A collaboration team to build social service partnerships within a safety-net health system.

BACKGROUND: To facilitate safety-net healthcare system partnerships with community social service providers, the Los Angeles County Department of Health Services (LAC DHS) created a new collaboration team to spur cross-agency social and medical referral networks and engage communities affected by health disparities as part of a Sect. 1115 Medicaid waiver in Los Angeles County entitled Whole Person Care-Los Angeles (WPC-LA). METHODS: This observational research reviews three years of collaboration team implementation (2018-2020) through Medicaid-reportable engagement reports, a collaboration team qualitative survey on challenges, facilitators, and recommendations for community engagement. Member reflections for survey findings were conducted with the collaboration team and LAC DHS WPC-LA leadership. RESULTS: Collaboration team Medicaid engagement reports (n = 144) reported > 2,700 events, reaching > 70,000 individuals through cross-agency and community-partnered meetings. The collaboration team survey (n = 9) and member reflection sessions portrayed engagement processes through outreach, service assessments, and facilitation of service partnerships. The collaboration team facilitated community engagement processes through countywide workgroups on justice-system diversion and African American infant and maternal health. Recommendations for future safety net health system engagement processes included assessing health system readiness for community engagement and identifying strategies to build mutually beneficial social service partnerships. CONCLUSIONS: A dedicated collaboration team allowed for bi-directional knowledge exchange between county services, populations with lived experience, and social services, identifying service gaps and recommendations. Engagement with communities affected by health disparities resulted in health system policy recommendations and changes.

Chapter 8. An indigenous narrative of resilience: Malama ko Aloha.

Many indigenous cultures use storytelling as the foundation for the transmission of important cultural information. Stories passed down from generation to generation sometimes teach, record history, provide examples, or inform. One important function of storytelling is the transmission of stories about cultural resilience illustrating how a cultural group has kept strong in the face of adversity. This article shows how storytelling in the Hawaiian culture has been used for this purpose and how the Beamer family has served as the master storytellers of their culture, keeping the culture and traditions alive through their music, dance, and stories.

Challenges in public health research with American Indians and other small ethnocultural minority populations.

As a result of the historical legacy of conquest, colonization, and cultural destruction, indigenous peoples often represent just a small segment of the population in many countries throughout the world. In the United States, American Indians/Alaska Natives are not only one of the smallest minority groups in the nation, but are also very culturally diverse. Disparities in health outcomes often occur along racial and ethnic lines, and culture can play an important role in shaping health behavior. Research on the distribution and patterning of disease and risk behaviors among population subgroups is critical for advancing evidence-based public health policy and practice. This article provides a brief overview of key challenges in conducting behavioral health research with American Indians at both community and population levels. Many of the issues raised also apply to other small ethnocultural minority groups.

Building partnerships between indigenous communities and universities: lessons learned in HIV/AIDS and substance abuse prevention research.

Many HIV/AIDS and substance abuse prevention studies in American Indian and Alaska Native communities have been directed by academic researchers with little community input. We examined the challenges in conducting HIV/AIDS-related research in American Indian and Alaska Native communities and the benefits of changing the research paradigm to a community-based participatory model. The lessons we learned illustrate that the research process should be a cyclical one with continual involvement by community members. Steps in the process include (1) building and sustaining collaborative relationships, (2) planning the program together, (3) implementing and evaluating the program in culturally acceptable ways, and (4) disseminating research findings from a tribal perspective. These steps can enhance the long-term capacity of the community to conduct HIV/AIDS and substance abuse prevention research.

[Strengthening family interventions for the prevention of substance abuse in children of addicted parents]. / Intervenciones de fortalecimiento familiar para la prevención del consumo de sustancias en hijos de padres adictos.

The scientific literature consistently reports that while children of substance abusers may be at biological, psychological, or environmental risk, the effects of these risks can be abbreviated through the use of effective interventions and treatments. Research has consistently demonstrated reductions in family and child dysfunction when effective family intervention programs are consistently utilized. While a number of effective family-based approaches have been developed and evaluated, only a few have been designed specifically for children of substance abusing parents. Just two have been tested in randomized control trials -The Streghtening Families Program and Focus on the Family. The Streghtening Families Program has demonstrated statistically significant reductions in family and child dysfunctions across several ethnocultural groups when consistently utilized. Clinical and advanced graduate programs should stress training in these evidence-based practices as well as how to adapt these models to be more culturally sensitive and age or gender appropriate in order to serve a growing and needy population of families.

