improving outcomes for diabetes in african americans: lessons learned for reach charleston and...
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Improving Outcomes for Diabetes in African
Americans: Lessons Learned for REACH
Charleston and Georgetown Diabetes Coalition
Improving Outcomes for Diabetes in African
Americans: Lessons Learned for REACH
Charleston and Georgetown Diabetes Coalition
Carolyn Jenkins, DrPH, APRN-BC, RD, FAAN
Ann Darlington Edwards Chair and Professor
Medical University of South Carolinaphone: 843-792-4625
e-mail: [email protected]
Carolyn Jenkins, DrPH, APRN-BC, RD, FAAN
Ann Darlington Edwards Chair and Professor
Medical University of South Carolinaphone: 843-792-4625
e-mail: [email protected]
Goals for Today• Review diabetes statistics.
• Share some processes and outcomes from community-based participatory research and service learning.
• Review an expanded chronic care model for improving outcomes in African American communities.
• Explore needed community changes.
• Review diabetes statistics.
• Share some processes and outcomes from community-based participatory research and service learning.
• Review an expanded chronic care model for improving outcomes in African American communities.
• Explore needed community changes.
Diabetes is the Fifth Deadliest Disease in the U.S. and Its Prevalence is Increasing
U.S. Prevalence(% of population)
1990 1999
4.9% 6.9%
Lifetime Risk if Born in 2000
Males Females
33% 39%
Whites:
African Americans: 40% 50%
27% 31%
Hispanics: 45% 53%Sources: American Diabetes Association: Economic Costs of Diabetes in the U.S. in 2002. Diabetes Care. 2003;26:917-932.Venkat Narayan KM, Boyle JP, Thompson TJ, Sorensen SW, Williamson DF. Lifetime risk of diabetes mellitus in the United States. JAMA.
2003;290:1884-1890.American Diabetes Association: Diabetes Statistics for African Americans. Available at: www.diabetes.org/diabetes-statistics/african-americans.jsp.
Accessed March 14, 2005.American Diabetes Association: Diabetes Statistics for Latinos. Available at: www.diabetes.org/diabetes-statistics/latinos.jsp. Accessed March 14, 2005.
2005
7 to 9.6%
How Serious Is Diabetes?
Source: Venkat Narayan KM, Boyle JP, Thompson TJ, Sorensen SW, Williamson DF. Lifetime risk of diabetes mellitus in the United States. JAMA. 2003;290:1884-1890.
It predictably affects both lifespan and quality of life
Males Females
40 40Age at diagnosis:
Lost # of life years:
18- 20 21 - 24
11 - 13 12 - 17
Lost # of quality-adjusted
life years:
The Burden of Diabetes Is Greater for Minority Populations in the United States
• 2.7 million (11.4%) over age 20
– 60% higher than in whites
• Higher complication rates
– 2X as likely to suffer lower-limb amputations
– 2X as likely to suffer from diabetes-related blindness
Diabetes in African Americans
Diabetes affects:
Sources: American Diabetes Association: Diabetes Statistics for African Americans. Available at: www.diabetes.org/diabetes-statistics/african-americans.jsp. Accessed March 14, 2005.
American Diabetes Association: Diabetes Statistics for Latinos. Available at: www.diabetes.org/diabetes-statistics/latinos.jsp. Accessed March 14, 2005.
Mokdad AH, Ford ES, Bowman BA, et al. Diabetes trends in the U.S.: 1990-1998. Diabetes Care. 2000;23:1278-1283.
10.8% of African Americans
10.6% of Hispanics
6.2% of Whites
The Financial Impact of Diabetes Is Staggering
Total Health Care Costs in 2007
Per capital costs averaged $11,744
Indirect Expenditures: $58B
Diabetes: $132B
• Lost workdays
• Restricted activity days
• Mortality
• Permanent disability
Diabetes Care
$27BRelated
Complications
$58BOther
Medical Care
$31B
Direct Expenditures: $92B
Source: American Diabetes Association: Economic Costs of Diabetes in the U.S. in 2007. Diabetes Care. 2008;31,1-20.
