Intersectionality, social support, and youth suicidality: A socioecological approach to prevention.

OBJECTIVE: This study examined the relationship between social support and suicidality among youth from a public health perspective by using (1) a socioecological framework and (2) an intersectional approach to social identity. METHODS: Secondary analysis of cross-sectional survey data (N = 5058) involved means comparisons and a series of standard and hierarchical regression analyses. RESULTS: Youth with intersecting marginalized identities (i.e., females and racial and sexual minority youth) were significantly more likely to report higher suicidality scores. Social support at the family, school, and community levels was significantly associated with lower suicidality scores, and the combination of family and school support was associated with the lowest suicidality scores. Finally, family support significantly reduced the relationship between intersecting marginalized identities and suicidality. CONCLUSIONS: Findings highlight the importance of protective factors in every context in which youth live, learn, and play. Measuring and reporting social identities as well as their intersections add to our understanding of both risk and prevention.

Health care access and breast cancer screening among Latinas along the California-Mexican border.

Latinas are more likely to exhibit late stage breast cancers at the time of diagnosis and have lower survival rates compared to white women. A contributing factor may be that Latinas have lower rates of mammography screening. This study was guided by the Behavioral Model of Health Services Use to examine factors associated with mammography screening utilization among middle-aged Latinas. An academic-community health center partnership collected data from community-based sample of 208 Latinas 40 years and older in the San Diego County who completed measures assessing psychosocial factors, health care access, and recent mammography screening. Results showed that 84.6 % had ever had a mammogram and 76.2 % of women had received a mammogram in the past 2 years. Characteristics associated with mammography screening adherence included a lower acculturation (OR 3.663) a recent physician visit in the past year (OR 6.304), and a greater confidence in filling out medical forms (OR 1.743), adjusting for covariates. Results demonstrate that an annual physical examination was the strongest predictor of recent breast cancer screening. Findings suggest that in this community, improving access to care among English-speaking Latinas and addressing health literacy issues are essential for promoting breast cancer screening utilization.

An investigation of the dynamic processes promoting citizen participation.

This study expanded the citizen participation literature by examining the dynamic nature of citizen participation and the extent to which the factors associated with citizen participation may be moderated by resident leadership status. Longitudinal survey data collected from 542 residents in one small Midwestern city implementing a community change initiative provide some insight into the challenges surrounding the promotion of an active citizenry. Within this one community, citizenship behaviors of emergent resident leaders and residents uninterested in a leadership role were influenced, to some extent, by different factors and the importance of these factors shifted in only a 2 years time span. Future research is needed to determine if the dynamics uncovered in this study were due to the initiative or to the nature of citizen participation processes.

The exchange boundary framework: understanding the evolution of power within collaborative decision-making settings.

Many community decision-making bodies encounter challenges in creating conditions where stakeholders from disadvantaged populations can authentically participate in ways that give them actual influence over decisions affecting their lives (Foster-Fishman et al., Lessons for the journey: Strategies and suggestions for guiding planning, governance, and sustainability in comprehensive community initiatives. W.K. Kellogg Foundation, Battle Creek, MI, 2004). These challenges are often rooted in asymmetrical power dynamics operating within the settings (Prilleltensky, J Commun Psychol 36:116-136, 2008). In response, this paper presents the Exchange Boundary Framework, a new approach for understanding and promoting authentic, empowered participation within collaborative decision-making settings. The framework expands upon theories currently used in the field of community psychology by focusing on the underlying processes through which power operates in relationships and examining the evolution of power dynamics over time. By integrating concepts from social exchange theory (Emerson, Am Soc Rev 27:31-41, 1962) and social boundaries theory (Hayward, Polity 31(1):1-22, 1998), the framework situates power within parallel processes of resources exchange and social regulation. The framework can be used to understand the conditions leading to power asymmetries within collaborative decisionmaking processes, and guide efforts to promote more equitable and authentic participation by all stakeholders within these settings. In this paper we describe the Exchange Boundary Framework, apply it to three distinct case studies, and discuss key considerations for its application within collaborative community settings.

Dimensions of community and organizational readiness for change.

