community health - Episcopal Health Foundation

Transcription

COMMUNITY HEALTH
Needs and Assets Assessment
Sharpstown | Alief | Gulfton
A Collaboration:
Episcopal Health Foundation with
November 2015
Suggested Citation
Bush-DiDonato, W.T., Barmasse, S.L., Balihe, P., Goetz, M., Lopez, K.K.,
Caldwell, K., Megdal, T., Herrera, B., Bray, P.G.
Episcopal Health Foundation and Legacy Community Health Services.
Community Health Needs and Assets Assessment: Sharpstown, Alief, Gulfton.
Houston, Texas: 2015.
This report is available at www.episcopalhealth.org
under Research
Please direct any comments or questions to:
Episcopal Health Foundation
Research Division
500 Fannin St., Suite 300
Houston, TX 77002
713.225.0900
© 2015 Episcopal Health Foundation and Legacy Community Health
Acknowledgments
Many people who live and work in the Sharpstown, Alief and Gulfton neighborhoods
in southwest Houston contributed to the completion of this report by generously
giving their time, talents and knowledge. Thank you!
Project Leadership
Valerie Ausborn
Philomene Balihe
Sheryl Barmasse
Patricia Gail Bray, PhD
Troy Bush-DiDonato
Katy Caldwell
Jordan Crawford
Margaret (Peggy) Goetz, MD
Baine Herrera
Kimberly Kay Lopez, DrPH
Tina Megdal
Local Investigators and Other Support
Yamilet Adarmes
Rina Chavez
Isora Colmenares
Sonia S. Espinoza
Margarita Marioni
Maria Maldonado
Alma Zuniga
Community Health Needs and Assets Assessment • Sharpstown | Alief | Gulfton • 2015
3
Table of Contents
Executive Summary
4
6
Introduction 15
Methods 18
How We Work in Communities 21
Quantitative Research 24
Qualitative Research 53
Key Informant Interviews
56
Participatory Community Groups
65
Recommendations
82
87
Photovoice
Themes
89
Recommendations
92
Conclusions and Recommendations 93
Appendices 96
COMMUNITY HEALTH
A Collaboration:
November 2015
Executive Summary
Executive Summary
Purpose of Assessment
Legacy Community Health Services is interested in a better
understanding of the needs and resources in the Sharpstown,
Alief and Gulfton (SAG) neighborhoods located in Houston
Texas. Legacy invited the Episcopal Health Foundation to lead
an independent community assessment study that includes
quantitative profiles of these neighborhoods, along with findings
from a qualitative participatory research study and a Photovoice
component. Using a mixed methods approach focused on the
Social Determinants of Health we bring community voices to the table to help understand the socio-cultural
and organizational structures and processes that promote or diminish the health of a defined community.
The goal is to create healthier neighborhoods – together with the community – by building on the
unique resources embedded in the community to help address health and social needs.
Overview of Study Area and Demographics
The SAG communities are located in the southwest section of the City of Houston. In 2000, the City of
Houston recognized all three of these communities as “Super Neighborhoods.” This is a large geographic
area with a correspondingly large population of 170,538 people. According to Super Houston, in 2010,
Sharpstown and Gulfton were two of the top ten most densely populated neighborhoods in Houston. In
2012, the City of Houston had 3,766 people per square mile compared to 4,477 in Alief, 8,072 in Sharpstown
and 13,502 in Gulfton. Sharpstown and Gulfton neighborhoods share more similarities than Alief.
The history of the Gulfton, Sharpstown and Alief neighborhoods closely parallels the historical changes
in Houston during the past 50 years. During the 1970s and 1980s, the migration pattern in Houston began
to change. What had been mostly white, single, American born, English-speaking neighborhoods became
Hispanic, foreign born and Spanish-speaking immigrant family communities, resulting in a rich diversity that
now mirrors Houston, which is one of the most diverse cities in the US.
Seventy percent of the population speak a language other than English. These neighborhoods also have
a higher percentage of Hispanics and Asians than the City of Houston overall. Sharpstown has a larger
percentage of Whites than the other two neighborhoods, whereas Alief has a higher percentage of Blacks.
All three areas have a much lower proportion of Whites than the City of Houston overall.
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The SAG community is predominantly a young community with 60% of the population being age
34 and below. Over one-third of the population 25 years of age or older have less than a high school
diploma, which is a significantly larger proportion than Harris County at 21%.1 More people (31%) in SAG
live below the Federal Poverty Level, than for the Houston area (26%). This study shows the geographic
distribution of those living with the highest poverty in the SAG neighborhoods. Since the present study
focuses on residents of lower-income neighborhoods, it is useful to note that the neighborhoods with the
highest poverty are located primarily in five census tracts, three of which are in Gulfton, one in Alief, and
one in Sharpstown.
The median household income is significantly lower in the SAG neighborhoods, when compared to
Houston, which was $44,648 in 2012. Gulfton’s median income is half of Houston’s. The current, as well as
historic, unemployment rates are higher in SAG than in Houston. In 2014, twenty percent of all city-wide
robberies and almost 20% of all city-wide murders occurred in the SAG study area.
Overview of Health Statistics
All of the recent published SAG-related community health assessments that we reviewed did not report
health data at the neighborhood level of analysis. The Health of Houston Survey (HHS) is a population
survey of 5,000 randomly chosen households in Houston and Harris County intended to provide communities
with information about the unmet health needs of both adults and children and to offer timely data to
local organizations, elected officials and health care leaders seeking to improve the public’s health. The
health data that is reported in this study is from the Health of Houston Survey (2010)2, which includes 28
geographic areas within Harris County, including Sharpstown, Alief and Gulfton that are combined as one
area. The local neighborhood data is compared to Houston area data overall. According to the Health of
Houston Survey, almost one-half of adult residents do not have health insurance and 79% do not have
dental insurance, which is a much higher proportion than for Houston (59%).
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The Health of Houston study includes eight survey categories. See Appendix 5 for the complete Health of
Houston Survey for the SAG community. A summary of the ratings of health data are as follows:
Sharpstown, Alief and Gulfton Health Indicator Summary
Health Indicator Category
SAG Indicators Ranking Below
Houston Area Average
Health Status and Chronic Disease
4 out of 12 indicators
Health Insurance
Access to Care
Mental Health
Preventive Services
Adult Behavioral Risk Factors
Child Behavioral Risk Factors
Neighborhood, Environment & Housing
SAG ranks remarkably well in five of the eight categories, specifically, the health status and chronic disease
indicators, mental health indicators, behavioral risk factors for adults and children, and the neighborhood,
environment and housing indicators. The health categories of concern include health insurance, access to
healthcare and especially preventive services, with 100% of the recommended screenings ranking lower
than that of the Houston area.
Overview of Key Informants and Participatory Groups
The qualitative participatory groups were led by Dr. Margaret A. Goetz, founder and President of ProSalud
– Health for All. The data included findings from twelve Key Informant Interviews and six participatory
group sessions, led by seven promotoras who were trained as local investigators for this study.
From the interviews and the participants’ perspective, there are many positive assets in this community,
including the diversity of the people living in harmony in a multicultural environment, good community
resources, affordable housing and a good, clean built environment.
8
Challenges in the community that the Key Informants identified included:
Sharpstown
Alief
Gulfton
Education
Education
Education
Poor Street Repair
Poor Street Repair
Increased self-sufficiency
No Respect for Shared Space/Trash
No Respect for Shared Space/Trash
No after-school activities for youth
– ripe for gangs No after-school activities
for youth – ripe for gangs
Unemployment
Unemployment
Crime
Crime, domestic violence, need for more police
Lack of connection to neighbors
and workforce
Lack of connection to neighbors and workforce
Lack of child care
Lack of child care
Poor parenting
Prostitution
Psychological trauma
after robbery
Specific health challenges in the community that the Key Informants identified included:
Sharpstown
AliefGulfton
Diabetes
DiabetesDiabetes
High Blood Pressure
High Blood Pressure
High Blood Pressure
No primary care and
preventative screening No primary care and
preventative screening No primary care and
preventative screening
Stress
StressStress
Eating Habits
Eating Habits
Eating Habits
Self-medicateSelf-medicate
Mental Health
Mental Health
Children’s Health
Children’s Health
ObesityObesity
Dental
Lack of physical activities
and parks
9
Challenges in the community that the participants identified included:
Sharpstown
Alief
Gulfton
Lack of time
Stagnant water
Discrimination
Lack of communication *
Lack of communication *
Complaints ignored or solutions not found
Garbage
Vandals
Lack of security
Apartments poorly maintained
Physical complaints/pain that
keeps you from exercising
Rundown apartments
Ignorance and lack of civility
Need more community resources and services
Alcoholism and
drug addiction
*Lack of communication includes lack of information and lack of talking amongst themselves and with others.
The Key Informants and participatory groups also identified some healthcare resources in the
community that included healthcare providers who deliver physical, mental and dental care. They also
noted these services are inadequate for the population and that many “mom and pop” clinics provide poor
quality services.
Overview of Photovoice
Dr. Kimberly Kay Lopez led and facilitated eleven
SAG participants in the Photovoice component of
the study.
The residents documented, discussed
and analyzed aspects of the community that help to
support or diminish health and well-being.
Following Photovoice training sessions, the local
participants took photographs of their community
and then identified four common themes as a group,
as follows:
1.Gangs
2. Lack of infrastructure
3. Lack of safety/security, especially at apartment complexes
4. Advantages to well-being that contributed positively to health and well-being.
10
The Photovoice participants shared how they are proud of their community, but see areas where it could
be improved. The residents offered many suggestions for possible next steps, including the opportunity to
utilize their photos in a public display in order to engage community members and leaders. These residents
care about their community and are interested in advocating for changes that could yield sustainable results.
Conclusions and
Recommendations
As noted in the quantitative and qualitative sections,
there are positive assets present in the community that
can be the starting place for recommending next steps.
One of the major themes to emerge from the Photovoice
and the community participatory groups was specifically
about the resources in the neighborhoods that contribute
positively to health and well-being.
One of the greatest resources in the Houston metro
area is the racial and multicultural diversity, with over 20% of the people foreign born.3 The Sharpstown,
Alief, and Gulfton neighborhoods are a microcosm of this rich tapestry. These three neighborhoods represent
places of great racial, ethnic, linguistic and cultural diversity.
This is important since place matters to health, a common theme that should pervade all recommendations.
Regarding the needs and challenges of SAG, other common themes should remain a part of all of the
recommended next steps and these include creating a culture of health and maintaining a focus on prevention.
When we study healthy communities through a Social Determinants of Health (SDOH) lens, then the
recommended solutions should also project a SDOH approach. We need to address root causes of poor
health – for individuals and communities. We know that health is more than the absence of disease, and
includes the following factors:
 Social and Economic Factors
 Health Behavior Factors
 Clinical Care
 Physical Environment
 Genes and Biology
The recommendations from this study attend to the first four of the five determinants. Unlike this study,
we have seen a typical healthcare focus with other recent community health assessments. While the overall
intent for this study is to help guide next steps in healthcare service delivery, we acknowledge the need to
take a wider purview. Our recommendations are broader than a healthcare focus since research tells us that
there are many direct and indirect causes of health linked to the social, economic and built environments.
The community members understand this.
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Our goal aligns with the Healthy People 2020 vision for the Sharpstown, Alief and Gulfton
neighborhoods to be a thriving community in which all people live long, healthy lives.
The following table includes an overview of the study results that are grouped by the type of evidence
gained from the mixed methods research. The results in this table are not rankl-ordered. There is not
always alignment among the three study components.
Overview of Study Results by Component
Quantitative Research
Qualitative Research
Community Voice
Photovoice
1. Improve health status.
1. Provide health literacy in
the community.
1. Improve barriers to good
health; Residents want to
walk and exercise, but are
fearful of crime.
2. Improve access to healthcare.
2. Do outreach to those
without a regular source
for medical care.
2. Acknowledge that the
residents are appreciative
of community resources
like Baker-Ripley.
3. Provide health insurance to adults; dental insurance for adults and children.
3. Improve mental health,
stress and dental health.
3. Address the residents fear of
retaliation with apartment
landlords or threatened
immigration status.
4. Attend to children with unhealthy weight.
4. Improve children’s health
and eating habits.
4. Improve swimming pools,
parks and playgrounds
5. Screen, prevent and manage chronic disease.
5. Provide primary care and preventative screening.
5. Provide primary care and preventative screening.
6. Manage and prevent cancer.
6. Provide health education in
fun and entertaining ways.
6. Acknowledge that residents
like community gardens and
community agencies that
provide services.
7. Attend to high crime rates, especially robberies and murders.
7.
Improve communication
within the community
and neighborhood groups
and regarding advocacy for
their community.
7. Address that residents are
fearful of gangs and
associated crime.
8. Improve neighborhood, environment and housing.
8.
Improve the built
environment, especially regarding poor sanitation,
housing repair and public
spaces such as parks.
8. Attend to gang graffiti,
potholes, broken water mains,
sidewalks and trash.
...continued on page 13
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9. Improve education indicators, esp. graduation from high
school rates.
Community Voice
Photovoice
9a.
9b.
9. Improve safety and security,
esp. trash dumpsters, broken
lights and discarded furniture.
Improve education.
Enhance education
regarding civility, legal
rights and responsibilities
and in general, such as
language, literacy and computer skills.
10. Create a stakeholder group
to synthesize gathered
information, in addition to
group feedback, to move
forward on promising ideas.
10.
Provide continued
opportunities for residents
to participate in future ways
to make SAG healthier.
Prioritized Recommendations
For the quantitative and the qualitative research findings, all of these recommendations are linked with the
following priorities:
 Priority 1 – Improve health status, preventative screening and access to healthcare
•
Proposed Action: Focus strategies around health education, particularly regarding adult
cancer screening, diabetes, hypertension and children’s health; and improving access
to preventative and healthcare services, including mental health and dental.
 Priority 2 – Improve the built environment, especially regarding safety, security,
sidewalks and poor sanitation
•
Proposed Action: Use advocacy skills to help improve general sanitation and safety.
Keep the diversity of the neighborhoods by anticipating possible gentrification by
improving housing stock. Research the Avenue Community Development Corporation’s
model in the Houston’s near north side.
 Priority 3 – Enhance the knowledge and awareness of health and community resources to
strengthen the bond between the residents and their communities
•
Proposed Action: Focus on developing more community centers and services, such as
Baker-Ripley. Include the residents in the planning and design of more resources since they
are aware that the perception about the community is directly related to how good they
feel about themselves. They explained that when they felt good about their neighborhood
it made them feel good about themselves.
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Looking Forward
The best way forward is to continue engaging the affected community members, interested
stakeholders and by creating public private partnerships between business and government. This study
helps to understand the three neighborhoods at this point in time, and most importantly presents the
voices of the residents. The many people who participated in this study are very passionate about being
a part of the decision making process in order to make Sharpstown, Alief and Gulfton neighborhoods a
healthier place for all.
A study that is based on community participatory research tenets is an excellent point of departure
for the community and supportive organizations such as Legacy Community Health Services and
Episcopal Health Foundation to help to create a healthier future.
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Introduction
is a 501(c)3 not-for-profit corporation that operates as a supporting
organization of the Episcopal Diocese of Texas. The Foundation works to
improve the health and well-being of the 10 million people in the 57 counties of the Diocese. The Foundation
embraces the World Health Organization’s broad, holistic definition of health: a state of complete physical,
mental and social well-being and not merely the absence of disease.
Vision
The Episcopal Health Foundation’s vision is a diocese in which the people, parishes, institutions and
community are all connected in service of transformation to healthy communities for all.
Mission Statement
The mission of the Episcopal Health Foundation is to advance the Kingdom of God with specific focus on
human health and well-being through grants, research, and initiatives in support of the work of the Diocese.
Core Values
 INFORMED ACTION. Rigorous research is the foundation for actions and initiatives that have
the potential to transform human lives and organizations.
 COLLABORATION. The most effective use of financial resources is often discovered in ministries
that go beyond the limits of individuals or individual congregations. Broad-based communities
galvanized around responses to particular human needs have a powerful potential to effect real
and lasting change.
 EMPOWERMENT. The old adage is true: It is good to give a hungry person a fish; it is empowering
to teach the same person to fish. Loving and compassionate people often need training to be
effective change agents. Leadership development and training are central to empowerment.
 STEWARDSHIP. Good stewardship requires careful oversight and development of the abundance
 TRANSPARENCY. All actions and decisions are open to the light of public scrutiny. Secrecy and
that God provides.
confidentiality are not the same thing.
 ACCOUNTABILITY. The results of decisions and actions of EHF are audited and measured against
reasonable benchmarks. Mistakes are made. When mistakes are treated with openness and honesty,
lessons are learned. Public accounting and reporting are made on a regular basis.
 TRANSFORMATION OF HUMAN LIVES AND ORGANIZATIONS. The best good is good that
lasts by effecting transformational changes in root causes.
 COMPASSION FOR THE POOR AND POWERLESS.
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The Episcopal Health Foundation is a unique entity that grants funds, convenes initiatives and performs
research within the 57 counties of the Episcopal Diocese of Texas.
The Foundation values local knowledge and local expertise, which is considered fundamental to the
research approach. Community engagement in research is time-intensive qualitative work, which helps to
assure that the Foundation is responsive and attuned to the local nuances of complex issues. Participating
in community-based planning and research activities ensures that a voice for healthy communities is heard
at multiple decision-making levels.
Legacy Community Health (Legacy) is a Federally Qualified Health Center (FQHC) and private 501(c)3
non-profit organization serving the Houston-Baytown-Sugarland and Beaumont–Port Arthur Metropolitan
Statistical Areas (MSA). Legacy has grown from a small neighborhood clinic incorporated in 1981 to the
region’s largest FQHC. As an FQHC, Legacy provides comprehensive health and wellness services to all
patients, regardless of their ability to pay.
Legacy was formed in 2005 as a result of the merger of two leading Houston area community
organizations—Montrose Clinic and The Assistance Fund—that had both been providing Houston and the
Harris County area with quality health care and medication services for nearly 30 years.
Legacy’s strong reputation fueled significant growth in the mid to late 2000s. In 2006, the City of Houston
awarded Legacy the opportunity to open a satellite location at 5602 Lyons Avenue, in part because of the
reputation for quality health care and fiscal prudence. Legacy now occupies the entire building, providing
health care and social services to any and all Houstonians with a focus on individuals and families living in
the greater Fifth Ward.
In 2010, Legacy acquired the CHRISTUS Health clinic in Southwest Houston, a location that now sees
more patients than any other Legacy campus. Later in the same year, Legacy opened a clinic in Neighborhood
Center’s Baker-Ripley complex.
In 2012, Legacy acquired a behavioral health clinic located in Baytown, Texas, as well as The Center
for AIDS. Shortly afterwards, Legacy received an invitation to partner with CHRISTUS Health to establish
an FQHC in Beaumont, Texas. Legacy received funding from CHRISTUS Health and developed a partnership
with the Ubi Caritas Family Medical Clinic in Beaumont, thus solidifying the provision of primary care and
enabling services in Beaumont. Spring boarding off its successes in Baytown, Legacy was then invited to
acquire the Houston Methodist San Jacinto Hospital Family Medicine clinic, thereby aligning the organization
with the Family Medicine Residency Program which trains there.
Legacy’s history is grounded upon the provision of high quality health care to all patients. In its
early years the clinic responded to the HIV/AIDS crisis of the 1980s and 1990s by initiating various
programs and initiatives before offering full-scale comprehensive health care services by the early 2000s.
Today, Legacy drives healthy change in its communities by offering premium primary care, dental care,
vision services, behavioral health services for adults and children, family planning, health promotion and
community outreach, wellness and nutrition, and comprehensive HIV/AIDS care regardless of the patient’s
ability to pay.
