVING COMMUNITY SERVICES?
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WHO SHOULD BE INVOLVED IN DEVELOPING AND IMPROVING COMMUNITY SERVICES?
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WHEN SHOULD YOU SEEK TO DEVELOP OR IMPROVE COMMUNITY SERVICES?
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OPTIONS FOR DEVELOPING AND IMPROVING COMMUNITY SERVICES
It all started on the day that two of the emergency room doctors at St. Mary’s Community Hospital happened to have coffee together as their shifts overlapped. Dr. Kowalski, who was just coming off duty, was tired. “I must have seen 45 kids today,” he told his colleague, Dr. Liu. “I know what you mean,” she answered. “I’ve been seeing an enormous number of children, too, and often for routine medical issues. Doesn’t anyone take their kids to a pediatrician any more?”
As the conversation continued, the two decided to check on the numbers, and to confer with area pediatricians about their caseloads. It turned out that far too many parents – particularly the uninsured and those on Medicaid – used the emergency room as the primary care physician for their children. This was bad for the hospital, since it meant that the emergency room staff was overworked. It was bad for other ER patients, since they often had to wait long periods in pain for treatment. And it was bad for the children, who weren’t being treated by doctors who specialized in child development, and who could spot problems that a non-pediatric physician might miss.
A core group of pediatricians and ER doctors contacted agencies that worked with children or health – Head Start, SPCC, the St. Mary’s Youth Development Corps, the St. Mary’s branch of the Public Health Service, and others – to discuss possible solutions to the problem. Ultimately, out of their discussions grew the St. Mary’s Child and Parent Health Clinic, staffed by pediatricians and family practitioners, which provided free or affordable health care to families with children. The establishment of this clinic is an example of the development of a community service that improved life for a significant number of people.
This chapter is about ways to develop and improve public services in your community. That can mean anything from getting a streetlight bulb replaced to starting a community-wide initiative that involves several new programs. Either might be effective in solving a problem and improving the quality of life in a neighborhood. An improvement in services in a community may or may not be an intervention in itself, but it may be an important part of the foundation for community change.
Developing and improving services also lays groundwork that can lead to larger changes down the road, and make other interventions easier. In some sections of this chapter, that groundwork appears as working relationships with other organizations and different parts of the community. In others, it takes the form of actual interventions in core areas that are basic to individuals’ and communities’ well-being.
This opening section discusses what we mean by improving services, and some ways in which an organization can use its community setting to address that improvement. It provides a context for the more specific information in the rest of this chapter and in others to come.
WHAT DO WE MEAN BY DEVELOPING AND IMPROVING COMMUNITY SERVICES?
In a healthy community, people have access to the services they need in order to live decent lives. There are really three kinds of public services in most communities, although there may be quite a bit of overlap among them. Let’s call them A-level, B-level, and C-level.
- A-level are the services that most people see as essential to community life, that make it possible for a community to exist as such – fire, police, schools, public works, local government. The existence of these services can be taken for granted. They are considered necessary to the well-being of any community.
- B-level are services that exist to prevent problems and to maintain the quality of life in a community. They usually address issues which, if left unattended, may lead to problems or deficiencies in the future, such as health, adult literacy, employment training, housing, and the development of youth. They also often include such quality-of-life services as recreation programs and support for the arts. These services may vary from one community to another. A community coalition in a South Carolina industrial town, for instance, found that the most important issue there was water pollution. For that coalition, B-level services included instituting limits on pollution, cleaning up local water sources, and monitoring to make sure that the community’s drinking water was safe.
- C-level services specifically exist to solve current problems and correct deficiencies. They are often short-term, narrowly focused, and may treat the symptoms of community problems – food for the hungry or shelters for the homeless, for instance – but may or may not get at the underlying causes of those symptoms – poverty, a shortage of affordable housing, lack of mental health services, and the disconnectedness of people in modern society.
While A-level services are automatically funded in some amount in the budget of virtually every community, no matter how large or small, B- and C-level services, though they may be equally important, seldom are. Therefore, we will primarily focus on services that would be considered B-level and C-level, although sometimes A-level services need to be improved as well to meet the needs of the target population and of the community as a whole.
A community with excellent preventive (i.e., B-level) services may need far fewer corrective or emergency (C-level) services, so part of improving services should involve establishing, maintaining, and expanding B-level services until they are obtainable by all who need them. Equally important, however, is making sure that people don’t starve or freeze to death – or get shot – while working to gain basic skills or job competencies. Corrective and emergency services also have to be available when needed.
