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Community Assessment Part Two: Data Collection Tool

Subsystems (Policy and Government, Education, Health and Social Services, Communication, and Recreation)


Community: _______________________________________________________________

At-risk population:_____________________________________________________________

Instructions: Use this tool to document your assessment findings. Include a succinct synopsis in paragraph form for each of the assessment categories below. Remember to provide adequate depth and breadth for each subsystem of the assessment. Be sure to cite the sources to support your findings, and include your reference list.



Health and Social Systems Subsystem

(2 points each)
Must Provide:
· Health facilities
· Providers
· Clinics/ Dialysis care
· Public health services
· Home-care
· Hospice /Palliative
· Long-term care
· Social services
· Counseling services
· Medicaid services

Education Subsystem

Must Provide:
· Educational level
· Literacy level of community members
· Educational sources:

· Children
· Adult
· Daycare
· Library

Politics and Government Subsystem

Must Provide:
· Local governmental leadership
· Politically active organizations present within the community
· Governmental facilities in the community (i.e., court house, jail, prison)
· Democrats and republicans voting statistics from last election.

Communication Subsystem

Must Provide:
· Formal communication
· Informal communication
· Cell phone towers
· Weather sirens

Recreation Subsystem

Must include:
· Recreation facilities
· Entertainment opportunities

Assessment of Selected At-Risk Population

And At-risk population field work.

Must include:
· Unique health needs faced by your at-risk as noted in national statistics and in scholarly sources.

· Health needs faced by your at-risk population as seen in your community, through your personal/professional observations, experiences and information gleaned from the field work with your chosen at- risk population on health issues is noted.

Key Informant Interview

Must be with a person working with the public. Preferably an expert in their field.

· What is your role in the community?
· How long have your worked in this community?
· Based on your area of expertise, what issues are a concern in the community?
· How is this specific at-risk population in this community struggling right now?
· What do you feel the strengths and weaknesses of your community are related to this at-risk population?


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