Diabetes Costs
• Annual health care costs for people with diabetes: $11,744.
• One of every 5 health care $ spent caring for person with diabetes.
• One of every 10 health care $ is attributed to diabetes.
– Costs for people with diabetes 2.3 X higher than those without diabetes.
• Annual health care costs for people with diabetes: $11,744.
• One of every 5 health care $ spent caring for person with diabetes.
• One of every 10 health care $ is attributed to diabetes.
– Costs for people with diabetes 2.3 X higher than those without diabetes.
Diabetes Care 2008
South Carolina Statistics• In 2005 BRFSS:
– 10.3% reported they had diabetes
• African Americans (15.4%)
• Non-Hispanic Whites (8.4%)
– Insulin treated (29.5%)
– “Pills” (72.9%)
– A1C test in past year (77%)
– Never had A1c (23%)
– Diabetic eye disease (21.7%)
– No insurance and/or no doctor (~18%)
• African Americans (26.6%)
• Non-Hispanic whites (15.1%)
• In 2005 BRFSS:
– 10.3% reported they had diabetes
• African Americans (15.4%)
• Non-Hispanic Whites (8.4%)
– Insulin treated (29.5%)
– “Pills” (72.9%)
– A1C test in past year (77%)
– Never had A1c (23%)
– Diabetic eye disease (21.7%)
– No insurance and/or no doctor (~18%)
• African Americans (26.6%)
• Non-Hispanic whites (15.1%)
Risk Factors Among African Americans in SC
Current Overweight Sedentary HBP Diabetes High Smoker Obesity Lifestyle Cholesterol
Diabetes in SC:•Two-thirds of people with diabetes die of heart disease and stroke•1 of every 7 African-Americans has diabetes, which is 80% higher than rate for non-Hispanic whites.
Diabetes in African Americans in South Carolina
• In Charleston and Georgetown Counties, 21% of African Americans reported having diabetes (2005 RRFS)
• Rural African Americans with diabetes:– 60.6 % have inadequate control versus
42.5% of urban whites (SC BRFSS)
• In Charleston and Georgetown Counties, 21% of African Americans reported having diabetes (2005 RRFS)
• Rural African Americans with diabetes:– 60.6 % have inadequate control versus
42.5% of urban whites (SC BRFSS)
Disease risk, diagnosis, progression of disease, response to treatment, caregiving, and overall quality of life are all affected by a number of variables including race, ethnicity, gender, socioeconomic status, age, education, occupation, country of origin, and perhaps other lifetime and lifestyle differences.
DIABETES-ATLAS Conceptual Model
National Minority Health Month Foundation (2007)http://www.nmhmf.org/diabetes_initiative.aspx
Percentage of the 2005 PopulationDiagnosed with diabetes
1994-present
CBPAR Activities and Diabetes ManagementCBPAR Activities and
Diabetes Management
From Meredith Minkler, DrPH University of California, Berkeley
Enterprise Neighborhood Health Program (1994 – 1998)
• HUD Grant with Charleston’s Enterprise Community to a) recruit and train community leaders to become Community Health Advocates;b) conduct needs assessment.
– Needs assessment identified diabetes and HTN as priority issues.
– 61 community health advisors trained.
– Video documenting needs and assets using community voices
– AKA Summer Enrichment Program for children
• HUD Grant with Charleston’s Enterprise Community to a) recruit and train community leaders to become Community Health Advocates;b) conduct needs assessment.
– Needs assessment identified diabetes and HTN as priority issues.
– 61 community health advisors trained.
