Community-level Work Research Articles

Go Ask Mom: The Gendered Dynamics of Color-Conscious Racial Socialization among White Parents

Abstract While most white parents avoid discussing race and racism with their children or tell them to be color-blind, recent research suggests that a growing number of color-conscious white parents intentionally talk with their children about racism as an ongoing, systemic issue. However, this research gives little attention to parents’ gender. Using interviews with 28 color-conscious white heterosexual parents, we examine how and why gender influences parents’ race-related conversations with their children. We show that, in theory, mothers and fathers share similar beliefs about race/racism and the need to discuss it with their children. In practice, however, mothers overwhelmingly shoulder these conversations. We trace this paradox back to mothers’ distinctively color-conscious refashioning of intensive mothering practices—which involves both personal and community-level work at the race-parenting intersection—that fathers do not undertake. This gender gap in parents’ personal/community work around race influences contrasting approaches to race-related conversations with their children, with mothers being more proactive and fathers being more passive. This dynamic ultimately casts race as a “Mom topic” within color-conscious white families. We argue that this can inhibit more egalitarian realizations of color-conscious white racial socialization and carries important implications for the sustainability and outcomes of these efforts.

Patient safety as a public health problem

Patient safety is an essential component of quality healthcare, which is what the general population is constantly demanding worldwide. Consequently, ensuring quality healthcare should not be a matter of clinical interest only but a public health priority so that all actions planned or implemented may have an impact at all levels and ensure intersectoral support to help the population remain safe when seeking and receiving health services. The definition and implementation of patient safety are currently circumscribed to the institutional setting. This article aims to present data that can help put into perspective the existing gaps pertaining to patient safety definition and fields of action, and conclude that there is room to work in public health in order to close those gaps. This requires understanding the complexities of the interactions between determinants of harm outside the physical setting where care is provided. These include community-level work, incorporation of knowledge from other disciplines in order to account for coverage, access and health outcomes, design strategies to counteract the impact that the absence of effective patient and people safety measures have on the general population and, in particular, on people differentially affected by the social determinants of health.

Driving Social Change Through Forum Theatre: A Study of Jana Sanskriti in West Bengal, India

This article examines Forum Theatre as a form of participatory communication for social change. Based on an ethnographic study of Jana Sanskriti ( JS), a Forum Theatre group working for over three decades in the eastern Indian state of West Bengal, this article seeks to show how this form of theatre, developed by the Brazilian activist Augusto Boal, subverts the passivity inherent in the communicator–receiver model of the dominant paradigm by activating the critical consciousness of the spectator and triggering a process of social change through dialogue and discussion. JS has been using Forum Theatre to address some of the deeply entrenched social norms in rural West Bengal, including those related to patriarchy, child marriage, domestic violence, and maternal and child health related issues, by extending Boal’s notion of the ‘spect-actor’ to encourage the spectators to become ‘spect-activists’, who then are engaged in community-level work on social change. We suggest that this form of communication is clearly bottom-up, radically participatory, community-based and led by the oppressed, as has been advocated by several scholars working on communication for social change.

Qualitative Analysis of Partnerships' Effect on Implementation of a Nationally Led Community-Based Initiative.

The American Heart Association (AHA) was funded to implement a nationally led initiative to implement policy, systems, and environment (PSE) interventions in communities across the United States. In Cohort 1, 15 communities were tasked with working with local community partners to plan and implement initiatives. Engaged as the evaluators, Texas A&M researchers conducted telephone interviews with project managers (employed by AHA) and community partners representing the 15 communities. Interviewees were asked questions pertaining to partnership planning and involvement in initiatives and overall perceptions of the impact of the program. Interviews were analyzed qualitatively using the Consolidated Framework for Implementation Research as the guiding framework. Thematic analysis revealed that partners were used in planning and implementing initiatives and felt that initiatives were successful in building community engagement. Some noted success in PSE changes, although this was not a major focus of respondents, regardless of it being a main indicator for the funder. Themes reveal several recommendations for those embarking on community-level work. Those recommendations include (1) build on existing priorities, (2) focus on incremental steps that build toward the bigger goal, (3) use national organizations to move more quickly, and (4) leverage resources through collaborative efforts.

Enhancing health literacy through co-design: development of culturally appropriate materials on genetic risk and customary consanguineous marriage.

