Community practice

Abstract: THERE HAVE BEEN RECENT PRACTICE AND POLICY CONcerns over the “quality chasm,” or gap between the promise of evidence-based medicine and the realities of community practice with little variation by geographic and sociodemographic factors. Studies document disparities in access of care for particular conditions, and there is widespread concern about disparities in health status and health risk factors disadvantaging underserved ethnic minority and lower-socioeconomic status groups. Addressing quality gaps and health disparities will require implementation of programs to address social determinants of health and improve services delivery across diverse communities. Doing so for underserved communities may be especially challenging owing to resource constraints, underdevelopment of research, and historical distrust in research and health care in some groups. Experts recommend promoting public participation and engagement of diverse communities in research as a strategy to enhance its relevance and to address disparities more effectively Community-based participatory research (CBPR) is the prevailing paradigm to facilitate these goals by promoting mutual transfer of expertise and power sharing in decision making and data ownership across community and academic partners. A recent review identified relatively few English-language CBPR studies in health but wide variation in extent and type of participation. Community-based participatory research has been used more as a paradigm for public health than for clinical or health services research. Many features of CBPR—such as spending time in the community, power sharing, and action research methods—might challenge physicians, given their clinical training that often requires interactions under time pressure, the hierarchical structure of academic medicine, and the focus of medical research on controlled trials as the standard for evidence. However, opportunities (such as the recent National Institutes of Health announcement for CBPR research [http://grants.nih.gov/grants /guide/pa-files/PAR-07-004.html]) are emerging for conducting CBPR in substantive areas for which physician leadership could be helpful. It is timely to familiarize clinical investigators with principles of participatory research and to offer strategies to build effective research partnerships that facilitate clinician leadership in efforts to improve health for all communities. Over several years, we collaborated in exploring ways of blending concepts and approaches from clinical services research and CBPR in research initiatives, research training of physicians in the Robert Wood Johnson Clinical Scholars Program (http://www.hsrcenter.ucla.edu/csp), and a multicenter effort to develop infrastructure to support community-based research. This approach is based on community-partnered participatory research (CPPR), a form of CBPR developed by Healthy African American Families and Charles R. Drew Medical University with support from the Centers for Disease Control and Prevention (CDC), that emphasizes authentic community-academic partnerships as distinct from many collaborative research activities conducted at community sites without partnership in design, implementation, or product ownership. In collaboration with Keith Norris and Paul Koegel, we blended this model with methods from services research initiatives, such as Partners in Care, that addressed quality disparities. Communitypartnered participatory research promotes equal community and academic partnership and power sharing in all phases of research, grounded in evidence-based practice as defined from academic and community perspectives, a framing of CBPR that is suited to physician coleadership. This Commentary provides lessons learned from these applications. Recent examples are available at http://www .communitytrial.org. Many components of CPPR are partly based on CBPR models but are organized into a particular approach.

Abstract: Part One: The value and significance of 'community' in our lives: The meaning and value of community networks Community development Part Two: What are networks and what are they for?: The use and value of networks What are networks for? Part Three: What is networking and what does it achieve?: The principles and processes of networking Networking as community practice Part Four: Networking, complexity and the well-developed community: Complexity and the well-connected community Issues and implications Conclusions and recommendations.

Abstract: Youth-adult partnership (Y-AP) has become a phenomenon of interest to scholars and practitioners. Despite the potential of Y-AP to promote positive youth development, increase civic engagement, and support community change, the practice remains unfamiliar to many. Although research has increased over the past decade, the construct remains vague with an insufficient grounding in developmental theory and community practice. This article seeks to address these gaps by synthesizing data and insights from the historical foundations of Y-AP, community based research, and case study. We propose Y-AP as a unifying concept, distinct from other forms of youth-adult relationships, with four core elements: authentic decision making, natural mentors, reciprocity, and community connectedness. We conclude that Y-AP functions as an active ingredient and fundamental practice for positive youth development and civic engagement. Directions for future research are offered.

Abstract: This paper reviews the implications of organizational and community intervention research for the implementation of effective mental health treatments in usual community practice settings. The paper describes an organizational and community intervention model named ARC for Availability, Responsiveness and Continuity, that was designed to support the improvement of social and mental health services for children. The ARC model incorporates intervention components from organizational development, interorganizational domain development, the diffusion of innovation, and technology transfer that target social, strategic, and technological factors in effective children's services. This paper also describes a current NIMH-funded study that is using the ARC intervention model to support the implementation of an evidence-based treatment, Multisystemic Therapy (MST), for delinquent youth in extremely rural, impoverished communities in the Appalachian Mountains of East Tennessee.