Building a Stronger Foundation: A Framework for Planning and Evaluating Community-Based Services in Canada

Appendix B

Community Health Needs Assessment Indicators

Much work on population health indicators has been undertaken in Canada in recent years. The indicators presented in this study are based upon the work of the Population Sub-Group of the Edmonton Health Information Network³⁴. They are consistent with the work of the Working Group on Community Health Information Systems and S. Chevalier et al.³⁵, National Task Force on Health Information³⁶ and the Community Health Information System Working Group of the National Health Information Council and Alberta Health³⁷. In the following pages, community health needs assessment indicators are presented under the following headings:

Population Health Needs

• Demographic
• Health
• Aberrations from Health
• Determinants of Health - Individual
• Determinants of Health - Societal

Community Concerns and Preferences

• Perceptions of Priority Needs and Service Preferences

Community Capacity

• Human, Capital, Technical and Financial Resources
• Service Availability and Utilization

An attempt has been made to propose indicators which emphasize the positive as well as negative aspects of health and which incorporate what is known about the determinants of health. In addition, indicators involving public concerns and preferences and community capacity have been included to enable consideration of these factors in the planning phase.

Application Considerations

All needs assessment indicators are preliminary and should be viewed as a warehouse from which to select indicators relevant for particular purposes and particular jurisdictions.

Three potential applications of the indicators are proposed: (a) ongoing monitoring and comparison across jurisdictions; (b) research to develop a greater understanding of health determinants and health dynamics in the community; and (c) evaluating CBHSs and other community initiatives which have been designed and implemented to influence the population's health status.

Because the health system (of which CBHSs are a part) represents only one contributor to improvements in population health status, using the health determinant and health status indicators to evaluate the performance of the health system is problematic. These population health indicators are more appropriately viewed as measures of the performance of society as a whole. In some cases, there may be a direct link between CBHSs and a population health outcome (e.g., control of measles through an immunization program). In these instances, direct evaluation of the population health impact can be undertaken.

The identification of characteristics such as geography, socio-economic status, gender and special sub-groups enables the study of variation across groupings of the general population.

Some overlap exists amongst the five categories of indicators. This has been intentional to demonstrate the different ways in which the indicators may be used. For example, measuring the proportion of regular smokers might be used to do the following:

• Identify particular groups that are at risk according to selected characteristics (e.g., gender, age, socio-economic status);
• Compare trends over time and amongst different geographic locations;
• Assist with setting goals and objectives related to smoking levels, and assessing progress;
• Assist with program/strategic planning.³⁸

It is important to acknowledge the many pragmatic problems associated with the collection, analysis and application of these indicators (i.e., timeliness, accuracy, availability, fragmentation and duplication of existing data and data sources). For example, census track data rarely conform to the boundaries of CBHSs catchment areas; provincial and national survey results are often dated by the time they are released; many data elements potentially useful for planning are not well developed; and standard forms often used for collecting data (e.g., surveys) are not appropriate for high risk target groups due to factors such as transiency, lack of telephone services and high illiteracy rates.

