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Power Sharing in Youth-Led Community Campus Partnerships


Power Sharing in Youth-Led Community Campus Partnerships Laurie J Bauman Preventive Intervention Research Center Albert Einstein College of Medicine – PowerPoint PPT presentation

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Title: Power Sharing in Youth-Led Community Campus Partnerships

Power Sharing in Youth-Led Community Campus
  • Laurie J Bauman
  • Preventive Intervention Research Center
  • Albert Einstein College of Medicine

Community Research Partnerships
  • Community-campus partnerships are common and
  • Partnerships usually are not CBPR i.e., shared
    power over the study topic, design, methods,
    analysis and use of results.
  • Sharing power is a challenge
  • Researchers dont want to give up control
  • Researchers have advantages that make equality
  • This challenge is particularly difficult to
    manage when the community partners are teenagers
  • The lessons we learned may be useful to any
    collaboration with vulnerable, disenfranchised

  • A collaborative approach to research that
    equitably involves all partners in the research
    process and recognizes the unique strengths that
    each brings.  CBPR begins with a research topic
    of importance to the community and has the aim of
    combining knowledge with action and achieving
    social change... --Community Health Scholars
    Program, WK Kellogg Foundation
  • from acting upon to acting with

Rationale for CBPR
  • Traditional research has failed to solve complex
    health disparities. 
  • research designs fail to incorporate multi-level
    explanations of health
  • researchers do not understand many of the social
    and economic complexities motivating individuals
    and families behaviors.
  • Community members are angry about being guinea
    pigs in parachute research and demand that
    research address their locally identified needs. 
  • recruiting research participants is harder
  • communities feel used by researchers in the past
    researchers get their publications, communities
    got nothing in return

Rationale, continued
  • Community involvement improves the science
  • identify variables
  • design and adaptation of research instruments
  • identify important program components
  • assist with cultural/normative fit
  • True collaboration can rebuild trust and respect
    between researchers and communities

Teenagers as Community Partners in CBPR?!
  • CBPR has focused a good deal on youth
  • However, most projects rely on youth as advisors
    not as partners
  • We were funded by NCMHD in November 2005 to work
    with youth as partners to reduce health
    disparities among Bronx teenagers (R24 MD001784)
  • We had to design an infrastructure that would
    support youth as a community and give them
    control over the project.

Goals for this Presentation
  • Describe how we applied principles of CBPR when
    the community is teenagers
  • Describe the challenges to true power sharing
    with youth and some solutions
  • Describe the health disparity youth chose and why
  • Describe the intervention they developed

Bronx Youth as Partners in CBPR
  • GOAL To reduce health disparities among African
    American and Latino youth in the Bronx
  • Using Community-based participatory research with
    our community, Bronx adolescents our agenda in
    this 3-year project was
  • Year 01 Choose one health disparity
  • Year 02 Develop an intervention
  • Year 03 Pilot the intervention
  • Year 04-09 Continuation for RCT to test the

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  • Composition
  • 14 Bronx teenagers aged 14-19
  • Two researchers
  • Two program specialists
  • Two physicians
  • Support
  • Three staff members
  • Outside evaluator, 4 interns, website coordinator
  • BYAP Coalition, 20 Bronx organizations

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Our Unique Two-Level Partnership
  • The Bronx Youth as Partners Coalition
  • SCIENCE Einstein, Bronx colleges and
  • PRACTICE Hospitals, clinics, insurance,
    community agencies, faith-based community
  • POLICY Bronx government and policy makers
  • Grew from 20 to 54 agencies in 3 years, because
    youth were the leaders
  • Albert Einstein College of Medicine is the lead
  • Coalition provided assistance without
    intimidating and dominating youth

What did the Coalition do?
  • Meet with youth 3-4 times per year for two hours
  • Make presentations to ALOT
  • Provide data on the health of Bronx youth
  • Mentor ALOT members
  • Offer their sites for meetings (Fordham
    University, Affinity Health Plan, NY Public
    Library, Fordham Road, Lehman College, Bronx
    Borough Presidents Office)
  • Advise on decisions to be made, voted on
  • Give workshops (sexual harassment, YD)

