Health promotion and public health research increasingly recognise that a range of community organisation and attitudinal factors are important to a community’s level of readiness, or capacity, to undertake effective prevention activity required to reduce population rates of adolescent substance abuse. Although the importance of tailoring community capacity building to readiness levels is acknowledged, little research has been done to date, to develop a systematic framework for measuring readiness in Australia. / Equally in Australia where national and state government drive public health drug policy and programme development, their interaction and support of community level interventions and efforts has not been widely examined. / This methodological study of 100 telephone interviews with 60 community practitioners (15 in each community) was conducted to identify and assess the specific attitudinal, systemic and resource characteristics of four regional communities in order to extend their capacity or readiness to address adolescent substance abuse within their community. The study provided the opportunity to assess the feasibility, reliability and validity and utility of two North American questionnaires that had been developed to provide quantitative measurement of community readiness. Additional questions were included to try and gauge to what extent state government engaged with, and responded to, the four regional communities in the planning and initiation of prevention activity. Examination of this domain would also contribute to the understanding of state and community engagement with community empowerment. / Each of the readiness questionnaires appeared comprehensible within the Australian context, requiring only minor modifications to wording and format to obtain reliable responses from community practitioners. Community readiness ratings for the four communities were consistent across the two instruments with each questionnaire assessing some overlapping and some distinct domains. / The comparison of results from the two community readiness survey instruments suggested some advantages for the TECPR instrument in its slightly higher face validity to key informants and its ability to significantly discriminate the total readiness scores for the four communities. Analysis revealed some associations between the two readiness assessment methods; supporting the view that they were assessing some common underlying dimensions but also that they each provided some unique information. Analysis of the additional questions related to community empowerment suggested that the two assessment methods each contributed unique information in predicting local perceptions of community empowerment. / It is concluded that each questionnaire has the potential to elicit detailed and reliable data concerning community-readiness, which can be quantitatively analysed; and is not unduly time-consuming or burdensome to the researcher or the respondents. One of the questionnaires holds particular merit for communities where research expertise in not available. Measurement of community readiness appears feasible in the Australian context opening opportunities for improved planning and evaluating of community development initiatives aimed at preventing adolescent substance abuse.

Yes / Participation in community programmes by the Roma community is low whilst this community presents with high risk of poor health and low levels of wellbeing. To improve rates of participation in programmes compatibility must be achieved between implementation efforts and levels of readiness in the community. The Community Readiness Model (CRM) is a widely used toolkit which provides an indication of how prepared and willing a community is to take action on specific issues. We present findings from a CRM assessment for the Eastern European Roma community in Bradford, UK on issues related to nutrition and obesity. We interviewed key respondents identified as knowledgeable about the Roma community using the CRM. This approach applies a mixed methodology incorporating readiness scores and qualitative data. A mean community readiness score was calculated enabling researchers to place the community in one of nine possible stages of readiness. Interview transcripts were analysed using a qualitative framework analysis to generate contextual information. An overall score consistent with vague awareness was achieved, which indicates a low level of community readiness. This score suggests there will be a low likelihood of participation in currently available nutrition and obesity programmes. To our knowledge this is the first study to apply the CRM in the Roma community for any issue. We present the findings for each of the six dimensions that make up the CRM together with salient qualitative findings. / Better Start Bradford

Denna kvalitativa studien har två syften: att, i en utvald statlig myndighet, 1) undersöka organisationens villighet till innovation och 2) att utforska vad som är allmänt kännetecknande för att ta sig an innovation i organisationen. Utgångspunkten är sju anställdas perspektiv och upplevelser kring hur deras myndighet och organisation arbetar med innovation. Data är insamlad via intervjuer och två olika former av analysmetoder har använts. Resultaten från den första delstudien visar på att organisationens villighetsnivå i arbetet med innovation (vid studiens genomförande) ligger på nivå 4, förplaneringoch förflyttar sig i riktning mot nivå 5, förberedelser. Den andra delstudiens fenomenologiska resultat visar på en allmän upplevd psykologisk processviktig att tänka på i arbetet med att ta sig an innovationi organisationen. Denna psykologiska process visar att förväntanär kopplad till att ta sig an innovation och att det även finns förväntan kopplad till värdesättande och uppskattning; kapacitet och skicklighet; modig beslutsamhet; praktiskt görande och samskapande; nytt lärande; möjliggörande dialog och stärkande relationer. Tillsammans kan dessa vara viktiga riktningsgivare att tänka på för att framgångsrikt möta organisationens och de anställdas behov av att navigera och orientera sig i arbetet med att ta sig an innovation; att uppnå fullt ägarskap/professionalism inom innovation samt att säkra organisationens hållbara värdeskapande.

