Subsidized Housing Communities Research Articles

"I make myself get busy": Resilience and social connection among low-income older adults living in subsidized housing.

Social isolation and loneliness are pervasive issues among older adults in the United States, carrying significant health risks. Low-income older adults are particularly vulnerable to these challenges compared with their higher-income counterparts due to their limited access to resources and social networks. Many low-income older adults live in subsidized housing, which has the potential to offer unique support tailored to their needs. The intersection of aging and the unique social circumstances faced by low-income older adults significantly influences how they navigate crises. We conducted semi-structured interviews with 24 older adults aged 63-86 residing in subsidized housing communities in the United States. The data were collected from August 2021 to November 2022 and subsequently analyzed using a thematic constant comparison analysis approach. Many participants felt connected to their housing community. Participants reported that their lives changed substantially due to the pandemic: communal activities ceased leading to isolation and feelings of loneliness. Amid this challenge, participants were resourceful and found creative ways to manage. Many emphasized the crucial role of technology in maintaining emotional support despite physical separation. Participants in subsidized housing shared their experiences before and during this unique crisis highlighting the challenges they face, as well as their resilience and adaptability when facing challenges. Our findings underscore the significance of community activation, demonstrating that activities motivated older adults to improve their well-being. Additionally, the role of technology in maintaining connections proved to be crucial.

ADVANCING POSITIVE SOCIAL CONNECTIONS FOR OLDER ADULTS IN SUBSIDIZED HOUSING: A HUMAN-CENTERED DESIGN APPROACH

Abstract Social isolation is a complex problem that impacts many community-dwelling older adults and has detrimental impacts on mental and physical wellbeing of older adults. This research aims to utilize Human-Centered Design (HCD) to develop and implement tools and design ideas that advance positive social connections of older adults residing in subsidized housing. HCD is a collaborative process used to understand and define social problems, identify opportunities, generate ideas, and design interventions to support positive change. We sought to capture the perspectives and insights from older adults living in two federally subsidized housing communities in Baltimore, Maryland. During a five-month period, we held listening and brainstorming sessions with over 50 residents, service coordinators and members of management. Valuable insights and ideas were recorded during each of these facilitated engagements and synthesized. Through our engagements we identified six themes that influence the social connections of older adults living in subsidized housing: feelings of exclusion, lack of community connections, burdensome transitions to communal living, changes to building policies, and concerns about the physical environment. These themes led to the creation of interventions such as providing physical materials to residents, facilitating cultural inclusion and connections, implementing effective engagement strategies for community coordinators and promoting resident leadership. HCD can be employed to develop tools and innovative opportunities that specifically target and address social isolation in older adults living in subsidized housing. HCD can be utilized to drive changes to policies that impact older adults in subsidized housing leading to social transformations to improve health.

“Our Voice and Dreams Matter”: Supporting Youths’ Racial Literacy

This qualitative study examines how youth participants in an ongoing community-based literacy initiative sought to increase awareness of racial justice among residents of their subsidized housing community in support of the Black Lives Matter movement in summer 2020 and throughout the 2020–2021 academic year. We utilize theories of racial literacy and critical arts-based literacy to examine youths’ engagement in 44 weekly two-hour-long Zoom sessions of the literacy initiative held between June 2020 and June 2021. Specifically, we examine how youths designed, facilitated, and participated in critical arts-based literacy projects related to children's and young adult literature they chose to read focused on racial justice. Findings contribute new insights into youths’ enactments of racial literacy, possibilities for art-making to support youths’ racial literacy, and the urgent need for literacy instruction responsive to youths’ voices and dreams, particularly during times of crisis.

SOCIAL CONNECTIONS AND HEALTH AMONG OLDER ADULTS LIVING IN SUBSIDIZED HOUSING: LOCAL STAKEHOLDERS PERSPECTIVES

Abstract Social isolation among older adults living in the United States is a major public health problem that disproportionately affects those living below the poverty line. Though decades of epidemiological studies have provided important insights on the impact of social isolation on health, there have been limited qualitative studies on the dynamics of social connections among older adults in subsidized housing. This study aims to advance our understanding of the perspectives of local stakeholders in the field of subsidized housing on the social connections of older adults and how to enhance social connection. Semi-structured interviews were conducted between July 2021 and October 2021 with local stakeholders in Baltimore’s subsidized housing community to better understand social connections among older adults. Stakeholders included, but were not limited to, the following positions: service coordinators, property managers, maintenance staff, and security guards. Interviews were imported and analyzed using NVIVO12 software and a qualitative content analytic approach. Preliminary themes identified included: barriers and facilitators of connection, engagement with family, and ideas about interventions. Mental and physical health challenges, access to and use of communications technology, and lack of transportation were barriers while food incentives, gift card giveaways, and resident champions were facilitators of social connection. Social isolation among older adults is an important concern among stakeholders in subsidized housing. To promote social connection in older adults, interventions must adopt a multi-pronged approach that addresses the barriers and leverage existing facilitators within subsidized housing communities.

