Step 1: Needs and Resources

Step 1
of the GTO framework is to conduct a needs assessment and choose which problems to focus on. A needs and resources assessment is a systematic approach to gathering information about the issues or problems your community faces and the existing assets and resources that could help remedy or lessen the problem.

The resources below may be used as you are conducting needs and resources assessment to help you answer the question, "What are the underlying needs and conditions in the community?


Community Health Assessment

  • Community Health Needs Assessment Toolkit helps hospitals, organizations, and community members better understand the needs and assets of their communities. The toolkit provides basic tools and resources for agencies completing Community Health Assessments (CHAs) and Community Health Improvement Plans (CHIPs).

  • Mobilizing for Action through Planning and Partnerships (MAPP) provides communities with a framework to collect and analyze health data, identify and prioritize community health issues, and develop and implement action plans that address defined needs.

  • PRECEDE-PROCEED Model is one of the frequently used models in health education and promotion. This model prescribes eight phases in planning, implementing, and evaluating health promotion programs.

  • Tool: GTO Community Needs Assessment Tool helps communities think through what measures they want to monitor, what data sources they should use, and how to best organize the data. Please note, this is a home visiting example and will need to be adapted to fit your focus. A Word version of the tool is also available.

  • Webinar: Introduction to Community Health Assessments in North Carolina: Webinar objectives are to describe a community health assessment and its role as a core public health function, identify the major phases in a community assessment process, and discuss the types of data that are appropriate for assessing the needs and assets of a population/community.


Data Sources

     North Carolina State Sources

  • Healthy NC 2020 describes North Carolina's objectives to address the physical, mental, and social components of health to improve the health status of every North Carolinian. Healthy NC 2020 has 40 objectives which address 13 focus areas.

  • North Carolina State Center for Health Statistics is responsible for data collection, health-related research, production of reports and maintenance of a comprehensive collection of statistics on health and health-related behaviors. The site includes links to

    • HealthStats for North Carolina.: Interactive health statistics on the health status of North Carolinians and the state of N.C.'s health care system.
    • N.C. Health Data Query System: Interactive database that provides customized reports of health data based on user-specified variables (e.g. age, race, county).

     Federal Sources (including CDC)

  • Behavioral Risk Factor Surveillance System (BRFSS). This annual CDC survey collects state-level data on residents’ health-related risk behaviors, chronic health conditions, and use of preventive services. In addition to raw, downloadable survey data, the BRFSS website provides  useful data analysis tools, including: 

  • Community Health Status Indicators (CHSI) produces public health profiles for all 3,143 counties in the United States. Each profile includes key indicators of health outcomes and factors that have the potential to influence health outcomes, such as health care access and quality, health behaviors, social factors, and the physical environment.

  • Healthy People 2020 is the federal government's prevention agenda for building a healthier nation. It is a statement of national health objectives designed to identify the most significant preventable threats to health and to establish national goals to reduce these threats.

  • US Census Bureau has many tools to help you find data for cities, counties, and states. Check out the American Fact Finder and the American Community Survey (ACS) websites.

     Other Sources

  • Community Commons gathers and analyzes community development related data and provides mapping and reporting capabilities. The site also has tools and stories to help inspire change and improve communities. 

  • County Health Rankings and Roadmaps provides state- and county-specific data and rankings.

Forming and Structuring a Team

  • Communities of Practice supports networks of individuals and organizations working to improve their own operations and public health as a whole. Communities form and collaborate on, an online collaboration tool supporting geographically dispersed public health professionals.

  • Selecting Team Members: You will need a core team of 4-8 individuals, though you may need additional "ad-hoc" team members to contribute at times. Team selection should be linked to your EBI focus area. Try to create a diverse and multi-discipline team. Use this document to help you think through your team selection.

  • Tool: Stakeholder Analysis is a process of collecting information to determine whose interests should be taken into account when implementing your EBI. This analysis helps identify stakeholders and develop a plan to increase support and reduce resistance to your EBI.

  • Tool: The Whole System Mapping Tool should be used at the beginning of a multi-partner process to capture  a full picture of the services currently being provided to your target population. 
  • Tools: Running a Successful Meeting provides tips on creating effective meeting plans, including scheduling huddles and debriefs, using the SBAN/SBAR technique, and the Seven-Step Meeting Process.

  • Tool: Choosing a Common Language: This is a Results-Based Accountability tool that helps you and your colleagues choose a common language. Unlike past work on glossaries, this tool does not start with words that need to be defined, but rather ideas that need to be labeled.



Continue on to STEP #2: Goals and Objectives