Local Community-based Organizations Research Articles

A Community Partnership to House and Care for Complex Patients

Summary Rising homelessness, especially among older adults, has significant ramifications for our health care system. People experiencing homelessness tend to experience worse health and poorer access to needed health care than do people with stable housing. Commonwealth Care Alliance (CCA), a not-for-profit payer and provider that offers health plans to people dually eligible for Medicare and Medicaid, sought to address homelessness among its beneficiaries through a partnership with a local community-based housing organization, Hearth. This partnership led to many CCA beneficiaries gaining access to permanent supportive housing in a setting that allowed CCA and Hearth to monitor and address their medical, social, and behavioral needs. It also provided an opportunity to examine health care utilization and cost trends associated with permanent supportive housing. The authors' experience demonstrates that a community-based partnership can effectively address homelessness among older adults with significant medical needs and that permanent supportive housing may contribute to meaningful reductions in health care expenditures.

Barriers and Facilitators of Mental Health Service Utilisation among Bhutanese Refugees in the USA: Findings from a Mixed-Methods Study

Although discussions regarding the need to develop culturally responsive mental health services for resettled refugee populations in the USA have been burgeoning, efforts to comprehensively understand the unique barriers and facilitators of mental health services across refugee subpopulations remain fragmented. Our study explored the barriers and facilitators of mental health services experienced by the resettled Bhutanese refugee population in a Midwestern city in the USA using a two-phased sequential explanatory mixed-methods study (N = 46). Study findings draw much needed attention to culturally grounded solutions generated by the community to reduce barriers and increase facilitators of mental health engagement. Building on community-generated solutions and expanding the capacity of local community-based ethnic organisations will be the first step in providing services that are truly responsive to the cultural needs of the Bhutanese refugee population. Recognition of refugee communities’ unique collective strengths will be much needed to holistically collaborate with these new members of the society to promote mental well-being and foster a sense of inclusion and belonging, especially in the post-coronavirus pandemic context. Our study also contributes to emerging knowledge on methodological rigor in research amongst understudied, hard-to-reach populations.

Healthcare stigma and HIV risk among rural people who inject drugs

IntroductionThe HIV epidemic is increasingly penetrating rural areas of the U.S. due to evolving epidemics of injection drug use. Many rural areas experience deficits in availability of HIV prevention, testing and harm reduction services, and confront significant stigma that inhibits care seeking. This paper examines enacted stigma in healthcare settings among rural people who inject drugs (PWID) and explores associations of stigma with continuing high-risk behaviors for HIV. MethodsPWID participants (n = 324) were recruited into the study in three county health department syringe service programs (SSPs), as well as in local community-based organizations. Trained interviewers completed a standardized baseline interview lasting approximately 40 min. Bivariate logistic regression models examined the associations between enacted healthcare stigma, health conditions, and injection risk behaviors, and a mediation analysis was conducted. ResultsStigmatizing health conditions were common in this sample of PWID, and 201 (62.0 %) reported experiencing stigma from healthcare providers. Injection risk behaviors were uniformly associated with higher odds of enacted healthcare stigma, including sharing injection equipment at most recent injection (OR = 2.76; CI 1.55, 4.91), and lifetime receptive needle sharing (OR = 2.27; CI 1.42, 3.63). Enacted healthcare stigma partially mediated the relationship between having a stigmatizing health condition and engagement in high-risk injection behaviors. DiscussionRural PWID are vulnerable to stigma in healthcare settings, which contributes to high-risk injection behaviors for HIV. These findings have critical public health implications, including the importance of tailored interventions to decrease enacted stigma in care settings, and structural changes to expand the provision of healthcare services within SSP settings.

Strengthening community-based adaptation for urban transformation: managing flood risk in informal settlements in Cape Town

ABSTRACT Urban citizens increasingly need to adapt to climate risk. This is especially the case in informal settlements that have limited state engagement and are particularly vulnerable to climate change. Community-based adaptation (CBA) in the informal settlement has the potential to support the transformation that re-shapes power relations as well as reducing climate risk. This paper explores how multiscalar governance in Cape Town can either empower or undermine CBA to flooding in informal settlements. Drawing on urban political ecology, the analysis reveals significant tension around differing ideas of the temporality of informal settlements, as well as token community inclusivity in participatory planning processes. While everyday governance practices have been used by the City of Cape Town at the local scale, a local community-based organisation has used insurgent planning to envision and enact a more just city. A community designed and spear-headed reblocking process (rearranging shacks in a settlement to allow for flood drainage and service delivery) is a powerful example of CBA and represents the potential of community-based organisations to take steps towards transformative action. In order to enable more widespread urban transformative CBA, it is important to address the drivers of vulnerabilities and underlying power dynamics of political decision-making to destabilise the status quo and move towards real adaptation.

