PACE EH Online Course Module 1

In order to begin the PACE EH process there are several key elements necessary to use the methodology. These elements include the agency capacity and external support that is required to complete the process (e.g. staff, experience, support, funds).  

During the first three tasks, local public health professionals embarking on the PACE EH journey must also determine the scope of the assessment (neighborhood level, county level or across jurisdictions).  From here the assessment coordinator can begin to assemble the community based environmental health assessment (CEHA) team by locating and inviting 12–20 key community members.  

Importantly, you can very reasonably complete Task 1 and answer “no.”  If you embrace the philosophy espoused by PACE EH but don’t have the ability to pull one together yet, this task can serve the valuable purpose of indicating which elements need to get organized before the agency can proceed (e.g. Board of Health support, or a meeting facilitator, etc.)

Key Points to Consider During Tasks 1–3:

  • The PACE EH process requires continuous re-iteration.  Once the CEHA team is formed, divergent points of view may impact the will impact the mapping of the community.
  • The facilitating agency is not solely responsible for the organization and implementation of the assessment. 
  • Diversity on the community team is crucial for success.  Diversity promises a broad view of environmental health, broad problem solving skills, a wide network into the community, and a system of checks and balances throughout the process.
  • The health official will have to make a decision between only facilitating the process or assuming responsibility for resulting action plans.  Also, must consider what is in it for them (i.e. improved footprint in the community, access to new networks, vanguard in protection of local environmental health).

Although PACE EH is designed as an assessment process, it is also a skill- and community-building process. Before committing to the assessment, users should assess the capacity of the community, including the public health agency, to undertake the PACE EH process. This initial appraisal is a way to identify and evaluate:

  • Resources and capacities needed for the assessment.
  • Resources and capacities available for the assessment.
  • The quality of the agency’s relationship with the community.
  • The existence of effective working relationships with other agencies and organizations that have essential resources and data for a community-based environmental health assessment

From start to finish, project duration can range from one to several years, depending on the level of community collaborative capacity and process dynamics. Team members should expect to commit to one or two meetings per month, with periods of increased or decreased intensity and the occasional out-of-meeting work assignment.

Financial resources will be required for printing, copying and postage for community outreach materials, as well as meeting space and refreshments. Staff will be needed for project coordination, attending community meetings (in addition to preparation and follow-up activities), data collection and analysis, and community outreach.

Specify available resources, skills, and capacities

The PACE EH process depends on strong internal agency capacity. Local public health agencies that lack strong data collection and data analysis capabilities, adequate staffing, or integrated planning and policymaking processes drawing on community input will find that community-based environmental health assessment only magnifies existing organizational weaknesses. An internal agency assessment will help evaluate:

  • the agency’s ability and capacity to undertake an assessment of this nature;
  • the level of community conflict, mistrust and disunity;
  • the success rate of prior collaborative efforts; and

  • the existence of leaders with energy, commitment, and credibility.

  • the willingness of the lead agency to share decision-making power with the broader community and

  • the ability of the lead agency to leverage relationships with other agencies or community players to address the community concerns that the health agency cannot adequately address on its own.

For further information: Collaborative Leadership: How Citizens and Civic Leaders Can Make a Difference (Chrislip and Larson, 1994)

Determine ability to carry out the assessment

At this point, the agency will need to gauge whether the level of local resources, capacities, and relationships — as well as the collective commitment and leadership potential — are sufficient to sustain an intensive community-based environmental health assessment. If it is, the likelihood that a full-scale assessment will be successful is enhanced. If not, recognize that engaging in the process can strengthen the very capacities, resources, and skills necessary for its completion.

Question to Consider

Begin to think about the capacity of your organization/agency to undertake a CEHA process.  What existing resources and capacities do you already have in place?  Has your agency built a relationship with external partners and the community?  What steps do you need to take to prepare for a CEHA process?

At the completion of this task, the process facilitator(s) and/or the assessment team should have:

  • Defined the community;
  • Described the community’s characteristics, composition, organization and leadership; and 
  • Refined the definition of the community as needed.