Long dismissed as a third world issue, the commercial sexual exploitation of children (CSEC) has been a significant problem across the United States over the past two decades, causing major concerns for child welfare stakeholders. The literature has shown a broad range of adverse consequences associated with CSEC. These include—but are not limited to—malnutrition, severe trauma, physical and sexual assault, sexually transmitted diseases, unwanted pregnancy, and medical neglect. The purpose of the study is to assess the readiness level of a large county in Southern California with regards to the well-being of children with a past or current record of victimization from commercial sexual exploitation. Embracing the Community Readiness Model, this case study aimed to evaluate (a) the county’s level of knowledge about programs and services to address CSEC, (b) the county leadership’s attitude toward addressing CSEC, (c) the county’s attitude toward addressing CSEC, (d) the county’s knowledge about CSEC, and (e) explore the county’s range of resources available to address CSEC. Results indicated that the county’s overall readiness score was 4.1 out of a possible 9. That is, the county had a low readiness level with respect to addressing the challenges associated with CSEC within its boundaries. Implications of the findings for theory, research, policy, and macro social work practice were discussed. Keywords: commercial sexual exploitation of children (CSEC), community readiness model

Thesis (Ph. D.)--Marquette University, 2009. / Sarah Knox, Susan Turell, Alan Burkard, Advisors.

Elder abuse has traditionally been a silent social issue in America. However, with an estimated increase in the older population over the next 50 years, and given the preventable nature of violence, it is quickly becoming a major public health priority area. Each year hundreds of thousands of elderly are abused, neglected, or exploited financially worldwide. In the United States alone, it is estimated that 500,000 cases of elder abuse occur annually—with research indicating that substantiated cases are a mere underreport of the true problem. The US federal government has appointed State Units on Aging to address elder abuse. Georgia’s Division of Aging Services (DAS) is located within the Department of Human Services and administers various services to elderly including advocating for their safety and well being. DAS carries out its work through locally appointed Area Agencies on Aging (AAA). While AAAs serves as a first point of entry for elderly population locally, their involvement in reporting and intervening in elder abuse cases has been limited. The purpose of this capstone project is to examine the AAAs’ stage of readiness to address elder abuse using the Community Readiness Model, developed by researchers at the University of Colorado. Telephone administered surveys were completed with 7 out of the 12 Georgia AAAs. Through a double rater review process, transcripts were coded according to diverse constructs of the Community Readiness Model and ultimately a readiness score was produced. The Community Readiness Score provides insight into evidence-based strategies that can be implemented in order to advance elder abuse intervention and prevention within the AAA communities. The findings from this study provide insights into cost-efficient, tailored strategies that can maximize the use of DAS funding for AAA elder abuse case response and service delivery.

Yes / Evidence for early intervention and prevention-based approaches for im-proving social and emotional health in young children is robust. However, rates of participation in programmes are low. We explored the dynamics which affect levels of community readiness to address the issues of social and emotional health for preg-nant women, young children (0-4 years) and their mothers.Setting:A deprived inner‐city housing estate in the north of England. The estate falls within the catchment area of a project that has been awarded long-term funding to address social and emotional health during pregnancy and early childhood.Methods:We interviewed key respondents using the Community Readiness Model. This approach applies a mixed methodology, incorporating readiness scores and qualitative data. A mean community readiness score was calculated enabling the placement of the community in one of nine possible stages of readiness. Interview transcripts were analysed using a qualitative framework approach to generate con-textual information to augment the numerical scores.Results:An overall score consistent with vague awareness was achieved, indicating a low level of community readiness for social and emotional health interventions. This score suggests that there will be a low likelihood of participation in programmes that address these issues.Conclusion:Gauging community readiness offers a way of predicting how willing and prepared a community is to address an issue. Modifying implementation plans so that they first address community readiness may improve participation rates. / Better Start Bradford