BACKGROUND: Readiness can influence whether health interventions are implemented in, and ultimately integrated into, communities. Although there is significant research interest in readiness and capacity for change, the measurement of these constructs is still in its infancy. OBJECTIVE: The purpose of this review was to integrate existing assessment models of community and organizational readiness. DATA SOURCES: The database PubMed was searched for articles; articles, book chapters, and practitioner guides identified as references cited in the list of core articles. REVIEW METHODS: Studies were included if they met the following criteria: (1) Empirical research, (2) identified community or organizational readiness for innovative health programming in the study's title, purpose, research questions, or hypotheses, and (3) identified methods to measure these constructs. Duplicate articles were deleted and measures published before 1995 were excluded. The search yielded 150 studies; 13 met all criteria. RESULTS: This article presents the results of a critical review of 13 community and organizational readiness assessment models, stemming from articles, chapters, and practitioner's guides focusing on assessing, developing, and sustaining community and organizational readiness for innovative public health programs. CONCLUSIONS: Readiness is multidimensional and different models place emphasis on different components of readiness, such as (1) community and organizational climate that facilitates change, (2) attitudes and current efforts toward prevention, (3) commitment to change, and (4) capacity to implement change. When initiating the program planning process, it is essential to assess these four domains of readiness to determine how they apply to the nuances across different communities. Thus, community-based participatory research (CBPR) partnerships, in efforts to focus on public health problems, may consider using readiness assessments as a tool for tailoring intervention efforts to the needs of the community.

The ABLe change framework: a conceptual and methodological tool for promoting systems change.

This paper presents a new approach to the design and implementation of community change efforts like a System of Care. Called the ABLe Change Framework, the model provides simultaneous attention to the content and process of the work, ensuring effective implementation and the pursuit of systems change. Three key strategies are employed in this model to ensure the integration of content and process efforts and effective mobilization of broad scale systems change: Systemic Action Learning Teams, Simple Rules, and Small Wins. In this paper we describe the ABLe Change Framework and present a case study in which we successfully applied this approach to one system of care effort in Michigan.

Examining Multi-Sector Community Collaboratives as Vehicles for Building Organizational Capacity.

While community collaboratives have emerged as a prominent vehicle for fostering a more coordinated community response to complex issues, research to date suggests that the success of these efforts at achieving community/population-level improvements is mixed. As a result, researchers and practitioners are increasing their focus on the intermediate outcomes accomplished by these entities. The purpose of this study is to expand upon this examination of potential intermediate outcomes by investigating the ways in which collaboratives strengthen the capacity of the organizations who participate as members. Utilizing a mixed methods design, we present an empirically-based framework of organizational outcomes associated with participation in a community collaborative. The dimensions of this framework are validated based on quantitative findings from representatives of 614 different organizations and agencies nested within 51 different community collaboratives. This article then explores how the characteristics of organizations and their representatives relate to the nature and type of impacts associated with membership. Based on study findings, we argue that community collaboratives can be effective interventions for strengthening organizational capacity across all sectors in ways that can promote greater community resiliency.

Youth ReACT for Social Change: a method for youth participatory action research.

Although participatory action research has become an increasingly popular method with youth, involving them in problem identification, analysis, intervention, and/or feedback, few PAR projects tend to involve youth in all of these phases-particularly the data analysis phase. Yet involvement in the data analysis phase of a research effort can help to promote critical awareness of the targeted issues, potentially increasing the effectiveness of subsequent PAR stages. In addition, although many YPAR projects aim to promote the critical consciousness of their youth participants, some projects struggle to promote this awareness, often because the methods used are not well matched to the developmental needs of their participants. In this paper we present the ReACT Method, a PAR approach specifically designed to promote local knowledge production and critical consciousness by engaging youth in the problem identification, data analysis, and feedback stages of research. Given the lack of attention in the literature to the methods used for engaging youth in these processes, we provide detailed descriptions of the methods we developed to engage youth in problem identification and qualitative data analysis.

Locating the system in a system of care.

While systems of care are recognized as a systems-level intervention, a gap remains between systems theory and practice that challenges the effectiveness of future system of care efforts. This article explores the extent to which the expanded system of care definition proposed by Hodges et al. [Hodges, S. Ferreira, K., Israel, N., & Mazza, J. (this issue). Systems of care, featherless bipeds, and the measure of all things. Evaluation and Program Planning] addresses this gap and suggests ideas for strengthening its systemic focus. Specifically, recommendations address considerations for assigning and adapting appropriate boundaries around intervention efforts and leveraging critical system characteristics and interactions to promote systems change. Implications for system of care practice and theory are discussed.

