ISSN: 2249-7196 IJMRR/ July 2014/ Volume 4/Issue 7/Article No-5/741-745 Dr. Nirmal Singh/ International Journal of Management Research & Review HEALTHCARE TOURISM: AN EMERGING CONCEPT Dr. Nirmal Singh*1 1 Department of Tourism & Hotel Management, Kurukshetra University, Kurukshetra, India. ABSTRACT The concept of travelling for medical care is now referred to as healthcare tourism, medical tourism or medical travel. Medical tourism or health tourism is new and researchable concepts for academicians and tourism industry in India as well. In the near future, travelling for healthcare needs may become more important rather than the exception with more consumers choosing options outside their immediate locale. Healthcare tourism is becoming a new and emerging international business which is gradually growing and gaining importance in the form of new tourism product. This paper has a focus on healthcare tourism as an alternate form of tourism, and has clear advantages over mass tourism almost without any adverse impact with comparison to other forms of tourism. Keywords: Health, care, India, emerging, comparison. INTRODUCTION Tourism has been proved as the driving force for the economy of the many countries in the world. The contribution of tourism can be seen in poverty eradication and conservation as well. Presently tourism is most important sector and major source of foreign exchange earning in Thailand, Australia, Newzealand, Singapore and Nepal. It is ranked second in Hong Kong, Malaysia, and Philippines and ranked 3rd in Singapore and Indonesia. The rapid growth of tourism industry has been attributed to a number of factors including strong economic growth; increase in disposable income leisure time, easing of travel instruction, successful tourism promotion and recognition by the host governments that tourism is powerful engine of growth. Besides all above discussed reasons tourism also affected negatively with positive as well. Among major negative impacts of tourism such as cultural impacts environmental impacts, tempering of archaeological sites , child prostitution etc. have compelled the policy maker researcher and tourism professional to think about health or medical tourism with other emerging concepts such as eco-tourism, rural-tourism, wildlifetourism, Agri-tourism as an alternate form of tourism with minimum negative impacts. Now the question arises that what is this health or medical tourism or what does it mean. Health tourism means to travel to other countries because of high cure, specialized treatment and low cost. According to Mckinsey (may 2008) medical tourism is defined as traveling explicitly for medical treatment in a foreign country. These patents typically seek higher quality medical services of an inpatient and outpatient nature in a hospital setting. Because of this group seek prompt service for their medical condition, searching for a lower cost procedure is not a priority. Mckinsey defined this group of medical travelers as individuals *Corresponding Author www.ijmrr.com 741 Dr. Nirmal Singh/ International Journal of Management Research & Review who demand the most-advanced technology, especially when those services are not available in the patient are who country. For travelers who travel overseas for medical purposes, conceptually they would meet the definition of a tourist. Since medical tourist are traveler whose main motivation for travel is for a specific purpose, medical tourist can be categorized as a group of special interest tourist (SIT), hence participating in a form of special interest tourism (Douglas, Douglas and Derrett, 2001) illustrates the components of medical and health tourism. Table 1: The Service Spectrum offered in India The Service Spectrum Wellness Alternative Cosmetic Advanced and tourism system of surgery life caring medicine healthcare Spas, stress Ayurvedics, Dental care, Organ Services relief, siddha, plastic surgery, transplants, offered rejuvenation treatment for breast cardio vascular centers disease like enhancement, surgery, eye arthritis and tummy treatment, hit rheumatism reduction, skin replacement treatment Source : (Sheenu Jain 2007) A) Treatment of illness: - The “treatment of illness” generally includes medical check-ups, health screenings, dental treatment, neurosurgery, transplants and other procedure that require qualified medical intervention ( C. Lee & M. Spisto 2007). For example chronic diseases which are not curable in developing countries and the patents of these disease look towards the advanced countries like USA, UK, and other European countries. But the facilities in above advanced countries are availed only by the patents of higher income group rather than low income group. B) Enhancement procedure :- these type of procedures are carried out mainly for aesthetic purposes some of these procedures require qualified medical personal but much of this nondisease related (unless disfigurement is caused by disease). The procedure included all cosmetic surgeries, breast surgery, facelifts, liposuction, and cosmetic dental work (C. Lee & M. Spisto 2007). India has immense potential for enhancement procedure facilities for example bollywood is situated in India and the film professional especially actors, actresses require this type of medical facilities because they have to present their selves before public as young. C) Wellness: The wellness segment of medical and health care tourism promotes healthier lifestyles (Bennett, King and Milner, 2004). Nowadays, spa-wellness services are quite common. Professionals apply thermal water and some aromatic cure treatment in order to reduce the pain and suffering to