community needs assessment training - houston · mh info / crs info / crs r s 1) mark the date of...
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Co
mm
un
ity
Nee
ds
Co
mm
un
ity
Nee
ds
Ass
essm
ent
Tra
inin
gA
sses
smen
t T
rain
ing
Pre
para
tion
for
the
Tri-
Com
mun
ity A
sses
smen
t & In
terv
entio
nF
riday
, Sep
tem
ber
8 an
d S
atur
day,
Sep
tem
ber
9, 2
006
TH
E M
ISS
ION
OF
PU
BLI
C H
EA
LTH
Mis
sio
n o
f P
ub
lic H
ealt
hM
issi
on
of
Pu
blic
Hea
lth
Ful
fill s
ocie
ty's
inte
rest
in
assu
ring
cond
ition
s in
w
hich
peo
ple
can
be
heal
thy
Ho
ust
on
Dep
artm
ent
of
Hea
lth
H
ou
sto
n D
epar
tmen
t o
f H
ealt
h
and
Hu
man
Ser
vice
san
d H
um
an S
ervi
ces
MIS
SIO
N
To
wor
k in
par
tner
ship
with
the
com
mun
ity
to p
rom
ote
and
prot
ect t
he h
ealth
and
so
cial
wel
l-bei
ng o
f Hou
ston
ians
How
do
we
assu
re c
ondi
tions
in w
hich
pe
ople
can
be
heal
thy?
TH
E C
OR
E F
UN
CT
ION
S O
F
PU
BLI
C H
EA
LTH
:
•A
sses
smen
t
•P
olic
y D
evel
opm
ent
•A
ssur
ance
Tri
Tri
-- Com
mun
ityC
omm
unity
Goa
ls o
f the
Tri
Goa
ls o
f the
Tri
-- Com
mun
ity
Com
mun
ity
Nee
ds A
sses
smen
tN
eeds
Ass
essm
ent
�A
sses
s “a
cces
s to
car
e”is
sues
�A
sses
s en
viro
nmen
tal (
air,
wat
er, a
nd la
nd)
issu
es
�C
onne
ct th
e co
mm
unity
to s
ervi
ces
�M
obili
ze th
e C
omm
unity
Com
mun
ity P
rofil
e
•R
esid
entia
lnei
ghbo
rhoo
d lo
cate
don
the
far
east
ern
ridge
of t
he H
oust
on c
ity li
mits
, whi
ch
lies
adja
cent
to th
e P
ort o
f Hou
ston
•3
sect
ions
: Clin
ton
Par
k, F
idel
ity M
anor
and
C
linto
n V
iew
•90
0 ho
mes
; 250
0 fa
mili
es
•It
enco
mpa
sses
2.7
5 sq
uare
mile
s an
d ta
kes
up
a po
rtio
n of
zip
cod
e 77
029
CO
MM
UN
ITY
D
EM
OG
RA
PH
ICS
Rac
e an
d N
atio
nal O
rigin
:M
ost r
esid
ents
are
Afr
ican
-A
mer
ican
. 86
% a
re n
ativ
e H
oust
onia
ns,
72%
wer
e bo
rn in
Tex
as,
5% a
re fo
reig
n bo
rnB
lack
/Afr
ican
A
mer
ican
90%
His
pani
c/La
tino
8%
Oth
er1%
Whi
te/A
nglo
1%
CO
MM
UN
ITY
D
EM
OG
RA
PH
ICS
Edu
catio
n: F
orty
per
cent
of t
he r
esid
ents
age
d 25
and
ab
ove
do n
ot h
ave
a hi
gh s
choo
l dip
lom
a
0%
10
%2
0%
30
%4
0%
less
than
9th
gra
de
9th-
12th
gra
de
Hig
h S
choo
l Dip
lom
a
Som
e C
olle
ge n
o de
gree
Ass
ocia
te D
egre
e
Bac
helo
r's D
egre
e
Gra
duat
e D
egre
e an
d hi
gher
CO
MM
UN
ITY
D
EM
OG
RA
PH
ICS
Age
: O
ne o
ut o
f eve
ry fi
ve r
esid
ents
are
age
d 65
yea
rs
or o
lder
.
