Greater New Brunswick Community Health Collaborative

Sergio Aguilar-GaxiolaProfessor of Clinical Internal Medicine

Director, Center for Reducing Health DisparitiesUC Davis School of Medicine

New Brunswick, NJMarch 31, 2015

The Power of Community Engagement for Health Improvement

I have no relevant financial interest/arrangement or affiliation with

any organizations related to commercial products or services

to be discussed at this presentation

Disclosure

The Bottom Line

Enhancing the health of our communities

A critical ingredient:

Community Engagement

Why Engage Communities

Community engagement and collaboration is a cornerstone of effective public health practice

Successful community engagement builds skills and capacity within the community

Communities are essential in proactively looking for effective, long-term, and sustainable solutions for reducing health disparities

Community involvement is crucial in the recruitment and retention of diverse groups’ participation in health research

Community-engaged Research

A framework or approach for conducting research

May incorporate both qualitative and quantitative methods

Recognizes and builds on community strengths and assets

Characterized by principles that guide the research

Requires partnership development, cooperation and negotiation, and collaboration with community partners and a commitment to addressing local health needs and issues

Source: Lasker & Weiss, 2003; Minkler, 2005; McDonald, 2009

CTSA Consortium

Congress authorized funding about 10 years ago for the CTSA consortium.

Its primary goal is to speed the process of translating basic research discovery into clinical application, clinical practice, and, ultimately, improved population health.

CTSAs provide critical tools and resources to improve health

Currently there are 62 CTSA sites in 30 states at a cost of about $500 million per year

Building a National CTSA Consortium

Members

CTSA States

Participating Institutions

CTSAs Provide Critical Tools and Resources to Improve Health

CTSAs provide a foundation for clinical and translational research by:

Providing specialized infrastructure support to NIH-funded scientists.

Engaging community partners to connect scientists with those who both are underrepresented and could benefit from research.

Training the next generation of clinical and translational scientists.

Learning and Disseminating Best PracticesPrinciples of Community Engagement

This booklet will impact the community at large by providing a guide for researchers when interacting with communities in research efforts through either implementation or through actual research activities (English and Spanish).

PRIMER

A standard research toolkit and website to support practice-based researchers across the country, from HMOs to small local networks.

Community Engagement Studios

Structured process of eliciting project-specific input. May be used in any phase of translational research. Stakeholders selected based on researchers’ needs. An experienced core team identifies stakeholders and prepares them for engagement; reduces burden to researcher

https://victr.vanderbilt.edu/pub/message.html?message_id=161

http://researchtoolkit.org

• On line English and Spanish: http://www.atsdr.cdc.gov/communityengagement

• Print copies: www.atsdr.cdc.gov/communityengagement/pce_printcopy.html

Follow the Principles of Community Engagement

How do you do meaningful community-engaged research or work?

Continuum of Community-Based Research:Community Engagement Core: N.M. CARES Health Disparities Center

University of New Mexico

Source: Wallerstein, 2014

Levels of Community Involvement

Source: Principles of Community Engagement (2nd Ed.), 2011

The Critical Role of Community Engagement

■ Partnerships with community stakeholders can: o identify community health needs

and priorities;

o provide critical input and data on clinically relevant questions;

o develop culturally appropriate clinical research protocols;

o promote successful enrollment and retention of research participants; and

o disseminate and implement research results more effectively.

Source: IOM CTSA Program at NIH report, 2013 (pg. 10).