– Video documenting needs and assets using community voices
– AKA Summer Enrichment Program for children
Diabetes Initiative of South Carolina
• 1994—Report to SC Legislature on “Scope and Problems of Diabetes in SC”
• Funding by State Legislature to create Center to address diabetes in SC– Center of Excellence at MUSC
• Professional Council• Outreach Council• Surveillance Council
• Annual Report on activities and outcomes to South Carolina Legislature and Governor
• 1994—Report to SC Legislature on “Scope and Problems of Diabetes in SC”
• Funding by State Legislature to create Center to address diabetes in SC– Center of Excellence at MUSC
• Professional Council• Outreach Council• Surveillance Council
• Annual Report on activities and outcomes to South Carolina Legislature and Governor
Enterprise Health Center 1995 - 2001
Donation of Lot
Building Completed
Opened November 2001Now a FQHC site (FCFFHC)
Service-Learning• An educational methodology based on a
community-campus partnership which combines student community service with explicit learning objectives. Students participating in service-learning are not only expected to provided direct community service but also to learn about the context in which the service is provided, and to understand the connection between the service and their academic coursework.
Seifer 1998
Service Learning with Students
>700 students (MUSC, Clemson, Howard, USC, Rhode Island, UNC)7 Doctoral Candidates/Graduates6 Certified Diabetes Educators
7 doctoral dissertations3 masters thesis20 regional or national presentations10 peer-reviewed publications
Healthy South Carolina Hypertension and Diabetes Management and Education Program (HAD-ME)
• Health care team conducted weekly screening, management, and education clinics (with linkages to primary care) in inner-city neighborhoods (1997-2001)
– > 900 community residents with diabetes and/or hypertension participated.
– > 1,100 referrals to primary care
– Significant decreases in BP, blood glucose, and weight
• Health care team conducted weekly screening, management, and education clinics (with linkages to primary care) in inner-city neighborhoods (1997-2001)
– > 900 community residents with diabetes and/or hypertension participated.
– > 1,100 referrals to primary care
– Significant decreases in BP, blood glucose, and weight
REACH 2010: Charleston And
Georgetown Diabetes
Coalition’s Efforts to Decrease
Disparities for Diabetes
REACH 2010: Charleston And
Georgetown Diabetes
Coalition’s Efforts to Decrease
Disparities for Diabetes
Arlene Case-The Lesson
A heath disparity population is “a population where there is significant disparity in the overall rate of disease incidence, prevalence, morbidity, mortality, or survival rates in the population as compared to the health
status of the general population”1.
Minority Health and Health Disparities Research and Education Act of 2000
REACH 2010: Charleston and Georgetown
Diabetes CoalitionTennessee
South Carolina
SC DHECRegion 6
GeorgetownDiabetes
CORE Group
St. James Santee Health
Center
Enterprise HealthCenter
Enterprise Community
Tri County Black
Nurses
MUSCMUHA
Diabetes InitiativeCollege of Nursing
Alpha KappaAlpha Sorority
Franklin C. FetterFamily
Health Center
Trident United Way
GeorgetownGeorgetown
North Carolina
Georgia
CharlestonCharleston
County Library
Statewide REACH home-basedin Columbia:
Communicare SC DHEC SC DPCP
Carolina Center for Medical Excellence
TriCounty FamilyMinisteries
SC DHECRegion 7
County Library
East Cooper Community
OutreachS. SanteeSt. James
Senior Center
Methods and Interventions• Community skill-building and neighborhood clinicsCommunity skill-building and neighborhood clinics
– 175 lay educators trained175 lay educators trained– Diabetes self management educationDiabetes self management education– Foot care trainingFoot care training– Wise Woman for AA women 40-70 years oldWise Woman for AA women 40-70 years old
• Community health professional trainingCommunity health professional training– 145 RNs with advanced foot/wound education145 RNs with advanced foot/wound education– 27 physicians with foot care education27 physicians with foot care education
• Outreach by professional and lay educators Outreach by professional and lay educators – 30 minute TV program aired 34 times on cable30 minute TV program aired 34 times on cable– Library program/Internet useLibrary program/Internet use– Weekly diabetes management classes in 8 sitesWeekly diabetes management classes in 8 sites
• Health systems changeHealth systems change– Registry and reminder systemRegistry and reminder system– CQI teamsCQI teams
• Coalition building and policy changeCoalition building and policy change
