Return to Portfolio Directions
Infrastructure Building
Population-Based Approach Services
Definitions Related to Leadership Portfolio
A. Infrastructure Building Services
A1. Needs Assessment refers to a discrepancy or gap between “what is” (the present state of affairs) in regard to a group and situation of interest, and “what should be.”(a desired state of affairs). (1) Assessment is the collection, analysis and sharing of information about health conditions, risks, and resources in a community. An assessment identifies: a) trends in illness, injury, or death, b) the factors that may cause these events, c) available health resources and their application, d) unmet needs, and e) community perceptions about health issues. A needs assessment is a systematic set of procedures undertaken for the purpose of setting priorities and making decisions about program and allocation of resources. ( 2, 4) The priorities are based on identified goals.
A2. Program Planning refers to the process of developing a set of statements that describe a package of services intended to accomplish a particular purpose. Program planning involves creating the goals, objectives and methods to satisfy the objectives and thereby reach the goals. (3)
A3. Evaluation/ Quality Assurance, Cost and Outcomes refers to an evaluation process of inquiry, focused on assessing the performance of a program, including cost and outcome, and based on a standard of comparison. (3) Quality assurance (QA) is the monitoring and maintaining of the quality of health care services through licensing and discipline of health professionals, licensing of health facilities, and the enforcement of standards and regulations. (2) QA is the estimation of the degree of excellence within the alteration of health status of consumers attained through providers’ performances of diagnostic, therapeutic, prognostic, and other health care activities. (9) Cost includes cost analysis and cost effectiveness of the health care activities. Outcomes are the results of health care activities which are differentiated to include: professional, agency or consumer results as outcomes.
A4. Policy Development/ Implementation refers to a process whereby health care agencies evaluate and determine health needs and the best way to address them. (2)
A5. Standards Development refers to the accepted professional measures of comparison having quantitative or qualitative value. Standards development is the creation of these measures. Outcome standards are long-term objectives that define optimal, measurable future levels of health status, maximum acceptable levels of disease, injury, or dysfunction, or prevalence of risk factors. Capacity standards are statements of what health agencies and other state and local partners must do as part of ongoing, daily operations to adequately protect and promote health, and prevent disease and injury. (2)
A 6. Information Systems is a method to collect, classify, store, link, retrieve, and disseminate recorded knowledge gathered on individuals, families, populations, agencies, organizations, and communities to form a unified whole understanding to enhance cognition and support action.
A 7. Systems/ Care Coordination refers to collaborative approaches among professionals, services, agencies, insurers and families to assure resources and services are accessible, comprehensive, effective and meet the needs of individuals, a group or population.
B. Population-Based Approach Services
B1. Primary Prevention Programs. Prevention is a strategy that reduces the likelihood of health problems occurring . Prevention programs have a set of coordinated strategies directly targeted to certain outcomes. Prevention may be accomplished, for example, by avoiding environmental conditions that increase the likelihood of the occurrence of the disease or seeking genetic counseling to avoid conception of a fetus by parents with genetic risk. Where environmental toxins, such as alcohol or lead, affect the developing fetus or young child, disease is prevented, for example, by reducing maternal alcohol use or through programs to eradicate lead-based paint from homes.
B2. Secondary Prevention Programs. Secondary prevention takes place after the conception of an affected fetus. Once a pregnant woman has been identified as either at high risk or clearly carrying a fetus with a severe chronic disease, options include termination of the pregnancy or, for some conditions, fetal surgery (for example, children with hydrocephalus). Research in genetics may soon allow enzyme modifications that will reverse the effects of some conditions.
B3. Tertiary Prevention Programs. Tertiary prevention involves avoidance of the untoward or unnecessary consequences of disease. What can be done for children who are born with or who acquire a severe chronic illness to prevent the disease from interfering with physiological, educational, or psychological functioning? Tertiary prevention aims at improving school participation, safeguarding the psychological integrity of the child and family, maximizing the child's functional abilities to carry out usual daily tasks, promoting emotional and physical growth most effectively, and limiting the effects of illness on the child's physical capacities. Tertiary prevention, that is, diminishing the impact of illness on daily life, is best understood in light of the distinctions among disease, disability, and handicap. Disease reflects the underlying interference with physical processes (for example, arthritis). Disability is the direct expression of disease (a knee joint functioning poorly because of arthritis, for example). A disability may or may not affect everyday activities of the child. Handicap refers to the impact of illness on normal growth and development or on specific tasks (such as the inability to climb stairs because of nonfunctioning knee joints). Some children with severe disease will have little handicap; others with mild disease may be severely handicapped. Tertiary prevention aims to diminish disability and to prevent a disability from becoming a handicap.
