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Ethn Dis. 2020;30(3):433-436; doi:10.18865/ed.30.3.433

Background: Little has been written about engaging potentially eligible members of a health care system who are not accessing the care to which they are entitled. Know­ing more about the experiences of African American Veterans who regularly experi­ence health care access challenges may be an important step toward equitable, coordi­nated Veterans Health Administration (VHA) care. This article explores the experiences of African American Veterans who are at risk of experiencing poor care coordination.Design: We partnered with a community organization to recruit and engage Veterans in three exploratory engagement workshops between October 2015 and February 2016.Participants and Setting: Veterans living in South Los Angeles, CaliforniaMain Outcome Measures: Veterans were asked to describe their experiences with community care and the VHA, a division of the US Department of Veterans Affairs (VA). Field notes taken during the workshops were analyzed by community and academic partners using grounded theory methodol­ogy to identify emergent themes.Results: 12 Veterans and 3 family members of Veterans participated in one or more en­gagement workshops. Their trust in the VA was generally low. Positive themes included: Veterans have knowledge to share and want to help other Veterans; and connecting to VA services can result in positive experi­ences. Negative themes included: functional barriers to accessing VA health care services; insensitive VA health care environment; lack of trust in the VA health care system; and Veteran status as disadvantageous for accessing non-VA community services.Conclusions: Veterans living in underserved areas who have had difficulty accessing VA care have unique perspectives on VA services. Partnering with trusted local com­munity organizations to engage Veterans in their home communities is a promising strategy to inform efforts to improve care access and coordination for vulnerable Vet­erans.Ethn Dis. 2018;28(Suppl 2):475-484; doi:10.18865/ed.28.S2.475.

Background: Given national concern over rising mortality from opioid use disorders (OUD) and challenges to increasing OUD treatment access, a coalition approach may hold promise to improve access and out­comes for diverse populations. We present considerations of a community-partnered working group on adapting the Community Partners in Care (CPIC) study and coalition approach to OUD.Method: During January 2016 through Jan­uary 2017, academic, provider, consumer and policy stakeholders reviewed options to adapt CPIC's Resources for Services (RS) for individual program technical assistance and Community Engagement and Planning (CEP) for coalition support to OUD treatments, integrating stakeholder input into design op­tions with estimated sample sizes.Findings: The working group recommend­ed Community Reinforcement and Family Treatment (CRAFT) as a stakeholder-support intervention to facilitate uptake and adher­ence to Medications for Addiction Treat­ment (MAT). Recommended implementa­tion interventions for MAT/CRAFT were expert technical assistance supplemented by organizational readiness, and CEP for coali­tion support with a Learning Collaborative. Power estimation suggests that to compare implementation intervention effects on abstinence would require a somewhat larger enrolled sample and 3-4 times the screening sample as CPIC, and for mortality, at least 5-10 times the enrolled sample as CPIC.Discussion: Stakeholders viewed the CPIC design and interventions as feasible and acceptable as community-wide approaches for addressing the opioid epidemic, but comparing impacts on mortality would require large, multi-site trials. Ethn Dis. 2018;28(Suppl 2):381-388; doi:10.18865/ed.28.S2.381.

Mental health research projects address sensitive issues for vulnerable populations and are implemented in complex environments. Community-Based Participatory Research approaches are recommended for health research on vulnerable populations, but little is known about how variation in participation affects outcomes of partnered research projects. We developed a conceptual model demonstrating the impact of community engagement in research on outcomes of partnered projects. We collected data on key constructs from community and academic leaders of 21 sampled partnered research projects in two cycles of an NIMH research center. We conducted empirical analyses to test the model. Our findings suggest that community engagement in research is positively associated with perceived professional development, as well as political and community impact.