Challenges to Teen-led Partnerships
  • Teens are at a power disadvantage with adults
  • Legally they are minors
  • Verbal, cognitive skills
  • Social skills
  • Confidence
  • Experience
  • Disenfranchised
  • Youth in the Bronx are not a mobilized
    community but are a community geographically and
    in identity
  • The population ages out taking with them the
    experience and skills we worked to give them

CBPR Principles
  • (1) CBPR is participatory
  • (2) CBPR is committed to full equity
  • (3) The community determines the research agenda
    and intervention technology
  • (4) CBPR empowers
  • (5) CBPR builds on strengths  
  • (6) CBPR nurtures growth
  • (7) CBPR is sensitive to the insider-outsider
  • (8) Avoid selecting the community members

Applying Principles of CBPR to A.LO.T.
  • We should not chose the community
  • Created the opportunity for interested youth to
    step forward
  • Distributed flyers and brochures to Coalition
  • Sought leaders/scholars as well as troubled
    out-of-school youth
  • Teens called us directly, to show initiative
  • We provided information, gauged their level of
  • Interested teens are invited to attend a teen
    group like ALOT
  • Decided if they want to participate
  • We excluded the rare (lt5) teens who were
  • From volunteers we selected teens to assure
    diversity in gender, age, race/ethnicity, schools
    and neighborhoods.

Applying Principles of CBPR to A.L.O.T.
  • CBPR is participatory
  • Participatory means who has the right to speak,
    analyze, act, decide
  • Problem Most CBPR efforts involve the community
    directly in conducting research
  • Comprehensive involvement not practical with
  • consent, IRB issues
  • they have limited time to conduct the research
  • dont control their own time

Applying Principles of CBPR to A.L.O.T.
  • Making CBPR participatory Solutions
  • Specify what participation is at every phase.
  • Identify benchmarks in the research process to
    involve members of the partnership
  • Participation does not mean everyone is involved
    in the same way or the same degree or capacity.
  • Have paid staff do the work, have youth DIRECT

Applying Principles of CBPR to A.L.O.T.
  • CBPR Values Equity
  • Equity means an equal role in decision-making and
    equality of contribution.
  • Luke at the individual level, power is the
    ability to make decisions within the rules of the
    game at the organizational level, power is the
    ability to define the rules of the game. The
    latter is our goal.
  • Problem Difficult when the community is
    economically marginalized and disenfranchised, as
    not had the power to name or define its own

Strategies to Facilitate Power Sharing
  • CBPR Values Equity Solutions
  • Teens are in the majority to help offset the
    natural advantages adults have
  • We have a skilled neutral moderator lead all
    meetings. She facilitates collaborative rather
    than adversarial interactions
  • We foster learning together as the model, so ALOT
    adults arent always teaching teens but we all
    learn together as students, which fosters
  • doing research and reporting back
  • hearing expert testimony
  • talking to other Bronx youth
  • voting

Strategies to Facilitate Power Sharing
  • CBPR Values Equity Solutions
  • Adults ALOT members are not in authority as
    employers or as disciplinarians.
  • BYAP project staff, who are not ALOT members,
    enforce rules.
  • Hours, pay, quality of work
  • Correcting and disciplining
  • Is that our job?
  • ALOT made the rules as a group, by vote.

