Public Policy

Edited by Melissa Strompolis (mstrompolis@gmail.com

The first section of the policy column contains the 2014-2015 recipients of SCRA Policy Mini-Grants.  The policy committee received many great proposals and was able to fund three projects that would have significant impact in the policy arena.  In the second section of the policy column, doctoral candidate Venoncia M. Baté-Ambrus provides SCRA with an update on the Community Health Worker (CHW) Initiative and the overlap between SCRA and the American Public Health Association.  Venoncia began her career, 13 years ago, as a Community Health Worker and now serves as the Outreach Consultant for the Suburban Primary Health Care Council’s Access to Care program. Understanding the need for organic, grass-roots leadership, Venoncia has been a champion of the CHW model and is working in collaboration with regional leaders to plan a conference for CHWs and stakeholders in 2015. Venoncia serves as an American Public Health Association (APHA) Governing Councilor representing the CHW section and co-chair of SCRA’s Community Health Interest Group.

2014-2015 SCRA Policy Committee Mini-Grant Awardees

Evaluation of an Innovative School District-Wide Assessment System

Written by Katrina Roundfield and  Kaja LeWinn

University of California – San Francisco

katrina.roundfield@ucsf.edu

The No Child Left Behind (NCLB) Act was enacted in 2001 by the federal government to centralize educational standards in the United States (U.S.). NCLB has met numerous challenges in practice. Academic underperformance among disadvantaged youth has persisted, and in some cases, been exacerbated by NCLB. As a result, a national waiver system was offered to individual states to develop accountability systems that are better-suited to address educational challenges at the state level. In the state of California, the California Office to Reform Education (CORE) successfully received a federal waiver in 2013 by proposing a new accountability system for the state. CORE developed a system that measures student, faculty, and school-family outcomes, the School Quality Improvement Index (SQII). This measure accounts more holistically for student outcomes, compared to accountability measures associated with NCLB, by examining multiple student dimensions, including socio-emotional competence. The Unified School District (USD) is one of ten school districts participating in the CORE waiver and in 2014 conducted its first assessment of schools in the district using the SQII. USD is now interested in integrating their existing data systems with student-level data collected from the SQII in order to address academic disparities of students in the district. USD seeks to link academic and socio-emotional data from the SQII to data collected quarterly by USD in an effort to make data-informed decisions to enhance student outcomes within the district. The current investigation will assist USD by providing consultation and data analytic assistance to answer specific questions about socio-emotional and academic disparities among students. In collaboration with the Head of Pupil Services at USD, the investigators will develop an integrative data system, build research capacity within the district, and conduct analyses of interest to USD. This community research partnership has policy implications at the district, state, and national level.

Postdisaster Home Buyouts and Relocation:  Integrating Context and Community Concerns into Disaster Mitigation Policy

Written by Sherri Brokopp Binder and Charlene Baker

University of Hawai’i at Manoa

brokopp@hawaii.edu

At present, policy and practice related to home buyout programs are outpacing research. The proposed project seeks to address this gap by linking community-based research to policy outcomes, and by integrating community experiences and concerns into the national debate on the efficacy and impacts of home buyout programs. Specifically, the SCRA Policy Grant will support the implementation of a second round of interviews (Time 2) that examine participants’ experience of the buyout or rebuilding process in the 18 months since the buyout was fully implemented. These interviews will focus on the experience of the buyout process and the early relocation and reintegration phase for households that relocate (and, for comparison, the early recovery phase for households that chose to rebuild in their original communities), and will include a specific focus on documenting experiences, perceptions, and recommendations that have implications for buyout and postdisaster relocation policy.

Building on an existing dataset from the 2013 study, this study represents a longitudinal exploration into the issue of with whom and in what contexts home buyout programs are successful. Using the State of New York’s post-Sandy Home Buyout Program as a case example, we will address the following four research questions.

RQ1: What are the medium-term impacts of home buyout programs for residents who accept buyouts, and what factors facilitate or hinder the successful integration of relocated residents into their new communities?

RQ2: How do households and communities that reject buyouts compare to those that relocate in terms of community resilience, social disruption, and perception of risk?

RQ3: What household- and community-level factors contribute to heterogeneous responses to the buyout decision within neighborhoods?

RQ4: How do communities that are impacted by home buyout programs perceive the value of those programs, and what recommendations do they have for how the programs could be improved?

