Community-based Nonprofit Organizations Research Articles

Building a community-academic partnership to expand services for childhood cancer survivors in a rural, low-income region in California.

360 Background: Community-engaged research is an effective approach to address health disparities that is well-established in the public health domain and has not been widely applied in childhood cancer survivorship. We present our multi-year experience building a community-academic partnership and community-engaged childhood cancer survivorship research portfolio. Methods: We have developed a partnership between Jacob’s Heart Children’s Cancer Support Services, a nonprofit community-based organization (CBO) and an academic pediatric cancer survivorship team, with the goal of improving health outcomes for childhood cancer survivors and their families in the Salinas Valley, a rural, low-income region in California with majority Hispanic/Latino/a/e residents. Our partnership process is guided by principles of community-based participatory research, prioritizing trust and involving community members as equal partners in all phases of research. Results: In year 1 (2021-2022), we held successive meetings which identified common goals and shared values, established the collaboration, and sought funding to advance our goals. In year 2 (2022-2023), with internal grant funding, we conducted a qualitative needs assessment interviewing childhood cancer survivors, parents, and CBO staff. Teamwork enriched the data analysis and allowed us to identify problems in communication as an area of need, which directly informed subsequent grant proposals. In year 3 (2023-2024), with external funding we began a multi-year study to understand and improve survivorship-related communication among Hispanic/Latino/a/e young adult childhood cancer survivors, their parents, and clinicians. Current and future projects include collaborative design and pilot testing of a novel communication intervention, formation of a dedicated community advisory board, and a CBO-driven program evaluation. Findings from our community-engaged studies have prompted new sets of research questions and illustrate opportunities for institutional change in the clinic setting. In parallel, the CBO has leveraged research findings in real-time to identify barriers to seeking support among childhood cancer survivors and families, and adapted and improved programming for families in response. Through our joint research portfolio, we have incorporated training and mentorship for staff at the CBO and medical trainees at the academic center. Conclusions: A community-academic partnership in a rural, low-income region has the potential to reduce health disparities and improve childhood cancer survivors’ health outcomes through collaborative program development and community-engaged research. Fueled by mutual investment and strong momentum, our partnership facilitates an interconnected cycle of research and practice change that is grounded in community needs.

“Round Peg in a Square Hole”: Lessons from Community Health Promotion Practice on Dynamics of Accountability, Reporting and Evaluation, and Governance

This paper presents results from a small-scale institutional ethnography study of reporting requirements and evaluation practices in two urban community health centers (CHCs), as a sample of community-based nonprofit organizations that focus on social justice and health equity. The study illuminated complex relationships among accountability, reporting and evaluation, and governance. Among the CHCs, reporting and evaluation practices consistent with goals of obtaining social justice and health equity were undermined by an imbalance toward funder-oriented functional accountability. Analysis of accountability and reporting practices as systemic factors shaping knowledge production, decision-making, and action revealed notable consequences for CHCs’ health promotion practice. This paper proposes a wholistic accountability model to encourage equitable power relations in evaluation, enable participatory methods, and better align CHC knowledge production and governance systems with their health promotion goals. This study further adds to the growing literature supporting critical attention to nonprofit accountability in the context of systems change work.

Project SIGNAL: A Dashboard for Supporting Community Confidence in Making Data-Driven Decisions.