Demographic Indicators

Dimension	Indicator	What Does It Measure?	Comments	Data Source
Population Growth and Distribution	Total population counts	Number of people in a particular geographic area for some time period. Often used as denominator for rates.	Highly reliable. Availability can be a problem if census information is not available. Estimates and projections can be generated through a variety of techniques, but the user must be aware of the underlying assumptions.	Federal census, municipal census, projections from census information or other data (tax filers)
	Age sex structure (pyramid)	Distribution of age and gender	Not all pyramids have the same number of age groups, particularly at the older age groups. % over all bars should equal 100%.	Federal, municipal census
	Sex ratio	Distribution of population	Sex ratio varies by age.	Federal, municipal census
	Dependency ratio	Distribution of population	Different definitions for working age have been used over time. Child and elderly dependency ratio.	Federal, municipal census
	Population density	Distribution of population	Subject to bias due to boundary changes.	Census, user generated
	Rate of natural increase	Population growth (excess of births over deaths)	Used as a point of reference.	Census, user generated
	Doubling time indicator	Population growth (time required for population to double in size)	Used as a point of reference.	Census, user generated
	Mobility	Length of time at particular address; gives introduction of transience		Census
Component Measures - Fertility	Crude birth rate (CBR)	Count of births over the total population	A crude measure that does not adequately identify the population at risk in the denominator.	Federal or municipal census and vital statistics data
	General fertility rate	Count of births over the female population aged 15-49	A better measure than CBR for fertility, but does not take into account age structure. Need to know female population aged 15-49. Cultural differences useful for planning.	Census data, vital statistics
	Age-specific fertility rates	Count of births by age over the population eligible by age and gender	A period or cross-sectional measure. Can be summed to TFR.	Census data, vital statistics
	Total fertility rate (TFR)	Average number of children a woman can expect to bear	A period or cross-sectional measure. A TFR of 2.1 is considered necessary for replacement.	Sum of age-specific rates
	Cohort fertility measures	Cohort or generational measures of fertility	Data for recent cohorts usually non-existent. Can be more intuitive than a period measure.	Census, vital statistics (historical data)
Mortality	Crude death rate	Number of deaths over the total population	Not refined - does not adequately identify the population at risk in the denominator.	Census, vital statistics
	Age-specific death rate	Number of deaths by age over the total population in those age groups	More refined than the crude death rate, but not cause specific. Used in lifetable analyses.	Census, vital statistics
	Cause-specific death rate	Number of deaths by cause of death over the total population at risk	Causes of death that can be prevented or are medically overdue are of most relevance; occurrence of sentinel events useful to identify system failures. Small numbers can be exaggerated. Used in multi-decrement lifetable analyses.	Census, vital statistics
	Standardized mortality rate under 65 years	Removes the effect of age structure on the death rate	Standardization permits comparisons among areas and/or across time.	Census, vital statistics, user generated
	Life tables	A population subject to age-specific death rates is observed in a particular period	Treatment of older ages and first year of life differs across lifetable methodologies. Various types exist. Can be used for more than studying mortality.	Published by Statistics Canada. Can also be generated by users
	Net growth due to migration	Growth due to migration	Difficult to get data for migration by age and sex.	Census, tax files, health care registration, survey
Overall Health	Infant mortality rate	Proxy measure for the health of the population	Easily calculated. It may be useful to use the perinatal mortality ratio in future.	Census data and vital statistics data
