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RSS Annual Conference 2012 Chicago

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  • Chicago Center for Excellence in Health Promotion Economics Workshop Chicago, IL 10/18/2007 Project EXPORT Community Outreach Core - UIC Rockford
  • Chicago Center for Excellence in Health Promotion Economics Workshop Chicago, IL 10/18/2007 Project EXPORT Community Outreach Core - UIC Rockford
  • Chicago Center for Excellence in Health Promotion Economics Workshop Chicago, IL 10/18/2007 Project EXPORT Community Outreach Core - UIC Rockford
  • Chicago Center for Excellence in Health Promotion Economics Workshop Chicago, IL 10/18/2007 Project EXPORT Community Outreach Core - UIC Rockford
  • Chicago Center for Excellence in Health Promotion Economics Workshop Chicago, IL 10/18/2007 Project EXPORT Community Outreach Core - UIC Rockford
  • Chicago Center for Excellence in Health Promotion Economics Workshop Chicago, IL 10/18/2007 Project EXPORT Community Outreach Core - UIC Rockford
  • Chicago Center for Excellence in Health Promotion Economics Workshop Chicago, IL 10/18/2007 Project EXPORT Community Outreach Core - UIC Rockford
  • Chicago Center for Excellence in Health Promotion Economics Workshop Chicago, IL 10/18/2007 Project EXPORT Community Outreach Core - UIC Rockford
  • Chicago Center for Excellence in Health Promotion Economics Workshop Chicago, IL 10/18/2007 Project EXPORT Community Outreach Core - UIC Rockford
  • Chicago Center for Excellence in Health Promotion Economics Workshop Chicago, IL 10/18/2007 Project EXPORT Community Outreach Core - UIC Rockford
  • Chicago Center for Excellence in Health Promotion Economics Workshop Chicago, IL 10/18/2007 Project EXPORT Community Outreach Core - UIC Rockford
  • Chicago Center for Excellence in Health Promotion Economics Workshop Chicago, IL 10/18/2007 Project EXPORT Community Outreach Core - UIC Rockford
  • Chicago Center for Excellence in Health Promotion Economics Workshop Chicago, IL 10/18/2007 Project EXPORT Community Outreach Core - UIC Rockford
  • Chicago Center for Excellence in Health Promotion Economics Workshop Chicago, IL 10/18/2007 Project EXPORT Community Outreach Core - UIC Rockford
  • Chicago Center for Excellence in Health Promotion Economics Workshop Chicago, IL 10/18/2007 Project EXPORT Community Outreach Core - UIC Rockford
  • Chicago Center for Excellence in Health Promotion Economics Workshop Chicago, IL 10/18/2007 Project EXPORT Community Outreach Core - UIC Rockford
  • Chicago Center for Excellence in Health Promotion Economics Workshop Chicago, IL 10/18/2007 Project EXPORT Community Outreach Core - UIC Rockford
  • Chicago Center for Excellence in Health Promotion Economics Workshop Chicago, IL 10/18/2007 Project EXPORT Community Outreach Core - UIC Rockford
  • Chicago Center for Excellence in Health Promotion Economics Workshop Chicago, IL 10/18/2007 Project EXPORT Community Outreach Core - UIC Rockford
  • Chicago Center for Excellence in Health Promotion Economics Workshop Chicago, IL 10/18/2007 Project EXPORT Community Outreach Core - UIC Rockford
  • The HHAC of Carbonale/Cobden Illinois was established in 2005. Its purpose was to identify Hispanic health needs, provide culturally sensitive and relevant health programs, and fill healthcare gaps to meet priority needs.
  • HHAC members are affiliated with one or more of 3 faith-based organizations; The Old School where Cecilia and I volunteered, Jesus Es El Senor United Methodist Church where Aurelia is and the Catholic Church where numerous members go. We decided that the folks at the Catholic Church would be comfortable attending functions at the community center or the Catholic Church in Carbondale. Initially, I traveled the 15 miles to the Methodist Church in Cobden to assist Aurelia with the research activities. Eventually she assumed responsibility for all aspects of the activities there.
