Nuestra Recuperación [Our Recovery]: using photovoice to understand the factors that influence recovery in Latinx populations.

BACKGROUND: Photovoice is a form of visual ethnography intended to engage impacted communities in research followed by action to ameliorate the injustices under study. Photovoice has increased in use, especially in collaboration with Latinx communities addressing health inequities. The Latinx population comprises nearly 18% of the overall United States population and according to the census is projected to reach just under 30% by 2060. This diverse panethnic community faces significant structural barriers in accessing services. Racism and the resulting marginalization, specifically, contributes to limited access to recovery services and treatment. Making meaningful advances in substance use disorder training, intervention and policy necessitates learning alongside the Latinx community. METHODS: We partnered with a Latinx serving integrated behavioral health and primary care setting in Boston Massachusetts to explore barriers and facilitators to recovery using photovoice. Spanish-speaking Latinx adults with a substance use disorder participated. The group met for three photovoice sessions over a six-week period. Together group members critically analyzed photographs using the SHOWeD method. RESULTS: Findings indicate a sense of purpose and meaning, security, faith and housing are important elements of recovery. The results illustrated the importance of sources of connection in maintaining sobriety. Through this photovoice project, Latinx Spanish speaking participants highlighted barriers and facilitators to their substance use disorder recovery which spanned individual, community, and structural levels. CONCLUSIONS: The experiences and voices of the Latinx community are crucial to drive discussions that advance policy (e.g., housing stability and access), enhance providers' understanding of Latinx Spanish-speakers' substance use disorder recovery, and inform culturally and linguistically appropriate services. This study demonstrated that photovoice is highly acceptable and feasible among Latinx clients receiving substance use disorder services. Visual images related to housing, faith, etc. communicate challenges, power structures, as well as hopes to policymakers at multiple levels (e.g., institution/ agency, state).

Critical Reflections From Doctoral Students Engaging in Local and Transnational Community-Based Participatory Research (CBPR) Approaches to Health Promotion.

Social work scholars have increasingly adopted Community-Based Participatory Research (CBPR) approaches to center community voice in research and action to promote youth's healthy development. While valuable contributions have emerged to engage in further dialectical learning processes, limited research has examined in depth the participation, critical reflection, and training of social work graduate students pursuing CBPR. This article emphasizes the role of critical reflexivity and collaboration by presenting four social work doctoral students' efforts designed to engage community and youth in CBPR to enhance health promotion initiatives. We conclude by discussing the importance of engaging graduate social work students in CBPR, the influential role faculty and mentors play in providing opportunities for students to gain experience in CBPR, and recommendations and potential strategies for future social work education and training.

Race and Place: Exploring the Intersection of Inequity and Volunteerism Among Older Black and White Adults.

Although the historical impact of racial segregation and ongoing health and economic inequities between older Black and White adults is well documented, little is known about the relationships among race, individual- and neighborhood-resources, and formal volunteering in later life. This study explores this intersection. Individual-level data from 268 respondents aged 55+ were collected in the St. Louis metropolitan area through paper-based mail surveys. Objective neighborhood data were obtained at the zip code level from secondary sources and matched with respondents. Using exploratory factor analysis, we constructed a 14-item environmental scale with 3 neighborhood dimensions (economic, social, and built environment). Older Black adults had lower levels of education; had fewer financial assets; lived in neighborhoods with less economic resources and lower built environment scores; and fewer formally volunteered when compared to older White adults. Individual resources (financial assets, health) and neighborhood resources (social and built environment) were positively associated with formal volunteering among older Black adults. Only individual resources (age, marital status, financial assets, health) were associated with formal volunteering among older White adults. A coherent set of policies that bolsters individual and environmental capacities may increase the rate of volunteerism among older black adults.

Interrogation, Negotiation, and Subversion of Power Differentials in Community-Based Participatory Research: A Scoping Review.

