Leaders Of Community-based Organizations Research Articles

Technology, data, people, and partnerships in addressing unmet social needs within Medicaid Managed Care

BackgroundIndividuals with unmet social needs experience adverse health outcomes and are subject to greater inequities in health and social outcomes. Given the high prevalence of unmet needs among Medicaid enrollees, many Medicaid managed care organizations (MCOs) are now screening enrollees for unmet social needs and connecting them to community-based organizations (CBOs) with knowledge and resources to address identified needs. The use of screening and referral technology and data sharing are often considered key components in programs integrating health and social services. Despite this emphasis on technology and data collection, research suggests substantial barriers exist in operationalizing effective systems.MethodsWe used qualitative methods to examine cross-sector perspectives on the use of data and technology to facilitate MCO and CBO partnerships in Kentucky, a state with high Medicaid enrollment, to address enrollee social needs. We recruited participants through targeted sampling, and conducted 46 in-depth interviews with 26 representatives from all six Kentucky MCOs and 20 CBO leaders. Qualitative descriptive analysis, an inductive approach, was used to identify salient themes.ResultsWe found that MCOs and CBOs have differing levels of need for data, varying incentives for collecting and sharing data, and differing valuations of what data can or should do. Four themes emerged from interviewees’ descriptions of how they use data, including 1) to screen for patient needs, 2) to case manage, 3) to evaluate the effectiveness of programs, and 4) to partner with each other. Underlying these data use themes were areas of alignment between MCOs/CBOs, areas of incongruence, and areas of tension (both practical and ideological). The inability to interface with community partners for data privacy and ownership concerns contributes to division. Our findings suggest a disconnect between MCOs and CBOs regarding terms of their technology interfacing despite their shared mission of meeting the unmet social needs of enrollees.ConclusionsWhile data and technology can be used to identify enrollee needs and determine the most critical need, it is not sufficient in resolving challenges. People and relationships across sectors are vital in connecting enrollees with the community resources to resolve unmet needs.

Lessons from Two Latino Communities Working with Academic Partners to Increase Access to COVID-19 Testing

Abstract: Objective: We sought to examine the experiences of community partners in a community–academic partnership to promote COVID-19 testing in two majority Latino communities. Methods: We conducted semistructured, in-depth interviews in English and Spanish with community-based organization leaders and community health workers/ promotoras ( n = 10) from June to July 2021. Interviews focused on identifying partner roles in planning and testing implementation and evaluating communication among partners. Interviews were transcribed and analyzed in ATLAS.ti version 8.4.5. Analyses involved deductive and inductive approaches to identify key themes. Results: Participants described both strengths and challenges to the collaborative approach within each of three core themes: building relationships in the time of COVID-19; uplifting existing community leadership; and commitment of the academic partners and community-based organizations to conduct partnership activities in Spanish. Conclusion: Community–academic partnerships that invest in strong relationships, community leadership, and a commitment to the community's preferred language offer a promising approach to addressing COVID-19 testing barriers. Findings provide direction for future research on how community members and academic partners can come together to inform strategies to continue addressing the COVID-19 pandemic.

COVID-19 Vaccine Policy Implementation and Differential Vaccine Uptake Trajectories in Chicago Communities.