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Purpose of Assessment
Legacy is a key partner in the new collective impact project called Connect@6800 Bellaire, which is also
a member of the national Purpose Built Communities National Network. The mission of the Connect@6800
Bellaire is to “use the power of healthy partnerships to create a dynamic place of hope and health that will
improve the lives of all the residents through self-reliance and partnerships.”4
The Legacy Clinic is co-located on a campus located at 6800 Bellaire Boulevard in the Sharpstown
neighborhood, which is a diverse and disadvantaged community. The Alief and Gulfton neighborhoods are
contiguous to the Sharpstown neighborhood.
Legacy’s role with Connect@6800 Bellaire is to operate a full-service Federally Qualified Health Center
(FQHC) that identifies unmet needs and gaps in health-related services and develops client-centered
programs to address those needs. The 6,000 square foot FQHC is a full-service community health clinic that
also provides patient education classes.
Legacy expanded once again in 2012, opening campuses in medically underserved areas in Baytown and
Beaumont, including a long-standing behavioral health practice in Baytown, and a well-established pediatric
practice in Beaumont.
Legacy is interested in a better understanding of the needs and resources in all three diverse geographic
neighborhoods – the Sharpstown, Alief and Gulfton (SAG) neighborhoods in Houston. Legacy invited the
Episcopal Health Foundation to lead an independent community assessment study.
The following report provides an overview of the methodology used; quantitative profiles for each of
the three study areas; the community voice section, which includes the qualitative participatory research
findings; and the Photovoice findings; and recommendations and conclusions.
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Methods
The assessment protocol was conducted in five phases for the Sharpstown, Alief and Gulfton
neighborhood study.
Phase
Components
1. Prior Assessment and Quantitative
Data from the Census’, Vital Statistics,
Behavioral Risk Factor Surveillance Survey;
Data Review
Maps; Asset Mapping; Meta-analysis of
prior assessments
2. Key Informant Interviews
Stakeholders Interviewed;
Social Networking Map
3. Community Participatory Groups
Resident Participatory Groups
4.PhotoVoice
Resident PhotoVoice
5. Dissemination of Results
Community Tour with PhotoVoice Results
6. Final Report
Findings and Recommendations; Printed Report;
Website Report
Each phase is explained in more detail below.
Phase 1: Prior Assessments and Quantitative Data Review
Phase 1 of the research began with a review of the most recent assessments that have been completed
for the study areas. The review was used to determine if there are results that are presented in more than
one assessment. If there were, then those priority topics were incorporated into the qualitative portion of
the study where appropriate.
This phase also included a detailed review of the demographic makeup of the study area, as well as
the epidemiologic data. In order to build on the resources in the area, a formal asset mapping process is
included in this study. This data helped to determine where to focus the qualitative phase of the study. For
example, the “hot spots” identified included areas with a greater concentration of uninsured, people living
below the poverty line and sparse resources. The quantitative data gathered is also included in this report.
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Phase 2: Key Informants Interviews
Phase 2 of the research overlaps somewhat with Phase 1. This phase consisted of key informant interviews
with area stakeholders, which was determined using a sector matrix5 (see Appendix 1). The interviews
followed an interview script with specific questions6 (see Appendix 2). The results of the key informant
interview questions enabled researchers to better develop the questions that used for the community portion
of the qualitative study. There were 12 interviews completed during the key informant interview portion of
the study. Those interviewed were asked to recommend residents to participate in the third phase of the
study. An analysis of the interview data is included in this final report.
Phase 3: Community-Based Participatory Research
Phase 3 consisted of six community participatory groups, with local residents participating in each group.
The residents identified by the key informants, as well those identified by other stakeholders and partners,
were asked to consider being a part of the local investigator team. Those selected from the application
process attended a three-day training session. The training enabled the residents to lead the participatory
exercises for the greater community event. The local investigators were trained to perform the roles of the
facilitator, co-facilitator or note-taker in the participatory groups.
Once trained, the local investigators were responsible for assisting researchers in recruiting residents
for the participatory groups. The residents invited to participate are the people most affected by the health
issues, and for this study focused on the Hispanic population. The perspectives from the residents increased
the local knowledge for this area and are reported in this study. That local knowledge will be useful information
for Legacy, and should help to guide future decisions that are more reflective of the local community needs
and gaps.
The participatory group format was guided by the results of the key informant interviews, as well as
Legacy’s questions regarding the delivery of the most appropriate services (see Appendix 3). The participants
also had an opportunity to add comments to discussion boards in order to define specific barriers (including
cultural) and potential solutions to these barriers that helps to create a healthier community. The boards
will also help to highlight additional community assets.
The local investigators and researchers analyzed the data gathered from the participatory groups. This
helped to ensure that the local knowledge assessed was interpreted and reported appropriately and accurately.
Phase 4: Photovoice
Photovoice refers to projects where participants generate their own photographic work that helps to
illuminate a specific research question. A facilitator then works with the group, which is often marginalized
and/or disadvantaged, and teaches them to use a camera with the aim of defining, communicating and
improving their health.7,8 Participants in this study had the option to use a digital camera or a personal cell
phone camera. After a training session, they were asked to return to their communities and document
through photographs what made their neighborhood healthy or unhealthy. Participants then reconvened
with researchers to review, categorize and select the most representative photos. The pictures expressed,
19
usually with captions composed by the photographers, the realities of the photographers’ communities. The
photographs can be shared with the public and policy makers in order to create change and to advocate for
positive changes in the community, that lead to health.
Phase 5: Dissemination
Finally, the Foundation and Legacy will host a community listening tour, where the participatory photos
and information gathered from the key informants and participatory interviews were presented. Legacy has
the option to display the photographs in their clinics and elsewhere.
It is the hope of the Foundation that the information compiled in this report will help to make
transformational change in these underserved communities.
20
How We Work in Communities
Social Determinants of Health
We acknowledge that health is about more than just the choices an individual makes.
The World Health Organization states: “The toxic combination of bad policies, economics, and politics is,
in large measure responsible for the fact that a majority of people in the world do not enjoy the good health
that is biologically possible…Social injustice is killing people on a grand scale.”9
Ecological models of health take into account multiple levels of influence on health including individual,
social/cultural, physical environment, and policy contexts.10 This approach emphasizes the factors that
impact individual health and form a complex web around the individual. The factors include living and
working conditions, education of parents and unemployment, or as the Robert Wood Johnson Foundation
states: health starts where we live, learn, work and play.11
Although some social factors, like unemployment may seem to be unrelated to health, this model
requires that we consider all of the contextual factors illustrated here by Dahlgren and Whitehead.12
Social determinants of health are considered especially important when building community health in
medically underserved, impoverished and disadvantaged neighborhoods.
21
Community Engagement
Community Engagement is the process of working collaboratively with and through groups of people
affiliated by geographic proximity, special interest, or similar situations to address issues affecting the wellbeing of those people.13
Research has shown greater social capital and participation in health improvement activities using
Community Engagement methods.
Additionally, social capital builds social ties, networks and support,
which is associated with better community health and well-being.
Research shows that participatory
decision-making can uncover and mobilize community assets, strengths and resources that would have
been otherwise overlooked.14
In Community Engagement approaches, there is a continuum that can be illustrated by sector. The
diagram below shows on the left, a minimal investment called transactional engagement in community
engagement, and as we move across the continuum, there is increasing investment to community
engagement, ultimately identified as transformational engagement.
CONTINUUM OF COMMUNITY ENGAGEMENT
Increasing Community Engagement
GOVERNMENT
(Ministry of Social Development,
New Zealand, 2007)
Information
provision
TRAINING ORGANIZATION
(International Association for
Public Participation, 2007)
Inform
VOLUNTARY SECTOR
(The Rowntree Foundation, 1994)
Information
COMMUNITY STANCE
(Hashagan, 2002)
CORPORATE
(Altria inc, 2004)
Monitor
NON-PROFIT CORPORATE
ALLIANCES
(Rondinelli & London, 2003)
Consult
Passive
Push
communication
Educate
Arm’s length
Collaborative
processes
Involve
Consultation
Lobby
Community
decision making
Collaborate
Deciding
together
Participative
Reactive
Transactional
Engagement
One-off
consultation
Engage
Empower
Acting
together
Supporting
Empowerment
Leadership
Collaborate
Interactive
collaborations
Intensive
alliances
Transitional
Engagement
Transformational
Engagement
The Community Stance begins with a Passive response from the community, with limited community
engagement. As you move along the continuum toward increased community engagement, the community
22
response leads to Reactive, Participative, Empowerment and finally, Leadership.
It is rare that the process
is carried through to the transformational points, because of money, time and constraints on resources.
Typically, in assessment and intervention design, we stop too soon, leaving the community with feelings of
exploitation and fatigue.15
Therefore, we acknowledge that community residents’ wisdom and perception is critical to a better
understanding of the needs and assets in the community.
One method of community engagement is
Community-Based Participatory Research.
Community-Based Participatory Research
Community-based participatory research (CBPR) is a collaborative, partnership approach that
equitably involves…community members, organizational representatives, and researchers in all
aspects of the research process.16
Community-based participatory research recognizes the community partner as a unit of identity:
 Building upon community assets
 Facilitating collaborative decision making
 Nurturing co-learning
 Balancing knowledge creation with direct community benefit
 Focusing on system level change
 Disseminating benefits to all partners
 Focusing on long-term commitment to social change.17
Mixed Methods Research
We acknowledge multiple ways of knowing and mutual understanding.
Mixed Methods Research integrates perspectives of different disciplines such as biostatistics, historical
analysis, and social and political theory.18
Mixed Methods Research also combines two types of data: qualitative and quantitative.
 Qualitative data includes pictures, music and words, such as what people say in interviews.
 Quantitative data includes counts and amounts such as population counts, disease rates,
and numbers of people served by a clinic.
We combine qualitative and quantitative data, bringing community voices to the table to contextualize
scientific data. By doing so, we hope to understand the socio-cultural and organizational structures and
processes that promote or diminish the health of a defined community.
23
Prevention Intervention Research
We acknowledge that it is best to start early.
We focus on prevention of disease and building wellness. Prevention intervention research incorporates
policy contexts and community wisdom to create health interventions with measurable outcomes.19
Quantitative Data
Sharpstown | Alief | Gulfton communities are located in the southwest section of the City of Houston.
In 2000, the City of Houston recognized all three of these communities as “Super Neighborhoods.”
Below is a map of Harris County, Texas with the Sharpstown | Alief | Gulfton areas highlighted. This is
a large geographic area with a correspondingly large population of 170,538 people.
Ü
Legend
Sharpstown, Alief, Gulfton Area
City of Houston
Major Roads
Harris County
24
0
2.5
5
10
15
20
Miles
Meta-Analysis of Community Health Needs Assessments
in the SAG Area
The findings and priority recommendations from the recent Community Health Needs Assessments,
reviewed before the study, are detailed below.
Title
Date
Alief – Houston, TX 2013 Community Profile
Gulfton Area Neighborhood –
2007 Community Health Reports
20
Study Area
12.2012Alief
2007Gulfton
21
Gulfton Expansion – Houston, Texas
2014 Community Profile 22
2014
Gulfton and Sharpstown
Houston’s Alief and Park Place
Super Neighborhood –
2004 Community Health Report
2004
Alief and Park Place
Memorial Hermann Southwest Hospital:
Community Health Needs Assessment 24
08.2012 – 05.2013
Harris County
Regional Healthcare Partnership (RHP) Plan:
Community Needs Assessment, Southeast Texas
Regional Healthcare Partnership – Region 3 25
2013
Harris, Austin, Calhoun,
Chambers, Colorado,
Ft. Bend, Matagorda,
Waller, Wharton
23
The Alief – Houston, TX 2013 Community Profile study was a survey completed in 2012 of 364 adults
and 824 school-aged children and youth in the Alief neighborhood. The Community Survey focused on
six elements of a vibrant community: education, connection, health, housing, economic opportunity and
infrastructure. The findings from the survey are summarized below:26
COMMUNITY STRENGTHS
 Overall desire to live in neighborhood due to proximity to work, families and schools
 Community diversity leads to the congregation of various cultural groups
 Housing viewed as affordable; mostly a peaceful environment
AREAS FOR IMPROVEMENT
 Affordability and accessibility of health care services; more clinics; more information
on healthy lifestyles
 Increase and improve after school programs and school activities; increase parent involvement
25
 Improve safety, property maintenance/cleanliness and cost of housing
 Increase neighborhood safety/security through more police patrols and better lighting;
improve streets and sidewalks; better transportation
COMMUNITY GOALS
 To purchase and own a home; find employment or better employment; send children to college;
learn English; finish school and pursue postsecondary education; save money for the future
The Gulfton Expansion – Houston, TX 2014 Community Profile study was a survey completed in
2012 of 842 adults and 3,081 school-aged children and youth in the Gulfton and Sharpstown neighborhoods.
The focus of the study was to better understand life in these neighborhoods from the community’s perspective.
This rich study had the following findings:27
COMMUNITY STRENGTHS
 Overall desire to live in neighborhood due to affordability, proximity (to work, schools,
clinics, churches/ mosques, stores, family), the quiet, tranquil environment; diversity
 School teachers/staff; bilingual classes/services/programs; activities
 Housing environments viewed as affordable, in proximate locations, and quiet/calm
AREAS FOR IMPROVEMENT
 Affordability and accessibility of health care services; more doctors/clinics; services for those
without healthcare and for undocumented residents; fewer rules/regulations to receive
services; dental and mobile services
 After school programs and school activities
 Increase safety around housing areas; property maintenance/cleanliness; better home
owners’ associations
 Increase neighborhood safety/security; transportation; cleanliness; community services/resources;
roads; parks
COMMUNITY GOALS
 To overcome citizenship obstacles; better employment opportunities; for residents’ children
to attend college; to save; to own a home; to start a business
The Memorial Hermann Southwest Hospital Community Health Needs Assessment was
completed in May 2013, in part, to fulfill the Federal Government Regulatory requirement for non-profit
hospitals. Although the Memorial Hermann Southwest Hospital is located in this study area, their focus was
a county-level analysis, including Harris County and Fort Bend County. Brazoria and Montgomery County
data is included as a comparison.
26
Memorial Hermann Southwest’s priorities from their assessment are listed below.
PRIORITY #1:  Heart disease
 Cancer
 Diabetes
 Alzheimer’s
Education and prevention for diseases and chronic conditions:
PRIORITY #2: Address issues with service integration, such as coordination
among providers and the fragmented continuum of care:
 Lack of information and record sharing, such as electronic medical records
 Lack of communication between providers
 Patient needs for medical homes
 Inappropriate ED use
PRIORITY #3: Address barriers to primary care, such as affordability and shortage
of providers
 Cost
 Number of providers
PRIORITY #4: Address unhealthy lifestyles and behaviors
 Obesity
 Communicable diseases (chlamydia, gonorrhea, AIDS, tuberculosis, syphilis)
 Accidents
PRIORITY #5: Address barriers to mental healthcare, such as access to services
and shortage of providers
 Number of providers
 Adequacy and access issues
 Substance abuse services
PRIORITY #6: Decrease health disparities by targeting specific populations
 Safety net population (under/uninsured, working poor, indigent)
 Unemployed
 Children
 Elderly and “almost elderly” (those who are not yet eligible for Medicare)
 Asian immigrant population
 Homeless
27
The Regional Healthcare Partnership (RHP) Plan: Community Needs Assessment, Southeast Texas
Regional Healthcare Partnership – Region 3 was completed in 2013 as part of the requirement for the
region’s Medicaid 1115 Waiver Expansion for Harris County, and eight other nearby counties.
The key challenges identified for this large region include the following:
 Inadequate number of primary and specialty care providers. As discussed throughout this
background overview, the region faces a significant shortage of primary and specialty care providers.
Patients are unable to locate a provider willing to serve them, face extended waits for appointments,
or are unable to locate a provider with extended hours in order to accommodate work schedules.
Addressing this problem requires a long-term solution that includes development of the educational
infrastructure as well as programs for attracting and retaining qualified providers.
 High prevalence of chronic disease including diabetes, heart disease, asthma, cardio-
vascular disease and cancer. Region 3 has high rates of chronic disease, which account for a
significant portion of health care spending, are a leading cause of disabilities, and are factors
in a majority of deaths. Many of these problems may be alleviated through a coordinated care
system that includes improved access to care, patient education, and care management to ensure
patients receive the right care at the right time in the right setting.
 Diverse patient population speaking multiple languages, and with varying cultural
backgrounds. Improving the health care services for a diverse population requires a variety of
approaches that are uniquely suited for each population. Without effective patient education and
communication programs that address language and cultural barriers, patients will not receive the
services they need for the best possible health outcomes and may delay seeking appropriate and
preventive care.
 High number of uninsured patients. With more than one million uninsured patients, the region
struggles to keep up with the demand for services. Patients do not receive basic health care services,
delay treatment, and often seek primary care services through the emergency rooms, resulting in
hundreds of millions of dollars in unnecessary spending.
 High prevalence of behavioral health conditions and lack of an integrated care solution.
The region lacks both the providers and facilities to adequately meet the demand for behavioral
health care, and is often unable to provide an integrated approach that meets both the physical and
mental health care needs of the patient. Many individuals may receive either physical treatment or
behavioral health care, but not both, or they receive no care at all. The current system is fragmented
and difficult to navigate, and challenging for both patients and providers.
These problems can
be addressed by creating a health service system that is fully coordinated and integrated with
behavioral health and primary health care, as well as services provided through school programs,
criminal justice systems, and social service providers.
28
 Fragmentation of patient services throughout a large, uncoordinated health care system.
Regardless of insurance status, many patients receive fragmented health care that is both inefficient
and ineffective. Patients may receive duplicative and unnecessary services, which could be avoided
through a regional integrated care system that maximizes the use of electronic health records
(EHR) and health information exchange.
While implementation of coordinated care systems
involves planning, training and communication strategies that maximize the use of technology, it
is both challenging and costly. The long-term benefits will be significant in terms of reductions in
unnecessary services and costs, and improved patient care and outcomes.
 Limited access to public transportation and emergency medical services. Many patients
live in areas that provide little or no options for public transportation to acquire medical care,
and have very limited options for emergency transportation.
Services vary greatly throughout
the region, and are especially limited for those living in rural communities with limited resources
and large territories to cover. The absence of these services results in patients delaying necessary
care until it becomes a critical health care condition, when relying on emergency transportation for
services could have been provided in a primary care setting, or avoided entirely.
 An aging population and increased need for high-cost services, including behavioral
health care.
Although this problem is certainly not unique to Region 3, the large number of
individuals that will require increased services (many of whom are already in poor health) poses
significant problems.
Dealing with these problems will require a coordinated delivery system
approach that takes into account the unique physical and behavioral health needs and limitations of
the elderly population and a community-wide effort to develop cost effective, long term solutions.
Increasing the number of specialty providers, and providing additional training for primary care
providers treating older patients are critical challenges that must be met to ensure these patients
receive appropriate care and services and secure the best healthcare outcome possible.
 Inadequate IT infrastructure necessary for improved care coordination. Though the region
has made progress on the implementation of EHR, extensive expansion and implementation is
necessary to meet the future needs of this community. Improvements in health care delivery as well
as the monitoring and tracking of progress and outcomes are dependent on an effective program
through which providers can track and share patient information and services.
Socio-Demographic Data
This section includes socio-demographic data for the SAG neighborhoods. More detailed data is included
in the individual neighborhood sections.
All three neighborhoods have a higher population density than Houston. Gulfton has the highest density
with 13,502 persons per square mile, which is 3.5 times the rate of the city of Houston.28
Sharpstown and Gulfton have a higher percentage of children under 5 years of age living in their
communities. Only 3% of the population in the Gulfton neighborhood was people over 65 years of age.
