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Community Arts in Healthcare
Program Planning
Adapting Community Health Program Planning Models
to the Arts in Healthcare
JILL SONKE
SHANDS ARTS IN MEDICINE
UF CENTER FOR THE ARTS IN HEALTHCARE
+Arts in Healthcare is a
diverse, multidisciplinary
field dedicated to
transforming the healthcare
experience by connecting
people with the power of the
arts at key moments in their
lives.
This rapidly growing field
integrates the arts, including
literary, performing and
visual arts and design, into a
wide variety of healthcare
and community settings for
therapeutic, educational
and expressive purposes.
Society for the Arts in Healthcare, 2009
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A rich body of
research defines
benefits, including:
• shorter hospital stays
•reduced need for medications
• increased employee retention
• more effective communication of
health information
Findings demonstrate that integration of the arts into
healthcare:
• helps to cultivate a healing environment
• supports the physical, mental, and emotional recovery of patients
• fosters a positive environment for caregivers
Sonke et al., 2009
Rural Communities
Higher rates of mortality are caused by preventable illnesses, including:
• obesity
•heart disease
•diabetes,
•infant and maternal death
•lower respiratory diseases
•suicide
Poor health literacy accounts for a general lack of health-supporting
behaviors and utilization of healthcare (Thomas, 2006; USDA, 2009)
Rural Communities
Significant factors in rural health disparities:
• urban bias in health policy
• poverty
• limited access to healthcare
• rural culture
Social determinants of health, including
rural culture itself, represent 50-60% of the
overall influence on health outcomes in
rural communities (Evans, 2004)
Franklin County, Florida
• One of the state’s largest counties at 545 square miles
• 12,257 residents
• 18% of those individuals living below the poverty level (compared with 12% in
the state)
• Median annual income of $26,756 (compared with $47,804 in the state)
• One hospital within a 60-mile radius with 25 beds (including rehab/swing and
emergency department beds) and an average daily census of 5-6 patients
• One Federally Qualified Health Center (of 285 in the state)
• Strong arts community due to tourism
Sources: Florida Department of Health (2009) and US Census Bureau (2009)
+ A Basic (and insufficient) Program
Planning Sequence
1.Needs Assessment
2.Clarify Goals and Objectives
3.Develop an Intervention
4.Implement the Intervention
5.Evaluate the Results
+ Background Information
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There is no perfect model

Use one or find what fits/adapt elements from various models
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Remember the importance of responding to local populations,
conditions, needs, culture, and resources
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Three F’s of program planning that can help with selecting the
appropriate model

Fluidity - steps are sequential

Flexibility - adapt to needs of stakeholders
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Functionality - useful in improving health outcomes
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Program Planning Models
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PRECEDE-PROCEDE
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MATCH

CDCynergy
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SMART
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MAPP
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APEX-PH
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Healthy Communities (USDHHS)
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The Communication Model (NCI)
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Healthy Plan-IT (CDC)
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Social Marketing
•Social marketing seeks to influence social behaviors not to benefit the
marketer, but to benefit the target audience and the general society
•Used extensively in international health programs, especially for
contraceptives and oral rehydration therapy, and is being used with more
frequency in the United States for topics such as drug abuse, heart disease
and organ donation
•A good fit for Arts in Healthcare given its creative nature
• Weinreich Communications: http://www.social-marketing.com/index.html
Needs Assessment

A systematic process of asking questions, comparing answers, and
making informed decisions about what to do next to improve human or
organizational performance

a systematic process to guide decisions-making

provide justification for decisions before they are made

provide a systemic perspective for decision-makers

allow for interdisciplinary solutions for complex problems

offer a replicable process that can be used over and over again
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Focuses partners on shared understanding of issues and shared goals
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http://www.needsassessment.org/
Needs Assessment
Maslow’s Hierarchy of Needs:
Needs Assessment