Corrective and preventive services are sometimes combined. The best homeless shelters, for instance, provide, either through collaboration or through their own resources, adult basic education, job training, parenting classes, budgeting instruction, and other supports to help residents gain the skills and strategies to keep them independent and housed when they leave the shelter.
All too often, however, these exemplary programs are only able to serve small numbers of people at a time. If there are several hundred homeless people in a community, working with ten of them will only address the homeless problem for those ten. Improving services in that community may mean extending the shelter program to a much larger portion of the homeless population.
In this context, developing and improving community services may mean establishing services where they didn't exist before; making existing services more effective; making existing services more widely available; improving access to effective services; and/or coordinating services so that all the providers in a community are working together, rather than at cross purposes. Each of these comes with its own priorities and its own set of issues.
ESTABLISHING SERVICES THAT DIDN’T EXIST BEFORE
The emphasis in this case has to be on planning and finding resources.
If you’re starting from scratch, you should:
- Put together an organization or work with an existing organization or coalition, each of which brings its own challenges
- Do a careful community assessment to understand exactly what services need to be delivered
- Plan out your initiative or intervention – involving the target population and other segments of the community – so that you’ll actually be making the services accessible and providing them to the right people in the best way possible
- Find the money and the people to make all this possible
There are a number of roles you might have in this situation. One would be as a leader or member of a coalition, initiative, or other group working to obtain a new service for the community. Another might be as the director or a staff member of an existing organization that wants to expand to provide this needed service, in addition to what it does already. Or you might be the director or a staff member of a new organization founded to provide the service in question. Obviously, depending upon your role, what you actually have to do can range from participating in planning meetings to taking responsibility for all or most of the process.
MAKING EXISTING SERVICES MORE EFFECTIVE
Here, the needed services exist, but are inadequate, because they don’t do what the target population needs. Improving services in this circumstance is very different from starting a new service, not least because of the amount of resistance you might meet.
Change is always difficult, and many staff people who are actually delivering services won’t recognize the need for it. The community, or some elements of the community –perhaps even those who stand to benefit from improving the service – may not see the need, or have reasons for opposing change. Planning for change needs to involve the people who’ll have to make it work, and will probably take more time than you anticipate. It will also take some time to determine whether the changes you’ve made have, in fact, made the service better (i.e. to evaluate your work), and to make adjustments.
MAKING EXISTING SERVICES MORE WIDELY AVAILABLE
In this circumstance, service is inadequate because the volume of services isn’t great enough to serve the people who should benefit from them. Trying to increase the amount of service available may be largely a matter of finding funding, or it may depend on finding and training more volunteers, or even on finding a different way to offer services.
For example, a Boston English as a Second or Other Language (ESOL) program aimed at Cantonese speakers had a three-year waiting list. In order to try to reach some of those waiting for classes, the program distributed instructional videotapes, and enlisted enrolled learners and graduates as tutors. The system didn’t take the place of the classes, but it did give those on the waiting list an opportunity to get started, and helped the student tutors practice their own newly-learned skills. Waiting list learners who participated in the program entered classes eventually as intermediates, rather than as beginners, and the tutors earned new respect in the community. Out of frustration, the program was able to create a positive situation for everyone.
INCREASING ACCESS TO SERVICES
This could refer to making services physically and otherwise accessible to disabled participants (ramps, accessible bathrooms, TTY phones for the hearing impaired, etc.), but it could also involve accessibility of other kinds. Transportation may be a major issue for participants. The location of services may exclude a group that doesn’t feel comfortable or safe in that area or neighborhood. The times when services are available may create difficulties for a large number of people. All of these may be factors in trying to increase access.
COORDINATING SERVICES
Another facet of improving services is trying to make the whole service system as seamless as possible. That means that even if there are many different organizations providing a variety of services to a number of different target populations, they should be coordinated enough that a participant in one program who needs other services will get them quickly and appropriately. It also means that organizations are aware of what others are doing, and that they work together as much as possible to assure a range of services for everyone who needs them.
All four of these ways of improving services also involve advocacy, public education, and reaching out to the community. It is important that the community at large – not to mention legislators, local officials, and other policy makers – understand the need for services, the benefits they confer on the community as a whole, and the fact that those using the services are their neighbors (or, potentially, themselves). Community support translates into funding, volunteers, and a voice in local policy-making for both service providers and the target population.
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