\u201cPrEP\u201ding for a PrEP demonstration project: understanding PrEP knowledge and attitudes among cisgender women

BackgroundPrior to implementing a pre-exposure prophylaxis (PrEP) demonstration study, we sought to explore cisgender women’s experiences with HIV prevention, PrEP knowledge and attitudes, and anticipated barriers and facilitators for PrEP uptake and adherence in Southern California.MethodsThree focus groups were held with cisgender women of mixed HIV serostatus in San Diego and Los Angeles between November 2015 and January 2016. Women were recruited through local testing sites, community-based organizations, and social media. Focus groups were audio-recorded and transcripts were analyzed using thematic analysis.ResultsTwenty-two women participated in focus groups, with median age 44 (IQR 30–53) and 6 identifying as non-Hispanic Black, 7 non-Hispanic White, 8 Latina and 1 mixed race. Despite limited prior PrEP knowledge and no PrEP experience, participants expressed interest in taking PrEP. Anticipated benefits were freedom from worry about HIV and control over sexual health; however, these were tempered by concerns including the possibility of increased HIV risk behaviors and potential side effects. Cisgender women reported potential barriers to PrEP uptake and adherence barriers, like competing priorities and poor PrEP access. Conversely, PrEP facilitators included utilizing practical tools such as phone apps and pill boxes as well as receiving encouragement from loved ones and support from other cisgender women on PrEP, women living with HIV and their medical providers.ConclusionsAlthough PrEP awareness was low, participants recognized the importance of PrEP and ways to facilitate adherence. Exploring perspectives of cisgender women is integral to developing effective interventions to support PrEP uptake and adherence for women at elevated risk for HIV.

Strategic value of interviewer training and local community-based organisations for WaSH and antibiotic resistance surveys

Abstract Water, sanitation, and hygiene (WaSH) research has long relied on household surveys to gather knowledge, attitudes, and practice (KAP) data with local enumerators or community correspondents (CCs). However, CCs must be trained to build capacity and ensure representative survey responses. Here, we use a case study in low-income, informal communities from New Delhi, India to assess the value of structured training for individuals who lead the gathering of KAP data (CC leaders, CCLs) on WaSH and antibiotic resistance. Feedback from CCLs showed that directed training increased their motivation, confidence, and technical competence and provided them skills that enhanced data collection. Training further strengthened relationships and empowered our local community-based organisation (CBO), expanding their role beyond being an implementing partner. Empowerment led to new insights, such as evident problems with communications between local doctors and community dwellers. Only three of 38 focus group attendees knew what an antibiotic was, apparently because they were never told. Overall, this work shows that interviewer training has many trickle-down benefits, improving the quality of data, building confidence in field teams, and empowering local CBOs, but most importantly, by increasing knowledge among community dwellers, such that they also might be empowered.

Bridge to Health/ Puente a la Salud: Rationale and design of a pilot feasibility randomized trial to address diabetes self-management and unmet basic needs among racial/ethnic minority and low-income patients

