HDRG Recap: Building Community Based Research through Community Coalitions

DannyEditedAt the November 2017, Health Disparities Research Group (HDRG) meeting, Danny Patterson, Coordinator, Collaborations and Partnerships, Gulf States Health Policy Center (GSHPC), shared about their experiences with coalition building to work for improving health outcomes. Working in 5 states (Alabama, Florida, Mississippi, Louisiana, and Texas) GSHPC united with community members, partner organizations, and service providers to form coalitions including 130 multi-sector community organizations in the states of Alabama (cities of Bayou La Batre, Mobile, Birmingham) and Mississippi (cities of Hattiesburg and Gulfport/Biloxi) and Louisiana via LSU in Baton Rouge. Coalition members represent a range of groups including faith-based organizations, government, education, primary care, mental health, housing, academia, public health, business, law enforcement, and other community-based organizations. GSHPC works with both local and national partners in their work. The work is supported by the National Institute of Minority Health Disparities.

With a focus on health policy research that leads to positive change, the coalition building process included three basic phases: member recruitment, development of strategic partnerships, and training of coalition members. Activities taking place throughout the process include community information meetings, coalition member recruitment, policy focus area identification, subject matter expert presentations, community forums/policy scans, literature reviews, community action plans (in development) and action plan implementation. The goal is to “empower communities and increase their capacity to improve health outcomes.”

The local coalition is currently working in 3 policy areas: health literacy, financial literacy, and educational literacy.  In terms of health literacy, the coalition is working on local practice or policy change by creating pathways for data sharing between Ozanam Charitable Pharmacy and Mobile Board of Health Clinics. The current research pilot, designed by the coalition, will recruit 50 diagnosed diabetes patients (as of November 6, 31 had been recruited). The two organizations serve mostly low-income and homeless individuals. The process under study will facilitate the sharing of information for the participating patients in order to provide more holistic care. To date, lack of transportation from the clinic to the pharmacy has been identified as one of the problems that will need to be addressed. The study will evaluate whether or not the increased communication between pharmacy and doctor translates into improved care and disease medication management for the patients.

During the question and answer phase of the HDRG meeting, Danny stressed the importance of transparency and open dialogue to build the coalition. Such an approach — a willingness to give a little while building something greater — helps develop the relationships needed to develop a healthy and impactful coalition.

Along with projects related to policy, the GSHPC coalition focuses on building community-based leadership capacity. This capacity is critical for sustainable once funding for the projects are over. The built capacity for local leaders to continue the policy work is essential for continued progress toward health equity.

Learn more about the Gulf States Health Policy Center.
Learn more about the Health Disparities Research Group.


A Key to Successful Health Transformation: Build Relationships

The following excerpt comes from the article by Lindsey Alexander, Pedja Stojicic, and Rebecca Niles published on September 22, 2017, on ReThink Health.

Several years back, Atul Gawande, a surgeon, public health researcher, and staff writer for the New Yorker, wrote an article on how good ideas spread. In his piece, Gawande detailed the BetterBirth Project, which strives to spread safer childbirth practices in parts of rural India. Gawande wrote:

To create new norms, you have to understand people’s existing norms and barriers to change. You have to understand what’s getting in their way. So what about just working with health-care workers, one by one, to do just that? With the BetterBirth Project, we wondered, in particular, what would happen if we hired a cadre of childbirth-improvement workers to visit birth attendants and hospital leaders, show them why and how to follow a checklist of essential practices, understand their difficulties and objections, and help them practice doing things differently. In essence, we’d give them mentors.

Gawande’s article suggests that the heart of any real transformation is, quite simply, relationships. While in recent years we’ve become enamored with spreading ideas at the speed of light (think TED talks and the quest for the next viral video), the bottom line is this: effective relationships, which take time, are incredibly powerful. For those of us engaged in the art of regional health transformation, it’s imperative that we step back and reevaluate our relationships, considering both their quality and their quantity; pondering the extent to which they are productive and whether anyone important is missing from the table.

Given the imperative of building relationships, we decided to take a look at just how multisector partnerships experience relationships in each of ReThink Health’s three practice areas of stewardship, strategy, and sustainable financing. What do effective relationships look like and what do these relationships enable partnerships to do?

Stewardship: Building Relationships is More Than Networking

Stewardship occurs when regional stakeholders–leaders, community members, organizations, and others across multiple sectors–align and act around shared priorities, strategies, and vision for fostering healthy people and thriving communities. Effective stewardship is often the key to addressing the core challenges facing multisector partnerships as they strive to transform regional health. In this process of alignment, relationships are critical.