• Community skill-building and neighborhood clinicsCommunity skill-building and neighborhood clinics– 175 lay educators trained175 lay educators trained– Diabetes self management educationDiabetes self management education– Foot care trainingFoot care training– Wise Woman for AA women 40-70 years oldWise Woman for AA women 40-70 years old
• Community health professional trainingCommunity health professional training– 145 RNs with advanced foot/wound education145 RNs with advanced foot/wound education– 27 physicians with foot care education27 physicians with foot care education
• Outreach by professional and lay educators Outreach by professional and lay educators – 30 minute TV program aired 34 times on cable30 minute TV program aired 34 times on cable– Library program/Internet useLibrary program/Internet use– Weekly diabetes management classes in 8 sitesWeekly diabetes management classes in 8 sites
• Health systems changeHealth systems change– Registry and reminder systemRegistry and reminder system– CQI teamsCQI teams
• Coalition building and policy changeCoalition building and policy change
Skill-Building forCHAs and Volunteers
Neighborhood Walk and TalkGroups
Individual and Group Education Sessions
Community and Media Activities reached >40,000
African Americans
Community Screening and
Education
50
60
70
80
90
100
1999 2000 2001 2002 2003 2004 2005 2006
African-American
Non-African-American
Percent with > Annual A1c by Race (increased from 76.8% in 1999 to 97.1% in 2006)
0
20
40
60
80
100
1999 2000 2001 2002 2003 2004 2005 2006
African-AmericanNon-African-American
Percent with > Annual Lipid Profile by Race (increased from 47.3% in 1999 to 87.2% in 2006)
Percent with Kidney Testing (microalbuminuria) by Race
(increase from 13.4% in 1999 to 56% in 2006)
0
20
40
60
80
100
1999 2000 2001 2002 2003 2004 2005 2006
Per
cen
t
African-American
Non-African-American
0
20
40
60
80
100
1999 2000 2001 2002 2003 2004 2005 2006
African-AmericanNon-African-American
Percent with > Annual Foot Exam by Race (increased from 64.1% in 1999
to 97.3% in 2006)
0
20
40
60
80
100
1999 2000 2001 2002 2003 2004 2005 2006
African-American
Non-African-American
Percent with BP < 130/80 by Race (increased from 24% in 1999 to 38.2% in 2006)
0102030405060708090
100
1999 2000 2001 2002 2003 2004 2005 2006
African-American
Non-African-American
Percent of Visits with Teaching by Race (increased from 41% in 1999 to 93% in 2006)
Lower Extremity Amputations (1999-2002)
Charleston County
0102030405060708090
1999 2000 2001 2002Rat
e p
er 1
000
dia
bet
es h
osp
ital
izat
ion
s
Total AA FAA MNon AA FNon AA M
0102030405060708090
1999 2000 2001 2002Rat
e p
er 1
000
dia
bet
es h
osp
ital
izat
ion
s
Total AA FAA MNon AA FNon AA M
Although studies documenting disparities are not in short supply, findings about what works to reduce disparities are. A 3-year, $6-million program called Finding Answers: Disparities Research for Change, sponsored by the Robert Wood Johnson Foundation, seeks to identify effective interventions to eliminate disparities.
Under the direction of Marshall Chin, MD, MPH, an associate professor of medicine at the University of Chicago Pritzker School of Medicine, the program reviewed more than 200 journal articles on disparity reduction interventions in cardiovascular disease, depression, diabetes, and breast cancer. The results appeared in October 2007 in a supplement to Medical Care Research and Review.
One of the few studies in the review that showed a reduction in racial disparities was part of the Racial and Ethnic Approaches to Community Health (REACH 2010) program, sponsored by the US Centers for Disease Control and Prevention in Atlanta, Ga. The demonstration program, which took place in Charleston and Georgetown counties in South Carolina, brought together 28 community partners, from health professionals to college sororities and local media, that set goals to improve diabetes care for blacks as well as eliminate health care disparities between black and white patients with diabetes.
The partners documented disparities in care for 12,000 black patients with diabetes in the 2-county community. The intervention included such community activities as health fairs, support groups, grocery store tours, community clinics, and church-based educational programs. After 24 months, the partners audited medical charts for 158 black patients and 112 patients who were white or of other racial or ethnic groups. They found that differences between black and white patients in rates of hemoglobin A1c testing, lipid and kidney testing, eye examinations, and blood pressure control that had ranged from 11% to 28% at baseline had been eliminated (Jenkins C et al. Public Health Rep. 2004;119[3]:322-330).