OBJECTIVES: To review empirical and peer-reviewed scholarly articles incorporating community-based participatory research approaches and examining discourses of how power differentials are interrogated, negotiated, and redressed within the partnerships using scoping review methodology following The Joanna Briggs Institute framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). DATA SOURCES: Articles were identified across five online databases: Embase, ERIC, PsycINFO, PubMed, and Web of Science. REVIEW METHODS: Keywords used in the search strategy were ("Community-Based Participatory Research" OR "Participa-tory Action Research"). Peer-reviewed scholarly articles discussing in-depth power differentials within the partnership published in English between 2010 and 2020 were included. RESULTS: Findings indicate scholars use critical reflexive qualitative methodologies to recognize and raise relevant questions of power issues between researchers and community stakeholders. Examination of individual biases, assumptions, and exertion of hierarchical top-down power is identified extensively. There is limited analysis on institutional and interdependent power. As a result of raising questions regarding power issues, individual actions to address emerging tensions and conflicts were reported. However, discussions on researchers' efforts to effect institutional and structural changes to redress power imbalances were limited. CONCLUSIONS: Building strong and equitable participatory action research collaborations between researchers and community stakeholders remains an arena of continuous struggle. This review offers some insights and relevant implications to better address power issues within participatory action research partnerships and inform the work of professionals engaged in the development, implementation, and evaluation of health promotion initiatives and policies.

Effect of the Communities that HEAL intervention on receipt of behavioral therapies for opioid use disorder: A cluster randomized wait-list controlled trial.

BACKGROUND: The U.S. opioid overdose crisis persists. Outpatient behavioral health services (BHS) are essential components of a comprehensive response to opioid use disorder and overdose fatalities. The Helping to End Addiction Long-Term® (HEALing) Communities Study developed the Communities That HEAL (CTH) intervention to reduce opioid overdose deaths in 67 communities in Kentucky, Ohio, New York, and Massachusetts through the implementation of evidence-based practices (EBPs), including BHS. This paper compares the rate of individuals receiving outpatient BHS in Wave 1 intervention communities (n = 34) to waitlisted Wave 2 communities (n = 33). METHODS: Medicaid data included individuals ≥18 years of age receiving any of five BHS categories: intensive outpatient, outpatient, case management, peer support, and case management or peer support. Negative binomial regression models estimated the rate of receiving each BHS for Wave 1 and Wave 2. Effect modification analyses evaluated changes in the effect of the CTH intervention between Wave 1 and Wave 2 by research site, rurality, age, sex, and race/ethnicity. RESULTS: No significant differences were detected between intervention and waitlisted communities in the rate of individuals receiving any of the five BHS categories. None of the interaction effects used to test the effect modification were significant. CONCLUSIONS: Several factors should be considered when interpreting results-no significant intervention effects were observed through Medicaid claims data, the best available data source but limited in terms of capturing individuals reached by the intervention. Also, the 12-month evaluation window may have been too brief to see improved outcomes considering the time required to stand-up BHS. TRIAL REGISTRATION: Clinical Trials.gov http://www. CLINICALTRIALS: gov: Identifier: NCT04111939.

Health Lens Analysis: A Strategy to Engage Community in Environmental Health Research in Action.

Health Lens Analysis is a tool to facilitate collaboration among diverse community stakeholders. We employed HLA as part of a community based participatory research (CBPR) and action study to mitigate the negative health effects of TRAP and ultrafine particles (UFPs) in Somerville, MA. HLA is a Health in All Policies tool with previously limited implementation in a North American context. As part of the HLA, community and academic partners engaged residents from across near-highway neighborhoods in a series of activities designed to identify health concerns and generate recommendations for policies and projects to improve health over an 18-month planning period. Noise barriers, which may reduce TRAP exposure among residents in addition to reducing traffic noise, were seen as an acceptable solution by community stakeholders. We found HLA to be an effective means to engage stakeholders from across sectors and diverse community residents in critical discourse about the health impacts of near-roadway exposures. The iterative process allowed the project team to fully explore the arguments for noise barriers and preferred health interventions, while building a stakeholder base interested in the mitigation of TRAP, thus, creating a shared language and understanding of the issue.

Priorities, concerns and unmet needs among Haitians in Boston after the 2010 earthquake.