Let’s be clear about what we mean by “relationships.” We’ve found that some people confuse building relationships with networking. While networking is done to connect and get informed, building meaningful relationships requires commitment and some degree of openness and vulnerability. Unlike networking, relationships are open-ended, creating the opportunity for growth. It’s similar to the difference between checking how your friends are doing on Facebook and getting together in person for a coffee or dinner. The former will get you informed, but the latter helps you truly connect (and may even take you on an adventure!).

Through ReThink Health’s work with regional transformation efforts, we’ve observed that multisector partnerships and integrator organizations with effective stewardship practices form relationships with at least three critical characteristics:

  1. Shared values – Shared values is about finding common ground; the areas where you agree. It does not necessarily mean everyone has to think or behave the same way. Instead, you can agree on a few foundational elements: that you want to improve health outcomes or increase economic vitality; or that achieving true systems change requires working together. The best way to create shared values is to explore and share stories that motivate us to act, such as deep personal stories that inspired us to do this work or collective stories that bind us as a community. Our Story of Self and Story of Now tools can help you do that effectively.
  2. Clear commitment  – Clear commitment is the glue in any relationship. Taking action and following through demonstrate that you care and that you are committed to collaboration. These are indicators that a relationship exists. We often see stakeholders coming together around the partnership table and participating in meetings or networking without actually taking any action between meetings. Without commitment to each other to meet common goals, there is no relationship.
  3. A spirit of co-creation – Co-creation of new things is a sure sign of a meaningful relationship. Groups that have good relationships tend to be very productive. They might create a Value Proposition for Health System Transformation, implement successful campaigns to improve population health, or develop new guides or manuals for their partners. If you are not producing anything together, soon you will discover that you are not in an effective relationship. You are just playing it safe–because creating something new requires courage, collaborative energy, and creativity.

Read the full article.

Guide for Training Community Based Researchers

Recently, a the United Nations Educational, Scientific, and Cultural Orgnaization (UNESCO) released the manual Training the Next Generation of Community Based researchers: A Guide for Trainers. An initiative of the UNESCO Chair in Community Based Research and Social Responsibility in Higher Education, the guide focuses on community based research (CBR) as “an approach to co-creation of knowledge based on the acknowledgement that multiple sites, modes and forms of knowledge production co-exist in society today. “

Section of the guide include:

Part 1: Understanding community based research

  • Historical trajectory
  • How can CBR help strengthen community-university engagement?
  • CBR vis-à-vis conventional research
  • Benefits of doing CBR

Part 2: Key findings of the global study on ‘Building the Next Generation of Community-Based Researchers’

  • (The NextGen Project)
  • Major Findings
  • Recommendations and suggestions
  • Key takeaways

Part 3: Pedagogical framework for training of next generation community based researchers

  • An orientation towards research ethics and values
  • Development of a deep understanding of power and partnerships
  • Incorporation of multiple modes of inquiry
  • Participation in learning CBR and ensuring a balance between classroom (theory) and field (practice)
  • The role of researcher as CBR facilitator

Download Training the Next Generation of Community Based researchers: A Guide for Trainers.

Improving Population Health by Working with Communities: Action Guide 3.0

From the Report released by the National Quality Forum:

The United States ranks lower than many other developed nations on health outcomes, faces unsustainable healthcare costs, and continues to struggle with significant health disparities. To address these issues, the National Quality Strategy is driving action to foster healthier people and communities, better healthcare, and more affordable care. Improving population health by working together is an essential part of the solution. In collaboration with a multi-stakeholder Committee and 10 groups at the regional and community levels working on population health improvement across the country, the National Quality Forum developed the Action Guide with funding from the Department of Health and Human Services.

The Action Guide is a framework to help multi-sector groups work together to improve population health by addressing 10 interrelated elements for success and using the related resources as needed. Like a “how-to” manual, the Action Guide is organized by these 10 elements and contains definitions, recommendations, practical examples, and a range of resources to help communities achieve their shared goals and make lasting improvements in population health. It is intentionally brief and written in plain language to be as accessible as possible for all types of stakeholders at the local, state, regional, and national levels to take action.

The Action Guide’s 10 key elements are:

  • Collaborative Self-Assessment
  • Leadership Across the Region and Within Organizations Audience-Specific Strategic Communication
  • A Community Health Needs Assessment and Asset Mapping Process
  • An Organizational Planning and Priority-Setting Process
  • An Agreed-Upon, Prioritized Set of Health Improvement Activities
  • Selection and Use of Measures and Performance Targets
  • Joint Reporting on Progress Toward Achieving Intended Results
  • Indications of Scalability
  • A Plan for Sustainability

Download the full Action Guide.