the patent. D) Reproduction related treatment: It is also an increasing and growing area of medical tourism travel under this component there are patents who seek fertility-related treatments such as in vitro and in vivo fertilization and other similar procedures (C. Lee & M. Spisto 2007). Copyright © 2012 Published by IJMRR. All rights reserved 742 Dr. Nirmal Singh/ International Journal of Management Research & Review E) Birth-tourism: Birth-tourism is also included in category of special interest tourism (SIT) like medical tourism (TRAM 2006) this category involves a pregnant mother who travels to another country to give birth to her baby in order to utilize the services which are often free. In addition a further advantage for her is to have her child gain citizen ship of the new country and thus be able to reside permanently in the new location. At times, potential parents travel for the purposes of adopting children because the legislation and supply of babies for adoption is easier in the host countries. F) Low-cost treatment: this group of patents looks towards the countries where healthcare centers are of hi-tech, and qualified and specialized medical experts with low-cost air traveling and approachability. For example neighboring countries patents of India are the potential market for Indian medical industry. Because India is within reach from the view of point of air travel and low-cost treatment. Table 2: Comparative costs for different ailments in India Treatment Approximate Cost in India Open Heart Surgery Cranio-Facial Surgery And Skull Base Neuro-Surgery With Hypothermia Complex Spine Surgery With Implants Simple Spine Surgery Simple Brain Tumor Biopsy Surgery 4,500 4,300 Cost in other Major Healthcare Destination (S)* >18,000 >13,000 9-11 6-8 6,500 >21,000 12-14 4,300 >13,000 9-11 2,100 >6,500 9-11 1,000 4,300 >4,300 >10,000 6-8 >6,500 >26,000 9-11 Parkinson’s Lesion DBS 2,100 17,000 Source : (Sheenu Jain 2007) Approximate Waiting periods in USA/UK (in months) MEDICAL TOURISM TRENDS During the last decade, the medical travel movement has accelerated sharply. More than 130 countries around the world are competing for a pie of this global business medical tourism became more important due to increasing attention on importance of health, Singapore, The Philippines, UAE and India pay a lot of efforts to increase the revenue on health tourism. For example, Singapore is planning to host one million patents and earn $ 1.8 billion in near future. Dubai has founded a “treatment city” for Asian patents (health tourism sector report, 2011). It is generally estimated that the present global medical tourism is to be approximately US $ 40 billion with an annual growth rate of 20%. Nigerian citizens spend about $ 2 billion Copyright © 2012 Published by IJMRR. All rights reserved 743 Dr. Nirmal Singh/ International Journal of Management Research & Review per year to get medical treatment outside the country. Japan is sending its employees abroad for even the most miner health problem and leads elderly people to nursing homes abroad. India holds competitive advantages in healthcare tourism – be it the low-cost advantage, availability of healthcare professionals, reputation for treatment in advanced healthcare segments such as cardio-vascular surgery, organ transplants, and eye surgery, increasing popularity of India’s traditional wellness systems, and strengths in information technology. Further, the International Passenger Survey – 2003 has estimated that about 2 million nonresident Indians visiting India every year, of which about 10% come with healthcare objective. This works out to about 200,000 NRI patients visiting India to undergo various treatments. All these put together, the visitors to India with healthcare objective could be estimated at around 300,000 patients. In addition, there are a large number of international visitors, including non-resident Indians, who come for other purposes, but use wellness systems, such as Ayurveda / Yoga or Spiritual Healing. Even if we assume that only 5% of foreign travelers undertake such wellness systems in India, the estimated number of travelers under this category would be 200,000. Thus, it may be quantified that the healthcare visitors to India would easily be in the range of around 500,000. We may assume that 10% of the general foreign visitors may use wellness systems during their travel to India, and spend about 20% of their total expenditure on healthcare; the total spending on healthcare by these travelers works out to approximately US $ 150 million. Putting together, the healthcare tourism industry in India generated revenue of over US $ 600 million (or about Rs 2400 crores) in 2006. It may be mentioned that the given estimate is considering healthcare in its broader perspective. SUMMARY • To get rid from the waiting list for the patent’s of chronic diseases such as cancer and heart diseases. • To avail the facilities from the qualified medical specialists within limited period, the hitech laboratories, • The low-cost of treatment. • And requirement of different environments for disabled and elder patients. • The availability of the facilities within reach are the factor that plays an important role in development of health tourism. CONCLUSION The disposable income is increasing with life quality of the people is also increasing and the cost of healthcare services is also growing up, people tended to some countries in order to get better quality and relatively cheap services. Proportional increase in the elderly population has been one of the factors that increase health tourism as well. In health tourism, the cures and medical