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Engaging Communities as Partners
Sergio Aguilar-Gaxiola, MD, PhDProfessor of Clinical Internal Medicine
Director, Center for Reducing Health DisparitiesDirector, Community Engagement UCD CTSC
UC Davis School of Medicine
Academy Health Annual Research Meeting Washington, DC
June 9, 2008
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Community engagement and collaboration is a cornerstone of effective public health practice;
Successful community engagement builds skills and capacity within the community, which are fundamental factors for optimal health.
Communities are essential in proactively looking for effective, long-term, and sustainable solutions for reducing health and healthcare disparities;
Community involvement is crucial in the recruitment and retention of diverse groups’ participation in health research;
The community is where the full impact of evidence-based information will be realized; dissemination and implementation are key.
Why Engage Communities?Why Engage Communities?
Principles of Community EngagementPrinciples of Community Engagement
Community engagement processes are about personal and local relationships that should be: Participatory Cooperative Conducive to learning from each other Encourage community development and capacity
building Empowering
IDENTIFY also ASSETS, STRENGTHS, RESOURCES within COMMUNITIES
Community engagement processes are about personal and local relationships that should be: Participatory Cooperative Conducive to learning from each other Encourage community development and capacity
building Empowering
IDENTIFY also ASSETS, STRENGTHS, RESOURCES within COMMUNITIES
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Important Goals when Working with Underserved Communities
Source: IOM Report “Examining the Health Disparities Research Plan of the National Institutes of Health: Unfinished Business”, 2006
Include underserved communities in research
Increase of URM researchers
Increase the diversity of the workforce
Address health disparities vigorously
Disseminate research results widely
Learning How to Reduce DisparitiesLearning How to Reduce DisparitiesLearning How to Reduce DisparitiesLearning How to Reduce Disparities
We need direct input from underserved communities.
Not an easy task. Underserved communities may be:
Unaware of potential benefits.
Not ready to participate in research/policy processes.
Suspicious and distrustful of health services.
We need direct input from underserved communities.
Not an easy task. Underserved communities may be:
Unaware of potential benefits.
Not ready to participate in research/policy processes.
Suspicious and distrustful of health services.
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Community Engagement at UC DavisCommunity Engagement at UC DavisCommunity Engagement at UC DavisCommunity Engagement at UC Davis
California Department of Mental Health Prevention and Early Intervention Needs Assessment for California’s Underserved Communities
to reach out and engage communities that have been underserved by public health/mental health services and solicit their input on communities’ needs, concerns, strengths, and resources.
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Outreach MethodsOutreach MethodsOutreach MethodsOutreach Methods
1. Identify specific underserved communities;
2. Interview key informantskey informants to focus on specific needs within communities;
3. Work with “cultural brokerscultural brokers” or community health community health representativesrepresentatives to develop outreach strategies;
4. Conduct focus groupsfocus groups with community members with community members about health needs, community assets, etc.;
5.5. Provide Provide feedback feedback to communitiesto communities about the impact of the information collected on policy and services.
1. Identify specific underserved communities;
2. Interview key informantskey informants to focus on specific needs within communities;
3. Work with “cultural brokerscultural brokers” or community health community health representativesrepresentatives to develop outreach strategies;
4. Conduct focus groupsfocus groups with community members with community members about health needs, community assets, etc.;
5.5. Provide Provide feedback feedback to communitiesto communities about the impact of the information collected on policy and services.
ParticipantsParticipantsParticipantsParticipants
30 focus groups were conducted primarily in community-based locations in 10 counties across California
specific ethnic groupsspecific ethnic groups:: African American, Native American, Native Hawaiian, and Pacific Islander, Asian (including Hmong, Cambodian, and Chinese), and Latino (Mexican and Central and South American);
other underserved groupsother underserved groups (LGBTQ, foster youth, young adults with juvenile justice history, and older adults) from rural and urban locations;
community-based providerscommunity-based providers that serve these communities.
30 focus groups were conducted primarily in community-based locations in 10 counties across California
specific ethnic groupsspecific ethnic groups:: African American, Native American, Native Hawaiian, and Pacific Islander, Asian (including Hmong, Cambodian, and Chinese), and Latino (Mexican and Central and South American);
other underserved groupsother underserved groups (LGBTQ, foster youth, young adults with juvenile justice history, and older adults) from rural and urban locations;
community-based providerscommunity-based providers that serve these communities.