Strategies to Facilitate Power Sharing
  • CBPR Values Equity Solutions
  • ALOT Coordinator advocates for youth
  • Collaborate with a consistent group of adults and
    select the ALOT adults carefully
  • Use small group work within ALOT
  • Have teen-only ALOT meetings
  • We conducted an evaluation of the partnership,
    e.g. leadership, power sharing, synergy,

Working with a Community That Ages Out
  • Over 3 years, two-thirds of the original ALOT
    members aged out or moved, military, college
  • We created alumni status, a formal role that
    retains these older experienced members in a
    non-voting capacity.
  • New teens are recruited to maintain
  • Challenge is to maintain momentum based on
    previous ALOT decisions
  • Hard to mix new members and veterans

Integrating New Members into A.L.O.T.
  • Mentoring model for new younger members
  • After a few meetings, new members choose a
    veteran to be a peer mentor
  • As mentors, veteran members emerge as the leaders
    that they are
  • New members learn assertiveness skills and their
    new role and responsibilities

Continuing Issues
  1. Putting teenagers (lt age 16) on payroll
  2. Sexual harassment
  3. Fine line between discipline and collaboration
  4. How explain adults bad behavior?
  5. Sometimes youth resist accepting the power
  6. Leadership within ALOT shifts
  7. Food, food insecurity
  8. Size of the coalition how do you know?
  9. Love triangles these may be true of adult
    partnerships too, but not as often

Unexpected Benefits of a Youth-Led Partnership
  • The voice of the affected community was unique
    and important. We did a better job with them. Our
    product is superior.
  • They inspired the entire Bronx community
    coalition, held them in rapt attention.
  • They are charming and passionate. They have no
    hidden agenda, and they make an eloquent case for
  • They are (embarrassingly) frank and politically
    incorrect and will ask (anyone) for what they

  • Youth can be equal research partners
  • Youth community-campus partnerships require a
    strong commitment from the team, some creativity
    and a high tolerance for ambiguity
  • They involve more effort than traditional
    collaborative research, but the benefits are

Choosing One Health Disparity
  • Disparities studied mental health, reproductive
    health, obesity, violence/injury, tobacco use,
    and alcohol/drug use
  • Reading (online and library)
  • Expert lectures
  • Interviews with community members
  • Data analysis of existing data sets
  • Consultation with the BYAP coalition in person
    and through a computer Delphi voting process

A.L.O.T. Chose Mental Health
  • Between 6 and 9 million young people have mental
    or behavioral problems
  • 20 have psychiatric disorders
  • 9-13 have serious emotional disturbance

Mental Health Disparities in Adolescents
  • 40 of low-income Black and Latino youth exhibit
    significant psychological symptoms.
  • Suicide attempts among inner-city African
    American adolescents are twice the national rate.
  • The treatment available to African American and
    Latino adolescents is of poor quality and is
    difficult to access
  • Only 1 in 5 youth who need treatment receive it.
  • Between 50-75 of youth with disorders do not
    engage in treatment or drop out of care.
  • These disparities are increasing

Mental Health of Bronx Youth
  • 34 of Bronx students reported that, in the past
    year, they felt so sad or hopeless almost every
    day for two weeks or more in a row that they
    stopped doing some usual activities
  • 9.9 of Bronx teen respondents reported a
    suicide attempt in the past 12 months
  • Among Latina and Black girls in the Bronx, the
    attempted suicide rate was 15

Why Mental Health?
  • It is neglected.
  • Stigma and public ignorance is high.
  • It is a common problem that affects many youth.
  • It often goes unrecognized in minority
  • Other health disparities are related to mental
  • Availability of youth friendly competent services
    is poor.

Shifting the ParadigmA.L.O.Ts Intervention
  • ALOT began planning an intervention to reduce
    mental health disparities.
  • In the process, it developed an intervention
    theory with three principles that shifts
    current service paradigms.
  • The first and most important principle is
  • All youth need positive mental
    health programming. Dont limit the intervention
    to those with disorders.

Shifting the ParadigmA.L.O.Ts Intervention
  • The second principle is
  • Symptomatic teens should receive
    youth-friendly, evidence-based mental
    health services in community settings where they
    already are, from
    clinicians they already know.

Shifting the ParadigmA.L.O.Ts Intervention
  • The third principle is
  • Mental health treatment will be more
    successful if it is combined with positive
    youth development.