treatment expenses diminishes more than fifty percent when compare to patent’s home country. The most efficient factor about development of health care tourism which is the branch of tourism filed are lowering the expenses, Improvement in medical technologies, low transportation costs and online marketing. Copyright © 2012 Published by IJMRR. All rights reserved 744 Dr. Nirmal Singh/ International Journal of Management Research & Review REFERENCES Bennett M, King B, Milner L. The health resort sector in Australia: A positioning study. Journal of Vacation Marketing 2004; 10(2): 122-137. Cahill A. Access to healthcare abroad. Irish Examiner.com. 2011. Cohen E. Medical tourism- A critical evaluation. Tourism Recreation Research 2010; 35(3): 225-238. Connell J. Medical tourism: Sea, sun, sun and …surgery. Tourism Management 2006; 27: 1093-1100. Lee C, Michael S. Medical tourism, the future of health services. International Tourism And Hospitality Research 2007; 1. Cockrell N. Spas and health resources in Europe. Travel and Tourism Analyst, 1, The Economist Intelligence Unit Limited. 1996. Department of Tourism. Incredible India: The Global Healthcare Destination. New Delhi: Department of Tourism, Government of India. 2006. Douglas N, Douglas N, Derrett R. Special Interest Tourism, Wiley, Australia. 2001. Garcia-Altes M. The development of health tourism services. Annals of Tourism Research 2005; 32(1): 22-266. George BP. Medical Tourism an Analysis with special Reference to India. Journal of Hospitality Application and Research (JOHAR) Goodrich JN, Goodrich GE. Health Care Tourism. In Managing Tourism, Medlik, S., ed. New York: Butterworth Heinman. 1990. Healthcare Management. Medical tourism: Opportunities and challenges for India. Express Healthcare Management 16-31 March 2005. www.expresshealthcaremgmt.com Health Tourism Sector Report. West Mediterranean Development Agency. 2011. Henderson JC. Healthcare tourism in Southeast Asia. Tourism Review International 2004; 7: 111-121. Medical tourism. Medical Tourism India: Medical Packages to India. Medical Tourism News and Reviews. 2005. www.indiamedicaltourusm.net Medical tourism. What is medical tourism? 2005. www.medicaltourism.ca Prakash M, Tyagi N, Devrath R. A study of problems and challenges faced by medical tourists visiting India. A study by IITTM Gwalior, 2011. Teh I, Chu C. Supplementing Growth with Medical Tourism. APBN 2005; 9(8): 306-311. TRAM. Medical tourism: a global analysis. A report by Tourism Research and Marketing (TRAM), ATLAS, 2006. Copyright © 2012 Published by IJMRR. All rights reserved 745 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Practice note Implementing Best Practices for Needs Assessment and Strategic Planning Systems: Social Work and Faith Based Organization Collaboration— A Case Study Nicholas Placido & David Cecil Needs assessment is a critical component of strategic planning and a powerful way for social workers to integrate their faith and practice by collaborating with faith-based organizations (FBOs). FBOs, including churches, provide critical human services and benefit from systematic needs assessment and evaluation processes (LaPiana, 2008), just like their secular counterparts. This article describes how social workers conducted a needs assessment with a local congregation utilizing proven methods (Dudley, 2014; Posavac & Carey, 1997; Witkin & Altschund, 1995) that can be generalized throughout the profession and faith-based organizations. This article includes a description of data collection, management, and analysis. Collaboration is defined as an approach that individualizes churches as FBOs, recognizing their expertise and the importance of wide buy-in from stakeholders. The eight-step process is an elaboration on the Multimethod Church-Based Assessment Process (MCAP) that includes consulting to generate specific questions (Steps 1-4), collecting information (Steps 5-7), and providing feedback (Step 8) (Dominguez & McMinn, 2003) (See Appendix A). The specific steps are 1) qualitative data analysis by church staff; 2) social worker collaboration to perform thematic analysis; 3) survey construction based on themes; 4) survey pilot; 5) data collection; 6) data management; 7) data analysis; 8) data reporting/recommendation (Dudley, 2014; Social Work & Christianity, Vol. 41, No. 1 (2014), 79–94 Journal of the North American Association of Christians in Social Work Social Work & Christianity 80 LaPiana, 2008; Posavac & Carey, 1997; Rubin & Babbie, 2005; United Way of America, 1996; Witkin & Altschuld, 1995). This article describes how this plan can be replicated as well as providing examples of results from the needs assessment. A full case study of this needs assessment is in NACSW Conference Proceedings (Placido & Cecil, 2012). But when you ask, you must believe and not doubt, because the one who doubts is like a wave of the sea, blown and tossed by the wind. That person should not expect to receive anything from the Lord. 8 Such a person is double-minded and unstable in all they do. (James 1: 6-8, NIV) F aith-based organizations (fbos) that provide human services must fearlessly ask the important questions about what it is doing and where it is going. FBOs, including churches, are currently providing important community and human services and can avoid double-mindedness by performing needs assessment, a critical part of strategic planning. Social workers, with our emphasis on relationship, strengths perspective, and problem solving, are optimally positioned to assist these FBOs in performing needs assessments in the context of relational and strengths perspectives. This also provides