	Life expectancy at birth	Proxy measure for the health of the population, mean length of life	Need to be aware of the assumptions underlying the method chosen to calculate life expectancy. Accuracy may be an issue with small population numbers.	Census data and vital statistics data
	Life expectancy free of disability	Helps to reflect the increasing importance of chronic disease, mean duration of life free of disability	Rarely measured, as required disability data are not available. Usual Canadian reference used is Wilkins, Chen and Ng, 1994.39	Census data, Health & Activity Limitation Survey
	Proportion of population with at least one health problem	General indicator of health status of population	Recall bias may be a problem. Underestimation of health problems is higher among men than among women.	Survey
	Subjective assessment of health using a rating scale	Subjective assessment of all aspects of health	Good reliability for the question "Do you consider your health to be excellent, good, fair, or poor?". Some comparative data are available as the question has been asked on previous surveys.	Survey (Has been asked on the National Health Promotion Survey)
	Q of L of Chronically ill (scale)	Reflects health of a subgroup within the population	Not available at a population level.	Census and survey
	Employment rate	Proxy for economic independence	Reliable - but must be aware of the methodology used.	Labour force survey
	% by education level attained	Proxy measure for health potential		Survey
	Income (average, median, distribution)	Proxy measure for health potential	Interpretation of measures is often controversial.	Census, tax filer information (Statistics Canada)
Physical Health - Growth and Development	Birthweight (average, % LBW)	Risk to newborn, mothers nutritional status	Reliable, and comprehensive data set.	Vital statistics (birth file)
	Weight for age	Early growth and development	Interpretation of growth charts can be problematic for selected subgroups in the population.	Growth charts
Physical Fitness	Step-test results	Cardiovascular and musculoskeletal fitness		Survey
	Task performance tests	Coordination, strength		Survey
	Absence of illness	Indication of ability to withstand challenge to health		Survey
Somatic Risk Factors	Body mass index	% body fat	May be bias due to self-report.	Survey
	% with high blood pressure	% with lower health potential and risk to cardiovascular health	Varies with self-report and actual measurement.	Survey (e.g., Heart Health Survey)
	Serum cholesterol levels	Cardiovascular health risk		Survey
	Immunization rates	Immune status	Very reliable for childhood immunizations. Information for adult population is not available in electronic format.	Immunization information systems
Social Health - Interpersonal Contacts	Frequency of visits with friends and relatives	Aspects of support that might be used	Interpretation depends on other variables.	Survey
Social Resources	Quantity and quality of social ties and networks	Support network adequacy		Survey
Role Functioning	Adjustment to parenting role	Capacity to perform social role	Measures not readily available. Very difficult to design a measure that would be acceptable given varied values and beliefs.	Survey
Activities of Daily Living	Feeding, dressing, bathing, meal preparation, etc.	Capacity to perform social roles and tasks	Some validated scales exist. Instruments often biased toward the very dysfunctional and therefore do not show good discrimination in the general population.	Survey (Sickness Impact Profile, Activities of Daily Living)
Other	- Level of health knowledge - Level of health skills - Frequency of self-help activities - Frequency of preventive behaviour	Potential to respond to health challenge		Survey (the federal Health Promotion surveys done in 1985 and 1990, and the SF-36 questionnaire address some of these measures)
Mental Health	Ratings of: - Self-esteem - Sense of coherence - Positive self-concept - Perceived control of the intended outcomes of actions - General positive affect - Ability to control behaviour - Life and coping skills	Potential to respond to health challenge. Degree to which challenges to health are being met adequately		Survey
	Cognitive functioning tests	Cognitive functioning ability		Survey