Chin is optimistic that other communities will develop their own, similar programs in the future. "There are a lot of promising models," he says. "But you may have to revise as you go along, just like in patient care."
Quote from R. Voelker in JAMA 2008;299(12):1411-1413.
Although studies documenting disparities are not in short supply, findings about what works to reduce disparities are. A 3-year, $6-million program called Finding Answers: Disparities Research for Change, sponsored by the Robert Wood Johnson Foundation, seeks to identify effective interventions to eliminate disparities.
Under the direction of Marshall Chin, MD, MPH, an associate professor of medicine at the University of Chicago Pritzker School of Medicine, the program reviewed more than 200 journal articles on disparity reduction interventions in cardiovascular disease, depression, diabetes, and breast cancer. The results appeared in October 2007 in a supplement to Medical Care Research and Review.
One of the few studies in the review that showed a reduction in racial disparities was part of the Racial and Ethnic Approaches to Community Health (REACH 2010) program, sponsored by the US Centers for Disease Control and Prevention in Atlanta, Ga. The demonstration program, which took place in Charleston and Georgetown counties in South Carolina, brought together 28 community partners, from health professionals to college sororities and local media, that set goals to improve diabetes care for blacks as well as eliminate health care disparities between black and white patients with diabetes.
The partners documented disparities in care for 12,000 black patients with diabetes in the 2-county community. The intervention included such community activities as health fairs, support groups, grocery store tours, community clinics, and church-based educational programs. After 24 months, the partners audited medical charts for 158 black patients and 112 patients who were white or of other racial or ethnic groups. They found that differences between black and white patients in rates of hemoglobin A1c testing, lipid and kidney testing, eye examinations, and blood pressure control that had ranged from 11% to 28% at baseline had been eliminated (Jenkins C et al. Public Health Rep. 2004;119[3]:322-330).
Chin is optimistic that other communities will develop their own, similar programs in the future. "There are a lot of promising models," he says. "But you may have to revise as you go along, just like in patient care."
Quote from R. Voelker in JAMA 2008;299(12):1411-1413.
REACH US:SouthEastern African American Center of
Excellence for Eliminating Disparities for Diabetes
REACH US SEA-CEEDREACH US SEA-CEED
REACH US Center of Excellence
• A coordinated multi-system, multi-media, intergenerational approach to prevention and control of diabetes and its cardiovascular complications to eliminate health disparities in African Americans at risk and with diabetes.
• A coordinated multi-system, multi-media, intergenerational approach to prevention and control of diabetes and its cardiovascular complications to eliminate health disparities in African Americans at risk and with diabetes.
Geographical Areas: African
Americans with
Diabetes and Stroke in
North Carolina,
South CarolinaGeorgia
Centers for Disease Control and Prevention
REACH US CEED MUSC College of Nursing
Diabetes Initiative of South CarolinaCollege of Nursing
REACH USCharleston and Georgetown
Diabetes Coalition
National African American Networks Alpha Kappa Alpha Sorority
Black Nurses Association (Professional Organization)Urban League
Baptist Association and COOLJC
Community and Systems Change Health Systems Change
Regional and National NetworksSoutheastern Region of
American Diabetes AssociationCarolinas and Georgia Chapter off
American Society of HTNNational and Regional Network of Libraries of Medicine
Statewide InstitutionsDiabetes Initiative of South Carolina
South Carolina DHECDiabetes Prevention and Control Program
Medical University of South CarolinaCenter for Health Care Disparities
South Carolina State Library
Stroke Belt Counties in Georgia, SC, NC
What is needed to improve diabetes care and outcomes in African
Americans in South Carolina?