an opportunity for social workers to integrate faith and practice. This integration channels the value-laden relational aspect of both Christian faith and social work (Northrop & Perry, 1985; Langer, 2003) into best practice approaches to needs assessment (Dudley, 2014; LaPiana, 2008; Posavac & Carey, 1997; Rubin & Babbie, 2005; United Way of America, 1996; Witkin & Altschuld, 1995). When done well, needs assessments of this kind can serve to validate and deepen the FBO identity and values, as well as carefully set the stage for growth and change. Literature Review FBOs as Powerful Sources of Human Services FBOs are powerful sources of human services because they mobilize volunteers and provide resources such as funding and facilities to the community. They are often trusted and engaged members of the community with established relationships. Thus, they are able to meet human service needs and become vital referral sources. The Lawndale Christian Health Center is an outreach of the Lawndale Community Church located in an underserved community of Chicago. It provides medical, mental health, and other related social work services to people with limited means and options (Serrano, 2003). Holland (2010) notes the work of The Riverside Social Work and Faith Based Organization Collaboration Church in New York City whose Social Service Ministry provides assistance to those in need, a food pantry, a barber training program, clothing distribution, homeless shelter, and HIV testing and support. The Salvation Army is a highly noted FBO that provides care and support to the needy and those facing difficulties in multiple countries (Whalen, 1992). History affirms that with careful planning, FBOs serve as powerful sources of community service that avoid stagnation and isolation. As James 2:17 (ESV) states, “Faith without works is dead.” Additionally, Holt (1922) reminds us that “religious experience cannot be held in a compartment by itself… A vigorous Christianity has always projected its great ideas about God, salvation, and human duty into the ordinary relationships of human living” (p. 5). “Almost all modern social services can be traced back to roots in religious organizations” (Garland, 1992, p. 1). Examples of these efforts include: • The Methodist Settlement Movement in the mid-1800s “staffed outreach programs to the most marginalized inhabitants of the inner cities” (Kreutziger, 2008, p. 81). • In the early 1900s, the Baptist Training School Settlement in Louisville provided aid to the immigrant communities (Scales & Kelly, 2012). • Phoebe Palmer, a holiness evangelist, founded the Five Points Mission in New York City in 1850 (Garland, 1992). Needs Assessment Critical to Strategic Planning Needs assessments are critical to planning, but must be anchored first in the organization’s identity; this includes their mission and vision. Leaders should look “for ways to understand how an organization is perceived to ensure positive impressions formation and transmission” (Aust, 2004, p. 515). It is the mission that points toward needed improvements. This is a comforting concept for many facing the hard work of needs assessments and evaluations of many kinds. Change requires motivation and can often create the perception that traditionally favored methods are facing abandonment. Conditions for excellent planning emerge when a needs assessment begins with validation for current successes and strengths, as well as an emphasis on collaboration and consensus building, while also conveying a strong sense of confidence in the available tools. The social worker finds helpful tools and understanding in areas of basic research, outcome measurement, organizational change and motivation, as well as needs assessment. Needs assessment enables human service organizations, such as FBOs, to strategically grow and change and avoid pitfalls that lead to apathy and attrition (Posavac & Carey, 1997). A high quality needs assessment includes a process (Witkins & Altshuld, 1995) that systematically reflects priorities of stakeholders (Dudley, 2014), includes 81 82 Social Work & Christianity the best data collection and analysis methods possible (Rubin & Babbie, 2005), clearly specifies and quantifies services (United Way of America, 1996), and accounts for the complex nature of motivation and needs (e.g., actual vs. perceived) (Posavac & Carey, 1997). Note that several of these sources are not specifically from needs assessment literature. For example, the United Way of America’s (1996) logic model is an excellent tool for an FBO to specify and quantify its identity and update plans for change. Once organizational identity is established and affirmed, the FBO can turn its attention to more efficiently and effectively serving its congregants and community. This orientation leads to enhanced capacity to meet community needs. Hair and Walsh-Bowers (1992) describe ideal change and growth characteristics, such as shared leadership, flexibility, openness to change, and responsiveness to needs. They state that FBOs “can promote the aims of the community mental health by developing resources to meet their needs” (Hair & Walsh-Bowers, 1992, p. 289). Social Work Collaboration with FBOs Spressart (1992) states, “Social change in America has been spurred on by organized religion” (p. 106). While it is important to remember that the culture and mission of FBOs are unique, FBO involvement in social service is consistent with current social work practice and past social service endeavors. This mutual focus of social work and FBOs provides an ongoing opportunity to develop processes that will allow them to effectively work together. Social