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Home, school, and community partnerships: integrating issues of race, culture, and social class.

The current review is an examination of home-school-community partnerships utilizing an ecological approach to understand the influences of race, culture, and social class. The ecological approach recognizes that families and schools are embedded in communities, and that these settings influence each other and the development of children. The roles of race, culture, and social class in the development of partnerships between the home, school, and community settings are explored. Race, culture, and social class may interact with parent and family attributes, teacher and school qualities, and community context. These factors are often misunderstood either through under investigation or lack of integration. The implications for future research, practice, and policy are discussed.

Adult↗

Partnerships for better oral health.

Improving oral health in populations who do not easily access the private dental office or the available community care site is a challenge to dental hygienists and others concerned with the health and well-being of all. Partnerships for improved oral health have been part of the community health efforts for many years and in many countries. With the knowledge, skills, and resources that are held by specific groups and organisations combined into a larger entity of a partnership or coalition, greater impact on oral health issue may be possible. Agencies and individuals interested in making improvements in oral health status in any particular target group may begin a process of working with others who have an interest in improving the health and well being of that target group. In a world that is increasingly synergistic and mutually dependent, improvements in oral health can be advanced by considering the elements of successful coalition building and forming partnerships with multiple organisations and individuals.

Community Health Services↗

Perceptions of issues associated with the maintenance and improvement of long-term health in people with SCI.

STUDY DESIGN: Qualitative design using focus groups. OBJECTIVE: To explore the perceptions of people with SCI and their caregivers about information needs and service delivery options that may assist them to maintain or improve their long-term health. SETTING: Province wide project in Alberta, Canada. METHODS: Eight focus groups were conducted; five with community dwelling people with SCI and three with unpaid caregivers (family and friends). Content analysis was used to identify categories and themes arising from the data. RESULTS: The findings from the study are broader than the original objective to explore information needs and service delivery options to promote long-term health. The participants more globally discussed factors that contribute to or provide barriers to their long-term health. Those factors are captured in five categories, including readiness, information pathways, community health care, health promotion, and contextual factors. A framework that illustrates the relationships between categories was constructed. CONCLUSION: The framework identifies areas to target in programmes designed to reduce or prevent secondary conditions in people with SCI. SPONSORSHIP: This study was funded by the Alberta Paraplegic Foundation and the Glenrose Rehabilitation Hospital Foundation.

Adult↗

The power of the collective: battered migrant farmworker women creating safe spaces.

In this article I describe the use of a participatory action research (PAR) methodology to address the problem of domestic violence among migrant farmworker (MFW) women in California. The article was generated from a variety of data sources used by the investigator over a 4-year period. These include the investigator's observations, field notes, informal conversations, written stories from the women, and interviews. The "power of the collective" is discussed as the development of a power base for battered MFW women to support and take care of one another. The concepts of liberation, enlightenment, and "conscientizacion" are used to describe the evolution of the collective.

Adult↗

An urban intergenerational program for cancer control education.

BACKGROUND: Recognizing the disparities in cancer morbidity and mortality that exist between African Americans and whites, an urban university and its neighborhood community undertook the development of an education program to transfer state-of-the-art cancer prevention, detection, and treatment information from an academic medical center to community residents, including school-age children. METHODS: An intergenerational, multilevel intervention was developed to: 1) assess the health beliefs of the community, 2) identify, develop, and train an intergenerational group of community residents who would serve as health educators, and 3) promote behavioral change among the target population. RESULTS: Ten community residents were trained as educators. Over the course of two years they conducted cancer education programs that reached 775 adults. During the same period, the school-based educational intervention reached 264 seventh-grade students. CONCLUSIONS: Implications for the design and implementation of community-based cancer education programs in this African American community are identified.

Academic Medical Centers↗

Bystander Trauma Care training in Iowa.

OBJECTIVE: The Iowa Bystander Trauma Care program trained citizens to provide initial care at the scene of a motor vehicle crash. The development, implementation, and evaluation of the program are described. METHODS: The National Highway Traffic Safety Administration's curriculum was used as the basis for developing the Iowa Bystander Trauma Care program. Emergency medical technicians (EMTs) were trained to be instructors in a two-hour course offered at each of four community colleges. The EMTs, in turn, provided instructions to the general populace. Five hundred participants were given a questionnaire before the one-hour Bystander Trauma Care training session, immediately after the training and six months later. The questionnaire obtained background data and assessed attitudes regarding willingness to stop and assist, and knowledge obtained. RESULTS: One hundred twenty EMT instructors trained more than 2,000 citizen bystanders in a 17-county area in central Iowa. Immediately after the training program, participants were more likely to provide assistance (p < 0.001), and understand the sequence of actions to be performed at the scene of a crash and how to prioritize the information provided to 911 (p < 0.05). There was also evidence of retention of the knowledge six months after training. CONCLUSIONS: Citizens readily volunteered for the Bystander Trauma Care training program. Results of the questionnaire suggest citizens can be successfully trained to recognize the needs of, and provide initial care for, acutely injured persons, and the positive effects of such training are maintained over time.

