Getting to know your community -The great thing is that, as psychiatrists involved in providing “front-line” services in your communities emergency rooms, inpatient units, community and specialty clinics, you already have a better sense of the community than most. However, we have to keep in mind the “iceberg” model of training… Especially in Academic Medical Centers (AMC), we are seeing those that are most impaired, most impacted by poverty, substance use, violence, etc. And then, based on various quirks of your AMC, you may only see certain geographical, SES, language slices of your community. This doesn’t mean you have to be an expert on all these different aspects of your community. But we have to start out knowing what we know and knowing what we DON’T know! -There is no substitute for getting to know your community than getting a little out of your comfort zone and visiting different areas. If there is a neighborhood you are less familiar with, see if there is a neighborhood organization or a local community center that can tell you a little about their community or perhaps even take you around on a “meet and greet” with local organizations, businesses, and residents. -When you are getting to know struggling communities, it is easy to see the blights… the abandoned buildlings, lack of business deveopment, signs of crime or drug problems. See these, note these… but don’t pass over the church that runs an after school tutoring program, the community garden, and the new mural project to paint over the graffiti. The movers and shakers in a community that are making these things happen are the ones that can be your natural teachers and allies.
Getting to know specific community partners There’s a difference between getting a better understanding of your overall community, and getting to better know a specific community partner. A few key things to consider: -Who are they? Organizations are made of people! Are they from a shared geographical area, or religious, ethnic, or racial group? What is their education level? What is their level of comfort/familiarity with mental health, with psychiatry? -Who do they serve? Again, geographical area? Religious/ethnic/racial group? What kind of SES level/range? -What is this organization’s mission? And how “penetrant” is their mission in their leaders and their day-to-day staff? -What do they do really well? What specific resources do they have? Any unique resources that no one else has? -Beware of potential liabilities to involvement… -Money matters… where does their money come from? How are they doing financially right now? These are usually not direct questions, but something you will understand as you meet and work with a group.
When beginning any kind of relationship with a community partner – first impressions matter! Think of it like an interview! Learn about the organization beforehand. Impress them by knowing their history, ask appropriate questions. Show interest and curiosity. Be punctual, be respectful of their time. We tell our patients they are the experts on themselves. Similarly, these leaders are experts – in their organization, their audience, their community. Learn from them. Make plans together, utilizing each group’s strengths and experience. Don’t leave the first meeting without committing to delivering something, or at least meeting again at a specific date and time. Too many community organizations have experience with “flaky” individuals and organizations that promise collaboration, but then do not follow through. Don’t be one of them! You did your research beforehand and know that you want to collaborate with this organization – FOLLOW THROUGH! You won’t regret it.
Needs Assessment At times, it’s important to take a “bigger picture” view of your community to determine where there are greatest needs that you may be able to impact. One caveat: this is really difficult to do for an ENTIRE city (e.g. “Okay, do a mental health needs assessment on New York City… go!” Ridiculous, right?) Try to get a sense of the numerous types of community stakeholders: -clinically: consumers, providers, administrators, support staff -civic: Mayor’s office, City Council, County Executive -Non-profits: civic support organizations, charities, development agencies -religious: churches, synagogues, mosques, temples, others -business: local, regional, large corps Once you’ve narrowed down to a specific community, try to describe it fully. Get to know a little about its history (e.g. steelworkers urban African American gentrification tension), its demographics (census.gov is great for this), the “official” take on its biggest problems (drugs, crime, abandoned property), as well as residents sense of its biggest problems (“abandoned by the city,” “no grocery stores or libraries,” “no park or civic spaces”). More than likely, community organizations may have published reports on the specific challenges or needs of the community. Also, look around to see if there are other efforts in your area (or elsewhere!) that have been successful at addressing some of the community’s concerns. The literature is not robust in these areas, but sometimes you’ll be surprised… There are times when you’ll actively want to solicit input from the community. You can do this informally by simply talking with people in the community. A more structured approach is to meet with key individuals and stakeholders. You could also try running a few focus groups or a town hall meeting. And on the more formal end, there are options like surveying the community.