Indicators Of Aberrations From Health

Dimension	Indicator	What Does It Measure?	Comments	Data Source
Level of Population Health	Crude death rate	Annual number of deaths per 1,000 population. Measures mean level of health of population	Lack of reliability for comparisons among populations. Crude rates react to significant and rapid changes in the health status of the population (e.g., epidemic, natural catastrophe).	Census data, vital statistics
	Standardized death rate	Annual number of deaths per 1,000 population which would be observed in the population if it had the same age composition as the reference or "standard" population. Measures mean level of health	Standardized rates are dependent on the standard population chosen. Standardized death rate is the weighted average of age at specific death rates.	Census data, vital statistics
	Life expectancy at birth	Mean length of life. Level of health of the population		Census data, vital statistics
	Life expectancy in good health	Mean duration of life in good health	Varying definitions of "good health" make data collection difficult. As well data are not readily available.	Survey, census data
	Potential years of life lost	Indicator of premature mortality	The upper age limit chosen is somewhat arbitrary.	Vital statistics, census data
Health Problems	Prevalence of a risk factor	Proportion exposed to a controllable factor involved in the emergence or worsening of a health problem (e.g., alcoholism, air pollution). Estimate of the fraction of the population whose future health could be improved	Prevalence can only be ascertained by survey.	Survey, census data
	Incidence rate of a disease	Average number of new cases for a particular disease per year, per 10,000. Gives an indication of vulnerability of the population to the disease.	Few sources of data available. The detection of new cases is often incomplete.	Surveys, Disease registries (e.g., Cancer registry), Census data
	Prevalence rate of a disease	Proportion of the population having a disease for a particular timeframe. Indicates the proportion of the population that requires specific support	Difficult to determine prevalence, as comprehensive case finding is rare. Duration, frequency, and seriousness of disease influence this measure.	Surveys, Hospitalization data, Census data
	Hospital morbidity rate	Number of hospital separations per year by cause (also number of days by cause). Level of severe morbidity by ca	May be influenced by factors exogenous to health status (e.g., availability of care, physical and financial accessibility to care). Often used to rank health problems on the basis of their impact on average health of the population.	Hospitalization data, Census data
	Cause-specific death rate	Measures extent of health problems linked to the development of certain pathological conditions, or brought on by outside causes	Differences in classification of cause of death for different timeframes or locations can bias the measure, as can selecting a single cause when the death was attributed to more than one cause. If the rate is standardized, then comparisons across time and place may be made.	Vital statistics, Census data
	Probability of dying from a specified cause	Measures relative importance of a specific health problem, as seen in terms of its contribution to the total deaths ultimately experienced by members of a cohort		Vital statistics
	Cumulative risk of dying from a specified cause	Probability of dying before a given time in the absence of all other causes of death. Measures impact of specified health problems considered over the entire life cycle		Vital statistics Census data
	Prevalence of disability by cause	Frequency of types of disability by cause for a particular timeframe	Limited data available. Also definitions of "disability" may vary. Sometimes used to assess the impact of prevention programs.	Vital statistics Census data
	Fraction attributable to a risk factor	Proportion of cases of disease, disability, or death which may be attributed to exposure of the population to a given risk factor	Incomplete information. The causal relationship may not be established for a particular risk factor or disease. May be used to assess the impact of previous measures designed to defend the population from exposure to the risk factor, or to eliminate the health damaging effects.	Vital statistics Census data
	Incidence of major notifiable diseases / Incidence of notifiable diseases requiring vaccination	Ratio of new cases of notifiable disease to the total population/ratio of NDs requiring vaccination to the total population. Latter provides indication of vaccination coverage	Data represent events not individuals. Rate increases/decreases must be interpreted in light of changes in reporting practices, specificity and sensitivity of testing, or the definition of the disease.	Notifiable disease reports Census data
Indicators Specific to Certain Stages of the Life Cycle	Infant mortality rate	Ratio of deaths among infants under a year old to the number of live births. Indication of the level of economic and social development	Definition of live birth may not be uniform. May identify sectors of the population with poorer health.	Vital statistics
	Perinatal mortality rate	Annual number of stillbirths and early neonatal deaths per 1,000 total births. May measure standards of care as well as general health of the populati	Usefulness of data is dependent upon quality (e.g., experience of certifying physicians and use of autopsy examination results). A decrease in mortality from a given cause may not indicate a better state of health, but progress in methods used (e.g., ultrasound to detect fetal problems).	Vital statistics
	Early neonatal mortality rate	Ratio of deaths in the first week of life to all live births for a given year. Indication of level of perinatal care	Data are readily available.	Vital statistics
	Incidence of low birthweight infants	Percent of live-born infants whose birthweight is less than 2,500 grams. In part, reflects mothers' health	Data are readily available. Indicator varies with health status and with quality and quantity of care available.	Vital statistics
	Life expectancy by marital status	Measures mean length of life by marital status	Data are readily available. Indicator does not take into account the marital history of individuals.	Vital statistics Census data
	Excess male mortality index	Ratio of male death rate to female death rate. Shows the extent of sex differentials		Vital statistics Census data