Who participates and why: building a process model of citizen participation.

Initiating and sustaining sufficient levels of participation among residents in low-income and urban neighborhoods have become significant focuses of many initiatives that strive to develop healthy communities. This study examines the factors associated with citizen participation levels in resident leaders and followers in seven low-income neighborhoods in one community. Overall, the findings suggest that different factors facilitate participation in leaders and followers. Leaders are more likely to actively participate in neighborhood and community affairs if they perceive themselves as having the skills needed to organize others and make change happen. Whereas perceived skill levels also matter for followers, these residents are strongly influenced by the norms for activism within their neighborhood. These norms mediate the impact of neighborhood readiness and capacity for change on citizen participation levels. Implications for funders and practitioners interested in promoting healthy communities are discussed.

GIS applications for community-based research and action: mapping change in a community-building initiative.

In this article we review practical and research applications for the use of geographic information systems (GIS) in the program development and evaluation of a community-building initiative designed to improve economic and educational outcomes in a Midwestern city. We discuss the use of GIS for targeting neighborhoods for program selection, random selection of survey respondents, verification of stratification and representativeness of survey samples, and linking survey data to data regarding physical and demographic characteristics of the community. We explore the benefits and challenges of using GIS with community audiences and highlight additional quantitative analysis tools for future use in this ongoing initiative.

Putting the system back into systems change: a framework for understanding and changing organizational and community systems.

Systems change has emerged as a dominant frame through which local, state, and national funders and practitioners across a wide array of fields approach their work. In most of these efforts, change agents and scholars strive to shift human services and community systems to create better and more just outcomes and improve the status quo. Despite this, there is a dearth of frameworks that scholars, practitioners, and funders can draw upon to aid them in understanding, designing, and assessing this process from a systemic perspective. This paper provides one framework--grounded in systems thinking and change literatures--for understanding and identifying the fundamental system parts and interdependencies that can help to explain system functioning and leverage systems change. The proposed framework highlights the importance of attending to both the deep and apparent structures within a system as well as the interactions and interdependencies among these system parts. This includes attending to the dominant normative, resource, regulative, and operational characteristics that dictate the behavior and lived experiences of system members. The value of engaging critical stakeholders in problem definition, boundary construction, and systems analysis are also discussed. The implications of this framework for systems change researchers and practitioners are discussed.

Systems change reborn: rethinking our theories, methods, and efforts in human services reform and community-based change.

This article introduces the reader to this special issue on Systems Change and highlights six lessons learned about theory, methods, and interventions for systems change that emerged across the included articles. The value of a systems approach to systems change is examined, including the need for frameworks, methods, and change activities that attend to the characteristics of systems.

Developing operating principles for systems change.

Based on an analysis of the articles in this special issue, the authors propose five operating principles for systems change work. These principles are: clarifying the purpose of the systems change; identifying whether the change is one to an existing system or the change is to create a new system; conceptualize the work as systems change from the beginning; use an eclectic approach; and be open to opportunities that emerge while also undertaking forma analysis to identify leverage points. The authors argue that the time is now ripe to develop such principles and encourage community change agents to engage in a dialogue to explore, revise, eliminate or expand on these principles.

Building an active citizenry: the role of neighborhood problems, readiness, and capacity for change.

Community-building initiatives strive to involve residents as the drivers of the change process, involving them in an array of activities including collective action efforts. Recent evaluations of many of these initiatives, however, suggest that developing the levels of resident involvement needed in such efforts is challenging. This study examines the neighborhood conditions that are related to whether and how much residents become involved in individual activism and collective action efforts. A random-digit-dial phone survey of 460 residents in 7 distressed neighborhoods suggested that while demographic variables were relatively unimportant, resident perceptions of neighborhood readiness (i.e., hope for the future and collective efficacy) and capacity for change (i.e., social ties and neighborhood leadership), and the level of neighborhood problems were strongly related to whether and how much residents were involved in individual and collective action efforts. Moreover, different elements of these neighborhood conditions were more or less important depending on the type and level of resident involvement. For example, while perceptions of neighborhood problems was the strongest predictor of whether an individual became involved at all, perceived strength of neighborhood leadership was the strongest predictor of an individual's level of activity. The implications of these findings for practitioners and scientists are discussed.