Since the onset of the COVID-19 pandemic, multiple public health interventions have been implemented to respond to the rapidly evolving pandemic and community needs. This article describes the scope, timing, and impact of coordinated strategies for COVID-19 vaccine uptake in Chicago for the first year of vaccine distribution. Using a series of interviews with public health officials and leaders of community-based organizations (CBOs) who participated in the implementation of the citywide COVID-19 vaccine outreach initiatives, we constructed a timeline of vaccine outreach initiatives. The timeline was matched to the vaccine uptake rates to explore the impact of the vaccine outreach initiatives by community area. Finally, we discussed the nature of policy initiatives and the level of vaccine uptake in relation to community characteristics. The Chicago Department of Public Health (CDPH) implemented myriad vaccine outreach strategies, including mass vaccination sites, improved access, and community-level vaccine campaigns. Protect Chicago+ was the primary vaccine outreach effort initiated by the CDPH, which identified 15 highly vulnerable community areas. More than 2.7 million (67%) Chicagoans completed the vaccine regimen by December 2021. Black (51.3%) Chicagoans were considerably less likely to be vaccinated than Asian (77.6%), White (69.8%), and Hispanic (63.6%) Chicago residents. In addition, there were significant spatial differences in the rate of COVID-19 vaccine completion: predominantly White and Hispanic communities, compared with Black communities, had higher rates of vaccine completion. The community outreach efforts to improve COVID-19 vaccine uptake in Chicago have shown the importance of community-engaged approaches in pandemic responses. Despite citywide efforts to build community infrastructure, Black communities had relatively lower levels of vaccine uptake than other communities. Broader social restructuring to mitigate disinvestment and residential segregation and to ameliorate medical mistrust will be needed to prepare for future pandemics and disasters.

The geographies, typologies, and trends of community-based organizations for solar energy in the United States

Community-based organizations (CBOs)11There is no single definition of or universally accepted characteristics of a CBO. We define a CBO as “formal or informal organizations or citizen groups engaged in activities explicitly designed to encourage the adoption of solar.” This definition is similar to what Noll et al. (2014) use in the solar PV context. play an important role in developing solar energy in low- and moderate-income (LMI) communities. This article shares the perspectives of CBO leaders in LMI communities, identifies and addresses solar information gaps, and provides recommendations State Energy Agencies and other government leaders can use to better involve CBOs in solar program initiatives. Using semi-structured interviews and focus groups with CBOs from across the United States (US) we develop typologies of CBO structure and function, and determine the primary motivations, challenges, opportunities, and communication barriers CBOs face. We explore the correlation between key typologies such as tenure, staff capacity, population served, organizational structure, and region with the organizational activities performed by solar-related CBOs. CBOs operate in disparate regional political and economic ecologies. Our findings suggest strategies for states to support their engagement in solar-related endeavors, particularly with respect to the dissemination of the Bipartisan Infrastructure Law, Inflation Reduction Act, and the EPA Greenhouse Gas Reduction Fund: Solar for All. Developing policies that encourage CBOs to enter the solar training and installation domains, alongside targeted grants and capacity-building initiatives can help maximize community benefits. States can additionally contribute to the positive trajectory and collaboration between state agencies and CBOs in advancing solar energy adoption by fostering a supportive environment.

Systemic Racism Affecting Latinx Population Health During the COVID-19 Pandemic and Beyond: Perspectives of Latinx Community Health Workers and Community-Based Organization Leaders.

The purpose of this study is to identify forms of systemic racism experienced by Latinx communities in North Carolina during the COVID-19 pandemic as identified by Latinx community health workers (CHWs) and community-based organization (CBO) leaders. We conducted three focus groups in July 2022 (N=16). We performed qualitative analysis of data using an iterative inductive approach of the original language in Dedoose. Four central themes emerged: (1) Access to resources for Latinx individuals; (2) Immediate, transitional, and future fears; (3) Benefits of CHWs; and (4) Lessons learned. Institutional and state policies often do not involve community members, such as CHWs and CBO leaders, at the start of the development process, leading to ineffective interventions that perpetuate health disparities and systemic racism. Community-informed policy recommendations can improve alignment of community and policy priorities to create more effective interventions to address systemic racism and promote health equity.

"At the End I Have a Say": Engaging the Chinese Community in Advance Care Planning.