Data dashboards have emerged as critical tools for surveillance and informing resource allocation. Despite their utility and popularity during COVID-19, there is a growing need to understand what tools and training are tailored to nonprofit community-based organizations that may partner with public health officials. In June 2021, the Rhode Island Department of Health and Brown University partnered to create Project SIGNAL (Spatiotemporal Insights to Guide Nuanced Actions Locally), which utilizes spatiotemporal analytics to identify Rhode Island's largest disparities in COVID-19-related outcomes (eg, testing, diagnosis, vaccinations) at the neighborhood level. Results were hosted in an interactive online dashboard (signal-ri.org) designed using principles of the CDC Clear Communication Index. The target audience included a network of 15 geographic areas called Health Equity Zones, funded by the health department to provide critical grassroots public health programs to address social, health, and economic outcomes in their communities. To disseminate the dashboard, a 6-hour virtual workshop series was created to train leaders to use the dashboard and increase their confidence in understanding common public health data terminology and concepts and better prepare attendees for rapid decision making during future public health emergencies. The Project SIGNAL dashboard was launched in August 2022 and has been accessed over 7500 times. A total of 84 community leaders were trained to use this dashboard, increasing their confidence in applying common public health metrics to make decisions about their COVID-19-related activities. While several studies have outlined best practices for data dashboards, this is among the first to examine incorporating these practices into a spatiotemporal decision tool designed specifically for community organizations. Project SIGNAL demonstrates that by incorporating design best practices and pairing data dashboards with hands-on training, we can empower community leaders to utilize advanced spatiotemporal methods to identify health disparities and take localized action.

Displacing the burden of representation: Engaging with critical Whiteness to expand the theory of representative bureaucracy

The theory of representative bureaucracy has provided an important yet limited framework for understanding exclusion in the public sector. This theoretical paper engages with critical approaches to argue for an expanded theory that centers social equity. Close attention to the relationship between the public and nonprofit sectors illuminates how public institutions protect and reproduce White, masculine space by shifting the burden of representation onto racially minoritized public administrators and community-based nonprofit organizations led by and for people of color. An expanded theory will (1) advance an understanding of both sectors as institutional spaces that protect Whiteness and impede full representation and (2) recognize the importance of the labor required to counter inequities and actively represent minoritized constituents.

Community-Based Organizations Leading Research Efforts: Preliminary Findings from the Chicagoland CEAL Program's COVID-19 Vaccine Uptake and Intention Survey.

To foster community engaged research in the communities most impacted by COVID-19, the National Institutes of Health (NIH) formed 21 teams of Community Engagement Alliance Against COVID-19 Disparities (CEAL). The national CEAL initiative developed a Common Survey to investigate attitudes and behaviors to the COVID-19 vaccine and clinical trials. This article describes survey implementation at the Chicagoland CEAL Program (CCP). This community-based participatory research project was the result of a strong collaboration between academic institutions, and a community-based non-profit health equity-focused partner organization. The survey implementation was developed and refined with strong input from CHWs, participants, and staff in the partner organizations and institutions. Survey data were collected with Qualtrics, a web-based survey tool. Survey implementation resulted in data collection for 852 participants during the period 12/18/2021-02/18/2023. Excluding participants on the basis of missing data resulted in a sample of 690, 601 of which (87.10%) indicated that they had received at least one dose or intended to get vaccinated. Overall, 54 (7.83%) respondents reported that they had not received the vaccine and were not planning to. Hard to reach populations present two unique challenges in emerging infectious disease events. Reaching populations vulnerable to poor outcomes with vaccines was essential to addressing the COVID-19 pandemic. Additionally, learning about barriers and hesitancy toward vaccine uptake is difficult in these communities. CCP's partnership of five academic institutions, a community research center, and a community-based non-profit health equity-focused organization shows what is possible when traditional models of research and inquiry are reconsidered for community-based participatory research. Results shown here are drawn from a collaboratively designed and implemented survey, collected in person, with over 90% completion.

Pilot Training Program on Hands-Only CPR and Choking First Aid for Frontline Police Responders in Rural Nepal.