29
Sharpstown, Alief and Gulfton Neighborhoods Population
by Race/Ethnicity and by Age
Sharpstown
Alief
Gulfton
Houston
68,939
63,253
38,346
2,107,449
8,072
4,477
13,502
3,766
White
10,341 (15%)
6,325 (10%)
3,068
(8%)
547,937 (26%)
Black
9,651 (14%)
15,181 (24%)
3,451
(9%)
484,713 (23%)
Hispanic
37,916 (55%)
29,096 (46%)
28,760 (75%)
927,278 (44%)
Asian
11,030 (16%)
12,018 (19%)
2,684
(7%)
126,447
(6%)
383
(1%)
21,074
(1%)
Total Population
Persons Per Square Mile
Race/Ethnicity
Other
(1%)
632
(1%)
6,894 (10%)
5,060
(8%)
4,218 (11%)
168,596 (11%)
689
Age Group
Under 5 Years
5 - 17 Years
12,409 (18%)
13,916 (22%)
7,286 (19%)
379,341 (19%)
18 - 64 Years
43,432 (63%)
40,482 (64%)
25,962 (67%)
1,369,842 (67%)
Over 65 Years
6,205
(9%)
4,428
(7%)
1,150
(3%)
189,670
(3%)
Source: City of Houston Planning and Development Department.
Data Source: US Census Bureau, 2000. American Community Survey, 2008-2012.
Sharpstown, Alief and Gulfton Neighborhoods
by Race/Ethnicity
The history of the Gulfton, Sharps-
town and Alief neighborhoods closely
parallels
the
historical
changes
in
Houston during the past 50 years.
During
the
1970s
and
1980s,
the
migration pattern in Houston began to
change. What had been mostly white,
single, American born, English-speaking
neighborhoods became Hispanic, foreign
born and Spanish-speaking immigrant
family communities, resulting in a rich
diversity that now mirrors Houston,
which is one of the most diverse cities
in the US.
30
The maps below display the race/ethnicity by census tract for each of the three study areas.
Sharpstown, Alief and Gulfton Race/Ethnicity by Census Tract
Poverty
According to the Health of Houston Survey, 31% of residents in the SAG area had a household income of
less than 100% of the Federal Poverty Level (FPL).29
SAG
Houston
Population Below 100% FPL
31.%
26.%
Population Below 139% FPL
56.%
42.%
Experiencing Economic Hardship
57.%
48.%
31
The Department of Health and Human Services (HHS) identifies the federal poverty level as:30
2015 Poverty Guidelines
Persons in family/household
Poverty Guideline
1
$11,770
2
$15,930
3
$20,090
4
$24,250
5
$28,410
6
$32,570
7
$36,730
8
$40,890
*For families/households with more than 8 persons, add $4,160 for each additional person.
32
The map below shows the highest concentration of the population living below the FPL. While there are
pockets of poverty in Alief, many more census tracts in both Sharpstown and Gulfton have a higher proportion
of people living in poverty.
33
Uninsured
Forty-seven percent of the adult residents living in the SAG neighborhood had no insurance compared
to 31% in Houston.31 Seventy-nine percent of the SAG residents do not have dental insurance, compared to
59% in Houston.32
The map below illustrates that there are several census tracts in Sharpstown and Gulfton that have
uninsured rates over 50%.
34
Health Data
The map below is from the Health of Houston Survey (2010). Sharpstown, Alief and Gulfton neighborhoods
are highlighted within the circle.
The Health of Houston Survey (HHS) is a population survey of randomly chosen households in Houston
and Harris County intended to provide communities with information about the unmet health needs of both
adults and children and to offer timely data to local organizations, elected officials and health care leaders
seeking to improve the public’s health. With participation from over 5,000 respondents, it is the area’s most
extensive health survey to date assembling facts on health, healthcare and lifestyle, as well as on social,
economic and neighborhood risk factors, and making these available free of charge to anyone interested.33
Almost one-third of the SAG population reports fair or poor health status. Reported limitations of pain
are lower in this community, compared to the Houston area. Additionally, fewer obese adults and being
overweight and obese are lower than the Houston area. However, this is not the case for children. Although
35
reported diabetes and cancer diagnoses are higher in this community, when compared with Houston, there
is a lower proportion of reported diagnoses of CVD, hypertension and asthma.
Uninsured rates in SAG are significantly higher for adults, but lower for children, with the exception of
dental insurance for children. All indicators related to access to care are worse for the adults, but better for
the children, when compared with the City of Houston.
Although there were a higher percentage of reports of serious psychological distress, there were much
fewer mental health visits.
Thirty-four percent of the residents (18+) in SAG rarely eats breakfast as compared to 28% in the
Houston area.
Almost half of the SAG population reported stray animals and crime as a neighborhood
problem. Regarding preventive services, this community seeks screening for common cancers much less
often than the residents of the City of Houston.
Sharpstown, Alief, Gulfton (SAG) –
Health of Houston Survey (2010)
Highlighted Questions from 2010
SAG
Houston Area
Fair or poor Health
29%
20%
Pain Ever Limits Function
32%
35%
Overweight and Obese Adults
58%
63%
Children at Unhealthy Weight
43%
34%
Diabetes Diagnosis
15%
11%
Cancer Diagnosis
7%
6%
CVD Diagnosis
5%
7%
7%
9%
No Insurance Adults
47%
31%
No Dental Insurance - Adults
79%
59%
No Dental Insurance - Children
32%
27%
Barriers to Healthcare Access - Adults
32%
24%
Barriers to Healthcare Access - Children
17%
23%
Serious Psychological Distress
12%
7%
Mental Health Perceived Need
16%
16%
Unscreened for Breast Cancer (women 40-74 yrs)
37%
36%
Unscreened for Cervical Cancer (women 21-65 yrs)
25%
20%
Ever Miss Breakfast
17%
19%
Fast Food consumption - Children
20%
22%
Less than recommended Physical activity
77%
77%
Not home owner
46%
36%
No Fruits and Vegetables Avialable
17%
16%
Crime Problem
42%
26%
Stray Animal Problem
48%
37%
Asthma Diagnosis
36
Crime Statistics
In 2014, twenty percent of all city-wide robberies and almost 20% of all city-wide murders occurred
in the SAG study area.34 The Houston Police Department beats included in Sharpstown, Alief and Gulfton
Superneighborhoods are 17E10, 17E20, 18F50, 18F60, 19G10, 19G20, 19G30, 19G40 19G50, 20G10. A
map of these beats can be found in Appendix 6.
Sharpstown, Alief and Gulfton Crime Statistics for 2014
Month
Aggravated
Assault
Auto
Theft
Burglary
Murder
Rape
Robbery
Theft
January
119
159
300
3
14
238
650
February
117
140
244
3
6
158
578
March
153
137
232
4
6
140
634
April
138
154
272
6
14
133
587
May
150
145
285
8
178
573
June
119
149
136
7
11
108
324
July
103
179
244
3
11
158
487
August
166
192
240
11
152
535
September
169
180
248
6
10
203
553
October
140
209
248
3
9
189
595
November
114
225
216
2
6
159
545
December
119
179
226
6
5
173
536
Total
1607
2048
2891
43
111
1989
6597
% of
Citywide
Crime by
Type
15%
15%
14%
19%
15%
20%
10%
37
Sharpstown Neighborhood
Today Sharpstown is an incredibly diverse area, ethnically, economically, and in terms of the many different
types of land use in the area. Sharpstown is located in the City of Houston, Harris County and is part of the
Houston Independent School District. This neighborhood includes frontage on two major freeways (US-59
and Beltway 8), the vibrant Harwin Street retail corridor, Houston Baptist University, Memorial Hermann
Hospital System, the Sharpstown subdivisions, PlazAmericas Mall, and dozens of churches, community
centers, recreation options, and much more.
Land Use
Map35
38
PUBLIC FACILITIES LOCATED IN THE SHARPSTOWN AREA
39
Population
The Sharpstown population has increased from 75,341 in 2000, to 83,906 in 2014, and is displayed in the
table below.36
Sharpstown Population by Age Group
2000
2012
Age
Number
Percent
Number
Percent
Under 5 years
7,709
10%
6,894
10%
5-17 years
13,104
17%
12,409
18%
18-64 years
50,105
65%
43,431
63%
65 and over
6,167
8%
6,205
9%
Education
Most of the education indicators for Sharpstown, show educational status decline, when compared to
Houston, with the exception of the percentage of those receiving a High School diploma. This percentage
increased in Sharpstown from 20% in 2000 to 23% in 2012. However, 40% of people living in Sharpstown
do not have a High school diploma, compared to 25% for Houston.37
EDUCATIONAL STATUS FOR SHARPSTOWN
Sharpstown Houston
200020122000 2012
Educational Status
No Diploma
34%40%30%25%
High School Diploma
20%23%20%22%
Some College
23%20%23%24%
Bachelor’s or Higher
23%18%27%29%
Percentages may not add up to 100% due to rounding.
40
Household Characteristics
According to the US Census Bureau, 54% of the homes in Sharpstown were built between 1970-1979.
Twenty-nine percent of the homes in Sharpstown were owner occupied, compared to 71%, which were
renter occupied.38
The median household income for Sharpstown has only increased $894 from 2000 to 2012. The median
household income for Houston on the other hand has increased $8,032 in the same period of time, as seen
in the table below.39
HOUSEHOLD CHARACTERISTICS FOR SHARPSTOWN
Sharpstown Houston
200020122000 2012
Households
Total Households
Family Households
27,802 23,289 717,945 773,450
67%
66%
64%
61%
29,503
29,454
782,378
902,153
Housing
Total housing Units
Occupied
94% 79% 92% 86%
6%
21%
8%
14%
Under $25,000
41%
39%
33%
28%
$25,000-$50,000
34%
34%
31%
26%
$50,000-$100,000
19%
19%
24%
26%
Over $100,001
6%
8%
12%
9%
Vacant
Income
Median Household Income
$31,377$32,271$36,616$44,648
41
Language
LANGUAGE SPOKEN IN SHARPSTOWN
100%
In Sharpstown, 59% of children,
90%
ages 5-17, and 53% of people
20%
22%
5%
9%
46%
38%
26%
19%
80%
between the ages of 18-64
70%
are Spanish speaking. Twenty-
9%
16%
60%
six percent of adults 65 years
50%
and older speak a language
53%
59%
40%
other than English or Spanish.
72%
30%
This compares to 9% of adults
58%
in Houston40 (as shown in the
10%
chart to the right).
53%
48%
20%
25%
21%
0%
5-17
18-64
65+
5-17
18-64
Sharpstown
 English
65+
Houston
 Spanish
 Other
Employment
In 2011, the unemployment rate in Sharpstown was almost 10%, higher than the the Houston rate of
8.4%.41
EMPLOYMENT CHARACTERISTICS FOR SHARPSTOWN
Sharpstown Count
Houston
PercentCount
Percent
Total
50,402
1,605,215
34,803
1,092,988
68.1%
34,787 69.0% 1,092,230 68.0%
31,382
62.3% 1,000,486 62.3%
3,405 6.8% 91,744 5.7%
16 0.0% 758 0.0%
512,227 31.9%
In Labor Force
Civilian Labor Force
Employed
Unemployed
Armed Forces
Not in Labor Force
Percent Unemployed
69.1%
15,599 30.9%
9.8%
8.4%
Data Source: US Census Bureau, American Community Survey, 2007-2011.
42
Alief Neighborhood
Alief is located in the City of Houston, Harris County and includes the Alief Independent School District.
Alief is located in far southwest Houston. It is bordered by the Fort Bend county line on the south, the
Sam Houston Tollway to the east, Westpark Tollway to the north, and Highway 6 to the west. The Alief
Independent School District serves the majority of the Alief Super neighborhood area.
Land Use Map
43
PUBLIC FACILITIES LOCATED IN THE ALIEF AREA
44
Population
The population by age for Alief has increased significantly for all age groups and is displayed
in the table below.42
Alief Population by Age Group
2000
2012
Age
Number
Percent
Number
Percent
Under 5 years
3,764
9%
5,060
8%
5-17 years
9,619
23%
13,916
22%
18-64 years
26,346
63%
40,482
64%
65 and over
2,091
5%
3,795
6%
Data Source US Census Bureau 2000. American Community Survey, 2008-2012.
Education
Three out of the four educational status indicators for Alief have declined from 2000 to 2012. Although,
there has been a moderate increase in the percentage of the population in Alief obtaining a High School
Diploma there has also been a slight increase in the percentage of population with no high school diploma.
EDUCATIONAL STATUS FOR ALIEF
Alief Houston
200020122000 2012
Educational Status
No Diploma
28%31%30%25%
High School Diploma
22%28%20%22%
Some College
29%24%23%24%
21%16%27%29%
Percentages may not add up to 100% due to rounding.
45
According to the US Census bureau 53% of the homes in Alief were built between 1970-1979. Forty-
seven percent of households were owner occupied and 53% were renter occupied.
The median household income for Alief has decreased $2,483 from 2000 to 2012. Interestingly enough
the median household income for Houston has increased $8,032 in the same period.
HOUSEHOLD CHARACTERISTICS FOR ALIEF
Alief Houston
2000
2012
2000 2012
Total Households
30,990 30,753 717,945 773,450
Family Households
76%
74%
64%
61%
33,067
36,443
782,378
902,153
Households
Housing
Total housing Units
Occupied
94% 84% 92% 86%
6%
16%
8%
14%
Under $25,000
31%
32%
33%
28%
$25,000-$50,000
38%
35%
31%
26%
$50,000-$100,000
25%
25%
24%
26%
Over $100,001
6%
8%
12%
9%
$37,237
$36,616
$44,648
Vacant
Income
$39,720
46
Language
LANGUAGE SPOKEN IN ALIEF
In Alief, 51% of children
ages 5-17 are Spanish speaking.
Thirty-three percent of adults
65 years and older speak a
language other than English or
Spanish.
100%
90%
13%
25%
80%
51%
42%
50%
9%
46%
38%
33%
21%
40%
72%
30%
20%
10%
9%
19%
70%
60%
5%
36%
33%
5-17
18-64
46%
48%
65+
5-17
53%
0%
18-64
Alief
 English
65+
Houston
 Spanish
 Other
Employment
In 2011, the unemployment rate for Alief was 9.5%, higher than the Houston rate of 8.4%.43
EMPLOYMENT CHARACTERISTICS FOR ALIEF
Alief
Count
Total
In Labor Force
Houston
Percent
74,881
Percent
1,092,988
68.1%
51,626 68.9% 1,092,230 68.0%
Employed
46,734
62.4% 1,000,486 62.3%
Unemployed
4,892 6.5% 91,744 5.7%
Armed Forces
20
Not in Labor Force
Percent Unemployed
51,647
Count
1,605,215
69.0%
0.0%
23,234 31.0%
758
512,227 9.5%
0.0%
31.9%
8.4%
47
Gulfton Neighborhood
Gulfton is located in the City of Houston, Harris County and is part of the Houston Independent School
District. Gulfton is located just outside of Loop 610, in southwest Houston, south of US 59.
Land Use Map
48
PUBLIC FACILITIES LOCATED IN THE GULFTON AREA
49
Population
The population by age for Gulfton has increased significantly since 2000, and is displayed in the
table below.44
Gulfton Population by Age Group
2000
2012
Age
Number
Percent
Number
Percent
Under 5 years
5,101
11%
4,218
11%
5-17 years
8,810
19%
7,286
19%
18-64 years
31,531
68%
25,692
67%
65 and over
927
2%
1,150
3%
Source: City of Houston Planning and Development Department. Data Source US Census Bureau 2000.
American Community Survey, 2008-2012.
Education
All of the educational status indicators for Gulfton have improved from 2000 to 2012 with the exception
of a slight decrease in the percentage of the population receiving a Bachelor’s degree or higher.
EDUCATIONAL STATUS FOR GULFTON
Gulfton
Houston
200020122000 2012
Educational Status
No Diploma
56%47%30%25%
High School Diploma
16%21%20%22%
Some College
13%18%23%24%
16%15%27%29%
50
According to the US Census Bureau 53% of the homes in Gulfton were built between 1970-1979. The
median household income for Gulfton has increased $6,358 from 2000 to 2012 as compared to $8,032
increase for Houston during that same time period.
HOUSEHOLD CHARACTERISTICS FOR GULFTON
Gulfton Houston
200020122000 2012
Households
Total Households
Family Households
15,659 13,307 717,945 773,450
63%
61%
64%
61%
17,467
17,012
782,378
902,153
Housing
Total housing Units
Occupied
90% 78% 92% 86%
10%
22%
8%
14%
Under $25,000
51%
44%
33%
28%
$25,000-$50,000
34%
34%
31%
26%
$50,000-$100,000
13%
17%
24%
26%
Over $100,001
3%
4%
12%
9%
Vacant
Income
$25,069$31,427 $36,616$44,648
51
Language
LANGUAGE SPOKEN IN GULFTON
In Gulfton, 78% of children
ages 5-17 and 71% of people
between the ages of 18-64 are
Spanish speaking. Twenty-four
percent of adults 65 years and
older speak a language other
than English or Spanish.
100%
6%
13%
90%
5%
9%
46%
38%
24%
19%
80%
70%
60%
50%
32%
78%
71%
40%
72%
30%
16%
16%
5-17
18-64
53%
48%
44%
20%
10%
9%
0%
65+
5-17
18-64
Alief
 Gulfton
Employment
65+
Houston
 Spanish
 Other
In 2011, the unemployment rate for Gulfton was 9.1%, higher than the rate for Houston at 8.4%.45 A
significant proportion of the population in Gulfton is working, when compared with Houston. This is, in part,
related to the younger population living in Gulfton, with only 3% of the residents over age 65.
EMPLOYMENT CHARACTERISTICS FOR GULFTON
Gulfton
Count
Total
In Labor Force
PercentCount
29,008
Percent
1,605,215
1,092,988
68.1%
22,321 76.9% 1,092,230 68.0%
Employed
20,295
70.0% 1,000,486 62.3%
Unemployed
2,026 7.0% 91,744 5.7%
22,370
Houston
Armed Forces
13
Not in Labor Force
Percent Unemployed
6,638 77.1%
0.0%
22.9%
758
0.0%
512,227 31.9%
9.1%
8.4%
52
Qualitative Community Health Assessment
PREPARED BY DR. PEGGY GOETZ
-------------May-August 2015-------------
53
Neighborhood/Area Specific Information and History
This assessment includes three large neighborhoods in southwest Houston. Although they are contiguous,
they are distinctive regarding the social determinants of health, their culture and their demographics.
Gulfton
The histories of the Gulfton, Sharpstown, and Alief neighborhoods closely reflect the times and history
of Houston, and explains much of the current local context.
Gulfton, the smallest of the three neighborhoods at 2.8 square miles, is bounded by S. Rice Ave to the
east, Interstate 69/U.S. Highway 59 to the north and northwest, Hillcroft Street to the west and Bissonnet
Street to the south.
Originally an orchard, Gulfton was eventually platted for homes on an acre or more of land, creating
large blocks, rather than more traditional sized lots. The blocks were eventually purchased in the 1970s for
construction of large two-story apartment complexes. These complexes targeted the influx of young singles
working in the oil boom years of the late 1970s and early 1980s. Bust followed boom and in the mid-1980s
these apartments became vacant as companies laid off workers.
This coincided with the civil wars in Central America and a large influx of immigrants into the Houston
area. Managers became more lenient when it came to occupancy laws, and the required deposits. In just
a few years what had been a white, single, American born, English speaking neighborhood, became an
Hispanic, foreign born and Spanish speaking immigrant family community.
