Using community based assessments to strengthen nonprofit-government collaboration and service delivery.
Abstract: Human service needs assessments are a valuable research tool for prioritizing services to address unmet and undermet needs, and they are essential to organizational and community planning efforts. This article looks at the role of nonprofits in conducting human service needs assessments, a responsibility often left to government health and human service administrators. Exploring the role of private nonprofits in community-based research is especially relevant due to current economic challenges that have caused increasing need for human services, dwindling resources available to meet those needs, and even greater pressures on nonprofit and public organization administrators to prioritize limited resources and services.

This article provides an overview of human service needs assessments--their purpose, benefits, problems, and strategies--and it reviews one exemplar human service needs assessment that may serve as a model for nonprofit and government administrators who are responsible for monitoring and responding to the health and human services needs of local communities and regions.
Subject: Nonprofit organizations (Services)
Nonprofit organizations (Alliances and partnerships)
Public health (Management)
Author: Eschenfelder, Beth E.
Pub Date: 03/22/2010
Publication: Name: Journal of Health and Human Services Administration Publisher: Southern Public Administration Education Foundation, Inc. Audience: Academic Format: Magazine/Journal Subject: Government; Health Copyright: COPYRIGHT 2010 Southern Public Administration Education Foundation, Inc. ISSN: 1079-3739
Issue: Date: Spring, 2010 Source Volume: 32 Source Issue: 4
Topic: Event Code: 360 Services information; 389 Alliances, partnerships; 200 Management dynamics Computer Subject: Company business management
Product: Product Code: 8380000 Nonprofit Institutions; 8300000 Social Services & Nonprofit Institutns; 8000120 Public Health Care; 9005200 Health Programs-Total Govt; 9105200 Health Programs NAICS Code: 813 Religious, Grantmaking, Civic, Professional, and Similar Organizations; 624 Social Assistance; 62 Health Care and Social Assistance; 923 Administration of Human Resource Programs; 92312 Administration of Public Health Programs
Organization: Government Agency: United States. Department of Health and Human Services; United States. Department of Health and Human Services
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 250033483
Full Text: INTRODUCTION

Nonprofit organizations are key partners in the development, delivery, and evaluation of health and human services. One tool essential to effective partnerships in this area is conducting or supporting human service needs assessments. This responsibility is often left to government health and human services administrators. However, exploring the role of private nonprofits in this type of community-based research is especially relevant at this time for several reasons. First, because many governments are scaling back budgets, funds previously committed to research and needs assessment endeavors may now be lacking. Second, the economic downturn is equally affecting, if not exponentially impacting, nonprofit organizations--both because of increasing human service needs and dwindling resources to address those needs. Making the most of available resources, therefore, is more important than ever. Finally, the longer-term challenges faced by nonprofits in recent decades, which will likely continue and increase in the future, have required nonprofits to become effective strategists in the planning and delivery of their own services. Conducting and supporting human service needs assessments is a central function nonprofit organizations should incorporate to maximize their planning efforts and to benefit the local community.

There are also many benefits to having nonprofits take the lead to conduct such needs assessments. This article examines the role of nonprofits in community planning and research. The purpose and process of conducting human service needs assessments will be explored, including a detailed example of one needs assessment initiated by a local nonprofit organization in Clearwater, Florida. This example offers a model for nonprofit and government administrators responsible for monitoring and responding to the health and human service needs of local communities, or those serving special subpopulations, such as people living with mental illness, substance abuse, HIV, homelessness, physical disabilities, and other challenges. The article also explores follow-up steps that may be used by local nonprofit agencies to collaborate with community partners, including government and other nonprofit health and human service providers, to share research findings, engage in bottom-up community planning to address human service needs and maximize allocation of resources for all stakeholder groups.

NONPROFIT STRATEGY AND COMMUNITYBASED RESEARCH

At the same time human service needs are increasing, financial support is diminishing. Nonprofits are being impacted by decreasing private charitable donations and cuts in funding from government and private foundations that support human services (Bridgeland, 2009; Independent Sector, 2008; Lawrence, 2009; Reed et al., 2009). Economic challenges are nothing new to nonprofits. For years, nonprofit organizations have been coping with increased competition, higher expectations from the public and funders, increasing costs, declining support, rapidly changing technology, and substantially different ways of conducting business. In addition to strategies that generate new revenue sources (Dees, 1999; Salamon, 2001; Wolf, 1999), nonprofit managers must be effective strategists to respond to constant changes in their operating environment, to fulfill their missions, and to satisfy community needs (Akingbola, 2006; Bryson, 1995; Wolf, 1999).

Collaboration is one strategy that has long been advocated for nonprofit, for-profit, and government sectors to maximize administrative efficiency, avoid redundant effort, prevent costly competition for resources or clients, pursue collaborative funding opportunities, conduct joint planning and program development, and increase the impact of advocacy efforts (see Alexander, 2000; Eisenberg & Eschenfelder, 2009; Kohm & La Piana, 2003; Mandell, 2001; McLaughlin, 1998; Snavely & Tracy, 2000; Vogel, Ransom, Wai & Luisi, 2007). The many reasons for partnering and other forms of collaboration will not be addressed here. Instead the focus of this analysis is the role and importance of collaboration in community-based research and planning to meet human service needs. One of the first steps in many collaboration efforts is planning--in particular, joint planning among community partners--to develop approaches to fill service gaps, better meet client needs, and provide a fuller range of services. Effective planning for collaborative service efforts calls for research to assess human service needs. The role of nonprofits in community-based research has been neglected and, therefore, is worthy of further examination.

