Getting Actionable About Community Resilience: The Los Angeles County Community Disaster Resilience Project

Community resilience (CR)—ability to withstand and recover from a disaster—is a national policy expectation that challenges health departments to merge disaster preparedness and community health promotion and to build stronger partnerships with organizations outside government, yet guidance is limited.A baseline survey documented community resilience–building barriers and facilitators for health department and community-based organization (CBO) staff. Questions focused on CBO engagement, government–CBO partnerships, and community education.Most health department staff and CBO members devoted minimal time to community disaster preparedness though many serve populations that would benefit. Respondents observed limited CR activities to activate in a disaster. The findings highlighted opportunities for engaging communities in disaster preparedness and informed the development of a community action plan and toolkit.THE NATIONAL POLICY enthusiasm for re-envisioning the preparedness agenda around community resilience (the ability to prevent, withstand, and mitigate the stress of a disaster) raises questions among local health departments (LHDs) about how to build or strengthen community resilience and how to integrate the “whole of community approach” (a community-integrated model to involve a diverse set of stakeholders) in usual disaster-planning activities.1–6 In the past 3 years, all federal agencies that oversee and fund state and local emergency preparedness and response developed requirements and some guidance to establish more of a focus on inclusion of communities in emergency planning and response activities, and as part of the Public Health Emergency Preparedness Cooperative Agreement, the Centers for Disease Control and Prevention now requires a set of capabilities in the area of community preparedness and resilience.2,4,7,8The purpose of this focus is 2-fold. There is a recognition based on previous disaster experience domestically and internationally (e.g., Hurricane Katrina, Joplin tornado, Hurricane Sandy) that greater partnership between government and a diverse set of nongovernmental organizations (NGOs; both for-profit and nonprofit) is necessary for more effective response and recovery.9–12 Furthermore, there is new acknowledgment that the principles of community engagement used in other aspects of public health promotion, including those employed for daily stressors (e.g., community violence), may serve the best strategy for engaging historically vulnerable populations, leveraging existing community assets, and integrating routine and disaster activities.13 Moreover, the principles of community resilience (e.g., strengthening social connections, finding dual benefit opportunities between routine public health and disaster preparedness) address many of the social and environmental issues that aid communities to withstand and mitigate overlapping disasters.12,14,15This new approach requires very different levels of partnership compared with the traditional top-down disaster response approach that has pervaded the past decade.3,5,9,16–18 Yet, even though all LHDs must address community resilience capabilities as part of their public health emergency preparedness cooperative agreement,7 key questions remain as to how LHDs can operationalize and measure this broader approach, and there are few examples of how to address these expectations. The Los Angeles County Community Disaster Resilience (LACCDR) Project is a comprehensive, community-based approach to answer these questions through both strategy and tactical activities, moving community resilience from conceptual (national policy and associated literature on community resilience) to operational (identifying and testing resilience-building activities in actual communities).The structure of the partnerships, the Los Angeles County Department of Public Health (LACDPH) design strategy, and the community engagement approaches used are described elsewhere in this issue.6,13 This article summarizes findings from a baseline survey of governmental public health and community organizations to document initial capacities and practices regarding community resilience and describes the initial logic model for the LACCDR project. The LACCDR builds on a conceptual framework for community resilience that emphasizes the engagement, education, and interconnection of governmental and NGO partners considered essential to a community’s ability to mitigate vulnerabilities and recover from stress.5,12,19     

Building Community Disaster Resilience: Perspectives From a Large Urban County Department of Public Health