Gulfton is the most densely populated neighborhood in Houston, with 13,502 persons per square
mile. In comparison, the average person per square mile for Houston is 3,766. One apartment complex
with 500 units is home to over 2,000 people. Gulfton’s residents see the people who share a common
language, as a positive influence, and on the other hand, they perceive problems related to overcrowding
as a negative influence.
The apartments were built for the short term, without thought to long term sustainability or the creation
of a functional community. Over the last 10-15 years much has changed with improved health, social
services, schools, and local businesses. However, much of the good and bad perceptions of the neighborhood
find its roots in the history of the neighborhood.
Sharpstown
The Sharpstown neighborhood is the second in size, at 8.5 square miles, and is bounded to the north by
the Westpark Tollway, the south by Interstate 69/Highway 59 and Bissonnet Street, the west by Beltway 8
and the east by Hillcroft Street.
54
The development of Sharpstown is in sharp contrast to Gulfton’s. Well thought-out and constructed,
Sharpstown was the first master planned community in Houston and was dedicated in 1955. Frank Sharp,
the developer, included schools, parks, and shopping in the design, which was quite novel at the time. The
Sharpstown Country Club Golf course had five lakes, complete with stocked fish, such as bass and perch. In
1965 the Houston Golf Open was held there.
Just six years later, the Sharpstown stock fraud scandal broke, with Frank Sharp at its center. By 1972,
top state officials were indicted, convicted and the political careers of many others were ruined. The Security
Exchange Commission’s indictment caused a run on Sharp’s Sharpstown Bank, which led to its failure, which
at that time, was the largest in FDIC history. One lasting local result was the purchase of 2/3 of the Country
Club by the City of Houston, now named the Sharpstown Golf Course and Community Center. The 1980s
and 1990s saw “white” flight as residents moved to newer developments in the suburbs, such as Sugar
Land. Today, the neighborhood has original residents, along with new families living in well maintained single
family homes. Primarily immigrants rent the apartment complexes, located along Bellaire Boulevard and
Harwin Street. The current population by ethnicity/race is 55% Hispanic, 15% White, 14% Black and 17%
Asian and Other.46
Alief
Alief, the largest of the three neighborhoods, at 14.1 sq. miles, is bordered by Westheimer to the north,
Sam Houston Tollway (Beltway 8) to the east, the Fort Bend County Line to the west and Interstate 69/U.S.
Highway 59 to the south. Until the 1970s Alief was primarily pastureland and a separate city from Houston.
Many people moved to Alief due to the growth of Houston and the oil boom of the 1970s and 1980s. In 1977
Houston began annexing sections of Alief.
During the 1970s, the migration pattern in Houston continued to change. Like residents in Sharpstown,
many White residents moved to the newer suburbs, such as Sugar Land. Minorities who could not afford to
do so, moved to Alief. The racial/ethnic diversity has continued to grow there. The population shifted from
80% white in 1978 to a current mix of 10% White, 24% Black, 19% Asian and 46% Hispanic. Like Gulfton,
the housing stock is primarily from the 1970s and 1980s and showing wear.
55
Key Informant Interviews
Key Informants for Sharpstown, Alief and Gulfton included twelve individuals from the following sectors:
Sector
Neighborhood
GenderAgeRace/Ethnicity
Political
Sharpstown
Female30sWhite
Political
Gulfton
Female30sHispanic
Health
Sharpstown
Female30sBlack
Health
Gulfton
Male
40sAsian
Police
Gulfton
Male
50sHispanic
Voluntary/Grassroots Sharpstown
Female60sWhite
Religious
Alief
Male
30sWhite
Religious
Gulfton
Male
60sHispanic
Religious
Gulfton
Male
50sHispanic
Individual
Sharpstown, Gulfton
Female
60s
Hispanic
Social Services
Sharpstown
Female
60s
White
Social Services
Sharpstown, Gulfton
Female
30s
Hispanic
Individuals were invited to participate based on the investigators’ existing networks and through
established contacts. All who were invited to be Key Informants agreed and were subsequently interviewed.
ProSalud works with community health workers (CHWs)/promotoras in the target neighborhoods. Seven
certified CHWs who work or volunteer with ProSalud were trained as local investigators. They recruited the
community participants and facilitated all six community participatory group sessions.
56
Language
Sex Age
Ethnicity
Preferred Language
Local Investigator 1
F
30s
Hispanic
Spanish
F
30s
Hispanic
Spanish
F
30s
Hispanic
Spanish
F
30s
Hispanic
Spanish
F
40s
Hispanic Spanish
F
60s
Hispanic
Spanish
F
60s
Hispanic
Spanish
Analysis Methodology
Key Informants
Episcopal Health Foundation’s Community Engagement Officer, Troy Bush, and the Sharpstown, Alief
and Gulfton (SAG) study investigator, Dr. Margaret Goetz, jointly interviewed the Key Informants, with the
exception of a few interviews due to primary language preference or scheduling. Roles of note taker and
interviewer were alternated between Mr. Bush and Dr. Goetz. Notes were typed as soon as possible after
the interview.
Participatory Groups
Mr. Bush and Dr. Goetz trained the Local Investigators to code their notes for the participatory group
sessions. The notes for the six sessions were divided into three groups of two sessions each and each group
was assigned two promotoras. For each community participatory group session, the promotoras alternated
roles of facilitator, co-facilitator and note takers. The promotoras coded all the notes taken for the assigned
sessions. After they completed the individual coding, the promotoras came together to discuss their findings
and major points of the participatory groups.
QUESTION 1. If a family you knew wanted to move into this neighborhood what would
you tell them about this neighborhood?
In all three neighborhoods, the strongest responses included:
a) “diversity” – of cultures, races, languages, immigrants
b) accessible centers with different resources for various groups, being described by one K.I.
as “good for first-timers (immigrants)”
c) affordable – especially housing.
For Sharpstown and Gulfton, good schools, neighborhood improvements, and improved safety were the
strongest responses. One Sharpstown Key Informant noted that their City Councilman is a strong asset.
Two Gulfton Key Informants warned about crime and unsafe apartments and one of them also noted that
parents are not involved in their children’s formal and informal education.
57
The Key Informants’ responses are grouped together in the table below.
S,A,G
S,G
S
G
Diversity
Good schools
City Councilman
very supportive of
neighborhood
Some apartments unsafe
Accessible
resource centers
Neighborhood
improvements
Violence/crime
Affordable
Improved safety
Good for “first timers” immigrants and refugees
Job opportunities
Parents’ lack of
involvement in
children’s’ formal and
informal education
QUESTION 2. What would you say are the strongest and best qualities of this community?
What are some of the good things about living in this community for you?
58
S,A,GS,G
G
Diverse
Services for immigrants
Multi-cultural
Churches
Businesses by foreign businessmen
Like a little town – can walk to almost anything you need
Their language
is spoken
METRO
Central to other Houston areas
Job, home, and/or school
all close by
Has grown for good
High trust level of
some centers
Eager for adult education
(language, training)
School options (pre-K -12th)
QUESTION 3. Think about the problems you see in the community. If you had the power
to solve all the problems in your community in a short time what problems would you address?
What would you say are the most serious needs in this community?
S,A,G
S,A
S,G
G
Education – all
ages for civility,
rights and
responsibilities
Poor street
repair
No respect for
shared-space trash
Increase selfsufficiency
(read, write, how to ride
bus, etc.)
No afterschool
activities for
youth – ripe for
gangs
Poor parenting
Unemployment
Domestic violence
Crime –with high
population density
comes more
vandalism,
robberies
Business opportunities;
lack of jobs
Immigrants vulnerable
to robberies
Psychological trauma
after robbery, nowhere
to go for treatment
Lack of connection
to neighbors –gangs,
robbery
Need more police
patrols and real time
communication of
community with police
Increase workforce
connections for dropouts,
under skilled, and those
with criminal background
Prostitution
Education – ESL
Lack of child care –
so women can keep
clinic appointments and
take care of themselves,
access other services
59
QUESTION 4. What would you say stands in the way of dealing with these issues?
S,A,G
S,G
G
S
Funding
Undocumented
status
Community meetings
where people talk
about why something is
important to them
Lack of agencies that
help with Harris Health
Financial Assistance
Application and provide
one-on-one education
about how to access
health resources
Lack of interagency
communication
Lack of space
for ESL
Focused on just surviving
Education – GED,
training, good
citizenship, behavior
Lack of
understanding;
how no GED,
no English
means one is
not a candidate
for workforce
programs
Lack of common
language between
people and all
categories of
providers
60
QUESTION 5. When you think about the people who live and work in this neighborhood,
what do you think are the biggest health concerns for them?
S,A,G
S,G
G
Diabetes
Self-medicate (buy or
share prescription meds)
Dental – too expensive
High blood pressure
Mental health*
Lack of physical activities and
clean parks and park facilities
Few have doctor/primary care
or have screenings, so don’t
know if they have an illnesses
until it’s obvious
Their children’s health
Stress
Eating habits
Obesity
*One responded that they don’t know where to go, or that it is too expensive or don’t have time. Also, one responded
that people don’t consider it an illness “because an illness is when something hurts in my body.”
QUESTION 6. When there is a health problem, either mental or physical, where do people
in the neighborhood get help?
S,A,G
S,A
G
Harris Health
Clinics:
Vallbona
El Franco Lee
Legacy
Mom and Pop clinics*
ER – Memorial
Hermann
Southwest or
Ben Taub
General Hospital
Ibn Sina
Need a place for divine healing
(prayer ministry)
City of Houston Southwest
Multi-Service Center –
they can direct the person
Busy Bee
Legacy for mental health
Dental – don’t know;
is low priority
*Three Key Informants from medical, religious, and social service backgrounds said independently that the quality of care
is unknown or very poor.
61
QUESTION 7. If individuals, groups or agencies could work together to improve the health
and well-being of this community, who do you think should participate in that effort?
S,A,G
S,G
G
“Everyone” -profit, and
non-profit, UTHSC dental,
optometry, nursing,
HBU, BCM
Most of agencies and
city and county services
already working together
Churches, businesses and schools
– Not agencies because they’re
thinking about how they can grow
SuperNeighborhood
Councils
Legacy, Houston Health Dept.,
Harris Health System, Vallbona
Clinic, Bo’s Place, FQHCs, Harris
County Youth Service, West Oaks
Hospital, Houston Area Urban
League (business and other
services), United Way, mental
health resources for all ages
Everyone who serves
families
NCI Baker Ripley where
community trust is high
School system, financial
system, housing
system, health system,
neighborhood centers,
Catholic Charities, United
Way, NCI, Jewish Family
Services, others
62
QUESTION 8. If you were advising a group interested in improving the health and wellbeing of this community, where would you recommend that they begin their work in further
developing the potential of this neighborhood?
S,A,G
S,A
G
S
Help families
“take ownership”
Social organizations
to decrease families’
intimidation that they
feel with our medical
system before they
go to doctor, clinic,
hospital, etc.
They’ve done the
studies, now they
need to put their
mission and vision
into practice
Have City Councilman
convene meeting
so it is not one
agency convening
and leading it
More information
about preventive care,
more holistic care –
not just grants about
a specific thing
Work with existing
classes and develop
topics from the
students’ interests
Safety
People who use
your services and
Community Health
Workers can get
information to the
people
Beautification
Healthier food options,
especially for
“fast food”
Front desk
receptionists to
smile, give each
person time, explain
things clearly and
slowly
Better and more
Spanish speaking
services
Crime – loitering,
prostitution
Work with apartments
and apartment
managers
Confusion between
SWMSC and NCI
B-R
Churches
SWMSC, City
Councilman, State
Rep – focus on family
building, empowering
youth, seniors, overall
health
63
Participatory Community Groups by Neighborhood
GULFTON
What Is Community?
 A group of diverse persons who live in the same area and who have good communication
with one another
 Where there are public services, community centers, stores, businesses, parks, churches,
and security
What is Health?
 Personal well-being / To be physically, mentally, emotionally and spiritually well
 Positive personal habits: healthy eating, exercise, good sleep, visiting the doctor, being happy
 It is not having vices – like smoking, drinking, and drugs
 Not being stressed
 “It is where poverty is not a barrier to seeing a doctor”
What is Healthy in Your Community?
 People treating each other well
 Recreation areas like parks, swimming pools, gyms; plants and trees
 (Major theme is people getting along and parks& recreation)
 Churches
 Services such as clinics, schools, including health education classes for parents; they offer,
after-school programs, safety (police), emergency clinics
 Trash goes where it belongs
 Work
What is Not Healthy in Your Community?
 Environmental
Pollution
 Trash and garbage everywhere
 Streets and apartments in bad repair
 Pests and stray dogs
 Human
Vices
●
Drugs and drug dealers
●
Smoking
Crime
64
●
Prostitution
●
Gangs
●
Human Trafficking
●
Lack of safety
 Personal Habits
●
Throw garbage everywhere
●
Don’t call police when they see a problem or crime in progress
What Keeps Your Community from Being Healthy?
 Environmental or Structural
 Undocumented status
 Low income, no jobs
 Old apartments
 Bars close to schools
Pests
 High rents
 Lack of information
Garbage
 Wastewater drains dirty and in poor repair
 Human
 Ourselves – we say we want something but we don’t do anything, not motivated
 Lack of information or communication
 Lack of civility
 Fear of retaliation by criminals if report incidents to police
 Fear to leave home (personal safety)
Racism
Language
What Do You Do that is Not Healthy?
 Unhealthy eating habits
 Fast foods
 Drink sodas, coffee, alcohol
 Tacos, papusas, tamales, too much fat
 Bad Habits
Smoking
 Don’t exercise
 Criticize people
 Don’t sleep well
 Lack personal and home cleanliness
65
What Do You Do that Is Healthy?
 Buy, cook and eat healthy foods
 Exercise
 Go to doctor
 Personal hygiene
 Do things with family and friends
 Go to church
 Be positive
What Keeps You from Doing Healthy Things?
 Procrastination or lack of motivation
 No Time
 Too much work
 Poor time management
 Watch TV
 Time on cell phone
 Depression, stress
 No safe places to exercise
SHARPSTOWN
What is Community?
 Made up of people (from different countries )
 People know each other, share, get together
 Where there are services
 Where people talk about community problems and what to do
 Where people feel good
 A geographic area
What is Health?
 Tied to personal or family’s well-being and health
 To feel well physically and mentally (spiritual health only mentioned once)
 Health is split 50/50 between being physically well and absence of illness
 To live in harmony (with family and community)
 To practice good health habits (exercise, eat well, sleep, check-ups, good attitude, hygiene)
66
What is Healthy in Your Community?
 Natural environment
 Trees, parks, plants
 Built environment
 Community centers, shopping centers, clinics, WIC, library,
schools, pharmacies, potable water, street lighting
 Keeping it clean
 Human
 Friends, family, nice neighbors
 Living in harmony with neighbors
 Medical services in Spanish
 No mention pro or con of police, security
What is NOT Healthy in Your Community?
 Environment
 Dirty neighborhood
 Noisy (can’t sleep)
 Lack of schools, health centers
 Vices
 Prostitution (particularly disliked because their children see it and
husbands can infect their wives)
Drugs
Alcohol/drunks
Smoking
 Individual
 Do not call police with reportable offenses - sometimes for fear of criminals’ retribution
Gangs
 Child abuse
 Community Level
Discrimination
●
Lack of documents
●
Feeling as if they have no value
●
Poor wages/no jobs/no income
Gangs
Garbage/trash
 Lack of information/communication
 Do not meet or attend community meetings (to discuss problems)
 Individual/Family Level
 No civility (polite, respectful, minimum of social requirements) this is major theme
67
●
As individual
●
Not taught to family members, especially children
 Family discord, especially regarding family plans
 Lack of communication within family
 Lack of information
What Do You Do that is NOT Healthy?
 Lifestyle (* - most frequently mentioned)
●
Lack of self-discipline/schedule
●
No eating schedule *
●
Lack exercise*
●
Sleep schedule
●
Do not make and/or do not keep doctor’s appointments
Nutrition
●
Poor food choices
●
Fast food
●
Drink – sodas, alcohol, coffee
Vices
●
Smoke
●
Drugs
●
Alcohol
 Personal
 Mental Health – worry, get angry
 Physical Health
●
Self- prescribe medicines
●
Doctor’s appointments – none
What Do You Do that IS Healthy?
 Lifestyle
 Healthy eating and cooking
 Hygiene (personal, home, food)
Exercise
 No drinking or smoking
 Personal
 Mental Health – being friendly (very important), patient
 Spiritual Health
 Physical Health
●
Keep doctor’s appointments
●
Take meds correctly
 Reading and being informed
68
 Insufficient money
 For healthy food
 To see doctor
 Linked to undocumented status
 Apathy, indolence, lack of discipline
 Work
 Lack of Time
 Technology (“the new technology interrupts the harmony of our lives”)
 Cell phones
TV
Computers
 Transportation, lack of
ALIEF
What Is a Community?
 A geographic area
 People
 Communicate with each other/get information
 Take care of one another
What Is Health?
 Personal
 To be happy
 “What I ask God to give me”
 To be able to work
 To live in harmony
 Community
Clean
Safe
What IS Healthy in Your Community?
 It’s clean
 Parks, yards, trees, flowers
 Streets maintained
 Harmony among ourselves
 People who look for what the community needs
69
What Is NOT Healthy in Your Community?
 Built Environment
Potholes
 Poor drainage (storm water)
 Animals
 Dogs/cats run over and left in streets
 Mosquitoes (no spraying)
Cockroaches
 Human
 Throw tires on sides of roads
Garbage/trash
Speeding
 Loose dogs
 Human
 Lack of cooperation among neighbors
Gangs
 Lack of communication/information
 Don’t go to meetings
 Leave trash/garbage
 Environment
Rats
 Standing water
 Mud (when rains)
 Structural
 Homeowners association does not send information
 Authorities don’t respond to our complaints
 Lack of safety/security
 Don’t spray for mosquitoes
What Do You Do that is NOT Healthy?
 Lifestyle (*-most frequently mentioned)
 Lack of self-discipline/schedule
●
Eating schedule*
●
Sleep schedule*
●
Doctor’s appointments
Nutrition
●
Poor food choices (too much, unhealthy foods, sweets)
●
Fast food
●
Don’t drink water
70
 Exercise –don’t
 Watch a lot of TV/sedentary
 Poverty
What Do You Do that IS Healthy?
 Lifestyle
 Healthy eating and cooking
 Hygiene (personal, home, food)
Exercise
 Personal
 Mental Health – being friendly, laugh, socialize, listen to music, read
 Physical Health
●
Keep doctor’s appointments
 Apathy, indolence, lack of discipline
 Lack of time
 Mental health concerns
 Stress (and stress eating, drinking sodas, coffee)
Isolation
 Worry (“don’t want to do anything” “just stay in bed or on the sofa”)
Sad
 Physical health concerns
 Aches and pains in knees, feet, body
Insomnia
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BOARD WORK BY COMMUNITY GROUPS
Following the participatory group sessions, the groups addressed some of the community problems that
were identified. During this facilitated discussion, they offered their solutions.