  • The HHAC rented the community pool for 3 hours on 8 Sundays during the summer.
  • HHAC negotiated reduced rates with the Black ’s Martial Arts Academy and also partially subsidized monthly fees for several children and adults.
  • Transcript

    • 1. RSS 75th Annual MeetingDiversity Gathering RoomCommunity Research with RuralHispanics in Southern Illinois:Issues, Approaches and ChallengesPanel –Cathy Bless- Shawnee HealthServices Aurelia ZaragozaSouthern Illinois Hispanic MinistryBen MuellerAvicenna Community HealthCenter
    • 2. Panel Overview: Telling our Story• Background of the Panelists• Roles we have played using the Community Participatory Research Approach – Partnership Building – Assessment and data collection – Problems/Issues Identification – Program development and implementation – Evaluation and Dissemination• Questions and Discussion
    • 3. Before we get started: Rationale for CBPAR and its Linkages to Local Solutions to Inequality• My CBPAR Research grounded in Human Rights and Social Justice perspectives – Undocumented Hispanic Immigrant population – Uninsured and underinsured families with health disparities – Rebuilding a local safety net for at risk families with Free Clinics • Faith-based free clinics • FQHCs and community healthcare partnerships• My Discipline Expertise – Community Health research and outreach – Rural Community and Economic Development – Multi-media Studies
    • 4. A Social Justice Perspective as it relates to Health Disparities• Health Disparity/Equity Frameworks (NIH 2002; DHHS 2000; WHO 1986)• Equity in health is the absence of systematic disparities in health (or in the major social determinants of health) between groups with different levels of underlying social advantage/disadvantage (e.g. wealth, power, prestige) – Starfield, 2000
    • 5. Community, Evaluation and Dissemination Research: Frameworks, Models and Approaches: Health Disparities Research• Vulnerability Model (Shi and Stevens, 2005)• CBPAR approach (Israel 2003; Fals-Borda 1987; Freire 1982)• Evidence based practice approach (Brownson 1999; CDC 2001)• Practice based evidence approach (Green, 2007)
    • 6. Community Research Strategic Objectives equity… – …to address health disparity and promote health• Identify and engage community partners in the joint conduct of in health-related research to reduce health and health care disparities using evidence-based disease prevention and intervention activities in rural underserved communities in Illinois• Implement and evaluate a practice based evidence model of community research using a participatory approach that encourages and equips the community in addressing their own health-related priorities• Build capacity in the community to create and deliver health information that is culturally sensitive and appropriate to needs of rural and underserved populations• Enhance the abilities of community members and health providers to identify and resolve health and health care disparities
    • 7. What is Health Disparity?• Differences in the incidence, prevalence, mortality and burden of diseases and other adverse health conditions and health states that exist among specific population groups (NIH, 2000)• Disparity manifests as shorter life expectancy and higher rates of CVD, cancer, infant mortality, birth defects, diabetes, stroke, STD’s and mental illness among others• Disparity among population groups is also evident at the health care delivery system level, in differential rates of access and use of services
    • 8. Types of Health Disparities• Health Status AND/OR Health Outcomes• Individual personal factors – biological/genetic, sociodemographic, socioeconomic, disabilities, residency, cultural norms and values, literacy levels, familial influences, environmental/occupational exposures• Societal/System factors – Social resource distribution, social and political advantages such as knowledge and social connections, insurance status, transportation/geography, distribution of health resources (clinics, health professionals training and approaches or patterns in providing care)
    • 9. Social Justice Linkages: Vulnerability Model• In rural communities, health disparities in underserved populations have adverse effects on health care institutions, schools and business• Negative social/economic impacts are related to access/navigational issues in the health care institutions (System)• Susceptibility to risk factors aligned to cultural background (Individual)