Key FindingsKey FindingsKey FindingsKey Findings
mental health problems in underserved communities;
problems accessing mental health care and quality of services received;
social determinants of health such as poverty and discrimination;
social exclusion of underserved communities based on current and historical experiences with government agencies
mental health problems in underserved communities;
problems accessing mental health care and quality of services received;
social determinants of health such as poverty and discrimination;
social exclusion of underserved communities based on current and historical experiences with government agencies
Community AssetsCommunity AssetsCommunity AssetsCommunity Assets
Individual and community resiliency
Traditional and spiritual healers
Religious leaders
Informal and formal support networks (family and friendships, reconnection to native cultures, role models and mentors)
Community-based organizations
Social service/Health programs
Individual and community resiliency
Traditional and spiritual healers
Religious leaders
Informal and formal support networks (family and friendships, reconnection to native cultures, role models and mentors)
Community-based organizations
Social service/Health programs
Project OutcomesProject OutcomesProject OutcomesProject Outcomes Reports:
“Building Partnerships: Key Considerations when Engaging Underserved Communities Under the MHSA”
“Engaging the Underserved: Personal Accounts of Communities on Mental Health Needs for Prevention and Early Intervention Strategies”
Dissemination and implementation of findings
Ongoing partnerships with community agencies and underserved groups
Reports:
“Building Partnerships: Key Considerations when Engaging Underserved Communities Under the MHSA”
“Engaging the Underserved: Personal Accounts of Communities on Mental Health Needs for Prevention and Early Intervention Strategies”
Dissemination and implementation of findings
Ongoing partnerships with community agencies and underserved groups
Recommended StrategiesRecommended StrategiesRecommended StrategiesRecommended Strategies
1. Identifying underserved communities within your county
2. Establishing bi-directional relationships
Finding community representatives
3. Facilitating meetings and exchanging information
Engaging community representatives and maximizing the opportunity for developing trust in communication
4. Using the information once it is collected
Making sure the voices are heard and integrated into programmatic plans
Building ongoing partnerships
1. Identifying underserved communities within your county
2. Establishing bi-directional relationships
Finding community representatives
3. Facilitating meetings and exchanging information
Engaging community representatives and maximizing the opportunity for developing trust in communication
4. Using the information once it is collected
Making sure the voices are heard and integrated into programmatic plans
Building ongoing partnerships
2. Establishing Bi-directional Relationships2. Establishing Bi-directional Relationships
Clarity of purpose Understand that the relationship will be a two-way relationship
Awareness of past interactions with community
Recognize that part of the purpose is building up ongoing relationships
Be clear about how participants can influence the decisions that may be made and what issues cannot be influenced
Clarity of purpose Understand that the relationship will be a two-way relationship
Awareness of past interactions with community
Recognize that part of the purpose is building up ongoing relationships
Be clear about how participants can influence the decisions that may be made and what issues cannot be influenced
Understanding the partner community Be clear about who should be engaged
Identify the community leaders and key community organizations with whom to partner (who has trust, respect, and credibility within the community?)
Address the “culture”, as well as the cultural, language, racial, and ethnic issues of the community
Use awareness and sensitivity when working with tribal communities. Recognize and honor tribal sovereignty issues
Understanding the partner community Be clear about who should be engaged
Identify the community leaders and key community organizations with whom to partner (who has trust, respect, and credibility within the community?)
Address the “culture”, as well as the cultural, language, racial, and ethnic issues of the community
Use awareness and sensitivity when working with tribal communities. Recognize and honor tribal sovereignty issues
2. Establishing Bi-directional Relationships (2)2. Establishing Bi-directional Relationships (2)
Approach communities with awareness of past interactions with community and be prepared to address mistrust and disbelief
Be aware of how government agencies are perceived
Validate concerns
Be transparent about your purpose and reasons for being there
Approach communities with awareness of past interactions with community and be prepared to address mistrust and disbelief
Be aware of how government agencies are perceived
Validate concerns
Be transparent about your purpose and reasons for being there
2. Establishing Bi-directional Relationships (3)2. Establishing Bi-directional Relationships (3)
Identify opportunities for co-learning From the community to the county: the communities’ needs,
priorities, assets, existing resources
Existing services, programs that can be enhanced or supported within the community
From the county to the community: Informing opportunities for accessing funds and learn about procurement process and participation in policy decisions
Identify opportunities for co-learning From the community to the county: the communities’ needs,
priorities, assets, existing resources
Existing services, programs that can be enhanced or supported within the community
From the county to the community: Informing opportunities for accessing funds and learn about procurement process and participation in policy decisions
2. Establishing Bi-directional Relationships (4)2. Establishing Bi-directional Relationships (4)
AcknowledgementsAcknowledgements
UCD CRHDSergio Aguilar-Gaxiola
Joshua Breslau
Leticia Carrillo
Natalia Debb-Sossa
Katherine Elliott
Ron King
Cristina Magaña
Arnulfo Medina
Elizabeth Miller
Marbella Sala
Bill Sribney
UCD CRHDSergio Aguilar-Gaxiola
Joshua Breslau
Leticia Carrillo
Natalia Debb-Sossa
Katherine Elliott
Ron King
Cristina Magaña
Arnulfo Medina
Elizabeth Miller
Marbella Sala
Bill Sribney
DMH/MHSOACEmily Nahat
Jennifer Clancy
Nichole Davis
Rachel Guerrero
Barbara Marquez
Sonia Mays
Sheri Whitt
Beverly Whitcomb
Lois Williams
CMHDAAlfredo Aguirre
Bill Arroyo
Nancy Peña
Dan Souza
Stephanie Welch
Examples of other Community Engaged Examples of other Community Engaged Research at UC DavisResearch at UC DavisExamples of other Community Engaged Examples of other Community Engaged Research at UC DavisResearch at UC Davis
National Demonstration of Early Detection, Intervention and Prevention in Psychosis in Adolescents and Young Adults (Carter, PI)
Reducing Disparities in Depression Care for Ethnically Diverse Older Men (Hinton, PI)
Community Partnerships with Pediatricians for Healthy Children (Pan, PI)
Transforming Education and Community Health (TEACH) Program (Henderson, PI)
Community Lactation Assistance Project (Chantry, PI)
National Faith-Based and National Community Cardiovascular Disease Prevention Programs for High-Risk Women (Villablanca, PI)
Epidemiology of Dementia in an Urban Community (DeCarli, PI)
National Demonstration of Early Detection, Intervention and Prevention in Psychosis in Adolescents and Young Adults (Carter, PI)
Reducing Disparities in Depression Care for Ethnically Diverse Older Men (Hinton, PI)
Community Partnerships with Pediatricians for Healthy Children (Pan, PI)
Transforming Education and Community Health (TEACH) Program (Henderson, PI)
Community Lactation Assistance Project (Chantry, PI)
National Faith-Based and National Community Cardiovascular Disease Prevention Programs for High-Risk Women (Villablanca, PI)
Epidemiology of Dementia in an Urban Community (DeCarli, PI)
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