GULFTON
1)Problem – DISCRIMINATION
Solutions:
(a)
Language
- Learn English
(b)
Among ourselves (Latinos)
-
Take care of each other
-
Advertising campaign (for those who suffer discrimination)
(c)Train staff at clinics and stores better (this is not merely language, but an
attitude to take time with and help clients as individuals) “When I’m
discriminated against it makes me feel bad and lowers my self-esteem”
(d)
Better understand staff
(e)Respect and communicate better with HPD and Metro
(f)
Grievances
-
Learn how to make a complaint
-
Learn where to lodge a complaint
-Use Facebook
2)Problem – COMPLAINTS IGNORED OR SOLUTIONS NOT FOUND
Solutions:
(a)
Among Ourselves
-Must work together
-Support each other
-Communicate among ourselves
-
Social networks – like Facebook
(b) In Community – racist police and metro drivers
-
Report them so they can change their behavior with the community
-
Negative PR so supervisors hear and take corrective action
3)Problem – LACK OF SECURITY
Solutions:
(a)
Human
-
Police patrol for problematic areas
-Apartment security services
72
-Report problems
-
Refer addicts to corresponding services
(b)
Technical
-Surveillance cameras
-Apartments
-Parks
(c)
Systems
-Background checks on renters
-Gun control
4)Problem – RUNDOWN APARTMENTS
Solutions:
(a)
Personal
-
Tenants keep their apartments and areas clean
-Be a good example
(b)
Apartments
-Get new managers
-Improve maintenance
-Eliminate pests
-Improve services provided
-Remodel the apartment
(c)
Political
-Talk with our representatives
-Call the mayor
-Call the city
-Have marches/demonstrations
5)Problem – IGNORANCE/ LACK OF CIVILITY
Solutions:
(a)
Education
-Personal
•
Read, study more
•
Early education in the home
•
Be a good example for children
•
Talk with people
-Institutional
•
More community centers
•
Head Start Programs
•
Vocation programs
•
Publicity/fliers
73
6)Problem – NEED COMMUNITY CENTERS/COMMUNITY SERVICES
Solutions:
(a)
Identify resources
-
Unified community members
-The Mayor
(b)
Built resources
-More schools
-Family Parks
-Sports
-Childcare facilities
(c)
Programing needs
-All ages
•Addiction
•
Help for people of all ages including help filling out forms
•
Volunteer programs
•
GED, ESL, computer
-YOUTH
•
Programs for youth
•
Field trips for children, youth
•
After-school programs
•
Camping programs
7)Problem – ALCOHOLISM AND DRUG ADDICTION
Solutions:
(a)
Personal
-
Hold meetings with addicts in the neighborhood
-Educate children
-
Hand out cards with information on support services
-Invite to church
(b)
Professional
-Rehabilitation centers
-Professional therapies/counseling
-Media advertising
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-
Moderate the sale of alcohol
SHARPSTOWN
1)Problem – APARTMENTS POORLY MAINTAINED
Solutions: SHINE A LIGHT ON IT
a) Communicate verbally, in writing, and as a group with
- Manage
- Main office(owner)
- City
- Local TV channels
(b) Document with photographs to use with
-Mayor
-Lawyers
-
Local Spanish language TV channels
2)Problem – LACK OF COMMUNICATION
Solutions:
a)
Attend community meetings
b)
Get involved
c) Be friendly with everyone
d) Information fairs re: employment, education, school supplies, food
3)Problem – LACK OF TIME
Solutions:
a)
ORGANIZE TIME
-Get up earlier
-
Make a list of priorities
-Have a schedule
-Reminders
b) Procrastination (“Decidia” is the Spanish word. Also connotes lack of
willpower, laziness)
-Motivation
-
Do things as soon as possible
c) FACEBOOK - INTERNET - TV
-
Schedule time to use it
-
Know how to use it
75
4)Problem – GARBAGE
Solutions:
a)
PERSONAL
-
Raise awareness to put garbage in its place
-We pick up garbage
•
keep ourselves and homes clean
•
trash containers
-recycle
•apartments
•homes
b)
STRUCTURAL /COMMUNAL
-
Sanctions on those who don’t comply with putting garbage in its place
-Apartments
•
communicate with managers
•
parking lots clean
•
pick up dog poop
•
pick up alcohol containers
-Parks
•
pick up garbage
•
pick up alcohol containers
ALIEF
1)Problem – STAGNANT WATER
Solutions:
a) Call authorities to which this corresponds (311)
b) Take pictures where there is the problem
c) Notify the office of the manager or a neighborhood partnership
d) Try to keep clean your area, your house, your apartment, etc.
2)Problem – VANDALS
Solutions:
a)
Call the police
b) Mutual aid with neighbors
c) No weapons (do not arm the community)
d)
Be alert
76
e) Find out the telephone number of local police – don’t just call 911
3)Problem – LACK of COMMUNICATION
Solutions:
a) Talk more among the community
b) We want to be heard/to be listened to
-Among ourselves
-Among neighborhood associations
-Among apartment managers
-
Among authorities of the county and city
c)
Meet
-With community
-With authorities
d) Find out who to go to for specific problems
4)Problem – PHYSICAL COMPLAINTS/PAIN THAT KEEP YOU
FROM EXERCISING (BEING HEALTHY)
Solutions:
a)
Individual
-Visit the doctor
-
Go to the herbalist
-
Take medicine as prescribed
-
Motivation (to do above and other healthy things)
b)
Communal
-
Spread the work-about health resources and what you can do to be healthy
c)
Structural
-
Community clinics – so cost is not a factor
77
INDIVIDUAL WORK IN COMMUNITY GROUPS
GULFTON
WHEN I AM SICK
I GO TO:
SHARPSTOWN
ALIEF
Clinic 1
Clinic 1
Ripley NW, TC Jester 1
Ripley NW, TC Jester 1
Legacy Clinic 1
Legacy Clinic 1
Dr. Ciro Porras 1
Doctor 10
El Franco Lee Harris
Health 4
BTGH 4
Clinic Vallbona 1
Harris Health 1
Legacy Clinic 2
Pharmacy 3
Clinica Familiar 1
Clinica del Pueblo 1
Hospital 2
The Good Samaritan
Clinic 1
Clinica de Amigos 2
Dr. Albino 1
Doctor 3
No one 3
Clinic Vallbona 1
Hope Clinic 2
Harris Clinic 1
Dr. Sanchez 1
GULFTON
WHEN MY CHILD
IS SICK I TAKE
HIM TO:
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SHARPSTOWN
ALIEF
Doctor 4
Doctor 5
Doctor 6
BTGH 3
BTGH 2
BTGH 5
Clinica de Amigos 1
Pediatrician/Clinic 4
Clinic 3
Casa de Amigos 1
Legacy 1
Legacy 2
Clinic Vallbona 1
Memorial Hospital 2
Memorial Hospital 1
Texas Children’s 2
Texas Children’s 1
Clinica Mi Doctor
Dr. Sanchez Burgos 1
Hope Clinic
Hospital 1
Dr. Portocarrero 1
Dr. Juan
Dr. Safaeda 1
Clinic at Bellaire &
Dairy Ashford
Dr. Gonzalez 1
Dr. Harrison
Dr. Sanchez Burgos
Pedi Benhurt
Dr. Porras 1
Dr. Porras 1
GULFTON
WHEN MY
FRIEND IS SICK
I TELL HER
TO GO TO:
SHARPSTOWN
ALIEF
Doctor 2
Doctor 2
Doctor 1
BTGH 4
BTGH 3
El Franco Lee Clinic 2
Memorial Hermann 1
Memorial Hermann 1
Legacy 4
Hospital 1
Clinic 1
Clinic on Bellaire
and Hillcroft 1
Vallbona Clinic 3
Legacy 2
Casa de Amigos 1
Legacy 2
Dr. Porras 1
GULFTON
WHEN MY
FRIEND’S
CHILD IS SICK
I TELL HER
TO GO TO:
SHARPSTOWN
ALIEF
BTGH 2
BTGH 2
Hospital 1
Hospital 1
Hospital 1
Legacy 1
Legacy 2
Memorial Hospital 1
Clinica del Pueblo 1
Legacy 2
TCH 1
Doctor 1
Vallbona Clinic 1
Clinic 1
Dr. Ciro Porras 1
TCH 1
Clinica Comunitaria 1
Clinic 2
Clinic at Bellaire &
Dairy Ashford 1
Doctor 1
Doctor 2
Pharmacy 1
GULFTON
WHEN I HAVE
A TOOTACHE
I GO TO:
SHARPSTOWN
ALIEF
The Dentist 8
The Dentist 3
The Dentist 3
Take pain med 1
BTGH 2
Harris Health 1
Clinic 1
Legacy 3
Clinic at Bellaire & Hillcroft 1
Take pain med 2
Texas Dental 1
Vallbona Clinic 2
South Texas Dental 1
University Dentist 1
Casa de Amigos 1
Bissonnet Dental 1
Bellaire Dental 1
Home remedies 1
Take them out myself 1
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GULFTON
WHEN MY CHILD
HAS A TOOTHACHE
I TAKE HIM TO:
SHARPSTOWN
ALIEF
Dentist 5
Dentist 2
Dentist 2
They don’t have
toothaches 1
Legacy 1
They don’t have
toothaches 1
Pull it 1
ABC Dental 1
Castle Dental 1
Vallbona Clinic 1
Apple Dental 1
Wild Smile 1
Bellaire & Hillcroft 1
Bellaire &
Chimney Rock dentist
I’ve not taken them
to a dentist
Sharpstown
(City of Houston
Dental Clinic)
GULFTON
WHEN MY FRIEND
HAS A TOOTHACHE
I TELL HER TO GO:
SHARPSTOWN
ALIEF
Dentist 6
Dentist 3
Dentist 2
Legacy 1
Legacy 1
Apple Dental 1
Pharmacy 1
Sharpstown Dentist 1
Bellaire & Hillcroft Clinic 1
Doctor 1
ECHOS 1
Casa de Amigos 1
ABC Dental 1
Dental Clinic AM 1
Dental Quest 1
Dentist on Chimney
Rock 1
GULFTON
WHEN MY
FRIEND’S CHILD
HAS A TOOTHACHE
I TELL HER TO GO:
SHARPSTOWN
ALIEF
Doctor 1
BTGH 1
Doctor 1
Dentist 7
Dentist 2
Dentist 2
Legacy 1
Clinic 1
Apple Dental 1
ABC Dental 2
Bellaire & Hillcroft clinic 1
Bissonnet Dental
TCH 1
80
GULFTON
WHEN I NEED
HELP WITH MY
FEELINGS
I GO TO:
SHARPSTOWN
ALIEF
Psychiatrist 2
Counselor
Go to the park to run 5
Therapist 4
Talk with girl friends
“Go to the bathroom and
cry and ask God” 1
Church 3
School counselor 1
Pray in my room 1
AA 2
Pray
Talk with a friend 2
Ask my mother 1
Dr. Ochoa Legacy
Talk with my daughter 1
Lakewood Church 1
Clinic/Doctor
Kingdom of God
Church 1
“Fiesta Supermarket
to talk with my friends
and drink coffee”
Talk with people 1
Talk with parents and
ask them where to go
I don’t go anywhere
GULFTON
WHEN MY CHILD
NEEDS HELP WITH
HIS FEELINGS
I TAKE HIM TO:
ALIEF
SHARPSTOWN
Talk with him 2
Talk with him 2
Talk with him 4
Church 3
Prvt. Psychologist 1
To park 4
Therapy 3
Teacher at school 1
Hug & rock them 1
Lakewood Church 1
Dr. Ochoa Legacy 1
Carrillo 1
School 1
Doctor 1
Church 1
GULFTON
WHEN MY FRIEND
NEEDS HELP WITH
HER FEELINGS
I TELL HER TO GO:
ALIEF
SHARPSTOWN
Church 5
Legacy 3
Park 3
Therapy 3
Doctor 2
Church 1
Carillo 1
Apostle & Prophets
Church 1
Talk with a friend 1
Lakewood Church 1
Social worker 1
Pray 1
Kingdom of God Church 1
School counselor 1
AA 1
Clinic 1
Go find help 1
Counselor 1
Psychologist 1
81
GULFTON
WHEN MY
FRIEND’S CHILD
NEEDS HELP
WITH THEIR
FEELINGS I TELL
HER TO TAKE
HIM TO:
ALIEF
SHARPSTOWN
Talk with their parents 1
School 1
Talk with their parents 1
Church 5
Church 2
Petition God 1
Therapy 3
All talk together 2
All talk together 1
To look for help 1
School Counselor 1
School Counselor 1
Lakewood Church 1
Legacy 3
The park 1
Carillo 1
Private counselor 1
Kingdom of God Church 1
Doctor 2
Sharpstown participants consistently refer to the same or very similar sources for themselves and for
their friends. Gulfton and Alief participants’ referrals parallel those for self for physical illness and dental
questions. The referrals for mental health questions are similar, but not the same.
Recommendations
Recommendations and potential actions are very interrelated by both topics and level of response
(individual, community, political). For example, noticing the presence of gangs requires an individual to call
police to report suspicious behavior, and a political response of more police officers patrolling risky areas.
The thematic categories include:
1.EDUCATION
 Civility: Learn to respectfully share common space with others
Suggestion – Using a neutral convener, increase conversations among the community members,
like in this project so they can implement their suggestions. Examples include the start-up
of media campaigns; the engagement of school children to bring messages to parents; begin to
give block or apartment beautification awards; the establishment of alternatives to bars for men.
 Legal: Learn rights/responsibilities to family, neighbors, organizations and businesses.
Suggestion – Bring education about legal concepts to the community schools, churches,
apartment complexes, and clinics.
 General: Learn language, literacy, computer skills, GED.
Suggestion – Identify underutilized space, such as in elementary schools. Bring general
82
education to this classroom space.
2.COMMUNICATION
 The community:
Suggestion – Host more open, guided community meetings on an ongoing basis, such as those
held by EHF for this project. Ask the community to help in the design of an information strategy.
Work with other neighborhood groups that share similar concerns, such as Positive
Interaction Program of the Houston Police Department.
 Advocacy skills: Encourage the communities to speak clearly and effectively
on its own behalf:
Suggestion – Identify local Houston advocacy groups to lead workshops. Create community
accountability to monitor the advocacy efforts. Identify how to start a “train the trainer”
program for advocacy.
3. BUILT ENVIRONMENT
 Poor sanitation
Suggestions: Encourage community members, managers and apartment owners, local businesses, and city officials to improve sanitation (the process of keeping places free from dirt, infection, disease by removing waste, trash and garbage, and by cleaning streets.)
 Housing in poor repair
Suggestions: Use advocacy skills to improve general sanitation and safety. Keep the diversity
of the neighborhoods by anticipating possible gentrification by improving housing stock.
Research Avenue Community Development Corporation’s model in the Houston’s near north side.
 Public Spaces
Suggestions: Use advocacy skills to improve the city and county’s response to streets in
poor repair and insufficient or poorly maintained parks. Identify allies and find solutions with
other organizations in addition to local governments.
4. OUTREACH TO THOSE WITHOUT A REGULAR SOURCE FOR MEDICAL CARE:
Suggestions:
 Extend Hours for Family Practice, Internal Medicine: Explore use of current offices in
Baker-Ripley or extended hours Monday – Friday and Saturday. Explore use of pediatric exam
rooms in Legacy Southwest (there are roughly 4-6 rooms currently not used on Sat. and Sun.)
Consider using Fellows or 3rd year internal medicine or family practice residents to staff the
extra clinic hours, if there is inadequate coverage from Legacy doctors.
 Ask media to encourage undocumented children and adults to use FQHCs for check-ups
and for urgent care. Inform them that fees are based on a sliding scale and if possible,
provide an approximate cost.
83
 Offer screenings for diabetes, hypertension in community settings. Only consider this if Legacy
has a plan to receive the possible referrals in a timely and affordable way. Many of those
needing follow-up may not qualify for insurance either through ACA or Medicare or Medicaid.
5. HEALTH LITERACY
Suggestions:
 A need exists in the community to learn how the current medical system is organized
and how to access it. Additionally, individuals need to learn how to talk with the doctor,
manage their health record (diagnosis, medications, immunization and tests) and understand
prescriptions (how to take the medicine, refills, how to contact the pharmacy).
 In the Clinics: Explore use of technology in waiting areas of clinics for TV “ads” done by
Legacy’s own physicians and nurses about appropriate themes for each clinic. For example,
LSW Pedi could do an “ad” demonstrating reading; BR Dental could do an “ad” about stopping
sweet drinks, etc. These could be interspersed with regular programming that is streamed
over the TV. 2) Film parents and/or staff doing “x” healthy behavior (reading, exercising,
new baby care, seasonal topics like flu shots, “hot topics” like Ebola). Consider using local
school or university students to film and edit this project. It will be positive for the students
and broaden Legacy’s presence in the community.
 In the Community: Contract community health workers to work with community
members in a variety of settings, such as schools, apartments, community centers
and churches. Make this a community project that is sponsored by Legacy.
This allows the presenter to provide information on a variety of health services, not just
Legacy’s services. Additionally, if the community sees that Legacy provides this education
but does not “expect anything in return” it will build good will.
 Chronic Health Conditions: Explore partnering with the City of Houston Health
Department to hold classes for patients on managing chronic health conditions using
Chronic Disease Self-Management Program developed by Stanford University School
of Medicine. The City also. The classes should be held in a variety of locations and times, not just regular
clinic hours.
 Language Barriers: Explore the English as a Second Language curriculum to include
84
some key words or phrases for health communication.
6. HEALTH EDUCATION
Suggestions:
 Do not call it health education. The community knows the “right” answers and is not
interested. But if it is part of a fun class – 10 minutes during Zumba or an arts and crafts
class – or a class by a catchy name and different presentation it will have a better chance of
success. This education will have a multiplying effect as they share it with family and community.
Contract with community health workers for this.
 Groups: This could be on a variety of topics. A common theme in the community groups
was the lack of civility, and community members talking together may be a starting point
to address it and the isolation many feel. Also, a need exists for parenting classes for all ages.
Look at established programs, such as Adults and Children Together (ACT) Against Violence
developed by the American Psychological Association, which was reviewed and found to be
a promising primary prevention strategy that can be implemented across diverse community
settings. Also, look at programs for youth such as Media Savvy Youth: Eat, Think, Be Active
(National Institute for Child Health and Human Development), which has also been evaluated
and found to have positive effects on participants’ knowledge and behaviors.
 Target Vulnerable Groups: Work with providers and schools to identify children who have
recently immigrated to the USA, some of whom have not seen their biological mother for
many years. A second group is the child whose father is deported and their future is unknown.
These families are dealing with multiple stressors at once.
 Addictions: In the community meetings, there was frequent mention of people abusing
alcohol and drugs. Explore working through schools, specifically the School Health Advisory
Committee for HISD. Consider peer mentors, use of apps or “personal reminders”. Include
the new adolescent medicine doctor for this.
 Group Appointments: Group appointments for patients with similar age (For example,
follow a group of newborns from 2 weeks until 12 months) or similar condition (children or
teenagers with obesity). This allows for more education and time for parents to
share experiences.
85
Conclusion
Houston has never stood still. The original developers of Sharpstown, Alief, and Gulfton did not imagine
that in a relatively short time, people from so many other countries would call their neighborhoods home.
This study helps to understand the three neighborhoods at this point in time, and most importantly presents
the voices of the residents. A study that is based on community participatory research tenets, is an excellent
point of departure for the community and supportive organizations such as Legacy Community Health
Services and Episcopal Health Foundation to help to create a healthier future.
The community members understand that barriers to health are not simply going to see the doctor,
but include the identification of gangs, discrimination, the poor built environment, lack of after-school
programs. The community knows that much is out of their control, such as wages or immigration status.
The community members admit that sometimes they are reluctant to take action, but they also consistently
remarked on what they can do. It is now up to us to continue with them in their next steps.
86
Photovoice in
Sharpstown, Alief, and Gulfton
PREPARED BY KIMBERLY KAY LOPEZ, DRPH
-------------Summer 2015-------------
87
Photovoice in
Sharpstown, Alief, and Gulfton
Prepared by Kimberly Kay Lopez, DrPH
----------------
SUMMER 2015
-----------------
Background
Legacy Community Health partnered with the Episcopal Health Foundation (EHF) to conduct a
community health assessment in the Sharpstown, Alief and Gulfton (SAG) neighborhoods. As part of the
assessment, EHF sponsored a Photovoice project within the community. The purpose of the Photovoice
project was to document facilitators and barriers to health identified by residents of SAG and to provide a
platform for change within the community. The photographs tell a story and the goal of Photovoice is that
the story is captured and shared publically with change agents, policy makers and community advocates
to impact change.
