Running Head: COMMUNITY ASSESSMENT

North Sound Accountable Community of Health Community Assessment

James Skar and Lindsey Helms
Western Washington University

COMMUNITY ASSESSMENT

North Sound Accountable Community of Health Community Assessment

The following paper reflects the experience of two Western Washington University
nursing students and their collaborative efforts to improve the North Sound Accountable
Community of Healths (NSACH) community health assessment of the north sound region. This
paper provides a summary of assessment data and analysis of the work the NSACH has
accomplished to date. The paper also provides suggested interventions at the systems,
organizational, and individual levels, as well as identifying one deliverable intervention that will
be implemented by the Whatcom Alliance for Health Advancement (WAHA).
North Sound Accountable Community of Health
The NSACH is a policy project that WAHA is helping to coordinate. WAHA is a
community based organization funded by a state grant and private donors with a triple aim to
transform the current healthcare system into one that improves health, reduces costs, and
improves the experience of care (WAHA, 2012). The NSACH encompasses San Juan, Island,
Skagit, Whatcom, and Snohomish Counties and has similar goals as WAHA, which are to
transform the healthcare system into one that improves health, improves the experience of care,
increases access, and lowers costs for residents in the North Sound Region. The NSACH will
achieve this by focusing on community health as well as promoting the integration of physical,
behavioral, and public health systems (WAHA, 2012).
Assessment Data Summary and Analysis
The NSACH began reviewing data that represented the top health priorities across the
five counties in the spring of 2014 (NSACH, 2015). A variety of data was reviewed including
community health assessments (CHAs), interviews with members of the Organizing Committee,
community listening sessions, qualitative interviews with health leaders in the community, a

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survey of NSACH community members, and community health needs assessments (CHNAs).
While there was a wide variation in themes across the five counties, many similarities arose.
From the data that was gathered, the governing board of the NSACH identified the top six
priorities as behavioral health integration and access, care coordination, prevention, housing,
dental and primary care access, and addressing health disparities (NSACH, 2015).
As could be expected, there are obvious gaps in the data. These gaps are due to a number
of issues such as the methods of data collection, the demographics of people who responded to
surveys and engaged in listening sessions, and because of the nature of the governing board of
the NSACH. In Accountable Community of Health Readiness Proposal (2015), some gaps in the
data are identified and suggestions to remedy those gaps are introduced. The Regional Health
Needs Inventory (RHNI) workgroup was tasked to fill in gaps in the data for the north sound
region. Many of the gaps were identified in relationship to health disparities such as refugee
communities, aging populations, ethnic communities, individuals with HIV/AIDs, tribal
populations, low-income individuals, and lesbian, gay, transgender, bisexual, and queer
(LGTBQ) communities. Although gaps in the data have been identified, the ability to gather
accurate data on these marginalized populations is inadequate, and there is a need for an
improved gaps analysis. In an effort to achieve this, the NSACH conducted 21 qualitative
interviews with leaders in the five communities who primarily work with groups of individuals
that experience the most health disparities. The data gathered through this effort was congruent
in highlighting behavioral health and health disparities as top priorities, but also indicated
substance abuse as top priority (NSACH, 2015). Specifically from the perspective of
marginalized populations with little access to resources, substance abuse is an epidemic that is
not only costing many people their lives, but costing communities an exorbitant amount

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resources. It is surprising that substance abuse did not make the list of priorities chosen by the
governing board of the NSACH.
Interestingly, the governing board of the NSACH is composed of a variety of
stakeholders in the region (NSACH, 2015). The board includes business men and women
working for health plans; high level administrators and directors at area hospitals and clinics;
professionals working for county health departments and social services; first responders; tribal
representatives; and those working in specialty sectors such as Planned Parenthood. Although
there is representation of those working with disenfranchised and marginalized populations on
the governing board, there is not a strong representation of marginalized people themselves. The
majority of community members serving on the governing board of the NSACH are affiliated
with financial entities that are directly impacted by the policies and proposed changes of the
NSACH. However, there is little representation of minority populations on the board, except for
the Native American tribal populations.
As was previously mentioned, the RHNI workgroup did identify current gaps in the
initial data. There is currently a plan to continue to focus on gathering data that will fill in the
current gaps (NSACH, 2015). The recommendations that follow are proposals for the governing
board of the NSACH to gather data that is representative of the populations in the region that
have been initially missed.
Systems Level Interventions
An intervention to be implemented at the systems level could focus on conducting a
better gaps analysis to reach populations that have been historically missed during data
gathering. Data gathering methods used in the county CHAs did not adequately reflect the
diverse populations in the regions. There is a disconnect in the data when it is not representative