IntroductionRacial/ethnic and socioeconomic disparities in diabetes prevalence and management persist. Unmet basic needs such as food insecurity and unstable housing interfere with optimal diabetes self-management. Bridge to Health/Puente a la Salud is a randomized pilot trial designed to examine the feasibility of testing the effectiveness of addressing unmet basic needs via navigation services versus navigation plus diabetes self-management support (DSMS) on improving diabetes-related outcomes among racial/ethnic minority and low-income patients with uncontrolled diabetes. Material and methodsWe recruited and randomized 110 African American, Hispanic, and Medicaid patients (any race/ethnicity) with diabetes and recent hemoglobin A1C ≥ 8% to one of two 6-month interventions: 1) Navigation only; or 2) Navigation + DSMS. In both arms, practice-embedded patient navigators help participants navigate social services and community-based resources to address unmet basic needs. In Navigation + DSMS, participants are also assigned to a community health worker (CHW) embedded in a local community-based organization who provides additional navigation support and delivers DSMS. A1C and unmet basic needs data are collected via routine lab and survey, respectively, at baseline and 6-month follow-up. Qualitative interviews with participants, health system leaders, CHWs, and patient navigators are conducted to explore intervention acceptability and determinants of implementation in a health care setting. DiscussionFindings from this pilot feasibility study will enhance understanding about acceptability, preliminary clinical effectiveness, and facilitators and barriers to implementation of the Navigation only and Navigation + DSMS interventions and inform refinements of the overall study design for the larger, randomized clinical trial.

Ageing in Place in Disaster Prone Rural Coastal Communities: A Case Study of Tai O Village in Hong Kong

Rural coastal communities face unique disaster risks that will impact interventions throughout the disaster risk reduction (DRR) cycle (mitigation, preparedness, response, and recovery). At the same time, these communities are experiencing an ageing population. As climate change contributes to rising sea levels and an increase in the intensity and frequency of climate-related disasters, older populations living in rural coastal communities face heightened risks. This is a qualitative case study examining the ageing in place (AIP) experiences of older people living in a disaster-prone rural coastal community in Hong Kong—Tai O Village. Findings highlight that: (i) a critical dimension of AIP is their ability to sustain and continue their work, which played a multidimensional role, (ii) local community-based organizations play an instrumental role in providing social support in a disaster context, (iii) more support and resources for mitigation activities are needed, and (iv) while supports exist for AIP and in a disaster situation, the older residents may not utilize such supports. In addition to informing age-friendly DRR programmes and research, these findings inform AIP practices, policies, and research relevant to rural coastal communities.

Use of multiple recreational drugs is associated with new HIV infections among men who have sex with men in China: a multicenter cross-sectional survey

BackgroundThere is limited information about the types of recreational drugs used by men who have sex with men (MSM) in China or the consequent impact on sexual health and human immunodeficiency virus (HIV) acquisition.MethodsWe recruited MSM from seven cities in China between 2012 and 2013 using multiple approaches including advertisements on gay websites, collaborating with local MSM community-based organizations, peer referrals, and venues such as gay bars and bathrooms visited by MSM. We divided participants into four subgroups based on the number of recreational drugs (RDs) used in the previous 6 months. We defined use of multiple RDs as use of ≥2 types of RDs. Demographics and HIV-related high-risk behaviors were collected, and blood samples were tested for recent HIV infection by the HIV-1 subtypes B, E, and D immunoglobulin G capture enzyme immunoassay (BED-CEIA). We used multivariable logistic regression adjusted for sociodemographics to determine the adjusted odds ratios (aORs) and associated 95% confidence intervals (CIs) of the subgroups of RD use for recent or established HIV infection.ResultsA total of 4496 Chinese MSM participated; 28.4% used RDs, and 5% used multiple types of RDs. The prevalence of each RD use was as follows: poppers (25.9%), ecstasy (2.4%), ketamine (1.2%), amphetamine (0.6%), tramadol (0.4%), methamphetamine (3.8%), and codeine (1.9%). Users of multiple RDs commonly used poppers combined with one or more other types of RDs. Multiple RD users were likely to be aged 26–30 years (vs. 18–25 and > 30 years), live in non-local cities (vs. local cities), never married (vs. married), have a high monthly income (vs. no income and 1–599 USD), use versatile positions during anal intercourse (vs. top or bottom), and have inadequate HIV-related prevention knowledge (vs. adequate). As the number of RDs used in the previous 6 months increased, the prevalence of HIV-related high-risk behaviors increased (P < 0.05 for all). The odds of recent HIV infection were higher among those who used one type (aOR = 2.2, 95% CI: 1.5–3.0) or two types of RD (aOR=2.3, 95% CI: 1.0-5.2) in the previous 6 months compared to the odds among those who did not use RDs.ConclusionThe level and pattern of multiple RD use among Chinese MSM were different from high-income countries. MSM who used more RDs are more likely to engage in high-risk sexual behaviors, and these behaviors may be associated with increases in new HIV infections.