AimTo develop a simple health literacy intervention aimed at supporting informed reproductive choice among members of UK communities practising customary consanguineous marriage. BACKGROUND: The contribution of 'health literacy' to reducing health inequalities and improving primary health-care efficiency is increasingly recognised. Enhancing genetic literacy has received particular attention recently. Consanguineous marriage is customarily practised among some UK minority ethnic communities and carries some increased risk of recessive genetic disorders among offspring compared with unions among unrelated partners. The need to enhance genetic literacy on this issue has been highlighted, but no national response has ensued. Instead, a range of undocumented local responses are emerging. Important knowledge gaps remain regarding how the development and implementation of culturally appropriate, effective and sustainable responses can be achieved. METHODS: Our co-design approach involved active participation by local people. Initial insight generation employed six focus group discussions and 14 individual interviews to describe current understandings and information needs. A total of 11 personas (heuristic narrative portraits of community 'segments') resulted; four participatory workshops provided further understanding of: preferred information channels; feasible information conveyance; and responses to existing materials. Prototype information resources were then developed and feedback gathered via two workshops. Following further refinement, final feedback from health-care professionals and community members ensured accuracy and appropriateness.FindingsThe project demonstrated the utility of co-design for addressing an issue often considered complex and sensitive. With careful planning and orchestration, active participation by diverse community members was achieved. Key learning included: the importance of establishing trusting and respectful relationships; responding to diversity within the community; and engendering a creative and enjoyable experience. The resultant materials were heavily shaped by local involvement. Evaluative work is now needed to assess impacts on knowledge and service uptake. Longer term sustainability will depend on whether innovative community-level work is accompanied by broader strategy including investment in services and professional development.

Recent developments in suicide prevention among the Indigenous peoples of Australia.

Suicide is an Aboriginal and Torres Strait Islander (hereafter 'Indigenous') population health issue. Over 2015-2016, the Aboriginal and Torres Strait Islander Suicide Prevention Project (ATSISPEP) aimed to identify success factors in Indigenous suicide prevention. For non-Indigenous practitioners working with indigenous clients at risk of suicide, ATSISPEP identified important considerations to make treatment more effective. The start is acknowledging the differences in the historical, cultural, political, social and economic experiences of Indigenous peoples, and their greater exposure to trauma, psychological distress and risks to mental health. These mental health difficulties are specific and more prevalent amongst Indigenous peoples and communities due to the ongoing impacts of colonisation in Australia including a range of social determinants impacting on the well-being of Indigenous peoples today. Working effectively with Indigenous clients also includes being able to establish culturally safe work environments, and the ability of non-Indigenous practitioners to work in a culturally competent and trauma-informed manner. There are also considerations regarding time protocols and client follow-up. Further, postvention responses might be required. Supporting selective suicide prevention activity among younger people (and other groups at increased risk) and community-level work is an important complement to working with Indigenous individuals at risk of suicide.

Building Community Capacity: What can health visitors do?

There is increasing support for public health professionals to adopt community-centred approaches in their work. This article discusses the importance of building community capacity in achieving good health outcomes across the life course and highlights current resources that health visitors can use to support their community-level work. It describes a national framework that identifies different approaches including community development, volunteer/peer roles, partnerships and linking to community resources. Some of the issues for local public health practice, including advocacy, skills and sustainability, are highlighted. The article concludes that health visitors can make an important contribution through championing community-centred prevention and using their skills, knowledge and experience to build resilient communities.

The care network for drug users: what do professionals say about it?

This article aimed to understand, from the framework of community psychology, the care network for drug users from professionals’ experiences, and implications of a community level work. Six semi-structured focus groups were conducted with 42 professionals from care networks of four Brazilian cities in the state of Minas Gerais. Data was analyzed through thematic content analysis. Results indicate the need of enhancing network’s operational structure and, mainly, consolidating a comprehensive and continuous care model. Professionals’ critical views of the care network lift a series of contributions to improve it, with the necessity of embracing a community level work and a resources-focus approach to drug abuse. Related to this, there is the necessity to focus care on community and its needs, by understanding it as the main element of care networks for drug users.