<p><strong>Objective: </strong>Limited data exist on approaches to improve depression services for men in under-resourced communities. This article explores this issue using a sub-analysis of male participants in Community Partners in Care (CPIC). <strong></strong></p><p><strong>Design: </strong>Community partnered, cluster, randomized trial. </p><p><strong>Setting: </strong>Hollywood-Metropolitan and South Los Angeles, California. </p><p><strong>Participants: </strong>423 adult male clients with modified depression (PHQ-8 score≥10). </p><p><strong>Interventions: </strong>Depression collaborative care implementation using community engagement and planning (CEP) across programs compared with the more-traditional individual program, technical assistance (Resources for Services, RS). </p><p><strong>Main Outcomes Measured: </strong>Depressive symptoms (PHQ-8 score), mental health-related quality of life (MHRQL), mental wellness, services utilization and settings. </p><p><strong>Results: </strong>At screening, levels of probable depression were moderate to high (17.5%- 47.1%) among men across services sectors. Intervention effects on primary outcomes (PHQ-8 score and MHRQL) did not differ. Men in CEP compared with RS had improved mental wellness (OR 1.85, 95% CI 1.00–3.42) and reduced hospitalizations (OR .40, 95% CI .16–.98), with fewer mental health specialty medication visits (IRR 0.33, 95% CI .15–.69), and a trend toward greater faith-based depression visits (IRR 2.89, 95% CI .99–8.45). </p><p><strong>Conclusions: </strong>Exploratory sub-analyses suggest that high rates of mainly minority men in under-resourced communities have high prevalence of depression. A multisector coalition approach may hold promise for improving community-prioritized outcomes, such as mental wellness and reduced hospitalizations for men, meriting further development of this approach for future research and program design.</p><p><em>Ethn Dis. </em>2017;27(3):223-232; doi:10.18865/ed.27.3.223 </p>

Objective: Depressed individuals may require help from different agencies to ad­dress health and social needs, but how such coordination occurs in under-resourced communities is poorly understood. This study sought to identify priorities of Latino and African American depressed clients, ex­plore whether service providers understand client priorities, and describe how providers address them.Methods: Between October 2014 and February 2015, we interviewed 104 clients stratified by depression history and 50 representatives of different programs in health and social community agencies who participated in Community Partners in Care, a cluster-randomized trial of coalition-building approaches to delivering depres­sion quality improvement programs. Clients were queried about their most pressing needs; program representatives identified their clients' needs and explained how they addressed them.Results: Physical and mental health were clients' top priorities, followed by housing, caring for and building relationships with others, and employment. While persistently depressed clients prioritized mental health, those with improved depression prioritized relationships with others. Program repre­sentatives identified housing, employment, mental health, and improving relationships with others as clients' top priorities. Needs assessment, client-centered services, and linkages to other agencies were main strate­gies used to address client needs.Conclusion: Depressed clients have mul­tiple health and social needs, and program representatives in under-resourced commu­nities understand the complexity of clients' needs. Agencies rely on needs assessment and referrals to meet their clients' needs, which enhances the importance of agency partnership in "whole person" initiatives. Our results illustrate agency capacity to adopt integrated care models that will ad­dress clients' multiple needs through multi-sector collaboration and describe potential strategies to help reach the goal of whole person care.Ethn Dis. 2018;(Suppl 2): 371- 380; doi:10.18865/ed.28.S2.371.

Objective: The New York City's Thrive (ThriveNYC) and the Los Angeles County Health Neighborhood Initiative (HNI) are two local policies focused on addressing the social determinants of behavioral health as a preventive strategy for improving health service delivery. On January 29, 2016, lead­ers from both initiatives came together with a range of federal agencies in health care, public health, and policy research at the RAND Corporation in Arlington, Virginia. The goal of this advisory meeting was to share lessons learned, consider research and evaluation strategies, and create a dialogue between stakeholders and federal funders – all with the purpose to build mo­mentum for policy innovation in behavioral health equity.Methods: This article analyzes ethnographic notes taken during the meeting and in-depth interviews of 14 meeting participants through Kingdon's multiple streams theory of policy change.Results: Results demonstrated that stake­holders shared a vision for behavioral health policy innovation focused on community engagement and social determinants of health. In addition, Kingdon's model highlighted that the problem, policy and politics streams needed to form a window of opportunity for policy change were coupled, enabling the possibility for behavioral health policy innovation.Conclusions: The advisory meeting suggest­ed that local policy makers, academics, and community members, together with federal agents, are working to implement behav­ioral health policy innovation. Ethn Dis. 2018;28(Suppl 2):407-416; doi:10.18865/ed.28.S2.407.