Using Smart Speaker Technology for Health and Well-being in an Older Adult Population: Pre-Post Feasibility Study.

BackgroundAlthough smart speaker technology is poised to help improve the health and well-being of older adults by offering services such as music, medication reminders, and connection to others, more research is needed to determine how older adults from lower socioeconomic position (SEP) accept and use this technology.ObjectiveThis study aimed to investigate the feasibility of using smart speakers to improve the health and well-being of low-SEP older adults.MethodsA total of 39 adults aged between 65 and 85 years who lived in a subsidized housing community were recruited to participate in a 3-month study. The participants had a smart speaker at their home and were given a brief orientation on its use. Over the course of the study, participants were given weekly check-in calls to help assist with any problems and newsletters with tips on how to use the speaker. Participants received a pretest and posttest to gauge comfort with technology, well-being, and perceptions and use of the speaker. The study staff also maintained detailed process notes of interactions with the participants over the course of the study, including a log of all issues reported.ResultsAt the end of the study period, 38% (15/39) of the participants indicated using the speaker daily, and 38% (15/39) of the participants reported using it several times per week. In addition, 72% (28/39) of the participants indicated that they wanted to continue using the speaker after the end of the study. Most participants (24/39, 62%) indicated that the speaker was useful, and approximately half of the participants felt that the speaker gave them another voice to talk to (19/39, 49%) and connected them with the outside world (18/39, 46%). Although common uses were using the speaker for weather, music, and news, fewer participants reported using it for health-related questions. Despite the initial challenges participants experienced with framing questions to the speaker, additional explanations by the study staff addressed these issues in the early weeks of the study.ConclusionsThe results of this study indicate that there is promise for smart speaker technology for low-SEP older adults, particularly to connect them to music, news, and reminders. Future studies will need to provide more upfront training on query formation as well as develop and promote more specific options for older adults, particularly in the area of health and well-being.

Resources Within: Between Resident Ties and Links to Health Among Older Subsidized Housing Residents

Increasing evidence points to the importance of non-family ties in promoting health among older adults. Less is known though about these ties within the context of subsidized housing. In this study we examine prevalence of social ties between residents and examine links to health. Data were collected through interviews conducted with 39 residents age 62 and older living in a subsidized housing community in Southeast Michigan. Residents reported knowing on average 10 (SD=6.5) other residents, and nominated three (SD=4.2) residents into their close social networks. Residents who reported getting out of the community less often and those with one or more health limitations nominated significantly more residents into their network. Also, getting out of one’s apartment more often was associated with knowing more residents in the community. Findings highlight between resident ties may serve as an important resource for those geographically restricted and may be useful to integrate into interventions.

Leisure Barriers Among Older Adults in Low-Income Housing: Demographic, Health, and Contextual Correlates

Despite increased research pertaining to the physical, cognitive, and psychosocial benefits of leisure engagement, few studies have explored leisure barriers experienced by older adults residing in subsidized housing, and how these barriers relate to sociodemographic, health, and psychosocial characteristics. Thirty-nine Black and White residents (M=68.01, SD=10.26) from two subsidized housing communities (Wilmington, NC and State College, PA) were surveyed as part of the Tailoring Environments for Active Life Engagement study. Findings indicated that lack of available activities and low awareness of activities, limited social connections, and transportation were the most common barriers identified. Additionally, individuals with lesser years of education and poorer quality of education, worse mental and physical health, poorer cognitive function, as well as those experiencing loneliness and social isolation reported significantly more leisure barriers (ps <.05). More research is needed that examines micro-, meso-, and macro-level factors associated with leisure participation for older low-income housing residents.

