1 Engaging Communities as Partners Sergio Aguilar-Gaxiola, MD, PhD Professor of Clinical Internal Medicine Director, Center for Reducing Health Disparities Director, Community Engagement UCD CTSC UC Davis School of Medicine Academy Health Annual Research Meeting Washington, DC June 9, 2008

2 Community engagement and collaboration is a cornerstone of effective public health practice; Successful community engagement builds skills and capacity within the community, which are fundamental factors for optimal health. Communities are essential in proactively looking for effective, long- term, and sustainable solutions for reducing health and healthcare disparities; Community involvement is crucial in the recruitment and retention of diverse groups’ participation in health research; The community is where the full impact of evidence-based information will be realized; dissemination and implementation are key. Why Engage Communities?

Principles of Community Engagement Community engagement processes are about personal and local relationships that should be:  Participatory  Cooperative  Conducive to learning from each other  Encourage community development and capacity building  Empowering IDENTIFY also ASSETS, STRENGTHS, RESOURCES within COMMUNITIES Community engagement processes are about personal and local relationships that should be:  Participatory  Cooperative  Conducive to learning from each other  Encourage community development and capacity building  Empowering IDENTIFY also ASSETS, STRENGTHS, RESOURCES within COMMUNITIES

4 Important Goals when Working with Underserved Communities Source: IOM Report “Examining the Health Disparities Research Plan of the National Institutes of Health: Unfinished Business”, 2006  Include underserved communities in research  Increase of URM researchers  Increase the diversity of the workforce  Address health disparities vigorously  Disseminate research results widely

Learning How to Reduce Disparities  We need direct input from underserved communities.  Not an easy task. Underserved communities may be:  Unaware of potential benefits.  Not ready to participate in research/policy processes.  Suspicious and distrustful of health services.  We need direct input from underserved communities.  Not an easy task. Underserved communities may be:  Unaware of potential benefits.  Not ready to participate in research/policy processes.  Suspicious and distrustful of health services.

6 Community Engagement at UC Davis California Department of Mental Health Prevention and Early Intervention Needs Assessment for California’s Underserved Communities to reach out and engage communities that have been underserved by public health/mental health services and solicit their input on communities’ needs, concerns, strengths, and resources.

7 Outreach Methods 1. Identify specific underserved communities; key informants 2. Interview key informants to focus on specific needs within communities; cultural brokerscommunity health representatives 3. Work with “cultural brokers” or community health representatives to develop outreach strategies; focus groups with community members 4. Conduct focus groups with community members about health needs, community assets, etc.; 5. Provide feedback to communities 5. Provide feedback to communities about the impact of the information collected on policy and services.

ParticipantsParticipants 30 focus groups were conducted primarily in community- based locations in 10 counties across California  specific ethnic groups:  specific ethnic groups: African American, Native American, Native Hawaiian, and Pacific Islander, Asian (including Hmong, Cambodian, and Chinese), and Latino (Mexican and Central and South American);  other underserved groups  other underserved groups (LGBTQ, foster youth, young adults with juvenile justice history, and older adults) from rural and urban locations;  community-based providers  community-based providers that serve these communities. 30 focus groups were conducted primarily in community- based locations in 10 counties across California  specific ethnic groups:  specific ethnic groups: African American, Native American, Native Hawaiian, and Pacific Islander, Asian (including Hmong, Cambodian, and Chinese), and Latino (Mexican and Central and South American);  other underserved groups  other underserved groups (LGBTQ, foster youth, young adults with juvenile justice history, and older adults) from rural and urban locations;  community-based providers  community-based providers that serve these communities.