Building and Bridging: Collaborating to Improve Health

From the article by Karen Minyard and Chris Parker on the Build Healthy Places Network Blog:

…Recognizing that health cannot be achieved or maintained in isolation, Bridging for Health: Improving Community Health Through Innovations in Financing takes a systemic approach to improving population health, much in the same way that the Build Healthy Places Network tackles community development through cross-sector collaboration.

Bridging for Health, supported by the Robert Wood Johnson Foundation, is aiding communities in the pursuit of financing mechanisms that rebalance and align investments in health. The Georgia Health Policy Center (GHPC) at Georgia State University in Atlanta is the national coordinating center. The center works with selected collaboratives across the country to improve population health and achieve equity. We believe that the key to this lies in the linkages among health care, public health, and other sectors like community development to support a national Culture of Health that will enable all to live longer, healthier lives now, and for generations to come.

Bridging for Health initially selected four geographically diverse sites. The sites differ in the leadership of the collaborative and potential financing mechanism being explored, but share a commitment to upstream investment in interventions to improve population health outcomes in their community.

…GHPC’s 20-plus years of experience in health care financing, public health, technical assistance, and sustainability planning made us realize that it is shortsighted to focus financing innovations in isolation.  While communities may be energized by the idea of pay for success or a wellness trust and are anxious to jump in, they must also address the areas that complement and support innovations in financing.  Collaboratives cannot successfully implement a financing mechanism without the right partners, the right strategy, or without considering sustainability. Population health will never truly improve without an eye toward equity. Our team did a great amount of thinking about the need for a mindset change.  How could we help our communities realize the importance of getting the pieces in place to nurture the innovation?

We have developed a framework, called the “Blueprint for Action.” This guides our focus on the core areas to address with our sites:  collaboration and collective impact, innovations in financing, and health and health equity.  Through tailored technical assistance, evaluation support, resources, subject matter experts, and opportunities for peer learning and exchange, Bridging for Health works with communities for two years to catalyze progress and share the learnings to spark further innovations across the country.

Read the full article.

Experiences and Lessons Learned from Attending Campus-Community Partnerships for Health 2016

At the May 2016 meeting of the Health Disparities Research Group (HDRG), several individuals shared their experiences from attending the Campus-Community Partnerships for Health (CCPH) 2016 conference in New Orleans, LA.  They discussed the various sessions they attended and the lessons they brought back from the conference. The discussion included several major themes.

Community-Academic partnerships were a centerpiece of the CCPH conference. Of those HDRG members who attended the conference, several spoke of the way community members led many of the sessions with academic partners playing a supportive role. One example was a session led by the translational research coordinator/community navigator from the Vanderbilt Institute of Public Health. The session featured the work of integrating community members into research design decisions by including community representatives in a scientific advisory board and the “community engagement studio” which forms a consultant group for impacted community members to review research protocols and provide feedback and advice to researchers.

The importance of funding and how funders work to ensure community engagement garnered much discussion. Naima Wells, research coordinator from the USA Center for Healthy Communities Research  (CHC) Core, described a meeting that she attended with leadership from CCPH and the Robert Wood Johnson Foundation. The session focused on two main questions: 1) Is philanthropy helpful?; and 2) Is there arrogance in philanthropy?. A strong vein coming from the discussion was the importance of considering community need, interest and infrastructure in developing calls for proposals. From the foundation perspective, there is a need for more community groups to respond to funding opportunities. From the research and community activist perspectives, the opportunities either don’t coincide with local need or are too cumbersome to allow for a proposal.

Community-Academic partnerships serve to foster the development of new participatory approaches. Shannon Shelley-Tremblay, project manager for the CHC, described a session on group level assessment developed by researchers at the University of Cincinnati. The model focuses on involving all key stakeholders in a process in which everyone is on the same level to discuss problems and solutions. In so doing, the model allows the use of different communication mechanisms such as drawing and speaking to ensure that all voices have a place in the discussion and allow for analysis within the group as well as data collection.

The impact of language on relationship and the views of the other was an underlying stream of discussion throughout the conference. Naima Wells mentioned that in many of the sessions that she attended individuals talked about the need to acknowledge the strengths within the communities where research is being done. The use of the word “empowerment” was questioned. The consensus was that ‘empowerment’ implies that marginalized communities do not have power and that researchers are giving them power. The reality is that these communities have always had power and strengths that researchers and other must recognize. Naima reported that two recommendations came out of the discussions: “in-powerment” and “redirect power.” The discussion was a reminder of the need to be cognizant of the language we use and the messages that are communicated through that language.

