Welcome!

1. Welcome! Considerations for Rural Research: A Community Based Practice Research Model Approach Presenter: Holly Hatton September 10, 2010

2. Today’s Presentation • Discuss challenges in doing research in rural communities • Present the Community-Based Practice Research Model (CBPR) • Provide an illustration for using “data” to help all key players involved in the CBPR model • Lake County: Case study video

3. Introduction • Working with community organizations collaborative research adds another dimension • Considerations of ethical issues • Researchers must be open to understanding communities’ values and priorities when conducting research collaboratively with community organizations. • This presentation provides considerations for conducting community engaged research.

4. Duality of Program Implementation and Research • Science looks for truth, practice looks for what works. What works is true, and what is true works. -Guy Steuart, 1963

5. To start with can be difficult to get funding to achieve Rural Success • Grants for rural projects assume deficit • Poor counties + fewer resources = poor outcome • Is this assumption valid? • A strengths-based approach and beyond • What can the rest of the world learn from the success of rural child welfare programs?

6. What’s in the literature? • Approach • Little recognition of rural continuum (metro-non-metro) • Largely qualitative • Outcomes • Few rural-urban comparisons • One finding suggest different rural and urban roles for child welfare • Resources • Greater rural poverty • Poorer access to transportation and health care • Policy and Practice • Professionalism is one focus—real or perceived difference?

7. To foster partnerships between communities and educational institutions…… • Build on each other’s strengths • Develop roles as change agents improve family outcomes

8. Our Question • What does “authentic community participation in research” mean to you?

9. What is a “community?” • The term is commonly used but seldom defined. • For this presentation the working definition of community is: “A group of people who are linked by social ties and share common perspectives or interests and may also share a geographic location.”

10. Necessary Conflict of CBPR • By whom research is to be conducted (Which groups come to the table?) • For whom research is to be conducted (Which issues get to the table?) • How research is to be conducted (Which groups shape awareness of the issues?)

11. Which Groups Come to the Table to form a Community Partnership?

12. University at the Table • Investigators from Social Work Education • Community Outreach Specialist • Ethnographer • Graduate Students

13. Funder at the Table • For example: • National: SAMSHA • Local: First Five

14. AOD worker/counselor Parent partners Family Team Meeting Facilitator Attorneys Child social worker Processing assistant at County Health Department Nurse at County Health Department Social worker at shelter for battered women Job trainer at Community Action Agency High School counselor Community & Agency at the Table: Formative Phase Community Advisory Group

15. Which Issues Get to the Table?

16. University Issues that Get to the Table: for example • Methamphetamine abuse takes on special significance in child welfare • Numerous implications for policy and practice • Families with parents who abuse substances are oft en affected by: • complex and difficult problems • such as unemployment, poverty, poor housing • homelessness, domestic violence, involvement with the criminal justice system and mental • health problems (Connell-Carrick, 2007; Green, Rockhill, & Furrer, 2006). • In addition, federal legislation designed to address the urgency of children lingering in foster care, policies that do not fully understand challenges of recovery

17. Community Issues that Get to the Table • Child entering CWS for maltreatment due to Meth abuse • Increased crime rates • High substance abuse rates and not enough treatment programs

18. Challenge of Research/ Community Relationships Shared University/ Community Control Shared University/ Community Control University Control Community Control CBPR

19. What should researchers do when:: • Community values are different from those of the researchers and conflict with the planned research methodology • Members of community partner organizations have different perceptions of what constitutes “risk” • Releasing research results may stigmatize an entire community

20. Some standard research protocols may not be acceptable to community organizations and agencies • Control groups • Different treatments or interventions provided to groups • Random assignment of participants

21. CBPR Continuum of Community Participation None A Lot cooperation coordination collaboration partnership (adapted from Winer and Ray 2000)

22. Evolution of a Participatory Partnership pre-partnership Getting to know each other partnership Working to achieve mutually valued objectives Partnership Developing and implementing research/programs together Mullinix BB, 2000

23. Rationale for CBPR • Complex health and social problems ill-suited to “outside expert” research • History of research abuse and mistrust: “helicopter” or “drive-by” research • Increasing community and funder demands for community-driven research • Disappointing results in intervention research • Increasing understanding of importance of local and cultural context/external validity • Increasing interest in use of research to improve best practices/best processes

24. Power of Community as Co-Investigator [T]he opportunity…for communities and science to work in tandem to ensure a more balanced set of political, social, economic, and cultural priorities, which satisfy the demands of both scientific research and communities at higher risk. -John Hatch et al., 1993

25. CBPR: What it is and isn’t • CBPR is an orientation to research • changes the role of researcher/agency and researched • CBPR is not a method or set of methods • Typically thought of as qualitative • Fewer epidemiologic examples, but promising • CBPR goal is to influence change in community health, norms, systems, programs, policies

26. Values and Principles of CBPR • Recognizes community as self-determining unit • Builds on strengths and resources • Facilitates partnership in all research phases • Promotes co-learning and capacity building • Seeks balance between research and action • Disseminates findings and knowledge to all • Involves long-term process and commitment Israel, Schulz, Parker, Becker, Allen, Guzman, “Critical Issues in developing and following CBPR principles,” Community-Based Participatory Research in Health, Minkler and Wallerstein, Jossey Bass, 2000.

