Community-academic Partnership Research Articles

A Community Call to Action: Use of Quality Improvement Strategies to Address Youth Suicides

ABSTRACT Youth suicide clusters are a tragedy that no community should have to face. This paper details how a large community came together to better understand and prevent the future loss of young lives in their County using interdisciplinary quality improvement (QI) teams and a multi-component, continuous QI project. This includes the formation of a Youth Suicide Review Team, the development of a County wide Blueprint for youth and family behavioral health services, and the launching of a training consortium in evidence-based practice for behavioral health providers. The details surrounding these efforts are discussed, and the SAFETY-Acute/Family Intervention for Suicide Prevention is highlighted as an example of the training conducted. Finally, a discussion of some of the successes, barriers, and attempts to address obstacles along the QI pathway are offered. Broadly, this paper offers one model for how to leverage interdisciplinary academic-community partnerships to decrease risk for youth deaths by suicide by improving the quality of behavioral healthcare for youth and families.

Community-academic partnerships helped Flint through its water crisis.

A city that faced a public-health emergency shows how collaborations with neighbourhood advocates can advance health equity. A city that faced a public-health emergency shows how collaborations with neighbourhood advocates can advance health equity.

Advancing racial justice in patient care encounters—yes, we can!

Advancing racial justice in patient care encounters—yes, we can!

The Creation of a Program of Engagement and Outreach for COVID-19 Among African Americans Through Community-Academic Partnerships.

The COVID-19 pandemic has disproportionately affected racial and ethnic minority groups in the U.S. Over a 7-week period in late 2020, with funding from the NC Office of Minority Health and Health Disparities, the West Greenville Health Council (WGHC), a community-academic, non-profit partnership, engaged and activated a 27-member organizational partnership network for COVID-19 health communication and personal protective equipment (PPE) distribution in African American communities in Eastern North Carolina. Outreach included: local production and dissemination of 10 culturally relevant safety videos, 10 risk, prevention, and safety postcard messages, 3 virtual forums, and PPE kit distribution via the network and their distribution venues. Communication mediums included social media posts (i.e., Facebook and YouTube), network email distribution lists, and postcards distributed along with PPE kits. Outreach activities were evaluated via an online survey, reach of social media posts, and PPE distribution. Working through the organizational network, the WGHC reached a combined total of 30,310 community members with educational materials. Forty-four outreach events were held during this period and over 8000 PPE kits were distributed. The online survey, distributed through the network, yielded more than 400 completed questionnaires. This tool was used to gain insights on community perceptions of COVID-19 safety barriers and media messages. The activation of the network as an approach for rapid response to an emerging public health crisis greatly expanded the reach of the WGHC. The WGHC is working to institutionalize the network to address future emerging health threats, as well as the dissemination of health information more generally.

Community-Led Health Promotion Groups in a Bhutanese-Nepali Refugee Community.

This practice note reports on the work of the Namaste Community Health Partnership, an academic-community partnership established to address health disparities in a metro-area Bhutanese-Nepali refugee community in the western United States. Partners worked together to develop, implement, and evaluate a culturally-tailored health promotion program where Bhutanese-Nepali individuals led weekly walking groups and shared health promotion information and behavior change tools with community participants. The program was implemented with approximately 70 community members across two metro-area neighborhoods and two adult day care centers serving elders. Evaluation strategies included documenting walk attendance, tracking engagement with health promotion goals, and focus group discussions with program participants. Once enrolled, most participants consistently attended walks and achieved weekly goals-some even increased walking frequency beyond program requirements. Participants provided positive feedback about having a community leader and reported learning new information and enjoying participating with other community members. Challenges and lessons learned included difficulties engaging younger adults from the community, concerns about signing research consent forms, cultural norms discouraging the distribution of individual research participation incentives, variability across groups in preferences for program activities, and barriers to administering survey-based evaluation instruments. This academic-community partnership built capacity in the local Bhutanese-Nepali community, produced culturally relevant health programming, and trained and employed community members as health educators and physical activity leaders. The program resulting from this work has the potential to improve health knowledge and chronic disease prevention practices and ultimately reduce health disparities in an underserved refugee community.