One likely cause for this absence is that few nonprofits have the resources necessary to design and implement comprehensive needs assessment studies and planning processes (Kietzman, Scharlach & Dal Santo, 2004). It also is difficult for nonprofits to conduct needed research and plan for the future when the job of responding to current needs and challenges consumes all attention and effort. It is precisely because of current economic challenges that more nonprofits are embracing research and strategy to guide their decision making and programmatic choices (Akingbola, 2006; Schneider, 2006).

During times of financial shortfalls, having adequate information upon which to base resource allocation is essential. Needs assessments are a valuable research tool for prioritizing services to address unmet and undermet needs, and they are essential to organizational and community planning efforts (Aparna, Lanum & Suarez-Balcazar, 2000; Chernesky & Gutheil, 2008; Rotary, 2006; Van Til & Ross, 2001). Following is an overview of needs assessments: their purpose, benefits, problems, and strategies. Also discussed will be "mission studies," a type of needs assessment more common within faith-based organizations. When nonprofits are able to conduct or support community-based research, it not only benefits their own organizations and constituents, but it also can assist local planning partners, including other nonprofits, governments, funders, and the community at large.

Needs Assessments

A "community-based needs assessment is the systematic process of determining what a group of individuals, an organization, or a community requires to achieve some basic standard or improve its current situation" (Finlayson, 2007, p. 29). Their general function is to gather information that can be used to plan, implement, and evaluate programs, but there are several other reasons and uses, including to guide the allocation of funding, to respond to external mandates, to garner support for actions an organization may undertake in the near future, and to ensure an organization's actions are consistent with needs expressed by the community (Aparna et al., 2000; Chernesky & Gutheil, 2008; Finlayson, 2007; Parsons, Higley, Okerlund, Wallock, Clark, Howard, 1995; Rotary, 2006; World Health Organization, 2000).

Needs assessments are often conducted to measure a number of factors including: a) the number of people in a community who need services, b) the types of services needed, including the emergence of new service needs, c) the relative need for services across different communities, d) the capacity of existing services to meet identified needs, e) the coordination of services within a system of care, and f) the appropriate mix of services required to respond to diverse needs (Aparna et al., 2000; Finlayson, 2007; World Health Organization, 2000).

Within religious-based organizations, the term "mission study" is sometimes used in place of needs assessment. A mission study may encompass the same elements of a needs assessment, but it also may look inward to the organization and its members to correlate the community needs to the organization's mission and religious purpose. Some organizations define a mission study as a disciplined study of an organization's culture; a review of past successes and failures; an assessment of a group's attitudes, values, and motivators; an examination of what the organization needs to do better; and a determination of future direction (First Presbyterian, 2007; Wilkerson, no date). For the Salvation Army (the case study organization for this analysis), the purpose of a "mission planning study" is to aid an individual Salvation Army unit to identify the following: the strengths of the unit's current mission, community trends that impact that mission, current and emerging community needs to which the Salvation Army unit is positioned to respond, community resources already existing to address the need, and concrete mission strategies (The Salvation Army USA, 2007).

Without a doubt, mission studies and needs assessments are beneficial for organizations and communities, but several barriers can inhibit assessment and evaluation activities: providers do not value evaluation; they perceive a conflict between evaluation and services activities; and they have a concern that assessment may result in decreased funding (Napp, Gibbs, Jolly, Westover & Uhl, 2002, pp. 41-44). When needs assessments are conducted, data is sometimes ignored or not used for its intended purpose (Stoecker, 2007). In addition, leaders and service providers assume they understand the needs of the population they serve, and they "make decisions based on outdated information" (Parsons et al., 1995, [paragraph] 1).

Problems can also relate to study design and data collection problems, such as researchers who have an anticipated outcome (Finlayson, 2007) and research participants who may experience difficulty pinpointing or communicating their needs (Cohen-Mansfiled & Frank, 2008) . Chernesky and Gutheil (2008), researchers who focused on aging populations, suggest that "even when needs assessments are carefully planned and adhere to generally recognized best practice principles, they may not be able to fully provide desired information" (p. 109).

With the right combination of research practices and approaches, needs assessments can yield valid results that can guide an organization's decision making. Good efforts are those that combine and triangulate various disciplinary approaches and research methods (Parsons et al., 1995; Schneider, 2006). This may include blending qualitative and quantitative methodologies, and using a variety of research tools, such as surveys, focus groups, interviews, and ethnography (observation).

The needs assessment conducted by the Salvation Army Clearwater Corps (Clearwater Salvation Army), featured in the next section of this article, utilized a blended approach that produced a range of useful information for local and regional health and human services planning.