As a locally based process, PACE EH depends on defining the target community and then involving members of that community in the assessment process. The community will influence many of the subsequent activities in the assessment process, such as selecting environmental health concerns, deciding on ways to involve community members, developing issue profiles, identifying community partners, identifying resources and collaborative opportunities, and developing an action plan.

Decisions about the definition of community had far-reaching repercussions in the pilot sites. One assessment team in a large metropolitan area had difficulty prioritizing sub-local environmental health issues (significant issues confined to a small segment of the overall population) because the size and demographics of the entire community tended to “push them off the table.” Another team addressed this problem by weighing community input not only objectively, but also subjectively. For example, despite the fact that very few people in the community were concerned about increasing rodent infestation, those who were all lived in the same sub-locality. This recognition influenced the team to keep the issue “on the table” even though it affected a statistically insignificant segment of the population. Their solution shows the importance of defining and characterizing the community culturally as well as statistically.

Define the Community

The definition of the community is an essential tool for identifying initial members of the assessment team. 

A community can be as small as a neighborhood or encompass many political jurisdictions. Community boundaries may be defined along health-agency jurisdiction lines, city limits, or county lines. The definition can be based on geographic boundaries, voting districts, cultural or ethnic groupings, or socioeconomic delineations. A community can also be defined as a watershed area or other topographical boundary. Depending on the goals of the assessment, geological conditions or ecological regions may define the community.

Note: Future decisions about appropriate methods for involving community members may depend on how the community is defined. For example, a very large community would be unmanageable if convened as a full group, language considerations must be taken into account in a community containing diverse populations, and frequent centralized meetings are unlikely to be well attended in a large, rural area. Further, the definition should be revisited after the initial assessment team is convened (Task 3). At that point, affected members of the community can refine the definition according to their individual perspectives. The goals and scope for the assessment (developed in Task 4) also might suggest the need to revisit how broadly or narrowly the community is defined.

Describe the Community’s Characteristics, Composition, Organization, and Leadership

Once the community is defined, the next step is to learn about the community and gain an understanding of citizens’ environmental health concerns. Each community has a unique demographic profile, history, political structure, business and social development, and values and perspectives. Important statistical descriptors may include:

  • Basic demographic and health data. 
  • Socioeconomic data; data on educational status. 
  • Language, culture, and religion.

Note: Knowledge of the level and scope of civic activity is important in understanding the context(s) in which environmental concerns will arise and decisions will be made.

Finally, a robust community description will help facilitate action planning (Task 12), by helping to identify partners, resources, and opportunities for engagement. A thorough description of the community will aid in developing environmental health profiles for selected issues identified in Task 5.

Question to Consider
What steps should you take to define and characterize your community? If working with a subpopulation of the community, what are the key considerations you must take into account when describing the composition of the community?

At the completion of this task, the process facilitator(s) and/or the assessment team should have:

  • Detailed the expectations of team members. 
  • Invited individuals to help design and carry out the assessment. 
  • Determined the governing structure, decision-making structure, and ground rules for the assessment.

Although most pilot test sites worked on assessments for up to two years, they discovered that payoffs—increased collaboration among government agencies, increased awareness, and identification of community strengths—can be realized quickly. They shared these lessons:

  • Ask for feedback throughout the process. 
  • Be clear about commitments (e.g., expected number of hours, expected number of meetings) up front. 
  • Celebrate early accomplishments. A three- to five-year plan is good, but do not wait until the end to acknowledge all achievements. 
  • Be flexible. The structure can change at different points in the process. For example, the community might take the lead in identifying environmental issues of concern, whereas staff may have a stronger role in developing indicators. 
  • Display “pomp and circumstance” around the process and the selection of members to the assessment team (e.g., press releases, letters of invitation from the board of health, etc.)

The information gathered in Tasks 1 and 2 will help determine the initial composition of the assessment team. The team should comprise a broad cross-section of the community and should include individuals who represent local economic interests, political structures, and organizational institutions.

The following section details each step of assembling your community environmental health assessment team.