Gender-Responsivity in the Juvenile Justice System

Written by Valerie R. Anderson  and William S. Davidson II

Michigan State University

ande1538@msu.edo

In recent years female juvenile offenders comprise a growing proportion of juvenile court caseloads. Thus, there is a growing interest and investment in gender-responsive services among juvenile justice practitioners. Given the increased visibility of girls in the juvenile justice system it is important to examine how juvenile court personnel understand and respond to girls. The reauthorization of the Juvenile Justice and Delinquency Prevention Act in 1992 mandated states to include gender-responsive services to youth. The literature on gender-responsive services broadly focuses on overarching themes and guidelines related to best practices with female youth. While a conceptual and theoretical basis exists in ways to work effectively with female adolescents, there is limited existing research on the efficacy of the implied approach (including both the evaluation of gender-responsive programming and the evaluation of programming disaggregated by gender) and practitioners’ understanding and utility of the construct. Therefore, the purpose of the study is to examine the meaning of gender-responsivity from a practitioner perspective and connect practitioners’ experiences of working with girls to the gender-responsive policy mandate. The study will focus on: (1) ideas that practitioners have about gender-responsivity and subsequently what they do with these ideas, (2) the types of services girls receive, (3) how these do (or do not) differ from services for boys, and (4) the degree to which services match gender-responsive policy goals.

Macro and Micro-level Community Health Worker (CHW) Advocacy: Recommendations for Community Psychologists

Venoncia M. Baté-Ambrus

National Louis University, Chicago IL

criollav@hotmail.com

The mission of the Policy Committee of the Society for Community Research and Action is to encourage two-way communication between community psychologists and policy makers; to encourage collaborative relations with other groups to work on policy activities; to assure that the experiential and empirical knowledge base of community psychology is used to make substantive contributions to contemporary policy debates at the state and federal levels; to create opportunities for training; and to encourage academicians and others who lack policy experiences to familiarize themselves with the policy process through both traditional (classroom) and field-based (internship/externship) training experiences (www.SCRA27.org). Community Health Work (CHW) and community psychology are kindred spirits with a shared cosmology (Baté-Ambrus, 2014). Therefore the American Public Health Association’s (APHA) new Community Health Worker policy and community psychology recommendations are presented as advocacy guidelines for community psychologists.

Pioneering community psychologist Robert Reiff and his co-author social psychologist Frank Riessman (1965) describe the indigenous nonprofessional (today’s CHW) as “a bridge between the middle class oriented professional and the client from the lower socio-economic groups. Implicit in the bridge concept is the notion that people drawn from the lower socioeconomic strata may have special skills for establishing communication across class lines. This ability is rooted in their background. It is not based on things that they have been taught but what they are” (p. 7). For the duration of this article the term CHW or indigenous worker will be used instead of “indigenous nonprofessional” for purposes of modern convention and in solidarity with CHWs’ legitimate right to be considered professionals, for the situated-knowledge that is possessed, rather than be referred to as “nonprofessional” or “paraprofessional”. Otherwise Reiff & Riessman’s description is very similar to the APHA CHW definition below:

The APHA defines a CHWs as a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the CHW to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.

A CHW also builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy (APHA, 2015).

There are many other CHW definitions currently in use including those of the World Health Organization (WHO), the Department of Labor (DOL), the Office of Minority Health (OMH) and the Patient Protection and Affordable Care Act (PPACA; Baté-Ambrus, 2015). This article utilizes the APHA definition and is informed by Reiff & Riessman’s indigenous worker description. 

Community psychologists are well-positioned to advocate for CHWs at the local, regional, national and international levels because of the value and emphasis placed upon social and economic justice, health in all policies and inter-professional collaboration. The new APHA policy adopted on Nov. 18, 2014 at the Annual Meeting offers a historical context and guidelines for community psychologists, policymakers and other stakeholders by providing a “relationship to the existing APHA policy statements, problem statement, evidence-based strategies to address the problem, opposing arguments and action steps”. This article focuses on the action steps recommended by the APHA in Support of Community Health Worker Leadership in Determining Workforce Standards for Training and Credentialing. To view the entire APHA CHW policy statement please view the link http://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2015/01/28/14/15/support-for-community-health-worker-leadership.

The APHA CHW policy does the following:

• Encourages local and state CHW professional associations to organize CHWs in developing a consensus about the desirability of training standards and credentialing, including decisions about the most appropriate organizational location for the administration of a credentialing program, if established.
• Calls on local and state CHW professional groups to consider creating policies regarding CHW training standards and credentialing, if appropriate for local conditions, in collaboration with CHW advocates and other stakeholders.   
• Urges state governments and other entities considering creating policies regarding CHW training standards and credentialing to engage in collaborative CHW-led efforts with local CHWs and/or CHW professional groups. If CHWs and other entities partner in pursuing policy development on these topics, a working group composed of at least 50% self-identified CHWs should be established.
• Encourages state governments and any other entities drafting new policies regarding CHW training standards and credentialing to include in the policies the creation of a governing board in which at least half of the members are CHWs. This board should, to the extent possible, minimize barriers to participation and ensure a representation of CHWs that is diverse in terms of language preference, disability status, volunteer versus paid status, source of training, and CHW roles (APHA, 2015).