NORTH PINELLAS AND THE HUMAN SERVICES NEEDS ASSESSMENT

The Clearwater Salvation Army is located in the city of Clearwater, the second largest of 24 municipalities in Pinellas County, on the Gulf Coast of Florida. Pinellas County is the second smallest county in the state, measuring 280 square miles (Pinellas County, no date), and has the sixth largest population with 910,260 people (U.S. Census, 2008 making it the most densely populated county in the state. The county also has a long, narrow shape. Public transportation is often cited as a problem, especially in the north part of the county (Boothroyd, 2005; Silva, 2007; St. Petersburg Times, 2008). This often requires the establishment of mirror-image services in the north and south parts of the county to provide access to residents. The county's shape, density, and poor transportation access have caused numerous problems for the county's nonprofits. Although located in Clearwater, the Clearwater Salvation Army serves the northern half of Pinellas County.

Over the past two decades, funders and policy makers have directed numerous research studies to explore human services needs in Pinellas County and to determine the adequacy of local agencies in meeting these needs (see Giard & Gamache, 2005; Interagency Committee, 1992; Marlowe, 2005; Stiles & Haynes, 20021). Although these previous studies were available for review, the leaders of the Clearwater Salvation Army wanted a current human service needs assessment focused on its service area.

Because the Clearwater Salvation Army is supported 99 percent by private donations, it had the ability to move quickly to conduct the human service needs assessment, without concern about political pressures to achieve certain expected outcomes--challenges sometimes faced by governmental counterparts. Confirming their openness to any findings and outcomes, the commanding officer for the Clearwater Salvation Army said, "Somewhere in the world, the Salvation Army does just about everything," explaining that whatever needs were demonstrated through the needs assessment, they would find a way to address the needs or partner with other community organizations that could. This flexibility is characteristic of faith-based organizations, as demonstrated in one study by Graddy and Ye (2006) in which they found faith-based organizations to be "more adaptive [and] more willing to conform services to an individual's needs, in contrast to a governmental program that insists that all participants conform to the program" (p. 312).

The goal of the human service needs assessment was to help Salvation Army leaders plan future responses to the growing needs of north Pinellas County and to identify ways to best serve the community. The assessment was initiated by the Clearwater Salvation Army's long-range planning committee and conducted by local university researchers (Eschenfelder & Friesen, 2009) (2). The Salvation Army committed to share the completed study with community partners to encourage joint planning, prioritization, and collaboration, and to host meetings with community partners to communicate and discuss research findings including health and human service administrators from partner nonprofits and city and county government offices.

Pinellas County, like many other communities across the county, was especially hard hit by the economic downturn and increasing unemployment rates. Unemployment data for the first part of 2009, showed Pinellas County surpassing Florida and the U.S. in its unemployment rate, with rates increasing into the double digits. Like the state of Florida, unemployment rates were the highest in decades (Agency for Workforce Innovation, 2009a, 2009b). The impact was also great for Pinellas County nonprofits, mirroring the national trends previously cited. At the same time donations and government funding were decreasing, demand for services was up. A new trend also emerged: "People who have never needed help are lining up for food, clothing and money for gas and housing" (Minaya, 2008, p. 1B). As a result of these economic challenges, "many local organizations have been forced to end some services, trim service hours and go into fundraising overdrive" (Minaya, 2008, p. 1B).

The Clearwater Salvation Army is one of thousands (3) of nonprofits providing services in Pinellas County. It has been responding to community needs and providing services in north Pinellas since 1926. In 2008, the Salvation Army Clearwater Corps provided social service support to more than 8,000 men, women, and children, in addition to serving more than 10,000 individuals through its correctional services program and providing supportive services to families throughout north Pinellas County (The Salvation Army Clearwater, 2009). The leadership of the Salvation Army-Clearwater has been active in local planning groups throughout Pinellas County helping to identify unmet needs and develop localized or countywide strategies for services to special subpopulations, such as people experiencing homelessness or at risk of becoming homeless, Hispanic and immigrant families, ex-offenders, and people in need of a range of health care and human services. The Clearwater Salvation Army commissioned the human service needs assessment to continue and strengthen their services in north Pinellas County by identifying where and how it can do the most good for the communities it serves.

METHODOLOGY

The needs assessment focused on the Clearwater Salvation Army's service area and was designed to answer four research questions: a) what are the social service needs of the north Pinellas population? b) what is the magnitude of the need? c) what is already being done to address these needs? and d) what gaps exist in service delivery that may become priorities for the Salvation Army officials as they engage in long-range planning (Eschenfelder & Friesen, 2009)?

To address these questions, data were collected from a variety of sources through several methods, both quantitative and qualitative. Research used both scientific sampling (for the community surveys) and purposive sampling (for interviews, focus groups, and client surveys) to provide a combination of viewpoints and perspectives.

Several assessment methods were considered for this study but rejected for various reasons. A survey to the general population was rejected as a stand-alone research method because of the difficulty in obtaining a representative sample and due to the potential for high response error from a general population that is not necessarily aware of social services in north Pinellas County. Also rejected were community forums--publicized forums intended to hear from the community about unmet needs. Community forums, in the past, have been stacked by small interest groups that attempted to influence outcomes.