    • 10. Social Justice Linkages: Vulnerability ModelVulnerability Model of Perceived Access Barriers for Rural Hispanic Immigrants Individual Models Systems Models Health insurance Health insurance High costs of High costs of Healthcare services Healthcare services Communication Communication Legal Status / Legal Status / Documentation and Individual and Systems Interaction Discrimination Model Transportation Documentation and Discrimination Transportation
    • 11. Community Based Participatory Action Research(CBPAR): Historical Foundations of Social Justice • PAR – Commitment to social transformation – Origins in Latin America (Fals-Borda, Freire) – Focus on oppressed and underserved populations • CBPR – Commitment to evidence-based scientific rigor – Emphasis on diverse partnership building – Grounding in ecological model of health
    • 12. Partnership Formation: EXPORT formed Hispanic Health Advisory Committees• Formed and supported 10 pilot Hispanic Health Advisory Committees (HHAC) in 14 IL communities• Stakeholders involved (based on preliminary HHAC evaluation; n=35): • Community Hospitals (5) • Non-Hispanic CBOs (1) • • State/County Government Org (5) City Officials (1) • School Districts (3) • Social Service Org (1) • Higher Education Org (12) • State Legislator (1) • Community Foundations (2) • Private Healthcare Providers • Hispanic CBOs (2) (1) • FBOs (2) • Private Clinics (1)
    • 13. Assessment Objectives– Assess rural Illinois Hispanics’ major health concerns in order to identify health disparity issues and help focus prevention efforts– Disseminate results to Hispanic Health Advisory Committees (HHACs) to inform their local implementation plans; and to rural practitioners to inform their clinical or public health practice
    • 14. Assessment Phase• Identify needs and appropriate research questions – Examine existing data (epidemiological, behavioral, archival, ethnographic, etc) and identify data needs – Develop exploratory research questions in collaboration with the partnerships
    • 15. Research Questions• What are rural Illinois Hispanics’ major… – perceived health concerns? – perceived risk factors? – perceived barriers to access healthcare? – preferred health education strategies?
    • 16. Implementation Phase:– Develop a minigrant proposal based on the findings from the Assessment phase • Problem description (use of assessment results) • Partnership description • Proposed activities • Budget • Timeline • Technical assistance needs
    • 17. Community Activities
    • 18. Importance of EvaluationThe whole evaluation process has to lead to self-determination. This means that any evaluationprocess has to be empowering to thestakeholders/community and give them somethingthat benefits them…something that gives them moreknowledge about what is happening in the project,the program and/or the community.
    • 19. Dissemination Phase:• Translational Research Framework• Translation Research characterizes the sequence of events (i.e., process) in which a proven scientific discovery is successfully institutionalized integrated into established practice and policy. Comprised of dissemination research, implementation research and diffusion research. • Dissemination Research is the systematic study of how the targeted distribution of information and intervention materials to a specific public health audience can be successfully executed to increase spread of knowledge.•  • Implementation Research is the systematic study of how a specific set of activities and designed strategies are used to successfully integrate an evidence-based public health intervention within specific settings.•  • Diffusion Research is the systematic study of the factors necessary for successful adoption by stakeholders and the targeted population of an evidence-based intervention which results in widespread use. 
    • 20. Dissemination Phase: Activities Dissemination Efforts/Activities Number of Products ProducedAssessment Reports 840Flyers: Health Ed/Capacity Building 5,700Newsletter Articles 1,250News Releases/Newspaper Articles 18Resources Guides/Newsletters 3,000Mass Media (TV and Radio) 6Community Informational Activities 4Health Fairs 3Educational Workshops 37
    • 21. Some Final Reflections to Communicate: Evidence and Practice Practice and Evidence• If we want more evidence-based practice, we need more practice-based evidence.• Recognize the importance of practitioners and other end-users in shaping the research questions.• Practitioners and their organizations represent the structural links (and barriers) to addressing the important health issues. Engage them.• Green, LW. From research to “best practices” in other settings and populations. Am J Health Behavior 25:165-178, April-May 2001.