Despite the association of advance care planning (ACP) with improved patient and caregiver outcomes, Chinese American elders have low rates of ACP. Assess ACP facilitators/barriers in the San Francisco (SF) Chinese community and codesign, implement, and test community-based ACP-promoting pilot events. A Chinese Community Committee (N=19 community-based organization leaders, health system representatives, community members) conducted focus groups in Cantonese and English with Chinese older adults (age ≥55), caregivers, and community leaders. The Committee designed and implemented pilot events in-person and online. We analyzed focus group data using thematic analysis; assessed pre-to-post-event readiness to engage in ACP (validated survey; 14 scale, 4=most ready); and assessed event acceptability. A total of 34 people participated in six focus groups. Themes described Chinese community-specific importance of ACP (e.g., reduces family burden), barriers (e.g., younger generations lack tools to discuss ACP with elders and vice versa), and facilitators (e.g., intergenerational events, culturally/linguistically appropriate materials). Based on focus groups findings, the Committee developed a novel ACP tool and designed intergenerational events. A total of 195 participants attended 10 events; 95% were Chinese, 90% spoke Chinese languages, 80% were women. ACP readiness increased significantly (1.66 [SD 0.84] vs. 2.03 [SD 0.85]; P < 0.001); 94% of participants were comfortable attending and 96% would recommend events. Community-developed intergenerational events that highlight the value of ACP and address barriers are acceptable and increase ACP engagement in the Chinese community.

NEGOTIATING HERITAGE THROUGH PRACTICE: COMMUNITY ENGAGEMENT AT THE INTERSECTION OF ETHNOGRAPHY AND ARCHAEOLOGY

Abstract For Maya communities in southern Belize, environmental and cultural heritage is not a static entity but an everyday lived experience. In this paper, we critically examine this living heritage through reflections on a series of collaborative heritage projects in Mopan and Q'eqchi' Maya communities in southern Belize. We collaborated with community members, community-based organization leaders, and archaeologists to exchange knowledge about land use and land management in the context of supporting and sustaining cultural heritage knowledge and practice. Building on long-term ethno-graphic research in a village with an archaeological site located on community lands, we designed a series of activities utilizing multiple pathways in support of the maintenance of heritage. We consider how sociocultural anthropologists navigate community/archaeology collaborations, documenting the successes and challenges of these groups working together and describing points of tension that have yet to be resolved but reflect broader patterns of negotiated heritage in Belize and beyond.

Ending the HIV epidemic PrEP equity recommendations from a rapid ethnographic assessment of multilevel PrEP use determinants among young Black gay and bisexual men in Atlanta, GA.

Efforts to mitigate HIV transmission among gay and bisexual men have not been sufficient to level persistent racial inequities which now extend to the use of daily oral pre-exposure prophylaxis (PrEP) for HIV prevention. Community-involved ethnographic research is crucial to galvanizing collaboration between patients, researchers, and policymakers to identify the social determinants of emerging PrEP inequities. In partnership with community key informants, we conducted a Rapid Ethnographic Assessment (REA) of multilevel PrEP use determinants among young Black gay and bisexual (YBGBM) men in the metropolitan Atlanta area to inform the development and coordination of local HIV programs. In the assessment, we drew upon the perspectives of local clinicians, community-based organization leaders, health educators, and PrEP clients to identify barriers and facilitators to PrEP use among YBGBM through interviews (N = 23). Data were collected from September 2020 -to January 2021 and were analyzed through a staged deductive-inductive thematic analysis. The themes were later summarized and presented to community stakeholder participants to facilitate member-checking. Our analyses revealed structural, cultural, relationship, and developmental factors which shaped PrEP use. The most prominent being "ease of access to PrEP" (structural level), "provider support" (interpersonal), and "life-stage traits" (individual). Our results also contribute novel information concerning the axes of intersectional stigma (spatial, racial, sexual identity, and HIV) among YBGBM in Atlanta and its divergent effects on PrEP use. Increased PrEP use among YBGBM, particularly among those living in the south, is essential to ending the domestic HIV epidemic. Altogether, our results emphasize the need for PrEP program modifications, which increase flexibility in methods and modes of access and are culturally adapted to the needs of YBGBM. There is also a need for resources that holistically focus on mental health, trauma, and racism as critical components of support.

"Everything in One Place": Stakeholder Perceptions of Integrated Medical and Social Care for Diabetes Patients in Western Maryland.