In January 2010, a massive earthquake struck Haiti. The devastation not only affected those living in Haiti at the time but also those Haitians living in the United States (U.S.). Few studies have assessed the degree of impact of the earthquake in U.S. Haitian communities. The purpose of this study was to elicit information about health priorities, concerns and resources needed to improve the delivery of health and social care for Haitians in Boston, MA. We conducted six focus groups among 78 individuals in the spring of 2011. Participants were recruited through community organisations, including churches, Haitian social service centres, restaurants and by word of mouth. Analysis of qualitative data revealed an enormous psychological, emotional, financial and physical toll experienced by Boston-area Haitians following the earthquake. Participants described increased distress, depressive episodes, headaches and financial hardship. They also noted insufficient resources to meet the increased needs of those living in the U.S., and those who had immigrated after the earthquake. Most participants cited an increased need for mental health services, as well as assistance with finding employment, navigating the immigration system, and balancing the health and financial needs of families in the U.S. and in Haiti. Despite this, many reported that the tragedy created a sense of unity and solidarity within the Haitian community. These findings corroborate the need for culturally and linguistically appropriate mental health services, as well as for employment, immigration and healthcare navigation services. Participants suggested that interventions be offered through Haitian radio and television stations, as well as group events held in churches. Further research should assess the need for and barriers to utilisation of mental health services among the Haitian community. A multi-faceted approach that includes a variety of outreach strategies implemented through multiple channels may offer a means of improving awareness of and access to health and social services.

Creating a Culture of Empowerment in Research: Findings from a Capacity-Building Training Program.

BACKGROUND: This paper uses a theory from educational research - "the culture of power" - to explore power differentials between academic researchers and community partners in community engaged research partnership programs. OBJECTIVES: This paper describes how a capacity-building program illuminated the tensions between academics and community partners related to power differentials and offers strategies for how to balance the power dynamic. METHODS: This paper relies on semi-structured interviews from 30 community partners who participated in the "Building your capacity" program. RESULTS: The framework of "culture of power" applied to research relationships helps us understand the following: (1) The power differentials between academic institutions and community agencies are deeply entrenched. That is there is a "culture of power." (2) This culture of power is often reinforced through the cultural rules and dominant language of the academy. (3) Academic institutions, by and large, have created and perpetuated the rules that have led to these uneven power relationships. (4) Being told explicitly about the rules of academic culture make acquiring power easier for community partners. (5) Community partners are often more aware of the culture of power in research and more willing to acknowledge these differentials than academic researchers. CONCLUSIONS: Academic partners who want to work with community partners need to acknowledge these power imbalances and be intentional about shifting these power dynamics. Capacity-building programs can help to shift these power imbalances because they help community partners acquire the confidence, knowledge and skills to advocate for more equitable research relationships.

Community engagement in the CTSA program: stakeholder responses from a national Delphi process.

In response to the Institute of Medicine (IOM) Committee's December 2012 public request for stakeholder input on the Clinical and Translational Science Award (CTSA) program, two nonprofit organizations, the Center for Community Health Education Research and Service, Inc. (CCHERS) and Community-Campus Partnerships for Health (CCPH), solicited feedback from CTSA stakeholders using the Delphi method. Academic and community stakeholders were invited to participate in the Delphi, which is an exploratory method used for group consensus building. Six questions posed by the IOM Committee to an invited panel on community engagement were electronically sent to stakeholders. In Round 1 stakeholder responses were coded thematically and then tallied. Round 2 asked stakeholders to state their level of agreement with each of the themes using a Likert scale. Finally, in Round 3 the group was asked to rank the Round 2 based on potential impact for the CTSA program and implementation feasibility. The benefits of community engagement in clinical and translational research as well as the need to integrate community engagement across all components of the CTSA program were common themes. Respondents expressed skepticism as to the feasibility of strengthening CTSA community engagement.

Employing a community based participatory research approach to bear witness: psycho-social impact of the 2010 earthquake on Haitians in Somerville, MA.

We employed a community-based participatory research approach to assess mental health among the Haitian community in the Somerville, MA area. The development of the survey coincided with the 2010 earthquake in Haiti, and so several questions related to the natural disaster were included in the analysis to increase understanding of the impact locally. We surveyed a convenience sample of 64 Haitians recruited with the assistance of the Somerville Haitian Coalition. The survey assessed demographic data, reasons for migrating to the area, response to the 2010 earthquake, and mental health. Mental health measures included the short versions of the Center for Epidemiologic Studies Depression Scale (CES-D) and the Perceived Stress Scale. Participants reported high rates of stress and depression post-earthquake. On the CES-D, men reported higher average depression and stress scores than women (13.8 vs. 11 and 20.6 vs. 17.6). Our results suggest that social and family support resources may be beneficial to Haitians in our sample.