27. Challenges in researcher-community relationships • Nuances of participation and community consent (who is participating/who is not) • Power and privilege: Who sets the research question? Who has power of knowledge? • Historical research abuse/stereotyping/racism (predominance of white academics) • Be willing to face the reality of negative history

28. Challenges in researcher-community relationships • Challenge of academic vs. community time: publishing versus taking action • Challenge of CBPR cyclical and iterative process; research goals are not always known at the beginning of work • Challenge of research team having necessary skills, i.e., cultural humility, listening, sharing decision-making

29. CBPR/Community Engagement Steps: 1. Building Partnerships • Self-Reflection • Our own intentions, capacities, and liabilities • Our institution’s strengths and liabilities • Identify Potential Partners (representing who?) • Negotiate Health Issues (how evolve) • Create and Build Participatory Structures between Academia and Community • Principles • Decision-making • Control of budgets and data

30. 2. Identify Research Questions and Methods • Difference between community outreach and CBPR • Where do questions come from: community or academy or both? • Initial participation by Advisory Committee and then RCT? • Continual participation throughout which informs and changes intervention?

31. 3. Participatory Data Collection • Participatory Process that is most used • Train community interviewers, survey data collectors, focus group facilitators • Job opportunities for community • Enables better response rate • Issues of confidentiality

32. 5. Participatory Dissemination • Accountability to communities and to community protection • Community reports (print/videos/etc) • Academic publishing issues (especially for junior faculty) Wallerstein, N.., Duran, B., Minkler, M., Foley, K., Developing and Maintaining Partnerships, Methods in Community Based Participatory Research, Israel, B., et al (eds). San Francisco, Jossey Bass, 2005

33. Benefits of CBPR • Increases accurate and culturally sensitive interpretation of findings; • Facilitates effective dissemination of findings to impact public health and policy; • Increases translation of evidence-based research into sustainable community change • Provides resources and benefits to communities • Joins partners with diverse expertise • Increases research trust

34. Your questions: • Can you provide examples of how adopting CBPR research would alter: • Client relationships • Systems of practice in agencies • Community interventions or policies to help achieve optimal outcomes for children

35. Common Pitfalls of Program Implementation Shoot Aim Ready Implement PlanNo Results

36. When Is CBPR NOT for You? • Is Opportunism and Self-Interest Driving the Agenda? • Does Your Research Team Have the Necessary Skills? • Cultural Competence • Communication Skills • Listening Skills • Sharing Power/Control Over Decisions

37. When Is CBPR NOT for You? • Do Ethical Considerations Related to Burden and Benefits to the Community Outweigh Potential Research Benefits? • Time • Burden to the Community • Research Results Will Provide Minimal Benefit to the Community

38. Dependency Drug Court: A Collaborative Approach for Families Involved in Child Welfare A Multidisciplinary Treatment Model That Exemplifies The Community Research Partnership: In Lake County

39. Northern California Regional Partnership Grant Promoting Safe and Stable Families

40. Funding • The Northern California Regional Partnership Grant (RPG) for Promoting Safe and Stable Families is comprised of four-county cohort: Butte, Lake, Tehama, and Trinity. The data presented in this report was collected on clients enrolled in the grant project in each of the four-county cohort. • The RPG grant has funded one staff position for each of the four-county cohort, training and leadership by UC Davis Extension and Susan Brooks

41. Sample • There were 450 adults served across the four-county cohort, along with 617 children. A total of 327 cases (comprised of adults and children) were served during this time period.

42. Collecting Data • Staff from each county’s Child Welfare Services Department have utilized the California Child Welfare Services Case Management System (CWS/CMS) for collecting and reporting Child Welfare data. • Staff from Butte County have provided leadership to help each county retrieve data from the CWS/CMS system through use of Business Objects reports in order to produce the data reflected in this report.

43. Collecting Data • Additionally to the Child Welfare data, • Data from each of the Four-County Alcohol and Drug programs • Each county Alcohol and Drug program reports data to the California Outcomes Measurement System (CalOMS). • Management Information System (MIS) that collects client service utilization data.

44. Who are the team members? • Children and Family Services (CFS)/ Child Welfare Social Worker • Alcohol and other Drug Counselor • Residential and Outpatient treatment providers • Dependency Court Judge and Court Coordinator • Family Team Meeting Facilitator • Parent Engagement Facilitator • Nurturing Parent Program Group Facilitator • Northern California Training Academy, UC Davis

45. The Benefit of Coming Together • For the professionals in Lake County: • The entire team meets on a weekly basis to review all clients who are scheduled to appear in Drug Court that day, as well as any “add on” clients who have been asked to appear. • In collaborating, the team is able to provide updated and accurate information to the Judge, as well as recommendations and solutions for obstacles that the client is experiencing. • Coming together allows everyone to bring their own expertise to the table, and ensure everyone is on the same page to better benefit the client.

46. Experienced some challenges collecting reliable data over time from each of the four counties • Difficulties with tracking information • Different programs and types of implementation • Differing policies and standards • Attrition • Confidentiality issues

47. Lake County: Case Study Video • An evaluation method for exemplifying the Community Based Participation Research Model

48. THANK YOU!!!