Indicators For Determinants Of Health - Individual

Dimension	Indicator	What Does It Measure?	Comments	Data Source
Socio-economic status	Income level, educational level, occupation	Socio-economic status (related to health status indirectly through nutrition, living and working conditions, health knowledge, etc.)	Self-report bias.	Survey Census data
Personal Health Practices	Smoking - Smoking prevalence, average number of cigarettes per day, number of years smoking	Smoking behaviour, as indicator of health risk	Self-report bias. Survey data underestimate the actual number of cigarettes sold.	Survey Census data
	Drinking - Prevalence of alcohol use, average number of alcoholic drinks per week	Drinking behaviour, as indicator of health risk	Self-report bias. Current research suggests a curvilinear relationship with health.	Survey Census data
	Nutrition - % following food guide, % eating breakfast, % reading food labels, % breastfeeding, % calories from fat, body mass index	Nutritional status as indicator of health potential. Body mass index, is an indicator of health risk	Self-report bias, also lack of knowledge re specific nutrient intake. For body mass index, self-report bias is well-known, both for height (over-estimate) and weight (under-estimate).	Survey Census data For body mass index, clinical measures may be used
	Physical activity - prevalence of leisure time physical activity (LTPA), duration of LTPA	Physical fitness, as indicator of health potential	Self-report bias.	Survey Census data
	Illicit drugs - lifetime use, prevalence of current use	Indicator of health risk	Self-report bias.	Survey Census data
Disease and Injury Prevention	Blood pressure (BP) - proportion having annual BP check, prevalence of "ever" being diagnosed with high BP	Early detection behaviour, elevated BP indicator of health risk	Self-report bias.	Survey Census data
	Women's cancer prevention - proportion having regular PAP smear, proportion doing regular breast self-exam	Early detection behaviour re cervical cancer and breast cancer	Self-report bias.	Survey Census data
	Sexual health - Number of sexual partners, frequency of unprotected sex, knowledge rating of STD prevention	Sexual practices, as indicator of health risk	Self-report bias.	Survey Census data
	Dental health - % dentate, DMF index, toothbrushing frequency, % accessing regular dental care	Preventive health behaviour. DMF index is a general indicator of dental health status	Self-report bias. Criteria for measuring decay may vary.	Survey Census data
	Injury control - frequency of seat belt use, frequency of helmet use	Preventive behaviour	Self-report bias.	Survey Census data
	Occupational injury - frequency, type and severity of worker related injury	Preventive practices and worksite conditions		Workers Compensation Board claims Insurance claims
Context for Personal Health	Proportion living alone	Indicates increased risk of social isolation, mental/physical health risk		Survey Census data
	Stress - Perceived stress level, % ever having contemplated suicide	Aspects of mental health status of the population	Self-report bias. The 'degree' of contemplation (casual versus intense) may not be assessed.	Survey
Genetic/Biologic Factors	(recognized as a large contributor to health, but no indicators found)
Physical Environment	Persons/unit area	Population density	Useful for large geographic areas, less so in cities (density varies less). Reflects housing situation somewhat.	Census data, municipal land area data
	Proportion of land assigned specific use: land zoning	Land use	Reliable; little value as an index of individual health status; may reflect likelihood of occupational disease. May be an indirect indicator of socio-economic status (SES).	Municipal planners, government
	Housing age, quality (state of repair), size	Housing characteristics	Helps to assess SES of community residents.	Census, municipal planning, tax assessment
	Workplace location	In/out of community; In/out of home	Where zoning prohibits residential work, reliability may be decreased. Provides index of mobility. May reflect changes in work practice.	Survey
	Air quality measures	Composition of local air, especially regarding pollutants	Where measured, reliable; measures often episodic and site specific. Strong determinant of asthma, emphysema, and other chronic respiratory diseas	Environmental monitoring agencies of provincial government
	Water quality measures	Composition of local water, especially regarding contaminants, micro-organisms	Reliable, valid for drinking water. Surface water quality less often measured, but important for irrigation, recreation purposes; monitoring is standard public health practice.	Provincial or municipal government
	Climate - average temperature, rainfall, hours of sunshine	Climate severity index	Somewhat subjective, but provides relative position. Marginal association with specific illness: frostbite, etc.	Environment Canada
	Landfill Use, Hazardous Waste Sites, Use of Hazardous Materials	Measures attitudes to waste management and indicates amount of waste produced	Hazardous waste sites may be unrecorded.	Municipalities, prov. & federal government environmental agencies
	Pests - number of infestations	Presence/absence of significant numbers of pests (rats, mice, etc.)	Measurement unreliable. Degree of control is an index of potential health problems in a community.	Self-report, Public health agencies (e.g., food monitoring)
	Recreational Facilities - number, accessibility	Presence/absence of community recreational facilities (pools, rinks, etc.)	Measurement reliable, but assessment of use would be problematic. General indicator of SES of a community.	Local parks and recreation authority