Determining readiness for a reablement approach to care in Australia: Development of a pre-employment questionnaire.

Reablement is described as a goal directed intervention with a view to maintain or improve the independence of clients through "doing with, rather than doing for". As a relatively new concept in care, lack of specific skills in reablement is not uncommon, however, intrinsic values aligned with reablement are beneficial to organisations providing care and support to clients. The aim of this study is to develop a pre-employment questionnaire to assess readiness for a reablement approach to care as a step towards developing a reablement culture across organisations. A questionnaire based on activities of daily living (ADL), developed by the research team in consultation with a local community-based care organisation, was completed by 166 staff members at a community-based care organisation in Tasmania across several timepoints during and following reablement education sessions in 2018. The scores from these questionnaires were utilised to develop a questionnaire appropriate for determining readiness for reablement prior to employment within the organisation. Over a period of twelve months, a total of 407 Reablement Readiness Questionnaires were submitted by staff, indicating high levels of willingness to engage in reablement prior to and following the education sessions. Exploratory factor analyses were performed, and the construct validity and internal consistency of the emerging factors were assessed. An exploratory factor analysis indicated that ADL, in relation to reablement, consist of three dimensions-Lifestyle, My body and Connecting. The corresponding questions were subsequently built into an online questionnaire for pre-employment use. This questionnaire also has potential benefit in recruitment of staff to other community service organisations, to ascertain their readiness for reablement prior to beginning a variety of different roles within client care and support.

Methodology for linking Ryan White HIV/AIDS Program Services Report (RSR) client level data over multiple years.

BackgroundThe Health Resources and Services Administration’s (HRSA), HIV/AIDS Bureau (HAB) is responsible for leading the nation’s efforts to provide health care, medications, and support services to low-income people living with HIV through the Ryan White HIV/AIDS Program (RWHAP). The RWHAP funds and coordinates with cities, states, and local community-based organizations to deliver efficient and effective HIV care, treatment, and support services for over half a million vulnerable people living with HIV (PLWH) and their families in the United States. The annual RWHAP Services Report (RSR) is an important source of information for monitoring RWHAP’s progress towards National HIV/AIDS Strategy goals. Since 2010, HRSA HAB has used the annual client-level RSR data to monitor program-related outcomes, conduct program evaluations, understand service provision, and conduct extensive analysis on disparities in viral suppression and retention in HIV care. HRSA HAB receives annual RSR submissions from RWHAP recipients and sub-recipients. However, the de-identified nature of the data limits HRSA HAB’s ability to expand beyond year-to-year analyses and conduct additional analyses to evaluate outcomes for clients who are seen in multiple years. The current paper describes the development and validation of a method to link RSR client-level records across multiple data years.Methods and findingsUsing seven RSR reporting years of data (2010 to 2016), we applied a Fellegi-Sunter (F-S) linkage model that used client demographic characteristics and their providers’ geographic locations to calculate matching weights for each record pair based on estimated agreement and disagreement conditional probabilities across RSR years. To validate our methodology, we conducted an internal sample review and external validation to assess the level of accuracy of the linkage, and the extent to which the linked data set corresponds accurately to clinical records of individual clients. The linkage result yielded 70 to 80 percent year-to-year client carry-over rate over seven years of the RSR data; 96 percent linkage ratio from the internal sample review and 79.9 to 94.2 percent of provider network client carry- over rate per year from the external validation.ConclusionsThis methodology addresses a gap in data analysis capabilities by allowing HRSA HAB to link RWHAP clients across reporting years. Despite weak identifying information and lack of continuity of service reporting, the longitudinal linkage improves HRSA HAB’s ability to evaluate the patterns of viral suppression and monitor service utilization over time for individuals who receive services in multiple years. These analyses will support future analytic activities in understanding the impact and outcomes of the RWHAP, and will assist HRSA HAB in monitoring progress toward meeting National HIV/AIDS Strategy goals. For those looking for ways to assess health services data, the F-S unsupervised method combining weak identifying attributes and geographic proximity offers practical solutions to the problem of linking de-identified information about individuals across multiple years and improving longitudinal research.

