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Community Practice

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On this page 9 sections
  1. In 30 seconds
  2. Why this matters
  3. The college version
  4. Eli explains
  5. Worked example
  6. Key takeaway
  7. Quick check
  8. Study tools
  9. Sources & references

In 30 seconds

is helping work whose client is a community rather than a person. That changes every step: you have to decide which community you mean, find out who already speaks for it, choose between building local capacity, planning technically, and organizing pressure, and then work out how anyone would know whether it worked. That last question is the weakest link. Community-level change is slow, hard to pin on any single effort, and often ends when the grant does.

Why this matters

Most of what brings people to a helping agency is not a property of the person in front of you. Whether affordable housing exists, whether a clinic is reachable without a car, whether a neighborhood has been counted at all: these are conditions, and community practice is the part of the profession that works at that level. It is also where the field's characteristic risk is sharpest, because an outsider holding the funding can end up defining a community's problem for it. Macro practice, community health, and public health planning courses examine this material closely, and the is a legal obligation that thousands of tax-exempt hospitals meet on a three-year cycle.

The college version

What counts as a community, and who decides

Three definitions are in circulation and they do not pick out the same people. A geographic community is a place with a boundary: a census tract, a school catchment, a hospital service area. An is a group linked by a shared characteristic or experience, which may be scattered across a whole country. A is formed by joint action around a shared concern, and it may have existed for six weeks. When researchers asked 118 people across four very different populations what the word meant, five elements kept recurring: locus, or a sense of place; sharing of interests and perspectives; joint action; social ties; and internal diversity. The elements were common but their weight was not. Participants in San Francisco stressed sharing and diversity; participants in Durham and Philadelphia put place first. The pooled definition the researchers derived is deliberately broad: people with diverse characteristics linked by social ties, sharing common perspectives, and engaging in joint action in geographical locations or settings. So where you draw the line decides who is counted and, therefore, whose account of the problem gets written down. This is not merely a conceptual worry. U.S. Treasury regulations let a tax-exempt hospital facility define the community it serves by geographic area, by target population such as children or the aged, or by principal function such as a specialty focus, but expressly forbid it from defining that community so as to exclude medically underserved, low-income, or minority populations who live in the areas from which it draws patients. Someone wrote that sentence because the definitional step is where a community can be disappeared.

Rothman's three models, and Rothman's revision

Jack Rothman's typology of community intervention is the field's standard vocabulary. pursues change through the active participation of a broad range of community members, with attention to building their organizational capacity along the way. Social planning is a technical planning and problem-solving process in which professional expertise does much of the work. organizes people who are disadvantaged so that they can press the wider community for more resources or better treatment. Practitioners use the three as a menu: in one Appalachian initiative funded in 2005, twenty-six communities working on local substance use problems used the trilogy explicitly to choose a direction, some strengthening local coalitions, some meeting service providers to identify new services, and some going to elected officials and local media. The reason to use it this way, rather than as three sealed boxes, is that Rothman himself stopped treating it that way. In a 2007 paper in the Journal of Community Practice he set out a multidimensional formulation with nine variants, breaking out three distinct forms each of social planning and policy practice, of capacity development, and of advocacy. Some of the modes are single-strand and others deliberately combine strategic elements, and he argued that the modes need not be seen as conflicting: rationalistic planning inside formal organizations and participatory grassroots problem-solving both have merits that grow when they are linked. Others reach the same verdict from outside: Speer and Han treat the early three-part taxonomy as no longer holding, because organizing is now classified by goals, methods, tactics, constituents, or issues under labels running from faith-based and labor to youth, identity-based, and neighborhood. So the honest way to teach the three models is as a description of emphases that mix, from an author who revised his own scheme toward mixing.

