How a health system in Los Angeles assembled the infrastructure and processes to incorporate communities in research, public health efforts, and health service design.
| TIMEFRAME | 2019-2021 |
| COMMUNITY | LatinX |
| GEOGRAPHY | Los Angeles, California |
| FOCUS | Strengthening patient and community engagement within an FQHC |
| CORE PRINCIPLES | Co-created, Multi-knowledge, Bi-directional |
| COMMUNITY ENGAGEMENT OUTCOMES | Strengthened Partnerships + Alliances Expanded Knowledge Improved Health + Health Care Programs + Policies Thriving Communities |
PROJECT BACKGROUND
Many organizations want to grow and systematize their capacity for community engagement but may not know how to get started. AltaMed, one of the largest Federally Qualified Health Centers (FQHCs) serving Southern California, offers lessons and encouragement for how to build a coordinated, system-wide capacity for community engagement.
AltaMed has a long history of engaging the LatinX community in Los Angeles. It is also one of the few FQHCs in the U.S. with an independent research department dedicated to addressing health disparities. As a result, AltaMed receives frequent requests to partner with other universities and community organizations. But until recently, it had no streamlined process for doing so. This resulted in mixed value for AltaMed and its community members. “We realized that patient-centered research can’t really exist in a silo at AltaMed, and that to be effective these efforts should be interconnected,” recalls Dr. Melissa Chinchilla, PhD, MCP, MS, a research scientist who ultimately led the work at AltaMed. Recognizing the need to create a broader organizational approach, in 2019 AltaMed applied for and received funding from the Patient-Centered Outcomes Research Institute (PCORI). The resulting Health Equity and Access for Latinos through Patient-Centered Outcomes Research Capacity-Building (HEAL through PCOR) engagement award provided a mechanism to reassess all of AltaMed’s current structures and processes for engaging patients and communities in health equity research and advocacy.
KEY ENGAGEMENT ACTIVITIES
The HEAL through PCOR vision was to systematize community engagement throughout AltaMed and its key activities: policy advocacy, research, health services, community health programs, and medical education. To get started, Dr. Chinchilla and her team:
Built a coalition of internal and external stakeholders. Over 30 community leaders, patients, medical providers, academic partners, and medical students were convened. To incorporate community perspectives, leadership reached out to people who had previously participated in AltaMed research or community engagement efforts. Those stakeholders were in turn encouraged to invite colleagues whose interests aligned with project goals. Many AltaMed employees also grew up or lived in the AltaMed service area. Collectively, these stakeholders were able to bring important resources to the table, including access to their networks and insights about how to successfully engage patients and community members. Together, they reviewed current AltaMed engagement processes and systems in monthly and quarterly working sessions.
HEAL through PCOR investigator Dr. Melissa Chinchilla offers advice to other health systems seeking to build their organizational capacity for community engagement.
Applied Community-Based Participatory Research (CBPR) methods. The team brought in outside experts to introduce CBPR principles and practices to all stakeholders (including medical professionals). Throughout the project, the team used CBPR principles and tools, such as partnership surveys and interactive activities, to stimulate reflection and equal contribution.
Worked cooperatively and adaptively. The team moved online in response to COVID-19, compensating for the lack of in-person connection with an increase in the number of meetings. They then used a snowball approach to expand participation: local nonprofit organizations joined various sessions, and additional community members were surveyed or joined interviews and focus groups. Collectively, this expanded group reviewed reviewed all the processes and structures used at AltaMed to engage community members.
PROJECT OUTCOMES
HEAL through PCOR laid the groundwork for AltaMed to infuse patient and community engagement into its programs, including research. Specific outcomes include:
Built a multi-year, system-wide plan for community engagement. The team drafted a five-year plan for building system-wide community engagement capacity. Near-term programs would embed community members into current efforts: community-engaged advocacy (e.g., voter drives), community-embedded research studies, trainings for medical professionals on how to engage community members, and one-off health services efforts such as vaccine drives. Mid-term programs would expand to civic engagement campaigns around the social determinants of health, engaging community members as co-investigators on grants, and co-developing medical educational curricula and new health services with community members. The long-term programs centered on a new Patient and Community Advisory Council to channel community priorities into all of AltaMed’s policy advocacy, research, health services, community health programs, and medical education activities.
Increased cross-departmental coordination for patient and community engagement. HEAL through PCOR brought together people and departments that typically did not talk to each other. This helped link civic engagement, research, and policy efforts across the organization. For example, the Strategic Analytics department maintained a list of community members who, when surveyed for their clinic experience, self-identified as wanting to join advocacy and research efforts—but Strategic Analytics had no way to engage them. Similarly, the Research department accrued patient stories of clinic and care experiences of potential relevance to Strategic Analytics but did not know the other department could use these stories. The two departments started meeting bi-monthly to share information and jump-start community member referrals.
Formulated new processes, guidelines, and tools to foster integration of community engagement. The stakeholder group drafted new guidelines for community- and patient-centered practices in research, research dissemination, and partnership identification. For example, “one of the things we realized is that these stakeholders had such great ideas for appropriate ways to speak to patients and community members, for using accessible language, for making sure we thank them for their time,” notes Dr. Chinchilla. These guidelines are now presented to all new AltaMed research partners with the expectation that they will align their behavior to the standards. The coalition also recognized that AltaMed needed to adopt standardized language—such as social determinants of health categories—to describe, track, and share community needs across departments. The group helped revise the partnership application because “oftentimes we had negative experiences with external researchers that helicoptered in and then left and didn’t provide any information about the activities or research findings,” said Dr Chinchilla. The new application asks for a dissemination plan back to AltaMed.
Launched a seven-week community research training academy. Recognizing that community members benefit from training before participating in health services research, the AltaMed Institute for Health Equity applied for and received a second PCORI award. The PARTNER SELA program trains members of the Southeastern Los Angeles (SELA) community to engage in patient-centered outcomes research. The program generated significant interest, and a cohort of 19 community members participated in the program’s first run. Program graduates reported enhanced confidence in their ability to collaborate on research projects as a community researcher. At five months post-training, all participants remained active in community research projects—for example, leading focus groups with SELA youth to understand their priorities and concerns about mental health. These efforts were central to AltaMed’s securing funding to launch a youth-led mental health project in Orange County.
ASSESSING COMMUNITY ENGAGEMENT OUTCOMES
Below, the Assessing Community Engagement Conceptual Model is mapped to the Impact Story. This mapping illustrates how CORE PRINCIPLES of engagement lead to impact across the four OUTCOME domains, and to specific measurable indices within those domains.
The HEAL through PCOR initiative used CORE PRINCIPLES of multi-knowledge (assembling a broad range of perspectives both internal and external to AltaMed), co-created (continuous collaborative work), and bi-directional learning (mutual discovery within and between external and internal stakeholders).
This approach generated STRENGTHENED PARTNERSHIPS + ALLIANCES, including diversity + inclusivity (incorporating residents of disempowered communities served by the FQHC); partnerships + opportunities and sustained relationships (ongoing engagement with community members through dedicated activities); mutual value (training community members in CBPR methodologies); and structural supports for community engagement (development of system-wide tools, processes, and practices for community engagement and establishment of the EMPOWER-ACT Committee, where AltaMed stakeholders continue to partner in patient and community engagement efforts across various programs).
The project EXPANDED KNOWLEDGE in the form of new curricula, strategies + tools (through the new community training program, PARTNER SELA, and new practice guidelines for effectively communicating with community members).
HEAL through PCOR contributed to THRIVING COMMUNITIES through community capacity + connectivity (creating a network of participants that can inform advocacy programs and research efforts going forward).
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