P3.411 Factors Affecting Utilisation of STI/HIV Clinics Among Sex Workers in Benin,

<h3>Background</h3> In Benin, HIV/STI clinical and prevention services (based on community mobilisation activities) for female sex worker (FSWs) were extended throughout the country. However, the attendance of clinical services remains very low. Most of the FSW-dedicated clinics are not functional. <h3>Objective</h3> This study explores factors related to low functionality and sub-optimal attendance of clinical services by FSWs. <h3>Methods</h3> Individual interviews and/or focus groups were conducted with 35 FSWs, 50 health care providers, 70 stakeholders from NGOs and 18 departmental heads of the National AIDS Program in 9 of the 12 regions of the country. Interview guides were developed using a conceptual framework describing actors, implications and issues of implementation activities. Direct observations in the field and analysis of activity reports were also conducted. Data from various sources were triangulated and validated with stakeholders. <h3>Results</h3> Several factors have undermined regular STI services utilisation by FSW, encompassing: (i) incomplete and insufficient package of services, with lack of integration of programme components, irregular and insufficient supervision, recurrent shortages of STI drugs and supplies; (ii) limited involvement of FSWs in the programme design, implementation and service organisation; (iii) police repression resulting in dispersion of FSWs, lack of empowerment activities (structural factors); (iv) fear of stigma, little motivation of some health provider to respond to FSWs needs; (v) dysfunctional referral between community level work and STI clinics. In addition poor planning that does not take into account local needs (size, diversification of sex work typologies) also contributes to the non-functionality of the FSW-dedicated clinical services. <h3>Conclusion</h3> The results of this study suggest that innovative service delivery models that maximise the synergy between community level work, and uptake of health services need to be designed, implemented and evaluated. Clinical and community level work should also be complemented by appropriate structural interventions.

Table of Contents

AbstractACMHA Event in D.C. Discusses Models for Community‐Level WorkTeenScreen Shuts Doors Suddenly after 13 Years, Taking Field by SurpriseAPA President Sees Practical, Symbolic Value in DSM‐5New Procedure Codes for MH Providers Require Billing ChangesLessons Learned in Transitioning to Automated Office SystemsBriefly NotedState NewsNames in the NewsCall for ProposalsResourcesComing up

Remodelling the Third Sector: Advancing Collaboration or Competition in Community-Based Initiatives?

AbstractIn the last decade, UK public agencies have increasingly been required to collaborate with non-state providers to deliver welfare services. Third sector organisations are now providers of services from early years to old age, taking a growing role in children and young people's services in socially deprived neighbourhoods. National policy has recognised third sector expertise in working with marginal groups of people. However, changing relationships with the state have drawn community organisations into new, often uncomfortable, organisational arrangements, affecting their work and their roles in relation to service users and community stakeholders.This article examines recent changes from a third sector perspective, drawing on data from a study of community-based organisations providing children and young people's services in deprived localities. It considers the changing environment of ‘new localism’ affecting these organisations, focusing on recent plans for local area commissioning of services.The article identifies some progress in supporting community services in deprived areas but illustrates how the continuing emphasis on competitive contracts and centrally driven frameworks undermines collaborative work and community trust. It argues that such mechanisms may serve short-term state interests but devalue the very community-level work, which is increasingly being promoted to address challenging social problems.

Responding to the mental health and psychosocial needs of the people of Sri Lanka in disasters

This paper describes the mental health and psychosocial response to the Boxing Day tsunami in Sri Lanka. The need to deal with the immediate psychological distress of survivors and provide psychosocial support after the tsunami was recognized early by the President of Sri Lanka and advisory group set up. In conjunction with the WHO regional office and local representatives, a National Plan of action for management and delivery of psychosocial and mental health care needs was set up. Advice was provided on the right type of psychological approaches to use when dealing with survivors–for example, not forcing people to relive their experiences, listening without offering opinions and not diagnosing or labelling people as suffering from post-traumatic stress disorder (PTSD). The early response and community level work are described in this paper as well as how this has led to a new level of disaster preparedness and a new national mental health policy and proposals for new mental health legislation.

Context, Culture, and Collaboration in AIDS Interventions: Ecological Ideas for Enhancing Community Impact

The paper describes developments in preventive interventions in AIDS/HIV that signal the emergence of a new perspective focusing on community-level intervention and community-level impact. These developments are reviewed, and a ecological framework from community psychology is offered as an integrating and guiding mind-set for future community impact interventions. Key ingredients are community assessment, the ecology of lives lived in different sociocultural communities, the development of collaborative relationships, and enhancing community empowerment through the development of local community resources. The perspective is outlined using existing examples of AIDS/HIV preventive interventions, which focus on such community-level issues as norms regarding sexual risk behavior. The paper concludes with a call to explore more fully the wisdom found in existing community-level work in the AIDS/HIV area and to develop an ecological mind-set when engaging in preventive community interventions.