Patients with type 2 diabetes frequently have both medical- and health-related social needs that must be addressed for optimal disease management. Growing evidence suggests that intersectoral partnerships between health systems and community-based organizations may effectively support improved health outcomes for patients with diabetes. The purpose of this study was to describe stakeholders' perceptions of the implementation factors associated with a diabetes management program, an intervention involving coordinated clinical and social services supports to address both medical- and health-related social needs. This intervention delivers proactive care alongside community partnerships, and leverages innovative financing mechanisms. Qualitative study with semi-structured interviews. Study participants included adults (18 years or older) who were patients with diabetes and essential staff (e.g., members of a diabetes care team, health care administrators) and leaders of community-based organizations. We used the Consolidated Framework for Implementation Research (CFIR) to develop a semi-structured interview guide designed to elicit perspectives from patients and essential staff on their experiences within an outpatient center to support patients with chronic conditions (the CCR) as a part of an intervention to improve care for patients with diabetes. Interviews illuminated three key takeaways: (1) team-based care held an important role in promoting accountability across stakeholders motivating patient engagement and positive perceptions, (2) mission-driven alignment across the health care and community sectors was needed to synergize a broad range of efforts, and (3) global payment models allowing for flexible resource allocation can invaluably support the appropriate care being directed where it is needed the most whether medical or social services. The views and experiences of patient and essential staff stakeholder groups reported here thematically according to CFIR domains may inform the development of other chronic disease interventions that address medical- and health-related social needs in additional settings.

Building Leadership Through Partnerships: Using Concept Mapping to Develop Community Capacity to Address Gender-Based Violence.

Building Leadership Through Partnerships:Using Concept Mapping to Develop Community Capacity to Address Gender-Based Violence Alisa J. Velonis, MPH, PhD, Erin Howes, MPH, Karla Altmayer, JD, Sheerine Alemzadeh, JD, Linda Forst, MD, MPH, and Jeni Hebert-Beirne, MPH, PhD What is The Purpose of This Study/Review? • Our study describes an academic–community partnership formed to help the leaders of a community-based organization (CBO) identify the critical elements for a leadership training program to address gender-based violence (GBV) in communities with high levels of precarious employment and little access to institutional supports. • The research partnership consisted of the leaders of the CBO, several academic researchers, and a team of "community animators," or community researcher trained in conducting research activities. • Concept mapping methods were used to generate and prioritize a list of resources and skills individuals from the targeted communities felt they would need to address GBV that happened at work and home. • While the findings directly influenced the content of the leadership program, the community partners found the process to be of equal benefit. What Is the Problem? • Despite the increased publicity surrounding workplace sexual harassment, women in temporary, low-wage jobs with few or no benefits are particularly vulnerable to experiencing GBV and its ramifications, both at home and at work. While some workplaces have initiated GBV response programs, the nature of precarious employment (e.g., few/no benefits, low wage, dangerous working conditions) and accompanying informal workplaces (e.g., private homes, warehouses, small businesses) preclude workers from having access to these programs, and likely discourage employees from seeing workplaces as a source of support. Thus, community-based and community-driven responses will be needed to provide support for women experiencing GBV in these populations. What Are the Findings? • The findings from the concept mapping activities suggested that participants believe that informal leaders from their communities who want to address issues of GBV would benefit from having skills and resources related to addressing workplace violence. ○ They suggested that a program that covered topics such as employee and survivor support and resources would be likely to draw participants to such a program. ○ Participants' focus on workplace violence may have been related to our initial emphasis on precariously employed individuals, but it is also likely that this is a less-sensitive form of GBV providing an entry point from which to initiate discussions about other forms of GBV, including violence initiated by partners and family members. [End Page e9] • The CBO leaders who co-led this research felt that the process of engaging members of the community (including the community animators) in prior to the launch of the programs was equally useful to the development of the program as the findings were. ○ They were able to build relationships and make connections they may not have made otherwise and allowed them to have a very successful program launch, with roughly one-third of program participants having been part of the concept mapping process, either as animators or as participants. Who Should Care Most? • The findings from our study are important for groups interested in developing community-driven approaches for addressing GBV. While the specific findings of our study may not be generalizable beyond low-wage communities and predominantly Latinx individuals, we believe that that the process of engaging communities was critical to our success. Our work highlights the platform that community driven research can provide in response to GBV. Recommendations for Action • Academic–community partnerships can be useful for soliciting input and buy-in from especially marginalized communities prior to launching programs in the area. [End Page e10] Alisa J. Velonis University of Illinois at Chicago, School of Public Health, Division of Community Health Sciences Erin Howes University of Illinois at Chicago, School of Public Health, Division of Community Health Sciences Karla Altmayer Healing to Action Sheerine Alemzadeh Healing to Action Linda Forst University of Illinois at Chicago, School of Public Health, Division of Environmental and Occupational Health Sciences Jeni Hebert-Beirne University of Illinois at Chicago, School of Public Health, Division of Community Health Sciences Copyright © 2023 Johns Hopkins University Press