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of an adequate cross section of the community, and when community leaders report on the health
needs of the populations they represent. Representatives from NSACH need to immerse
themselves in the communities they serve and gather data that accurately represents the
population from the populations themselves. These measures will require more resources be
allotted for data collection, but are ultimately necessary to ensure that the NSACH is working
towards its goal of acheiving the triple aim. Methods for improving data collection include
making surveys more accessible to individuals without internet access, creating trusting
relationships with marginalized populations in the community, and spending time talking with
actual community members suffering from the greatest disparities. This is an example of primary
prevention as the goal is to engage marginalized populations in health promotion and disease
prevention through policy work.
Community Level Interventions
One intervention that could be implemented at the community level is to diversify the
governing board of the NSACH to include more members of the community who are
representative of those populations experiencing the greatest health disparities. One way to
gather better data is to have access to the people whose voices are not being heard. By including
community members that are minority populations suffering from the most health disparities, the
NSACH would be able to gain helpful insight on how to more effectively gather data, and how to
implement interventions that would best reach these populations. This is an example of both
primary prevention and secondary prevention as there are multiple goals in reaching
marginalized populations. One goal is to prevent the health disparities from happening to begin
with, while the other is intervening so these populations are able to receive the treatment they
deserve.

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Family/Individual Level Interventions

An intervention at the family or individual level could be to engage providers that work
with marginalized populations to gather data about what these populations perceive to be their
biggest health challenges. For example, in an effort to fill in the gaps in data, providers on the
NSACH governing board could initiate surveys within their own facilities with their current
clients. It is likely that more individuals would respond to these surveys in a setting where they
feel safe and have established a relationship with the staff. Data collection could also benefit
from this if participants had access to translation services available at the time of service. As
opposed to interviewing the leaders in the health community, the board of the NSACH could
focus on interviewing actual community members in the community where they seek services.
This is also an example of primary prevention as it is focused on data collection to promote
health among marginalized populations.
Deliverable
In an effort to address the many quality gaps in healthcare, the NSACH could develop a
better strategy to conduct a gaps analysis. In a recent report by the Agency for Healthcare
Research and Quality (AHRQ) it was noted that more than 60 percent of health related
disparities have either not improved or worsened for Blacks, Hispanics, Asians, and poor
populations (Umbdenstock & Lofton, 2011). It is evident that the NSACH is making an effort to
reach marginalized populations and adress the gaps in data. Below are specific recommendations
for collecting data that is more representative of the diverse north sound region:
Diversify the governing board of the NSACH to include more community members
representing marginalized populations

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Expand community surveys to areas of community where they can be easily accessed by
minority populations
Invest time and energy in creating trusting relationships within the community to
encourage participation in health planning from marginalized populations
Create listening sessions specifically for minority groups in areas that are comfortable
and convenient, at times that are accessible
Overall, the NSACH is making great strides to address the priority health needs of the
north sound region. This organization is on the forefront of change taking place in the way
healthcare is delivered in the United States. Although progressive in their ideas and goals, the
NSACH still has to address the health disparities that have negatively influenced many
populations for centuries. While the NSACH recognizes that there are gaps in the data, and are
working to improve the data collection process, they must also be willing to deviate from the
current norm.

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8
References

North Sound Accountable Community of Health (2015). Accountable community of health

readiness proposal. Retrieved from http://whatcomalliance.org/policy-2/north-soundaccountable-community-of-health/resources/
Whatcom Alliance for Health Advancement (2012). What we do. Retrieved from
http://whatcomalliance.org/what-we-do/
Umbdenstock, R. & Lofton, K.E. (2011). Eliminating health disparities: Why its essential and
how to get it done. American Hospital Association. Retrieved from
http://www.aha.org/advocacy-issues/disparities/issues-overview.shtml