During the HDRG meeting, members of the Research Core reported on their own presentation during CCPH. They described the positive reception of the research apprentice concept and the very lively dialogue with the audience members. Sherron Dortch, senior research apprentice, talked about the individual feedback that she received from different conference attendees she met. She also expressed her appreciation for attending CCPH 2016 and learning more about the importance of health disparities research.

How Baton Rouge Got Its Hospitals to Join Forces to Improve Residents’ Health

From the article by Kathleen Costanza on the Building Healthy Places Network Blog:

The Affordable Care Act is a whopping 10,000 pages long—the biggest regulatory overhaul of the American health care system in decades. And nestled in Section 9007(r) is a small but important new requirement: nonprofit hospitals are now required to conduct a Community Health Needs Assessment.

To retain their tax-exempt status, nonprofit hospitals have always been required to contribute some of their income to charity care or to supporting their surrounding community. But in reality, few focused on community health. The health needs assessment now requires these hospitals to identify unmet need in the community every three years and create detailed plans to address those health needs.

But Baton Rouge, Louisiana, which has always marched to the beat of a different drum, wanted to do something innovative. In 2015, the area’s five major hospitals came together to conduct the country’s first Joint Community Health Needs Assessment.

“If you’re going to make any difference in population-level health outcomes, it’s going to take a coordinated effort,” said Andy Allen, outreach officer for the Office of the Mayor-President, which coordinated the initiative. The assessment was powerful, if not surprising. Baton Rouge residents were struggling with many serious health issues. The area has one of the highest rates of HIV in the country, and nearly one-third of residents are obese, according to CDC data.

“Following that assessment, we weren’t just doing random acts of kindness or fulfilling our federal obligations,” Allen said. “We saw our mission as a cohesive mission.”

It wasn’t the first time Baton Rouge’s hospital leaders had worked together. In 2008, Mayor-President Melvin “Kip” Holden established Healthy Baton Rouge, called Healthy BR, an ongoing initiative of more than 70 partners working to reduce health disparities. Partners include local government, nonprofits, schools, faith-based organizations, and the area’s five major hospitals.

So when ACA required a health needs assessment, the hospitals had already been working with each other to improve community health. It made sense for them to approach the CHNA together, since they all serve the same populations.

The implementation plan that emerged from the needs assessment includes efforts to reduce obesity, improve behavioral and mental health, and reduce emergency room overuse. The partnership has generated funding for mobile farmers’ markets in areas that lack stores with fresh food. The plan also outlines a goal to make HIV screenings available at community events, urgent care clinics, and college campuses. And the city continues to bring new partners together. An organization focused on behavioral health, for example, is working with the HIV committee at Healthy BR to help people better manage chronic illness. They are also exploring growing partnerships with Community Development Financial Institutions to improve health.

Read the full article.

Research Apprentices’ Presentation

In preparation for their upcoming formal presentation to  the 14th International Conference of the Community-Campus Partnerships for Health Research Apprentices Sherron Dortch, Valerie Grimes, and Carla Taylor together with Research Technician, Marcellus Hudson and Research Assistants, Lynette Parker and Andrea Hudson, spoke to members of the Health Disparities Research Group during the April meeting.  They provided the HDRG members with an overview of their work with the Sentinel Surveillance Project  which is currently being conducted by the CHC Research Core under the leadership of Dr. Martha Arrieta.

The discussion highlighted the research training experienced by the Research Apprentices who are members of the community who have a wide variety of backgrounds and interests, but no prior formal education in the research process.  Additionally, the group provided an overview of the Sentinel Surveillance Project and why the inclusion of community members as a part of the research team is integral to meeting the goals of and adhering to the values of community-based participatory research. Structured in an interview format, the team described recruitment and training of research apprentices, the work done in collecting, managing, and analyzing data gathered from the community.

RA Presentation Quote -- SherronWhile describing their participation in the research team, the various research apprentices discussed both what they had brought to the research project and what they had learned. Sherron Dortch, a senior research apprentice, stated that her attention to detail and strong organizational skills allowed her to focus on quality data management while at the same time providing her with the opportunity to develop computer skills. At the same time, Sherron shared that through this research project she developed a deeper awareness and understanding of the health disparities that exist in a neighborhood and community where many of her friends and relatives live. This sentiment was echoed by Valerie Grimes and Carla Taylor who also work as Research Apprentices.

Marcellus Hudson, currently a Research Technician II with the Research Core, described his journey from Research Apprentice to a full-time staff member at the University. He talked about the many ways the experience provided avenues to foster his interest in computer programming and further enhanced his desire to learn and pursue his education. Marcellus also talked about the importance of uncovering the health situation in the community where he and many of his relatives live.