Background: Opioid use disorder (OUD), prescription opioid misuse, and increased heroin use are major public health crises in the US. Excessive non-medical use of prescription opioids and illicit drugs can alter the brain, disrupt mental health, and increase the risk of blood-borne illnesses and bacterial infections. The CDC reported that opioids caused nearly 70% of the 67,367 overdose deaths in 2018. Rural areas have high prescription and illicit drug use rates, limited resources, and unique challenges. There is an emerging need to understand rural residents' perspectives on OUD and substance use disorder (SUD) in their community in order to implement efforts. A community-based participatory research (CBPR) approach addresses the need for a systematic participatory solutions, and reduces community opposition and promotes sustainable, culturally appropriate interventions that can reduce the health-related harms caused by substance abuse. Methods: Two studies were conducted using CBPR principles to address the opioid crisis in a rural Southern Virginia community. Study I aimed to provide insight into community members' perceptions, knowledge, and experiences with OUD/SUD to inform community-led strategies. Study II assessed whether a virtual community platform with a Nominal Group Technique (NGT) can build consensus around Comprehensive Harm Reduction (CHR) in the same rural Southern Virginia community. Study II used the Community Readiness Model (CRM) and assessment tool. Stakeholder focus groups were conducted by a participatory research team, EM, as part of a larger project using the Stakeholder Engagement in quEstion Development (SEED) method. To assess the community's readiness to implement CHR using the CRM, Study II used semi-structured qualitative interviews with key stakeholders. The results of the readiness assessment were then used to inform a virtual community forum with members of a drug-free coalition. On the basis of CRM interview themes and findings, the forum used the NGT consensus-building technique. Results: The primary themes identified in the analysis of the community stakeholder focus groups conducted for Study I included the importance of family dynamics and social networks as risk and resiliency factors, addressing hopelessness as a preventive strategy, the need for holistic approaches to treatment, childhood exposure resulting in intergenerational substance use, the needs of overburdened healthcare providers, the expansion of long-term rehabilitation programs, and the need for judicial reform towards those with OUD. Comprehensive methods to address OUD's complexity require specific and well-defined strategies. Understanding the factors that contribute to OUD in rural communities should be the first step in developing actions. The overall community readiness score for Study II was 4.07, indicating the community is still in the pre-planning stage for bring CHR to the community. The majority of key informants believe that leaders and community members recognize the problem of SUD/OUD harms and that something should be done to improve and integrate harm reduction efforts. The forum had 12 attendees. The community forum produced 13 topics and a list of action priorities that at least 80% of participants agreed on. The two areas of high priority included: (1) raising awareness of secondary harms of SUD/OUD and available resources to assist the community, and (2) reducing the stigma associated with CHR and appeal to people's sense of humanity in order to create an environment conducive to understanding and increase buy-in around CHR. Implications: Both studies show rural stakeholders can help curb the drug epidemic. Their knowledge of internal community dynamics and needs allows them to prioritize actions to improve health outcomes. In addition, Study II demonstrated the effectiveness of the CR Model in determining community readiness to adopt CHR and the value of a virtual community forum in conjunction with an NGT process in fostering stakeholder consensus. / Doctor of Philosophy / Background: Opioid use disorder (OUD), prescription opioid misuse, and rising heroin use are major public health crises in the US. Taking too many prescription opioids or illegal drugs can be harmful. This can alter the brain, cause stress, and increase the risk of blood-borne illnesses and infections. Opioids caused nearly 70% of the 67,367 overdose deaths in 2018, according to the Centers for Disease Control and Prevention. Rural areas have high prescription and illicit drug use rates, limited resources, and unique issues. There is an emerging need to understand rural residents' perspectives on OUD and substance use disorder (SUD) in their community in order to implement efforts. Thus, this research which is based on the principles of Community-Based Participatory Research (CBPR) was conducted to help address this need. To reduce the health-related harms caused by substance abuse, CBPR promotes sustainable, culturally applicable interventions. Methods: Two studies used CBPR to address the opioid crisis in rural Southern Virginia. The goal of Study I was to gain insight into community members' perspectives, knowledge, and experiences to inform community-led action. For the first study, a community-research team, EM, conducted group discussions with community members as part of a larger project that used a participatory approach to unite the community in actions to address OUD in their community. Study II used the Community Readiness Model (CRM) and an assessment tool to determine community readiness for comprehensive harm reduction (CHR). The study also wanted to see how a virtual community platform with a consensus building process could help build agreement around CHR. In Study II, key stakeholders were interviewed to assess the community's readiness for CHR. Then a virtual community forum with members of a drug-free coalition was held. The forum got responses and put them in order based on themes and results from CRM interviews. Results: We learned from the first study, family dynamics, social networks, hopelessness, intergenerational substance use, and healthcare provider needs all influence risk and resilience. Long-term rehab programs should be expanded, and the justice system should treat OUD differently. Detailed methods to address OUD's complexity require specific and well-defined strategies. Understanding what causes OUD in rural communities should be the first step in finding solutions. Study II found that the community is still in the pre-planning stage, with a score of 4.07 out of 9, indicating that leaders and community members recognize that the harms associated with OUD are a problem and something should be done to improve and incorporate harm reduction efforts. The results of the community forum also show a list of important topics on which at least 80% of participants agreed. The two areas of high importance were: (1) raising awareness of secondary harms and available resources to help the community, and (2) lowering the stigma associated with CHR to make it easier for people to understand, but be deliberate in appealing to people's sense of humanity to get them to buy into CHR. Conclusions: Both studies show that people who live in rural areas can help solve the local drug problem. Their understanding of how needs change within a community gives us a unique way to improve health outcomes. Study II found that using CRM and a virtual consensus-building process can aid stakeholders in reaching an agreement on how to address issues. Study II also showed how useful it is to use a virtual community forum and an NGT process to figure out if a community is ready for CHR.