Em
ploy
men
t:�
Less
than
hal
f of t
he r
esid
ents
age
d 16
yea
rs a
nd
olde
r ar
e no
t par
t of t
he w
orkf
orce
. �
The
ave
rage
per
Cap
ita In
com
e is
in th
e lo
wes
t 25
perc
entil
e w
hen
rank
ed w
ith o
ther
sup
er
neig
hbor
hood
s
CO
MM
AN
D S
TR
UC
TU
RE
CO
MM
AN
D S
TR
UC
TU
RE
CO
MM
AN
D:
CO
MM
AN
D:
Clin
ton
Par
k E
lem
enta
ry,
Clin
ton
Par
k E
lem
enta
ry,
158
Mis
siss
ippi
158
Mis
siss
ippi
CO
MM
AN
D R
OLE
SC
OM
MA
ND
RO
LES
Inci
dent
Com
man
d: A
lgia
Hic
kenb
otha
m
Pro
ject
Coo
rdin
ator
: Van
essa
Bro
wn
•T
ime
Kee
pers
(4)
•P
-Car
d H
olde
rs (
2)
•D
ata
Ent
ry L
ead
(1)
•D
ata
Ent
ry O
pera
tors
(11
)
CO
MM
AN
D R
OLE
SC
OM
MA
ND
RO
LES
•T
ier
1 C
oord
inat
or
•T
ier
2 C
oord
inat
or –
conn
ectio
n w
ith
com
mun
ity a
genc
ies
•S
ite C
oord
inat
ors
(8)
•Lo
gist
ics
•M
aps
•C
ase
Liai
sons
(will
be
coup
led
with
team
lead
ers)
PO
D S
TR
UC
TU
RE
POD
1PO
D 2
POD
3
CO
MM
AN
D C
EN
TE
R
POD
4
PO
D S
TR
UC
TU
RE
1.(2
) S
ite
Coo
rdin
ator
2.(3
) D
ata
Ent
ry O
pera
tors
3.3
Tea
ms
(bas
ed o
n R
AT
str
uctu
re)
EA
CH
PO
D W
ILL
HA
VE
Tea
m A
TIE
R 1
TIE
R 1
Ass
essm
ent &
Edu
catio
n
4+ p
airs
of
HD
HH
S st
aff
and
com
mun
ity
mem
bers
TIE
R 2
TIE
R 2
Dir
ect A
ss. &
Ed
2 pa
irs
of H
DH
HS
staf
f an
d co
mm
unit
y ag
enci
es
TIE
R 3
TIE
R 3
Em
erge
nt C
are
1 pa
ir o
f H
DH
HS
nurs
ing/
epid
emio
logy
st
aff
Tea
m B
TIE
R 1
TIE
R 1
Ass
essm
ent &
Edu
catio
n
4+pa
irs
of H
DH
HS
staf
f an
d co
mm
unit
y m
embe
rs
TIE
R 2
TIE
R 2
Dir
ect A
ss. &
Ed
2 pa
irs
of H
DH
HS
staf
f an
d co
mm
unit
y ag
enci
es
TIE
R 3
TIE
R 3
Em
erge
nt C
are
1 pa
ir o
f H
DH
HS
nurs
ing/
epid
emio
logy
st
aff
Tea
m C
TIE
R 1
TIE
R 1
Ass
essm
ent &
Edu
catio
n
4+ p
airs
of
HD
HH
S st
aff
and
com
mun
ity
mem
bers
TIE
R 2
TIE
R 2
Dir
ect A
ss. &
Ed
2 pa
irs
of H
DH
HS
staf
f an
d co
mm
unit
y ag
enci
es
TIE
R 3
TIE
R 3
Em
erge
nt C
are
1 pa
ir o
f H
DH
HS
nurs
ing/
epid
emio
logy
st
aff
TIE
R T
RA
ININ
GT
IER
TR
AIN
ING
TIE
R O
NE
Ass
essm
ent &
Edu
catio
nin
eve
ry h
ome
•A
sses
smen
t•
Bas
ic in
form
atio
nal f
lier
(com
mun
ity
reso
urce
s, e
nviro
n. r
isk,
hea
lth e
duca
tion
mes
sage
s)•
Tie
r T
wo
Ref
erra
l For
m if
nec
essa
ry•
Sta
ffing
: HD
HH
S s
taff
and
com
mun
ity
agen
cies
& m
embe
rs
QU
ES
TIO
NN
AIR
E A
ND
Q
UE
ST
ION
NA
IRE
AN
D
FO
RM
SF
OR
MS
HO
US
EH
OLD
ID #
SE
CTI
ON
#R
ES
IDE
NT'
S N
AM
E
HO
US
EH
OLD
AD
DR
ES
SP
HO
NE
#
Con
sent
by
sign
atur
eD
ate
Witn
ess
by s
igna
ture
Dat
e
?Ne
edRe
ferr
alRe
ferr
ed T
oIn
itial
Fol
low
-Up
Ass
ista
nce
Prov
ided
