Community-Based Health Interventions in an Institutional Context
Community-Based Health Interventions in an Institutional Context examines challenges of "institutionalizing" community-based health care. While the community-based or localized model is growing in popularity and importance in the United States, in practice it must often be brought in to larger institutions in order to grow to scale. The typical goals of an institution—standardization, formalization, and control—may be seen as antithetical to those of a community-based healthcare provider, such as spontaneity, customization, and flexibility.
The contributions to this work raise questions about how the community-based model can be scaled up through institutions, and how "institutionalization" can be rethought from a bottom-up approach. They provide not only an overview of community-based organizations, but also delve into practical topics such as establishing budgets, training workers, incorporating technology, as well as more theoretical topics like goal-setting, policy effects (like the ACA), and relationships between patient and community.
This work will be of interest for researchers interested in exploring the community-based health care model, as well as practitioners in health care and health policy.
Chapter One: What is a Community-based Organization? (John W. Murphy, University of Miami)
The focus of community-based work is local knowledge and community control of health projects. To deliver services in accordance with these principles, community-based organizations must be instituted. What these organizations require, separate from the past, are a different management style and unique division of labor. Most organizations that are employed to provide health services in a community-based manner, however, have a traditional structure, and thus have difficulty fulfilling their aims. A new organization must be created that is consistent with the philosophy that underpins community-based work. Such an organization, for example, would be less hierarchical and not focused on a specific division of labor as in the past.
Chapter Two: Establishing Community-based Partnerships (Karen A. Callaghan, Barry University)
Community-based health services are not provided by stand-alone organizations. Simply put, a network of providers must be available. Accordingly, a variety of organizations must enter into partnerships. This arrangement is not necessarily novel, but traditionally these associations have been fraught with conflicts and struggles for power, thus undermining their effectiveness. Community-based partnerships, on the other hand, must be predicated on dialogue and mutual respect. Instead of fighting for dominance in a community, these new organizations must be integrated around the plans established by communities. A new way of conceptualizing and carrying out this process must be established.
Chapter Three: Community-based Funding and Budgeting (Jung Min Choi, San Diego
Often funds are directed to community organizations in ways that are either irrelevant or difficult to use. Additionally, budgets are formulated by agencies that are disconnected from the communities where services are needed. Community-based funding and budgeting, accordingly, are beginning to receive serious attention. Communities, accordingly, are given the latitude in some cases to establish budgets and spending strategies, along with identifying and pursuing sources of funds that are consistent ethically with these priorities and desires. Community-based funding and budgeting, in this way, are vital to supporting interventions in a community-sensitive manner.
Chapter Four: Training Community-based Health Workers (Tashina Vavuris, University ofCalifornia at Santa Cruz)
Health practitioners receive a significant amount of training before and after they enter the field. But often this education is mostly pragmatic, that is, focused on how to conduct needs assessments, evaluate interventions, or implement accreditation standards. Of course, these tasks are important. But this education does not necessarily begin from the philosophy that sustains community-based work. When beginning with the principle that community knowledge matters, training must be initiated with how to enter the world constructed by a community’s members. Every task, accordingly, must be thought of as a mode of engaging a community, instead of simply gathering data or making observations. Valid knowledge, communities, and norms, for example, must be rethought in the training process to produce persons who can work effectively in community-based interventions. This shift in orientation is not often currently the centerpiece of training.
Chapter Five: Developing a Community-based Curriculum for Health Worker Training (Dawn Graham, Ohio University)
The previous chapter explored the use of community-based health workers in interventions and the importance of integrating local experts into planning. In this chapter, the experience of developing a training curriculum for the State of Ohio will be shared. Given new rules regarding certification in different areas of the United States and internationally, developing a curriculum that can be approved and disseminated is of increasing importance. In these programs, significant institutional support is needed to develop curricula and train additional trainers, so that training can be shared with communities interested in adopting community health workers into their programming. The goal of this chapter is to present the challenges faced in creating a certified training curriculum and the potential for future curriculum development efforts.
Chapter Six: Technology and Community-based Work (Eric Kramer & Elaine Hsieh, University of Oklahoma)
Technology is becoming a significant part of community-based work, in the form, for example, of telemedicine, including interventions through online forums, mobile apps, and other web-based data storage and health management. But traditionally, technology is thought of as dehumanizing and alienating. The introduction of technology to community-based interventions, accordingly, can easily become antagonistic to the person and community-centered strategies that are central to community-based health projects, particularly to cultures that emphasize interpersonal (as opposed mediated) interactions. In this chapter, the philosophy and practices of technological implementation will be discussed, within the context of health projects, to avoid the possible deleterious effects of technology. A community-based intervention strategy is not going to be meaningful or effective unless it is responsive to the needs and preferences of the communities to which it is applied.