Community Networks↗

Community outreach rehabilitation.

OBJECTIVE: to review controlled studies evaluating the effectiveness of community rehabilitation schemes developed to facilitate effective discharge from hospital. To briefly describe the community outreach rehabilitation scheme which has been developed in York, UK. RESULTS: in the last 10 years, 9 controlled trials were identified of which 6 resulted in improved outcome. There were no overall or mixed outcome differences observed in the other 3. Cost analysis calculations were controversial. However, in 4 of the studies early structured discharge appeared to result in cost savings-mainly by reducing hospital length of stay. CONCLUSION: though the studies were heterogeneous in design and involved different patient groups, community rehabilitation schemes appeared to be effective in facilitating earlier discharge from hospital.

Aftercare↗

The SAFE project: community-driven partnerships in health, mental health, and education to prevent early school failure.

This article presents a case study of an innovative school-based health and mental health project that prevents early school failure in one county in Oklahoma. Success is attributed to social work development of broad-based partnerships involving families, schools, communities, and public policy officials. Citizen-driven, these partnerships have meshed previously fixed institutional boundaries in health, mental health, and education to prevent early school failure. The article describes school-family partnerships that form the core of the project's service intervention model. Statistics on service activities and outcomes are presented, along with a discussion of lessons learned for implementation of the project.

Adolescent↗

Meeting the needs of rural populations through interdisciplinary partnerships.

This article describes the organization and outcomes of a Rural Health Outreach Initiative (RHOI) designed to increase collaboration between the medical education and health care delivery sectors to improve the quality of health care delivery and health outcomes in rural communities. Two inter-related partnership strategies were utilized in rural communities to address the health and social service needs of rural populations. The partnerships were created through the efforts of a rural health professions education program located in a community-based medical school. The two partnership models were implemented at the same time and target the same rural populations. Both strategies relied upon interdisciplinary collaborations to achieve their goals and outcomes. One strategy involved the creation of partnerships among rural medical students and the projects they initiate, using the model of community oriented primary care (COPC). The second strategy involved the establishment of partnerships by a variety of rural, community-based entities that resulted from a three-year Health Resources and Services Administration Rural Health Outreach grant that supported a "mini-grant" program. This article summarizes the process and results of these innovative collaborations that occurred at two levels: (1) between health and service institutions representing multiple disciplines and (2) between academic institutions and local communities. Specific attention is given to projects that resulted from the work of the partnerships that address the needs of older adults residing in the rural communities. The two strategies are compared and implications for the success of similar efforts are discussed.

Aged↗

The African American breast cancer outreach project: partnering with communities.

This article describes the African American Breast Cancer Screening Outreach project, a community-based participatory intervention that was designed to increase the numbers of African American women screened for breast cancer in Texas, especially those who are poor and underserved. The project was very successful, and between 1998 and 2003, more than 114,000 people received cancer information and education and 8,459 African American women who had contact with the project were screened. Several lessons were learned from these experiences that are pertinent to engaging communities to partner with researchers in conducting community-based participatory research and illustrate the application of guiding principles outlined by Israel and colleagues in 1998.

Black or African American↗

Aiding resocialization of the chronic psychotic patient.

One difficulty of moving the focus of care for the mentally ill from hospital to the community is that some patients with severe mental illness, who have been in hospital for a long time, are difficult to place in the community. The main problems that appear to be barriers to community-based care are aggressiveness and adverse sexual behaviour. New antipsychotics, such as risperidone, are likely to increase the proportion of patients who can be successfully placed in the community because the low liability for extrapyramidal symptoms will contribute to better compliance. A crucial aspect of the move to the community is the attitudes of neighbours. Studies show that the public is deterred from making contact with the mentally ill because they expect them to have inadequate communication skills. The public also expect bizarre behaviour and aggressiveness. However, the majority of those living near proposed new community homes would welcome the establishment of mental health facilities in their neighbourhood. A study of a public education campaign focussed on the neighbours of a sheltered home found that fear of the mentally ill was reduced and willingness to socialize with them was increased. This change in attitudes was reflected in increased social contact between patients and their neighbours. Therefore, attempts to open community homes for the mentally ill as unobtrusively as possible are likely to lead to more objections than if well constructed public education campaigns focussed on the neighbours are undertaken.

Community Mental Health Centers↗

Partnering essentials.