Organizing traditions and their critics

Community organizing in the United States runs back to the settlement house movement and to the pragmatic organizing associated with Saul Alinsky, whose Rules for Radicals appeared in 1971. Organizing in this tradition is confrontational in a specific sense: it starts from the causal assumption that systems produce social problems and that changing a system requires the exercise of power, in deliberate contrast to approaches that treat the system as basically fair and the problem as an information deficit. Notably, what Alinsky's book supplies is less a technique than a description of the organizer's dispositions, curiosity, irreverence toward the way things have always been done, and imagination about alternatives. Critiques of the tradition as it has developed are not all from one direction. One line of argument holds that the professionalization of organizing pushes non-professional organizers to the margins, and that dependence on grants from government and large foundations narrows a community organization's control over its own mission and timeline. A second concern is structural: work designed by outside experts brings expertise, resources, and legitimacy, but risks importing the experts' worldview, losing community voice in translation, and reinforcing the existing distribution of power. Work that originates with residents avoids that but often lacks money and technical capacity, which is why the two are so often combined. Any partnership can produce iatrogenic effects, and the standard advice is to agree on values, terminology, conflict handling, and the intended duration of the relationship early, then revisit those agreements as things change. Organizing itself is usually taught as a repeating cycle: assess what exists, research who controls it, act, then reflect and reassess. The relational work at its core, the one-to-one conversation, is slow by design, and systemic change takes long enough that a short evaluation window will often show nothing.

Assets rather than deficits

, associated with John Kretzmann and John McKnight, is the community-scale analogue of a strengths perspective. Its founding move is a critique of deficit framing: a community described entirely through its problems becomes a case to be managed by outsiders, while a community described through what it already has becomes a partner with something to contribute. The operational first step is asset mapping, a systematic inventory of a place's health-promoting features: tangible assets such as parks, clinics, welfare agencies, nonprofits, and businesses, and intangible ones such as social networks, cultural practices, and local knowledge. Practitioners are advised to look for the well-connected individuals and organizations who can introduce them to everyone else. Two limits belong alongside the method. The first is practical: short-term, grant-funded assets are transient, so a map ages quickly, and even where a community dialogue does happen, the link between what the community said and how resources are actually allocated is often weak. The second limit is a contested critique. MacLeod and Emejulu argue that asset-based approaches can be turned into a way of recasting structural inequality as a matter of individual or community responsibility, providing cover for reductions in public provision, while acknowledging that other practitioners use the same approach for genuine democratic renewal. This lesson does not adjudicate that argument. It is enough to know that pointing out what a neighborhood already has can be a way of taking it seriously, or a way of explaining why it needs less, and that the difference lies in what happens next.

The community needs assessment as a formal method

An individual assessment describes one life in enough detail to build a plan with that person; that method belongs to case management and is treated separately. A community needs assessment shares the name and little else: the unit of analysis is a defined population, there is no service plan at the end, and in its regulated form the product is a public document. U.S. tax-exempt hospital facilities must have conducted a community health needs assessment in the current taxable year or one of the two preceding ones, and an authorized body of the facility must adopt an implementation strategy in response. The regulation names five steps: define the community served; assess its health needs; solicit and take into account input from persons representing the broad interests of that community, including people with public health expertise; document the assessment in a written report adopted by an authorized body; and make that report widely available to the public. Assessing health needs is itself defined, as identifying the community's significant health needs, prioritizing them, and identifying the resources potentially available to address them. Required input includes at least one governmental public health department or a State Office of Rural Health, members of or organizations representing medically underserved, low-income, and minority populations, and written comments on the previous assessment. Note what is left open. The regulation lists possible prioritization criteria, including burden, scope, severity, urgency, feasibility, associated health disparities, and the importance the community itself places on the need, without ranking them. Prioritization is therefore a judgment, which is exactly why the composition of the room matters. This is where power analysis and earn their place: identify the parties with influence over the issue and the parties with an interest in it, notice when those are different people, and use several independent entry points so that a single gatekeeper does not determine the participant list. The documented failure is relying on the residents and organizations who are already organized and easy to reach, which compromises equity and produces a confidently biased result.

Community-based participatory research

is defined in AHRQ's evidence report as a collaborative approach that combines methods of inquiry with community capacity-building strategies, in order to close the gap between what research produces and what communities practice. Its distinguishing commitment is that the community is a partner in the research rather than a site where research is conducted, which means shared authority over what question is asked, not merely cooperation once the question is set. The gap between that commitment and the record is documented. Reviewing sixty CBPR studies, AHRQ found that steering committees and advisory boards were the main mechanism for sharing research decisions but generally did not develop the research questions or the proposals; community participation was strongest in recruitment, retention, and intervention design. Many studies had strong community-institution collaborations, few combined that with solid research methods, and of thirty intervention studies only twelve had been completed and evaluated. That report dates from 2004 and is now provided for historical reference, so it describes a literature rather than the field today. The lesson it supports is durable anyway: the label is easier to claim than to earn, and the diagnostic question is who wrote the research question.