Key Findings  mental health problems in underserved communities;  problems accessing mental health care and quality of services received;  social determinants of health such as poverty and discrimination;  social exclusion of underserved communities based on current and historical experiences with government agencies  mental health problems in underserved communities;  problems accessing mental health care and quality of services received;  social determinants of health such as poverty and discrimination;  social exclusion of underserved communities based on current and historical experiences with government agencies

Community Assets  Individual and community resiliency  Traditional and spiritual healers  Religious leaders  Informal and formal support networks (family and friendships, reconnection to native cultures, role models and mentors)  Community-based organizations  Social service/Health programs  Individual and community resiliency  Traditional and spiritual healers  Religious leaders  Informal and formal support networks (family and friendships, reconnection to native cultures, role models and mentors)  Community-based organizations  Social service/Health programs

Project Outcomes  Reports:  “Building Partnerships: Key Considerations when Engaging Underserved Communities Under the MHSA”  “Engaging the Underserved: Personal Accounts of Communities on Mental Health Needs for Prevention and Early Intervention Strategies”  Dissemination and implementation of findings  Ongoing partnerships with community agencies and underserved groups  Reports:  “Building Partnerships: Key Considerations when Engaging Underserved Communities Under the MHSA”  “Engaging the Underserved: Personal Accounts of Communities on Mental Health Needs for Prevention and Early Intervention Strategies”  Dissemination and implementation of findings  Ongoing partnerships with community agencies and underserved groups

Recommended Strategies 1. Identifying underserved communities within your county 2. Establishing bi-directional relationships  Finding community representatives 3. Facilitating meetings and exchanging information  Engaging community representatives and maximizing the opportunity for developing trust in communication 4. Using the information once it is collected  Making sure the voices are heard and integrated into programmatic plans  Building ongoing partnerships

2. Establishing Bi-directional Relationships  Clarity of purpose  Understand that the relationship will be a two-way relationship  Awareness of past interactions with community  Recognize that part of the purpose is building up ongoing relationships  Be clear about how participants can influence the decisions that may be made and what issues cannot be influenced

 Understanding the partner community  Be clear about who should be engaged  Identify the community leaders and key community organizations with whom to partner (who has trust, respect, and credibility within the community?)  Address the “culture”, as well as the cultural, language, racial, and ethnic issues of the community  Use awareness and sensitivity when working with tribal communities. Recognize and honor tribal sovereignty issues 2. Establishing Bi-directional Relationships (2)

 Approach communities with awareness of past interactions with community and be prepared to address mistrust and disbelief  Be aware of how government agencies are perceived  Validate concerns  Be transparent about your purpose and reasons for being there 2. Establishing Bi-directional Relationships (3)

 Identify opportunities for co-learning  From the community to the county: the communities’ needs, priorities, assets, existing resources  Existing services, programs that can be enhanced or supported within the community  From the county to the community: Informing opportunities for accessing funds and learn about procurement process and participation in policy decisions 2. Establishing Bi-directional Relationships (4)

Acknowledgements UCD CRHD Sergio Aguilar-Gaxiola Joshua Breslau Leticia Carrillo Natalia Debb-Sossa Katherine Elliott Ron King Cristina Magaña Arnulfo Medina Elizabeth Miller Marbella Sala Bill Sribney UCD CRHD Sergio Aguilar-Gaxiola Joshua Breslau Leticia Carrillo Natalia Debb-Sossa Katherine Elliott Ron King Cristina Magaña Arnulfo Medina Elizabeth Miller Marbella Sala Bill Sribney DMH/MHSOAC Emily Nahat Jennifer Clancy Nichole Davis Rachel Guerrero Barbara Marquez Sonia Mays Sheri Whitt Beverly Whitcomb Lois Williams CMHDA Alfredo Aguirre Bill Arroyo Nancy Peña Dan Souza Stephanie Welch

Examples of other Community Engaged Research at UC Davis  National Demonstration of Early Detection, Intervention and Prevention in Psychosis in Adolescents and Young Adults (Carter, PI)  Reducing Disparities in Depression Care for Ethnically Diverse Older Men (Hinton, PI)  Community Partnerships with Pediatricians for Healthy Children (Pan, PI)  Transforming Education and Community Health (TEACH) Program (Henderson, PI)  Community Lactation Assistance Project (Chantry, PI)  National Faith-Based and National Community Cardiovascular Disease Prevention Programs for High-Risk Women (Villablanca, PI)  Epidemiology of Dementia in an Urban Community (DeCarli, PI) 18