Basic life support (BLS) is an emergency skill that includes performing appropriate cardiopulmonary resuscitation (CPR). Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality worldwide and is rising in Nepal. After an OHCA event, a bystander starting CPR quickly has been shown to increase the survival rate. While the Nepali police are generally the first responders to emergencies in rural parts, they are not trained in BLS. This program assesses a pilot training of hands-only CPR and choking first aid to the Nepal Police and Nepal Army participants in rural Nepal. A community-based nonprofit organization, HAPSA-Nepal, coordinated with local government to pilot this program. The program included pre- and post-tests, lectures, videos, and small group hands-on exercises; facilitators included faculty emergency physicians, residents, and medical officers. Structured pre- andp post-test questionnaires, confidence surveys, and skills checklists were conducted. Descriptive analysis examined the respondent's characteristics, and paired t-test was used to compare pretest and post-test scores. A total of 126 participants received the training in this pilot phase. Prior to this training, 98.4% of the participants had not received any CPR training, and 100% of the participants had not received training on first aid for choking. The average pretest score was 4.4 with 95% CI ± 1.75, and the average post-test score was 8.06 with 95% CI ± 1.73 (out of a total of 11). All participants passed the skills assessment. Locally adapted BLS training programs that included hands-only CPR and choking first aid showed a significant knowledge gain and skills competence among the frontline participants.

Assessing food systems funders’ use of data and evidence to make funding decisions

Although academic journals are often considered to be reliable sources of evidence for informing practice, the extent to which funders turn to them to shape their decisions is unclear. We carried out a survey to examine the types of evidence and knowledge that food systems funders use—and need—to make informed decisions, and to under­stand how research, particularly from journal publications, is or is not informing food systems investments. The majority of the 19 respondents worked for private foundations or community-based nonprofits that offer grants, loans, or other program-related investments to U.S.-based initia­tives focused on local food, sustainable agriculture, and food access. Many respondents indicated that they draw primarily on local stakeholders and grantees to make funding decisions and do not prioritize scientific knowledge or externally derived evidence. For most, peer-reviewed academic journals, including the Journal of Agriculture, Food Systems, and Community Development (JAFSCD), are one of the last places they currently turn to for information that could shape their funding priori­ties. In other sections of the survey, however, respondents indicated that they value utilizing a blend of scientific research and local knowledge. Only four respondents require grantees or bor­rowers to carry out formal evaluations, and over a third of respondents are not satisfied with how their organization uses data and evidence to make decisions. They suggested a variety of ways that research could be made more accessible and rele­vant to them as funders and investors in the food systems arena. We suggest various ways that more comprehensive research could be conducted to study what drives the decision-making processes of the diverse U.S. food systems funding community.

Refugee and Immigrant Youth Leaders: Strengths, Futurity, and Commitment to Community

This study explored the Youth Leadership/Peer Tutoring program at Refugee and Immigrant Transitions (RIT), a community-based non-profit organization in Northern California. It includes 12 semi-structured interviews with refugee and immigrant youth leaders. Bringing together works on Community Cultural Wealth (with the addition of Migration Capital) and Critical Refugee Studies collectively as a conceptual framework, this study highlights three themes: (a) commitment to community, family, and giving back; (b) encouraging communication and cultivating a pan-newcomer community; and (c) leadership as commitment to community and positive, collective futurities. Data support a strengths-based framework when working with refugee and immigrant youth as they transition and adjust to their new school environments and communities. All 12 participants were refugee and immigrant newcomer youth who participated as youth leaders/peer tutors in RIT’s Youth Leaders/Peer Tutoring program. Countries of origin included Burma (Karen), Bhutan, Nepal, China, and El Salvador. As scholars and practitioners in the field, we are seeing an increased need and demand for more scholarship in this area through a strengths-based lens, as evidenced by calls from educators and school/district administrators requesting support and resources. We submit this article at a time of growing numbers of immigrant and refugee youth in schools in the United States, including non-diverse school environments that are unprepared (and sometimes unwilling) to receive newcomer youth. Our hope is for this study to reveal possibilities for extending welcome and mutual support through a strengths-based lens within diverse newcomer peer learning environments.