Coalitions, and how anyone would know it worked

A coalition brings residents together with public and private organizations to work on a problem larger than any one partnership can carry, usually agreeing a mission, a vision, and shared values, then writing action plans carried out by the coalition or by affiliated organizations. Reviewing the empirical literature from 1980 to 2004, Zakocs and Edwards found twenty-six qualifying studies and six coalition-building factors associated with effectiveness in five or more of them: formalization of rules and procedures, leadership style, member participation, membership diversity, agency collaboration, and group cohesion. The more revealing number is what those studies measured. Of the twenty-six effectiveness indicators in use, nineteen measured how the coalition itself was functioning and only two measured change in community-wide health behavior. A coalition that meets reliably and gets along well has demonstrated that it is a functional coalition. The broader evidence is genuinely mixed. A meta-analysis of 131 controlled trials of community-engaged public health interventions for disadvantaged groups in wealthy countries found positive pooled effects on health behavior, health consequences, self-efficacy, and perceived social support, with the largest around four-tenths of a standard deviation, and found insufficient evidence to say that any one model of engagement outperforms another. Meanwhile the Accountable Health Communities Model, which ran from May 2017 to April 2023 across twenty-eight bridge organizations, tested navigation to community services against a randomized control group and found no significant increase in the rate of connection to service providers or in the rate of need resolution; where connections were made, the available resources were often not enough to resolve the need. That model funded the bridge organizations' infrastructure and staffing rather than the community services themselves, which is part of how the result should be read. Underneath the evidence problem sits a measurement problem: Speer and Han argue that an inflated emphasis on individual-level metrics obscures the relational processes through which organizing builds collective power, so the easiest things to count are not the things doing the work. Taken together, community engagement as a class of intervention has positive average effects on individual outcomes, no particular model has been shown superior, specific mechanisms can and do fail, and causal attribution at community scale stays hard because the unit is large, the timescale is long, and nothing holds still. This lesson is educational material about how community practice is described, taught, and studied. It is not legal, political, organizational, or clinical advice, it takes no position on any party, movement, or ideology, and decisions about a real community belong to that community and its qualified advisors.

Eli, the EliExplains learning guide

Eli explains

The same idea, in plain words

Explain it like I’m 10

Usually a helper works with one person. Community practice is what happens when the thing that needs help is a whole group, a neighborhood, or a town. The first hard question is not what to do but who you are talking about. If you say 'this neighborhood', do you mean everyone inside a boundary on a map, or everyone who shares something in common, or everyone already working on the problem? Those are three different lists of people. The second hard question is who gets to speak. If you only ask the groups that already hold meetings and answer emails, you will hear a real opinion, just not the whole one. The third hard question is the meanest: how would you ever know if you helped? A neighborhood changes for a hundred reasons at once, slowly, and your project is only one of them.

Picture it like this

It is like being asked to improve a river instead of a fish. You cannot bring the river into an office, you cannot ask the river what it wants, and if the water gets cleaner five years later you will never fully prove it was your work rather than the rain, a factory closing, or a rule someone passed upstream.

Where the picture stops working

The analogy breaks in the most important place. A river has no opinion and no internal disagreements, but a community does, and it argues with itself about what the problem even is. A river also cannot tell you that you are working on the wrong thing, cannot organize, and cannot outlast your funding. Communities can do all three, which is why the real work is negotiating with people rather than managing a system.

Worked example

A hospital preparing its three-yearly community health needs assessment defines its community as its patient service area, then holds two listening sessions publicized through the three neighborhood associations that reliably respond. Both sessions rank parking and clinic wait times as the top concerns, and the draft implementation strategy follows. A staff member checks the regulation and finds two problems. First, the community may not be defined so as to exclude medically underserved, low-income, or minority populations living in the areas the hospital draws patients from, and the northern tracts have been quietly dropped. Second, required input includes members of, or organizations representing, those populations, plus a governmental public health department. The team re-runs consultation through a health center, a tenants' group, and two churches. Uncontrolled diabetes and the absence of any bus route to the clinic after six in the evening now rank above parking. Nothing about the neighborhood changed. The list of people in the room did.

