scholarly journals Community Partnering for Behavioral Health Equity: Public Agency and Community Leaders’ Views of its Promise and Challenge

2018 ◽  
Vol 28 (Supp) ◽  
pp. 397-406 ◽  
Author(s):  
Elizabeth Bromley ◽  
Chantal Figueroa ◽  
Enrico G. Castillo ◽  
Farbod Kadkhoda ◽  
Bowen Chung ◽  
...  
Keyword(s):  
Los Angeles ◽  
Behavioral Health ◽  
Health Systems ◽  
Safety Net ◽  
Relationship Building ◽  
Health Improvement ◽  
System Transformation ◽  
Structured Interviews ◽  
Community Based ◽  
Public Agency

Objective: To understand potential for multi-sector partnerships among com­munity-based organizations and publicly funded health systems to implement health improvement strategies that advance health equity.Setting: In 2014, the Los Angeles County (LAC) Board of Supervisors approved the Health Neighborhood Initiative (HNI) that aims to: 1) improve coordination of health services for behavioral health clients across safety-net providers within neighborhoods; and 2) address social determinants of health through community-driven, public agency sponsored partnerships with community-based organizations.Design: Key stakeholder interviewing dur­ing HNI planning and early implementation to elicit perceptions of multi-sector partner­ships and innovations required for partner­ships to achieve system transformation and health equity.Participants: Twenty-five semi-structured interviews with 49 leaders from LAC health systems, community-based organizations; and payers.Main Outcomes Means: Grounded the­matic analysis of interview data.Results: Leaders perceived partnerships within and beyond health systems as transformative in their potential to: improve access, value, and efficiency; align priori­ties of safety-net systems and communities; and harness the power of communities to impact health. Leaders identified trust as critical to success in partnerships but named lack of time for relationship-building, limitations in service capacity, and ques­tions about sustainability as barriers to trust-building. Leaders described the need for procedural innovations within health systems that would support equitable part­nerships including innovations that would increase transparency and normalize infor­mation exchange, share agenda-setting and decision-making power with partners, and institutionalize partnering through training and accountability.Conclusions: Leaders described improv­ing procedural justice in public agencies’ relationships with communities as key to effective partnering for health eq­uity.Ethn Dis.2018;28(Suppl 2):397-406; doi:10.18865/ed.28.S2.397.

scholarly journals Community-based organizations’ perspectives on improving health and social service integration

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Etsemaye P. Agonafer ◽  
Savanna L. Carson ◽  
Vanessa Nunez ◽  
Kelli Poole ◽  
Clemens S. Hong ◽  
...  
Keyword(s):  
Los Angeles ◽  
Health Systems ◽  
Social Service ◽  
Social Needs ◽  
Assessment Process ◽  
Structured Interviews ◽  
Community Based ◽  
Community Based Organizations ◽  
Health And Social Care ◽  
The Impact

Abstract Background Collaborations between health systems and community-based organizations (CBOs) are increasingly common mechanisms to address the unmet health-related social needs of high-risk populations. However, there is limited evidence on how to develop, manage, and sustain these partnerships, and implementation rarely incorporates perspectives of community social service organizations. To address these gaps, we elicited CBOs’ perspectives on service delivery for clients, the impact of the Whole Person Care-Los Angeles (WPC-LA) initiative to integrate health and social care, and their suggestions for improving health system partnerships. Methods Using stakeholder engaged principles and a qualitative Rapid Assessment Process, we conducted brief surveys and in-depth semi-structured interviews with 65 key informants from 36 CBOs working with WPC-LA. Results Major themes identified by CBOs included: 1) the importance of a holistic, client-centered, continuously engaged approach that is reliant on regional partnerships; 2) benefits of WPC-LA expanding capacity and networks; 3) concerns about communication and redundancy hindering WPC-LA; and 4) a need for more equitable partnerships incorporating their approaches. Conclusions CBOs value opportunities for integration with health systems, bring critical expertise to these partnerships, and seek to strengthen cross-sector collaborations. Early, equitable, and inclusive participation in the development and implementation of these partnerships may enhance their effectiveness, but requires policy that prioritizes and incentivizes sustainable and mutually beneficial partnerships.

scholarly journals Systems leadership in practice: thematic insights from three public health case studies

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Charlotte Bigland ◽  
David Evans ◽  
Richard Bolden ◽  
Maggie Rae
Keyword(s):  
Public Health ◽  
Case Studies ◽  
Health Systems ◽  
System Structure ◽  
Health Improvement ◽  
Global Public Health ◽  
Structured Interviews ◽  
Public Health Systems ◽  
Systems Leadership ◽  
Indicators Of Success