#BlackBreastsMatter: Process Evaluation of Recruitment and Engagement of Pregnant African American Women for a Social Media Intervention Study to Increase Breastfeeding.

BackgroundIn the United States, there are lower rates of breastfeeding among African American mothers, particularly those who are younger women. Recent epidemiological studies have shown a strong association of more aggressive types of breast cancer (estrogen receptor negative) among African American women, with a higher risk in African American women who did not breastfeed their children.ObjectiveThis study aims to describe the process evaluation of recruitment and educational strategies to engage pregnant African American participants for a pilot study designed to determine whether social media messaging about breast cancer risk reduction through breastfeeding may positively influence breastfeeding rates.MethodsThis pilot study is conducted in collaboration with a local Women, Infants, and Children (WIC) organization and hospital and prenatal clinics of a local health care network. To engage African American women to enroll in the study, several methods and monitoring processes were explored, including WIC electronic text-based messages sent out to all phones of current WIC recipients (referred to as e-blasts); keyword responses to texts from flyers and posters in local community-based organizations, hospitals, and prenatal clinics; keyword responses using electronic links posted in established Facebook groups; and snowball recruitment of other pregnant women by current participants through Facebook. Once enrolled, participants were randomized to 2 study conditions: (1) an intervention group receiving messages about breast cancer risk reduction and breastfeeding or (2) a control group receiving breastfeeding-only messages. Data were obtained through electronic monitoring, SurveyMonkey, qualitative responses on Facebook, focus groups, and interviews.ResultsMore than 3000 text messages were sent and received through WIC e-blasts and keyword responses from flyers. A total of 472 women were recruited through WIC e-blast, and 161 responded to flyers and contacts through the local health care network, community-based organizations, Facebook, and friend referrals. A total of 633 women were assessed for eligibility to participate in the study. A total of 288 pregnant African American women were enrolled, consented, and completed presurvey assessments (102.8% of the goal), and 22 participants attended focus groups or interviews reporting on their experiences with Facebook and the educational messages.ConclusionsThis process evaluation suggests that using electronic, smartphone apps with social media holds promise for both recruitment and conduct of health education intervention studies for pregnant African American women. Providing messaging and resources through social media to reinforce and educate women about breastfeeding and potentially provide lactation support is intriguing. Convenience (for researchers and participants) is an attribute of social media for this demographic of women and worthy of further research as an educational tool.Trial RegistrationClinicalTrials.gov NCT03680235; https://clinicaltrials.gov/ct2/show/NCT03680235

Perceptions and Barriers to SNAP Utilization Among Asian and Pacific Islanders in Greater Los Angeles.

To examine the perceptions of and barriers to Supplemental Nutrition Assistance Program (SNAP) participation among Asian and Pacific Islander (API) immigrants. Qualitative focus groups were conducted in 4 API communities. Participants were recruited from 4 API communities (n = 68; 22 Tongan, 18 Vietnamese, 16 Filipino, and 12 Chinese) through local community-based organizations in Los Angeles and Orange Counties. Trained bilingual and bicultural researchers conducted 8 focus groups in English, Chinese, and Vietnamese. Prior to the start of each focus group, participants completed a demographic questionnaire which included a United States Department of Agriculture (USDA) Food Security Module. Audio recordings were transcribed verbatim and those in the native languages were transcribed verbatim. Transcripts in native languages were reviewed and translated into English. All transcripts were organized in ATLAS ti version 8.0 and analyzed using thematic analysis. The USDA Food Security Module results were scored and assessed for food insecurity. Median age of participants was 58 years and 59.4% (n = 38) were food insecure. Barriers to SNAP participation were identified and organized within the Social Ecological Model by the following themes: (1) unclear program information, (2) application process, (3) shame, and (4) pride. Despite commonalities found across API subgroups, unique challenges with public charge and immigration existed within the subgroups. Culturally relevant in-language SNAP materials and multilevel interventions are needed to mitigate barriers and increase SNAP participation rates among low-income API groups.