Stat
us
XPr
ogra
m/A
genc
yD
ate/
Nam
e of
Sta
ffLo
catio
n / T
ype
Ope
n / C
ompl
4M
edic
al H
ome
6M
edic
al S
uppo
rtsE
quip
men
tP
resc
riptio
ns
26E
nviro
nmen
tal
Air
/ W
ater
Land
/ L
ead
26C
ouns
elin
g/M
H
26C
hild
Car
e/A
fter S
choo
l
26Fa
mily
Rec
reat
ion
26B
asic
Nee
dsFo
od /
Clo
thin
gH
ousi
ng /
Util
ity
26N
utrit
ion
Info
rmat
ion
26E
duc
/ Job
Tra
inin
g
I, __
____
____
____
____
____
____
____
___
WO
ULD
LIK
E M
OR
E IN
FOR
MA
TIO
N O
R A
SS
ISTA
NC
E W
ITH
TH
E
FOLL
OW
ING
SU
PP
OR
TS A
ND
GIV
E P
ER
MIS
SIO
N F
OR
TH
E C
ITY
OF
HO
US
TON
DE
PA
RTM
EN
T O
F H
EA
LTH
&
HU
MA
N S
ER
VIC
ES
AN
D/O
R IT
S A
GE
NTS
TO
CO
NTA
CT
ME
RE
GA
RD
ING
TH
E F
OLL
OW
ING
:
LIA
ISO
N
AS
SE
SS
ME
NT
DA
TE:
9/8
9/9
CO
MM
UN
ITY
ASSE
SSM
ENT
& IN
TER
VEN
TIO
N
TIE
R 2
RE
FER
RAL
& R
ESPO
NSE
FO
RM
R-Grp Eligibility Environ. MH Info / CRS Info / CRS RS
1) M
ark
the
date
of
refe
rral
by
circ
ling
2) F
ill in
ID
&
Sect
ion
And
Add
ress
3) P
ut N
ame
of p
erso
n as
king
for
ass
ista
nce
And
Pho
ne #
TIE
R 1
: I
f ye
s to
Que
stio
n #
27 C
ompl
ete
Ref
erra
l For
m
4) R
evie
w A
sses
smen
t an
d m
ark
an X
by
Nee
ds th
at th
e ho
useh
old
wou
ld li
ke
assi
stan
ce w
ith
5) O
btai
n th
eir
cons
ent w
ith
sign
atur
e. Y
ou w
ill
witn
ess
with
you
r si
gnat
ure.
Giv
e a
copy
to th
e ci
tize
n.
6) T
urn
Ass
essm
ent w
ith
othe
r pa
rts
of R
efer
ral F
orm
to
you
r T
eam
Lea
der.
X
If yo
u ar
e a
Tie
r 2
Tea
m M
embe
r, w
ith
the
appr
opria
tein
form
atio
n, p
rovi
de it
at
that
hou
seho
ld.
TIE
R 2
TIE
R 2
Res
pons
ible
for
deliv
erin
g m
ore
spec
ific
and
in-d
epth
info
rmat
ion
and
need
ed
refe
rral
s to
per
sons
who
req
uest
them
.
TIE
R 2
: Dire
ct A
ssis
tanc
e &
Edu
catio
n
•Trig
gere
d by
ass
essm
ent q
uest
ions
TIE
R 2
�D
oes
your
hou
seho
ld h
ave
a re
gula
r fa
mily
doc
tor
or c
linic
to g
oto
whe
n so
me
is s
ick?
�In
the
past
yea
r ha
s yo
ur h
ouse
hold
had
pro
blem
s ob
tain
ing
need
ed m
edic
al s
ervi
ces?
•In
form
atio
n an
d re
ferr
al
•T
arge
ted
Edu
catio
n ba
sed
on s
elf-
iden
tifie
d ne
ed
•F
ollo
w-u
p by
HD
HH
S s
taff
and
com
mun
ity
agen
cies
•S
taffi
ng: H
DH
HS
sta
ff (C
RS
s, M
edic
al S
ocia
l W
orke
rs, e
tc)
and
com
mun
ity a
genc
ies
Tie
r T
wo
Pro
toco
l
1.T
ier
One
Sur
veyo
rs w
ill g
ive
com
plet
ed a
sses
smen
ts a
nd o
rigin
al
Ref
erra
l For
ms,
alo
ng w
ith o
ne
copy
/dup
licat
e to
thei
r T
eam
Lea
der.
2.T
he T
eam
Lea
der
and
Cas
e Li
aiso
n w
ill r
evie
w a
sses
smen
ts a
nd R
efer
ral
For
m,
sort
, and
ass
ign
as a
ppro
pria
te3.