OBJECTIVE: The New York City's Thrive (ThriveNYC) and the Los Angeles County Health Neighborhood Initiative (HNI) are two local policies focused on addressing the social determinants of behavioral health as a preventive strategy for improving health service delivery. On January 29, 2016, leaders from both initiatives came together with a range of federal agencies in health care, public health, and policy research at the RAND Corporation in Arlington, Virginia. The goal of this advisory meeting was to share lessons learned, consider research and evaluation strategies, and create a dialogue between stakeholders and federal funders – all with the purpose to build momentum for policy innovation in behavioral health equity. METHODS: This article analyzes ethnographic notes taken during the meeting and in-depth interviews of 14 meeting participants through Kingdon's multiple streams theory of policy change. RESULTS: Results demonstrated that stakeholders shared a vision for behavioral health policy innovation focused on community engagement and social determinants of health. In addition, Kingdon's model highlighted that the problem, policy and politics streams needed to form a window of opportunity for policy change were coupled, enabling the possibility for behavioral health policy innovation. CONCLUSIONS: The advisory meeting suggested that local policy makers, academics, and community members, together with federal agents, are working to implement behavioral health policy innovation.

Objective: To understand potential for multi-sector partnerships among com­munity-based organizations and publicly funded health systems to implement health improvement strategies that advance health equity.Setting: In 2014, the Los Angeles County (LAC) Board of Supervisors approved the Health Neighborhood Initiative (HNI) that aims to: 1) improve coordination of health services for behavioral health clients across safety-net providers within neighborhoods; and 2) address social determinants of health through community-driven, public agency sponsored partnerships with community-based organizations.Design: Key stakeholder interviewing dur­ing HNI planning and early implementation to elicit perceptions of multi-sector partner­ships and innovations required for partner­ships to achieve system transformation and health equity.Participants: Twenty-five semi-structured interviews with 49 leaders from LAC health systems, community-based organizations; and payers.Main Outcomes Means: Grounded the­matic analysis of interview data.Results: Leaders perceived partnerships within and beyond health systems as transformative in their potential to: improve access, value, and efficiency; align priori­ties of safety-net systems and communities; and harness the power of communities to impact health. Leaders identified trust as critical to success in partnerships but named lack of time for relationship-building, limitations in service capacity, and ques­tions about sustainability as barriers to trust-building. Leaders described the need for procedural innovations within health systems that would support equitable part­nerships including innovations that would increase transparency and normalize infor­mation exchange, share agenda-setting and decision-making power with partners, and institutionalize partnering through training and accountability.Conclusions: Leaders described improv­ing procedural justice in public agencies' relationships with communities as key to effective partnering for health eq­uity.Ethn Dis.2018;28(Suppl 2):397-406; doi:10.18865/ed.28.S2.397.