Factors influencing the well-being of Asian American LGBT individuals across the lifespan: perspectives from leaders of community-based organizations

BackgroundLesbian, gay, bisexual, and transgender (LGBT) individuals have documented disparities in mental health that are experienced across the life course. However, limited research has been conducted to identify the factors which contribute to evaluated risk for poor mental health among older Asian Americans who identify as LGBT. The purpose of this study was to determine the perspectives of leaders of community-based organizations about the mental health needs and concerns of their LGBT constituents from diverse Asian backgrounds.MethodsSemi-structured qualitative interviews were conducted with leaders of community-based organizations serving the needs of LGBT individuals. A qualitative framework analysis approach was used to identify, analyze and report themes within the data.Results11 members of community organizations located in California (54.5%), Chicago (27.2%), and New York (18.1%) were interviewed. Chronic stress was identified as negatively impacting constituents’ lives and was attributed to social determinants of health, including inadequate housing, financial insecurity, discrimination, barriers to adequate health care, and immigration status. Ageism, social isolation, language barriers, and limited connections to cultural, religious, or LGBT communities were identified as factors impacting middle-aged and older adults. Participants identified homelessness, violence, and lack of parental acceptance as contributing to distress among youth and younger adults. The most vulnerable community members were identified as gender minorities, undocumented individuals, and individuals with limited English proficiencies. Organizational leaders described strategies to address social determinants.ConclusionsAsian Americans who are LGBT are confronted with substantial risks for poor mental health that are linked to modifiable social determinants of health. Organizations serving these populations play a vital role in meeting the needs of a highly underserved population.

EMBRACING COMMUNITY: ADVANCE CARE PLANNING FOR AFRICAN AMERICAN OLDER ADULTS LIVING WITH DEMENTIA

Abstract Lower socioeconomic status African American older adults living with dementia and their family caregivers face unique advance care planning challenges, including achieving appropriate preference-consistent healthcare near the end of life. The purpose of this project within a larger multi-stakeholder study is to assess community stakeholder perspectives on the needs of African American older adults living with dementia and their family caregivers. Diverse community-based organization leaders (n=9) were interviewed and identified the following thematic needs: Reframing of Advance Care Planning, Clarification of Misinformation, and Expansion of Available Resources. Community leaders expressed strong desires to assist families with advance care planning. The use of creative, culturally-tailored, non-traditional approaches to this process offers innovative ways to promote advance care planning through community engagement. This will change the narrative on advance care planning from a cultural perspective while embracing diversity, enriching discovery, and reimaging aging in the community

Development and design of a culturally tailored intervention to address COVID-19 disparities among Oregon's Latinx communities: A community case study.