Abstract MP19: Academic-community Partnership To Evaluate The Effectiveness Of The Greater Boston Food Bank’s Healthy Pantry Program

Background: Food pantries are a significant nutrition source for food-insecure households. Traffic-light labeling is a new strategy in some pantries to help clients and staff identify healthier food choices. Healthy Pantry Program (HPP) is an online training designed by The Greater Boston Food Bank (GBFB) to teach staff of its affiliated pantries how to promote healthier choices by implementing traffic-light labels using Supporting Wellness at Pantries and behavioral nudges, such as placing healthy foods at eye level. Our academic research team partnered with GBFB to evaluate HPP by assessing if food pantries that participated in HPP increased their GBFB purchases of healthier (green and yellow) foods more than matched control pantries. Methods: We conducted an observational study of 107 food pantries in the GBFB network in eastern Massachusetts, including 10 pantries that completed HPP training and 97 control pantries matched by organizational characteristics and baseline food purchases. Five HPP pantries participated during Wave 1 (Oct 2018-Jan 2019), and 5 participated during Wave 2 (May 2019-Aug 2019). Outcomes were changes in percentage of pantries’ monthly green and yellow purchases from GBFB at 6-month (Waves 1 and 2) and 12-month (Wave 1 only) follow-ups compared to baseline purchases (6 months pre-HPP). We used a difference-in-differences analysis to examine whether HPP pantries increased green-yellow food purchases more than control pantries. Results: In Wave 1, HPP pantries had small but nonsignificant increases in green-yellow purchases at 6 and 12 months compared to matched controls (Table). In Wave 2, HPP and control pantries had similar increases in green-yellow purchases at 6 months. Conclusions: An online training implemented by a food bank to improve healthy choices in food pantries did not significantly improve pantries’ purchases of healthier foods. Academic-community organization partnerships to evaluate health promotion initiatives can help guide effective program design and development.

Multidisciplinary consensus recommendations for the management of non-spine bone metastases: Results of a modified Delphi process in a community-academic partnership.

e24092 Background: Local therapy for bone metastases is becoming increasingly complex, but national guidelines remain limited. We leveraged a community-academic partnership to develop consensus recommendations for multidisciplinary treatment of non-spine bone metastases which are generalizable to diverse practice settings. Methods: We convened a group of 15 physicians (9 radiation oncologists, 2 orthopaedic surgeons, 2 medical oncologists, 1 interventional radiologist, 1 interventional pain specialist) treating bone metastases across 4 institutions from Apr 2020-Feb 2021. We distributed a survey to identify questions warranting consensus development in the treatment of non-spine bone metastases. A literature review was conducted to inform answer statements, and evidence was rated using the Strength of Recommendation Taxonomy. A modified Delphi process was employed to reach consensus defined (a priori) as ³75% of respondents indicating “agree” or “strongly agree”. Results: A total of 16 questions were identified, including indications for multidisciplinary discussion or referral (n=4), appropriate use and duration of RT (n=4), and handling of systemic therapies during RT (n=5). After 2 rounds of modified Delphi process, consensus has been reached on 9 questions (see Table). Strength of Recommendation was rated A (1/9, 11%), B (5/9, 56%), or C (3/9, 33%). Conclusions: Our consensus process provides guidance for management of non-spine bone metastases that expands upon current guidelines. We also highlight areas where prospective trials are needed, including the role of RT prior to stabilization surgery and the selection of patients for ablative treatment. [Table: see text]

Engaged communication of environmental health science: Processes and outcomes of urban academic-community partnerships

Environmentally overburdened communities need information and resources to cope with hazards. We describe, and use a case study to depict, a participatory process of engaging Detroit stakeholders with academic researchers in the co-production of environmental health communication tools to enhance their capacity to address the unjust conditions. Over five years, we disseminated tools to 763 individuals who connected us to their network members so that we reached three times as many (n = 2,273) through snowball methods. On-going demand and evaluation findings indicated that our model was responsive to local circumstances, which may inform and encourage others to engage in such collaborations.