An emerging approach to public health emergency preparedness and response, community resilience encompasses individual preparedness as well as establishing a supportive social context in communities to withstand and recover from disasters. We examine why building community resilience has become a key component of national policy across multiple federal agencies and discuss the core principles embodied in community resilience theory—specifically, the focus on incorporating equity and social justice considerations in preparedness planning and response. We also examine the challenges of integrating community resilience with traditional public health practices and the importance of developing metrics for evaluation and strategic planning purposes. Using the example of the Los Angeles County Community Disaster Resilience Project, we discuss our experience and perspective from a large urban county to better understand how to implement a community resilience framework in public health practice.BUILDING COMMUNITY resilience to disasters—the ability to mitigate and rebound quickly—has received increased attention in the relatively new field of public health emergency preparedness and is now a central focus and a required activity for all public health departments that are recipients of Centers for Disease Control and Prevention (CDC) Public Health Emergency Preparedness (PHEP) grants.1 Critical lessons from Hurricane Katrina in 2005, the H1N1 pandemic of 2009, and, most recently, Hurricane Sandy continue to demonstrate that underlying issues of lack of trust and the absence of sustainable engagement with community-based organizations, faith-based organizations, and other neighborhood-level organizations create significant disparities in population health outcomes following emergencies and disasters. This situation hampers public health interventions in both everyday public health work and emergency response.2,3 As a theory and approach, community resilience provides a framework that embraces principles of equity and social justice with a focus on developing the core capacities of populations both to mitigate disasters and to rebound from them.4 The challenge is to clearly and operationally define community resilience, develop principles and practices that expand and enhance current community-based activities, and, through these changes, better align and integrate traditional public health and public health emergency preparedness.Although the term community resilience is relatively new to emergency preparedness, the emerging operational frameworks embrace many of the core components of effective community-based public health practice and, in many ways, represent a reframing of long-standing approaches to improve community well-being that have not been incorporated in preparedness programmatic activities.5We review the origins of the community resilience framework in the multidisciplinary research on individual resilience and assess how community resilience and related frameworks are shaping federal policies in all agencies involved in disaster and public health emergency response. We describe how the community resilience framework augments public health preparedness and reinforces longer-standing public health approaches to improving community health by examining a multiyear process developed by the Los Angeles County Department of Public Health (LACDPH) to implement this approach. The strategy consists of operationalizing community resilience through the following steps:

• Improving the community engagement skills of health department staff and building sustainable community engagement processes;
• Developing a resilience tool kit that can be used by community organizations to build coalitions and coordinated neighborhood strategies to increase community preparedness and specific mitigation skills; and
• Identifying metrics so that systematic interventions that can improve the abilities of communities to promote resilience and mitigate disaster impacts can be measured and evaluated.

     

Assessment of a primary care-based telemonitoring intervention for home care patients with heart failure and chronic lung disease. The TELBIL study

Background

Early onset and high prevalence of chronic disease among Indigenous Australians call for action on prevention. However, there is deficiency of information on the extent to which preventive services are delivered in Indigenous communities. This study examined the variation in quality of preventive care for well adults attending Indigenous community health centres in Australia.

Methods

During 2005-2009, clinical audits were conducted on a random sample (stratified by age and sex) of records of adults with no known chronic disease in 62 Indigenous community health centres in four Australian States/Territories (sample size 1839). Main outcome measures: i) adherence to delivery of guideline-scheduled services within the previous 24 months, including basic measurements, laboratory investigations, oral health checks, and brief intervention on lifestyle modification; and ii) follow-up of abnormal findings.

Results

Overall delivery of guideline-scheduled preventive services varied widely between health centres (range 5-74%). Documentation of abnormal blood pressure reading ([greater than or equal to]140/90 mmHg), proteinuria and abnormal blood glucose ([greater than or equal to]5.5 mmol/L) was found to range between 0 and > 90% at the health centre level. A similarly wide range was found between health centres for documented follow up check/test or management plan for people documented to have an abnormal clinical finding. Health centre level characteristics explained 13-47% of variation in documented preventive care, and the remaining variation was explained by client level characteristics.

Conclusions

There is substantial room to improve preventive care for well adults in Indigenous primary care settings. Understanding of health centre and client level factors affecting variation in the care should assist clinicians, managers and policy makers to develop strategies to improve quality of preventive care in Indigenous communities.     

Treating Mental Health Disorders for Children in Child Welfare Care: Evaluating the Outcome Literature

Background

Children involved in the child welfare system (CWS) have a greater need for mental health treatment relative to children in the general population. However, the research on mental health treatment for children in the CWS is sparse with only one known previous review of mental health services with children in the CWS.

Objective

This review reports on an evaluation of the literature examining mental health interventions for children within the CWS.

Methods

The Grades of Recommendation Assessment, Development and Evaluation (GRADE) process was used as the basis of the evaluation.

Results

The results reflect that, while the overall quality of research in this area is low and findings are, at times, inconsistent, detailed, manualized interventions using multiple treatment components that focus on family, child, and school factors showed the most promise in regards to child mental health outcomes and placement stability. These interventions not only report the best quality outcomes for children and families, but they were also most highly recommended within the GRADE analysis.

Conclusions

These findings emphasize the importance of comprehensive intervention efforts that involve the family and community, as well as the child. The inconsistent positive outcomes may be partially explained by the lack of trauma-informed practices incorporated into treatment for these often traumatized children. Recommendations for research in regards to mental health interventions for children in the CWS are discussed.     

