Science Based-Solutions to Promote Child and Adolescent Well-being

by Gina Cardazone

"We don't know everything, but we know enough." This simple statement sums up so much that is true about prevention research. While it is accurate that there is much more research to be done before we truly understand the mechanisms behind preventing negative outcomes and promoting well-being, we do know enough that there is absolutely no reason why we shouldn't be funding and supporting successful prevention programs on a large scale.

Transdisciplinary Translation Prevention Research Model

There is no politician in America (or anywhere else, I'd imagine), that would take a stance against promoting the well-being of children and adolescents. Yet when it comes to taking action to ensure that every child gets a healthy start in life, policy makers often lag behind the expectations of researchers and others who know that there are proven steps that can be taken to further that goal.

The Coalition for Science-Based Solutions to Promote Child and Adolescent Well-being is a recently formed association of researchers, educators, community stakeholders, practitioners, policy makers, advocates, and foundation representatives who share the common belief that when it comes to promoting healthy development and preventing negative outcomes for children and adolescents:

(1) more knowledge is needed, but
(2) we know enough to exert an impact

Coalition members are dedicated to promoting transdisciplinary translation research in order to address the first point, and on the second, to act on our current knowledge by implementing and scaling evidence-based programs and policies. At the helm of Dr. Diana Fishbein, the originator of the opening quote of this post and the new Director of the Center for Translational Research on Adversity, Neurodevelopment, and Substance Abuse (C-TRANS) at the University of Maryland, the Coalition is off to an extremely promising start. So far, the nascent association has, among other accomplishments: hosted an NIH-funded conference, titled "Advancing Transdisciplinary Translation for Prevention of High-Risk Behaviors," published a special issue on translation prevention research in Prevention Science, produced congressional briefings for Capitol Hill, and developed a website at www.ttpr.org

Those interested in joining the Coalition or otherwise supporting this effort can use the contact form at http://www.ttpr.org/index.php/about-us/contact , or email us at compsychpractice@gmail.com for more information.
 

Community Psychologists in Healthcare

THEory into ACTion

A Bulletin of New Developments in Community Psychology Practice
April, 2014

by

Mary C. Benton, Seattle

     Recently I had the opportunity to speak with three community psychologists–William Neigher, Ph.D., Sharon Johnson-Hakim, Ph.D. and Chris Kirk, Ph.D. Their situation is unique in that they are all employed as community psychologists working at the same place, Atlantic Health System, in New Jersey (www.atlantichealth.org). This is in large part due to the shared vision of healthcare between Neigher, Vice President and Chief Strategy Officer, and the President and CEO of Atlantic Health System, Joseph Trunfio, Ph.D. Trunfio trained as a clinical psychologist but completed a postdoctoral fellowship in community psychology with SCRA’s first President, Robert Reiff.  Neigher and Trunfio, along with many of the board of trustees and others at Atlantic Health System, believe that communities play a vital role in their own personal well-being. 

     This belief is reflected in the recent change in Atlantic Health System’s vision statement, which now reads “Empower our communities to be the healthiest in the nation.” It is also demonstrated in the mission statement of the organization, which is to “Deliver high-quality, safe, affordable care within a healing culture” (Neigher & Hakim, 2012). The phrase, “within a healing culture,” emphasizes the complexity of patient well-being and recognizes that settings and contexts matter.  It acknowledges that patient health is best viewed from an ecological, multi-layered approach. It also posits that health care staff work together with patients and their families in order to affect real change in patients’ well-being.

     The importance of communities’ involvement in their own patient healing is also reflected in the change in the vision statement of Atlantic Health, from a focus on applying top clinical care to one that emphasizes community psychology principles of prevention and health promotion. These changes do not simply reflect a change in wording or a new marketing campaign, but rather a fundamental shift in the way the health system sees itself and defines its role. The goal now is to develop a “line of sight” understanding between each Atlantic Health System employee’s job and the vision and mission of the organization. This “line of sight” mentality was eloquently demonstrated to Neigher earlier in his career when visiting a nursing facility operated by his friend, Dr. Sidney Greenwald. When introduced to an elderly gentleman with a mop and bucket, Dr. Greenwald asked the gentleman, “Tell my friend Dr. Neigher what you do here.” To which he replied, “I’m in infection control.” He then demonstrated how he cleaned toilets to prevent residents from getting sick (Neigher, 2011).  The elderly man’s role was seen as integral to the success of the nursing facility.

     Drs. Neigher, Kirk and Johnson-Hakim are working to develop a variety of innovative programs consonant with the principles of community psychology, aimed at shifting the focus from one centered on disease to well-being. Additionally, the concept of empowerment rings true in their work; one such avenue where they apply an empowerment perspective is health literacy. Defined as the “degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (Ratzan & Parker, 2000), health literacy has great implications for health status. For example, those with lower levels of health literacy demonstrate less ability to read labels, take medications correctly, and among seniors, poorer health status (Agency for Healthcare Research and Quality, 2011).  In an effort to empower and minimize the confusion of being a patient, Atlantic Health System developed a Health Literacy Task Force in order to create a more health literate healthcare system (Kirk & Neigher, 2013).