Improving parent-child relationships: Effects of the Your Family, Your Neighborhood intervention

Your Family, Your Neighborhood (YFYN) was developed to strengthen parent-child relationships among families living in low-income and subsidized housing communities, using a dual-generation approach. Few, if any, family-based interventions with a primary focus of enhancing parent-child relationships target parents and their children between the ages of seven to 12 years living in subsidized housing communities. This study aimed to fill this gap and examine the effects of the YFYN intervention on parent-child relationships. This mixed-methods study was conducted in three low-income neighborhoods, in a city in the western United States. Intention-to-treat (ITT) analysis was conducted on the entire quasi-experimental sample (N = 101) and a repeated measures ANOVA was conducted on the per protocol sample (N = 70). ITT analysis indicated no significant group by time differences. However, results of the two-way ANOVA on the per protocol sample revealed a significant group by time effect, with treatment families demonstrating improvements in the parent-child relationship from pre-assessment to post-assessment compared to the control group. Focus groups were conducted with parent participants in the treatment group, in which they indicated their parent-child relationships improved after participating in YFYN, including feeling closer to their children, improving communication, spending more time together, and eating dinner together as a family more often. This study offers preliminary findings regarding the effects of the YFYN intervention on the parent-child relationship for families living in low-income and subsidized housing communities. Future directions for family-based and neighborhood interventions are discussed.

Centering community: enacting culturally responsive-sustaining YPAR during COVID-19

PurposeThis paper aims to provide insights for educators seeking to enact culturally responsive-sustaining education and research in the midst of the COVID-19 global pandemic. The authors examine what happened when the community-based Youth Participatory Action Research (YPAR) initiative they engaged with traditionally marginalized high school students was interrupted as a result of physical distancing necessitated by COVID-19.Design/methodology/approachData for this inquiry were taken from a broader on-going ethnography of youth’s participation in the YPAR project and included audio and video recordings from meetings of the YPAR initiative and messages exchanged between and among authors and youth. Authors used components of culturally responsive-sustaining education and theories related to student voice as an analytic frame through which they considered how the COVID-19 pandemic influenced their work.FindingsThree findings are examined in this paper. They consider: how youth participants and the authors stayed connected after they were no longer able to meet in person; how youth chose to center the needs of the subsidized housing community where they lived while continuing their work; and how youth and authors navigated the uncertainties they encountered in looking ahead to future possibilities for their study as the pandemic continued.Originality/valueThis study provides urgently needed insights for educators and researchers grappling with how they may enact culturally responsive-sustaining education and research during the COVID-19 global pandemic and beyond.

Seattle’s Yesler Terrace Redevelopment: Assessing the Impact of Multisector Strategies on Redevelopment Plans and Community Health

ABSTRACTThere is growing evidence supporting comprehensive community development efforts that focus on multiple determinants of well-being. Yet evaluation has been limited by a lack of longitudinal studies, difficulty tracking displaced residents, and limited data on diverse cultural communities. The Yesler Terrace Redevelopment Project analyzes longitudinal and repeated cross-sectional data to evaluate the impact of redevelopment on a low-income, ethnically diverse cohort of residents in Yesler Terrace. Yesler Terrace is a 30-acre publicly subsidized housing community in downtown Seattle, Washington, owned and operated by the Seattle Housing Authority. To evaluate the redevelopment strategies and related programs on resident well-being, we are examining multiple sources of data, linking housing and healthcare data, and collecting contextual data about residents’ experiences. Here we describe the participating agencies and residents, study objectives and methods, and preliminary results. Early study results include shifts in resident demographics, health outcomes, and community social cohesion and perception of safety measures.

Examining neighborhood and interpersonal norms and social support on fruit and vegetable intake in low-income communities

BackgroundWe examined whether neighborhood-, friend-, and family- norms and social support for consumption and purchase of fruits and vegetables (F&V) were associated with F&V intake among low-income residents in subsidized housing communities. We examined baseline data from a study ancillary to the Live Well/Viva Bien intervention. Participants included 290 residents in four low-income subsidized housing sites who were ≥ 18 years of age, English and/or Spanish speaking, and without medical conditions that prevented consumption of F&V.MethodsLinear regression models examined associations of norms and social support with F&V intake after adjustments for sociodemographic characteristics.ResultsIn the analysis, neighborhood social support for F&V was associated with a 0.31 cup increase in F&V intake (95% CI = 0.05, 0.57). The family norm for eating F&V and family social support for eating F&V were associated with a 0.32 cup (95% CI = 0.13, 0.52) and 0.42 cup (95% CI = 0.19, 0.64) increase in F&V intake, respectively.ConclusionsTo our knowledge, no other studies have examined neighborhood, family, and peer norms and social support simultaneously and in relation to F&V intake. These findings may inform neighborhood interventions and community-level policies to reduce neighborhood disparities in F&V consumption.