Kommunale Gesundheitsf?rderung f��r ?ltere in ?sterreichischen Gemeinden

Background

Community health promotion for older people is a process for the development of healthy living conditions in the community setting. This raises the question of how far Austrian municipalities intend to carry out health promotion and how they appraise the conditions for implementation.

Material and methods

In a questionnaire survey 2,379 Austrian mayors were contacted and asked about their attitude towards community health promotion, the social norms and the perceived resources. A total of 458 (19.3%) Austrian communities participated in the study.

Results

Positive attitude, appropriate social norms and resources are necessary to enable the implementation of health promotion at the community level. These requirements for implementation are only partly available in the communities and only half of the municipalities intend to carry out community health promotion in the future.

Conclusions

A significant success factor of health promotion is the development of capacities at the community level. Therefore representatives and decision-makers of municipalities must be encouraged to develop the necessary capacities and be supported in their efforts.     

Das steirische Netzwerk der Gesunden Gemeinden

Background

During the last 20 years, the Styrian Health Association (Austria) has established a network of healthy communities. Twenty-eight percent of the Styrian communities have joined this network by now, which means a participation rate of 23% of the Styrian population.

Methods

The network is an example of health promotion in accordance with the Ottawa Charter, using participation, empowerment, and networking as tools to implement health-oriented capacity building in communities. Healthy communities in Styria may choose from three levels of cooperation.

Results

Three cohort studies (n=1,089; 539; 908, respectively) are documenting the effects on personal, social, and physical determinants of health. These results can basically be transferred if the required level of community readiness exists.

Conclusions

Sustainable effectiveness in community building rises with the level of participation (bottom-up policy) and the level of community readiness (top-down policy).     

Stärkung von Gemeinschaften: Partizipative Forschung zu HIV-Prävention mit Migrant/innen

Background

Communities play a key role in health promotion, in the concept of structural prevention and also in participatory health research. Community-Based Participatory Research (CBPR) aims to equitably involve community partners in investigating problems, identifying resources and developing solutions in order to improve community health. The participating communities are supposed to benefit from the research collaboration. However, whether this aim is actually realized in practice is only rarely analyzed.

Aim

This article explores how the community partners benefited from participating in a CBPR study on HIV prevention with migrant communities in Germany (PaKoMi).

Methods

The PaKoMi-Project was a 3-year participatory research project which aimed to improve the involvement of migrant communities in HIV research and prevention services. It was conducted by the national association of community-based AIDS service organisations (Deutsche AIDS-Hilfe e. V.) in collaboration with partners from different immigrant communities, AIDS service providers and researchers from the Social Science Research Center Berlin (WZB). Community members were trained as peer researchers and supported to conduct local CBPR-projects (case studies) in four cities. In the final evaluation, the partners stated what they gained from collaborating in the project. The current analysis focuses on the benefits for the participating partners, their communities and the field of HIV prevention.

Results

Competences were developed by the participating individuals and community capacities were strengthened, for example by developing networks, peer-based initiatives and migrant self organisations. Concepts, tools and recommendations for improving HIV prevention services for migrants were developed.

Conclusions

The PaKoMi-project shows how communities can benefit from participatory research.     

Oral health status of 12-year-old children in Russia

Background

The prevalence of the main oral diseases varies in different countries and within the same country or region and it is very important to conduct oral health surveys according to WHO recommendations. National epidemiological oral health surveys were carried out in Russia during 1996–1998 and 2007–2008.

Objective

The aim of the study is to compare the mean prevalence of dental caries and periodontal diseases among 12-year-olds in 1996–1998 and 2007–2008.

Methods

The oral health status of 12-year-olds was evaluated with criteria recommended by the World Health Organization.

Results

The results of the first national epidemiological oral health survey showed that caries prevalence among 12-year-old children was 78% with a mean DMFT index of 2.91. The prevalence of caries in permanent teeth was 1.4 times higher among children in Russian regions where the fluoride content in drinking water was much below 0.5 mg/l in comparison with those regions where the F^? content exceeded this figure. Signs of periodontal diseases (gingival bleeding and dental calculus) evaluated by the community periodontal index occurred in 48% of 12-year-old teenagers and on average in 2.5 periodontal sextants. The second oral health survey revealed that caries prevalence decreased in this age group (to 73%) as well as both mean DMFT index (to 2.49) and its component values. The periodontal status of the children also improved.