Capacity Mapping Capacity Mapping is an alternative way to view community assessment. Instead of focusing solely on community’s needs, you also want to do a thorough inventory of its assets and capacities. A strength in this approach is decreasing the reliance of a community on outside “service providers” and encouraging its ability to utilize its own strength and assets. PRIMARY BUILDING BLOCKS are assets WITHIN a community, CONTROLLED BY the community – thinks churches, cultural organizations, local businesses, individuals. SECONDARY BUILDING BLOCKS are assets WITHIN a community, but largely CONTROLLED BY outsiders – hospitals, libraries, schools, parks, police and fire departments. And POTENTIAL BUILDING BLOCKS are assets OUTSIDE a community, CONTROLLED BY outsiders – think human services funding organizations, federal capital investment projects
Capacity Mapping Now, this does NOT mean you have to go out into your community and survey 100s of people to determine community needs and capacities. But maybe other community organizations already have, and you could familiarize yourself with this. At the very least, you can use this framework to evaluate strengths and needs in the community.
Now there are a million different types of Community Events and Partnerships. You have to find the right type of event and process that fits the community organization’s needs and your residents’ interests, availability, and abilities. Some are one-time events that raise money or awareness. Others are ongoing collaborations with a community group. Each can be rewarding and impactful in different ways!
Know the purpose for your fundraiser, even if it as simple as “Raise funds and awareness for people with SPMI that are homeless in our community.” How much are you looking to raise? Sometimes, this is easier the second time around for an event. But talking with your community orgs can get you a better sense of their needs. How much can you spend to make this event happen? Where will the money come from? Will you have access to funds beforehand, or only after proceeds are collected? Have an organized leadership structure in place, with at least a committee and preferably one or two people that are the “leads.” Also, have a sense of other administrations/organizations that you will need to consult, i.e. your residency training office, the community organization admin/leadership, etc. Who are you trying to get to attend? Other residents? Everyone that works in your hospital? Community members? Good events take a LOT of preparation, start thinking ahead (MONTHS, not weeks) and get started with the logistics. You have to let people know about your event – targeted emails, flyers and posters, social media. Sometimes, word of mouth is your best bet… getting to housestaff meetings, inviting your clinics, attending community meetings to let them know you’d like them to attend. Sell tickets at the door. If you can set up a process in which people just have to pay one sum “at the door,” this can streamline things and you can generally charge a bit more. Also, consider other ways to raise funds… raffles, selling “easy things.” And also think about soliciting donations from local businesses, corporations, or individuals. You can offer advertising space, If appropriate. Do a run-through prior to the event. Plenty of logistical issues will come up last-minute that you may not have thought of. Thank people for coming to your event. Thank your DONORS and SPONSORS!! Send thank you notes to donors and sponsors later. Follow-through on any offers of help or assistance given at the event.
Psychoeducation is essentially the process of teaching individuals and groups about mental health. Try not to give a talk just because you want to talk about a specific talk. See what the community group would like to hear about. Meet with their leaders or members beforehand, offer your areas of interest and expertise, and see what they’d be interested in hearing more about. Many organizations have advocacy weeks, during which they will facilitate community outreach events. One excellent example is AACAP’s Speak Up For Kids! During Children’s Mental Health Awareness Week in May, hundreds of child psychiatrists go out into their communities and teach about common children’s mental health issues. They offer slide sets that can be used in their entirety or modified for a specific group (recommended). They offer sample promotional materials (e.g. outreach emails, flyers, etc.) A talk to a community organization of concerned parents or church parishioners has to be very different than a Journal Club to your colleagues. Avoid jargon/lingo and explain things clearly. Don’t assume that people know what SSRIs, RCTs, and “atypical antipsychotics” mean. Spend some time thinking about your audience and how best to get across what you’re trying to convey. Psychoeducation events can be one-time or they can be part of an ongoing series. The advantages of one-time are obviously that they are kinder to our busy schedules. However, ongoing series can really develop a strong relationship with community partners that can really flourish later on.