workers can provide assistance with organizational development, program evaluation, and administrative oversight, as well as counseling (Edwards, 2003), consultation, and social action (Watkins, 1992; Ferguson, 1992; Bailey, 1992; Spressart, 1992). Garland and Yancey (2012) maintain that FBOs have “several characteristics that taken together make congregations a unique setting for social work practice” (p. 313). This collaboration occurs in a voluntary setting, values the laity as well as the clergy, and considers the unique religious culture (Garland, 1992). In this spirit of collaboration, the social worker individualizes to FBOs by utilizing varying methods of needs assessment. Some focus on the task environment rather than the internal workings of the agency (Northrop & Perry, 1985). Others emphasize organizational identity (OI). Aust’s (2004) assessment of the United Church of God attempted to determine its “communicated values in order to gain a sense of its OI” (p. 515). Hair & Walsh-Bower (1992) utilize multiple methods such as a nominal group technique (NGT), a structured group interview, and a community forum in their congregational assessment process. The Multimethod Church-based Assessment Process (MCAP) is “a flexible idiographic system that allows each church to craft a customized assessment for its particular needs and strengths.”(Dominguez & McMinn, 2003, p. 334). Its three stages are gen- Social Work and Faith Based Organization Collaboration erating specific questions, collecting information, and providing feedback. The focus is a collaborative process that allows identification of important issues and customizes an assessment to those areas. Method The methodology for this needs assessment builds on a number of proven approaches to needs assessment and evaluation (Dudley, 2014; LaPiana, 2008; Posavac & Carey, 1997; Rubin & Babbie, 2005; United Way of America, 1996; Witkin & Altschuld, 1995). This includes various phases as well as data collection and analysis approaches. The social worker adapted the MCAP Model (Dominguez & McMinn, 2003) to carefully construct a needs assessment methodology in collaboration with church staff. The eight-step process elaborates on the three-stage MCAP in the following way: consulting to generate specific questions (Steps 1-4), collecting information (Steps 5-7), and providing feedback (Step 8) (Dominguez & McMinn, 2003). The specific steps are: 1) 2) 3) 4) 5) 6) 7) 8) qualitative data analysis by church staff; social worker collaboration to perform thematic analysis; survey construction based on themes; survey pilot; data collection; data management; data analysis; and data reporting/recommendation (Dudley, 2014; LaPiana, 2008; Posavac & Carey, 1997; Rubin & Babbie, 2005; United Way of America, 1996; Witkin & Altschuld, 1995). Note that collaboration and individualizing are stressed throughout this process. The social worker carefully explained this process to church staff, including timelines on deliverables. Church Staff Qualitative Data Analysis Before a specific and individualized survey was constructed, the church staff walked through a broader, more qualitative exploration of the areas they needed to explore. At this point, teams were established to meet and formulate questions to bring back to the broader group. After much discussion, a set of open-ended questions was collected to be used as a structured interview guide with church members. They were ordered from more broad to more specific. Members of the staff scheduled interviews with church members to get their impressions on the areas in the structured interview guide. Topics on the interview discussion guide included meaningful events, unmet community needs, necessary changes, things that should never 83 Social Work & Christianity 84 change, most influential aspects of church, and favorite activities outside of church. The social worker built on this work to do deeper qualitative exploration and thematic analysis. Collaboration for Thematic Analysis and Survey Construction Once interview discussion guide data was collected, the social worker collaborated with church staff to identify themes that would serve as the outline for the survey (See Appendix B). Dudley (2014) asserts that measures in needs assessments must capture perceptions and motivation, as well as allow participants to prioritize preferences. There were two steps to the thematic analysis. First, interviewers provided their impressions. Second, interview transcripts were analyzed. Each response was grouped in terms of type and frequency. The top five themes under each question served as options on the survey that members could prioritize. For instance, under the question/theme of community service, the top five themes are collaboration with community agencies, assisting the needy, working with youth, pool resources with other churches, and missions. Each question also includes other as an option, where the participant may write in additional preferences. Participants indicate, in order, their top three preferences on each theme. The survey uses the themes as dependent variables and gender, age, membership status, and university/seminary status as independent variables. To improve internal consistency, the survey was piloted with the church board, which led to minor, non-substantive revisions. Data Collection and Analysis Data were strategically collected at a high attendance event using the survey. This included an announcement of the informed consent nature of the survey. Survey data were entered into a spreadsheet. There is a column for each independent variable (e.g., Gender) and six (6) columns for