Throughout all methods, attention was paid to determining the extent of need in the following categories of service: basic needs, health and behavioral healthcare, employment and job training needs, children and family services, elder care needs, and needs for special subpopulations (such as Hispanic, victims of domestic violence, ex-offenders, teens aging out of foster care, and others). A common survey instrument was used for the four stages of research that involved human subjects. The survey tool contained a list of about 50 services that people might need or access occasionally or on a regular basis, for example, rental assistance, parenting skills training, vision services, job training, and other services. Respondents were asked to indicate the level of need for each service and to add any explanation that would help researchers better understand their situation. For surveys administered to key informants and service providers, respondents were asked to rate their perception of need in the northern part of the county. The rating scales were altered accordingly, depending on the type of respondent.

Research was carried out over a 4-month period of time with some methods being sequential, others concurrent. The community survey was completed last, because other methods produced new knowledge that was incorporated into the community survey to ensure greater applicability to the survey audience. Following is a brief overview of the five research methods used and summarized in Table 1.

Method 1, Review of Existing Data

Reviewing existing data and reports on the needs of north Pinellas County was a cost-effective way to gain insight into the needs of both general and targeted populations. Existing data helped identify the composition and needs of special subpopulations in north Pinellas County, including aging, Hispanic, homeless and others. It also helped identify geographic parts of north county that were impacted more heavily by certain needs, for example, a growing Hispanic population in Clearwater, and a large number of homeless individuals in Tarpon Springs. A list of existing data reviewed for this research is included in the appendix.

Method 2, Key Informant Interviews

Interviews were conducted with 25 "key informants"--people who are experts in certain areas of service delivery, leaders of local governments, and administrators of countywide health and human services. Attempts were made to include a diverse cross-section of representatives from diverse service industries and geographic locations.

Interviews with key informants were conducted using a loosely structured list of interview topics, and interviews ranged from 1 to 2 hours. Most participants were asked the same series of questions, although each interview varied slightly depending on the participant's area of expertise and the natural flow of conversation. Respondents were asked about diminishing services, best practice models, referral systems, duplication, service and geographic areas that are under-funded or over-funded, barriers for receiving services, top priorities for new or continued services, and service recommendations for Clearwater Salvation Army.

As part of the interview protocol, the needs assessment survey tool was incorporated with 22 out of 25 interview participants, and participants responded to all questions for which they felt they had an adequate level of knowledge and familiarity; other questions were skipped/left blank. Nine (9) survey questions out of 51 received response rates below 50 percent, because some respondents preferred to answer only questions related to their areas of expertise.

Method 3, Service Provider Focus Groups

Like key informants, social service providers are directly in touch with people in need, and they are often aware of other unmet needs among their clients. Input from service providers was gleaned through focus groups and surveys. The service provider groups were chosen through purposive sampling--by targeting groups that represented diverse client populations, based on both service needs and geographic area.

* Six focus groups were conducted that included 52 people. Where appropriate, participants also were asked to complete the needs assessment survey.

* Needs assessment surveys also were distributed at a large meeting of human service providers where 27 surveys were completed.

* In total, 79 service providers were included in this method of the need assessment by participating in one of six focus groups and/or by completing a survey.

* Service providers who completed the survey answered most questions, with an average response rate of about 85 percent per survey item.

Similar to interviews with key informants, service provider focus groups were conducted with a loosely structured set of questions used to guide discussion. The focus groups were intended to generate discussion among service providers to illicit ideas, answers, and feedback that might not otherwise be obtained through a survey response.

Method 4, Client Survey

Surveys were conducted with existing Salvation Army clients, including clients receiving services at the two service offices and their transitional living center, in addition to citizens accessing holiday support for Thanksgiving and Christmas. The survey with Salvation Army clients provided a glimpse into the service needs of persons who may be facing difficult circumstances or multiple life challenges. The method, research tool, and interview times for these surveys were determined collaboratively with staff from Salvation Army Social Services. To encourage participation, modest incentives were offered in the form of a one-day bus pass.

Client surveys were administered face-to-face by members of the research team and by Salvation Army social services staff. Clients were able to complete the survey on their own if they preferred. For each kind of service/type of assistance listed on the survey, respondents were asked to indicate one of the following categories of need that best matched their circumstances: a) "I am currently receiving this type of assistance." b) "I have no need for this right now." c) "I need this once in awhile but not very often." d) "Not having this sometimes causes problems in my life." e) "Not having this often causes problems in my life." or f) "Urgent need! I need this right now." Researchers collected 334 surveys from a mix of English and Spanish-speaking individuals and families. Although the gathered sample was voluntary, the sheer number of clients interviewed, combined with the different days, times, and services locations, ensured information was obtained from diverse client populations.

Method 5, Community Survey

The last assessment method was the community survey that was conducted to estimate the magnitude of certain needs in the general population of north Pinellas County (residents not reached in the first four stages of the needs assessment) to give them an opportunity to articulate their own social service needs. The survey was similar to the one administered to Salvation Army clients, but minor modifications were made to incorporate improvements noted during the client surveys and to tailor the survey to "households" instead of individuals.