    • 22. Acknowledgments• NIH/NCMHD (5 P20 MD000524) – Project EXPORT Center of Excellence in Rural Health• National Center for Rural Health Professions• UIC College of Medicine at Rockford• UI Extension• Community Health Advisory Committees
    • 23. Hispanic HealthAdvisoryCommittee
    • 24. United Methodist Faith-based CatholicChurch Partners Church Cobden Carbondale The Old School Carbondal e
    • 25. Hispanic Community Health AssessmentThe OldSchool,CarbondaleCatholicChurchCarbondaleMethodistChurch Cobden Bilingual group interviewer and recorder
    • 26. Gender separation is an importantmeans of getting Hispanic men andwomen to open up
    • 27. Having a “conversation” about health care needs
    • 28. Researchers present assessment results back to the community Diabetes Lack of •participants Medical Interpreters validate results Mini-grant • HHAC Chronic Respiratory selects Illnesses 2 problems to Sexually Transmitted address Infections Dental Problems
    • 29. NOT EVERY BILINGUALPERSON CAN BEAN INTERPRETER
    • 30. Interpreters must… • Be fluent in both languages • Follow Code of Ethics • Be culturally competent • Be assertive • Understand medical terminology • Understand systems (hospital, mental health and health center settings)
    • 31. Culture Club celebrates Valentine’s Day
    • 32. When a Man Loves a Woman
    • 33. A woman with diabetes undergoes a personal transformation
    • 34. Glucometers and test strips
    • 35. Promoting eye care
    • 36. HEALTH SCREENINGS HEALTH FAIRS
    • 37. Health FairCrossings Mobile Home Park
    • 38. Health Chat• Blood Sugar• Diabetic education and supplies• High Blood Pressure• First Aid• Information, referral and case management
    • 39. Nutrition Education
    • 40. Cooking Classes
    • 41. Hispanic Health Swim
    • 42. Volleyball for Adults and Teens Coach Pedro Infante
    • 43. Child care during the games
    • 44. Black’s MartialArts Academy
    • 45. Mexican Martial Arts Team
    • 46. Hiking in Shawnee National Forest
    • 47. “Clubs Vida” and theCommunity Work of Aurelia Zaragoza, Health Outreach Director in Cobden, IL(Prepared by Cathy Bless for Aurelia Zaragoza)
    • 48. Aurelia organized a summer tutoring program• Held at her church community center• Focused on students having trouble in school• Encouraged parents to keep their kids in school• Worked as coordinator for 6 years as part of her volunteer work in the community
    • 49. Action Research Partnership in Southern Illinois Cobden and Carbondale worked together to form a Hispanic Health Advisory Committee
    • 50. Hispanic Health AdvisoryCommitteeof Cobden 2005
    • 51. Partnerships• Southern Illinois Hispanic Ministry, Inc• Jesus Es El Senor UMC• Hispanic Health Advisory Committee of Carbondale• University of Illinois• Grace United Methodist Church, Carbondale• Shawnee Health Service, Family Counselor
    • 52. Implementation: Minigrant• $4,999 minigrant awarded• Four youth leaders and 5 youth volunteers, ages 17- 28, met with the mental health grant coordinator team, reviewed the assessment findings and created the “Clubs Vida” program• 3 Life Clubs were formed – Club El Cafecito—for seniors 65 or older – Kid’s Club—for 5-12 year olds – Tween Club—for 12-16 year olds• 2 clubs met weekly and 1 met biweekly during June and July, 2009
    • 53. Purpose of Clubs Vida Program Improve mental health by preventing: Loneliness Depression Despair Aggression“These feelings create persons with socialdysfunction that create disunity in the communityand increase a sense of isolation. Problems ofdomestic violence, substance and alcohol abuse areincreasing in our communities.”