Academic-community partnerships to promote end-of-life care competencies through interprofessional teamwork

This curricular resource describes an interprofessional educational program and curricular structure for teaching a rare but critical skill: how to care for someone when there is no cure, and to do so in a home environment when death is expected and supported as a natural process. Through academic-community partnerships and a blended-experiential model, students learn from hospice patients, their family members, other community volunteer caregivers, and hospice staff while simultaneously engaging in curricular activities that include online training modules, reflective writing exercises, and weekly discussion sessions with peers, faculty, and providers, all key components identified for professional identity formation (Simmonds et al., 2020; Wald et al., 2015). 1,2 The program was developed with the Learn, See, Practice, Prove, Do model, an evidence-based educational framework that helps students gain competence in their procedural skills and transition from the role of observer to that of a skilled care provider (Sawyer et al., 2015). Students were given pretest and posttest surveys, reflective journaling assignments, and a posttest questionnaire. Triangulation of data sources indicates that learning objectives and desired outcomes were consistently achieved. In addition, students reported high levels of satisfaction with the program, significant improvements in both empathy and self-efficacy to provide end-of-life care, and program impacts on both their personal perspectives and career goals/professional identities.

Learning-by-Teaching and Service Learning to Promote Bleeding Control Education: An Academic-Community Partnership.

Stop the Bleed is a free 1-hour class that teaches laypersons to identify and treat life-threatening bleeding. The training requires a 1:10 instructor-to-participant ratio, which creates a resource drain on volunteer instructors. Nursing students are eligible to assist instructors. Our State Legislature mandated that public schools equip themselves with bleeding control kits resulting in thousands of school staff needing training. Our nursing school used a service learning model to aid schools. Nursing students coordinated the program, and student learning occurred through a learning-by-teaching strategy. We trained 656 community members, taught in 5 counties, and students received 320 clinical hours. If not for COVID-19 (coronavirus disease 2019), numbers would have been doubled. We developed a sustainable relationship with school nurses. Students rated the program highly with respect to meeting course objectives and preparation for professional practice. The program met its goals and will continue.

Social-ecological theory, substance misuse, adverse childhood experiences, and adolescent suicidal ideation: Applications for community-academic partnerships.

Suicide is the second leading cause of death among youth in the United States. Data from the 2015 Youth Risk Behavior Survey of 9th–12th grade students in New Hampshire (N = 14,837) were utilized. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using logistic regression models to evaluate associations between suicidal ideation, adverse childhood experiences (ACEs), and other risk factors including using opioids/drugs without a prescription and food insecurity. We also examined whether potentially protective behaviors may attenuate the relationship between ACEs and suicidal ideation. The prevalence of suicidal ideation was 15.4% (girls 20.15; boys 10.67). In unadjusted models, the crude odds ratio reflecting the relationship between suicidal ideation and higher ACE scores was 1.85 (95% CI 1.76–1.94). In adjusted models, suicidal ideation remained positively associated with higher ACE scores (aOR 1.61, 95% CI 1.52–1.70). Risk and protective behavioral factors identified in relation to suicidal ideation and ACEs are discussed within the context of community–academic partnerships and policy.

Recently-Arrived Afghan Refugee Parents' Perspectives About Parenting, Education and Pediatric Medical and Mental Health Care Services.