IOM’s 8 Competency Areas
• Informatics• Genomics• Cultural competence• Communications• Community based participatory research• Ethics• Policy and law• Global health
Gebbie et al. (2001)
• Informatics• Genomics• Cultural competence• Communications• Community based participatory research• Ethics• Policy and law• Global health
Gebbie et al. (2001)
Evidence-Based Practice
• Practice supported by research findings and/or demonstrated as being effective through a critical examination and review of current and past practices. EBP integrates patient preferences with research evidence, to determine best course of action to improve health.
• Practice supported by research findings and/or demonstrated as being effective through a critical examination and review of current and past practices. EBP integrates patient preferences with research evidence, to determine best course of action to improve health.
45
Listen to the Stories
While the stories are being told, don’t offer solutions too early!!
Work together to identify the issues and
develop the solutions.
46
Go to the people.Live among the people.Learn from the people.Work with the people.
Start with what the people know.Build on what the people have.
Teach by showing, learn by doing.Not a showcase but a pattern.
Not odds and ends, but a system.Not piece meal, but an integrated
approach.
Social & Economic Policies
Institutions
Neighborhoods/Communities
Living Conditions
Social Relationships
Individual Risk Factors
Genetic/Constitutional Factors
Pathophysiologic Pathways
Individual and Population Health
Life
Cou
rse
Environment
Determinants of Health from National Academy of Sciences, Epidemiology Review 2004;26:124-125
Informed,ActivatedPatient
ProductiveInteractions
Prepared,ProactivePractice Team
Improved Outcomes
DeliverySystemDesign
DecisionSupport
ClinicalInformation
Systems
Self-Management
Support
Health System
Resources and Policies
Community
Health Care Organization
Chronic Care Model
Wagner, E. H. (1998). Chronic disease management: What will it take to improve care for chronic illness? Effective Clinical Practice(1), 2-4.
A Model for Chronic Illness Care
Delivery System
Design
DecisionSupport
Clinical Information
Systems
Self-Management Support
Health System Organization
Links to Community Resources
Leadership support
Provider participation
Coherent system QI
Guidelines
Provider education
Expert support
Registry
Info for care management
Performance data
Care man. roles
Practice team
Care coordination
Proactive follow-up
Planned visit
Visit system changes
Patient education
Patient activation
Self-management assessment
Self-management resources
Collaboration on decisions
Guidelines to patients
For patients
For community
Adapted from: Wagner, E. H. (1998). Chronic disease management: What will it take to improve care for chronic illness? Effective Clinical Practice(1), 2-4.
World Health Organization Social Ecology Adaptation of Wagner’s Chronic Care Model
• Notice the added community involvement
• Still low on patient, family & social network participation or accounting for sociocultural variations
• Taken from Epping-Jordan, J., Pruitt, S., Bengoa, R., and Wagner, E. (2004). Improving the quality of health care for chronic conditions. Quality and Safety in Health Care, 13, 200-305. doi:10.1136/qshc.2004.010744
Community Resource Systems2
Community Information System
Community & Service System
Design
Community Decision Support
Self-Management Support
Clinical Information System
Delivery System Design
Clinical Decision Support
Patient Self-Management
Support
Prepared, Proactive HealthSystems
Policies & Actions Social,
Health, &Economic
Informed, Activated Persons
External Environment,1 Resources, and Dissemination influences:
Prepared, Proactive Community
Systems
Improved Community-Wide Health Outcomes and Elimination of Health Disparities
Influences Influences
Health Care Provider Systems
Conceptual Model for REACH US: Charleston and Georgetown Diabetes Coalition
(adapted from Jenkins et al., Barr et al. , Wagner)
1 Environment is viewed through an ecological framework and includes social, political, and economical aspects.2 To categorize the various community resource systems, we use the Community Systems Wheel (Anderson and McFarland, 2006). The systems include: Health and Social Services, Politics and Government, Safety & Transportation, Education, Communication, Economics, Recreation, and Physical Environment. We added Faith-based Services.
Community-Based Participatory Action Research
• A collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community, has the aim of combining knowledge with action and achieving social change.
• A collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community, has the aim of combining knowledge with action and achieving social change.
WK Kellogg Foundation Community Health Scholars Program
Fundamental Characteristics of CBPAR
• It is:– participatory.