Note: Institute of Medicine and NIH has recently recommended a revised model of prevention. This model was proposed by Gordon and is as follows:
Universal prevention is aimed at large groups of low risk people. Brief and low dose intervention. Selective prevention programs focus in specific high risk groups. Intervention in low doses is sufficient to impact risk and protective factors. Indicated prevention programs are oriented to high risk individuals who have indicators of risk factors. Intervention doses are sufficient to have desired effect on risk and protective factors. Costs are greater per session that universal or selective. (6,7)
C1. Family Support services refers to the array of activities, amenities, and programs that respond to the needs of the total family to promote capability in raising its children, especially those with special health care needs. Characteristics of family support principles are (a) enhancing a sense of community, (b) mobilizing resources and supports, (c) sharing responsibilities and collaboration, (d) promoting family integrity, (e) strengthening family function, and (f) implementing proactive human services practices. (8)
C2. Accessibility refers to the ability to obtain or make use of something. Access to health is the ability to obtain health services when needed and has two major components: (a) ability to pay (i.e. insurance), and (b) availability of health care personnel and facilities that are close to where people live, accessible transportation, culturally acceptable, and capable of providing appropriate care in a timely manner and in a language spoken by those who need assistance. (5)
C3. Health Education is instruction directed toward positive changes in knowledge levels, attitudes, or behaviors to improve the physical, social, emotional, and mental well- being of people. Health promotion is the general process of advocating health. It may include education, environmental change to support improved health, legislation, or shifts in societal norms. Health promotion may focus on the individual, on groups, or on society at large. (3)
C4. Ally Building with Families /Advocacy Groups is the process of forming a bond or connection by joining forces, resources, knowledge, and skills to further common interests. Ally building with families and advocacy groups involves the process of forming a bond with them to enhance autonomy in expressing their own values, desires, and goals to further their best interest. Advocacy is when a person or group pleads or speaks for another. The objective of advocacy is to try to change the way in which agencies or institutions operate to improve the lives of people. Sometimes an advocate can operate without the knowledge of the people he or she is representing. Advocacy does little in changing the power relationships between people of interest and power structures because the people do not speak nor represent themselves directly. (10)
D. Direct Health Care Services
D1. Family-Centered Health Care is individualized to child and family and responsive to child's needs and family's priorities. Parent and child collaboration with professionals at all levels of care. (11)
D2. Culturally Competent refers to the five essential elements that characterize a culturally competent system: a) values diversity, b) capacity for cultural self-assessment, c) conscious of the dynamics inherent when cultures interact, d) institutionalized cultural knowledge, e) developed adaptation to diversity. Culturally Competent systems of care are made up of culturally competent institutions, agencies, and professional. (12)
D3. Comprehensive/ Coordinated Care refers to health care that is provided cooperatively among health professionals at the primary, secondary, and tertiary levels of care (see Surgeon General's Report on Children with Special Health Care Needs). Case Management/ Family Resource Coordinator: "Services to promote the effective and efficient organization and utilization of resources to assure access to necessary comprehensive services for children and their families." (13)
D4. Interdisciplinary refers to the participation of professionals from multiple disciplines who contribute their respective disciplinary knowledge, skills, and perspectives for a synergistic response to the needs of a group, population, or community.
D5. Community-based refers to local development and situation of services and programs that are accessible to a group or population in their own community identified by a connection to a geographic location, psychological bond, involvement in institutions, or a network of social-cultural ties.
E.
Cultural Competence
Set of congruent attitudes, beliefs, behaviors, practices, and policies
that reflect cultural competence as defined at the individual professional
and institutional levels. (12,15,16,17)
E1. Scientific Mindedness involves the systematic formation and testing of hypotheses about the status of culturally different clients rather than applying general theories to one group or individual and making assumptions or premature conclusions about the meanings of their behaviors or symptoms. (14)
E2. Dynamic Sizing is the process of knowing and understanding individual variations versus group patterns and avoids stereotyping individual members of a group. (14)
E3. Cultural Self/ System-Assessment and Adaptation involves the assessment of professionals', agencies' and systems' awareness of their own cultural beliefs and how these influence them. (15) This assessment includes the acknowledgment of the tendency to have personal or systemic prejudicial judgments of persons, families, or communities according to their race, class, gender, sexual orientation, religious/spiritual beliefs, lifestyles, country of origin, values and beliefs, physical or mental disabilities, professional orientation, and system participation. Adaptation to diversity involves acknowledgment of diversity and concomitant changes in providers, programs, and systems to create a better fit between the needs of cultural groups and services available. (12)
E4. Cultural Acknowledgment and Respect refers to the recognition and the appreciation of culture and cultural diversity. This involves eliciting clients' perspectives about their experiences and the meaning, beliefs, and values associated with those experiences and appreciating that there are vast differences in how people from different cultures go about meeting their needs. (12)
E5. Conscious of Dynamics Inherent when Cultures Interact involves the understanding and appreciation of the forces, processes, and tensions when different cultures act upon one another on the basis of historical relationships, political experiences, and power. (12)