Chapter Seven: A New Role for Patients & Clients (Khary K. Rigg and Amanda Sharp, University of South Florida)
Patients and clients play a central role in community-based health care. In both theory and practice, their role is supposed to differ from traditional biomedical approaches. Specifically, patients and clients play an increasingly active role in health care delivery and their backgrounds are central in any interventions. In short, a new form of participation is involved in community-based practice. Some examples of these efforts can be found in cultural sensitivity training in hospitals and other health centers. While the recognition of patients’ language and their biographies are important, other aspects to patient participation may go unrecognized. Becoming technically competent of a patient’s cultural background does not necessarily offer patients access to how health care is being conceptualized and who manages health services. This chapter explores the fundamental shifts in health-care that are necessary to reimagine the role of patients and clients.
Chapter Eight: Aims of a Community-Based Research Program (Steven L. Arxer, University of
North Texas at Dallas)
Clearly research plays a key role in community-based health work. Understanding the health needs of a community is vital to the success of any health care project. From an organizational perspective, however, the focus of a research program is often methodological. That is, developing scientifically sound data collection instruments is often the focus. However, such an emphasis leaves little room for appreciating how knowledge is socially produced and legitimized. Moreover, an overemphasis on methodological concerns can diminish the ability of researchers to appreciate the underlying assumptions of a community’s world-view and frustrate their entrance to that world. This chapter examines the philosophical and practical considerations of implementing a research program in health projects that preserves the knowledge production of community members
Chapter Nine: Community-Based Political Interventions (Karie Jo Peralta, University of Toledo)
A central way institutions gain legitimacy and the ability to guide human behavior is through claims of value-neutrality and objectivity. Institutions are often thought to be bureaucratic and based on formal rules that facilitate decision-making in most any sphere of life. In the case of health organizations, the language of science, technology, and standardization guide how community needs and the authority of health practitioners are understood. In this context, health professionals attain their unique status vis-à-vis patients and community members. But this dichotomy can contradict the aims of community-based health interventions. In particular, health organizations become the center of health assessments, while medical professionals attain greater power to direct health initiatives as opposed to patients. Nonetheless, community health workers, for example, require respect and legitimacy. In this chapter, the political dimension of community-based health organization is discussed, along with the challenges this model presents to conventional depictions of health institutions.
Chapter Ten: Hospitals and Community-based Planning (Michael Wright, Rachel Kamet, Berkeley A. Franz Berkeley A. Franz, and Daniel Skinner, Ohio University)
Non-profit hospitals have the potential to be strong partners in community-based projects. Since the Affordable Care Act was passed in 2010, hospitals have new requirements to engage communities in identifying health needs and developing new community health programs. In this chapter, we explore two case studies of how hospitals are developing new partnerships and the challenges they face in fostering relationships with the communities in which they are located. The conclusion will suggest potential strategies for improving communication between hospital employees and community members in the planning of community-based projects.
Chapter Eleven: Dimensions of a Community-Based Health Care Institution (Airín Martínez,
University of Massachusetts)
This chapter discusses how a community-based health care institution reimagines the basic operation of health care. Because a community-based model understand knowledge to be locally produced, the basic operations of identifying and exploring health needs, as well as the ways in which treatment is approached changes. Specifically, patients and communities do not internalize the directives of professionals, but rather collectively legitimize health initiatives and direct the process of community healing. Simply put, an entirely new model is proposed for identifying illness, formulating interventions, defining health, and evaluating outcomes.
Conclusion: A Reevaluation of Institutionalized Health Care (Steven L. Arxer & John W. Murphy)
Drawing from the chapters described above, the Conclusion emphasizes the benefits of institutionalizing community-based health projects, but in a manner different from the past. To the extent that community-based efforts are described as substantially different from conventional health practices, service institutions must be conceptualized and operationalized to preserve the intention of a community-based approach. Furthermore, an entirely new ethic of health care must be promoted. In short, a careful examination of how community-based projects can be institutionalized has the prospect for advancing effective strategies for community health planning.