Mobilizing residents for action: the role of small wins and strategic supports.

Yes we can! is a community-building initiative funded by the W. K. Kellogg Foundation that aims to improve educational and economic outcomes in Battle Creek, Michigan by mobilizing low-income communities and resident leaders and building their capacity to influence the decisions and policies that impact their lives. This paper describes the strategies pursued during the first phase of this initiative to foster resident mobilization by building small wins within the neighborhood. Primarily through a neighborhood-based mini-grant program and staff supports to encourage collective action, Yes we can! has started to increase levels of resident mobilization within the seven economically distressed neighborhoods that initially partnered with the W. K. Kellogg Foundation on this effort. The specific programming components and how they were implemented as well as the initial successes experienced are described. Lessons learned are discussed.

Revealing the cues within community places: stories of identity, history, and possibility.

Place-based approaches to community change have become increasingly popular strategies for addressing significant social problems. With their intentional focus on 'place,' most efforts have sought to gain greater understanding into how neighborhood contexts affect people. However, while both aggregate characteristics and social dynamics of neighborhoods have been subject to scrutiny in the literature, less attention has been paid to understanding how the environmental characteristics of neighborhoods and communities as places have meaning for residents. The present study used an innovative methodology called Photovoice to obtain a greater understanding of the meanings residents ascribe to the salient characteristics of their neighborhoods and communities. As part of a place-based initiative, 29 adult and youth residents in seven distressed urban neighborhoods photographed and dialogued about the meaningful physical attributes of their community. According to participants, place characteristics provided cues about their personal histories as members of the community; communicated messages about the value and character of the community and its residents; defined social norms and behavior within the community; and provided markers that could remind residents of who they are and inspire a sense of possibility for who they could become. Implications for practice are discussed.

Using methods that matter: the impact of reflection, dialogue, and voice.

In recent years, the field of community psychology has given considerable attention to how research and evaluation methods should be designed to support our goals of empowerment and social justice. Yet, as a field, we have given much less attention to whether the use of our methods actually achieves or supports our empowerment agenda. With the primary purpose of beginning to establish the norm of reporting on the impacts of our methods, this paper reports on the findings from interviews of 16 youth and adults who had participated in one participatory evaluation method (Photovoice). Two specific questions were examined: (1) What is the impact of participating in a Photovoice effort; and (2) How does the method of Photovoice foster these impacts? Overall, participants noted that they were significantly affected by their experiences as photographers and through their dialogue with neighbors during Photovoice group sessions. Impacts ranged from an increased sense of control over their own lives to the emergence of the kinds of awareness, relationships, and efficacy supportive of participants becoming community change agents. According to participants, Photovoice fostered these changes by (a) empowering them as experts on their lives and community, (b) fostering deep reflection, and (c) creating a context safe for exploring diverse perspectives. The implications of these findings for the science and practice of community psychology are discussed.

The adoption of innovation in collective action organizations.

This study used a quantitative/qualitative methodology to explore how collective action organizations (CAOs) remain open to organizational change and innovation. It examined the adoption of inclusion--a recent innovation in the field of disabilities--by local chapters of The Arc Michigan (a disabilities CAO). We found considerable variability in the adoption of inclusion by local Arc chapters. This variability was significantly related to the ecology surrounding these chapters. Local Arc chapters that had adopted an inclusion philosophy had significantly different internal and external environments from those that had not adopted inclusion. Our qualitative findings make it clear, however, that innovative Arc chapters were not the passive recipients of these internal and external influences. These chapters were proactive players in defining and shaping the nature of their internal and external environments. Strategies that were related to a chapter's ability to remain open to innovation included (a) a change orientation, (b) a conscious philosophy or vision, (c) a proactive strategy for achieving chapter goals and overcoming barriers to change, (d) the creation of a supportive organizational network, and (e) avoidance of resource dependencies that required them to engage in activities that were inconsistent with the innovation. These findings provide a framework by which CAOs can maintain an openness to innovation and remain on the forefront of social change.