"The Management Moment" is a regular column within the Journal of Public Health Management and Practice. Janet Porter, PhD, and Edward Baker, MD, MPH, MSc, are serving as The Management Moment Editors. Dr. Porter is Associate Dean for Executive Education, The North Carolina Institute for Public Health, School of Public Health, at the University of North Carolina at Chapel Hill, and Dr. Baker is Director of the North Carolina Institute for Public Health, School of Public Health, at the University of North Carolina at Chapel Hill. This column provides commentary and guidance on timely management issues commonly encountered in public health practice.

Community Health Planning↗

Collaboration between communities and universities: completion of a community needs assessment.

Health care reform can provide opportunities for collaboration between universities and the public at large. An advanced community nursing class within a post-RN program at a university combined resources with a nearby rural community to complete a community health and social needs assessment. The partners in the project included the local hospital, health unit, and the university; funding was secured from the Regional Center for Health Promotion and Community Studies and the two health agency partners also made a financial donation. Community liaisons who were both registered nurses and residents of the community, we instrumental in completing tasks and activities related to the project. The students were taught the various data collection methods and participated in class assignments refining the necessary skills required for the actual assessment. This project benefited the community by providing baseline health status and social needs data in an era of dramatic health care reform while simultaneously affording undergraduate nursing students the opportunity to apply theory to practice.

Alberta↗

Essential concepts in developing community-university partnerships. CareLink: the Partners in Caring Model.

University and community partnerships are being created to increase community-based educational experiences for nursing students and to assist agencies in facing ever-decreasing resources to pay for health services for clients. Many challenges often burden these partnerships, leading to a less than satisfying experience for all those involved. The Partners in Caring Model described in this article is one approach to forming a successful partnership, proven effective in meeting the educational needs of the University of Connecticut, School of Nursing students, while providing additional resources to the Visiting Nurse Association of Central Connecticut, Inc. Using Anderson and McFarlane's Community as Partner Model as the framework, the essential principles behind the development of this successful partnership are discussed. The Partners in Caring Model demonstrates that community-university partnerships can sustain themselves when the partners have a commitment to care for the population being served, and it is a shared responsibility between education and practice.

Community Networks↗

The effects of community pluralism on press coverage of health risks from local environmental contamination.

Based on the conflict/consensus model of Tichenor, Donohue and Olien, we proposed that mass mediated information signalling that local agents are contaminating the local environment and posing health risks is conflict-generating information and, therefore, will be controlled in the interest of community stability. We expected such control to vary by community structure. A content analysis of nine months of coverage by 19 newspapers supported the hypothesis that papers in more pluralistic communities were more likely than papers in less pluralistic communities to link contamination from local agents to threats to human health in the community and to frame such stories as problems. Newspapers in less pluralistic communities were more likely to frame local contamination in the context of solutions to the problem and were more likely to link contamination to health risks if the contamination were in a distant community.

Community Networks↗

A systematic review of the effectiveness of community-based mental health outreach services for older adults.

OBJECTIVES: Psychiatric outreach services that provide mental health assessment and treatment to older adults in their homes or communities are widely promoted as improving access and outcomes for older adults. However, a systematic review of the efficacy of these services has not been done. This review evaluates the evidence base for the effectiveness of outreach services for older adults with mental illness in noninstitutional community settings. End points of interest include the ability of the outreach program to increase access to mental health services and improve psychiatric outcomes. METHODS: MEDLINE, CINAHL, PsycINFO, and Web-of-Science databases were searched for articles in English that were indexed through May 2004. Studies were included if they evaluated face-to-face psychiatric services provided to adults aged 65 and older with mental illness and if they were randomized controlled trials, quasi-experimental outcome studies, uncontrolled cohort studies, or comparisons of two or more interventions. Articles were excluded that evaluated interventions that were provided in institutional settings or that focused on persons with dementia or their caregivers. RESULTS: Fourteen studies matched all the inclusion criteria. Two studies (one controlled prospective study and one study that used a comparison group) found support for the use of gatekeepers-nontraditional referral sources-in identifying socially isolated older adults with mental illness. Twelve studies (five randomized controlled trials, one quasi-experimental study, and six uncontrolled cohort studies) found that home and community-based treatment of psychiatric symptoms were associated with improved or maintained psychiatric status. All randomized controlled trials reported improved depressive symptoms, and one reported improved overall psychiatric symptoms. CONCLUSIONS: Limited data supported the effectiveness of outreach services in identifying isolated older adults with mental illness. A more substantial evidence base indicated that home-based mental health treatment is effective in improving psychiatric symptoms. Studies are needed that apply more rigorous methods evaluating the efficacy of case identification models and subsequent treatment for older persons with a variety of psychiatric diagnoses.

Aged↗