– cooperative, engaging community members and researcher(s) in a joint process with both contributing equally.
– a co-learning process.
– an empowerment process through which participants can increase control over their lives.
• It is:– participatory.
– cooperative, engaging community members and researcher(s) in a joint process with both contributing equally.
– a co-learning process.
– an empowerment process through which participants can increase control over their lives.
54
Fundamental Characteristics of CBPAR
• It involves systems development and local community capacity building.
• It achieves a balance between research and action. (Israel et al. 1998)
• It involves sharing of funding among partners (usually equally).
• It involves systems development and local community capacity building.
• It achieves a balance between research and action. (Israel et al. 1998)
• It involves sharing of funding among partners (usually equally).
• Understanding cultures– Community culture– Academic and institutional culture
• Differing philosophies.
• Sharing of budgets in an equitable way.• Clearly defining and continuously
implementing our principles for the partnership in a fair and equitable way.
• Understanding cultures– Community culture– Academic and institutional culture
• Differing philosophies.
• Sharing of budgets in an equitable way.• Clearly defining and continuously
implementing our principles for the partnership in a fair and equitable way.
Identified Challenges for Communities and Academic Institutions
Instructions for Community for Partnering with Academic Institutions--Look For People
that:
• Begin their discussions with you by asking questions, rather than offering solutions.
• Recognize the gap between measuring differences and making differences.
• Demonstrate a willingness to help you measure the differences you make.
• Share control over financial resources and decisions with community representatives.
• Express commitment to a working relationship built on trust and equity.
Prev Chronic Dis. 2004 January; 1(1): A12.
• Begin their discussions with you by asking questions, rather than offering solutions.
• Recognize the gap between measuring differences and making differences.
• Demonstrate a willingness to help you measure the differences you make.
• Share control over financial resources and decisions with community representatives.
• Express commitment to a working relationship built on trust and equity.
Prev Chronic Dis. 2004 January; 1(1): A12.
Common Characteristics of Successful Community-Institutional Partnerships
• Trusting relationships• Equitable processes and procedures• Diverse membership• Tangible benefits to all partners• Balance between partnership process,
activities, and outcomes• Significant community involvement in
scientifically sound research (Continued on next slide)
• Trusting relationships• Equitable processes and procedures• Diverse membership• Tangible benefits to all partners• Balance between partnership process,
activities, and outcomes• Significant community involvement in
scientifically sound research (Continued on next slide)
Seifer, 2006
Common Characteristics of Successful Community-Institutional Partnerships
• Supportive organizational policies/reward structure• Leadership at multiple levels• Culturally competent and appropriately skilled staff
and researchers• Collaborative dissemination• Ongoing partnership assessment, improvement
and celebration• Sustainable impact
• Supportive organizational policies/reward structure• Leadership at multiple levels• Culturally competent and appropriately skilled staff
and researchers• Collaborative dissemination• Ongoing partnership assessment, improvement
and celebration• Sustainable impact
Seifer, 2006
Recommendations for Emerging and Established Partnerships
• Pay close attention to membership issues• Build on prior history of positive working
relationships• Obtain support and involvement of both top
leadership and “front line” staff of partner organizations
• Embrace diversity in the partnership• Decide who the “community” is and who
“represents” the community.
• Pay close attention to membership issues• Build on prior history of positive working
relationships• Obtain support and involvement of both top
leadership and “front line” staff of partner organizations
• Embrace diversity in the partnership• Decide who the “community” is and who
“represents” the community.