Abstract Background ‘Systems leadership’ has emerged as a key concept in global public health alongside such related concepts as ‘systems thinking’ and ‘whole systems approaches.’ It is an approach that is well suited to issues that require collective action, where no single organisation can control the outcomes. While there is a growing literature on the theory of systems leadership in a number of fields, there remains a lack of published empirical studies of public health systems leadership for professionals to learn from. The aim of the current project was to conduct cases studies in UK public health to provide empirical evidence on the nature of effective systems leadership practice. Methods Three system leadership case studies were identified in the key domains of public health: health protection, healthcare public health and health improvement. A total of 27 semi-structured interviews were conducted. Data were thematically analysed to identify the components of effective systems leadership in each case and its impact. Results The thematic analysis identified themes around ‘getting started,’ ‘maintaining momentum’ and ‘indicators of success’ in systems leadership. In terms of getting started, the analysis showed that both a compelling ‘call to action’ and assembling an effective ‘coalition of the willing’ are important. To maintain momentum, the analysis identified themes relating to system structure, culture and the people involved. Regarding culture, the main themes that emerged were the importance of nurturing strong relationships, curiosity and a desire to understand the system, and promoting resilience. The analysis identified three components that could be used as indicators of success; these were a sense of enjoyment from the work, resource gains to the system and shifts in data indicators at the population level. Conclusions This study has provided insight into the nature of systems leadership in public health settings in the UK. It has identified factors that contribute to effective public health systems leadership and offers a thematic model in terms of establishing a systems leadership approach, maintaining momentum and identifying key success indicators.

scholarly journals Su salud a la mano (your health at hand): patient perceptions about a bilingual patient portal in the Los Angeles safety net

2019 ◽  
Vol 26 (12) ◽  
pp. 1525-1535 ◽  
Author(s):  
Alejandra Casillas ◽  
Giselle Perez-Aguilar ◽  
Anshu Abhat ◽  
Griselda Gutierrez ◽  
Tanya T Olmos-Ochoa ◽  
...  
Keyword(s):  
Los Angeles ◽  
Technology Acceptance ◽  
Health Systems ◽  
Safety Net ◽  
Patient Portal ◽  
Annual Household Income ◽  
Patient Centered ◽  
Spanish Speaking ◽  
English Speaking ◽  
Education Support

Abstract Objectives Driven by beneficial patient-centered outcomes associated with patient portal use and the Affordable Care Act, portal implementation has expanded into safety nets—health systems that offer access to care to a large share of uninsured, Medicaid, and other vulnerable populations. However, little attention has been paid to the factors that affect portal accessibility by the vulnerable patients served by these health systems—including those who are limited English proficient (LEP). Materials and Methods The Los Angeles County Department of Health Services (LAC DHS), the second-largest safety net system in the nation, launched its first patient portal, and one of the few bilingual English-Spanish interfaces in existence, in March of 2015. To explore portal awareness and perceptions, we conducted focus groups with LAC DHS patients, in English and Spanish (LEP). The Technology Acceptance Model was used to guide thematic analysis of focus group data. Results Of the 46 participants, 37 were patients and 9 were caretakers; 23 were English-speaking and 23 Spanish-speaking LEP. All patients had diabetes or hypertension. Over half had an annual household income <$10 000, yet 78% of English-speaking and 65% of Spanish-speaking LEP participants reported at-home Internet access. Participants’ discussion centered around 3 major thematic narratives: (1) participants’ awareness or attitudes about the LAC DHS portal; (2) role of culture, language, or community with regard to portal accessibility and utility; and (3) perceived needs for successful portal implementation. Conclusions Safety net participants identified concrete benefits to the portal and emphasized the need for portal engagement that offered accessible education, support, and resources in clinical and community settings. The portal offers an additional opportunity to engage the patient and family with trusted and validated health information, and should be further developed in this capacity. This study provides a better understanding of preferred improvements of patient portal engagement that guide broader health technology efforts to address electronic health disparities.

scholarly journals Characterizing the Community Collaborations of a Community-Based Student-Run Clinic

2020 ◽  
Vol 11 ◽  
pp. 215013272098440
Author(s):  
Kaylin Pennington ◽  
Eileen Harwood ◽  
Brian Sick
Keyword(s):  
Community Health ◽  
Local Community ◽  
Community Outreach ◽  
Access Point ◽  
Primary Objective ◽  
Advisory Board ◽  
Relationship Building ◽  
Community Advisory Board ◽  
Structured Interviews ◽  
Community Based

