3/21/2012 The 25th Annual Children’s Mental Health Research & Policy Conference March 4-7, 2012 Hyatt Regency, Tampa, Florida
Richard Briscoe, USF Debra Mowery, USF
Estrellita “Lo” Berry, REACHUP Deborah A. Austin, REACHUP
John Mayo, S4K
Translating Research into Action: Improved Health Outcomes for
Black Families
3/21/2012 2
Purpose The symposium will outline an interdisciplinary approach used with Black communities that integrated culturally competent interventions and research to improve health outcomes 1.Framework to implement interdisciplinary intervention and research strategies
WITH Black communities to improve health outcomes 2.Culturally competent organizational and direct service strategies by Black
community organizations 3.REACHUP an example of a community-based agency/organization illustrating how
theories and research may be transformed into action.
4.Discussant
3/21/2012 3
Background Black Families Researchers have noted the influence of cultural, economic, and social factors on health promotion
Health Promotion and Behavioral Health Promotion
Interdisciplinary Approach
Challenge in reducing health disparities requires considering the complex set of interrelated factors; this requires some new research and services which includes more collaboration and integration of knowledge.
3/21/2012 4
Background Understanding disparities of Blacks must be understood and examined within the
context of their racial and ethnic realities (Jackson & Jones, 2001). The social, educational, health, economic, related political factors between Blacks and Whites in America when addressing
disparities
Behavioral scientists who conduct research and practitioners who provide treatment for Blacks to improve health outcomes must acknowledge, understand, and incorporate the experiences of Blacks to assist in the development of treatment, research, and policy to improve behavioral health outcomes.
The foundation for improving health outcomes in Black communities are challenged by engaging research and/or interventions that must address identified historical, social, educational, economic and political contextual factor to translate research into action.
,
3/21/2012 5
Black Families When compared with Whites Blacks have higher rates of poverty,
unemployment, and they live in high-crime neighborhoods. (U.S. Department of Health and Human Services [USDHHS], 1999)
Poverty is the risk factor for Blacks leading to poor physical health and mental health outcomes, inequalities of education child/abuse/ neglect, and drug abuse. (Brooks-Gunn, 1977)
Blacks are less likely to receive a high school diploma than the general
population. (Davis, Saunders, Williams & Williams, 2004)
Black males in particular have higher rates of suspensions. (Saunders, Davis, Williams & Williams, 2006)
3/21/2012 6 6
Improved Health Outcomes
3/21/2012 7
Health Disparities Minorities from racial and ethnic groups in America have worse health
conditions than Whites and receive less standard of healthcare.
The lack of equity is one of the major deficiencies of the healthcare system in America to provide minority groups high quality care (Institute of Medicine, 2001; 2003).
The mortality rate for Blacks from heart disease is three times that of Whites (Robert Wood Johnson Foundation, 2011).
For the following health conditions -- cancer, hypertension, diabetes, stroke and infant mortality-- Blacks have higher prevalence rates than Whites. (NAACP, 2006)
Racial and ethnic minorities receive differential quality of care which results in poorer health outcomes, compared to Whites.
(La Veist, 2005; Smedley, Stith & Nelson, 2003)
3/21/2012 8
Behavioral Health Disparities
Racial and ethnic minorities are reported as having higher rates of psychiatric conditions, such as schizophrenia, post-traumatic stress disorder (PTSD), phobic disorders, and somatization disorders.
(Dixon, et al., 2001; McAlpine & Mechanic, 2000; McCarthy, 2001)
While Blacks overall experience higher rates of behavioral
health disparities, certain sub-populations of Black veterans and the elderly experience even higher rates of disparities.
(Satcher, 2001).
3/21/2012 9
Building Blocks for an Interdisciplinary Approach:
A New Way of Thinking Behavioral Health
Children’s Behavioral Health
Health Disparities
Cancer/Cardiovascular
Nursing
Social work
Education/Counseling/Psychology
3/21/2012 10
Building Blocks for an Interdisciplinary Approach: A New Way of Thinking
Cultural Competence
Strengths-based Principles and Practices
System of Care Philosophy
Collaborative Practices
Community-Based Participatory Research (CBPR)
3/21/2012 11
Community and University of
South Florida
African-American family support analysis: Strengths of African-American
families
Strengths of African-American families: A cross-site analysis of families in Baltimore, Detroit, Plant City, San Diego and Savannah. Tampa
Spiritual Educational Network Directory (SEND): A resource directory of educational and social service programs for children
A Resource Manual for the Implementation and Sustainability of summer and after-school Programs within churches and community organizations
A Resident-Driven Needs Assessment for the East Tampa Community
3/21/2012 12
Other Scholarly Activities
Book Chapters
The strengths and challenges facing African-American families. (Briscoe, McClain, Nesman, Mazza, & Woodside, 2010)
A culturally competent community-based research approach with African American neighborhoods: Components and examples.