Seifer, 2006
Recommendations for Emerging and Established Partnerships (continued)
• Develop rationale, criteria and procedures for adding new partners
• Develop structures and processes that facilitate the development of trust and sharing of influence and control among partners
• Jointly develop partnership principles and operating procedures
• Jointly create mission, vision, and priorities for the partnership
• Develop rationale, criteria and procedures for adding new partners
• Develop structures and processes that facilitate the development of trust and sharing of influence and control among partners
• Jointly develop partnership principles and operating procedures
• Jointly create mission, vision, and priorities for the partnership
Seifer, 2006
Recommendations for Emerging and Established Partnerships (continued)
• Strive to achieve an equitable distribution of costs, benefits, and resources among the partners
• Conduct ongoing evaluation of partnership process• Build the capacity of all partners • Plan ahead for sustainability• Pay close attention to the balance of activities within
the partnership• Be strategic about dissemination
• Strive to achieve an equitable distribution of costs, benefits, and resources among the partners
• Conduct ongoing evaluation of partnership process• Build the capacity of all partners • Plan ahead for sustainability• Pay close attention to the balance of activities within
the partnership• Be strategic about dissemination
Seifer, 2006
Build Capacity of All Partners
• Facilitate partner training, technical assistance and continuing education
• Invest partnership resources in local community
• Establish and maintain partnership infrastructure
• Facilitate partner training, technical assistance and continuing education
• Invest partnership resources in local community
• Establish and maintain partnership infrastructure
Seifer, 2006
63
Cultural Humility:
“A life long commitment to self evaluation and self critique” to redress power imbalances and “develop and maintain respectful and dynamic partnerships with communities”
Tervalon & Garcia, 1998
“A life long commitment to self evaluation and self critique” to redress power imbalances and “develop and maintain respectful and dynamic partnerships with communities”
Tervalon & Garcia, 1998
64
Assets in CommunityFrom: Kretzmann & McKnight. (1993) Building Communities from the Inside Out
65
Identifying Natural Community Leaders
When you have a problem, who do you go to for advice?
Who do others go to?
When people in the neighborhood have come together around a problem in the past, did a particular individual or group play a key role?
What things do people tell you you’re good at?
Eng et al, 1990; Israel, 1985; Sharpe, 2000
Insider-Outsider Tensions
• Power dynamics; the “power of authority” of the outsider’s often multiple sources of unspoken privilege (Wallerstein, 1999)
• Conflicting time tables & demands
• Differential reward structures (Minkler, 2006)
• Power dynamics; the “power of authority” of the outsider’s often multiple sources of unspoken privilege (Wallerstein, 1999)
• Conflicting time tables & demands
• Differential reward structures (Minkler, 2006)
Perceived clash between community desires and “good
science”
68
““We want to know We want to know how much you care, how much you care, before we know how before we know how much you know.”much you know.” Alma Joseph FloresAlma Joseph Flores Enterprise CommunityEnterprise Community
Partnership
• A strategic combining of resources that create power far beyond the capabilities of individual players working alone.
• A strategic combining of resources that create power far beyond the capabilities of individual players working alone.
Thanks to Our Team (and to you)!• REACH Community Partners and Staff
– Gayenell Magwood, Barbara Carlson, Jane Zapka, Martina Mueller, Leonard Egede, Marilyn Laken, Montrese Edwards, Virginia Thomas, Joyce Linnen, Lee Moultrie, Sonja Smalls, Syndia Moultrie, Karen Hill, George Bush
• REACH Partners Coaltion
• Charleston Diabetes Coalition
• Georgetown Diabetes CORE Group• Diabetes Initiative of South Carolina
– Dr.John Colwell – Dr. Kathie Hermayer– Dr. Dan Lackland– Dr. Brent Egan– Pamela Arnold
• SC Diabetes Prevention and Control Program
• Centers for Disease Control and Prevention• National Institutes of Health-NIDDK• American Diabetes Association
• REACH Community Partners and Staff– Gayenell Magwood, Barbara Carlson, Jane Zapka, Martina Mueller,
Leonard Egede, Marilyn Laken, Montrese Edwards, Virginia Thomas, Joyce Linnen, Lee Moultrie, Sonja Smalls, Syndia Moultrie, Karen Hill, George Bush
• REACH Partners Coaltion
• Charleston Diabetes Coalition
• Georgetown Diabetes CORE Group• Diabetes Initiative of South Carolina
– Dr.John Colwell – Dr. Kathie Hermayer– Dr. Dan Lackland– Dr. Brent Egan– Pamela Arnold
• SC Diabetes Prevention and Control Program
• Centers for Disease Control and Prevention• National Institutes of Health-NIDDK• American Diabetes Association