     Besides community and hospital based programming, Drs. Neigher, Kirk, and Johnson-Hakim are involved in a line of applied research around adaptability (Neigher & Hakim, 2012).  Instead of focusing solely on healing patients and returning them to their previous state before illness or injury, Atlantic Health System wants to foster more adaptable patients. They have developed an Adaptability model which is operationally defined as the ratio of an individual’s resilience to their vulnerability. Many times health circumstances are beyond a person’s control, but what is in their control is how they adapt and cope with those circumstances. Currently, a study using a large sample of joint replacement patients is examining the predictive validity of the Adaptability model.  The objective is to develop a valid and reliable measure that can be utilized and administered by an individual’s physician each time they visit a healthcare facility. Over time, the use of such an instrument would provide a life course perspective of an individual’s adaptability, and allow providers and community agencies to intervene earlier. In addition, the model could be used by organizations or communities, measuring their adaptability and/or creating interventions to increase adaptability to events such as terrorist attacks or natural disasters.

     As evidenced, a lot of exciting work is being conducted by community psychologists at Atlantic Health. Furthermore, as Neigher remarked, with the passage of the Patient Protection and Affordable Care Act (2010), now is a very good time to be a community psychologist, especially in the field of healthcare. The skills that community psychologists have are precisely those skills that are paramount for successful implementation of the Affordable Care Act. And while most positions are not advertising for community psychologists as such, the skills and expertise necessary are very often ones that we have. The challenge for community psychology and community psychologists is to translate our language into the lexicon of the employer, which is often very medically focused. The experiences of community psychologists at Atlantic Health System have shown how effectively this can be done. 

References

Agency for Healthcare Research and Quality (2011). Health Literacy Interventions and Outcomes: An Updated Systematic Review.  Washington D.C.: Agency for Healthcare Research and Quality, 2011.

Kirk, C. M. and Neigher, W. D. (2013). Community psychology and the future of healthcare. Global Journal of Community Psychology Practice, 4(4), 1-9. http://www.gjcpp.org/en/article.php?issue=16&article=82

Neigher, W. D. (2011). Invited address to the 2011 SCRA Biennial Conference accepting the Distinguished Contribution to Practice in Community Psychology [2010]. Global Journal of Community Psychology Practice, 2(3), 1-15. http://www.gjcpp.org/en/resource.php?issue=8&resource=62

Neigher W. D. & Hakim, S. M. (2012). Creating a sustainable “healing culture” throughout a healthcare system: Using community psychology principles as a guide.  Global Journal of Community Psychology Practice, 2(3), 1-25. http://www.gjcpp.org/en/article.php?issue=8&article=36

Patient Protection and Affordable Care Act, PL 111-148, March 23, 2010. http://www.hhs.gov/healthcare/rights/law/

Ratzan,  S.C. & Parker R. M. (2000). Introduction. In: National Library of Medicine Current Bibliographies in Medicine: Health Literacy. NLM Pub. No. CBM 2000-1. Selden CR, Zorn M, Ratzan SC, Parker RM, Editors. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services.

This is one of a series of bulletins highlighting the use of community psychology in practice. Comments, suggestions, and questions are welcome. Please direct them to Bill Berkowitz at william_berkowitz@uml.edu 

Cesar E. Chavez: Social Justice Advocate

(updated August 26, 2014)

     March 31st marks what would have been Cesar Chavez's 87th Birthday. In a recent statement from the White House, President Barack Obama declared 3/31 a Cesar Chavez Day, calling Americans to observe this day to honor Cesar’s legacy.

     As an advocate for the farm workers Cesar led the creation of their first union, United Farm Workers of America (UFW), facilitating access to better working conditions, such as rest periods, access to toilets, clean drinking water, and protection against pesticide exposure. Additionally, they gained access to healthcare through a joint union-employer fund and a pension plan. As Cesar said it: "We cannot seek achievement for ourselves and forget about progress and prosperity for our community...Our ambitions must be broad enough to include the aspirations and needs of others, for their sake and for our own".

     Cesar's advocacy efforts were not limited to farm workers rights, as he also advocated for animal rights. Stephanie Ernst (2011) noted:  "Chávez also was a voice for and friend to animals. A vegetarian for the last 25 years of his life and a vegan for at least some segment of those years, Chávez did not just make efforts toward removing himself from animal exploitation and call it a personal choice. He called on others to do the same, including many of his friends within the farm labor movement". 

     Today, we continue to find challenges in our localities that require approaches that enhance solidarity and propel better life conditions for our communities. May Cesar’s life continue to inspire us in advocating for those who struggle the most and generating the necessary structures for improving community’s quality of life.

     If you’d like to get a better look at Cesar Chavez life and the UFW movement, you can watch PBS Documentary The Struggle in the Fields, or the recent released film Cesar Chavez.

Cesar Chavez Foundation. (2012). Historic Victories for Union. Retrieved from: http://www.cesarechavezfoundation.org/_page.php?code=001025000000000&page_ttl=Years+of+adversity&kind=1

Chicano! PBS Documentary - The Struggle In The Fields

Ernst, S. (2011, March 31). César Chávez: “The Basis for Peace Is Respecting All Creatures”. Retrieved from: http://challengeoppression.com/2011/03/31/cesar-chavez-the-basis-for-peace-is-respecting-all-creatures/

Riojas. R. (2011). The Life and Legacy of Cesar Chavez. Retrieved from: https://vimeo.com/15930287

The White House Office of the Press Secretary. (2014, March 28). Presidential Proclamation - - Cesar Chavez Day, 2014. Retrieved from: http://www.whitehouse.gov/the-press-office/2014/03/28/presidential-proclamation-cesar-chavez-day-2014

United Farm Workers. (2006). Education of the Heart- Quotes by Cesar Chavez. Retrieved from: http://www.ufw.org/_page.php?menu=research&inc=history/09.html

United Farm Workers. (2006). Our vision. Retrieved from: http://www.ufw.org/_page.php?menu=about&inc=about_vision.html