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

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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

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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.

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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.

,

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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)

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Improved Health Outcomes

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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)

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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).

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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

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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)

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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

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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

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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)

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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)

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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)

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Cultural Competence

Culturally competent organizational factors and direct service strategies to increase access, availability and utilization of behavioral health services and supports.

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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)

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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

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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.

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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)

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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)

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Neighborhood

Solutions

Family

Networks

Neighborhood

Pride

Community Strengths

Value

Education

Power of the

Church

Youth

Achievement

Traditional

Organizations

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Minority Health Conference

Creating a Culturally Competent

Approach

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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)

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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)

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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

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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