To ensure generalizability to the full research population (north Pinellas households), a process of scientific random sampling was used. A comprehensive list of addresses was obtained from a local government office, and statistical software (SPSS) was used to select a random sample large enough from which to be able to generalize to the larger population of north Pinellas County. It was determined that a sample size of almost 400 was needed to meet this criterion. This size was increased to 567 to allow for the possibility of wrong addresses, households that may refuse to take part in the study, and an oversampling for one targeted community that was identified in previous research methods as underserved. In total, 567 surveys were mailed out, using multiple methods for preview notification and follow-up. The survey mailing was preceded by an informational postcard notifying residents that the survey would be mailed to them shortly.

It is important to note that the university researchers recommended using incentives for the community survey, but the members of the Salvation Army long range planning committee were sensitive to the perception of their organization spending funds in such a manner, and they requested that no incentives be offered. The research team accommodated the request not to use incentives by enhancing the amount and forms of follow-up to help increase response rates. Follow-up included three follow-up post cards, phone calls, and home visits.

All materials were prepared and distributed in both English and Spanish. Responses were received from 143 households--a 26.1 percent response rate, once bad addresses were omitted. Of the 143 responses, however, 39 were unusable (returned blank), leaving 104 valid surveys from which data have been calculated and analyzed for this report.

FINDINGS

Findings presented include a review of top-ranked needs identified from the research and an identification of service gaps. Data from all stages of the needs assessment were analyzed numerous ways and were compared across methods to identify commonalities. Presented here is an overview of data analysis methods, followed by summary findings from each research method. Due to space limitations for this article, detailed findings from each method of research are not presented; rather, the focus here is on the final comparison of data across assessment methods that helped identify the most pressing service needs for the community studied.

Data from the surveys were used to: a) identify the respondents (demographic variables), b) calculate frequencies of responses pertaining to service needs/barriers, and c) examine meaningful relationships between respondent characteristics and their indication of certain needs. Frequency tables were run to show responses for services sorted into different levels of need, including no need. For some data sets, other statistical analyses were run to explore relationships among variables, for example to determine need for various services in relation to the age of the survey respondent.

Transcripts from focus groups and interviews were analyzed, first using a method of open coding (Corbin & Strauss, 2007) to identify and segment key concepts that were recurrent and prevalent in the data. Concepts then were categorized to identify common themes. For the purpose of snapshot analysis, the recurrence of these themes was quantified to calculate repeated references to the same theme. For example, 21 out of 25 key informants referenced affordable housing and rental assistance when asked about services needed in the community. This allowed for some comparisons between quantitative and qualitative data, and the qualitative data also allowed for richer accounts of needs and challenges as seen through the eyes of community social service experts and front-line service providers. Data from secondary sources were reviewed and assessed similar to focus group and interview transcripts, using a method of review and coding to identify common themes related to top-ranked needs and other issues related to the needs assessment.

Top survey rankings from all respondent categories (key informants, service providers, clients, and community) were calculated in a similar fashion. The rankings do not correlate precisely across methods because the response rates varied. For example, a top ranking among key informant surveys was a response rate of 19 (out of 22, 88.2 percent); a top ranking among Salvation Army client surveys had a response rate of 248 (out of 333; 74.5 percent). Viewing needs based on top rankings across methods was most helpful to identify commonalities.

Top-Ranked Needs

The following data table (Table 2) identifies the top-ranked needs extracted from key informant interviews and surveys (columns 1 and 2), service provider focus groups and surveys (columns 3 and 4 ), Salvation Army client surveys (column 5), community surveys (column 6), and existing data and studies (column 7). Because of the diversity of sample sizes and research methods used, the table reflects a general picture of the top-ranked service needs identified through each method. Data are presented as "rankings"; i.e. a ranking of 1 indicates a service need that had the highest response rate within the specific data set. Only the top 20 ranked needs are identified.

Services are shown in order of overall ranking based on commonality of top-ranked service needs across research methods. In Table 2, two services* achieved top rankings across all assessment methods, including dental coverage and medical care. Four services** achieved top-rankings in six out seven data sets: rental assistance, mortgage assistance, utility assistance and transportation.

Data collected across the multiple methods were reviewed several ways to explore consistency of responses, and top rankings of needs were compared across methods. The researchers combined data rankings and explored various methods of weighting (and not weighting) top-rankings; i.e. to give greater value to some respondent groups or methods over others. The research team determined not to use any kind of statistical formula or method to combine and tally top-rankings from each data set. (4) The only factor explicitly taken into account was to weight the community survey more heavily because it was based on a scientific random sample.

Although slight variations in top-ranked needs among data sources are noted, when rankings of top needs were considered across all research methods, a consistent set of top-ranked needs did emerge. As shown in Table 3 below, the majority of these fell into two primary categories: health care and basic needs.

Other needs that showed up in multiple lists of top-rankings were: 1) food assistance, 2) services to teens aging out of foster care, and 3) services for Hispanic populations. In addition to exploring top-ranked needs, gaps in service delivery in the targeted portion of the county were also identified.