The research team will next make their presentation to an international audience of researchers and community members at the 14th International Conference of the Community-Campus Partnerships for Health. The presentation will take place on Thursday, May 12, at 3:30 pm. If you are in New Orleans, the team would love to see you there!

Does Your Health Team Include a Lawyer?

From the article by Mary E. Kennelly, on Health.gov:

When most people go to the doctor’s office, they don’t expect to leave with a referral to see a lawyer. This may be changing. At the primary care centers of Cincinnati Children’s Hospital Medical Center, when a patient presents with asthma symptoms and reports living in rental housing with mold, pests, or other substandard conditions, the family will have the opportunity go down the hall and speak with a legal aid attorney.

This arrangement, called a medical-legal partnership, adds public interest lawyers to the health care team in medical practices that serve vulnerable populations. As part of the health care team, these lawyers train their health care colleagues to identify patients where eviction, loss of employment, or any number of other civil legal problems limit the patient’s ability to achieve full health. The patient is then offered a consult with a lawyer, just as a physician would make a recommendation to consult a medical specialist. A growing body of research shows that medical-legal partnership adoption is associated with reduced hospitalizations, lower stress levels, and improved treatment adherence among patients who receive services from a medical-legal partnership lawyer.

Medical-legal partnerships are just one example of a continuum of legal and policy services needed to support communities in addressing social determinants of health — conditions in the environment in which people are born, live, learn, play, work, and age that affect health. Healthy People 2020 sets 10-year national objectives for improving the health of all Americans and approaches the social determinants of health through a place-based framework with five domains: economic stability; education; social and community context; health and health care; and neighborhood and built environment.

Read the Full Article.

A Shave and a Health Check

From the article by Marshall Terrill from Arizona State University:

…[Barber Marvin] Davis is the manager of Ageez Hair Center in Chandler and is one of a handful Phoenix-area barbers who sit on the steering committee of the African American Cardiovascular Disease Health Literacy Demonstration Project . The project puts an emphasis on prevention and health literacy through culturally grounded community efforts for African-American men in the greater Phoenix area. Participating barbershops and hair centers are supplied with blood-pressure monitors — and training  — to give readings to their customers.

“Barbers hold a unique and esteemed place in the African-American community,” said Dr. Olga Idriss Davis, who is principal investigator for the project and for community engagement at the Southwest Interdisciplinary Research Center (SIRC).

“The culture of the black barbershop is a folk tradition, a gathering place in the male community, a site where knowledge can be traded, disputes resolved and wisdom transferred from generation to generation. It’s a wonderful microcosm of society.

“Barbers are looked upon as leaders in the African-American community. Clients often tell their barbers intimate things, sometimes things they would never tell their partners and family members.”

Dr. Davis, who started the project in 2013, admits it took her a while to earn the trust of the barbershops and the surrounding communities in which they serve.

“Researchers employed by institutions of higher learning have not had the best interactions with African-American and Native American communities. Historically, they smile at the door, gather data and leave without any follow-up that supports the community,” Dr. Davis said.

Dr. Davis said even though she’s African-American, it didn’t entitle her to a free pass or easy entree into the community. That trust had to be earned over a long period of time.

“Early in my research and fieldwork there was a woman from the community who frequented a barbershop, and all of the barbers were her ‘babies.’ She walked into the shop one day, and asked the barbers, ‘Who is this chick on my turf?’ ” Dr. Davis said. “She then got an inch away from my face and said, ‘I wanna talk to you. You’re one of them and you’re here to take our stories. You’re part of the establishment.’ ”

Dr. Davis calmly explained to her that nearly 50 million men in the U.S. have high blood pressure, 40 percent of whom are African-Americans. She added that African-American males are particularly at risk because they are often unaware of the disease, do not receive treatment and rarely adhere to a treatment regimen if one is prescribed. That had to change, Dr. Davis said.

She then explained a vision: transforming barbershops into a health-care space where barbers become “community health advocates.” Dr. Davis said it was a moment where she could see the woman’s defiance morph into understanding.

“I told her, ‘I want this to have a ripple effect throughout the entire African-American population, not just in this community … but I’m going to need your help, too,’ ” Dr. Davis said. “She finally got it and smiled, then said, ‘You all right, sister.’ I said, ‘You’re all right, too, sister.’ We’ve been good ever since.”

So has the program, which had made serious headway in the African-American communities in Chandler and south Phoenix. Barbers are casually talking to their clients about their health and discreetly taking blood-pressure readings.

Read the full article