BackgroundLatinx communities are disproportionately affected by COVID-19 compared with non-Latinx White communities in Oregon and much of the United States. The COVID-19 pandemic presents a critical and urgent need to reach Latinx communities with innovative, culturally tailored outreach and health promotion interventions to reduce viral transmission and address disparities. The aims of this case study are to (1) outline the collaborative development of a culturally and trauma-informed COVID-19 preventive intervention for Latinx communities; (2) describe essential intervention elements; and (3) summarize strengths and lessons learned for future applications.MethodsBetween June 2020 and January 2021, a multidisciplinary team of researchers and Latinx-serving partners engaged in the following intervention development activities: a scientific literature review, a survey of 67 Latinx residents attending public testing events, interviews with 13 leaders of community-based organizations serving Latinx residents, and bi-weekly consultations with the project's Public Health and Community Services Team and a regional Community and Scientific Advisory Board. After launching the intervention in the field in February 2021, bi-weekly meetings with interventionists continuously informed minor iterative refinements through present day.ResultsThe resulting intervention, Promotores de Salud, includes outreach and brief health education. Bilingual, trauma-informed trainings and materials reflect the lived experiences, cultural values, needs, and concerns of Latinx communities. Interventionists (21 Promotores) were Latinx residents from nine Oregon counties where the intervention was delivered.ConclusionsSharing development and intervention details with public health researchers and practitioners facilitates intervention uptake and replication to optimize the public health effect in Oregon's Latinx communities and beyond.

The Three E’s Revisited: How Do Community-Based Organizations Define Sustainable Communities and Their Role in Pursuit of?

A sustainable community seeks to protect and enhance the environment, meet social needs, and promote economic success. On average, local governments lack meaningfully connecting their environmental and economic sustainability efforts to equity and social justice. Community-based organizations (CBOs) have emerged as local leaders with a growing capacity for pursuing community sustainability. Based on data from a national survey National Community Action Partnership member organizations, this study explores (1) how CBO leaders define sustainable communities; (2) how important each of the three pillars of sustainability are to their mission; and (3) with what organizations do CBOs collaborate in their pursuit of sustainable communities. A content analysis of responses to an open-ended query to define sustainable communities revealed a significant focus on the social equity pillar of sustainability which is closely linked to economic sustainability. Similarly, CBO leaders ranked social equity and economic sustainability as the highest priority for their core mission. Lastly, CBO leaders heavily engaged in local collaboration in their sustainable community efforts. Therefore, serious pursuit of sustainable cities and communities must shift from a go-at-it-alone, centralized government approach to more inclusive, collaborative efforts that take advantage of the economic-social equity sustainability focus of CBOs in both planning and implementation.

Perspectives of cancer prevention and control resources from stakeholders in rural southern Illinois.

Rural residents have a higher cancer burden than urban residents, which is likely related to multiple socioecological factors. This study sought to investigate the perspectives of a diverse set of rural stakeholders regarding access to cancer prevention and control resources in rural southern Illinois. Stakeholders were recruited from counties in southern Illinois and included residents (cancer survivors or caregivers), leaders of community-based organizations with health-related missions, and health care providers. Individual interviews and focus groups assessed recommended cancer prevention, control, and treatment resources; helpfulness of regional resources; and needed resources. The research team used an iterative approach to thematic analysis wherein codes were derived inductively and refined repeatedly to reveal overarching themes. Forty-four stakeholders reported challenges to health care access (eg, travel distance, financial burdens, and poor quality of care) and limited access to supportive care services (lack of caregiver support and "spotty" area resources). To mitigate these barriers, local residents used a combination of individual (self-reliance and adaptive measures) and organizational (patient navigation and financial services) approaches. Finally, stakeholders reported multiple forms of cancer control and prevention communication, including formal discussions with health care providers and various types of informal social support (eg, friends and family). Stakeholders experienced barriers to cancer prevention and control often mitigated by a reliance on personal adaptations, nonclinical organizational supports, and informal support systems. While resources remain minimal in southern Illinois, researchers and practitioners must make efforts to leverage existing community organizations and social networks to improve cancer outcomes in this region.