Clarify Expectations of Team Members

Before assembling the team, decide on a basic set of expectations for the members. Make sure that all members of the team understand their roles and responsibilities, and the rights of all participants. This will help build the communication and trust essential for a well-functioning team.

Identify and Invite Individuals to Help Design and Carry out the Assessment

A team typically consists of program managers in the local health and environmental agencies working in partnership with community members. Representation should be sought from key community groups, such as:

  • Healthcare providers/facilities; 
  • Educational institutions; 
  • News media; 
  • Government agencies; 
  • Economic/commercial organizations; 
  • Labor organizations; 
  • Professional and trade groups; 
  • Faith groups; and 
  • Voluntary and private organizations.

*Note: Strong consideration should be given to establishing links with schools of public health and other local colleges or universities, because academic institutions are an abundant source of information, expertise, and student assistance—benefiting not only the assessment process, but also the professional development of the students.

Remember: to be effective, the team should be small enough to be manageable and large enough to adequately represent the community and to ensure a reasonable workload for participants.

Diversity in the Assessment Team

A community-based environmental health assessment is a complex process. Teams cannot predict at the outset which issues will become the focus. A successful assessment team will be prepared to investigate a plethora of environmental health issues. This requires ensuring that members represent as many local interests as possible.

Overwhelmingly, pilot site coordinators found diversity to be the most important element of a successful assessment team. A diverse team has two distinct advantages: 

  1. It reliably reflects the community and  
  2. It incorporates a system of checks and balances.

Pilot site coordinators had these suggestions:

  • Build an assessment team as diverse as the community it represents. 
  • Include a range of citizen groups (e.g., from high school civics clubs to the local AARP). 
  • Seek volunteers from minority groups and local civil rights organizations. 
  • Incorporate both ecological interest groups and local business/industry concerns. 
  • Include persons representing no specific interests.* 
  • In short, bring to the table persons and groups that you would never expect to see sitting together.

*Note: Citizens without an “axe to grind” provide a “reality check” for the assessment team. They balance the viewpoints of single-issue advocates for whom a community-based environmental health assessment is a potential vehicle for pre-formed priorities.

Determine a Governing Structure, Decision-Making Structure, and Ground Rules

  • Specify what team members will be expected to do. Will all team members have the same responsibilities, or will some have special responsibilities? Will all team members have the same rights? 
  • Explicitly state how the team will be governed and how decisions will be made. Will there be a chair? If so, what are the chair’s responsibilities and rights? Will specialized committees or work teams be needed for certain tasks? Will these subgroups have an advisory or decision-making role? 
  • Clarify how decisions will be made. Will all members of the team have an equal voice? Will decisions be made by consensus? By voting? When and how will outside voices be considered in decisions? 
  • Establish ground rules for participation. Although ground rules are often used in the context of a meeting, they can also be used throughout a project to keep meetings moving, relationships positive, and purposes clear. 
  • Specify needed and available resources, including time, money, personnel for data collection and analysis, and sources of technical assistance. The team, and the community, must have reasonable expectations about the time frame, content, and costs of the assessment. 
  • Not all resources must come from the health agency. Although the agency might have initiated the project, this is a collaborative effort designed to draw on the strengths and resources of community partners.

Guidelines for Participation

  • Participate actively! 
  • Honor time limits. 
  • Listen to, consider, and respect the experiences and opinions of others; focus discussion on content and not the individual. 
  • Keep comments brief and on-topic. 
  • Remember that everyone’s opinion is legitimate. 
  • Support positive confrontation; encourage each other to explore issues more deeply. 
  • Give voice to differences; do not be afraid to say things that you anticipate will be controversial. Acknowledging and explaining differences promotes understanding. 
  • Be clear on fact versus opinion. 
  • Do not be afraid to express your view up front. 
  • Try to contribute things that work toward the goal. 
  • Do not quote others. 
  • Give each other the freedom to explore ideas with trust.
  • Become an observer of self. 

Questions to consider

What protocol must be put in place before convening the CEHA team? Describe the importance of diversity in the CEHA team makeup. Why is it important to set ground rules from the beginning of the process?