Youth Change the Paradigm
  • ALOT youth loved learning about disorders
  • Wanted to learn how to help their friends
  • Eventually they asked a key question When do we
    study positive mental health?
  • Inner-city youth are exposed to many well
    intentioned programs (to prevent mental health
    problems, HIV/STIs, pregnancy, drug and alcohol
    use, violence, obesity)
  • In the aggregate, we give an unintentional,
    demoralizing message -- teens are a problem to be
    solved or fixed or prevented.
  • You should be building us up.

Our Intervention Bronx Thunder
  • Based on the three principles, BxThunder has
    three parts
  • Part I TEEN
  • Universal positive youth development
  • Peer education training
  • Communication skills
  • Problem solving skills
  • Trust, respect
  • Positive peer culture
  • 14 sessions, 7 weeks, 3.5 hours/week
  • Award winning, evidence based

Our Intervention Bronx Thunder
  • Part II Youth-Led Workshops
  • TEEN graduates participate in a 6-week
    internship giving mental health workshops
  • They use peer educator skills
  • Educate peers and the community
  • Workshop designed to
  • Decrease stigma
  • Increase knowledge
  • Involve youth

Our Intervention Bronx Thunder
  • Part III Targeted Cognitive Behavioral Therapy
  • TEEN trainers are clinical psychologists
  • Identify youth with psychological disturbance
  • Two psychology externs co-train on TEEN
  • Externs provide CBT to those who need it
  • Youth whose disorders arent appropriate for CBT
    will be referred

Our Intervention Bronx Thunder
  • Universal positive youth development
  • TEEN
  • Workshop
  • Targeted CBT treatment for those who need it
  • Treatment given by people who teens know
  • Cost effective because externs offer treatment
  • Doesnt require mental health licensing

Randomized Trial of Bronx Thunder
  • Funded by NCHMD June 2008
  • The study involves 17 Coalition partners
  • 3 sites for BxThunder
  • 3 Bronx universities provide externs
  • 3 mental health agencies train externs in CBT
  • 6 CBOs will take mental health referrals
  • 2 will work on sustainability
  • BxThunder sites are
  • John V. Lindsay Wildcat Academy Alternative High
  • Citizens Advice Bureaus Jill Chaifetz Transfer
    High School
  • Mosholu-Montefiore Community Center

Thank You!
Current A.L.O.T. Work in Progress
  • Mostly new members
  • Started with mental health and worked on a new
  • Studied eight topics in mental health of their
    choosing bereavement, body image, coping with
    stress, family issues, peer pressure, school
    issues, sexual relationship issues, violence and
  • Which one did they choose?

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Making the Rules
  • ALOT considered various models of decision-making
    (e.g., simple majority, complete consensus) and
    chose a 66 vote requirement
  • full consensus too difficult to achieve
  • 51 did not assure full equity
  • Other rules lateness, cell phones, irregular
    attendance, participation

What about Efficiency?
  • Efficiency is one of the criteria that a
    partnership is judged on
  • Projects that drag on will likely fail
  • We believe with Israel et al. that day-to-day
    project management is best done by paid staff
  • ALOT performed as a project steering committee.
    It set priorities and policy then project staff,
    interns and researchers provided the expertise
    and did the work.

A.L.O.T. Team
  • Laurie Bauman
  • Qui Juan Q Bellinger
  • Abigail Boetang
  • Yvette Calderon
  • Darlene Corporan
  • Patricia Danials
  • Seanika Ladson
  • Sean Law
  • Sylvia Lim
  • Ramn McFarlane
  • Adriana Ortiz
  • Virginia Ramos
  • Jonathan Junior Reyes
  • Angelic Rivera
  • Jamie Sclafane
  • Martha Velez
  • Jasmine Vega
  • Kenneth Wilson
  • Miguel Beltre
  • Jonathan Ramos
  • Felicity Arenas
  • Elvis Guzman
  • Tanisha Jones
  • Rosy Chhabra, Coalition moderator
  • Marni LoIacono, Project Director
  • Janice Robinson, ALOTCoordinator
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