	Telephone access	Coverage re: one mode of communication	General (crude) indicator of SES. Not directly related to health.	Telephone company
	Use of bus/rail/air service, special transport for handicapped	Use of transport options	Measurement of service valid, use assessment reflects only those who use it, not those who may need it but can't or won't use it. Both direct and indirect effects on health. Presence of disabled adult transportation service is an indicator of access to services for handicapped. Utilization statistics may help assess need	Municipal planners, economic authority, transportation authority
	Amount, condition, and maintenance practices re roads, bridges, public lighting, snow removal, etc.	Quality of transport infrastructure	Poor index of individual health. More an index of overall social affluence and priority setting.	Municipal and provincial transportation departments
	Incidence of motor vehicle accidents	Number, type, and severity of motor vehicle accidents	Indicator of frequency of accidents; probably highly reliable for accident cases (where implemented), but for lesser accidents, probably quite unreliable.	Municipal policy
Demographic Indicators	Population by age and sex (pyramid)	Number of people in each age-sex group, residing in a given area	Generally reliable - best just after a census. Less reliable in areas of high migration. Less accurate for subgroups, e.g., homeless. Fundamental to the description of a population and as a denominator for many health indicators.	Census data
	Population growth rate	Rate of change in population size	Requires accurate population estimates at two points in time. Permits estimates of future population size, thus aids planning.	Census data Population projections
	Total Fertility Rate (TFR)	Total number of children women can expect to bear in a lifetime	Valid index for comparisons among populations. May be of questionable usefulness for small subgroups in the population. Good descriptor of overall fertility. Used for population planning, preand post-natal services.	Census data Vital statistics
	Age-specific birth rate, births by mother's education level	Live births by age of mother. Live births by educational level of mother	Reliability and validity in part a function of the accuracy and timing of census data. Used to identify risk groups, to develop family planning programs, pre and post-natal programs, and to document trends.	Census data, vital statistics
	Life expectancy (at age x)	Mean length of life (at age x)	Relates to population groups, not individuals. Supplies no information concerning morbidity.	Census data
	Percent of population born outside of Canada	Aspect of population composition. Used to account for variation in education, income, etc	The country of birth does not equate to a homogeneous cultural/social experience. Useful for planning program delivery to immigrants. If sub-divided by origin may provide data about likelihood of specific illness.	Census data
Socio-economic Indicator	Proportion of single-parent families with children under 18	As stated. Proxy measure of poor socio-economic conditions	Used to help determine size of high risk groups.	Census data
	Income level, income distribution, sources of income	Proxy measure for socio-economic status	Definition of income varies. Media income may be more useful measure than mean income. May relate to personal, family or household income.	Census data, surveys, tax filer data
	Incidence of low income	As stated relative to a given population	Definition of low income can vary across place and time. Does not take into account the "near poor" or "low wage earners" who may have very similar living conditions. Identifies potentially high risk groups.	Census data, surveys
	Proportion of population receiving welfare	As stated relative to a given population	Data do not include all who are eligible. Definitions vary across time and place. Can calculate a disadvantage index. Identifies potentially high risk group.	Census data, surveys, municipal and provincial welfare data
	Unemployment rate	As stated, relative to given population. Key socio-economic indicator	Definition of unemployment varies. Useful for planning assistance programs and economic development programs.	Labour force survey data
Educational Attainment	Percent of eligible persons who attend school	Access and coverage for eligible population	Can help to identify poorly educated groups.	Education department School boards
	Average formal educational level	Proxy measure for health potential		Surveys Education department School boards
	Percent of population 15 years and older with < 9 years of education	Indicator of socio-economic status	Indication of likelihood of functioning effectively in society.	Surveys
	Literacy rate (basic and functional)	As stated	Definitions must be specified before comparisons can be made. A crude educational index. Used to determine the proportion of the population with insufficient reading and writing skills to be able to function in society.	Surveys, census data
	Percent of eligible children in kindergarten/day care	As stated. Proxy measure for health potential	Data difficult to obtain.	Surveys, school enrollment data
Nutrition	Incidence of food poisoning, regulatory compliance rate of food premises	Safety of food supply	Incomplete data.	Provincial lab, health units
	Food bank use	Food supply accessibility. Measures number of individuals/families accessing food bank	Few demographic data available on selected population. General indicator of societal need. Useful in assessing trends and relative changes in social circumstances.	Food bank and other agencies