Barriers and Facilitators to Accessing Health Services for People Without Documentation Status in an Anti-Immigrant Era: A Socioecological Model

Purpose: This qualitative study explores the barriers and facilitators to health care from the perspective of providers who care for patients without documentation status in the San Francisco Bay Area.Methods: Twenty-four direct providers were interviewed using semi-structured in-depth interviews. Participants included health care providers and community-based organization leaders. Interviews were independently coded using grounded theory analysis. The socioecological framework was used to develop the interview guide, analyze findings, and guide the discussion.Results: Participants identified fear as a barrier that transcended multiple levels of influence. At the public policy level, national policies, such as public charge and anti-immigration rhetoric, limited access to services. Local expansion of health care coverage, such as Healthy San Francisco, facilitated access to care. At the organizational level, law enforcement presence generated fear. This was countered by a welcoming environment, described as culturally concordant clinical sites, representation of the community in the provider pool, and resources to address social needs. Individual-level fear, rooted in trauma and economic insecurity, was eased by trauma-informed care and health navigators. Community engagement and sustained partnerships built trust and credibility to transcend the fear that hindered access to care.Conclusion: In a region with expansive policies for improved health care access, barriers are rooted in fear and span individual, organizational, and public policy levels of access to care. Richer community engagement may lessen the national and systemic barriers that this vulnerable population continues to face. Developing an understanding of this topic improves health care providers' ability to meet the needs of this growing and vulnerable population.

Expert Perspectives on Effective Community-Based Pediatric Healthcare for Low-Income Latino Families: Persistent Issues over Time.

US Latinos continue to experience significant health inequity, despite fluctuating healthcare policies over the past 20 years. Recent studies highlight the importance of comprehensive care and collaboration of stakeholders in reducing inequity. Few studies examine the perspectives of community-based organization leaders, health researchers, and policy experts regarding the most effective practices in the delivery of healthcare to Latino children and families. This unique study employed a mixed-methods cross-sectional design to compare perceptions of effective practices and action strategies among two groups. Analysis of qualitative data gathered from 17 organizational leaders and 28 research/policy experts resulted in four broad themes: (1) engagement of families as participants in their healthcare; (2) provision of comprehensive, family-focused healthcare services across the lifespan; (3) engagement of ethnically competent staff to provide outreach; and (4) development of community collaborations for resource building. Respondents identified three major barriers to the provision of high-quality care: (1) inequities in social determinants; (2) ongoing changes in insurance coverage; and (3) funding challenges for the support of community-based health centers (CHCs). Although the data were collected in 2001, these thematic findings remain relevant given the persistence of inequities and the lack of progress in mitigating inequity among Latino children and families, despite evolving healthcare system changes. The study conclusions reaffirm the importance of community-driven preventive healthcare services across the life course. These community services are the frontline of healthcare for many Latino children and their families; therefore, their sustainability is crucial. The voices of organizational leaders, health research, and policy experts are important and relevant.

Barriers and Facilitators of Smoking Cessation among Latinos Living with HIV: Perspectives from Key Leaders of Community-Based Organizations and Clinics.

The purpose of this study was to identify the perspectives from key leaders of community-based organizations (CBOs) and clinics serving people living with HIV on barriers and facilitators of smoking cessation among Latino smokers living with HIV. Semi-structured interviews were conducted in English and Spanish with 10 key leaders. Using a social ecological model, qualitative theoretical analysis was used to analyze the results. Participants identified barriers at the individual (e.g., low education level, HIV, and financial stress), interpersonal (e.g., language barriers, low social support), organizational (e.g., lack of smoking cessation resources and targeted interventions), community (e.g., HIV and mental health stigma), and policy (e.g., paperwork for insurance) level. Participants identified facilitators at the individual (e.g., high participation in trials, good medication adherence), interpersonal (e.g., no smoking in social circles), organizational (e.g., bilingual staff, culturally competent care), community (e.g., providing transportation, the coronavirus disease 2019 as an opportunity for smoking cessation), and policy level (e.g., existence of funding, comprehensive insurance programs). These results provide operational strategies to address smoking disparities among Latino smokers living with HIV. Further research is needed on how to integrate these perspectives into effective smoking cessation interventions.