As part of the assessment in SAG, the ProSalud Promotoras were trained to conduct participatory groups
with the community. For Photovoice, the promotoras recruited members from the participatory group and
from their outreach activities to take part in Photovoice. Fourteen community members were recruited for
Photovoice and eleven community members completed the project. There were ten women and one man,
ages ranged from 18-60. All participants spoke primarily Spanish, and had lived in the community from
2-24 years.
Photovoice Process
For the Photovoice project, participants attended three group sessions. The first session consisted of
gathering informed consent to participate, an overview of the community health assessment process, an
introduction to Photovoice, photography, cameras, and a review of personal safety and ethics. Participants
had the option to use a disposable film camera or to use their cell phone camera. Nine participants used
disposable cameras and two participants used their cell phones. Participants had two weeks between the
first and second sessions to take photos that answered the questions: a) what is healthy in my community
and b) what is unhealthy in my community.
After two weeks, participants texted their cell phone photos
or returned the cameras for processing. Duplicate prints were made of all the images so that participants
would be able to have a copy of all their photos. During the second session, participants received training
on data sorting, coding and theme identification. They used this information to code and sort more than 300
88
photos. The Photovoice group met a third and final time to review their coded photos and themes and to
write captions for their photos. At each of the three sessions, participants were provided refreshments and
a $25.00 gift card for their time.
Participants reviewed all photos and coded each photo as to the meaning and significance of the photo.
Once the photos were coded, the group collated similarly coded pictures, discussed commonalities of the
photos, and identified a theme for the photos. After all the photos were coded and themed, the group
condensed the categories of photos several times. They were mindful to not collapse into too few categories
as maintaining the granular context is important.
Results
The Photovoice participants identified four key themes: gangs, lack of infrastructure, lack of safety/
security and advantages to well-being. Photos depicting numerous gang sign “tags” or graffiti represented
the theme of gangs. Participants discussed the graffiti not only in terms of how it was a blight on the
community, but additionally, gang activity was a serious concern. Gang activity was viewed as a stressor
and residents were fearful of the criminal activities associated with gangs. Residents were also upset to see
youth joining gangs and being injured, incarcerated or murdered. Examples of the types of photos with the
theme of gangs is in Exhibit A.
89
Exhibit A
There was much discussion about the lack of infrastructure/maintenance regarding municipal and public
services. This was represented by numerous photos of potholes. Residents noted that driving through
potholes damages vehicles and contributes to accidents. Photos depicted chronically leaking water mains
as this was also a concern for residents. These leaks cause standing water to accumulate creating risks for
mosquito-borne illnesses and street ponding. The street ponding also creates mud pits, which the residents
deemed unsightly and make sidewalks impassable. Residents also noted many city owned easement areas
were not maintained causing overgrowth on sidewalks and trash piles forming blocking sidewalks.
The
residents talked about it being a pedestrian community and the need for people to be able to safely get
around the neighborhood. Exhibit B displays sample photos from the lack of infrastructure/maintenance of
public property and services such as leaking water mains, overgrown and blocked sidewalks.
Exhibit B
The Photovoice participants identified lack of safety and security as a predominant theme. This primarily
refers to conditions at apartment complexes. The majority of participants live in apartment complexes. This
community is population dense and there are many multi-unit complexes, and most of the complexes are
of old construction. The residents depicted issues with trash collection, as dumpster were overflowing as
well as trash littered about. They showed many examples of discarded furniture; this was of issue not just
because of the aesthetics but because these furniture dumps became places where illegal activity would
occur, such as drug use and prostitution. There were also pictures depicting broken security lights and
gates not functioning as well as parking lots with many potholes, impacting driving and walking. There were
swimming pools and playground structures in disrepair leaving safety hazards for children. Participants
also documented homeless people living in the community. They were dismayed that some people in their
community had no place to go, and they were upset by the aftermath of the homeless such as human waste
at bus stops and other public areas. Exhibit C below shows photos from the lack of safety and security
theme, including disgarded furniture, trash dumpsters and broken lighting.
90
Exhibit C
Participants identified advantages to well-being as an important theme because it depicted items in the
community that contributed positively to health and well-being. Photos included pictures of community
gardens, sidewalks, maintained playgrounds and swimming pools, water vending machines on site at
apartment complexes next to soda machines, and of community agencies providing direct services. Below
in Exhibit D are photos representing the theme of advantages to well-being. They include a community
garden, Baker-Ripley, and a community playground.
Exhibit D
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Conclusions
Through detailed discussions and photo analysis, the participants identified four themes and collectively
the themes provide a framework for addressing health in this community.
This is a population dense
community; diverse in many areas, and home to people who have recently immigrated and people who
have lived in the community a long time. Participants talked about residents being in transition, meaning
people move around a lot with in the community.
Someone may move in with family when they first
arrive in the country and then move to their own apartment and then move again to a nicer apartment or
to an another complex offering free rent or other financial incentives. The residents shared how they are
proud of their community but see areas where it could be improved. They compared driving through the
community and how it compares to other communities that are more maintained. And while the participants
identified things that at first glance may seem cosmetic, i.e. trash and graffiti, they are representative of
more. Participants talked about some areas within the community that are not safe for children to play
outside and that gang and other criminal activities are of issue. These conditions also impact residents’
ability to exercise outside (walks, group sports, etc.) as there is fear of criminal activity. Because many in
the community rely on walking as their primary mode of transportation to local resources, schools, medical
services, social services and employment, it is a major area of concern if residents do not feel safe walking
because of criminal activity or lack of sidewalks or broken sidewalks. Participants talked about how people
may be hesitant to report issues to the city, landlords or housing authorities because of fear of retaliation
or fear regarding their immigration status. Participants said not knowing how and who to report issues to
was a factor. There was also discussion of how when something is run down people are less likely to have
ownership or have an interest in making it better. Participants were appreciative of the assets they identified
to improve well-being. Having community centers such as Baker-Ripley and the services provided were
a key resource. The participants agreed that the community needed more information on their rights in
regards to housing and legal standing if someone is undocumented. The residents discussed their feelings
about the community were directly related to how good they felt about themselves. They explained that
when they felt good about their neighborhood it made them feel good about themselves.
As the final part of the Photovoice process a public display is planned for the community. The public
display of photos is critical to engage community members, stakeholders, elected officials and other
advocates in a dialogue about the issues identified by the community.
The participants want to invite the
mayor of Houston, members of city council, trustees from the Houston Independent School District, state
elected officials, religious leader and area health and human services providers to the public display. They
were very interested in having high ranking authorities at the display so that change could occur both
from the top level down and from grassroots advocacy. Through conversations from the public display
and findings from the needs assessment, stakeholders can move forward with developing action plans for
improving community health in the SAG area through structural changes that yield sustainable results for
the SAG community.
92
Conclusion and
Recommendations
As noted in the quantitative and qualitative sections, there are positive assets present in the community
that can be the starting place for recommending next steps. One of the major themes to emerge from the
Photovoice study was specifically about the resources in the neighborhoods that contribute positively to
health and well-being.
One of the greatest resources in the Houston metro area is the racial and multicultural diversity, with
over 20% of the people foreign born.47 The Sharpstown, Alief, and Gulfton neighborhoods are a microcosm
of this rich tapestry. These three neighborhoods represent places of great racial, ethnic, linguistic and
cultural diversity.
This is important since place matters to health, a common theme that should pervade all recommendations.
Regarding the needs and challenges of SAG, other common themes should remain a part of all of the
recommended next steps and these include creating a culture of health and maintaining a focus on prevention.
When we study healthy communities through a Social Determinants of Health (SDOH) lens, then the
recommended solutions should also project a SDOH approach. We need to address root causes of poor
health – for individuals and communities. We know that health is more than the absence of disease, and
includes the following factors:
 Social and Economic Factors
 Health Behavior Factors
 Clinical Care
 Physical Environment
 Genes and Biology
The recommendations from this study will attend to the first four of the five determinants. Unlike this
study, we have seen a typical healthcare focus with other recent community health assessments. While the
overall intent for this study is to help guide next steps in healthcare service delivery, we acknowledge the
need to take a wider purview. Our recommendations are broader than a healthcare focus since research
tells us that there are many direct and indirect causes of health linked to the social, economic and built
environments. The community members understand this.
Our goal aligns with the Healthy People 2020 vision for the
Sharpstown, Alief and Gulfton neighborhoods to be a thriving
community in which all people live long, healthy lives.
93
The following table includes an overview of the study results that are grouped by the type of evidence
gained from the mixed methods research. The results in this table are not rank-ordered and there is not
always alignment among the three study components.
Overview of Study Results by Component
94
Community Voice
Photovoice
1. Improve health status.
1. Provide health literacy in
the community.
1.
2. Improve access
to healthcare.
2. Do outreach to those without a regular source for
medical care.
2. Acknowledge that the
residents are appreciative
of community resources
like Baker Ripley.
3.
3. Improve mental health,
stress and dental health.
3. Address the residents fear
of retaliation with apartment
landlords or threatened
immigration status.
4. Attend to children with
unhealthy weight.
4. Improve children’s health
and eating habits.
4. Improve swimming pools,
parks and playgrounds
5. Screen, prevent and
manage chronic disease.
5. Provide primary care and
preventative screening.
5. Provide primary care and
preventative screening.
6. Manage and prevent
cancer.
6. Provide health education
in fun and entertaining ways.
6. Acknowledge that
residents like community
gardens and community
agencies that provide
services.
7. Attend to high crime
rates, especially
robberies and murders.
7. Improve communication
within the community and
neighborhood groups and
regarding advocacy for their
community.
7. Address that residents are
fearful of gangs and
associated crime.
8. Improve neighborhood,
environment and housing.
8.
8. Attend to gang graffiti,
potholes, broken water
mains, sidewalks and trash.
9.
9a. Improve education.
9b. Enhance education
regarding civility, legal
rights and responsibilities
and in general, such as
language, literacy and computer skills.
9.
Improve safety and
security, esp. trash
dumpsters, broken lights
and discarded furniture.
10. Create a stakeholder
group to synthesize
gathered information,
in addition to group
feedback, to move forward
on promising ideas.
10.
Provide continued
opportunities for residents
to participate in future ways to make SAG healthier.
Provide health insurance
to adults; dental
insurance for adults
and children.
Improve education
indicators, esp.
graduation from
high school rates.
Improve the built
environment, especially
regarding poor sanitation,
housing repair and public
spaces such as parks.
Improve barriers to good
health; Residents want to
walk and exercise, but are
fearful of crime.
Prioritized Recommendations
For the quantitative and the qualitative research findings, all of these recommendations are linked with
the following priorities:
 Priority 1 – Improve health status, preventative screening and access to healthcare
 Proposed Action: Focus strategies around health education, particularly regarding adult
cancer screening, diabetes, hypertension and children’s nutrition; and improving access
to healthcare services, including mental health and dental.
 Priority 2 – Improve the built environment, especially regarding safety, security, sidewalks
and poor sanitation
 Proposed Action: Use advocacy skills to help improve general sanitation and safety.
Keep the diversity of the neighborhoods by anticipating possible gentrification by
improving housing stock. Research the Avenue Community Development Corporation’s
model in the Houston’s near north side.
 Priority 3 - Enhance the knowledge and awareness of health and community resources to strengthen the bond between the residents and their communities
 Proposed Action: Focus on developing more community centers and services, such as
Baker-Ripley. Include the residents in the planning and design of more resources since
they are aware that the perception about the community is directly related to how good
they felt about themselves. They explained that when they felt good about their
neighborhood it made them feel good about themselves.
Looking Forward
Looking forward we should continue to engage the affected community members, interested
stakeholders, and by creating public private partnerships between business and government. This study
helps to understand the three neighborhoods at this point in time, and most importantly presents the voices
of the residents. The many people who participated in this study are very passionate about being a part of
the decision making process in order to make Sharpstown, Alief and Gulfton neighborhoods a healthier place
for all.
A study that is based on community participatory research tenets is an excellent point of departure
for the community and supportive organizations such as Legacy Community Health Services and Episcopal
Health Foundation to help to create a healthier future.
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Appendices
APPENDIX 1
Key Informant Interview Sector Matrix
Community Interviews By Sectors
96
Political
Economic
Health
Police
Communication
Recreational
Other Community Groups
Individuals
Education
Religious
Social Services
Voluntary/Grassroots
APPENDIX 2
Guide to Key Informant Interviews
Interviews with Key Informants in the community are semi-structured. Questions serve to guide a
conversation and participants are encouraged to elaborate on their thoughts and feelings on any of the
topics. The following questions guide the interview:
1. If a family you knew wanted to move into this neighborhood what would you tell
them about this neighborhood?
2. What would you say are the strongest and best qualities of this community? What
are some of the good things about living in this community for you? (You may want
to consider social, spiritual, political, economic, or other aspects of life here.)
3. Think about the problems you see in the community. If you had the power to
solve all the problems in your community in a short time what problems would you
address? What would you say are the most serious needs in this community?
4. What would you say stands in the way of dealing with these needs and issues?
5. When you think about the people who live and work in this neighborhood, what do
you think are the biggest health concerns for them?
6. When there is a health problem, either mental or physical, where do people in the
neighborhood get help? (Think about different age groups, and different health needs
such as preventative care, medical, dental, mental health, etc.)
7. If individuals, groups or agencies could work together to improve the health and
well-being of this community, who do you think should participate in that effort?
8. If you were advising a group interested in improving the health and well-being of
this community, where would you recommend that they begin their work in further
developing the potential of this neighborhood?
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APPENDIX 3
PARTICIPATORY GROUPS / FACILITATOR GUIDELINES
*** You have 4 hours, plan a break when time is right for group (or signal from Supervisor). A meal is
planned but not scheduled, so it will need to be added depending on time of day. ***
I.
WELCOME
***30 minutes***
Greet participants as they arrive at the table
Once seated ask them to fill out the demographic forms and read the consent
Read Consent Form (attached)
Ask if anyone has any questions!
Ask each person to sign each consent form, collect both
Introductions (including staff) can include mini ice-breaker
Review Ground Rules.
II. ICEBREAKER EXERCISE
Facilitator begins Icebreaker Exercise
1. Using the map in front of you of your community.
2. Place a star on the map where you live.
3. Now circle all the “important places” in your community.
4. Is everyone done, would anyone like to add anything else?
Remember you can always go back later and add things.
5. Go around the room and share the most “important place”
III. HEALTH ASSET DIAGRAM
***30 minutes***
***15 minutes***
1. Now turn the map over, and write down for us all the places that you
would go for help if you were sick, had a toothache or had emotional problems.
2. Then think about where you would take your child if they need this kind of help.
3. Then think about where would you send a friend if they need this kind of help.
4. Finally, share with us where you would send a friend if their child need this kind of help.
IV.
“WHAT IS A COMMUNITY?” ***5 minutes***
Yellow Balloon
extra probes –
V.
“WHAT IS HEALTH?”
***5 minutes***
Green Balloon
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extra probes –
VI.
“WHAT IS UNHEALTHY IN THIS COMMUNITY?”
***10 minutes***
Blue Balloon
extra probesVII.
“WHAT IS HEALTHY IN THIS COMMUNITY?”
***10 minutes***
Pink Balloon
extra probesVIII. “WHAT KEEPS THIS COMMUNITY FROM BEING HEALTHY?”
***10 minutes***
Orange Balloon
extra probesIX.
“WHAT DO YOU DO THAT IS UNHEALTHY?”
***10 minutes***
Red Balloon
extra probesX.
“WHAT DO YOU DO THAT IS HEALTHY?”
***10 minutes***
Purple Balloon
extra probesXI.
“WHAT KEEPS YOU FROM DOING THINGS THAT ARE HEALTHY?”
Maroon Balloon
***10 minutes***
extra probesXII. BOARD WORK
Place the list of what is unhealthy in the community, what keeps this community
from being healthy, and what keeps you from doing things that are healthy.
With stickers place prioritization to select top 3 issues. With those issues selected
brain-storm on what could be done to remedy the issues or barriers.
***30 minutes***
XIII. CONCLUSION
Summarize what has been shared. Ask if there are any further thoughts or
comments. Remind everyone that everything is confidential. Thank everyone,
distribute gift cards, and collect receipts for same. Make sure everyone has a
copy of their signed Consent Form.
***5 minutes***
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Appendix 4
Community Assets
Assets by Zip Code48
77036
PUBLIC SOCIAL SERVICES
Texas Office of the Attorney General: Child Support Division
 713-787-7140
6161 Savoy Drive #320, Houston 77036
http://www.oag.state.tx.us
For assistance in collection of child support, contact Regional Field Offices, based on zip code.
Help in locating absent parent using public records such as social security, driver license, unemployment, etc. Voluntary and court ordered paternity established. Paternity tests available.
Texas Juvenile Justice Dept.
 10165 Harwin Suite 180, Houston 77036
713-942-4200
Texas Department of Human Services – SNAP Offices
 Westside 9450 Harwin Drive,
Houston, TX 77036
713-266-5535 713-268-1448 Monday-Friday,
7:30AM-5:00PM
PRIVATE/NON-PROFIT SOCIAL SERVICES
Community Alliance United in Service (CAUS)
 Christian Community Service Center:
3434 Branard
www.ccschouston.org
713-961-3993
Mon-Fri. 10-2pm Sat. 9-12:00pm. Food and clothing and hygiene.
Possible financial assistance with interview.
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Limited assistance with medication.
 Back to school assistance (May registration) 713-961-3993 x215 Serves
77002-77007, 77011, 77012, 77019, 77020, 77021, 77023-77027, 77030, 77046, 77056, 77057, 77010, 77081, 77096, 77098, 77401. Bring picture ID with current address or anything mailed
to current address.
Food Pantry
 6856 Bellaire, serves 77031, 77036, 77072, 77074,
Thurs & Fri, 10a-1p, Sat 9-12.
Asset Building Network, Inc.
 9888 Bissonnet, Suite 242
Houston, TX 77036
Location: Southwest
Phone: (713) 776-3925 Hotline: Fax: (713) 271-7215
www.assetbuildingnetwork.org
Program Type: Assistance Program
Days of Operation: Monday – Friday
General Services: Clothing, Counseling, Food, Information and Referral, Case Management
Path to Independence
 10101 Forum Park Drive
Houston State: TX Zip Code: 77036
Location: Southwest
www.pticommunities.com
Program Type: Transitional Housing
Days of Operation: Monday - Sunday Intake Hours: 9a - 6p
ADA Compliant: Yes
Populations Served: Single Men Only, Veterans
Barriers Served: Disabled - Mental, Disabled - Physical, Elderly (65+), Ex-Offenders, HIV/AIDS, Substance Abusers
Languages: English
General Services: Clothing, Counseling, Detox, Food, Job Placement, Transportation
Houston Center for Independent Living Voice/TTY
 713-974-4621
6201 Bonhomme Suite 150S, Houston 77036
Coalition for Barrier-Free Living. Provides outreach services to assist individuals with disabilities
in accessing services. Peer support. Serves 13 counties. http://www.hcil.cc/
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Residential Care
 Texas Mentor
http://thementornetwork.com
713-432-0827
6161 Savoy Dr, Suite 1020, Houston 77036
Child placing agency for males and females 0-21. Contracts with CPS, TYC.