Community philanthropy in South Africa: a case study of grant distribution in the Western Cape

How funding is distributed is an important question in philanthropy. But limited work has asked this question about philanthropy originating on the continent of Africa. This article explores the effective distribution of grants by a community-based South African non-profit organisation through the lens of transaction cost economics. Instead of needs-based indicators, this study finds that internet access is the main indicator of funding, with areas with lower internet access receiving fewer funds than those with higher internet access. This indicates that funding by community-based non-profits may not always be reaching the areas with the highest amount of need, but areas with lower search costs. Overall, community-based organisations may deal with issues similar to international organisations in reaching local non-profit organisations and disenfranchised communities. Targeted outreach, specifically to areas with lower access to the internet, can help to ameliorate these differences.

The political economy of healthcare access and Chicagoland health-oriented non-profit organizations

This paper analyzes how nonprofit organizations targeting Latine communities in the Chicago suburbs played a role in healthcare access during the COVID-19 pandemic through both political and material actions. Using mixed methods, this research explores the organizational and political infrastructural differences between Chicago and Chicago suburban nonprofit community-based organizations (CBOs) as they responded to the COVID-19 crisis. Data was collected through both interviews with CBO organizers, and spatial analysis of a database of nonprofit organizations in the Chicagoland area. The findings advance the concept of the infrastructure of civic institutions through finding that distance and differences in funding and collaboration amongst CBOs significantly impact the access of CBOs to structural supports to then provide for their communities. This analysis also includes the comparison of two CBOs to illustrate these geographic differences in funding and collaboration. These findings help demonstrate the need for a more collaborative and versatile design of community-based work, which moves away from the traditional nonprofit funding structure.

Building adaptive capacity to address coastal flooding: The case of a small Texas City

Coastal flooding is a severe and recurring problem, as evidenced by recent disasters that have caused significant damage for coastal communities. A community’s ability to mitigate the effects of coastal flooding depends on the local context and its adaptive capacity. Although past research has highlighted the important role that non-governmental organizations play in building adaptive capacity to support effective adaptation, few studies have focused specifically on rural, community-based nonprofits. To fill this gap, we employ a mixed-methods approach to evaluate the role of the Ingleside on the Bay Coastal Watch Association (IOBCWA), a resident-led, community-based nonprofit, in building adaptive capacity to coastal flooding in the City of Ingleside on the Bay (IOB; pop. 800), located in the Coastal Bend Region of Texas. By applying a grounded theory framework, we show that IOBCWA has improved the adaptive capacity of IOB through five primary activities: engaging in community organizing, boosting advocacy and outreach, implementing evidence-based data collection, building capacity among residents, and developing regional communication networks. Our findings are further examined using the Regional Fingerprint tool (Hirschfeld et al., 2020) to assess progress toward building regional adaptive capacity. We identify a need for more formalized policies, enhanced regional partnerships, and broader inclusion of socially vulnerable groups to address environmental challenges. Overall, this work highlights the important role that small, community-based nonprofits like IOBCWA play in building community adaptive capacity and suggests the need for a more comprehensive regional approach with participation from multiple stakeholders to address challenges related to coastal flooding.

An action research partnership in an urban Texas county to explore barriers and opportunities for collaborative community health needs assessments.

The Affordable Care Act mandated triennial community health needs assessments (CHNAs) for greater nonprofit hospital accountability in responding to community health needs. Over 10 years later, hospital spending on community benefits remains largely unchanged. While greater collaboration in CHNA implementation can increase hospital investment in community-based initiatives, nonprofit hospitals in conservative states are subject to policy, political, and economic factors that inhibit public health partnerships and magnify existing disparities in health care access. This participatory action research study explores the decision-making environment of collaborative CHNA implementation within a group of nonprofit hospitals in a north Texas urban county. In 2017 faculty from an urban anchor institution initiated an academic-community partnership with a coalition of nonprofit hospitals, public health departments, and academic institutions. An interdisciplinary research team engaged in multi-method document review and qualitative data collection to describe historical barriers for local CHNA processes and develop practical strategies for joint CHNA initiatives. Local CHNA documents were first reviewed through team-based content analysis and results applied to develop a qualitative study protocol. Key informants were recruited from county-based nonprofit hospitals, community-based nonprofit organizations, and public health systems. Seventeen senior- and mid-level professionals participated in semi-structured research interviews to describe their perspectives relating to CHNA-related planning and implementation decisions. Through iterative data collection and analysis, the research team explored CHNA-related knowledge, experiences, and processes. A constructivist lens was subsequently applied to examine historical barriers and future opportunities for local collaboration. Findings reveal CHNA implementation is a multi-stage cyclical process in organizational environments with accountability to a wide range of public and private stakeholders. This promotes varied levels of inclusivity and conservatism in data collection and community benefit implementation. Decisions to collaborate are hindered by competing priorities, including compliance with existing guidelines, administrative simplicity, alignment with health care service delivery, and efficient resource use. Efforts to promote greater CHNA collaboration may be facilitated through intentional alignment with organizational priorities and clearly communicated benefits of participation for leaders in both public and private nonprofit health systems. We consider implications for policymakers and health systems in restrictive political environments and advance a conceptual framework for greater CHNA collaboration.