Conclusions

Changes of children’s oral health during a 10-year interval might be explained by implementation of different preventive programs.     

Schwerpunkte der Prävention und Gesundheitsförderung in Bayern

Background

Based on a parliamentary mandate a comprehensive survey on projects of health promotion and disease prevention was conducted in Bavaria.

Methods

Institutions and their umbrella organizations active in health promotion and disease prevention were contacted with a structured questionnaire via a snowball system.

Results

The main areas of activity among 1,280 projects that were active in 2004 were nutrition/physical activity, tobacco/alcohol/illegal drug dependencies, health resources, AIDS prevention and sexual activity, and clinical preventive services. The leading methods were counseling and provision of information. The main target groups were adults (24%), young people (17%), and children (12%). Few projects (<3%) focused specially on socially disadvantaged groups. Fewer than half of the projects had a documentation process in place, and less than one of four conducted a formal evaluation.

Conclusions

An improved culture of documentation and evaluation, formal networks among projects and institutions, and the assurance of the necessary local capacities and competencies are important areas for further development in this field.     

Linking public health research with policy and practice in three European countries

Aim

To transform knowledge from public health and health services research into actual improvement of services is highly relevant for spending public research resources effectively. Fostering stakeholder interaction throughout the entire research process is one potential avenue towards this aim. The objective of this paper is to look for established practices with the aim to promote the usability of research in policy and practice through interaction.

Subject and methods

We conducted 11 semi-structured telephone-interviews with senior experts from the same number of public health and health services research institutions in the Netherlands, the United Kingdom and Norway.

Results

Practice patterns are manifold, but three key domains were identified:

1. Research implementation is explicitly part of the organisation’s mission. Research commissioning institutions serve as intermediaries between research, policy and practice.
2. Funds are earmarked for implementation activities. In regular evaluation cycles special consideration is given to the impact of research.
3. Multiple forums for interaction support the ability of researchers to actively communicate with stakeholders. Network-building skills are developed alongside scientific competence.

Conclusion

Promising initiatives can be found in practice. Further research is needed into what difference it makes how the exchange between research and policy is organised.     

Kommunale Strategien der prim?ren Pr?vention hitzebedingter Gesundheitssch?den

Background

The increase in heat extremes and heat spells presents a threat to human health. Differences in the spatial distribution of heat exposure necessitate the development of suitable prevention strategies also at the communal level.

Approach

As a model, a prevention network focussing on urban districts was established as a platform for the development and implementation of adequate strategies for the prevention of heat-related health impairment.

Results

Strategies and measures developed in the network pursue behavioural and situational preventive goals and apply on the level of the individual (micro level), the setting (meso level) and the population level (macro level).

Discussion

Whilst interventions on the meso and macro level can be realized well, access to a larger part of the target group presents a problem that has not yet been resolved.

Conclusion

Sensitization of the population is essential for the prevention of heat-related health risks in the community.     

Interdisziplinäre Gesundheitsfrühförderung

Background

The early oral health care concept includes prenatal and post-delivery dental prevention for mother and child until the age of 3 years. The main goal of this approach is to improve ”health awareness” and to generate the prerequisites for permanent children’s dental and oral health. An improvement or preservation of the mother’s oral health may then reduce the risk of caries, periodontitis and diet-associated systemic diseases of children and their parents as well.

Results

The efficiency of early oral health care was evaluated by a long-term-study. Early oral health care promotion starting during pregnancy may result in sustained and long-term improvement of the oral health of children.

Conclusion

The concept is not yet sufficiently known. To anchor early oral health care promotion in the minds of pregnant women, optimization of the cooperation between paediatricians, family doctors, gynaecologists, midwives and dentists is required. Integration of dental preventive measures in the maternity log and children’s health care book can help to gain access to so-called risk groups.     

Health,well-being and quality of life of community members displaced after an industrial disaster in Trinidad

Aims

The study sought to investigate the lived experiences regarding the health, well-being and quality of life of persons experiencing displacement due to an industrial disaster in Trinidad.

Study and methods

The study used qualitative design using focus group discussions and semi-structured interviews. The study explored the experiences of two tiers of participants: first, participants were drawn from people who experienced the disaster themselves and second from the health care providers who provided intervention for persons affected by the disaster. Purposive sampling was used to select a list of participants from these two groups of participants, and data were collected over a 3-week period following the oil spill.