Introduction Community-based student-run free clinics (SRCs) can advance health on a community level by reaching populations not served by other organizations and serving as an access point to the healthcare system. However, little is known about the scope of community-engaged efforts undertaken by SRCs, including interorganizational partnerships and relationship-building activities. The primary objective of this study was to characterize the community collaborations of an interprofessional SRC located in a high-poverty area. Methods Qualitative data was collected through semi-structured interviews with key stakeholders, which included student volunteers holding leadership roles, representatives of community-based organizations, and current and former members of the community advisory board. Results Key informant interviews with student and community leaders offered insight into local community outreach activities and the community advisory board. Findings revealed opportunities to impact community health through more intentional collaboration and relationship-building. Conclusions This exploratory study adds to literature suggesting that community-based SRCs can address service gaps in medically underserved communities while advancing community health through intentional community engagement.

Dealing with Diversity: Recruiting Churches and Women for a Randomized Trial of Mammography Promotion

2000 ◽  
Vol 27 (5) ◽  
pp. 632-648 ◽  
Author(s):  
Kathryn Pitkin Derose ◽  
Jennifer Hawes-Dawson ◽  
Sarah A. Fox ◽  
Noris Maldonado ◽  
Audrey Tatum ◽  
...  
Keyword(s):  
African American ◽  
Los Angeles ◽  
Los Angeles County ◽  
Ethnically Diverse ◽  
Relationship Building ◽  
Education Programs ◽  
Recruitment Process ◽  
Close Collaboration ◽  
Community Based

There is little documentation about the recruitment process for church-based health education programs. In this study, the authors recruit African American, Latino, and white churches and women members (age 50 to 80) for a randomized church-based trial of mammography promotion in Los Angeles County. Efforts to enhance recruitment began 10 months before churches were invited to participate and included a variety of community-based strategies. Subsequently, 45 churches were recruited over a 5-month period through group pastor breakfast meetings and church-specific follow-up. In close collaboration with the 45 churches, the authors administered church-based surveys over 6 months and identified 1,967 age-eligible women who agreed to be contacted by the program team. It was found that an extended resource intensive period of relationship-building and community-based activities were necessary to conduct church-based programs effectively, particularly among older and ethnically diverse urban populations.

Barriers and Facilitators to Implementation of Virtual Reality as a Pain Management Modality in Academic, Community, and Safety-Net Settings: A Qualitative Analysis (Preprint)

2020 ◽  
Author(s):  
Urmimala Sarkar ◽  
Jane Lee ◽  
Kim Hanh Nguyen ◽  
Sarah Lisker ◽  
Courtney R Lyles
Keyword(s):  
Virtual Reality ◽  
Pain Management ◽  
Los Angeles ◽  
Qualitative Analysis ◽  
Safety Net ◽  
Academic Community ◽  
Barriers And Facilitators ◽  
Structured Interviews ◽  
Patient Feedback ◽  
Management Approaches

BACKGROUND Prior studies among primarily White, relatively advantaged populations show that virtual reality (VR) is an efficacious treatment modality for opioid-sparing pain management. OBJECTIVE We conducted a qualitative, theory-informed implementation science study to assess readiness for VR in safety-net settings. METHODS Using the theoretical lens of the Consolidated Framework for Implementation Research (CFIR) framework, we conducted semi-structured interviews with current VR users and non-users based in safety-net health systems (n=15). We investigated barriers and facilitators to a commercially available, previously validated VR technology platform, AppliedVR (Los Angeles, CA). We employed deductive qualitative analysis using the overarching domains of the CFIR framework and performed open, inductive coding to identify specific themes within each domain. RESULTS Interviewees deemed the VR intervention to be useful, scalable, and an appealing alternative to existing pain management approaches. Both users and non-users identified lack of reimbursement for VR as a significant challenge for adoption. Current users cited positive patient feedback, but safety-net stakeholders voiced concern that existing VR content may not be relevant or appealing to diverse patients. All respondents acknowledged the challenge of integrating and maintaining VR in current pain management workflows across a range of clinical settings, and this adoption challenge was particularly acute given resource and staffing constraints in safety-net settings. CONCLUSIONS VR for pain management holds interest for front-line pain management clinicians and leadership in safety-net health settings, but will require significant tailoring and adaption to address the needs of diverse populations. Integration into complex workflows for pain management is a significant barrier to adoption, and participants cited structural cost and reimbursement concerns as impediments to initial implementation and to scaling VR use.