Service Gaps

Service delivery gaps were explored through multiple approaches: by looking at obvious and noted lack of services and by reviewing barriers that prevent people from accessing needed services. Lacking and dwindling services were identified through key informant interviews and service provider focus group responses. Additionally, secondary data sources were used that contained inventories of services, for example, a bed inventory for homeless shelters (2-1-1 Tampa Bay Cares, 2008); however, inventories were not readily available for most types of service. Lacking and dwindling services included programs and services that have gone away (closed) or reduced service capacity in the past year, and service needs respondents say cannot be met. Of special concern were service gaps that impact vulnerable populations (such as homeless children).

Key informants and service providers gave similar responses regarding lacking and dwindling services, as shown in Table 4.

Three out of the top five services identified as lacking or dwindling, as shown in Table 4, were homeless programs or homeless prevention programs, including: financial/rental assistance (to prevent eviction), homeless services (especially shelter for families), and drop-in centers (for street homeless and others). Also top-ranked was mental health and substance abuse services (treatment and beds). This also relates to homelessness, because mental illness and substance abuse are closely tied to homelessness; approximately 65 to 70 percent of homeless people living on the streets are living with mental illness and/or substance abuse problems (5) (Health and Behavioral Health Leadership Network, 2008c). The identification of this mix of services strongly pointed to an absence of services for homeless persons.

Also referenced repeatedly during the needs assessment study was the need for services and lack of services in certain geographic parts of the community. Most often referenced was the lack of services in the most northern part of the county, in particular, the city of Tarpon Springs. The key informants and service providers from Tarpon Springs especially emphasized homeless services as being the most critical needs and the most lacking services in their community.

Identification of lacking and dwindling services confirmed evidence related to top-ranked needs--that basic needs are one essential area for increased focus and attention of the Salvation Army and other health and human service delivery partners.

Even if services are available, barriers exist that prevent people from accessing needed services. These may include external barriers that prohibit access, and internal and personal barriers, such as language/communication barriers, depression or other mental health issues, and help-seeking avoidance. Top-ranked barriers were reviewed through key secondary data sources, and transcripts from key informant interviews and service provider focus groups. As in Table 2, because of the diversity of sample sizes and methods of presenting data in those reports, no summative values are included; rather, the table reflects a general picture of the barriers commonly identified within each report. Although the sources and groups that identified these barriers were diverse, similar themes in their lists of commonly identified barriers can be seen in Table 5.

Mosy of the barriers identified in Table 5 relate to service coordination efforts. Although not the immediate focus of this needs assessment study, these were important to note for current and future service delivery planning and monitoring efforts. Two identified barriers, however, did pertain directly to service planning efforts: transportation and lack of childcare.

Looking at these data sets collectively, a picture emerged that helped identify areas for critical attention and service planning. Many of the prioritized lists and rankings evidenced patterns, pointing the way to the most pressing issues facing Pinellas County and the potential challenges and opportunities facing the Salvation Army and other health and human service planning partners--primarily, health care and basic needs.

IMPLICATIONS AND DISCUSSION

The data and findings presented provide a solid starting point from which the Salvation Army and other health and human service delivery partners may begin planning. Other important factors warrant discussion and further exploration, such as: a) identifying community partners (both government and nonprofit) and creating opportunities to involve them in joint planning efforts; b) determining one or more service areas along a continuum of care where the Clearwater Salvation Army should focus its attention and resources; c) further examining needed services to vulnerable populations; d) beginning and continuing exploration of funding opportunities; and e) researching best practices within Salvation Army Corps worldwide and among other service providers.

The Clearwater Salvation Army leadership understands that their organization cannot meet the needs of the north Pinellas community alone, and that partnerships will continue to be vital in future planning efforts. A likely beginning place for the Salvation Army leadership is to identify other community partners that may share the mission of the Salvation Army in meeting the needs of north Pinellas County residents. Many of these organizations and individuals already work closely with the Clearwater Salvation Army; others are known but not yet engaged while still others are yet to be identified. The first partners the Salvation Army leaders will likely turn to are those who participated in the needs assessment study. This included a diverse range of health and human service administrators from governmental agencies and nonprofits organizations. The first step in the collaborative planning process will be a meeting with these partners to review the needs assessment data and to discuss its implications for health and human services planning and coordination.

For the Salvation Army, the challenge is to determine the organization's place along the continuum of services. The spectrum of service needs is vast, ranging from birth to end of life. A depiction of the continuum of services is shown in Figure 1. Services at any place along the continuum can impact citizens and the community in many ways. One suggestion raised by a Salvation Army member, for example, pertained to the importance of education and youth services--i.e., providing needed and effective services at the early part of the continuum can have a positive impact on the remainder of someone's life, decreasing the need for more costly and demanding services later in life.

[FIGURE 1 OMITTED]

Another consideration is the vulnerability of certain populations in north Pinellas, including: a) teens aging out of foster care, b) Hispanic populations, especially illegal immigrants, c) aging populations, d) homeless families, and e) ex-offenders. These populations are vulnerable because of a range of factors: age, lack of supports, language barriers, legal barriers, and the like. The overall magnitude of need to these populations is small in comparison to top-ranked service needs for general populations, such as health care; however, the vulnerability of these populations may raise the level of importance for the provision of services. The Salvation Army leadership and other community planning partners may choose to focus attention and resources to serve these or other vulnerable populations. Although this would impact a smaller group of persons, the impact would be meaningful and significant.