Results

Residents experienced the disaster as a life-threatening tragedy. The immediate effects of the disaster were felt as many people complained of respiratory problems. Diets were also affected since people were not allowed to use gas and electric stoves or flammable materials. The groups most vulnerable to sickness were the elderly and children. The medical officers revealed that they were unprepared for dealing with a disaster such as was caused by the environmental pollution.

Conclusions

The authors suggest that community-level health workers in industrial disaster situations should focus on building community social capital and train first respondents and health workers to become alert to possible health challenges such as delayed or postponed health routines and the emergence of psychological and mental health issues.

     

Factors associated with social support in child-rearing among mothers in post-disaster communities

Background

Natural disasters have long-term negative impacts on the health and socioenvironmental conditions of a population, affecting the physical environment as well as the relationships within the community, including social networks. Mothers in post-disaster communities may have difficulty receiving social support not only from family members and relatives but also from members of their community, such as people in their neighborhoods. This study focused on mothers with infants and preschool-aged children in post-disaster communities. The associations of social support with sociodemographic characteristics and socioenvironmental conditions related to child-rearing among mothers in post-disaster communities were assessed.

Methods

An anonymous self-administered questionnaire survey was conducted in October 2015 in 988 households in areas affected by the Great East Japan Earthquake and Tsunami. The data collected on sociodemographic and socioenvironmental characteristics included the presence of pre-disaster acquaintances in the neighborhood and social support for child-rearing. The associations of sociodemographic and socioenvironmental characteristics with social support were examined.

Results

We analyzed 215 completed questionnaires from mothers living in different houses from those they lived in before the disaster to reflect continuous relationships with people from the pre-disaster communities. Social support was significantly associated with infant sex, extended family, support obtained from relatives not living together, pre-disaster acquaintances, use of child support resources, and no perceived difficulties in child-rearing. In addition, the presence of pre-disaster acquaintances was associated with categories of mental/physical place of comfort and child-rearing support, with adjusted odds ratios of 1.88 (95% CI 1.03–3.44) and 2.84 (95% CI 1.46–5.52) compared with mothers who did not have any pre-disaster acquaintances.

Conclusions

Factors associated with the obtainment of social support in child-rearing among mothers in post-disaster communities were attributed not only to mothers themselves and family members but also to socioenvironmental factors such as the presence of pre-disaster acquaintances. The presence of pre-disaster acquaintances promoted rich social support in child-rearing in post-disaster communities. When reconstructing a community following changes in residence location after a disaster, the pre-disaster relationships among the community dwellers should be considered from the viewpoint of child-rearing support.

     

Education and training of public health professionals in the European Region: variation and convergence

Objectives

To assess the exit competences of public health graduates across a diverse European landscape.

Methods

The target population comprised 80 full institutional members of the Association of Schools of Public Health in the European Region with a participation rate 82.5 %. The web-based questionnaire covered institutional profiles and the ranking of exit competences for master of public health programmes, grouped according to WHO Essential Public Health Operations.

Results

European schools and departments usually are small units, funded from tax money. A total of 130 programmes have been indicated, together releasing 3,035 graduates in the last year before the survey. All competence groups showed high reliability and high internal consistency (α > 0.75, p < 0.01). The best teaching output has been assessed for health promotion, followed by disease prevention and identification of health hazards in the community, the least in emergency preparedness.

Conclusions

Given the fragmentation of the institutional infrastructure, the harmonisation of programme content and thinking is impressive. However, the educational capacity in the European Region is far from being sufficient if compared to aspired US levels.     

Förderung von Qualitätsentwicklung durch Partizipative Gesundheitsforschung

Background

Participatory Social Research has as a central goal the improvement of practice in the health and social welfare systems. Under the heading “action research” measures for improving practice are developed and evaluated in a cooperation between practitioners and the people they seek to help. The goal is to alleviate the effects of marginalization and other social and health issues. Participatory Health Research seeks specifically to develop strategies and methods for improving health care, including health promotion and prevention activities.

Goal

Internationally proven methods and concepts for Participatory Health Research were applied to German practice contexts for the purpose of developing appropriate quality development measures in the field of health promotion and prevention for socially disadvantaged communities.

Result

The most important result of the research is the development of an approach known as Participatory Quality Development, which unites under one umbrella the various theoretical and methodological contributions from the studies. The research shows that Participatory Health Research can be applied successfully to German practice contexts focusing on health promotion and prevention for socially disadvantaged communities. However, several factors were also identified which can promote and hinder the successful application of Participatory Quality Development in this field.