Barriers and facilitators to healthy eating and disease self-management among older adults residing in subsidized housing.

As adults transition into older ages, meeting age-specific dietary recommendations can become increasingly challenging, especially for low-income seniors who reside in publicly subsidized rental housing. The primary objectives of this study were to: 1) identify barriers and facilitators to healthy eating and self-management of nutrition-related chronic illnesses experienced by low-income seniors residing in a subsidized housing setting; and 2) assess the interest in community nutrition programming among low-income seniors residing in a subsidized housing setting. A qualitative study design, using food focus groups and food pantry observations, was used. Participants included 24 male and female senior adults, between 65 and 75 years of age, residing in a subsidized housing community in Philadelphia, PA. This setting also included the unique features of a community garden and food pantry. Data were manually analyzed using a content analysis approach, which included familiarization, identification of themes, categorization and interpretation; and verified using NVivo 10. Personal barriers, including food cost and accessibility, physical limitations, desire for convenience, and low self-efficacy to change dietary habits, inhibited motivation to change. External barriers in the food environment, including lack of transportation and distance of markets to access fresh produce, were commonly cited; as well as negative influences of the internal environment, such as the presence of vending machines, common cultural cooking and eating practices, and the lack of social cohesion. Facilitators focused on food preparation and recipe adaptation. Participants expressed an interest in learning more about food, nutrition, and health through community-based programming.

A Qualitative Examination of Health Barriers and Facilitators Among African American Mothers in a Subsidized Housing Community.

Although African American families are at particular risk for obesity and its associated health comorbidities, few interventions have directly targeted low-income members of this group living in subsidized public housing. Using a consensual qualitative research approach, we conducted 11 interviews with African American mothers living in two public housing communities to enhance understanding of their perceived barriers and facilitators to health. Five primary domains emerged, including barriers (access, financial, personal, and neighborhood concerns), resources (personal and community), current behaviors (diet, physical activity, and program participation), definition of health (mental well-being, physical well-being, and health behaviors), and needs/interests in programming (health behavior-specific programs, non-health-related programs, child-focused programming, and qualities of programs and their leaders). Results demonstrate the complex interaction among social, environmental, and personal factors on health behaviors for this priority population, and highlight the need for community members' involvement in the development of community-based obesity prevention programming.

Vision Impairment Among Older Adults Residing in Subsidized Housing Communities.

To examine the rate of vision impairment and the relationship between vision impairment, cognitive impairment, and chronic comorbid conditions in residents of federally subsidized senior housing facilities. Cross-sectional, observational study. Vision screening events were held at 14 subsidized senior housing facilities in Jefferson County, Alabama for residents aged 60 years and older. Visual function (distance vision, near vision, and contrast sensitivity) measured with habitual correction if worn, cognitive status, and chronic comorbid conditions (hypertension, heart problems, circulation problems, and diabetes) were assessed. A total of 238 residents participated in the vision screenings. Most residents (75%) were African American. Vision impairment was common, with 40% of participants failing the distance acuity screening and 58% failing the near acuity screening; failure was defined as vision worse than 20/40 in either eye. Additionally, 65% failed the contrast sensitivity screening. A total of 30.6% of seniors had cognitive impairment. Regarding comorbid chronic conditions, 31% had circulation problems, 39% had diabetes, 41% had heart problems, and 76% had hypertension (59% had 2 or more of these). Visual acuity differed significantly between cognitive status groups and with the presence of heart and circulation problems. This study is among the first to provide information about vision impairment in this socioeconomically disadvantaged group of older adults. Vision impairment was common. Cognitive impairment and comorbid chronic conditions accounted for a small to moderate percentage of the variance in distance vision, near vision, and contrast sensitivity. Future studies should focus on strategies to facilitate access to eye care in this vulnerable population.

The National Hartford Center of Gerontological Nursing Excellence: An Evolution of a Nursing Initiative to Improve Care of Older Adults.