Incorporating a Required Student Research Experience into a Terminal MS Nutrition Program

Abstract Objectives Research experiences for graduate students in MS nutrition programs are often optional due to limited faculty, physical, and fiscal resources. Thus, the objective of this work was to develop a protocol for instituting a required, rather than optional, research experience in a terminal MS nutrition program in a large, urban public college with high academic standards. Methods Faculty specified several options for fulfilling the required capstone research experience: original research, grant proposal, or systematic review of literature. Students determined area of interest and identified a qualified research mentor either inside or outside the program (spring 2019). Students prepared research proposals according to specific guidelines; and students met with a faculty coordinator in periodic group sessions to establish expectations for preparing Literature Review, Methods, and Results sections of eventual final paper (fall 2019). Students submitted required progress reports throughout to facilitate accountability. Students enrolled in a seminar-style course, with two members of faculty, which provided mentoring to refine drafts and culminated in oral presentations to share results (spring 2020). Lastly, students submitted final papers in spring semester to assure timely graduation. Results All students in the MS nutrition programs anticipating June 2020 graduation enrolled in the required capstone research experience (n = 27). The majority of students engaged in original research with fewer opting for preparation of a grant proposal or a systematic review. The majority were mentored by program faculty whereas others were mentored by researchers in the broader nutrition community, namely in local medical centers and large community-based organizations. Course grades for the research experience were determined as follows: proposal, 10%; progress reports, 15%; oral presentation, 10%; and final paper, 65%. Conclusions A required research experience undoubtedly elevates the academic acumen of graduate students and potentially supports faculty research. Furthermore, identifying qualified research mentors outside the program augments available faculty resources and research opportunities for students. Funding Sources None

It Takes a Village: Understanding African American High School Students’ Self-Determination in School

The present study examined African American high school students’ perceptions of their development and use of self-determination skills (e.g., goal setting, choice/decision making, self-advocacy, etc.) in school. The term development refers to the cultivation of self-determination skills through various means (e.g., structured learning opportunities), and the term use refers to students actually employing the skills in school and other settings across time. We conducted four focus group interviews with a predominately African American female sample to examine (a) how various self-determination skills contributed to their success in school and (b) how they developed these skills through community-based support. Key findings indicate that the participants perceived their use of multiple self-determination skills as facilitating their success in school by helping them (a) be independent, (b) remain motivated in school, (c) prioritize their time, and (d) receive support from classroom teachers. Through their involvement in community-based programs, the participants developed the skills through hands-on activities, group discussions, field trips (e.g., college visits), and interacting with peers in their community organization. Findings from this research support calls for educators to promote African American students’ self-determination while taking a culturally responsive approach by collaborating with local community-based organizations that were developed to support these students.

PrEP Awareness Among MSM in Cameroon: An Exploratory Study

Despite the high risk of HIV in men who have sex with other men (MSM) in Cameroon, with an infection prevalence of 37.2%, socio demographic data on this population are very scarce. This study provides the first report on Pre Exposure Prophylaxis (PrEP) in Cameroon. It was conducted online in two of the country’s major cities - Yaounde and Douala - with the aim of exploring MSM level of awareness and understanding of PrEP. The study’s statistical analysis focused on factors associated with PrEP awareness. Descriptive data on understanding of PrEP was also collected. With a mean age of 27 years of age, almost half of the sample ( n =364) had at least a high-school diploma (46%), yet 54% were unemployed. Sixty-percent had had more than two sexual partners during the six months preceding the survey, and more than half of the sample reported a recent HIV test. Only 30% ( n =107) were aware of PrEP. Awareness was associated with education level (reference: high-school diploma OR=1.725, 95%, CI 1.036-2.873), knowledge of antiretroviral therapies (OR= 4.557 [2.388-8.699]) and a HIV test in the previous six months (OR=9.484[2.743-32.790]). Our study revealed that local community-based organisations (33%), online media (23%) and peers (17%) are the major sources of information on PrEP in Cameroon. Among those who are aware of PrEP, confusion remains between PrEP and Post-Exposure Prophylaxis despite a relatively good understanding of the basic principle of PrEP. Findings suggest that it is important to acknowledge and consider PrEP as part of a combined HIV prevention strategy for MSM, through local community-based interventions, digital campaigns and training of healthcare workers on MSM health issues. Funding Statement: SIDACTION Paris. Financement Jeunes ChercheurEs 2016-2018. Declaration of Interests: There is no conflict of interest with the present research paper. Ethics Approval Statement: The protocol for the research project received approval from the National Ethics Committee of Cameroon, and administrative research authorisation from the Cameroonian Ministry of Public Health.