Objective: To assess the feasibility of a novel, partnered technology development process to co-create mobile health applica­tions (apps) addressing community health priorities, using psychoeducation of cogni­tive behavioral therapy (CBT) principles for enhancing resilience as an example.Design: Stakeholder engagement, work­groups, pilot feasibility study using mixed methods during October 2013 through January 2016 over three phases: 1) defining the vision of the project and increasing technical capacity, 2) co-development and pilot testing of the app, and 3) planning for sustainability.Setting: An academic-community partner­ship in South Los Angeles, California.Participants: Eight stakeholders; 30 pilot participants from the community.Main Outcome Measures: Qualitative analysis of audio-recordings of the app development process and stakeholder inter­views, surveys of stakeholders' perception of the development process, app use data, and feedback from pilot participants.Results: The participatory technology development process resulted in creation and pilot-testing of a resiliency-focused text messaging app. Of the 1,107 messages sent, 23 out of 30 (77%) app users responded to explore interactive content. Stakeholders reported increased perceived competency in creating mobile apps and that the process fostered a culture of co-leadership. There was also sustained engagement in mobile app development by stakeholders beyond the initial project period.Conclusions: This is the first study, to our knowledge, to demonstrate the feasibility of participatory technology development, an approach involving direct participation in the development, tailoring and maintenance of a mobile app by a broad set of stakehold­ers with high representation from racial/ ethnic minorities from an under-resourced community. Participatory technology devel­opment is a promising approach for creating sustainable, relevant and engaging health technologies across different technological, clinical and community settings.Ethn Dis. 2018:28(Suppl 2):493-502; doi:10.18865/ed.28.S2.493.

Objective: Racial/ethnic minorities experi­ence disparities in depression1 and there is a paucity of evidence-based interventions to improve depression care access and outcomes. Community Partners in Care (CPIC) is a community-partnered study of depression care quality improvement (QI) in under-resourced, urban communities: Community Engagement and Planning (CEP) for multi-sector coalitions, and Resources for Services (RS) for program technical assistance.2 CEP demonstrated benefits for the overall CPIC study population; effects for Black and Latino sub-populations are unknown.Methods: This sub-analysis examines outcomes for 409 Latino and 488 Black (non-Latino) adults recruited from 90 pro­grams who completed baseline or 6-month follow-up. Regression analyses were used to estimate CEP vs RS intervention effects on primary (Mental Health Related Quality of Life [MHRQL], Patient Health Question­naire-9 [PHQ-9]) and community-priori­tized (mental wellness, physical activity, risk for homelessness) outcomes at 6-months.Results: Baseline characteristics did not differ significantly by intervention in either group. In the adjusted analysis for Black adults, CEP resulted in decreased odds of poor MHRQL (OR: .62, 95% CI=.41- .94, P=.028) with a trend for reducing homelessness risk (OR: .60, .35-1.05, P=.69). For Latino adults, CEP resulted in greater probability of mental wellness (OR: 1.81, 1.05-3.13, P=.034) and a trend for increased physical activity (OR: 1.52, .93- 2.49, P=.091).Conclusions: Exploratory analyses of CEP for depression quality improvement sug­gests significant 6-month benefits in mental health outcomes for Black and Latino participants and trends for improvement in community-prioritized outcomes for both groups. Findings may inform research in multi-sector coalitions to promote equity in depression care. Ethn Dis. 2019;29(2):277- 286; doi:10.18865/ed.29.2.277

Objective: To compare community engage­ment and planning (CEP) for coalition support to implement depression quality improvement (QI) to resources for services (RS) effects on service-use costs over a 12-month period.Design: Matched health and community programs (N=93) were cluster-randomized within communities to CEP or RS.Setting: Two Los Angeles communities.Participants: Adults (N=1,013) with depressive symptoms (Patient Health Questionnaire (PHQ-8) ≥10); 85% African American and Latino.Interventions: CEP and RS to support pro­grams in depression QI.Main outcome measures: Intervention training and service-use costs over 12 months.Results: CEP planning and training costs were almost 3 times higher than RS, largely due to greater CEP provider training partici­pation vs RS, with no significant differences in 12-month service-use costs.Conclusions: Compared with RS, CEP had higher planning and training costs with simi­lar service-use costs.Ethn Dis. 2018;28(Sup­pl 2):349-356; doi:10.18865/ed.28.S2.349.