Community and health system partnership.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 190-190
Author(s):  
Madeline G. Harris ◽  
Rebecca M. Di Piazza ◽  
Alia Tunagur ◽  
Susan E. Sellers ◽  
Kristen G. Noles ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Health Systems ◽  
Cancer Survivorship ◽  
Breast Cancer Survivors ◽  
Models Of Care ◽  
Relationship Building ◽  
Local Health ◽  
Breast Cancer Survivorship ◽  
Community Based

190 Background: Breast cancer survivors face physical, psychological, medical, social, cultural and spiritual challenges. Services to address these needs are frequently not available or if available unknown. We sought to determine whether formation of a community-based comprehensive breast cancer survivorship program was feasible. Methods: After months of relationship building, the Women’s Breast Health Fund of the Community Foundation of Greater Birmingham (CFGB), awarded funding to support a systematic assessment of available services in the region. Survivors, their loved ones, providers and other national models of care were surveyed and interviewed. Focus groups including a Lesbian, Bisexual, Gay, Transgender, Queer (LGBTQ) group were held. Aggregated results were presented in monthly meetings to executive level hospital administrators from all health systems in the area, the UAB School of Nursing and CFGB. Results: Survivors seek advice from other survivors more than any other source. Gaps in services exist. Breast cancer survivors were often unaware of existing services. Services were not available to some cultural/ethnic groups or loved ones; staff of some services were not culturally sensitive to the needs of survivors. Some services were available to all, while others require payment. There was no source of authoritative, evidence-based information on breast cancer survivorship except for a few providers. After 12 months the group of executives from all health systems committed to support the formation of a community-based comprehensive breast cancer survivorship program designed to assist breast cancer survivors, their loved ones and institutions by providing reliable information about services. Conclusions: Breast cancer survivors, providers, and local health systems all support the development of a comprehensive breast cancer survivorship program. We feel that it will address unmet needs of breast cancer survivors, allowing each institution to address needs for individual patients. By using the breast cancer survivorship program to assess individual needs and to provide information about services for identified needs, we expect repetitive services will be reduced and quality of life for breast cancer survivors will improve.

scholarly journals An Untapped Potential in Primary Care: Semi-Structured Interviews with Clinicians on How Patient Portals Will Work for Caregivers in the Safety Net (Preprint)

2020 ◽  
Author(s):  
Alejandra Casillas ◽  
Anupama Gunshekar Cemballi ◽  
Anshu Abhat ◽  
Miya Lemberg ◽  
Jennifer D Portz ◽  
...  
Keyword(s):  
Health Systems ◽  
Digital Literacy ◽  
Limited English Proficiency ◽  
English Proficiency ◽  
Safety Net ◽  
Security And Privacy ◽  
Structured Interviews ◽  
Patient Portals ◽  
Privacy And Security ◽  
Safety Net Providers

BACKGROUND Patients within safety-net settings are less likely to access health information on patient portals, despite expressed interest. Family and friends are important resources to assist these patients (ie, Medicaid recipients, older patients, patients with limited English proficiency) in navigating health systems, and provider support of the use of patient portals among these groups may also facilitate caregivers’ use of their patients’ portal. OBJECTIVE Because safety net providers work closely with caregivers to care for their patients, we used qualitative methods to explore safety net providers’ perspectives on portal use among caregivers for their patients, especially as there is limited literature about caregivers’ use of portals in the safety net. METHODS We conducted 45- to 60-min semistructured telephone interviews with providers from three large California safety-net health systems. The interviews focused on providers’ experiences with caregivers, caregiver roles, and how the portal could be leveraged as a tool to support caregivers in their responsibilities. A total of three coders analyzed the interview transcripts using both deductive and inductive approaches and established a consensus regarding major themes. RESULTS Of the 16 participants interviewed, 4 specialized in geriatrics, and all held a leadership or administrative role. We described themes highlighting providers’ recognition of potential benefits associated with caregiver portal use and specific challenges to caregiver engagement. CONCLUSIONS Providers recognized the potential for portals to improve information delivery and communication by helping caregivers assist socially and medically complex patients in the safety net. Providers in safety net sites also discussed a clear need for better ways to keep in touch with patients and connect with caregivers, yet security and privacy are perhaps of higher importance in these settings and may pose challenges to portal adoption. They noted that caregivers of patients in the safety net likely face similar communication barriers as patients, especially with respect to digital literacy, health literacy, and English proficiency. Further research is needed to assess and support caregivers’ interest and ability to access portals across barriers in health and digital literacy, and English proficiency. Portal platforms and health systems must also address specific strategies to uphold patient preferences while maintaining privacy and security.