    • 54. •Improve mental and physicalhealth by: •Providing physical and cultural activities for groups that are age appropriate •Promoting social belonging, camaraderie, stability and unity•Develop and strengthen youthleaders by: •Involving them in all aspects of the program planning process
    • 55. Club “El Cafecito”• Ten seniors participated weekly• Club members took turns hosting at their apartments at the migrant camp or own homes• Seniors told “their stories”—Oral histories, photos• Cooking classes• Out to restaurant X 2• Traditional meal to celebrate completion of “Club Cafecito Photo and Story Album”• Field trip—day spa for facials, hairdos, manicures
    • 56. Kid’s Club• 30-41 children participated weekly; ½ Hispanic and ½ African American• Club members resided primarily in or near the Crossings Mobile Home Park in Carbondale• Most club meetings were held outdoors at “The Crossings”• Youth leaders organized an outdoor clean-up, painted cemented area, mowed the area and set up open air tents for the weekly activities
    • 57. • Weekly activities—arts & crafts, family values classes, physical activities, bible stories, etc. inside tents and surrounding area• Kid’s Fair—41 children attended. – Soccer games, sack races, Frisbee tag – Posters and artwork – Healthy snacks – Prizes
    • 58. Tween’s Club• 3 youth leaders and 2 youth volunteer organized the club• 15 teens participated regularly• Teens were recruited form the migrant camp and surrounding area; Cobden, Murphysboro and Carbondale (lots are settled out)• Biweekly field trips—bowling, pizza party, movie and Dairy Queen afterwards, Six Flags in St. Louis
    • 59. Evaluation• Three youth leaders, Pastor Adrian and his wife, Lilly and Ben Mueller met with Aurelia, the minigrant coordinator, and 2 other adult leaders and talked about how the clubs went and how to further develop youth leadership.• Youth leaders words paraphrased: – El Cafecito—It was very important to the seniors just to have someone to talk to and they greatly looked forward to the weekly program
    • 60. • Meetings must take place when parents of the grandchildren are not working• Seniors want to continue the program over the winter for those who are settled out• Seniors who were not able to travel were willing and took pride in hosting meetings• Kid’s Club—It was very important to provide transportation for the children• Hispanic and African American children showed a lot of affection toward youth leaders and invited them to their homes but this was not allowed
    • 61. • Grace United Methodist Church wants to help maintain the program over the winter; indoor space at the trailer park is being explored• Tween’s Club—Teens made new friends• It was a safe escape from some risky homes• It helped teens stay away from risky behaviors• At first, 5 teens from the migrant camp were reclusive but later they came out of their shell and were more sociable• At the bowling activity club members cheered for members who were loners
    • 62. • Activities gave teens a break from caregiver activities and allowed them just to be kids• Youth Leadership—Live what you preach and love and care about others• When planning, make a vision that tells the purpose of the activity, see what is needed for the activity and solve problems as they come up• Listen to suggestions and criticisms• Work to include people who are less involved• Be a voice for the persons you are trying to help
    • 63. Dissemination• Pastor Adrian promoted the program during church, recruited participants, and talked to the congregation about the program during all its phases.• The program was presented to other congregations; i.e., Aurelia talked to St. Mathews Church, Belleville, IL• Pastor at Grace United Methodist Church talked with his congregation about the program
    • 64. •Announcements aboutthe program were printedin: • “Jesus Es El Senor” church bulletin •Souther Illinois Hispanic Ministries bulletin
    • 65. Perspectives From Cobden• Benefits: – Youth leaders participated freely and with great enthusiasm – Kids, teens and elderly participants felt connected to their age cohorts and community• Challenges: – Recruiting and retaining club participants – Fronting the money for grant programs• Next Steps: – Youth are committed to continue to be involved with the Kid’s Club and Club Cafecito – Recruit new youth leaders – Look for funds to continue high quality social programs – Continue to publicize the success of the program with other churches in the region
    • 66. Acknowledgments• Karen Peters, University of Illinois at Chicago• Benjamin Mueller, University of Illinois at Urbana- Champaign• Andiara Schwingel, University of Illinois at Urbana- Champaign• Lisa Beni, Legal Foundation of Chicago• Administrator, Crossings Mobile Home Park• Pastor and Youth Pastor of Grace United Methodist Church, Carbondale, IL• Cathy Bless, President Hispanic Health Advisory Committee of Carbondale
    • 67. Gracias!Questions/Comments?