Refugee children are at risk for mental/behavioral health problems but may not receive timely diagnosis or care. Parental experiences and perspectives about resources in the US may help guide interventions to improve mental/behavioral health care. In a community-academic partnership, we performed a qualitative study of recently-arrived Afghan refugee parents, using in-depth, semi-structured interviews to characterize experiences with parenting, education, and health care services. A four-person coding team identified, described, and refined themes. We interviewed 19 parents from ten families, with a median residence in the US of 24months. Four themes emerged; parents described: (1) shifting focus as safety needs changed, (2) acculturation stress, (3) adjustment to an emerging US support system, and (4) appreciation of an engaged health care system. Health and educational providers' appreciation for the process of acculturation among newly-arrived refugee Afghan families may facilitate screening, diagnostic, and intervention strategies to improve care.

Virtual Reality Technology and Remote Digital Application for Tele-Simulation and Global Medical Education: An Innovative Hybrid System for Clinical Training

Objective. Although simulation-based medical education is fundamental for acquisition and maintenance of knowledge and skills; simulators are often located in urban centers and they are not easily accessible due to cost, time, and geographic constraints. Our objective is to develop a proof-of-concept innovative prototype using virtual reality (VR) technology for clinical tele simulation training to facilitate access and global academic collaborations. Methodology. Our project is a VR-based system using Oculus Quest as a standalone, portable, and wireless head-mounted device, along with a digital platform to deliver immersive clinical simulation sessions. Instructor’s control panel (ICP) application is designed to create VR-clinical scenarios remotely, live-stream sessions, communicate with learners and control VR-clinical training in real-time. Results. The Virtual Clinical Simulation (VCS) system offers realistic clinical training in virtual space that mimics hospital environments. Those VR clinical scenarios are customizable to suit the need, with high-fidelity lifelike characters designed to deliver interactive and immersive learning experience. The real-time connection and live-stream between ICP and VR-training system enables interactive academic learning and facilitates access to tele simulation training. Conclusions. VCS system provides innovative solutions to major challenges associated with conventional simulation training such as access, cost, personnel, and curriculum. VCS facilitates the delivery of academic and interactive clinical training that is similar to real-life settings. Tele-clinical simulation systems like VCS facilitate necessary academic-community partnerships, as well as global education network between resource-rich and low-income countries.

Recruiting Low-Income African American Men in Mental Health Research: A Community-Based Participatory Research Feasibility Study.

African Americans (AAs) are 20% more likely to develop serious psychological distress compared to Whites but are less likely to use mental health services. The study objective was to evaluate the effectiveness of recruitment strategies to engage AA fathers in a mental health intervention.Using the community-based participatory research (CBPR) approach, a community-academic partnership (CAP) developed and implemented direct and indirect referral strategies to engage AA fathers in a mental health intervention. Direct referral strategies focused on community partner identification of potentially eligible participants, providing information about the study (i.e., study flyer), and referring potential participants to the study. Indirect referrals included posting flyers in local businesses frequented by AA men, radio advertisements, and social media posts from community organizations.From January to October 2019, 50 direct and 1388 indirect referrals were documented, yielding 24 participants screened and 15 enrolled. Of all participants screened, 58% were referred through indirect referral, 38% were referred directly by community partners, and 4% of the participants were referred through both direct and indirect referrals. Twenty percent of those exposed to the direct referral methods and 1% of those exposed to the indirect referral methods were enrolled. The indirect referrals accounted for 60% of enrollment, whereas the direct referrals accounted for 33.3% of enrollment.Collaborating with the community partners to engage hard-to-reach populations in mental health studies allowed for broad dissemination of recruitment methods, but still resulted in low participant accrual. Additional focus on increasing direct referral methods appears to be a fruitful area of CBPR.

Personal care product use among diverse women in California: Taking Stock Study.