Key takeaway

Community practice changes the client from a person to a population, and every hard question follows from that: which community you mean, who is in the room when its problems get named, and how anyone would establish that your work rather than everything else is what changed. The evidence supports engagement as a class of intervention; it does not yet support confident claims about any particular model.

Quick check

3 questions here, of 5 in this lesson’s practice set. Answers stay hidden until you check.

Question 1 of 3foundational

In Rothman's original threefold typology of community intervention, what distinguishes social planning from locality development?

Choose an answer, then check it.
Question 2 of 3intermediate

Under the U.S. Treasury regulation governing community health needs assessments, what constraint applies when a tax-exempt hospital facility defines the community it serves?

Choose an answer, then check it.
Question 3 of 3intermediate

A team planning a community assessment schedules listening sessions and recruits participants by asking three long-established neighborhood associations to nominate attendees. What is the most likely methodological problem?

Choose an answer, then check it.
Practice all 5

Keep learning

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Practice this lesson
Study tools & related lessonsYou’ll learn to · Common mistakes · Easily confused · Key vocabulary · Related

You’ll learn to

  • Define community practice and distinguish geographic, identity-based, and functional definitions of a community.
  • Explain why the boundary drawn around a community determines whose problem definition prevails, and identify who is typically missed.
  • Distinguish Rothman's locality development, social planning, and social action, and explain how he later revised the typology.
  • Compare asset-based community development with deficit framing, and evaluate the structural critique made against it.
  • Apply the required steps of a community health needs assessment and contrast them with an individual assessment.
  • Evaluate what the evidence does and does not establish about the effectiveness of community-level intervention.

Common mistakes

  • Speaking of 'the community' as though it has one view, and treating whoever showed up as its representative.

    A community contains disagreement, and consultation that runs through established gatekeepers reaches the already-organized. Plan stakeholder identification deliberately by influence and by interest, use several independent entry points, and record who was not reached.

  • Treating Rothman's three models as three mutually exclusive boxes that a project must be sorted into.

    Rothman himself replaced the threefold scheme in 2007 with a nine-variant formulation spanning planning and policy practice, capacity development, and advocacy, in which modes mix and are not treated as conflicting. Use the three as a vocabulary for describing emphases.

  • Presenting asset-based community development as the settled, obviously superior alternative to a needs focus.

    It is a real methodological shift with a live structural critique: MacLeod and Emejulu argue it can recast structural inequality as community responsibility and be used to justify withdrawing public provision. Teach the method and the critique together.

  • Calling a study community-based participatory research because community members were recruited as participants or sat on an advisory board.

    The defining commitment is shared authority over research decisions, including the research question. AHRQ found that advisory structures were the main decision-sharing mechanism but generally did not develop the questions or proposals, so the label needs checking against who set the agenda.

  • Concluding that a community intervention worked because the coalition running it functioned well.

    In the reviewed coalition literature, nineteen of twenty-six effectiveness indicators measured coalition functioning and only two measured community-wide behavior change. Coalition health is a process measure, and the community outcome has to be evidenced separately.

Easily confused

Individual needs assessment vs. Community needs assessment

The unit of analysis differs and so does the product. One describes a single life to support that person's plan; the other identifies and prioritizes the significant needs of a defined population, names the resources potentially available, and in its regulated form ends in a report published for anyone to read.

Locality development vs. Social action

Locality development works through broad participation and capacity building inside the community, generally seeking consensus. Social action organizes disadvantaged people to press the wider community for resources or better treatment, and treats conflict as a usable instrument rather than a failure.

Deficit framing vs. Asset-based framing

A deficit inventory describes what a place lacks and positions outsiders as the source of the fix. An asset inventory describes the relationships, institutions, and knowledge already present and positions the community as a partner with something to contribute. Both are selective descriptions, and each can be misused.

Community-placed research vs. Community-based participatory research

Community-placed research happens in a community that supplies participants and a setting. Participatory research gives the community real authority over research decisions, above all over what question is asked. The test is not where the study ran but who shaped it.

Coalition functioning vs. Community-level outcome

Functioning measures cover membership, participation, leadership, cohesion, and formalized procedures, and they describe the vehicle. A community-level outcome measures whether the condition in the population moved. The literature has measured the first far more often than the second.