each dependent variable (e.g., Community Service) question. These six columns are for the six selections (including other) under each question. Each row represents a different participant. Once an independent variable is coded, prioritized data (1, 2, or 3) is entered for each response given. This allows the researcher to derive sums, means, and frequencies. For means, one (1) represents highest priority while three (3) represents lower priority (but still a priority). For frequency, the percentage reflects how often a particular item is in the top three selections. Following is an example of how these results are presented to the church board. Example of Needs Assessment Results Social Work and Faith Based Organization Collaboration The following is an excerpt from actual results provided to the FBO. See Placido and Cecil (2012) for full results. Question 3 asked about perceived community needs that go overlooked. Results are displayed in Table 1. In order of average priority, congregants selected Other, Increased Involvement with Youth in the Community, Greater Involvement with Other Churches, Greater Involvement in Missions, Assisting the Needy, and Increased Involvement with Community Groups/Agencies. Write-ins under Other included: Availability of People to Meet Needs, Community Involvement, Fellowship with Community, and Community Outreach. Greater Involvement with Other Churches and Assisting the Needy were selected with high frequency. Increased Involvement with Youth in the Community and Increased Involvement with Community Groups/Agencies were selected with moderate frequency. Greater Involvement in Missions was noted with low frequency. Other was noted with very low frequency. Note that Greater Involvement with Other Churches and Assisting the Needy were both high priority and high frequency selections. Table 1: Community Needs Preferences Sum Average Frequency Increase involvement with community 51 2.32 22 (48%) Assist the needy 56 2.00 28 (61%) Increase involvement with youth 44 1.83 24 (52%) Collaborate with other FBOs 56 1.87 30 (65%) More involvement in missions 19 1.90 10 (22%) Other 7 1.75 4 (9%) Other included: availability of people to meet needs, community involvement, fellowship with community, and community outreach. Process Observations The implementation of the needs assessment with this FBO had a number of positive outcomes and challenges to navigate; it also raised other dynamics to be aware of in the unique setting of an FBO. This collaborative approach fostered a cooperative spirit which enhanced the involvement of the congregation. A strategic use of hospitality was utilized to enhance involvement. For example, the church sponsored a potluck on the day of the survey administration to enhance participation in the survey. The team-based procedure provided greater investment by the pastoral staff and fostered greater involvement with lay members in instrument development. Because the procedure allowed the use of data previously obtained by the 85 86 Social Work & Christianity lay committee, it assisted in the development of an instrument that had better application to the church’s needs. A number of issues arose in the development process of the procedure. At times, there developed unrealistic expectations as to what the instrument could measure. This required the social worker to aid the staff and board in focusing on those aspects of the project that were measurable and important to the church. The pastoral staff and board needed assistance in better prioritizing the areas of focus to be measured and setting priorities in the application of the findings of the study. Also, they needed to be reminded that the survey was a “snapshot” of the congregation on that one particular Sunday morning. Social work in this context has unique considerations and can be time consuming compared to similar projects in other organizations. Regular meetings with the pastors and the church board are required to keep current with assessment developments. Awareness of the roles of pastoral and lay leadership is helpful in understanding leadership structure and assessment planning. An awareness of the church’s calendar was essential in determining the strategies, implementation and scheduling of the assessment. Most planning occurred in the summer months, while the project was implemented in the fall. It is important to use a model that cooperatively develops an assessment with the church. It requires culture awareness in order to plan and implement the assessment in a way that is meaningful and helpful to the church. Discussion An individualized needs assessment performed by a competent social worker that includes systematic best practices plays a critical role in the success of the FBO (Dudley, 2014; LaPiana, 2008; Posavac & Carey, 1997; United Way of America, 1996; Witkin & Altschuld, 1995). The application of needs assessment procedures to such settings can assist FBOs in understanding their capabilities and facilitating informed planning. McMinn, Aikens, and Lish (2003) propose that advanced competence includes holistic and integrative care that fosters an awareness of spirituality and shared values with the FBO. In this way, this needs assessment is a good example of an ethical integration of the social worker’s faith and practice. This methodology worked well for this needs assessment. Data collection and analysis assisted in capturing the perception and motivation of the participants and enabled the social worker to help FBO personnel prioritize those issues that are important to them. The social worker tailored these methodological approaches around these important