Personal care product use may contribute to elevated body burdens of consumer product chemicals among women of color; however, racial/ethnic differences in product use has been understudied. Community-engaged research can support the recruitment of diverse participants. To document personal care product use among a diverse group of women (aged 18-34 years) living in California. Through a community-academic partnership, we surveyed 357 women in California about product use information for 54 cosmetic, hair, menstrual/intimate care, and leave-on and rinse-off personal care products. We compared type and frequency of product use among Black, Hispanic/Latinx, Asian, and White women. We also summarized use of scented products and reasons women select products. Women reported using a median of 8 products daily, with some women reporting up to 30 products daily. Hispanic/Latinx and Asian women used more cosmetics, and Black women used more hair and menstrual/intimate products than other women. Of the 54 products compared, there were significant differences in use by race/ethnicity for 28 products, with the largest number of significant differences between Black and White women. There is growing information on chemical exposures from personal care products and consequent adverse health effects, with implications for health disparities. Yet, there remains limited information on the range and types of products used by diverse racial/ethnic communities. This study helps close an important gap on product use inventories that can enable more informed public health interventions to limit exposures from personal care products.

Arts, Culture, and Creativity as a Strategy for Countering the Negative Social Impacts of Immigration Stress and Gentrification.

Background. This article looks at the role that arts, culture, and creativity play in promoting social cohesion and community well-being. It presents research on the role that a community arts center plays in an ethnic enclave that is under stress of immigration and gentrification. Method. An academic-community research partnership conducted this research. A mixed-methods approach was used. Twenty-four interviews were conducted with stakeholders (including community leaders, neighborhood residents, and business owners). Surveys (n = 102) were done of community members and those who participate in the Center activities. Results. Interviewees and survey respondents point to the importance of the ethnic enclave as a close-knot community that helps to foster a sense of belonging, security, and cultural identity. Arts, culture, and creativity plays a role in maintaining this sense of social cohesion, despite the threat of gentrification. Engagement in the arts and creative practice are important for buffering the stress of immigration. Discussion. The center has an important role as a critical cultural, civic, and creative space for the neighborhood and the broader community who sees the ethnic enclave as their cultural home.

PROTECT: a novel psychotherapy for late-life depression in elder abuse victims.

Elder abuse is prevalent, and victims have high rates of depression and low quality of life. We established an academic-community partnership to test the feasibility, acceptability, and impact of a brief psychotherapy for depression (PROTECT) among elder abuse victims with capacity to make decisions. Elder abuse service providers referred depressed (Patient Health Questionnaire-9 [PHQ-9] ≥ 10) older victims (age ≥ 55 years) for potential pilot study participation. Forty eligible victims who consented were randomized to PROTECT psychotherapy (N = 25) or a Usual Care (N = 15) condition involving a community psychotherapy referral. Follow-up research assessments were conducted at 6 weeks (mid-treatment) and 9 weeks (end of treatment) after study initial assessment. We used mixed-effects regression models to examine treatment effects on depression severity and quality of life over time. Most victims (75%) reported two or more types of abuse. The a priori acceptability benchmark was met at the end of PROTECT therapy. All PROTECT participants initiated therapy; this engagement rate is greater than the a priori 75% standard set for feasibility. We found a significant reduction in depression severity (Montgomery-Åsberg Depression Rating Scale [MADRS]), with PROTECT leading to greater benefits compared to Usual Care. Both study groups had a similar improvement in quality of life. The pilot project results found that PROTECT psychotherapy is feasible, acceptable, and effective in reducing depression. With the support of our partnership, we found that PROTECT could be delivered alongside elder abuse services with victims willing to initiate therapy that leads to meaningful treatment effects.