Key vocabulary

Community practice
Professional helping work in which the unit of change is a defined population or place rather than an individual case, covering organizing, planning, development, and advocacy at that scale.
Identity-based community
A group whose members are linked by a shared characteristic, experience, or perspective rather than by a shared address, and which may be dispersed across many places.
Functional community
A grouping that comes into being through joint action around a shared concern, which may be recent, temporary, and cut across both geography and identity.
Locality development
Rothman's strategy of pursuing change through the broad participation of diverse community members, with attention to strengthening their organizational capacity as the work proceeds.
Social action
Rothman's strategy of organizing people who are disadvantaged so that they can make demands on the wider community for increased resources or improved treatment.
Asset-based community development
An approach that begins from the strengths, relationships, and resources a place already holds rather than from its deficits, in order to mobilize local partnerships for change.
Asset map
A systematic inventory of a place's health-promoting features, covering tangible resources such as clinics, parks, and agencies and intangible ones such as social networks and local knowledge.
Community health needs assessment
A population-level study that U.S. tax-exempt hospital facilities must conduct at least once every three years, which identifies and prioritizes significant health needs, names available resources, and ends in a published report.
Community-based participatory research
Inquiry in which the people being studied hold genuine authority over research decisions, including what question gets asked, rather than serving as a setting in which outsiders conduct a study.
Stakeholder mapping
A planning step that identifies the parties holding influence over an issue and the parties holding an interest in it, so that consultation is designed rather than left to whoever is easiest to reach.

Sources & references

  1. What Is Community? An Evidence-Based Definition for Participatory Public Health — MacQueen KM, McLellan E, Metzger DS, et al.; American Journal of Public Health 91(12):1929-1938
  2. Trilogies: Lessons from 50 Years Facilitating Community-based Health Assessments and Planning in Appalachia — Behringer B; Journal of Appalachian Health 6(1-2):149-163, East Tennessee State University
  3. Multi Modes of Intervention at the Macro Level — Rothman J; Journal of Community Practice 15(4):11-40
  4. 26 CFR 1.501(r)-3 - Community health needs assessments — Office of the Federal Register / Internal Revenue Service, via eCFR
  5. How to do (or not to do)... asset mapping in community health — Chen X, Ye E, Fong N, et al.; Health Policy and Planning 41(3):513-526, Oxford University Press
  6. Neoliberalism with a Community Face? A Critical Analysis of Asset-Based Community Development in Scotland — MacLeod MA, Emejulu A; Journal of Community Practice 22(4):430-450
  7. Community-based Participatory Research: Assessing the Evidence (Evidence Report/Technology Assessment No. 99) — Viswanathan M, Ammerman A, Eng E, et al.; Agency for Healthcare Research and Quality (US), Report No. 04-E022-2
  8. What explains community coalition effectiveness? A review of the literature — Zakocs RC, Edwards EM; American Journal of Preventive Medicine 30(4):351-361
  9. The effectiveness of community engagement in public health interventions for disadvantaged groups: a meta-analysis — O'Mara-Eves A, Brunton G, Oliver S, Kavanagh J, Jamal F, Thomas J; BMC Public Health 15:129
  10. Community Organizing, Partnerships and Coalitions (Chapter 15), in Introduction to Community Psychology — McKibban AR, Steltenpohl CN; in Jason LA, Glantsman O, O'Brien JF, Ramian KN (eds.), Rebus Community
  11. Critiquing and Analyzing the Effects of Neoliberalism on Community Organizing: Implications and Recommendations for Practitioners and Educators — Brady SR, Schoeneman AC, Sawyer J; Journal for Social Action in Counseling and Psychology 6(1):36-60
  12. Re-engaging Social Relationships and Collective Dimensions of Organizing to Revive Democratic Practice — Speer PW, Han H; Journal of Social and Political Psychology 6(2):745-758, PsychOpen
  13. Accountable Health Communities Model — Centers for Medicare & Medicaid Services, Center for Medicare & Medicaid Innovation
  14. Addressing Health-Related Social Needs Via Community Resources: Lessons From Accountable Health Communities — Renaud J, McClellan SR, DePriest K, et al.; Health Affairs 42(6):832-840

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Researched 2026-08-18

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