Partnering to Improve Health: The Science of Community Engagement

1. Partnering to Improve Health: The Science of Community Engagement James W. Mold, MD, MPH Department of Family and Preventive Medicine University of Oklahoma Health Sciences Center

2. The Earth at Night

3. Bottomless Pit

4. General Impressions Reconnection between �science� and �practice� Re-alignment of priorities Potentially revolutionary � could change the way we think about research �New era� �Coordination of prevention, wellness, public health across the federal government� Ann Bonham

5. Requirements for Participation A kind heart A desire to help others > self > science Faith / optimism Creativity Patience Respect for others �Recognize our strengths�� �The Reverend� �Acknowledge altruism within the culture� Ida Spruill �Must be responsive to local innovations and ideas� Bruce Rapkin �PhDs of the sidewalks� Keith Norris Commitment �I have a commitment to this community.� Ida Spruill

6. Engagement = Partnering Long Term Relationships Long-term relationships are �foundational� Research and developmental activities must be built upon that foundation Harold Perl �The community became our client.� Ida Spruill. (Like primary care, the relationship is foundational.)

7. Goals Outcomes for which it makes no sense to ask ��so that�? Improved health of individuals and communities �Outcomes that matter� Ann Bonham Objectives are steps on the way to goals. Understanding of problems Solutions Strategies are ways to achieve objectives. Research �How can we use science to help the people�?�

8. Objectives May Differ Clear understanding from the �get-go� (Okie dialect) about what each partner needs from the partnership Memorandum of understanding Keith Norris Community outcomes, academic outcomes, mutual outcomes Lee Green Multi-disciplinary, interdisciplinary, transdisciplinary, and �anti-disciplinary� Paul James Primary care: Negotiating/balancing short and long term goals (current quality of life and prevention of premature death and disability Goal-directed rather than problem-oriented

9. The Science of Engagement How do we structure community partnerships? Nina Wallerstein What are the roles and responsibilities of researchers? Community Health Councils as �unbiased conveners Florida Community organization drives research agenda, trains the research community (researchers a consultants only) Keith Norris

10. Science ??= Methods Complexity/ Complex adaptive systems - Mike Parchman Evolution, co-evolution Ecology, weather Comprehensive Dynamic Design Trials � Bruce Rapkin �The science of bridge building (in a place�from existing materials)� �wiki�s� �deliberation process� and �implementation process� Qualitative Inquiry method Kelly Newlin

11. Data People gravitate to it Paul James If it is local If they trust it If they were involved in generating it Can use secondary data to find out where more primary data is needed Bob Phillips GIS mapping

12. Theories of Research Utilization Knowledge-Driven (e.g. SuGaR) Investigator-defined Contributions to knowledge Problem-Solving (e.g. Minding the Baby) User-stated problem Social-Interaction (Keith Norris, Kelly Newlin) Problems co-defined Dynamic process of discovery and progress

13. On Learning to Swim �Evidence-based practices AND practice- and community-based evidence� Nina Wallerstein �Go in search of people. Begin with what they know. Build on what they have.� Chinese proverb (Sergio Aguilar-Gaxiola)

15. Push Me Pull You

16. Honey, you�re not helping.

17. Push � Pull

18. Push � Pull

19. Push � Pull

20. Chronic Care Model for Community Engagement Community Self-management support Community Service Systems Design Community Decision Support Community Information Systems Carolyn Jenkins

23. Rebuilding the Research Engine A better mission statement with actual goals More pressure from constituents CTSA was a response to constituent concerns Engage the community regarding expectations What types of �scientific rigor� will we accept? New metrics related to progress toward goals Goal-directed rather than method-directed? (relevance as important as methods) More community-based researchers on study sections Less concern about the source of funding

24. The Art and Science of Community Engagement Warnings: It is possible to lose the forest by focusing too hard on the trees It is possible to over-evaluate Complexity is most interesting at the interfaces Lee Green Research and practice Art and science Discovery and implementation

25. Spreading Community-Based Discoveries Fidelity versus Context-dependency �May not the best way to frame the challenge� Lee Green Decision matrices Bruce Rapkin Break interventions into their components Keith Norris Principles, techniques, and scripts Toolkits Mike Parchman, Lee Green Economics MUSC Diabetes Program ($2 million savings)

26. Primary Care Extension

27. Funding Stable infrastructure funding Federal government Insurance companies Miscellaneous (contributions, local industries, etc.) Project-specific funding Public health (CDC, OSDH, etc.) Dept. of Defense (preparedness, surveillance, obesity, etc.) Foundations (demonstration projects) Research (NIH, AHRQ) Manpower development (HRSA, etc.)

28. If you build it� Do good work; the money will follow.

29. Parting Shots The �science� of community engagement is likely to resemble its products principles, stories, toolkits rather than tightly defined methods ???? Reflective functioning (mentalization) seems like a good way for us all to be involved in this emerging �science.� The process may actually be as important as the outcomes Goals are important primarily because they organize a process