Ass
igne
d T
ier
2 st
aff w
ill b
e in
dica
ted
in “
Ref
erre
d T
o”co
lum
n on
form
.4.
Ass
igne
d T
ier
2 st
aff (
HH
S p
rogr
am
and/
or a
genc
y pa
rtne
r st
aff)
will
mee
t w
ith id
entif
ied
fam
ily a
nd c
ompl
ete
In-
Hom
e In
take
For
m.
5.A
des
crip
tion
of “
Ass
ista
nce
Pro
vide
d”w
ill b
e co
ded
into
the
syst
em.
It w
ill
note
hom
e, p
hone
or
offic
e co
ntac
t an
d th
e ty
pe o
f sup
port
(in
form
atio
n,
enro
llmen
t, el
igib
ility
scr
een,
etc
.)
6.S
tatu
s w
ill b
e no
ted
as o
pen
or c
lose
d7.
Com
plet
ed fo
rm w
ill b
e gi
ven
to T
eam
Le
ad.
8.C
ompl
eted
Ref
erra
l For
ms
will
be
assi
gned
to
a D
EO
.9.
For
fam
ilies
nee
ding
furt
her
inte
rven
tion,
the
Cas
e Li
aiso
n w
ill r
evie
w n
eed,
link
to
appr
opria
te s
ervi
ce p
rovi
der,
and
pro
vide
fo
llow
-up,
as
appr
opria
te.
10. T
he C
ase
Man
agem
ent C
oord
inat
ion
Tea
m w
ill p
rovi
de o
n-go
ing
revi
ew o
f fo
llow
-up
to a
ny r
efer
rals
mad
e ba
sed
on
the
C A
& I.
Thi
s te
am w
ill e
ngag
e re
pres
enta
tives
from
Med
ical
Cas
e M
anag
emen
t, A
ging
, Pro
ject
Mile
ston
e,
Lead
, Env
ironm
enta
l, T
B, F
IMR
, and
H
IV/S
TD
.
Tie
r T
wo
is s
truc
ture
d to
mee
t the
info
rmat
iona
l nee
ds o
f pe
ople
who
req
uest
mor
e sp
ecifi
c in
form
atio
n or
ref
erra
ls.
HO
US
EH
OLD
ID #
SE
CTI
ON
#R
ES
IDE
NT'
S N
AM
E
HO
US
EH
OLD
AD
DR
ES
SP
HO
NE
#
Con
sent
by
sign
atur
eD
ate
Witn
ess
by s
igna
ture
Dat
e
?Ne
edRe
ferr
alRe
ferr
ed T
oIn
itial
Fol
low
-Up
Ass
ista
nce
Prov
ided
Stat
us
XPr
ogra
m/A
genc
yD
ate/
Nam
e of
Sta
ffLo
catio
n / T
ype
Ope
n / C
ompl
4M
edic
al H
ome
6M
edic
al S
uppo
rtsE
quip
men
tP
resc
riptio
ns
26E
nviro
nmen
tal
Air
/ W
ater
Land
/ L
ead
26C
ouns
elin
g/M
H
26C
hild
Car
e/A
fter S
choo
l
26Fa
mily
Rec
reat
ion
26B
asic
Nee
dsFo
od /
Clo
thin
gH
ousi
ng /
Util
ity
26N
utrit
ion
Info
rmat
ion
26E
duc
/ Job
Tra
inin
g
I, __
____
____
____
____
____
____
____
___
WO
ULD
LIK
E M
OR
E IN
FOR
MA
TIO
N O
R A
SS
ISTA
NC
E W
ITH
TH
E
FOLL
OW
ING
SU
PP
OR
TS A
ND
GIV
E P
ER
MIS
SIO
N F
OR
TH
E C
ITY
OF
HO
US
TON
DE
PA
RTM
EN
T O
F H
EA
LTH
&
HU
MA
N S
ER
VIC
ES
AN
D/O
R IT
S A
GE
NTS
TO
CO
NTA
CT
ME
RE
GA
RD
ING
TH
E F
OLL
OW
ING
:
LIA
ISO
N
AS
SE
SS
ME
NT
DA
TE:
9/8
9/9
CO
MM
UN
ITY
ASSE
SSM
ENT
& IN
TER
VEN
TIO
N
TIE
R 2
RE
FER
RAL
& R
ESPO
NSE
FO
RM
R-Grp Eligibility Environ. MH Info / CRS Info / CRS RS
You
r na
me
has
been
pl
aced
her
e by
the
Cas
e L
iais
onTIE
R 2
: W
hen
you
have
bee
n gi
ven
a R
efer
ral F
orm
1)R
evie
w li
st o
f ne
eds;
pul
l pr
ogra
m/r
esou
rce
info
rmat
ion
as
need
ed f
rom
the
vehi
cle.