Recommendation 6: Ensure Community Engagement in All Phases of Research

NCATS and the CTSA Program should ensure that patients, family members, health care providers, clinical researchers, and other community stakeholders are involved across the continuum of clinical and translational research.•ensure active and substantive community stakeholder participation in priority setting and decision making across all phases of clinical and translational research and in the leadership and governance of the CTSA Program…

Background – IOM Report Recommendations

Engaging Communities in the Full Spectrum of Translational Research

Source: Kaufmann, 2015

Collaboration/Engagement Domain Task Force

Lead Team• Sergio Aguilar-Gaxiola, UC Davis (co-chair)

• Julian Solway, Univ. of Chicago (SC appointee, co-chair)

• Ronald Ackermann, Northwestern University

• Nancy Bennett, University of Rochester

• Consuelo Wilkins, Vanderbilt University (partnering withMeharry Medical College)

• Meryl Sufian, NCATS (DCI representative)

• Leslie Boone, C4 (Project Manager)

CollaborationA collaborative effort to address a scientific challenge that leverages the strengths and expertise of professionals and other stakeholders from different fields or backgrounds. [adapted from NCI Team Science Toolkit definition of Team Science]

EngagementA bidirectional relationship between the stakeholder and researcher that results in informed decision-making about the selection, design, conduct, and use of research. [PCORI]

So, for the Collaboration and Engagement DTF …

NCATS Advisory Council WG Recommendations for Collaboration/Engagement

Collaboration/Engagement Goal: Stakeholders are engaged in collaborations to advance translation.

This goal focuses on: 1. Engaging stakeholder communities so they contribute

meaningfully across the translational sciences spectrum.

2. Enabling team science to become a major academic model.

3. Ensuring that all translational science is performed in the context of collaborative team science and that shared leadership roles are the norm throughout the entire translational science process.

Community Engagement Challenges

People. How are we going to manage the simultaneous clinical, research, and educational challenges, when the academicians who do community engagement and who can bridge the cultures are few?

Metrics. What outcomes should we be measuring? What are the measures that matter to individuals, to communities, to researchers, to decision-makers, to health system administrators?

Sustainability. How will the efforts be sustained?

The Road(s) Ahead: Outcomes that Matter

Who Benefits?

Matter to Whom?

Who Defines the Outcomes?

How do We KnowWhen we Get There? Wrong Turn!

■ Developed a taxonomy framework looking for a unified approach that allows for monitoring progress in improving population health outcomes while including the interests and priorities of community stakeholders.

■ Did a comprehensive literature review of 21 health indicator projects and these were synthesized and categorized into either international (multi-country), national (one country), or local jurisdictions (state, county, or special population).

Academic Medicine, 89(4), 564–572.

Determinants of Health

Classes of Indicators

Quantifiable Measurements

have

which include

Source: Aguilar-Gaxiola, Ahmed, Franco, et al., 2014.

Taxonomy of Community Health Indicators

{1st Level

{2nd Level

{3rd Level

Source: Aguilar-Gaxiola, Ahmed, Franco, et al., 2014.

Determinants of Health■ Health system services

■ General health status

■ Health-related quality of life and well-being

■ Personal behavioral factors

■ Community socioeconomic composition

■ Disparities

■ Social cohesion

■ Social structureSource: Aguilar-Gaxiola, Ahmed, Franco, et al., 2014.

Session Title: Effective Community-Engaged Approaches to Improving Community Health and Reducing Health Disparities in Underserved Populations: Are we There Yet?

HealthStreet: An Innovative Community Engagement Model to Detect Needs and Concerns of Underserved Populations – Linda Cottler, PhD

The Steps Model: Methods and Metrics for Community-Engaged Research with Underserved Communities – Alex Adams, MD, PhD

A Cultural Transformation Model: Increasing Access and Improving Culturally and Linguistically Competent Services and Outcomes to Filipino and Latino Underserved Communities – Sergio Aguilar-Gaxiola, MD, PhD

Solano County, CA Cultural Transformation Model

Develop collaborative network of community, county, and CBO leaders trained on CLAS standards

Design and Implement CLAS policies, procedures, and programs

Address the mental health needs of three of Solano County’s most underserved communities (i.e., Filipinos, Latinos, and LGBTQ)

Transforming Solano County through the MHSA Innovations

Program

1. Develop collaborative network and train community, county, and CBO leaders on CLAS

1. Design and implement policies and systems to promote CLAS

1. To address the mental health needs of Solano County’s two most underserved communities

County CBOs

Community

Phase I: Engagement & Organizations’ Cultural Assessment

Determine what matters to community, county, CBOs, and researchers and strike a balance