Normative Need
The existence of standards or
norms
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Expressed Need
The level of “attempts” that have
been made to meet needs/the
number of people who have
attempted to get help
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Perceived Need
What people think their needs are
or feel their needs to be

Relative Need
The gap between the level of
services available in the
community compared to those in
similar communities or geographic
areas
Types of Needs Assessment

Extrapolating from existing data (normative needs)

Using resource inventories/community maps (normative needs)
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Using service statistics from social services or human services
agencies (expressed need)
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Conducting a social survey (perceived need)
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Holding a public forum (expressed need)
Community Mapping

Identifying and understanding
the “geography” of community
resources in a particular area

Serves as a basis for partner
cultivation
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Inclusive in nature
Sustainability
Sustainability – factors influencing routinization

resource stabilization – identification/commitment of human, financial, and other resources

risk-taking - balance between exploitation of recognized activities and the exploration of
new activities (builds confidence)

Incentives - benefits outweighing costs for those involved in planning and managing

adaptation of activities - the incremental adjustment of activities according to circumstances

objectives fit – the level to which the program’s objectives fit with the values of the
organizations and individuals involved
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transparent communication - helps program planners maintain a focus on a common
purpose, increases trust and resource sharing, and allows members to discuss and resolve
program challenges
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sharing of cultural artifacts - a means through which programs and organizations adapt to
each other and encourage routinization
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integration of rules - the program’s rules are integrated into the rules of the participating
organizations
Pluye et al, 2005
Sustainability – guidelines for external organizations
developing programs
 fund
projects in existing agencies with some capacity to
support them and to provide the expertise needed for
carrying out the many facets of sustainability
 fund
smaller scale projects that have local resources
involved in order to build ownership of the project among
local stakeholders
 identify, work
with, and strengthen local champions to
provide the leadership and knowledge of local
organizations needed to sustain the project over time
 encourage
planning for sustainability early in a project’s
life cycle
Scheirer, 2005
Meaning
According to Viktor Frankl (1959), meaning is:
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•
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a universal human phenomenon that reflects an attitude
or idea that people have about their reality
the primary motivational force in humans
the ultimate goal of human life
Self-transcendence, Frankl
an inherent characteristic of being human that leads to feelings of selfconfidence and the discovery of new purpose and meaning
We self-transcend in three primary ways:

by giving to the world creatively
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by being receptive to the world and others
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by choosing how to face adversity and find meaning
Self-Transcendence – defined…
The expansion of one’s awareness or boundaries:
intrapersonally (sense of wholeness within self),
interpersonally (connectedness to others and the environment)
temporally (connectedness to future and past situations)
transpersonally (connectedness to something greater than the self)
Reed, 2003
Moving beyond the known boundaries of the self to achieve a broader perspective,
which in turn helps one discover or make new meaning.
Coward, 1993
The expansion of one’s conceptual boundaries inward through contemplative or
introspective activities and outward through a heightened concern for the
welfare of others.
Vaughan, 1985
Reed’s Model of Self-transcendence
Appreciative Inquiry Study of Weems Arts in
Medicine Program (Sonke, 2009)
Seven themes emerged in the analysis as primary
categories:

Meaning

opportunities to help others

benefits to others

sense of community

recognition of health benefits

self-transcendence

diversity (the functional coming together of diverse populations)
Summary of Findings (grounded theory):

program stakeholders can have experiences that lead either to selftranscendence or directly to meaning;

through enhanced self-understanding, purpose and insight, selftranscendence leads to meaning;

meaning, with its seven identified facets, leads to sustainability by
producing excitement, commitment, collaboration; and routinization;
and
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enhanced conditions for sustainability lead to continued
involvement in the program.
Thus, if a program can produce meaning, with or without selftranscendence, it has greater potential to be sustained over time.
Sonke, 2009
I value the sense that I am helping people feel
better… The difference that one person can
make in another person’s life… It drives me.
Weems Arts in Medicine Program Participant