Reflections and Challenges of Pregnant and Postpartum Participant Recruitment in the Context of the Opioid Epidemic

Opioid use disorder among women of childbearing age has reached epidemic proportions. In rural regions of the United States, recruiting perinatal women who use nonmedical opioids to participate in research is wrought with challenges, including barriers such as community stigma, lack of transportation, and time constraints. The current study describes our process and challenges of recruiting pregnant and postpartum women in rural Indiana consisting of women who misuse opioids and those who do not. We employed multiple strategies to recruit participants. Methods included (1) sampling from healthcare facilities based on referrals from front-desk staff and frontline healthcare workers; (2) dissemination of flyers and brochures within healthcare facilities and the community, supported with onsite research assistant presence; (3) digital methods coupled with snowball sampling; and (4) local community talks that provided information about the study. Our multiple recruitment efforts revealed that building relationships with community stakeholders was key in recruiting women who use nonmedical opioids, but that digital methods were more effective in recruiting a larger sample of pregnant and postpartum women in a short amount of time. We conclude by making several recommendations to enhance academic-community partnerships in order to bolster sample sizes for prolonged research studies. Furthermore, we highlight the need to destigmatize addiction in order to better serve hard-to-reach populations through research and practice.

From policy to practice: A DNP student perspective

Healthcare's rapid evolution has increased focus on doctoral nursing education and expanded experiential immersion opportunities created through innovative academic-community partnerships. A partnership between an academic institution and a state board of nursing was formed to provide two Doctorate of Nursing Practice (DNP) students with a fellowship opportunity to learn health policy, strategy, and systems thinking which culminated in participation in a state-wide collaborative and published report. Practicum experience outcomes consisted of learner comprehension of DNP Essential II as evidenced by attendance at health policy meetings, participation in state-wide Summit planning meetings with community partners and Summit participation, facilitation and follow-up report contribution. Providing students with a practicum experience based on the DNP essentials promotes a curriculum based on scholarly evidence to assure the DNP will be competent to face current demands in healthcare. Experiential learning provides a framework for the DNP to fulfill curriculum while applying skills learned in a real-world environment.

The ethical challenges and opportunities of implementing engagement strategies in health research

PurposeThe American College of Epidemiology (ACE) held its 2019 Annual Meeting in Pasadena, California, September 7–10 with a theme of “Real-World Epidemiologic Evidence in Policy and Practice”. The ACE Ethics Committee hosted a symposium session at the annual meeting on the ethical challenges of stakeholder engagement in the health research setting. The purpose of this paper is to further examine the design and conduct of stakeholder engagement and reflect on the ethical challenges with the goal of offering best practices and identifying areas where future guidance, critical reflection and teaching may be needed. MethodsThree speakers with diverse affiliations were selected to present on the opportunities and ethical challenges of stakeholder engagement in epidemiology and community health. Dr. K Coleman presented an “Overview of Stakeholder-Engaged Research Strategies” and “Engaging Stakeholders in Retrospective Observational Studies”; Dr. J Salerno presented on “An Ethical Perspective to Optimize Engagement Strategies”; and Ms. F Jones presented on the “Structure of Community-Partnered Participatory Research”. ResultsThree main insights were identified: (1) the need for a unifying framework of ethical principles for the implementation of stakeholder engagement, (2) an expanded set of research activities for stakeholders aligned with their engagement in epidemiology studies, and (3) strengths of a community-based partnership model of stakeholder engagement in community health, known as community-partnered participatory research (CPPR). ConclusionsThere is a need to broaden the dialogue and understanding of stakeholder engagement for researchers who are increasingly faced with the ethical challenges of implementing approaches and strategies to engage patients, communities, policy makers and the public as stakeholders. To address current challenges, we offered a unifying framework to guide best practices of stakeholder engagement by integrating the core ethical principles of research conduct involving human subjects with the guiding principles of patient engagement. We shared 2 model overviews of implementing stakeholder engagement: (1) a 4-staged model when implementing stakeholder engagement using an epidemiological study design, (2) a stakeholder engagement model rooted in authentic academic-community partnerships, known as community-partnered participatory research (CPPR) to address depression disparities. By critically reflecting on stakeholder engagement across disciplines and appraising the opportunities and ethical challenges of implementing stakeholder engagement in health research, we have provided insights on how to operationalize, conduct and implement stakeholder engagement and have contributed to moving this important field forward.