(Briscoe, Keller, McClain, Best, & Mazza, 2009)
Publications/Reports
Presentations/Training (National and Local)
Grants and Contracts
3/21/2012 13
Cultural Competence Conceptual model to operationalize the definition of
cultural competence
Community context to understand the population being served
Knowledge of the population
Compatibility of organizational structures and process
Domains of the organizational structural and processes
Outcomes (Hernandez & Nesman, 2006)
3/21/2012 14
Cultural Competence Listen and learn = Build Trust
Must be different than historical approach to university working with community Be present in the community in multiple venues
Describe and document community assets – share with community; is description and documentation accurate?
Check with community
Develop an understanding of community culture and history
Information sources – personal contact points to access information, assets (Briscoe, Keller, McClain, Best, & Mazza, 2009)
3/21/2012 15
Cultural Competence Conceptual model to operationalize the definition of
cultural competence
Community context to understand the population being served
Knowledge of the population
Compatibility of organizational structures and process
Domains of the organizational structural and processes
Outcomes (Hernandez & Nesman, 2006)
3/21/2012 16
Cultural Competence
Culturally competent organizational factors and direct service strategies to increase access, availability and utilization of behavioral health services and supports.
3/21/2012 17
Strengths-based Principles and Practices
Foster greater involvement and will make the sustainability more likely
Reduces the impact of discriminatory cultural expectations, and focus on improving behaviors regardless of environmental conditions.
Promoting successful behavioral change in their environment and their own strengths in contributing to this change. (Briscoe, Keller, McClain, Best, & Mazza, 2009)
3/21/2012 18
Strengths-based Principles and Practices
Residents have confidence of having lived and survived in their community and have know about how they want their community to be and how to get things done
Residents know their community- are experts about their community-history-cultural-values
3/21/2012 19
Strengths-based Principles and Practices
Identified and promotes the strengths, networks, and assets within the family and community that are relevant and sustainable
faith-based organizations,
extended family as support systems,
formal and informal support groups.
3/21/2012 20
Strengths-based Principles and Practices
1. …critical resources for the multi-systemic needs of the African-American community and fundamental supports for educational, health, political, civic, and economic survival.
(Hill, 1972; 1998) 2. …the need for concerted efforts by policymakers and
program planners to identify and promote solutions and strategies for African-American families that build upon and reinforce strengths.
(Hill, 1972; 1998)
3/21/2012 21
Strengths-based Principles and Practices
Robert Hill identified five important strengths in African-American families
1. High achievement orientation 2. Strong work orientation 3. Adaptability of family roles 4. Strong kinship bonds 5. Strong religious orientations (Hill, 1972)
3/21/2012 22
Neighborhood
Solutions
Family
Networks
Neighborhood
Pride
Community Strengths
Value
Education
Power of the
Church
Youth
Achievement
Traditional
Organizations
3/21/2012 23 23 August 1, 2008
Minority Health Conference
Creating a Culturally Competent
Approach
3/21/2012 24
August 14, 2008 Minority Health Conference
System of care Children and families have multiple needs to address
Child and family centered.
Emphasizes multi-agency involvement, community-based nonresidential services,
Strong partnership between parents and professionals,
Meeting the needs of ethnically and racially diverse populations
Supports the advancement of community-based programs to meet the needs of this multiple and varied population of children
Emphasis on family and culturally sensitive approaches (Stroul & Friedman, 1994)
3/21/2012 25
Collaboration
1. A collaboration of needs, agencies and systems for children and families
2. Mutually responsible and equal partnerships that guide the structure for all aspects of services and supports.
3. Collaboration is maintained through shared values and communication
(Anderson, McIntyre, Rotto & Roberson, 2002)
3/21/2012 26
Community-based Participatory Research 1. An applied social process that involves a partnership between trained evaluation
personnel and practice-based decision makers, organization members with program responsibility, or people with a vital interest in the program, the primary users of the program
(Cousins & Earl, 1992; McKernan, 1988)
2. Characterized by direct involvement and influence in the real world experience of participants.
3. It frames community issues, determines possible solutions to address these concerns, places solutions into practice, and to study the outcomes
4. Local practitioners play central roles in simultaneous action and enlightenment through the process of problem framing, planning, action, observation, and reflection
5. Participatory action research helps the community build resiliency in solving problems, and utilize research findings to promote the community’s well-being
6. Participatory action research also gives an equal share of control to the community engaged in the research
(Turnbull, Friesen & Ramirez, 1998; Israel, Schulz, Parker, & Becker,1998; Davis, Durlak,, Isenberg, 2006
3/21/2012 27
Guidelines for Establishing and Maintaining
Cultural Competence 1.Gaining an understanding of strengths, natural supports, resources
and community context
2.Community-driven for community ownership of sustainable solutions
3.Building trust thru “open” and honest communication
4.Timely feedback to the community
5.Neighborhood-based
6.Comprehensive Approach
7.Multidisciplinary Partnerships
8.Community capacity building
9.Expanding financial resource
10. Inclusive interpretation, dissemination and utilization of findings
11. Multifaceted accountability, evaluation and research