The Reentry Health Care Hub: Creating a California-Based Referral System to Link Chronically Ill People Leaving Prison to Primary Care.

People released from prison experience high health needs and face barriers to health care in the community. During the COVID-19 pandemic, people released early from California state prisons to under-resourced communities. Historically, there has been minimal care coordination between prisons and community primary care. The Transitions Clinic Network (TCN), a community-based non-profit organization, supports a network of California primary care clinics in adopting an evidence-based model of care for returning community members. In 2020, TCN linked the California Department of Corrections and Rehabilitation (CDCR) and 21 TCN-affiliated clinics to create the Reentry Health Care Hub, supporting patient linkages to care post-release. From April 2020-August 2022, the Hub received 8420 referrals from CDCR to facilitate linkages to clinics offering medical, behavioral health, and substance use disorder services, as well as community health workers with histories of incarceration. This program description identifies care continuity components critical for reentry, including data sharing between carceral and community health systems, time and patient access for pre-release care planning, and investments in primary care resources. This collaboration is a model for other states, especially after the Medicaid Reentry Act and amid initiatives to improve care continuity for returning community members, like California's Medicaid waiver (CalAIM).

Abstract P6-05-59A: Developing a Community Standard of Care for Individuals Diagnosed with Breast Cancer Patients Across Oregon

Abstract Early in the pandemic, cancer centers across the nation and Oregon canceled their cancer support programs as non-essential medical care. Breast cancer patients were forced to look elsewhere for essential assistance and community support to move along their cancer journeys. Pink Lemonade Project (PLP), a Vancouver, WA based community based nonprofit, helped fill the gaps and expanded its local support for breast cancer patients. A virtual format allowed PLP to serve more individuals with our psychological, emotional and financial support programs. Next, PLP convened an informal coalition of all the local breast cancer support organizations including those that offer breast cancer support programs, community including dragon boating and rowing, and others that serve broader communities and more people of color. Then, as Komen National announced its restructuring, and closed the Oregon-Southwest Washington affiliate in Spring 2021, Pink Lemonade Project stepped up again to maintain two locally-grown Komen programs that met critical community need–the MBC Dinner Series and the Treatment Access Program (TAP), a transportation assistance program that served all of Oregon and reduced the geographic barrier to care. Through the coalition, PLP heard patients express concern that they were receiving outdated information and were struggling more to find needed support and resources from their providers. Understandably, nurse navigators and social workers could not maintain and/or update patient resources while they assisted COVID patients. The goal of the coalition was to increase communication across the organizations and to share more event schedules for the ease of patients to understand what support programs are available. This session, delivered by an all breast cancer patient panel, will give an overview of Pink Lemonade Project; its programs that helps with psychological, emotional, community and financial support for breast cancer patients, survivors and those living with metastatic breast cancer; and will highlight the results from the patient point of view of the systematic review of the contents of 6 regional health systems new patient binders and present recommendations for consistent, community-wide content for all future breast cancer patients. The project’s main strength was that Pink Lemonade Project could draw upon on an existing coalition of local, community-based breast cancer organizations to help update and standardize breast cancer support information from the patient point of view. Then by acting as a neutral convener, PLP could request and receive the binders from all the region’s healthcare providers to help standardize and update the community resources across all the region’s cancer centers. The result is that any new breast cancer patient, regardless of where their access to care is, can receive consistent community-based information and resources. Another result of this project showed the importance of the partnership of healthcare and human service agencies, especially in a post-pandemic world. As the pandemic continues to strain healthcare, community-based nonprofits have a unique role to help coordinate community resources and improve the quality of life for those affected by breast cancer. Developing a Community Standard of Care for Individuals Diagnosed with Breast Cancer Across Oregon Developing a Community Standard of Care for Individuals Diagnosed with Breast Cancer Across Oregon Citation Format: Susan Stearns, Thalia Williams, Lisa Peters, Sonja Trytko. Developing a Community Standard of Care for Individuals Diagnosed with Breast Cancer Patients Across Oregon [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-59A.