In addition to identifying an appropriate place(s) along the service continuum, Salvation Army leadership must consider the geographic placement of their services within the community. Creating or moving needed service into a community that is severely lacking services or access to services (such as Tarpon Springs in the northern portion of the county) would have a great impact for the residents of that community, as well as other communities that currently bear the burden of meeting this need.

Another consideration raised by Salvation Army leaders was the exploration of opportunities for funding partnerships. While recent cutbacks at all levels of government and many private foundations have limited resources available, an ongoing search of potential funding partners may be worthwhile, especially because planning and execution of these strategies can take time. Strong funding partnerships require time to foster, and collaborative funding efforts among community partners take time to coordinate.

Finally, Salvation Army leaders expressed the imperative need to explore and build on existing best practices from other Salvation Army Corps, worldwide, and other service providing entities. Although the Clearwater Salvation Army is open to meeting any service need, The Salvation Army and the Clearwater Corps are stronger in some service delivery areas than others, and these strengths should be taken into account. Additional exploration of these best practices and strengths can benefit the leadership of the Clearwater Salvation Army as it moves forward with its strategic planning.

The human service needs assessment featured in this article focuses on one community in west central Florida; therefore, the findings from the needs assessment may not be easily generalized to other communities around the country. Nonetheless, many of the challenges faced by this community, its health and human service agencies, and the Clearwater Salvation Army, are universal, including government budget cuts, decreasing private donations, and increasing needs for services. In general, nonprofits and government agencies today must prioritize dwindling resources to meet increasing human service needs. The challenges of community collaboration to accomplish this task are also shared, and the use of human service needs assessments can benefit any nonprofit or government health and human service administrator responsible for or involved in such efforts. The methods for conducting this assessment are transferable and can be replicated in most communities.

The overview of the human service needs assessment conducted by the Clearwater Salvation Army, and the discussion of challenges and considerations presented in this article, provide an exemplar that others may adapt to address the needs of communities and service industries. As demonstrated, nonprofit organizations can play a significant role in sponsoring and conducting needs assessments, and the results can be used to foster community partnerships to strengthen the planning and delivery of health and human services.

APPENDIX 1

Method 1, Review of Existing Data

Following is a sample of the existing research that was reviewed for this research study. Studies were summarized that examined service needs for multiple subpopulations, including:

* aging populations (Scicchitano & Johns, 2006),

* the growing Hispanic community (Advantage Training Systems, 2007; Hispanic Outreach, 2009; U.S. Census, 2000, 2007a, 2007b),

* persons living with HIV/AIDS (The Health Councils, 2008),

* homeless individuals and families (Department of Children and Families, 2008; Pinellas County Coalition for the Homeless, 2007, 2008), and

* people living with mental illness or addiction to substances (Health and Behavioral Health Leadership Network, 2008a, 2008b).

Studies also looked at general community service needs identified through three primary sources:

* recent helpline data (2-1-1 Tampa Bay, 2009),

* an earlier countywide human services needs assessment for Pinellas County (Giard & Gamache, 2005), and

* health care data related to insurance coverage and emergency room utilization (BayCare Health Systems, 2008; Garvan, Duncan & Porter, 2005a, 2005b; HCA West Florida, 2008; Suncoast Health Council, 2004).

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BETH E. ESCHENFELDER

The University of Tampa

ENDNOTES

(1) The needs assessment by Stiles and Haynes (2002) was reviewed as part of the secondary research for the Clearwater Salvation Army human service needs assessment, and key findings were referenced. The study by Stiles and Haynes provides a sound framework for such needs assessment studies.

(2) Details of the featured needs assessment are included in a report prepared by the university researchers (Eschenfelder & Friesen, 2009) who conducted this study on behalf of the Salvation Army. Many of the references included in this article that describe the needs assessment methodology and findings have been adapted from this study.

(3) Within the state of Florida, Pinellas County ranks seventh in its number of nonprofit agencies, with more than 2,400 public charities, equal to more than 5 percent of the state's total (U.S. Census, 2003, 2007a, 2007b; The Urban Institute, 2007, 2006).

(4) One flexible ranking methodology that can be used for prioritizing data results across multiple methods (for example, identifying top-ranked needs) is an approach developed by The Health Councils (no date), called the Popular Empirical Assessment for Community Health (PEACH) process. This method involves capturing qualitative data provided by the community in a quantitative way by assigning certain weights to data elements collected through various means. This makes it easier for a collaborative planning group to prioritize issues or narrow the scope of focus for a project.

(5) The statistic presented is consistent across local, state and national levels. Correspondingly, the U.S. Department of Health and Human Services Administrations (2003) reports that 50 percent of homeless individuals are living with both mental illness and substance abuse, also referred to as having a co-occurring disorder.
Table 1 Research Methods Utilized

Method   Review of          Researchers gleaned information from a
  1      existing data      diverse array of previously published
                            reports, studies, and statistics on the
                            area.

Method   Key informant      Interviews were conducted with
  2      interviews         community leaders (i.e., key
                            informants).