Resilience in children of substance users: in their own words.

Understanding what children of alcoholics and other substance users experience has dominated the scientific literature and popular press for the past several decades. To date, the empirical studies have relied primarily on quantitative data to understand the individual and environmental factors associated with the lives, the developmental trajectories, and the growth of children of alcoholics and other substance users. Many of these studies focus on their risks, and very few of them focus on their strengths. Additionally, very few studies have used qualitative techniques to collect data. While quantitative studies have given us great insight, perhaps we could learn a great deal more if we employed data collection methods which would actually provide us with the child's perception of their strengths, or resilience, and what they think it takes to grow into happy, healthy adults. For this reason, this study presents data from the interviews of 50 children of substance users who present their views on resilience.

The healing forest metaphor revisited: the seen and "unseen world" of drug use.

There is one world we live in. Its geographical and spatial boundaries tell us this. We see it on maps, we see it on television, and we see it when we walk out of the door. Children, adults, and people of all races and creeds live in this one world. The world we live in is viewed differently by these many individuals. Some see it as hostile, some see it as peaceful, and some go about their daily business and do not see it at all. This is the seen world. The one we can see with our eyes. The seen world is not the only one that exists, however, because there is also another world behind our eyes. When we close our eyes, it is in there. We have an imagination to tell us what it could be like, we have thoughts to tell us what we want it to be like, and we have dreams to tell us what we want it to be. Where is this unseen world? We carry it around with us every nanosecond of every day that we are alive. While we live in the seen world, the unseen world is alive in us. What could the unseen world be like for substance users? This is the topic of the current article.

HIV/AIDS, substance abuse, and hepatitis prevention needs of Native Americans living in Baltimore: in their own words.

A needs assessment funded by the Center of Substance Abuse Prevention was conducted in 2005-2006 to determine the HIV/AIDS, substance abuse, and hepatitis prevention needs of Native Americans living in Baltimore, Maryland. We used a community-based participatory approach to gain an in-depth understanding of local Native American health service needs. Community stakeholders and key informants embedded in the local Native American population were consulted at each stage of the research planning process. Two complementary methodologies (focus groups and surveys) produced a holistic assessment of the population's needs, risks, and strengths and uncovered the social and cultural contexts in which health risk behaviors unfold. The use of these methods within a participatory framework produced a more complete portrait of the service needs of the Native American population in Baltimore. Findings from this study support the necessity for future HIV/AIDS, substance abuse, and hepatitis prevention programming for urban Native Americans.

Introduction to the special issue on resilience.

This article introduces this special issue on resilience by briefly reviewing its history and how contemporary researchers and theorists deliberate it today. Resilience, as a concept, emerged primarily from the work of Norman Garmezy, Emmy Werner, and Ruth Smith. It has transformed the field and shifted research, theory, and practice paradigms to a focus on strengths rather than deficits.

The role of caring adults in the lives of children of alcoholics.

Longitudinal studies of children of alcoholics in a community context are rare, but are of special interest because they provide the opportunity to study families with alcoholic parents who do not reach clinical settings and with offspring who do not receive professional help. The current study reports on the 65 offspring of alcoholics who participated in the Kauai Longitudinal Study. The extensive data on these analyses included questionnaires and interviews of both children and adults that were collected over a 30-year period. The data showed that individuals who coped effectively with the trauma of growing up in an alcoholic family and who became competent adults relied on a significantly larger number of sources of support in their childhood and youth than did the offspring of alcoholics with coping problems by age 32.

Outcomes for substance user treatment in women: results from the Baltimore Drug and Alcohol Treatment Outcomes Study.

The Baltimore Drug and Alcohol Treatment Outcomes Study is a large study focusing on a single city. Over 1000 adult male and female substance users entering treatment in 16 publicly funded substance use treatment programs in the City of Baltimore between 1998 and 1999 were evaluated at four time periods (intake, 30 days after treatment, 6 month, and 12 month follow-ups). A comprehensive psychological battery was administered at each assessment interval. In this article, we report on the seven domains (alcohol, drug, medical, legal, employment, family, and psychological) of the addiction severity index (ASI) with the 459 women who participated in the study. Overall, statistically significant differences across time showed improvement as a result of substance user treatment were found in six of the seven ASI domains; no statistically significant effects for time were found for the medical composite scores. Drug and alcohol use among the participants was significantly reduced as early as 30 days after treatment. We discuss these findings in relation to the specific treatment needs of women who are addicted.