The Patient Centered Outcomes Research Institute (PCORI) supports patient-centered clinical comparative effectiveness research (CER) including health disparities and engagement portfolios. In 2013, PCORI launched the Pipeline to Proposal (P2P) mechanism to support development of nov­el patient- and stakeholder-centered part­nerships focused on designing clinical CER funding proposals. By providing a tiered structure of successive small contracts and technical assistance, the P2P mechanism encourages development of new research partnerships among diverse stakeholders. As a comparatively new field, patient-centered outcomes research (PCOR) has few well-delineated methods for engaging patients and other non-scientists in effective teams with academics or clinicians to develop and implement rigorous, scientific research pro­posals. Community partnered participatory research (CPPR) provides a useful frame­work for structuring new partnerships.In this article we highlight the origins, de­velopment, and prospects of three current examples of funded P2P initiatives based in New Orleans and Los Angeles. We outline how these projects – Prisoner to Patient, the NOLA Partnership, and Resilience Among African American Men – use CPPR principles. We also describe how they have collaborated with, and contributed to, a two-way learning and knowledge exchange among members of the PCORI-funded Community and Patient Partnered Research Network. Lessons learned may be ap­plicable to other groups planning to create new partnerships focused on implementing PCOR.Ethn Dis. 2018;28(Suppl 2):303- 310; doi:10.18865/ed.28.S2.303.

Background: Patient and community engagement in under-resourced communi­ties is a key issue for precision medicine research. We report proceedings from a community-academic partnered confer­ence in Los Angeles to promote community understanding of precision medicine and generate engagement recommendations.Methods: Planning group review of plan­ning, presentations, and audience discus­sions from facilitator notes and participant survey data from a one-day conference.Findings: Community-academic planning broadened community participation and presentations. More than 80% of survey par­ticipants indicated they would participate in the national precision medicine initia­tive, and most were willing to share diverse sources of data. Discussions identified trust concerns related to historical research abus­es, data privacy, potential effects of findings on health care, personal safety, research procedures, the time-frame for benefit, and confusion about different initiatives. Con­cerns were balanced by belief in science to improve health. Recommendations in­cluded a community partnered participatory approach with support for local community and academic teams to engage stakeholders with written/online resources and partnered workgroups addressing key concerns.Conclusion: Conference participants expressed high willingness to participate in precision medicine studies, but discus­sions highlighted trust and transparency issues and suggested community partnered research with local capacity building.Ethn Dis. 2018:28(Suppl 2):503-510; doi:10.18865/ed.28.S2.503.

Objective: With internal validity being a central goal of designed experiments, we seek to elucidate how community partnered participatory research (CPPR) impacts the internal validity of public health compara­tive-effectiveness research.Methods: Community Partners in Care (CPIC), a study comparing a community-coalition intervention to direct technical as­sistance for disseminating depression care to vulnerable populations, is used to illustrate design choices developed with attention to core CPPR principles. The study-design process is reviewed retrospectively and evaluated based on the resulting covariate balance across intervention arms and on broader peer-review assessments. Contribu­tions of the CPIC Council and the study's design committee are highlighted.Results: CPPR principles contributed to building consensus around the use of randomization, creating a sampling frame, specifying geographic boundaries delimit­ing the scope of the investigation, grouping similar programs into pairs or other small blocks of units, collaboratively choosing random-number-generator seeds to deter­mine randomized intervention assignments, and addressing logistical constraints in field operations. Study protocols yielded samples that were well-balanced on background characteristics across intervention arms. CPIC has been recognized for scientific merit, has drawn attention from policy­makers, and has fueled ongoing research collaborations.Conclusions: Creative and collaborative fulfillment of CPPR principles reinforced the internal validity of CPIC, strengthening the study's scientific rigor by engaging comple­mentary areas of knowledge and expertise among members of the investigative team.Ethn Dis. 2018;28(Suppl 2):357-364; doi:10.18865/ed.28.S2.357.