characteristics by building a quantitative survey after thorough consultation and analysis of qualitative data. Percentiles and frequency statistics were ideal for this approach. The social worker leaned heavily on theological training and self- Social Work and Faith Based Organization Collaboration awareness to competently develop authentic working relationships (McMinn, Aikens & Lish, 2003; McMinn, Meeks, Canning & Pozzi, 2001). Plante (2005) proposed that training for professionals should “include training in religious diversity” (p. 78). Some maintain that to effectively serve FBOs, “the first step is determining what services are appealing to clergy” (Lish, Fitzsimmons, McMinn, & Root, 2003, p. 297). The development of effective community, shared values, and mutual respect are necessary to form useful alliances with FBOs (McMinn, Ammons, McLaughlin et. al., 2005; McMinn, Runner, Fairchild, Lefter & Suntay, 2005). Some faith traditions may not utilize secular helping professions if they do not include explicit components of Christian faith (Plante, 2008). Collaboration with FBOs must “overcome several barriers that have been erected due to years of tension between the disciplines” (Bland, 2003, p. 299). Barriers include a lack of awareness of important church teachings and issues (Plante, 1999), limited trust of the professionals by the church (Bene, Walsh, McMinn, Dominguez, & Aikens, 2000), financial practices (Edwards, Lim, McMinn, & Dominguez, 1999), and the unidirectional nature of the relationship (McMinn, Chaddock, Edwards, Lim & Campbell, 1998). A needs assessment can be a useful and powerful source of reflection and information for the FBO. Such an assessment can in itself initiate change through the recommendations that are given and the process that is experienced by its members. This FBO initiated a number of change processes resulting from the needs assessment they experienced. Examples of Outcomes This needs assessment prompted and informed a number of change processes for this FBO. Some of these changes had clear consensus and were relatively easy to implement. Others have consensus but will require some time in terms of resources and process. Still others may not be a high priority or lack consensus but are now items on agendas across FBO committees. An example of change with clear consensus and easy implementation included the findings regarding student attendees. The findings of this assessment indicated that a significant portion (40%) of attendees at Sunday services were students. The vast majority (75%) consider themselves as regular attenders rather than visitors. These findings led the church to continue to support the off-campus Wednesday night meetings in order to minster to students in a neutral site. They would also maintain the continued use of graduate students to preach and teach on a periodic basis. The FBO also initiated a new policy that would routinely place one to two students on the church board to advise the church regarding ministries to students. An example of change with clear consensus, but that will take time and a resource to implement is a need for enhanced involvement and communication. Findings indicated a need for improved management, 87 88 Social Work & Christianity enhanced member involvement, and increased communication between various ministries of the church. This data led to a streamlined model of church governance in which the board is the main administrative body for completing tasks. To further simplify, church officers, such as deacons and trustees, temporarily joined the board until member census grows to the point that it is self-sustaining. Finally, there were areas that came up enough to be concerns, but do not reflect consensus that are being reviewed by the board for further exploration. One idea to enhance attendance, participation, and community orientation was to phase in community-oriented children’s programming. It will not be implemented at this time, but illustrates areas for future consideration. Limitations Limitations include a small convenience sample from a single denomination, which did not lend itself to inferential statistical analysis (Rubin & Babbie, 2005). Therefore external validity (generalizability) is limited. Also, social work collaboration with congregations is not widely researched, resulting in few established norms. Internal validity is limited due to the use of a non-standardized instrument, although the survey items were carefully constructed and piloted with the pastoral staff and board (Rubin & Babbie, 2005). This study also does not account for process differences related to denominational values. Some faith traditions emphasize community service more than others. There may be a tendency to under- or over-report concerns based on the relational nature of a smaller group in a rural setting. Anonymous completion of surveys fosters honest responses, but also limits potential follow up studies. Conclusion This needs assessment revealed important needs that emerged due to the use of a research-based plan, accessibility, a flexible and customizable approach, careful data collection, management and analysis, and sensitivity to cultural norms. This study explored and examined both archival and original data collected from this church’s congregation. It included the development of a collaborative needs assessment process. Further research is necessary in order to systematically understand the needs of FBOs as well as the use of needs assessment procedures in church and/or FBO settings. This needs assessment provided an opportunity for further research, such as the development of more formalized needs