Abstract PO-041: A framework for transformed community-academic partnerships to reduce cancer disparities

Abstract To meaningfully impact cancer disparities, scientists and community need to work differently together. Community-based participatory research (CBPR) offers a strong first step but in practice often falls short of its full potential. The Community Cancer Science Network (CCSN) is an initiative of the Medical College of Wisconsin Cancer Center to address breast and lung cancer disparities statewide. This initiative began with a three-year study and design team process which identified a need for academic medicine and community to come together to address disparities in Wisconsin. A design team made up of basic and population science researchers, clinicians and community-based organization leaders representing communities impacted by disparities convened to gather data and examine trends to better understand root causes. The team identified several hurdles impeding authentic community-academic partnerships including: 1) isolated solutions putting the primary responsibility for change on individuals and communities; 2) significant issues of trust due to racism and other forms of oppression; 3) misunderstandings and misinformation about community priorities/needs and the intersections of science and quality of life; and 4) structures to support working together in authentic ways. Following this work, the initiative moved into the next phase to address these hurdles. In this phase, CCSN uses developmental evaluation to help shape new ways of working together to go beyond CBPR by explicitly addressing mistrust, shared understanding, power and privilege differentials and more. CCSN begins with creating change in academic medicine and places community members at the table as experts. We report on first year learning, including the development of our guiding framework, managing resistance to change, and putting in practice an anti- oppression, co-learning model to support innovation and engage community and researchers as equitable partners. Further, we discuss the challenges of using a developmental evaluation approach in an academic environment. These include: 1) the need for significant shifts within core leadership teams and funders to look inward at their commitment to change internally; 2) differences in beliefs and practice between evaluation and research around planning, credibility of evidence, and use of data and language; 3) multiple levels of leadership models and engagement structures starting at different places and with varying understandings and assumptions of the models and approaches we are trying to use; 4) moving forward within a set of much larger systems that are becoming ready and changing at different paces. Conclusion. Eradicating cancer disparities requires novel ways to facilitate authentic community and academic medicine collaborations. Developmental evaluation supports an iterative process to quickly identify challenges and successes promoting ongoing learning and the ability to pivot and adapt approaches. Citation Format: Laura Pinsoneault, Tobi Cawthra, Beth Brunner, Linda Conlon, Lyle Ignace, Judy Heubel, Sandra Millon-Underwood, Hallgeir Rui, Jose Salazar, Ellen Velie, Alonzo Walker, Melinda Stolley. A framework for transformed community-academic partnerships to reduce cancer disparities [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-041.

The Torch Theory of Youth Leadership in Nusantara Malay Archipelago: Four Typologies in Indonesian Cities

The present discourse on leadership has been dominated by literature centred on the baby-boomers and even on the older cohorts. Yet, with the rise of the millennial generation and their influx into the various spaces within the society, be they economic, social or political, there are limited studies and established theories of youth leadership in this era.  Even more at stake is the draught of youth leadership theorizing based on home-grown communities, local identities and indigenous cultures.  This is especially true in the cultural space of Nusantara Malay Archipelago, where Indonesia, Malaysia, Brunei, Singapore, southern Thailand and Philippines are situated. This article is based on a research to lay-down foundational constructs in order to address this empirical and theoretical vacuum.  The objective of the research is to examine the paradigms of youth leaders. The sample involves thirty-five (35) youth leaders of community-based organizations (CBOs), born between 1980 to 2000, from four major cities in Indonesia. It employs an abductive research strategy whereby the constructs are built from the informants’ own conceptualization of meanings and practices of leadership. Through analysis of in-depth interviews and organizational profiling, the authors discovered four typologies of youth leadership. They are namely Piningit (saviour), Penyatu (unifier), Perantau (explorer) and Pemberdaya (enabler), together they form what the authors term as the Torch theory of Nusantara Malay Archipelago youth leadership as these leadership models are based on local wisdom, cultural values and heritage of the archipelago.