County CBOs

Community

CLAS Teams andQI Projects

Phase II: CLAS Transformational Curriculum

Health System Transformation through

Culturally and Linguistically Appropriate

Services (CLAS)

Train health systems leaders to design and implement culturally and linguistically appropriate services

Year Quarter 1 Quarter 2 Quarter 3 Quarter 4One • Recruit staff for project

• CRHD attend community forums/agency meetings to foster CRHD-Solano relationship

• Identify cultural brokers and key informants

• Identify County data sources to establish baseline

• Initiate key informant Interviews

• Analyze County data sources

• Continue to build CRHD-Solano Relationships

• Plan and starting to conduct focus groups

• Plan community forums• Plan interviews with CBOs• Plan focus groups with

cultural competency advisory workgroups (Latino, Filipino-American and LGBTQ)

• Analyze Key Informant Interviews

• Conduct focus groups and community forums

• Conduct focus groups with cultural competency advisory workgroups

• Analyze community forum and focus group data

• Starting to customize CLAS Transformational Curriculum based on information gained through key informant interviews, focus groups, and community forums.

• Recruit for participants CLAS Transformational Curriculum

• Train CLAS Transformational Curriculum Trainers

Two • Customize CLAS Transformational Curriculum

• Recruit cohorts

• Train Cohort 1• Cohort 1 implementation

process

• Train Cohort 2• Cohorts 1

implementation process

• Train Cohort 3• Cohorts 1 and 2

Implementation Process

Three • CLAS Transformational Curriculum Conference

• Design and disseminate CLAS Strategies Sourcebook

• Implementation Process

Implementation and Ongoing Quality Improvement Process

Four • Implementation and Ongoing Quality Improvement Process• Design and disseminate CLAS Implementation Tips Sourcebook• Recruit and train CLAS sustainability coordinator

• Design evaluation methods to measure county wide impact of CLAS on patient satisfaction and outcomes and effectiveness of the efforts of the Solano County governance, leadership and workforce.

Five • Continue work with the CLAS sustainability coordinator

• Convene CLAS Sustainability Symposium

• Implement Countywide CLAS evaluation process

• Design and Implement CLAS Sustainability Plan

• Design and disseminate resources on the Solano County CLAS Transformation Process

Table 2. Timeline and Activities

Outcomes■ Short-term (i.e., increased bidirectional trust,

communication, and collaboration). Use metrics re: what matters to communities, county, CBOs, and researchers and reach a balance

■ Intermediate-term (i.e., increased community capacity to engage in joint decisions re: service delivery AND county and CBOs capacity to engage with communities): Enhance the experience of care, improve health outcomes, and lower the costs (Triple Aim)

■ Long-term outcomes: Achieve health equity in access and utilization of mental health services by Filipinos, Latinos, and LGBTQ communities

Is it possible to improve community health by

focusing primarily in access to care?

Source: Schroeder, 2007

“Even if the entire U.S. population had access to excellent medical care —which it does not — only a small fraction of these deaths could be prevented. The single greatest opportunity to improve health and reduce premature deaths lies in personal behavior. In fact, behavioral causes account for nearly 40% of all deaths in the United States” (p. 1222).

Determinants of Health

Source: Miller, 201439

The Affordable Care Act (ACA)

Source: Figueroa, 2013

Conclusions There is a growing national and local interest in

community engagement driven by an understanding that:▬ Some learning, teaching and research goals

can only be achieved through collaborative relationships with local communities

▬ Academic institutions have a responsibility to contribute to “the public benefit” of their surrounding communities

Communities and campuses will benefit from working collaboratively with each other and forging partnerships to improve community health.

We are all on this together.Source: Michener, 2012

“Go in search of people. Begin with what they know. Build on

what they have”

Chinese proverb