assessment procedures tailored to FBOs. Although generalizability is a limitation, this needs assessment is a Social Work and Faith Based Organization Collaboration blend of accepted Christian and social work values with best practices for needs assessment and evaluation. The FBO is a collection of faith communities with a common mission. It is important to view FBO groups, such as congregations, as unique “communities of believers” (Bland, 2003, p. 78). This requires an adaptive approach that shows sensitivity and flexibility in assisting such groups. Ongoing theological training for the social worker fosters sensitivity and respectful collaboration (CCPC: McMinn, Meek, Canning, & Pozzi, 2001). Therefore, competence, flexibility, and sensitivity in the context of authentic relationship are the key elements of a successful FBO needs assessment. v References Aust, P. J. (2004). Communicated values as indicators of organization identity: A method for organization assessment and its application in a case study. 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Appendix B: Congregation Survey Instrument 91 Social Work & Christianity 92 Community Church Congregational survey Administered by the MSW program of Asbury University. The findings of this survey may bear important information worthy of consideration of educational dissemination or publication. This aids our profession in more effectively serving similar populations or groups. By completion of this survey I hereby grant the permission to use data collected for educational/publication purposes. I understand that the identity of the church and information obtained from its members will be handled in a private manner. No part of it will be used for anything other than educational/publication purposes. No individuals attending the church will be individually identified. Your involvement is purely on a voluntary basis. You, and/or your leadership team may choose at any time to discontinue their participation in this project. Gender (M / F) Please circle! Age: Please check! Less than 18____ 18-21____ 22-30_____31-40___ 41-50___ 51-65___ Greater than 65____ (Please check one of the following) Member____ Regular Attendee ___ Visitor____ Are you a university/seminary student? (YES/NO) Please circle! Please complete the questions below. Place (1, 2, 3) a number by your top three (3) choices according to your preference (1 – first choice, 2 – second choice, 3 – third choice). You may write in an additional preference if you wish on item F. Please place number by it to indicate your level of preference. Only select three items. 1. What are some of the ministries (i.e.-event, activities) at CMC that have been important to you? ___A. Food related events (Potlucks, Breakfasts) ___B. Special fellowship events (VBS, bible study, special speakers) ___C. Worship Team ___D. Woman’s Ministry ___E. Pastoral Ministry (Preaching, Teaching) ___F. Other ____________________________________________ (write in comment above) 2. What important needs have you seen in CMC church community that Social Work and Faith Based Organization Collaboration seem to go overlooked or unaddressed? ___A. Group meetings (greater opportunity for fellowship) ___B. Effective communication between various ministries of the church ___C. Building improvements ___D. Increased youth programming ___E. Increased Children programming (VBS, Sunday School) ___F. Other ____________________________________________ (write in comment above) 3. What important needs have you seen in the Wilmore community that seem to go overlooked or unaddressed? ___A. Increased involvement with community groups/agencies. ___B. Assisting the needy ___C. Increased involvement with youth in the community ___D. Greater involvement with other churches ___E. Greater involvement in missions ___F. Other____________________________________________ (write in comment above) 4. What would you change about CMC, if you were able to? ___A. Increased member involvement ___B. Increased community involvement ___C. Enhanced mentoring/growth experiences (retreats, special speakers) ___D. Enhanced church programs (children, Sunday school, youth) ___E. Increased connection to missions ___F. Other ___________________________________________ (write in comment above) 5. What are some things about CMC that should NOT be changed? ___A. Accepting, open, friendly place ___B. Fellowship/relational structure (“being a part of a community”) ___C. Music/worship style (Casual, informal) ___D. Connection to pastor (accessible) ___E. Allowing other groups/organizations to use the church ___F. Other_____________________________________________ (write in comment above) 6. What social/spiritual issues/topics do you find to be important? 93 Social Work & Christianity 94 ___A. ___B. ___C. ___D. ___E. ___F. Youth issues (sex, drugs) Spiritual growth/formation Issues for women (communication, personal growth) Marriage Suffering Other ____________________________________________ (write in comment above) Nicholas Placido, Psy.D., LCSW, MSW, Associate Professor of Social Work, Asbury University, One Macklem Drive, Wilmore, KY 40390. Phone: (859) 858-3511, x2390. Email: Nick.placido@asbury.edu. David Cecil, Ph.D., MSW, Associate Professor of Social Work, Asbury University, One Macklem Drive, Wilmore, KY 40390. Phone: (859) 312-8231. Email: David.cecil@asbury.edu Key Words: needs assessment, church collaboration, church social work Copyright of Social Work & Christianity is the property of North American Association of Christians in Social Work and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. 
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