Lessons Learned from the Protección en Construcción Community Research Partnership.

PenC seeks to build community-university-labor partnership in order to design, implement and evaluate an intervention aimed at preventing falls and silica exposure among Latino construction workers. This study evaluated the PenC partnership process. Semi-structured partner interviews and surveys were used. Thematic, univariate and bivariate analyses were conducted; results were presented back to partners who then provided data context. Although all partners report increased capacity including new connections and knowledge, resident researchers, here promotores, are much more likely to share information with their neighbors and other local residents. Engaging residents can lead to deeper community penetration.

Team-building activities as strategies for improving community-university partnerships: lessons learned from Nuestro Futuro Saludable.

BACKGROUND: Collaboration characterized by mutual capacity building, asset sharing, and tangible outcomes that work to further health equity are central tenets of community-based participatory (CBPR) approaches to research. Such efforts require the establishment, development, and maintenance of trusting relationships between community and institutional stakeholders. OBJECTIVES: The objective of the strategies discussed here was to strengthen a community-academic partnership by facilitating communication and empowering project partners. METHODS: Team-building activities and experiential exercises were intentionally utilized with project stakeholders to clarify roles and responsibilities, provide alternative avenues for authentic communication, and share power. LESSONS LEARNED: Team-building activities can be effective in promoting CBPR partnerships when utilized appropriately. Through the course of the partnership building process, best practices emerged for utilizing experiential learning exercises to enhance partnership dynamics. CONCLUSIONS: Team-building activities provide a useful tool for developing supportive environments that encourage open dialogue.

Clinical and translational research and community engagement: implications for researcher capacity building.

This research sought to better understand how clinical and translational research is defined and perceived by community service providers. In addition, the research sought to elicit how the perspectives of service providers may hinder or facilitate collaborative research efforts. The study employed a qualitative methodology, focus groups. A nonprobability sampling strategy was used to recruit participants from three neighborhoods in the Tufts University's catchment area. Focus group findings add to the nascent body of literature on how community partners view clinical and translational research and researchers. Findings indicate that cultural disconnects, between researchers and community partners exist, as does mistrust, all of which serve as potential barriers to community research partnerships. This paper suggests rethinking the business of community engagement in researcher, particularly as it relates to building research capacity to approach, engage, and partner with communities.

Research as curriculum: engaging undergraduates and community residents in immigrant health research partnerships.

BACKGROUND: Engaging undergraduate students in applied community research partnerships can promote greater health equity by providing students with the skills and capacity to work collaboratively with diverse populations. OBJECTIVES: The aim of this project was to develop a sustainable model to engage community members and students in public health research. METHODS: Using an integrated research-as-curriculum model, students, community members, and faculty collaborated on the study design and implementation. CONCLUSIONS: Community residents in the classroom provided insights that strengthened the research process and helped to develop our understanding of contextual factors that influence health and well-being. This model provides a mechanism by which to fully incorporate undergraduate students in interdisciplinary partnership research for health.

Community-engaged pedagogy: a strengths-based approach to involving diverse stakeholders in research partnerships.

BACKGROUND: To help build community capacity to partner in translational research partnerships, new approaches to training that incorporate both adult learning models and community-based participatory research (CBPR) are needed. OBJECTIVES: This article describes the educational approach-"community-engaged pedagogy"-used in a capacity-building training program with community partners in Boston. Drawing from adult learning theory and CBPR community-engaged pedagogy embraces co-learning and is rooted in a deep respect for the prior knowledge and experiences that community partners bring to the conversation around CBPR. This approach developed iteratively over the course of the first year of the program. Participating community partners drove the development of this educational approach, as they requested the application of CBPR principles to the educational program. METHODS: The dimensions of community-engaged pedagogy include (1) a relational approach to partnership building, (2) establishment of a learning community, (3) organic curriculum model, (4) collaborative teaching mechanism with diverse faculty, and (5) applied learning. CONCLUSIONS: Using a community-engaged pedagogical approach helps to model respect, reciprocity, and power sharing, core principles of CBPR. Although community partners appreciate this approach, traditionally trained academics may find this method unfamiliar and uncomfortable.