CDC’s Healthy Community Program Success Story Worksheet Paper

CDC’s Healthy Community Program Success Story Worksheet (modified version)

Thank you for choosing to share your story! This worksheet will help you gather and organize information. As you read each question, imagine you are telling a friend about your program or strategy. What is the first thing you would tell them that answers the question?

Consider this a summary of your policy, system, or environmental change strategy that you’ll reference later. Keep your answers short, no more than a sentence if you can.

Your Name:

1. Do you have a name for the policy, system, or environmental change strategy you’re trying to implement?

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2. What risk factors does it address?

3. What kind of change are you trying to implement?

4. Who participates? Or rather, who participated in the passing of the policy? Who are your coalition members?

5. Who does the strategy benefit most? Or, to put it another way, who is your target audience?

6. Where are you trying to implement the policy, system, or environmental change? Within a corporation or school system? Across a region (city, state)?

7. Why did you choose to target this policy, system, or environmental change?

Challenge

1. What is the challenge that your community faces that your policy, system, or environmental change strategy addresses?

2. What might happen if the challenge is not addressed? How does it affect your community in the short-term? The long-term?

3. Were there any barriers encountered during development or implementation of your policy, system, or environmental change strategy? What were they and how did you overcome them?

Results

1. What are the positive results your strategy brought to the community? Try to be specific, with a few statistics or examples.

Health Educators’ Areas of Responsibility

1. Which of the 7 Areas of Responsibility were demonstrated in the project? Give examples. The areas are listed at http://www.nchec.org/credentialing/responsibilities/

CDC’s Healthy Community Program Success Story Worksheet Paper