Engaging Communities as Partners

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Engaging Communities as Partners
Sergio Aguilar-Gaxiola, MD, PhD Professor of
Clinical Internal Medicine Director, Center for
Reducing Health Disparities Director, Community
Engagement UCD CTSC UC Davis School of
Medicine Academy Health Annual Research Meeting
Washington, DC June 9, 2008
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Why Engage Communities?

• 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.

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Principles 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

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Important Goals when Working with Underserved
Communities

• Include underserved communities in research
• Increase of URM researchers
• Increase the diversity of the workforce
• Address health disparities vigorously
• Disseminate research results widely

Source IOM Report Examining the Health
Disparities Research Plan of the National
Institutes of Health Unfinished Business, 2006
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Learning 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.

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Community Engagement at UC Davis

• California Department of Mental Health Prevention
  and Early Intervention Needs Assessment for
  Californias 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 Methods

1. Identify specific underserved communities
2. Interview key informants to focus on specific
   needs within communities
3. Work with cultural brokers or community health
   representatives to develop outreach strategies
4. Conduct focus groups with community members about
   health needs, community assets, etc.
5. Provide feedback to communities about the impact
   of the information collected on policy and
   services.

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Participants

• 30 focus groups were conducted primarily in
  community-based locations in 10 counties across
  California
• specific 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 groups (LGBTQ, foster youth,
  young adults with juvenile justice history, and
  older adults) from rural and urban locations
• community-based providers that serve these
  communities.

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Key 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

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Community 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

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Project 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

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Recommended Strategies

• Identifying underserved communities within your
  county
• Establishing bi-directional relationships
• Finding community representatives
• Facilitating meetings and exchanging information
• Engaging community representatives and maximizing
  the opportunity for developing trust in
  communication
• Using the information once it is collected
• Making sure the voices are heard and integrated
  into programmatic plans
• Building ongoing partnerships

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2. 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

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2. Establishing Bi-directional Relationships
(2)

• 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

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2. Establishing Bi-directional Relationships
(3)

• 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

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2. Establishing Bi-directional Relationships
(4)

• 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

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Acknowledgements

• UCD CRHD
• Sergio Aguilar-Gaxiola
• Joshua Breslau
• Leticia Carrillo
• Natalia Debb-Sossa
• Katherine Elliott
• Ron King
• Cristina Magaña
• Arnulfo Medina
• Elizabeth Miller
• Marbella Sala
• Bill Sribney

DMH/MHSOAC Emily Nahat Jennifer Clancy Nichole
Davis Rachel Guerrero Barbara Marquez Sonia
Mays Sheri Whitt Beverly Whitcomb Lois Williams
CMHDA Alfredo Aguirre Bill Arroyo Nancy Peña Dan
Souza Stephanie Welch
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Examples of other Community Engaged Research 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)

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