CITY RESOURCES Assisted Living Locators
 8321 Sand Point Drive.
Houston, TX 77036
EDUCATION/VOCATIONAL TRAINING:
YES Prep Public Schools
 http://www.yesprep.org 713-967-9001
6201 Bonhomme, Ste. 168 N., Houston 77036
Free, open-enrollment school system serving low-income minority students in 6th -12th grade. 100% of graduating seniors are accepted by a 4-year college or university
Job Training Institute/Southwest Campus
 10101 Harwin Dr, Ste 100
Houston, TX 77036
Location: Southwest
www.jobtraininginstitute.org
Days of Operation: Monday – Friday
General Services: Vocational School with Job Placement, 6-8 week state-certified courses
Vocational Training
 Demonstration Learning Centers:
Sharpstown Learning Center
7684 DeMoss, Houston 77036
713-777-7323
Excel’s Health Institute & Home Care
 9898 Bissonnet, Ste 380
Houston, TX 77036
713-773-1701
102
Houston Training & Education Center
 7547 Harwin Ste 35
Houston, TX 77036
713-783-2221,
Sanford Brown Institute-Houston
 10500 Forum Place Drive, Suite 200
Houston, TX 77036
713-779-1110,
www.sbhouston.com
Career Gear Houston
 750 Sharpstown Center
Houston, TX 77036
Telephone: 713-778-9959
Contact: Janay Fishback
http://www.careergearhouston.org
Eligibility: Must be a male, unemployed, low income, and at least 18 years old.
Description: Career Gear Houston provides career readiness training, interview readiness,
interview attire, soft skills networking, employment-linking services.
HEALTH
Houston City Health Centers/Houston Department of Health and Human Services
 Sharpstown
6201 Bonhomme
Houston, TX 77036
713-780-5600
Hope Clinic, Asian American Health Coalition
 9800 Town Park, Suite 266
Houston, TX 77036
713-773-0803
St. Hope Foundation, Inc. – Medical Transportation Services
 6200 Savoy Drive, Suite 540
Houston, TX 77036
Area Served: Greater Houston
Hours/Days: Monday-Thursday, 8:00AM-5:00PM, Friday, 8:00AM-12:00PM
Contact: Tracy Minter, Transportation Coordinator
103
Phone: 713-778-1300
Fax: 713-778-0827
http://offeringhope.org
Local Bus Routes: 81, 132, 163
Ages/Grades Served: All ages
Eligibility: Serves HIV+ persons. • Requires proof of income, proof of residence, and
proof of HIV+ status.
Costs: Free
Onsite at Schools: No
Languages: English, French, Portuguese, Spanish, Vietnamese
Direct Services: Provides transportation in vehicles and vans to persons living with HIV/AIDS.
COUNSELING
ARENA Counseling and Emotional Trauma Center
 713-271-8430
5800 Ranchester, Suite #142, Houston 77036
Bilingual counseling for victims and perpetrators of physical and sexual abuse. Parenting Program. Children’s Trauma groups. Women’s Survivor Groups. Treatment program for perpetrators.
Clients are CPS, JPD or private pay. Medicaid & Medicare accepted. 10am-6pm.
Asian American Family Services
 http://www.aafstexas.org 713-600-9400
Bellaire, Suite 228, Houston 77036
Serves the mental health needs of the Asian-American community. Provides bilingual and
bicultural counseling, screening, referral and follow-up for social services, training, education,
and advocacy; case management and interpreting/translation upon request. Project YEA
(Youth Education Advancement) in Alief ISD. Court ordered parenting classes, substance
abuse prevention program. Newcomer outreach, education & early intervention program for
Asian American seniors. Psychological/psychiatric evaluations. Training for mental
health professionals
Family Enrichment Clinic
 http://www.familyenrichmentclinic.com 713-780-2833
7100 Regency Square, Suite 136
Houston, TX 77036
Counseling and therapy services for children, adolescents, adults, couples, and families.
Group therapy, anger management, and parenting classes. Free pre-marital counseling workshop. Services provided in Cambodian, Chinese, English, Mandarin, Japanese, Korean, Spanish, Sign Language, Vietnamese, Taiwanese, Punjabi, Hindi, Cantonese, Uro. Insurance, Medicaid accepted.
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Houlue Counseling & Consulting Services
 281-433-7790
6201 Bonhomme, Ste. 464
Houston, 77036
832-226-0121
Domestic violence, mental health and substance abuse counseling. Drug and alcohol screening.
Services provided in Harris and Fort Bend counties for all ages. Specializing in school issues,
children with disabilities, parenting skills, anger management, depression, adoption, grief,
mood, anxiety and trauma related disorders. Medicaid and private pay accepted.
Lee’s Counseling Services
 281-772-8407
6630 Harwin, Suite 215G
Houston 77036
Individual, group, and family counseling. Non-profit agency. Sliding scale fee
Tzu Chi Foundation
 www.tzuchi.org Main: 713-981-8966
6200 Corporate Drive, Houston 77036 MHMRA liaison: 713-970-8385
Provides monthly support group for families with special needs children.
Serves all Harris County.
Revelation Healthcare Services
 6610 Harwin, Suite 266
Houston, TX 77036
713-266-7979
Services: Adult and adolescent outpatient substance abuse treatment
Sacred Heart Treatment Center
 6630 Harwin, Suite 180
Houston, TX 77036
281-953-7488
Houston Northwest Rehab
 2611 FM 1960 West, Bldg. H, Ste. 120
Houston 77068 281-537-2800
Houston 77036 713-773-4900
Intensive outpatient program offers educational, individual, and group counseling services
for a minimum of six weeks. Longer term supportive outpatient is available.
105
Drug testing and evaluation. Classes for adolescents/adults.
Weekend classes available. Service costs vary from $20 to $40. Self pay and private
insurance accepted
Together in Giving Everlasting Recovery
Houston, TX 77036
713-773-0299
Services: Adult outpatient substance abuse treatment
The Turning Point, Inc.
 10175 Harwin, Ste 101, Houston, TX 77036
713-773-3280
RECREATION
Chinese Community Center
 http://www.ccchouston.org 713-271-6100
9800 Town Park Drive
Houston, TX 77036
After-school tutorial, individual, and group counseling, Child Development Program,
field trips/recreation, summer camp, ages 6-18. Focus is to deter gang activity/delinquency.
Monthly parenting workshop. Focus on cultural awareness and adjusting to new environment.
Adult ESL, job training, and senior program.
Salvation Army Boys and Girls Club
 5757 Ranchester, Ste. 1900
Houston, TX 77036
Serves Asian community.
713-988-5201
106
77074
HEALTH
Harris Health Community Health Center
 People’s Health Center
6630 DeMoss
Houston, TX 77074
713-272-2600
Houston City Health Centers/Houston Department of Health and Human Services
 Southwest
6441 High Star
Houston, TX 77074
713-779-6400
Legacy Community Health Services
 1415 California
Houston, TX 77006
713-830-3000
http://www.legacycommunityhealth.org
713-830-3072
 5602 Lyons Ave.,
Houston, TX 77020
713-671-3041
 6441 High Star
Houston, TX 77074
713-779-6400
 6500-B Rookin
Houston, TX 77074
713-351-7350
Eye care only at California location; dental only at Rookin location.
Pregnancy/Pregnancy Termination
 Concerned Women’s Center
http://aaacwc.com
713-988-2200
7324 SW Fwy, #978
Houston, TX 77074
Mon-Fri 7:30am - 5:30pm
Free pregnancy test, STD testing, morning after pill $175, well woman plan - pap smear,
breast exam, and 11 month prescription for birth control pills for $175.
Conduct pregnancy termination.
107
Harris County Hospital District
 Gold Card - Southwest
6654 Hornwood
Houston, TX 77074
Location: Southwest
713-995-3500
Monday - Friday
ADA Compliant: Yes
Populations Served: ALL
Barriers Served: ALL
Languages: English
General Services: Gold Card
CHRISTUS Southwest Health Center
 6441 High Star, Houston, TX 77074
713-779-6400
Neighborhood Health Center Southwest, Memorial Hermann Healthcare System
 8150-C Southwest Freeway,
Houston, TX 77074
713-981-1605
COUNSELING
Kinghaven Group Counseling Services
 http://www.kinghavencounseling.com
713-457-4372
9100 Southwest Fwy., #100
Houston, TX 77074
Counseling services for ages 2--adult. Focus on sexual abuse, attachment disorder,
conduct & behavior problems. Individual and family counseling, psychological assessments,
and play therapy. Home-based or office. Medicaid, private insurance and sliding scale.
Thomas, Michael J.
 713-623-2984
4615 Southwest Freeway Suite 430
Houston, TX 77074
Parenting skills, divorce, family conflicts, depression, sexual abuse, chemical abuse,
school problems, runaway, and conflict resolution. Accepts Medicaid, insurance,
and sliding scale. Trauma therapy.
108
Hotline
 Jason Foundation: Community Assistance Resource
800-784-2433 /800-SUICIDE
West Oaks: 6500 Hornwood, Houston 77074
A nonprofit organization dedicated to the awareness, education and prevention of youth suicide. All services are free in West Oaks, Kingwood Pines, Cypress Creek Hospitals service area.
Carol F. Zuccone Ed.D. & Associates/Irlen Center
 713-771-3108
8303 Southwest Frwy, Suite 216,
Houston, TX 77074
http://www.zuccone-irlen.com
Reading problems due to Scotopic Sensitivity Syndrome (SSS), a perceptual problem,
may be corrected by the use of precision tinted filters worn as glasses or colored overlays
to eliminate light sensitivity and perception difficulties. Psychological testing. Works with
children with learning disabilities. Bilingual.
Substance Abuse Toxicology Associates Inc.
 http://www.toxicologyassociates.com
Administration: 713-541-3218
Admissions: 6910 Bellaire, Suite 13 77074 713-271-0067
Provides services for opiate addicted patients in Texas.
Methadone maintenance treatment, counseling, and drug screens.
Supporting Hands Veteran Services
 9100 Southwest Freeway, Suite 134
Houston, Texas 77074
832-295-9693, fax 832-295-9701
www.supportingh.org
Eligibility: Call for information
Services: Counseling and family services to veterans and their families. Psychiatric diagnoses,
developmental or intellectual disabilities, substance abuse and social/environmental factors
such as disadvantaged, socio-economic status, exposure to family violence, post-combat trauma, or juvenile justice system involvement.
Versatile Healthcare Institute
 8300 Bissonnet, Suite 626, Houston, TX 77074
713-771-5178
109
MHMRA of Harris County - Shelter Plus Care
 7011 Southwest Freeway
Houston, TX 77074
Location: Southwest
Program Type: Permanent Supportive Housing
Days of Operation: Monday - Friday Intake Hours: 8a - 5p
ADA Compliant: Yes
Populations Served: Couples, Singles Males and households with Children, Single Females
and households with Children
Barriers Served: Disabled-Mental
Languages: English Spanish
Small Business Administration (SBA) Veterans Representative
 Houston District Office
8701 S. Gessner Drive, Suite 1200
Phone: 713-773-6542
Gracewood
 7511 Wanda Lane
Houston, TX 77074
www.gracewood.org
Days of Operation: Monday - Friday Intake Hours: 7:30a - 4:30p
ADA Compliant: Yes
Populations Served: Single Females and households with Children
Barriers Served:
Languages: English
Neighborhood Centers, Inc. Central Services
 713-667-9400
4500 Bissonnet
Baker-Ripley Center
6500 Rookin
Houston, TX 77074
713-592-0288
110
Child Abuse/Neglect Prevention
 Healthy Family Initiatives
http://www.hfihouston.org 713-270-8849
7500 Beechnut, #366
Houston, TX 77074
Assists parents to improve care of their newborns and access services. Voluntary visitation
to teach childcare, assist in obtaining medical care. Advocacy and public development
EDUCATION
Houston Baptist University, 7502 Fondren Road, Houston, TX 77074,
281-649-3212, www.hbu.edu
Academy of Health Care Professions
 8313 S.W. Freeway
Houston, TX 77074
713-471-2427
www.ahcp.edu
HISD – Refugee Programs
 Las Americas/Jane Long Middle School, Temporary Building, Room 608
6501 Bellaire Boulevard
Houston, TX 77074-6428
Hours/Days: Monday-Friday, 8:00AM-5:00PM
Contacts: Jennifer Alexander, Amelia De Landa, Andrea Antwi, or Shirin Herman
Phone: 713-556-6973
Email: [email protected]; [email protected]; [email protected];
or [email protected] Website: http://www.houstonisd.org/Page/32057
Direct Services: Provides support to newly arrived refugee students during their resettlement process in the United States; also provides training for teachers and parents and coordinates
all appropriate area service providers.
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VOLUNTARY
Big Brothers Big Sisters Lone Star
 http://www.bbbstx.org
713-271-5683
6437 High Star
Houston, TX 77074
Mentoring one on one for children ages 6 – 15. Both community and school-based programs.
77072
House of Amos
 http://www.houseofamos.org
281-495-9061
8030 Boone Road
Houston, TX 77072
Emergency food pantry. Mon-Thurs 9-12pm & Sat 10-12pm. Saturday sack lunches.
Computer classes, immunizations, ESL classes for adults. M-Th 9a-12p & 6p-9p.
Monthly Food Fair 2nd Sat. of month 10am-12pm for fresh produce.
VN TeamWork
 11210 Bellaire Boulevard, Suite 118, Houston, TX 77072
Area Served: Greater Houston
Hours/Days: Monday-Friday, 10:00AM-6:00PM. • Accepts walk-ins.
Contact: Michael Cao-My Nguyen, Executive Director
Phone: 281-495-8936
Fax: 281-495-8938
Email: [email protected]
http://www.vnteamwork.org/english-as-second-language
Local Bus Routes: 2
Ages/Grades Served: Adults ages 18+
Eligibility: Primarily serves low-income to moderate-income persons including recent immigrants, refugees, relocated disaster evacuees, and dislocated workers.
Costs: Free
Languages: English, Vietnamese
Direct Services: Provides adult ESL classes. • Offers computer skills, citizenship preparation,
and help with immigration, legalization, and naturalization.
112
Boat People SOS (BPSOS)
 11360 Bellaire Boulevard, Suite 910, Houston, TX 77072
Area Served: Harris County
Hours/Days: Monday-Friday, 9:00AM-5:00PM
Contact: Trish Nguyen
Phone: 281-530-6888
Fax: 281-530-6838
Email: [email protected]
http://www.bpsos.org/mainsite/en/where-we-work/us-branches/houston.html
Local Bus Routes: 2
Ages/Grades Served: Adults ages 18+
Eligibility: Some services require proof of income, proof of identity, and proof of residence.
Costs: Costs vary; some language services may charge a fee.
Languages: English, Khmer, Spanish, Vietnamese
Direct Services: Provides ESL classes and citizenship and naturalization services. Offers case management,
health education, housing assistance and referrals, legal assistance, direct emergency assistance, and help
for victims of domestic violence.
EDUCATION
Alief ISD
 12302 High Star
Houston, TX 77072
Location: Alief
www.alief.isd.tenet.edu
ADA Compliant: Yes
Populations Served: Single Males and households with Children, Single Females and
households with Children, Households with Children, Youth (Males and Females), Children
Barriers Served: Educational needs of Children
Languages: English Spanish
113
77081
HEALTH
Wild Smiles Dental Centers
 www.smallsmiles.com
713-668-5437
5720-D Bellaire Blvd, Bellaire 77081 Contact: Vicky Cardiel (Children’s Advocate, Marketing)
Dental care for children ages 6 months-21 yrs. and adults. Free dental screenings, exchange toothbrush
service, free oral hygiene education. Accepts Medicaid, CHIP, CHSCN, Aetna, Cigna, and works with
parents of uninsured children to provide low fees.
Planned Parenthood – Gulf Coast
 http://www.ppgulfcoast.org
Business office: 713-522-6363
SW: 5800 Bellaire Blvd, Bldg. 1B,
Houston, TX 77081
713-541-5372
Physical exams, information and birth control services, prenatal services, pregnancy testing,
and counseling. STD screening and treatment, well woman exam. Tubal ligation, vasectomy,
abortions. Sliding scale fee. Varied hours accommodate those who work. Call for appointment. Medicaid clients must bring a picture ID. HIV counseling and testing. Women’s advance
care (colposcopy).
Texas Children’s Pediatric Associates–Project Medical Home
 www.texaschildrenspediatrics.org
Gulfton 5900 Chimney Rock, Suite Y
Houston, TX 77081
713-661-2951
Project Medical Home provides low-cost, comprehensive primary health care for children from
birth to 18 years of age. Fees are based on income and family size. Medicaid, CHIP & insurance
are also accepted. Please call for more information.
RECREATION
Day Camps - City of Houston Mayor’s Anti-Gang Office – Campo del Sol
 832-668-4516
6200 Chimney Rock
Houston, TX 77081 (Burnett Bayland Park)
8-week summer day camp, ages 10-17 who reside in 77081 zip code.
Applications available in April.
114
Harris County Community Resource Coordination Group (CRCG)
 713-295-2517
6300 Chimney Rock, Houston 77081
Community-based approach to provide better coordination of services for children and youth
who have multi-agency needs and require interagency coordination. Referrals by agencies,
families, & schools.
Neighborhood Centers, Inc. http://neighborhood-centers.org
 The BRIDGE/El Puente
6114 Renwick
Houston, TX 77081
713-592-0288
(Nancy and Rich) Kinder Emergency Shelter
 713-295-2700
6300 Chimney Rock Road
Houston, TX 77081
The Kinder Emergency Shelter provides youth 12-17 years old who are in crisis with a safe,
short-term, home-like environment until they can be returned home or to a more permanent
placement. Youth placed in the Shelter must have a sponsoring caseworker from DFPS,
CYS, TRIAD, JPD, SOH, AFCI or YMCA.
Alliance for Multicultural Community Services
 713-776-4700
6440 Hillcroft, #411
Houston, TX 77081
http://www.allianceontheweb.org
Refugee resettlement, job placement & training, health care access, interpreter program,
ESL classes, savings account program, after-school program, community center,
driver’s education. Micro-loan enterprise services.
115
COUNSELING
TRIAD Prevention Program
 713-295-2500
6300 Chimney Rock
Houston, TX 77081
Debra Colby, Director
Combined staff of Juvenile Probation, Harris County Protective Services, and MHMRA offers
early intervention services to runaways, truants, and Class C Misdemeanor offenders
apprehended by law enforcement or from “walk-ins” requesting help with parent/child conflict
issues. Counseling, information and referral, parenting program available. Also located in
the Justice of the Peace Court and Municipal Courts.
Systems of Hope
 http://www.systemsofhope.org 713-295-2500
6300 Chimney Rock
Houston, TX 77081
Pam Schaffer, LMSW-AP, Project Director
Community collaborative system of care development project. Works with children with serious
emotional disturbance and their families using the wraparound process and developing child
and family teams. Funded the HOGG Foundation for Mental Health. Works to incorporate family
involvement and peer support into agencies through grant from the Harris County Hospital
District Foundation.
New Hope Counseling Center, Inc.
 6420 Hillcroft, Suite 314
Houston, TX 77081
Location: Southwest
ADA Compliant: Yes
Populations Served: Single Females and households with Children, Households with Children, Youth (Males and Females, Married Couples, Veterans, Common Law Couples
Barriers Served: Disabled - Mental, Disabled - Physical, Domestic Violence, Elderly (65+),
Ex-Offenders, HIV/AIDS,
Pregnant/Parenting Teens, Substance Abusers, Refugees
Languages: English
116
The Behavioral Hospital of Bellaire
 713-600-9500
5314 Dashwood Dr. (Mapleridge Outpatient Services)
Houston, TX 77081
Free assessment, 24 hours, 7 days a week
EDUCATION/VOCATIONAL TRAINING
Proprietor School
 Interactive College of Technology - Houston Campus
Hillcroft Avenue, Suite 200
Houston, TX 77081
713-771-5336
VOLUNTARY
Juvenile Court Volunteers (Crossroads)
 www.crossroads-volunteers.org
713-295-2789
6300 Chimney Rock
Houston, TX 77081
Volunteer mentors for youth involved in Juvenile Probation system.