Community organizations are really looking for more than “white knights,” they want PARTNERS that can help them work on their missions to help others in their community Residents really enjoy being affiliated with a community organization. For those in leadership, these experiences can be career-defining. For those that participate, this can be a great way to get away from some of the drudgery and frustration of day-to-day clinical work in the ER, inpatient units, clinics, etc. Just as with any other partnership, you have to MANAGE the relationship. Things WILL come up that require putting out fires, holding hands, making apologies, and even, at times, asking people to NOT be involved any more. So YOU’RE doing this now… how about in 2 or 3 years when you’re finishing residency. Community organizations that are used to working with residents are acutely aware of this and will ask you themselves about your sustainability plans. See if you can get junior residents involved and interested earlier on in their careers. Once they get involved – they’ve got the bug! Think about some ways to assess the impact of your involvement in the partnership. Sometimes it is anecdotal, or based on number of man-hours. Other times, you may have the opportunity to be more objective – you can survey folks before and after to determine what outcomes your partnership may have addressed. NOTE OF CAUTION: Be WARY of community projects being a perceived/real “front” for research endeavors. Most community organization are not necessarily LOOKING to participate in research. However, if you develop a relationship and demonstrate the benefits of your partnership together, many may be willing to consider research participation. TREAD LIGHTLY! BE SENSITIVE! And of course, go through your institution’s usual IRB channels for this kind of thing.
Sometimes it makes sense to join or create a coalition with other interested groups of professionals around a specific cause or event. Consider AACAP and AAP joining together to address bullying in area schools. Or the local APA District Branch chapter and the regional Medical Society addressing cuts to elder services. Other times, you can join or create a coalition around a one-time fundraising or educational outreach event. The only addendum to the above guidelines is PLAY NICE WITH OTHERS! Coalitions don’t have to stand the test of time – they are often temporary or really just focused on one or a few issues on which your groups’ interests align. This is OKAY! Don’t worry, just utilize each other’s support on the areas of overlapping interest.
Community Advocacy for Psychiatry Residents
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AgendaGetting to know your communityNeeds Assessment vs. Capacity MappingCommunity Events and PartnershipsCoalitionsHave fun!
Getting to know yourcommunity You already know… BUT, mostly “tip of the iceberg” certain neighborhoods, groups, communities Get out there… Understand challenges AND strengths Leave any judgment at home. Listen, look, learn!
Getting to know specificcommunity organizations Who are they? Who do they serve? Why do they do what they do? (mission) What are their strengths and resources? Any specific liabilities? What is their funding and financial status?
First impressions matter! Think of it like an interview… Do your research! Respect their time. Respect their experience, solicit their input. Plan together. Make (reasonable) commitments. Follow through. Follow through. Follow through.
Needs Assessment Who are the relevant stakeholders? Describe your community. Literature? Best Practices? Community Standards? Informal? Key meetings? Focus Groups? Survey? Town Hall Meeting?
Capacity Mapping Focusing solely on needs ignores community’s STRENGTHS Think of community assets and capacities Within the community and controlled by the community Within the community, controlled by outsiders Outside of the community, controlled by outsiders
Educational Outreach Target content to community interests Team up with national organizations/events Know your audience!! One time event vs. ongoing series
Ongoing partnerships Community organizations want PARTNERS! Residents enjoy being affiliated with community organization Have to manage the relationship Develop plans for SUSTAINABILITY Assess impact, measure outcomes
Coalitions Cause Event Often temporary or issue-focused
Have fun! Be flexible and creative! Be patient! Keep working! Celebrate success, generous in praise! Focus on the community – needs and strengths! Advocacy is entrepreneurial! If this doesn’t work, that’s okay – maybe the next project will! Questions: Email firstname.lastname@example.org!