In what ways can community psychologists serve as strong advocates for CHWs? Macro-level, global advocacy can be done by following the recommendations outlined in the APHA action steps above. Micro-level, institutional advocacy can be performed by fostering genuine inter-professional collaboration between CHWs and other members of organizational work teams and promoting proper training and supervision for CHWs. Specific guidelines suggested by Reiff & Riessman (as paraphrased by the author) are just as relevant today as they were in 1965 when the Indigenous Nonprofessional: A Strategy of Change in Community Action and Community Mental Health Programs was first published in the Community Mental Health Journal Monograph:

1) Agencies should make clear the “roles, tasks and competencies” of the indigenous worker/CHW to internal personnel and external partners to mitigate inter-professional mistrust, tension and skepticism, prior to hiring CHWs and “as their jobs develop”.

2) Agencies should provide “continuous on the job training” preferably using popular education pedagogy and encourage use of situated knowledge and personal style in service delivery and community outreach. 

3) Agencies should provide support, acknowledgement and realistic expectations for CHWs so that they do not become overwhelmed or dejected by working in high stress, low resourced communities.

4) Agencies should provide meaningful, stimulating work for CHWs and take great care not to relegate them to menial tasks or tasks beyond their training, experience and scope of practice.

5) Agencies should provide adequate supervision for CHWs that is flexible, yet direct and most importantly conveys understanding of the unique nature of CHW work.

6) Agencies should recruit and select CHW candidates based on recommendations from trusted community partners such as “local agencies, neighborhood groups” and houses of worship. The hiring manager should be careful not to hire based on dominant societal perceptions but rather for community acumen and lived experience working with the target populations. Hiring a candidate with situated knowledge and passion for the community is more important than hiring to match task requirements as these can most likely be taught post-hire (pp. 20-27).

The aforementioned macro and micro-level advocacy will increase CHW empowerment and in so doing decrease CHW burnout and staff turnover.

CHWs are poised to make even more significant contributions to health and human services with the advent of the Patient Protection and Affordable Care Act. The policies that are developed, particularly at the state level will impact CHWs’ ability to improve the holistic health of communities. CHWs seek the same type of occupational objectives listed in the SCRA Policy Committee mission (paraphrased for CHW specificity):

• to have bidirectional communication with policymakers in order to shape the future of their occupation
• to coalesce with stakeholders to design and advance policies beneficial to CHW and the communities they serve
• to ensure that policies and programs are informed by both situated-knowledge and evidence-based practices
• to create training that soundly prepares CHWs for the workforce and provides opportunity for workplace advancement
• to facilitate the education of CHWs and their allies on the policy-making process thereby fostering CHW leadership at policy-making tables

Reiff & Riessman (1965) cautioned that only a grand scale “movement” to recruit, prepare and hire indigenous workers in novel ways can address issues of labor force shortages and diversification, deployment and necessity. “These problems continue to grow and threaten to the promising plans for the future” (p. 6). This advice was written fifty years ago and the effects of not heeding it can be seen in the tenuous state of the CHW workforce today. Perhaps the type of “movement” championed by Reiff & Riessman is emerging with the development policies advantageous to CHWs such as the new APHA CHW policy, the PPACA and state level legislation. Community psychologists can collaborate with CHWs to advocate for, create and implement beneficial CHW policies.

References

APHA Date: Nov. 18, 2014 Policy Number: 201414 Support for community health worker   leadership in determining workforce standards for training and credentialing.

http://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-   database/2015/01/28/14/15/support-for-community-health-worker-leadership Retrieved February 23^rd, 2015.

Baté-Ambrus, V. (Summer 2014). Kindred Spirits: CHWs and Community Psychologists a Call For Mutual Support. The Community Psychologist, 47, 6-8.

Baté-Ambrus, V. M. (2015) Unpublished dissertation draft. National Louis University. Reiff, R. & Riessman, F. (1965). The Indigenous nonprofessional: A Strategy of change in community action and community mental health programs. Community Mental Health J.Monograph. 1, 1-32.

To join the SCRA Policy Committee, inquire about the SCRA Policy Practicum, or add your name to the call-to-action listserv, please email Melissa Strompolis at mstrompolis@gmail.com

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