Towards a pedagogy of social-ecological collaborations: engaging students and urban nonprofits for an ecology with cities.

The online version contains supplementary material available at 10.1007/s11252-023-01343-x.

Seeding Community Intermediary Organizations and the Liability of Growth in Obtaining Local Giving

Over the past 50 years, philanthropic institutions and governments have invested millions of dollars to support the growth of community intermediary organizations (CIOs) for developing vibrant civic lives. CIOs are community-based nonprofit organizations that do not directly deliver services but support other local nonprofit organizations. The key issue for these investments is how to generate more local giving for CIOs to reduce their dependence on external funders. It is believed that CIOs established in wealthy communities are more likely to attract local giving. However, an investigation into community foundations—a type of CIOs—seeded by a funder shows that foundations in the wealthiest communities did not receive much local giving. Rapid population growth in wealthy communities disrupted conventional, close-knit social relations and undermined the efficacy of foundations’ traditional fundraising model that relied on personal relationship-building, local brokers, and word-of-mouth referrals to attract giving. Community foundations suffered from low visibility and lost competitive advantages over commercial and national competitors. It suggests that funders should pay more attention to increasing volatility in communities and help CIOs transform their fundraising model.

Feasibility of a Community-Based, Online, Peer-Supported Spinal Cord Injury Self-management Intervention: Protocol for a Pilot Wait-Listed Randomized Trial

People with spinal cord injury (SCI) report feeling unprepared to manage their disability upon discharge to the community. This situation is exacerbated when they return to settings where self-management support and resources are sparse, thus increasing the risk of costly secondary conditions and rehospitalizations. These factors make a compelling case for implementing innovative community-based SCI self-management programs that empower and engage individuals with SCI. Using a community-engaged research (CEnR) approach, we developed a peer-supported SCI self-management intervention, known as PHOENIX (Peer-supported Health Outreach, Education, and Information Exchange), which integrates online educational content and support from peer navigators (PNs) through telehealth, to promote health and community participation after SCI. The objective of this pilot study is to evaluate the feasibility and acceptability of PHOENIX and the study design, and to obtain estimates of the variability of relevant outcome measures. We conducted a pilot randomized waitlist-controlled trial (n=30) in collaboration with the South Carolina Spinal Cord Injury Association (SCSCIA), our long-standing community-based nonprofit organization research partner. We recruited 4 PNs through our SCSCIA collaboration using its existing network of trained peer mentors. Our study design supported comparison of the following 2 randomly assigned groups: PHOENIX intervention group and waitlist enhanced usual care (EUC) group. The PHOENIX intervention was administered online by PNs over 16 weeks through scheduled "video visits." The EUC group participated in the study for 16 weeks with usual community services and no navigation, and received 4 monthly newsletters from the SCSCIA on a variety of SCI-relevant topics. At the end of the waitlist period, the waitlist EUC group received the full PHOENIX intervention. Measures of feasibility included PN and participant recruitment and retention, PN workload, protocol adherence, and incidence of technical issues. We conducted qualitative interviews with participants and PNs to evaluate the acceptability of PHOENIX and the study design. Outcome measures, including community participation, quality of life, and the occurrence and subjective impact of medically serious secondary conditions and rehospitalizations, were assessed at baseline after randomization and at subsequent time points to allow between-group comparisons. PN hiring and training were completed in August 2018. Recruitment began in November 2018. A total of 30 participants were recruited across South Carolina, and 28 participants completed follow-up by August 2020. An analysis of the results is being finalized, and the results are expected to be published in 2023. This study will provide valuable information to guide future research seeking to address unmet self-management needs and improve outcomes in individuals with SCI. Feasibility findings of this study will provide evidence from CEnR guided by people with SCI and SCI service providers to inform further development, testing, and dissemination of effective and scalable self-management strategies for people with SCI. RR1-10.2196/42688.