Leveraging Population Health Expertise to Enhance Community Benefit.

As the Internal Revenue Service strengthens the public health focus of community benefit regulations, and many states do the same with their tax codes, hospitals are being asked to look beyond patients in their delivery system to understand and address the needs of geographic areas. With the opportunities this affords come challenges to be addressed. The regulations' focus on population health is not limited to a defined clinical population—and the resulting emphasis on upstream determinants of health and community engagement is unfamiliar territory for many healthcare systems. At the same time, for many community residents and community-based organizations, large medical institutions can feel complicated to engage with or unwelcoming. And for neighborhoods that have experienced chronic underinvestment in upstream determinants of health—such as social services, housing and education—funds made available by hospitals through their community health improvement activities may seem insufficient and unreliable. Despite these regulatory requirements, many hospitals, focused as they are on managing patients in their delivery system, have not yet invested significantly in community health improvement. Moreover, although there are important exceptions, community health improvement projects have often lacked a strong evidence base, and true health system-community collaborations are relatively uncommon. This article describes how a large academic medical center tapped into the expertise of its population health research faculty to partner with local community-based organizations to oversee the community health needs assessment and to design, implement and evaluate a set of geographically based community-engaged health improvement projects. The resulting program offers a paradigm for health system investment in area-wide population health improvement.

Increasing the Literacy Knowledge of Teacher Candidates: Why Service-Learning Matters

Educator preparation programs seek to provide teacher candidates with authentic learning experiences that support the learning process, and one means is to engage teacher candidates in service-learning. Elementary schools are tasked with improving the literacy outcomes of struggling readers, and community-based programs focused on literacy, seek to improve the literacy achievement of its’ citizens. This work explores how an educator preparation program collaborated with a community-based organization to provide elementary, struggling readers with 1:1 literacy instruction via teacher candidates from the local university. The aim is to showcase the process, procedures, and benefits of universities partnering with local PK-12 schools and community-based organizations.

Play Captains on Play Streets: A Community-University Playful Learning and Teen Leadership Collaboration

Playful Learning Landscapes (PLL) merges playful learning pedagogy with community spaces to create playful learning opportunities for children, families, and communities. Prior PLL projects have demonstrated effectiveness in enhancing social interaction between children and caregivers by creating opportunities for social interaction derived from the learning sciences literature. In the present case study, a university-based team of PLL researchers partnered with a local community-based organization (CBO) that provides educational, skill building, and job training opportunities for teens in low-income neighborhoods. PLL provided consultation and training to transform the CBO’s Play Captains program into a Playful Learning program where local teenagers led playful learning activities for children on city streets (Play Streets) that were closed to vehicular traffic by Philadelphia’s Parks and Rec department. The teen Play Captains also conducted research observations of children on streets and completed surveys that assessed their own personal growth as a result of their experiences as Play Captains. Results suggest considerable social interaction and use of learning language among children on the Play Streets where Play Captains ran playful learning activities and significant increases in Play Captains’ self-confidence and understanding the benefits of playful learning. We discuss key lessons learned that can help to inform future university-community playful learning collaborations.

Building a Culture of Health at the Neighborhood Level Through Governance Councils

To explore facilitators and barriers to developing and sustaining collaboration among New York City Department of Health and Mental Hygiene’s Neighborhood Health Action Centers and co-located partners, who share information and decision-making through a Governance Council structure of representative members. Semi-structured interviews were conducted in 2018 with 43 Governance Council members across the three Action Centers of East Harlem (13), Tremont (15), and Brownsville (15), New York City. Governance Council members identified collaboration through information- and resource-sharing, consistent meetings and continuous communication as valuable for fostering a culture of health in their communities. Immediate benefits included building relationships, increased access to resources, and increased reach and access to community members. Challenges included difficulty building community trust, insufficient advertisement of services, and navigation of government bureaucracy. The Governance Councils forged collaborative relationships among local government, community-based organizations and clinical providers to improve health and well-being in their neighborhoods. Sharing space, resources and information is feasible with a movement towards shared leadership and decision-making. This may result in community-driven and tailored solutions to historical inequities. In shared leadership models, some internal reform by Government partners may be required.