The mission of the John A. Hartford Foundation is to improve the health of older Americans. This mission has been realized throughout the evolution of the National Hartford Center of Gerontological Nursing Excellence-an international collaboration between Schools of Nursing and Sigma Theta Tau International Honor Society of Nursing-whose goal is to support research, education, and practice to provide better nursing care for our aging society. The National Hartford Center is the focus of this supplement and an example of the Foundation's grant-making to prepare the nursing workforce to be competent to care for our aging society. This article traces the innovative origin and inception of the National Hartford Center, first as the Building Academic Geriatric Nursing Capacity (BAGNC) Initiative in 2000 under the leadership of two groundbreaking scholars in nursing and aging sciences: Claire M. Fagin, PhD, RN, and Patricia G. Archbold, DNSc. We continue through to today's leadership and culminate by describing the Center's influence on the gerontological nursing workforce and clinical practice; the paper also includes a brief introduction to the articles, highlighting advances in gerontological nursing science. With funding from the John A. Hartford Foundation, The Atlantic Philanthropies, The Mayday Fund, and a number of creative public and nonprofit partnerships, the National Hartford Center celebrates two decades and its greatest asset-the nearly 300 gerontological nursing leaders, including Archbold nursing pre-docs, Fagin nursing post-docs, and expert faculty, along with its Hartford Centers of Gerontological Nursing Excellence across the country. We trace the transition of BAGNC to the membership-based National Hartford Center and its move to The Gerontological Society of America to become a self-sustaining, autonomous unit. Current needs, challenges, lessons learned, and strategies of the National Hartford Center are examined within the context of sustainability, which has become paramount as Hartford Foundation funding ends in 2016. Despite the auspicious beginnings of the National Hartford Center, system change has been slow. There remains a strong need to continue to grow the field of gerontological nursing and aging sciences. We are working diligently to drive health system reform, and develop and support gerontological nursing leaders and members of the National Hartford Center as exemplars for innovation in care of older adults. The contributing authors of this supplement are from member schools of the National Hartford Center or are current or past program Scholars or Fellows. Herein these authors showcase innovation for older adults through their research that addresses an array of diseases and conditions affecting human systems, embedded in a variety of environments, including in-home care, subsidized housing communities, nursing homes, assisted living facilities, memory care units, and rural community environs.

Housing conditions, sanitation status and associated health risks in selected subsidized low-cost housing settlements in Cape Town, South Africa

This paper provides an assessment on the structural living conditions of selected government-subsidized low-cost housing settlements in the City of Cape Town and the associated health conditions of the inhabitants. Almost all of these houses have one or more informal dwellings in the backyard. Four subsidized housing communities were selected within the City of Cape Town in this cross sectional survey. Structured interviews were administered in 336 dwellings on 173 plots. Data was obtained from 1080 persons with a response rate of 100%. The vast majority of the main houses had two (38%) or three (48%) structural problems and 99% of the home owners could not afford repairs to the home. The integrity of the walls of the dwelling structure was problematic, showing large visible cracks. None of the walls were plastered causing rainwater to penetrate during rainstorms. During an inspection of the sanitation facilities in the home, 58% of toilets were non-operational, 66% of the bathrooms did not have toilet paper but had a supply of old newspaper instead, while 82% of the bathrooms did not have soap available to wash hands. At present the design of these low-cost housing schemes contribute to an increased risk of communicable diseases, rather than an improvement. The recipients of these houses were previously disadvantaged and their sanitation behaviour is inter alia shaped by the amenities at their disposal. The designers of low-cost houses should take serious note of the pathways of disease created by the provision and layout of sanitation-associated structures. The design of low-cost housing should not force the inhabitants of such houses into unsafe habits because of poor provision or poor layout of basic amenities.

Racial differences in colorectal cancer screening practices and knowledge within a low-income population.

Although colorectal cancer (CRC) is the third leading cause of cancer death among US women and is particularly deadly among African Americans, CRC screening rates remain low. Within a low-income population of women, the authors examined racial differences in practices, knowledge, and barriers related to CRC screening. Face-to-face interviews were conducted with 941 women (white, n= 186; African American, n= 755) older than age 50 years who were living in subsidized housing communities in 11 cities in North and South Carolina. Women were asked questions about their CRC screening history and their knowledge and beliefs concerning CRC screening. Half (49%) of the women interviewed were within CRC screening guidelines, and this did not vary by race (P= .17). However, African American women were half as likely as white women to report having had a screening colonoscopy within the past 10 years (odds ratio [OR], 0.46; P< .001). Awareness of tests for CRC was low overall (39%) and was lower among African Americans than whites (OR, 0.44; P< .001). Compared with white women, African American women were less likely to report embarrassment as a barrier (OR, 0.59; P= .008) and more likely to report lack of insurance coverage (OR, 1.75; P= .098). Efforts must continue to increase women's knowledge of both CRC screening tests and colon cancer risk factors. Among these low-income women, routine encounters with the healthcare system may present opportunities to reduce deficits in CRC knowledge and to improve overall CRC screening rates.