scholarly journals Developing a performance framework for measuring comprehensive, community-based primary healthcare for people with HIV

2015 ◽  
Vol 17 (04) ◽  
pp. 361-384
Author(s):  
Sharon Johnston ◽  
Matthew Hogel ◽  
Ann N. Burchell ◽  
Gabriel Rebick ◽  
Tony Antoniou ◽  
...  
Keyword(s):  
Performance Measurement ◽  
Primary Healthcare ◽  
Performance Data ◽  
Hiv Care ◽  
System Transformation ◽  
Structured Interviews ◽  
Community Based ◽  
Performance Framework ◽  
Measurement Framework ◽  
A Performance

ObjectivesPeople with human immunodeficiency virus (HIV) are living longer lives and like many other patients, need a health system better adapted for the management of complex chronic conditions. A key element of system transformation is measuring and reporting on system performance indicators relevant to the different stakeholders. Our objective was to produce a performance measurement framework for assessing the quality of comprehensive community-based primary healthcare for people with HIV.MethodsSemi-structured interviews were performed with HIV providers, advocates, and policy-makers to obtain input on a draft performance framework, constructed using existing HIV-specific indicators, as well as the use of performance data in improving care for people with HIV.ResultsStakeholders were overwhelmingly supportive of the framework’s comprehensiveness. Many noted the absence of indicators addressing social determinants of health and had mixed opinions on the importance of indicators addressing access to after-hours care and the frequency of routine screening for behavioural risk factors. The draft framework was modified to reflect stakeholder input, triangulated against expert opinion and recently released HIV care guidelines, and finalized at 79 indicators. The resources and infrastructure to collect and use performance data will have to be improved for performance measurement to contribute to improving care for people with HIV.ConclusionsThis framework presents a comprehensive though not exhaustive tool to support performance measurement and improvement in the care for people with HIV. However, advances in data collection and use across the system will be needed to support performance measurement driving quality improvement.

scholarly journals An Untapped Potential in Primary Care: Semi-Structured Interviews with Clinicians on How Patient Portals Will Work for Caregivers in the Safety Net

10.2196/18466 ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. e18466 ◽  
Author(s):  
Alejandra Casillas ◽  
Anupama Gunshekar Cemballi ◽  
Anshu Abhat ◽  
Miya Lemberg ◽  
Jennifer D Portz ◽  
...  
Keyword(s):  
Health Systems ◽  
Digital Literacy ◽  
Limited English Proficiency ◽  
English Proficiency ◽  
Safety Net ◽  
Security And Privacy ◽  
Structured Interviews ◽  
Patient Portals ◽  
Privacy And Security ◽  
Safety Net Providers

Background Patients within safety-net settings are less likely to access health information on patient portals, despite expressed interest. Family and friends are important resources to assist these patients (ie, Medicaid recipients, older patients, patients with limited English proficiency) in navigating health systems, and provider support of the use of patient portals among these groups may also facilitate caregivers’ use of their patients’ portal. Objective Because safety net providers work closely with caregivers to care for their patients, we used qualitative methods to explore safety net providers’ perspectives on portal use among caregivers for their patients, especially as there is limited literature about caregivers’ use of portals in the safety net. Methods We conducted 45- to 60-min semistructured telephone interviews with providers from three large California safety-net health systems. The interviews focused on providers’ experiences with caregivers, caregiver roles, and how the portal could be leveraged as a tool to support caregivers in their responsibilities. A total of three coders analyzed the interview transcripts using both deductive and inductive approaches and established a consensus regarding major themes. Results Of the 16 participants interviewed, 4 specialized in geriatrics, and all held a leadership or administrative role. We described themes highlighting providers’ recognition of potential benefits associated with caregiver portal use and specific challenges to caregiver engagement. Conclusions Providers recognized the potential for portals to improve information delivery and communication by helping caregivers assist socially and medically complex patients in the safety net. Providers in safety net sites also discussed a clear need for better ways to keep in touch with patients and connect with caregivers, yet security and privacy are perhaps of higher importance in these settings and may pose challenges to portal adoption. They noted that caregivers of patients in the safety net likely face similar communication barriers as patients, especially with respect to digital literacy, health literacy, and English proficiency. Further research is needed to assess and support caregivers’ interest and ability to access portals across barriers in health and digital literacy, and English proficiency. Portal platforms and health systems must also address specific strategies to uphold patient preferences while maintaining privacy and security.

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