Method   Service provider   Focus groups were conducted with
  3      focus groups       service delivery providers.

Method   Client survey      Salvation Army clients were surveyed
  4                         regarding their social service needs.

Method   Community          Surveys were sent to a random sample of
  5      survey             north Pinellas households.

Table 2 Top-Ranked Service Needs across Research Methods Data
Sources

Top-Ranked                 1 Key Informant   2 Key Informant
Service Needs              Interviews        Surveys

Dental care *              2                 18

Medical coverage           10                2
assistance *
Rental assistance **       6                 6

Mortgage assistance **     4                 6

Walk-in clinic                               2

Utilities assistance **    9                 11

Transportation **                            3

Vision services            8

Counseling                                   5

Drop-in center             14                4

Prescription drug          11
assistance

Mental health                                5
services

Services for non-          3                 12
citizens ***
Support group                                5

Help getting a job         17                10

Phone bill                                   11
assistance

Help with                  7                 12
immigration

Help kids stay out         19                8
of trouble

Food assistance                              19

Job training               15                10

Top-Ranked                 3 Service Provider   4 Service Provider
Service Needs              Focus Groups         Surveys

Dental care *              3                    11

Medical coverage           14                   5
assistance *
Rental assistance **       8                    1

Mortgage assistance **     1                    1

Walk-in clinic                                  5

Utilities assistance **                         4

Transportation **          18                   7

Vision services            2

Counseling                                      8

Drop-in center             20                   2

Prescription drug          15
assistance

Mental health                                   8
services

Services for non-          11                   6
citizens ***
Support group                                   8

Help getting a job         10                   15

Phone bill                 4
assistance

Help with                  16                   6
immigration

Help kids stay out         13                   3
of trouble

Food assistance                                 18

Job training                                    15

Top-Ranked                 5 Client   6 Community   7 Existing Data
Service Needs              Surveys    Surveys       and Studies

Dental care *              3          1

Medical coverage           9          4             2
assistance *
Rental assistance **       4                        1

Mortgage assistance **                15            1

Walk-in clinic             2          2             2

Utilities assistance **    1          7             111

Transportation **          7          14            5

Vision services            6          3

Counseling                 17         10            3

Drop-in center                                      7

Prescription drug          12         5             4
assistance

Mental health                         12            3
services

Services for non-                     **
citizens ***
Support group                         20            3

Help getting a job                    6

Phone bill                 10         13
assistance

Help with
immigration

Help kids stay out
of trouble

Food assistance            2          17            9

Job training               14         11

*** This service was not included in the client and
community survey.

Table 3 Top-Ranked Needs Common Among Multiple Data Sources

Health Care Needs              Basic Needs

Dental care                    Rental assistance
Health care                    Mortgage assistance
Medical coverage assistance    Homeless services
Vision services                Transportation
Prescription drug assistance   Other emergency financial
                                 assistance

Table 4 Key Informant Interviews and Service Provider Focus
Groups Top Identification of Lacking and Dwindling Services

                                                         Service
                                             Key        Providers:
                                         Informants:       # of
Lacking and Dwindling Services          # of Mentions    Mentions

Financial and rental assistance               9             9

Mental health and substance abuse
services (treatment services and
beds)                                        10             5

Homeless services                             5             7

Health insurance coverage/health
care                                          5             1

Drop-in center (at risk of closing)           4             1

Dental care                                   4             1

Services in the extreme north part of
county / Tarpon Springs                      12             4

Table 5 Commonly Identified Barriers to Access Needed Service

                                          Data Sources

Commonly Identified Barriers         1         2         3

Communication/cultural barriers   [check]   [check]   [check]

Transportation                    [check]   [check]   [check]

Lack of information about         [check]   [check]
services

Service coordination/             [check]   [check]
fragmentation

Stigma, fear                                [check]   [check]

Strict/complicated service                  [check]
admission criteria

Waiting lists

Lack of child care                [check]   [check]   [check]

Service times                                         [check]

Location (lack of access)

                                          Data Sources

Commonly Identified Barriers         4         5         6

Communication/cultural barriers   [check]   [check]   [check]

Transportation                    [check]   [check]   [check]

Lack of information about         [check]   [check]   [check]
services

Service coordination/                       [check]   [check]
fragmentation

Stigma, fear                      [check]   [check]   [check]

Strict/complicated service        [check]   [check]   [check]
admission criteria

Waiting lists                     [check]   [check]   [check]

Lack of child care                [check]   [check]   [check]

Service times                     [check]   [check]

Location (lack of access)                   [check]   [check]

Only barriers identified in two or more sources are listed in the
above table. Data Sources:

Data Source 1: 2004 Pinellas County Health and Human Services
Needs Assessment (Giard & Gamache, 2005)

Data Source 2: 2006 10/year plan to end homelessness (Homeless
Leadership, 2006) Data

Source 3: 2007 Hispanic Community Survey (Advantage Training
Systems, 2007)

Data Source 4: HIV: 2008 Ryan White [HIV/AIDS] Needs Assessment
(The Health Councils, 2008) Data

Source 5: key informant interviews

Data Source 6: service provider
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