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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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