Perceptions Of Priority Needs And Service Preferences

Dimension	Indicator	Comments	Data Source
Perceptions of Priority Health Needs	Expressed relative levels of concern regarding health issues, including: - Major causes of death, disease and injury - Social environment - Physical environment - Health related lifestyle issues - Equity issues - Economic issues - Issues relating to life stages - Health service delivery	Responses will reflect level of awareness of general health issues	Local survey Focus sessions Interviews Informal feedback Provincial and national surveys (e.g., Canada's Health Promotion Survey)
Preferred Services to Address Needs	Type of service desired to address perceived needs, e.g., - Advocacy - Counselling - Education - Enforcement - Intervention	Bias towards existing services/facilities	Local Survey Focus Sessions Interviews
	Type of service providers preferred to address perceived needs, e.g., - Self-management - Informal providers (volunteers, friends, etc.) - Formal providers by type (doctors, nurses, assistants, indigenous workers, etc.)	Bias towards the familiar types of service providers	Surveys Focus sessions Interviews
	Level of service	Useful for planning services	Surveys, focus sessions, interviews

Human, Capital, Technical And Financial Resources

Dimension	Indicator	Comments	Data Source
Human Resources	Types of formal CBHSs providers available in or accessible to the community	Indicates the range of human resources available to meet health needs; suggests service gaps	Professional registries Survey Organizational records
	Comparison of provider: population ratios with other jurisdictions by type of CBHSs provider	Indicates over- or under-servicing by provider type	Census data Organizational records
	Number of registered community service volunteers	Useful for service planning	Volunteer registries
	Types of related service providers in other organizations/departments available to the community	Indicates range of human resources available and suggests service gaps	Organizational records
Capital and Technical Resources	Presence and condition of necessary facilities (health and other)	Useful for capital planning	Audit Survey
	Presence and condition of necessary diagnostic and treatment equipment		Audit Survey
	Availability and quality of technical supports	Examples are on-line computers, libraries, tele-video, etc.; important for improving consumer access to health information	Audit Survey
	Availability and adequacy of transportation systems (e.g. public and handicapped)	Indicator for service accessibility	Survey
Financial Resources	Comparison of funding levels with other jurisdictions, by type of service (i.e., health and other services)	May suggest over- or under-servicing	Survey
Availability of Services	Range and levels of CBHSs available to the community	See section 3.3 in main document for discussion of "core" CBHSs	Organizational directories
	Availability of Institutional health services: - Acute care - Long-term care - Specialty (cancer, rehabilitation, TB) (comparison of beds/1,000 with other jurisdictions; service procedures by type of service)		Library registries Community directories Community centres
	Availability of related community resources, e.g., - Support and self-help groups - Drop-in centres - Food banks - Shelters (women, homeless, youth) - Social services - Employment centres - Courses (stress management, bereavement, etc.) - Spiritual support - Recreation facilities - Volunteer associations - Day cares		Organizational records Provincial data bases
	Assessment/intervention waiting lists by type of service in: - Health agency - Other community organizations	Indicative of met/unmet demand	Organizational records Provincial data bases
Patterns of Service Utilization	Service utilization by demographic variables (e.g., age, gender, race, SES) - Health services - Other related community services	Suggests areas of met/unmet need and service practice problems; however, only possible to obtain for those currently provided Useful for service planning for vulnerable/high risk groups	Organizational records Provincial data bases
	Service utilization by problem/condition	Suggests areas of met/unmet needs and service practice patterns	Organizational records Provincial data bases
	Service utilization by type of service	Suggests areas of met/unmet needs; service practice patterns	Organizational records