Urban Communities for Transition toward Sustainable Behavior in the Context of Authoritarianism: Analysis of Non-Profit Community-Based Organizations in Budapest, Hungary

Communities can play an important role in the transition toward sustainable living; however, a meso perspective bridging individual behavior and social context has rarely been applied. To address this issue, our study introduces the broad landscape of nonprofit community-based organizations as meso-level entities whose activities relate in one way or another to sustainability. Through an exploratory study relying on in-depth interviews, we examine the meaning of community and the role of sustainability in the operation of these communities. The emergence of a new authoritarianism in Hungary gives a special context for the study and enables identification of the characteristics of urban communities from “illiberal democracy.” The findings indicate the presence of five different types of community-based organizations with sustainability-related activities. We argue for the analytical usefulness of a meso-level perspective and for the importance of researching how community-based organizations help individuals in transition to a more sustainable lifestyle.

Factors affecting collaboration between clinical and community service organizations.

Collaboration between clinical and community-based social service organizations is increasingly seen as vital for preventing and managing chronic diseases but has been challenging to establish and sustain. The aim of this study was to identify organizational barriers and facilitators for clinic-community collaboration. We employed multiple methods to study a national sample of nonprofit community-based organizations that each collaborated with local clinical organizations for diabetes prevention in the United States. We used qualitative data collected longitudinally through 65 semistructured interviews from 2016 to 2017 at seven of these organizations and their clinical collaborators to understand their relationships. We employed survey data ( N = 247 with 73% response rate) to measure and explore relationships among qualitatively identified themes and collaboration performance. We documented three levels of organizational challenges to community-clinic collaboration. Interorganizational challenges pertain to facing only weakly aligned interests across organizations. Interpersonal challenges pertain to misperceptions and miscommunications that occur as frontline employees from differing organizations seek to work together. Task-related challenges pertain to the inadequacy of current processes to effectively link services across clinical and community settings. We found that bridging leadership , provisional teamwork, and learning processes helped to overcome these challenges by enabling iterative progress. Follow-up national survey results indicated that these facilitators were significantly associated with collaboration performance. Because community-clinic collaboration presents substantial interorganizational, interpersonal, and task-related challenges, financial incentives alone are likely insufficient for success. Resources that help develop capacity to work across community and clinical settings may be vital and warrant dedicated funding.

Public Art, Representation, and Questions of Revising the Past

Operating from the position of an artist with a mature practice in creating public art, this essay chronicles and contextualises the development of a series of works that consider the history, symbolism, interpretation, and evolving understanding of specific historic public artworks. There is a paradox in my development as a muralist: my significant experience while being affiliated with and working on behalf of a prominent community-based non-profit arts organization, where I repeatedly faced constraints upon the content and attitude of the work being created, earned me the notoriety and reputation that facilitates for-profit work that critiques design-by-committee at best, and malignant censorship at worst. Works in the series deal with the intersections of gender and race in the content of public artworks in tones that range from reverent to harshly critical and – in some cases – suggestive of reparative action.