The work described herein is situated in a larger study investigating regional food systems as a method for improving food access for vulnerable communities. This research is part of the United States Department of Agriculture's Agriculture and Food Research Initiative project titled Enhancing Food Security in the Northeast for Underserved Populations (EFSNE). This work is ongoing and currently in year five of five. One of the primary objectives in year five is to facilitate the development of Learning Communities in each of the eight communities participating in the study. To do so, the research team planned to develop tools and strategies for facilitation. The team identified a need to match strategies to the specific situation of each community. Thus, a tool was identified that might be useful in assessing the needs and readiness of the communities with respect to their access to healthy food sources. This research simultaneously evaluated the usefulness of the tool while assessing community readiness in six of the eight project communities. The tool used in this study, was a community level behavioral change model, the Community Readiness Model (CRM). The model was originally developed by the Tri-Ethnic Center in Colorado. We followed the CRM protocol for identifying participants. Twenty-four individuals from six locations involved in the EFSNE study participated in the interview process. The interviews were conducted using the semi-structured interview guide provided in the CRM protocol. We amended the guide by tailoring questions to address food access and ensuring questions were asked at the five levels of influence found in the Socio-Ecological Model. The final guide contained 40 questions; 18 were required by the protocol to score each community. Interviews were conducted by telephone by one researcher, transcribed, and then scored by two researchers according to the CRM protocol. The mean overall readiness score for the six communities assessed was 4.9 (SD 1.0). This score is firmly rooted in the pre-planning stage of readiness. Scores ranged from 3.7 to 6.2 on the 9-point scale. The CRM scoring protocol coupled with the overall readiness scores indicated that the three urban communities scored higher (mean 5.7, SD 0.6) than the three rural communities (mean 4.1, SD 0.7). While we found a utility to having scores on a continuum to quickly assess the communities of study, we found the qualitative data obtained from the interview process imperative to understanding the scores and the communities. We concluded that with a few amendments, the Community Readiness Model is a useful methodology to understand food access at the community level. Revealing the stages of readiness for food access change in the study communities contributed to our understanding of what types of programs exist for food access, what the communities' attitudes and feelings are around food access and guided strategy development for moving readiness for change forward. This lens also revealed that there is a need for education on existing and development of new food access policies. Furthermore, this work contributes to the practice of assessing community food security while simultaneously contributing to the development of parameters for community food security theory in food systems scholarship.

Yes / The importance of including members of the public has been accorded a significant position in health planning, service delivery and research. But this position masks a lack of clarity about terms that are used. This paper identifies terms that are in common use in the lexicon of community based involvement and engagement in health with the intention of clarifying meaning and thus reducing ambiguity. We define and distinguish between key terms related to inclusion, we consider the terminology attached to community processes and to the challenges of inclusion and we engage with the strengths and weaknesses of the commonly used metaphor of "a ladder of participation". We wish to contribute to the clear communication of intentions, challenges and achievements in pursuing varied forms of inclusion in health.