77099
HEALTH
Community Health Centers: Administration
 2525 Holly Hall #265
713-566-6856
El Franco Lee 8901 Boone Rd
Houston, TX 77099
281-454-0500
Ibn Sina Foundation, Community Medical Center
 11246 South Wilcrest, Suite 190B
Houston, TX 77099
832-328-1680
117
COUNSELING
Substance Abuse
 19. Lifeway International & Three Oaks Academy
http://www.lifewayinternational.org
713-270-6753
9920 West Sam Houston Pkwy South, #410
Houston, TX 77099
Alternative peer group and recovery system in the field of chemical dependency.
Serves ages 13-24 and their families throughout the greater Houston area with 10 locations.
Fully accredited alternative high school and college bound campus. Highlights the spiritual
side of recovery. Adult program ages 22+.
Southwest Area Ministry
 12621 Bissonnet
Houston, TX 77099
Location: Southwest
281-530-8633 Hotline: Fax: 281-530-5839
Days of Operation: Monday - Friday Intake Hours:
ADA Compliant: Yes
Populations Served: Single Males and households with Children, Single Females and
households with Children, Households with Children
Barriers Served:
Languages: English
Merciful Outreach Services
 12310 Bexely Street
Houston, TX 77099
Days of Operation: Monday - Sunday Intake Hours: 24 Hours
ADA Compliant: Yes
Populations Served: Single Males Only, Veterans
Barriers Served: Disabled - Mental, Disabled - Physical, Domestic Violence, Elderly (65+),
Ex-Offenders, Substance Abusers
Languages: English
118
EDUCATION
Proprietor School
 Cardiotech Ultrasound School
12315 Bissonnet, Ste E
Houston, TX 77099
281-495-0078
www.cardiotech.org
Houston-Galveston Area Council (H-GAC) – Workforce Solutions Southwest
 12710 Bissonnet Street,Houston, TX 77099
Direct Services: Provides access to industry and occupation profiles and other resources to
help with career planning. Helps persons to create a budget, determine eligibility for aid, and
apply for financial aid for education and training. May offer scholarships to clients to pursue
high-skill, high-growth jobs. Offers help with work-related expenses such as childcare,
transportation, work clothing, work tools, and/or licenses.
119
Sharpstown
CLINICS LOCATED IN THE SHARPSTOWN AREA
Zip Codes 77036 and 77074
 Sharpstown Health Center
6201 Bonhomme, Suite 300 South Houston, TX 77036
Dental Clinic, HIV Testing, STD Testing, STD Treatment, GYN/Women - WIC
 HOPE Clinic
7001 Corporate Drive Suite 120
Houston, TX 77036
Breast Imaging - Diagnostic, Community Outreach, Diabetes Care, Diabetes Education, General Operating
Hours, GYN/Women - Gynecology (including pap smears),HIV Testing, Immunization, Lab, Nutrition
Counseling, Patient Education, Preventive Care, Primary Care, STD Testing, STD Treatment, Sutures,
Clinical Breast Exam, Community-Based Screenings, Community Education, Imaging - CT Scan, Radiation
- External, Mammogram - Screening, Biopsy - Stereotactic-guided, Support Groups, Imaging - Ultrasound,
Prenatal Care, GYN/Women - Ultrasound (OB/GYN),GYN/Women - Family Planning, Optometry, Mental
Health Counseling/Therapy, ACA Specialist
 Memorial Hermann Centers for Schools - Jane Long
6501 Bellaire Blvd. Houston, TX 77074
Dental Clinic, GYN/Women - Family Planning, General Operating Hours, GYN/Women - Gynecology
(including pap smears),HIV Testing, Immunization, Lab, Mental Health Counseling/Therapy, Nutrition
Counseling, Pharmacy, Preventive Care, Primary Care, STD Testing, STD Treatment, Urgent Care
120
 People’s Health Center
6630 Demoss Houston, TX 77074
Dental Clinic, Diabetes Care, Diabetes Education, GYN/Women - Family Planning, General Operating
Hours, GYN/Women - Gynecology (including pap smears),HIV Testing, Immunization, Lab, Mental Health
Counseling/Therapy, Nutrition Counseling, Prenatal Care, Patient Education, Pharmacy, Podiatry, Primary
Care, STD Testing, STD Treatment ,X-Ray, Clinical Breast Exam, Mammogram - Screening, Social Work
 Legacy Community Health Services- Southwest Clinic
6441 High Star Houston, TX 77074
Diabetes Education, General Operating Hours, Immunization, Lab, Prenatal Care, Patient Education,
Preventive Care, GYN/Women - Ultrasound (OB/GYN), Urgent Care, Primary Care, Mammogram Screening, Clinical Breast Exam, Nutrition Counseling, Immunization - HPV,ACA Specialist
 Neighborhood Health Center - Southwest
7600 Beechnut, Suite A Houston, TX 77074
Diabetes Care, GYN/Women - Family Planning, General Operating Hours, GYN/Women Gynecology (including pap smears), Immunization, Lab, Preventive Care, Primary Care, STD Testing,
STD Treatment
 Legacy Community Health Services- Baker Ripley 6500 Rookin, Building B, Suite 200 Houston, TX 77074
Dental Clinic, GYN/Women - Family Planning, General Operating Hours, Mental Health Counseling/Therapy,
Primary Care, Clinical Breast Exam, Immunization, Immunization - HPV,STD Testing, HIV Testing,
ACA Specialist
121
Alief
CLINICS LOCATED IN THE ALIEF AREA
Zip Code 77072 and 77099
 Memorial Hermann – Alief Health Center
12360 Bear Ram Road, No. T-1
Medical and Dental home for uninsured children and a secondary access point for insured children
Zip Code 77079
 El Franco Lee Health Center
8901 Boone Road
Primary care services, on-site optometry, pharmacy, podiatry, psychiatry, radiology, nutrition and health
education, behavioral counseling, spiritual care
 Ibn Sina Foundation Community Medical and Dental Center
11226 South Wilcrest Drive
Primary care, specialty care, diagnostic and dental, discounted and free programs
 Legacy Community Health Services
12677 Bissonnet
Behavioral Health Services, Pediatrics
122
Gulfton
CLINICS LOCATED IN THE GULFTON AREA
Zip Code 77081
 Legacy Community Health Services
6500 Mapleridge, Suite 106
Adult primary care, pediatrics, behavioral health services
 Robindell Same Day Clinic
5420 Dashwood, Suite 200
Minor illnesses, minor injuries, lab tests, vaccinations
 IDC Charity Clinic
6550 Mapleridge Street
Free medical services to people who are in dire need of medical services and can not afford them
 Planned Parenthood Southwest
5800 Bellaire Boulevard, Building 1B
Birth control, general healthcare, HIV testing, men’s healthcare, emergency contraception, pregnancy
testing and services, STD testing, treatment & vaccines, women’s healthcare
 Texas Children’s Clinic – Gulfton
5900 Chimneyrock, Suite Y
Full service pediatric care including prenatal consultations, well-child visits, care of illnesses, care and
treatment of minor injuries, vaccinations and immunizations, preventable health care, school and sports
physicals, hearing and vision screening, health care and nutrition education
123
AREA SCHOOL DISTRICTS
Houston ISD
Alief ISD
HIGHER EDUCATION
Houston Baptist University
The University of Houston
Houston Community College Southwest Campus
PARKS
Sharpstown
..............................................................................................................................................
Bonham Park
8401 Braes Acres, 77074
Crain E.L. Park
9051 Triola, 77036
Forum Park
9900 Sugar Branch Drive 77036
Landsdale Community Center and Park
8201 Roos Road 77036
Sharpstown Green Park
6300 Sharpview, 77074
Sharpstown Community Center and Park
6600 Harbor Town, 77036
Sharpstown Park and Golf Course
6600 Harbor Town, 77036
124
Alief
..............................................................................................................................................
Arthur Storey Park
7400 W. Sam Houston Parkway, 77072
Alief Amity Park Alief
12509 Alief Clodine Road, 77082
Dotson Family Park
12935 Old Richmond, 77099
Harwin Park
11305 Harwin Drive, 77072
Boone Road Park
7700 Boone Road, 77072
Hackberry Park
7777 S. Dairy Ashford Road, 77072
Gulfton
..............................................................................................................................................
Burnett Bayland Community Center
6000 Chimney Rock, 77081
Pin Oak Park
Harris County Bayland Park
6400 Bissonnet Street, 77074
125
Appendix 5
Health of Houston Survey
TABLE 1
Health Status and Chronic Conditions
SAG
Houston Area
Fair or Poor Health 29%20%
Poor Physical Health 18%18%
Pain Limits Function 7+ days
12%15%
Pain Ever Limits Function
32%35%
Obese Adults
24%30%
Overweight and Obese Adults
58%63%
Children at Unhealthy Weight
43%34%
Diabetes Diagnosis
15%11%
High Blood Pressure Diagnosis
26%30%
Cancer Diagnosis
7%6%
CVD Diagnosis
5%7%
Asthma Diagnosis
7%9%
TABLE 2
126
Health Insurance
SAG
Houston Area
No Insurance Adults
47%31%
No Insurance at some point last 12 months
52%36%
No Prescription Drug Coverage (18+)
45%32%
No Dental Insurance - Adults
79%59%
Problems Paying for Medical Bills
26%25%
No Insurance - Children
12%13%
No Insurance at some point
last 12 months (0-17)
15%16%
No Prescription Drug Coverage (0-17)
18%18%
No Dental Insurance - Children
32%27%
TABLE 3
Access to Care
SAG
Houston Area
No Personal Doctor
44%31%
Excessive Travel Time
16%15%
Excessive Waiting Time
39%32%
Dependent for Travel to Doctor
24%18%
Barriers to Healthcare Access - Adults
32%24%
Barriers to Healthcare Access - Children
17%23%
TABLE 4
Mental Health
SAG
Serious Psychological Distress
12%
Mental Health Perceived Need
16%16%
Mental Health Visits in the Last
12 Months (18+)
Mental Health Visits with psychological distress in the Last 30 Days
(based on K6 questions)
Houston Area
7%
4%
8%
12%16%
TABLE 5
Preventive Services
SAG
Houston Area
Unscreened for Breast Cancer (women 40-74 yrs)
37%36%
Unscreened for Cervical Cancer (women 21-65 yrs)
25%20%
Unscreened for Colorectal Cancer (residents 50-74 yrs)
50%42%
127
TABLE 6
Behavioral Risk Factor
SAG
Houston Area
Current Smokers
15%17%
Smoking in the House
5%6%
Fast Food Consumption - Adults
18%25%
Rarely Easts Breakfast
34%28%
Less than Recommended Aerobic activity
50%53%
Binge Drinking
22%29%
TABLE 7
Child Behavioral Risk Factors
SAG
Ever Miss Breakfast
17%19%
Soda Consumption
30%23%
Fast Food Consumption - Children
20%22%
Less than Recommended Physical Activity
77%77%
Screen Time
65%72%
Houston Area
TABLE 8
128
Neighborhood, Environment & Housing
SAG
Houston Area
Not Home Owner
46%36%
No Regular Car
10%7%
No Fruits and Vegetables Available
17%16%
Crime Problem
42%26%
Stray Animals Problem
48%37%
Water Pollution Problem
18%10%
Drinking Water Problem
26%19%
Dumping Problem
14%17%
Traffic Fumes Problem
17%17%
Industry Fumes Problem
7%15%
Outdoor Noise
23%22%
No Support for Daily Chores
16%12%
No Support for Relaxation
10%8%
No Support to Understand One’s Problems
14%10%
Appendix 6
Houston Police Department Beats
129
References
COMMUNITY HEALTH
A Collaboration:
1 http://hhs2010.sph.uth.tmc.edu/AreaProfileReport/ Accessed 9.16.2015.
2 Health of Houston Survey. http://hhs2010.sph.uth.tmc.edu/AreaProfileReport/
Accessed 9.16.2015.
November 2015
3 Capps, Fix and Nwosu. A Profile of Immigrants in Houston, the Nation’s Most
Diverse Metropolitan Area. Migration Policy Institute. March 2015.
http://www.migrationpolicy.org/research/profileimmigrantshoustonnationsmostdiversemetropolitanarea
Accessed 9.18.2015.
4 2014 Progress Report. Purpose Built Communities.
http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&sqi=2&ved=0CC8QFjAD&url=http%3A%2
F%2Fpurposebuiltcommunitiesorg%2Fwpcontent%2Fuploads%2F2014%2F10%2FStateofPurposeBuiltGregGiornelli
September302014.pdf&ei=BR0VOjHKNfWoATC6oKgCA&usg=AFQjCNEvYNmAMgIVwM3hNruHb6AoYK8cxA
Accessed 1.12.2015.
5 N. Bracht and L. Kingsbury, 1990, Community Organizational Principles in Health Promotion, in N. Bracht, ed.,
Health Promotion at the Community Level, Sage Publications, Newbury Park.
6 I. Reisz, J Peranteau, PG Bray, KK Lopez, C Meyer, L Mendoza, AC Bracey, K Chan and N Ferrell.
St. Luke’s Episcopal Health Charities. 2007 Community Health Reports: Gulfton Area Neighborhood. Houston, Texas.
7 Photovoice website: www.photovoice.org. Accessed 9.6.2015.
8 I. Reisz, KJ Williams, PG Bray, J Peranteau, SL McIntrye, R Khali. St. Luke’s Episcopal Health Charities Healthy Neighborhood Initiative: 2003 Community Health Report: Denver Harbor/Port of Houston Super Neighborhood.
Houston, Texas.
9 World Health Organization. Inequities are killing people on grand scale, reports WHO’s Commission. Press
Release 28 August 2008. http://www.who.int/mediacentre/news/releases/2008/pr29/en/ Accessed 9.6.2015.
10 Sallis J. Using research to create a less obesogenic world. Texas Obesity Research Center. 04.9.2009.
http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0CCcQFjAB&url=http%3A%2F%2Fsa
llis.ucsd.edu%2FDocuments%2FPubs_documents%2FSlides_HoustonObesity_040909.pdf&ei=j0a0VLq8E8SWNuqX
gLAD&usg=AFQjCNGnOHrjzOdZuHikHquH2Z5xrJMyeg&bvm=bv.83339334,d.eXY Accessed 1.12.2015.
11 Robert Wood Johnson Foundation. Health Starts Where We Learn. 10.19.2010.
http://www.rwjf.org/en/library/research/2010/10/healthstartswherewelearn.
html Accessed 09.06.2015.
12 Dahlgren and Whitehead. 1991.
https://www.bing.com/images/search?q=Social+Ecological+Model+Health+Disparities&view=detailv2&&id=7C31A
BD6F60E74158F802281635DD5C8EA45F64E&selectedIndex=34&ccid=Uc5I8Wgx&simid=607993857438453166&th
id=JN.EHOorGYapDrtj%2bz9NR32vQ&ajaxhist=0 Accessed 09.6.2015.
13 Agency for Toxic Substances & Disease Registry. Principles of Community Engagement. Second Edition. June 2011. http://www.atsdr.cdc.gov/communityengagement/index.html Accessed 09.06.2015.
130
14 University of California at Berkeley. Community Engagement Strategies, Tip Sheet.
http://socrates.berkeley.edu/~pbd/pdfs/Community_Engagement_Strategies.pdf Accessed 09.06.2015.
15 Bowen, F, NewenhamKahindi, A, Herremans, I. 2010. When Suits Meet Roots: The Antecedents and
Consequences of Community Engagement Strategy. Journal of Business Ethics.
16 Israel BA, Schulz AJ, Parker EA, Becker AB. 2001. Communitybased participatory research: policy
recommendations for promoting a partnership approach in health research. Educ Health (Abingdon); 14(2):182197.
17 Israel BA, Schulz AJ, Parker EA, Allen AJ, Guzman JR. 2003. Critical issues in developing and following community based participatory research principles. In: Minkler M, Wallerstein N, editors. Community Based Participatory Research in Health. San Francisco, CA: Jossey Bass.
18 Greene, J. 2007. Mixed Methods in Social Inquiry. San Francisco, CA: JosseyBass.
19 The Prevention Institute. http://www.preventioninstitute.org/ Accessed 09.6.2015.
20 Neighborhood Centers Inc. 2012. Alief – Houston, TX 2013 Community Profile.
21 I. Reisz, J Peranteau, PG Bray, KK Lopez, C Meyer, L Mendoza, AC Bracey, K Chan and N Ferrell.
St. Luke’s Episcopal Health Charities. 2007 Community Health Reports: Gulfton Area Neighborhood.
Houston, Texas.
22 Neighborhood Centers Inc. 2014. Gulfton Expansion – Houston, TX. 2014 Community Profile.
23 Peranteau, J., Cooper, C.M., Bray, P.G., Reisz, I., Lopez, K., Haygood, B., and R. Khalil. (September 2004).
St. Luke’s Episcopal Health Charities Community Health Assessment Committee. 2004 Community Health Report:
Houston’s Alief and Park Place Super Neighborhood. Houston, Texas.
24 http://www.memorialhermann.org/locations/texasmedicalcenter/communityhealthneedsassessmenttmc/
Accessed 9.16.2015.
25 http://www.setexasrhp.com/external/content/document/6182/2504518/1/Community%20Needs%20Assessment
%20for%201115%20Waiver%20RHP%20Plan%203%202015.pdf Accessed 9.16.2015.
26 Neighborhood Centers Inc. 2012, p. 9.
27 Neighborhood Centers, Inc. 2014, p. 9.
28 https://en.wikipedia.org/wiki/Gulfton,_Houston Accessed 09.9.2015.
29 The University of Texas Health Science Center of Houston: School of Public Health. The Health of Houston Survey. http://hhs2010.sph.uth.tmc.edu/AreaProfileReport/ Accessed 6.15.2015.
30 HHS Poverty Guidelines for 2015. http://aspe.hhs.gov/povertyguidelines.Accessed 10.1.2015.
31 The University of Texas Health Science Center of Houston: School of Public Health. The Health of Houston Survey. http://hhs2010.sph.uth.tmc.edu/AreaProfileReport/ Accessed 6.15.2015.
32 Ibid.
131
33 The University of Texas Health Science Center of Houston: School of Public Health.
The Health of Houston Survey. http://hhs2010.sph.uth.tmc.edu/AreaProfileReport/ Accessed 6.15.2015.
34 Source: Houston Police Department.
35 Source: City of Houston Planning and Development Department.
37 Ibid.
38 Ibid.
39 Ibid.
40 Ibid.
46 Source: American Community Survey, 2008-2012.
47
Capps, Fix and Nwosu. A Profile of Immigrants in Houston, the Nation’s Most Diverse Metropolitan Area.
Migration Policy Institute. March 2015.
http://www.migrationpolicy.org/research/profileimmigrantshoustonnationsmostdiversemetropolitanarea
Accessed 9.18.2015.
48 http://www.hcps.org/cys%20directory%202012.pdf
http://www.houstontx.gov/housing/cfhservices2011.pdf
http://www.houstontx.gov/vetaffairs/vetaffairsguide.pdf
http://www.houstonisd.org/cms/lib2/TX01001591/Centricity/Domain/8339/FACECommResourceGuideFinal032014.pdf
http://www.hcps.org/cys%20directory%202012.pdf
Accessed January – March, 2015.
132
We extend a special thanks to the residents for their
time, talents, knowledge and their participation in
the community groups and Photovoice activities.
Without you there would be no report.
THANK YOU!
133
Research Division
500 Fannin St., Suite 300
Houston, TX 77002
713.225.0900
© 2015 Episcopal Health Foundation and Legacy Community Health Services

community health - Episcopal Health Foundation

Transcription

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