2)
Vis
it w
ith f
amil
y.
Prov
ide
need
ed
info
rmat
ion,
su
ppor
t, an
d fu
rthe
r re
ferr
als
as
nece
ssar
y.
3) A
fter
the
visi
t, pl
ace
your
nam
e an
d da
te o
f th
e fo
llow
-up.
6) R
efer
ral F
orm
to y
our
Tea
m
Lea
der
if a
ll ite
ms
are
clos
ed.
If
any
need
s ar
e pe
ndin
g, tu
rn in
R
efer
rals
for
m to
Cas
e L
iais
on
X X X
AA
A
Hou
Cou
ncil
Par
ks D
ept
9906
S. S
avan
nah
9906
S. S
avan
nah
Ho
me
Elig
ibili
ty fo
rm
Ref
erra
l
Info
rmat
ion
Ope
n
Ope
n
Clo
sed
Prog
ram
s or
age
ncie
s m
ay h
ave
been
sp
ecif
ied
by C
ase
Lia
ison
4) L
ist t
he
serv
ice/
supp
ort
prov
ided
and
loca
tion
(i.e
. pho
ne, i
f vi
sit i
s no
t mad
e du
ring
A
sses
smen
t per
iod)
5) N
ote
whe
ther
eac
h ne
ed is
ope
n or
clo
sed
in s
tatu
s co
lum
n.
TIE
R 3
TIE
R 3
•C
linic
al a
ssis
tanc
e an
d re
ferr
als
to h
ome
in th
e ca
se o
f an
emer
genc
y.•
Sep
arat
e tr
aini
ng fo
r cl
inic
al s
taff
will
occ
ur
prio
r to
the
even
t.
ME
TH
OD
S /
GU
IDE
LIN
ES
ME
TH
OD
S /
GU
IDE
LIN
ES
Met
hods
/ G
uide
lines
•T
he T
ri-C
omm
unity
are
a w
ill b
e br
oken
up
into
fo
ur s
ectio
ns. T
hese
sec
tions
will
be
brok
en
dow
n fu
rthe
r in
to b
lock
s. W
ithin
eac
h bl
ock,
one
pa
ir w
ill c
ondu
ct s
urve
ys o
n on
e si
de o
f the
bl
ock,
whi
le a
noth
er p
air
will
con
duct
sur
veys
on
the
oppo
site
sid
e of
the
sam
e bl
ock.
•T
alki
ng P
oint
s–
Sec
tions
–R
oute
s–
PO
Ds
–C
omm
unic
atio
ns
* It
is v
ery
imp
ort
ant
that
eac
h p
air
stay
wit
hin
th
eir
sect
ion
an
d b
lock
ass
ign
men
t to
avo
id d
up
licat
ion
of
surv
eyed
ho
mes
th
at m
ay c
on
sum
e va
luab
leti
me
Sec
tion
1
Sec
tion
1 is
en
clos
ed b
y th
e fo
llow
ing
stre
ets:
Nor
th: T
ite
Sou
th: B
orde
n
Wes
t: S
ol
Eas
t: T
eal
Eac
h pa
ir w
ill
star
t sou
th
and
mov
e no
rth.
Sec
tion
2S
ecti
on
2is
enc
lose
d by
the
follo
win
g st
reet
s:
Nor
th: L
anew
ell
Sou
th: Y
uma
Wes
t: D
ead
end
Eas
t: D
ead
end
Thi
s se
ctio
n w
ill b
e di
vide
d in
to g
roup
s th
at w
ill c
onta
in
four
str
eets
eac
h. P
airs
will
st
art i
n th
e no
rth
on
desi
gnat
ed b
lock
s. B
ecau
se
the
num
ber
of h
ouse
s di
ffer
from
blo
ck to
blo
ck in
this
se
ctio
n, p
airs
com
plet
e th
eir
bloc
k an
d th
en a
ssis
t eac
h ot
her
to c
ompl
ete
this
gro
up
of s
tree
ts. O
nce
the
grou
p of
st
reet
s is
com
plet
e, p
airs
will
pr
ocee
d to
geth
er to
the
next
gr
oup
of s
tree
ts in
that
se
ctio
n.
N S
EW
Exa
mpl
e in
se
ctio
n 2
N S
EW
