Background:
Social determinants affect health, yet there are few systematic clinical strategies in primary care that leverage electronic health record (EHR) automation to facilitate screening for social needs and resource referrals. An EHR-based social determinants of health (SDOH) screening and referral model, adapted from the WE CARE model for pediatrics, was implemented in urban adult primary care.
Objectives:
This study aimed to: (1) understand the burden of SDOH among patients at Boston Medical Center; and (2) evaluate the feasibility of implementing a systematic clinical strategy to screen new primary care patients for SDOH, use EHR technology to add these needs to the patient’s chart through autogenerated ICD-10 codes, and print patient language-congruent referrals to available resources upon patient request.
Research Design:
This observational study assessed the number of patients who were screened to be positive and requested resources for social needs. In addition, we evaluated the feasibility of implementing our SDOH strategy by determining the proportion of: eligible patients screened, providers signing orders for positive patient screenings, and provider orders for resource referral guides among patients requesting resource connections.
Results:
In total, 1696 of 2420 (70%) eligible patients were screened. Employment (12%), food insecurity (11%), and problems affording medications (11%) were the most prevalent concerns among respondents. In total, 367 of 445 (82%) patients with ≥1 identified needs (excluding education) had the appropriate ICD-10 codes added to their visit diagnoses. In total, 325 of 376 (86%) patients who requested resources received a relevant resource referral guide.
Conclusions:
Implementing a systematic clinical strategy in primary care using EHR workflows was successful in identifying and providing resource information to patients with SDOH needs.
In this manuscript, we explore the promise and challenges of youth participatory action research (YPAR), paying particular attention to ethical issues and power dynamics that emerge in the context of research partnerships between youth and adults. We begin by reviewing the key tenets of YPAR and then go on to discuss how these tenets are often at odds with dominant approaches to research. We describe the tension between the values of YPAR and the systems and structures embedded in the academy. Further, we elucidate how adultism and the capitalist nature of the academy intersect with white supremacy culture, posing significant barriers to meaningful youth participation in community research partnerships. We then describe ways in which participatory scholars can disrupt these systems as well as larger paradigm shifts in the culture of academia that will be required to elevate youth voices and to amplify their efforts for equity.
Highlights
HEALing Communities Study is a parallel-group cluster randomized controlled trial.
Communities That HEAL intervention’s goal is to reduce opioid overdose deaths.
Structured consensus decision-making strategy guided study measure development.
More than 80 study measure specifications and a common data model were developed.
The study will provide methodology and longitudinal community data for research.
The opening plenary session at the 2017 Annual Conference of the Society for Social Work and Research, which focused on ensuring healthy youth development, highlighted the need to include young people as partners in research and evaluation. In doing so, the conference participants joined the voices of a growing group of social work scholars committed to youth participation and engagement, who have also highlighted the importance of youth voice in the development of prevention strategies and programming that are aligned with the lived experience of young people. Presenting four unique social work efforts designed to harness the power of youth voice, this article shines a spotlight on the role of social work research and practice in harnessing the power of youth participation in efforts of promote healthy youth development. This article concludes by illustrating the benefits of youth engagement for young people, communities, and researchers.
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 shar ing, core principles of CBPR. Although community partners appreciate this approach, traditionally trained aca demics may find this method unfamiliar and uncomfortable.
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. Clin Trans Sci 2014;
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 non probability 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 article suggests rethinking the business of community engagement in researcher, particularly as it relates to building research capacity to approach, engage and partner with communities.
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