Improving colorectal cancer screening by using community volunteers

The goal of the Carolinas Cancer Education and Screening (CARES) Project was to improve colorectal cancer (CRC) screening among low-income women in subsidized housing communities in 11 cities in North and South Carolina who were traditionally underserved by cancer control efforts. Cross-sectional samples were randomly selected from housing authority lists at 5 timepoints in this nonrandomized community-based intervention study. Face-to-face interviews focused on CRC knowledge, beliefs, barriers to screening, and screening behaviors. The intervention components were based on a previous evidence-based program. A total of 2098 surveys were completed. Seventy-eight percent of the respondents were African American, 62% were 65+ years, and 4% were married. At baseline, the rate of CRC screening within guidelines was 49.3% and physician recommendation was the strongest predictor (odds ratio [OR] = 21.9) of being within guidelines. There was an increase in positive beliefs about CRC screening (P = .010) and in the intention to complete CRC screening in the next 12 months (P = .053) after the intervention. The odds of being within CRC screening guidelines for women living in a city that had received the intervention were not significantly different from women living in a city that had not received the intervention (P = .496). Although CRC screening rates were not significantly better after the intervention, there was a positive change in beliefs about screening and intention to be screened. The results suggest that the dissemination of an evidence-based behavioral intervention may require a longer duration to engage hard-to-reach populations and change behaviors.

Learning to Lead from the Middle: An Apprenticeship in Diversity

Cultural difference is sometimes such a subtle thing that we can walk right by it without seeing it. It leaps out at us if it comes packaged in different coloured skin, ethnic dress or foreign speech cadences. Rural and urban values and lifestyles, the survival skills learned in economic disadvantage or a refugee camp, the challenges of raising a child with special needs, coming to terms with one's sexual orientation, or trying to sustain a livelihood in an emergent and little-known occupation might easily fall our definition of cultural difference -- yet many of the same principles of diversity and inclusion apply. Life's deepest learnings -- the lessons that really stick with us and become part of who we are -- seldom happen in a classroom. The more we open ourselves up to startling and unsettling discoveries that can occur anywhere, at any time, the more the journey becomes an adventure of the unknown, lived from the heart. Learning how to learn from one another across cultural boundaries calls for openness of spirit. Recognizing and moving beyond our own deeply rooted assumptions is a crucial first step -- willingly trying on someone else's perspective, and accepting that it is just as valid as our own. Our maps often prove unreliable and we may be called upon to rethink not only our route but also our very destination, making our way together through uncharted territory toward a shifting end point. But we will eventually find our way Chances are very good that some of the views along the route will be quite breathtaking. Creating a Climate of Safety Being listened to is something I've always taken for granted. In my early work with a subsidized housing community, I soon discovered that not everyone has been so fortunate. When such a simple thing has been withheld for so long, it becomes of monumental significance. The most powerful thing I could do for these people was incredibly basic: to listen to their stories, openly and wholeheartedly, without judging. For many of them, this was an entirely new experience. As they became more at ease with me, they poured out their hearts -- their hurts and frustrations, their hopes and dreams -- all of themselves. I was honoured and humbled by their trust and thunderstruck by the very different reality that I was seeing through their eyes. The certainty of unconditional caring has to come first. That's a huge commitment. When people have been deeply hurt, their trust, once earned, can never be treated lightly. Only on these terms can we create a safe place in which to be authentic -- with ourselves as well as with one another. Paradoxically, it is only when we feel safe that we are ready to take risks. Leading from the Middle The other prevailing concern was to ensure that these people remained in charge of whatever might occur between us -- nothing would be done against their wishes or without their agreement, and no one would attempt to exert control over them. If the community members sat on couches and chairs, I sat on the floor in order to stay below their eye-level and avoid any hint of dominance. I took special care to avoid jargon or unfamiliar idioms. If we recorded flip chart notes, we made a game of enlivening them with humourous little drawings. In this light-hearted and transparent way we melted literacy barriers. Those sheets of notes always stayed in the community, rather than leaving with me. We chose any outside experts with care, selecting people who were both committed and genuine, who valued and respected differently-acquired wisdom and who would be open to whatever they might learn along the way. All of these measures helped to reinforce that these people, themselves, owned the process -- and that it was one of outreach and inreach, a multidirectional flow of learning. I was there only to act as the midwife, if you will; this was their baby to which I was helping them give birth. …