Community-Based Health Interventions in an Institutional Context (International Perspectives on Social Policy, Administration, and Practice)

__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. Contents 6 Contributors 8 Chapter 1: Introduction 13 What Is an Institution? 14 Institutionalization and Dualism 15 Institutions and Community-Based Work 16 Organization of Book 17 Conclusion 21 References 21 Chapter 2: A Community-Based Organization 23 Introduction 23 Realism Is Problematic 24 Realism Is Not Needed 26 A Few Practical Concerns 27 A Move Away from Philosophy 30 Conclusion 31 References 32 Chapter 3: Establishing Community-Based Primary Health Care 34 Introduction 34 Primary Health Care as Community-Focused Projects 36 Participation, Dialogue, and Local Knowledge 41 Community-Based Primary Health Care 42 Conclusion 46 References 47 Chapter 4: Community-Based Funding and Budgeting: Participatory Budgeting as a Transformative Act 50 Why Community-Based Budgeting? 50 A Community-Based Philosophy 51 What Is a Community? 52 Participatory Budgeting (PB): Beyond Traditional Budgeting 53 Participatory Budgeting Must Do More than Simply Reform 55 Cultural Challenges of Participatory Budgeting 56 The Philosophical Thrust of Participatory Budgeting 57 Communal Budgetary Discourse: A New Moral Framework 58 Conclusion 60 References 60 Chapter 5: Aims of a Community-Based Research Program 63 Introduction 63 Against Positivism and Realism: Roots of Community-Based Participatory Research in Health 65 Qualitative Approaches and the Rejection of Grand Designs 67 The New Language of Qualitative Research: Cultural Competence 68 Beyond Cultural Sensitivity and Toward Praxis 69 Conclusion 71 References 71 Chapter 6: Training Community-Based Health Workers 73 Introduction 73 Traditional Community-Based Pedagogy 75 The Need for Community-Based Philosophy 77 Engaging a Community 79 Conclusion 80 References 81 Chapter 7: Creating a Community Health Worker Training Program 83 CHW Importance in the Region 83 The Appalachian Region 84 Developing a New Curriculum 85 The Appalachian Region and Stakeholders 86 History of the Program 86 CHW Regional Training and Utilization 87 Stakeholder Needs 88 Diversity of Programs 89 Logistical Challenges 89 Scope of Work/Timeline 90 CHWs Addressing Health Disparities 91 Program Metrics 91 The Curriculum 93 Community-Based and Experiential Learning Curriculum 93 Identification of Students and Community Partners 94 Evaluation Plan 95 Proposed Partnerships 96 Placement Sites 96 Addressing Social Determinants of Health 97 Implementation Timeline 98 Future of the Training Program in Southeast Ohio 98 References 99 Chapter 8: Is the Affordable Care Act Encouraging Hospitals to Engage their Communities? Experiences from Appalachian Ohio 100 Methods 102 Overview of Study 102 Recruitment and Sampling 103 Data Collection and Analysis 103 Findings 104 Challenges 104 Low-Resource Communities 104 Rural Geography 105 Hospital Resources 106 Implementing Programs 107 Cautious Optimism About CHNA Process and Effects 108 Doubting that CHNA Process Will Positively Affect Communities 108 Describing Change as Slow in Community Health 109 Believing CHNAs will Improve Local Health Outcomes 109 Discussion 110 Conclusion 113 References 114 Chapter 9: Community-Based Political Interventions 117 Introduction 117 Analytical Framework 118 Institutional Barriers to Community Participation 120 Norms that Constrain Community Participation 120 Schemes that Sideline Community Members 121 Routines that Restrain Community Action 123 Institutions that Support Community Authority 124 Values that Promote a Community’s Vision 124 Formations that Foster Community Leadership 125 Communication that Creates Community Knowledge and Cohesion 126 Conclusion 128 References 128 Chapter 10: Re-examining the Role of Patients in Community-Based Interventions 132 Introduction 132 Towards Involving Patients in Their Own Care 133 Obstacles to Genuine Patient Involvement 134 Patient-Centered Communication for Improved Experience 136 Re-thinking Cultural Competence for Providers 137 Promising Strategies for Involving Patients in Treatment 137 Partners in Health Model 138 Community Health Workers/Promotores de Salud 138 OurNotes 139 Narrative Medicine 140 Conclusion 140 References 141 Chapter 11: Work as Health: Tensions of Imposing Work Requirements to Medicaid Patients in the United States 146 Healthcare Cost Trends 147 Reducing Access Through Work Requirements 148 A New Rhetoric of Exposure 153 Instinct as Justification for Limiting Access to Healthcare 155 Mytho-ideology 156 The Presumed Criteria: The Linguistic Ground Staked Out and Where Disputation Must Engage 158 The Body as Material Production 159 References 162 Chapter 12: Overcoming Institutional Barriers Faced by Community-Based Healthcare Institutions 165 Present Chapter 166 Clarifying Definitions 167 A Note on Positionality 169 Institutional Barriers that Community-Based Health Centers Face 170 The Integration of FQHCs into Accountable Care Organizations (ACO) 172 FQHC Community Advisory Boards 174 Recommendations to Overcome These Institutional Barriers 176 Conclusion 181 References 182 Chapter 13: Conclusion: A Re-evaluation of Institutionalized Health Care 185 Introduction 185 Reimagining Institutions Through Community-Based Philosophy 186 Making Institutional Health Planning Transparent 188 Issues of Power and “Community-Driven” Health Institutions 189 References 190 Index 191 Front Matter ....Pages i-xi Introduction (John W. Murphy)....Pages 1-10 A Community-Based Organization (John W. Murphy)....Pages 11-21 Establishing Community-Based Primary Health Care (Karen A. Callaghan)....Pages 23-38 Community-Based Funding and Budgeting: Participatory Budgeting as a Transformative Act (Jung Min Choi, John W. Murphy, Ramsey Dahab, Charlene Holkenbrink-Monk)....Pages 39-51 Aims of a Community-Based Research Program (Steven L. Arxer)....Pages 53-62 Training Community-Based Health Workers (Tashina J. Vavuris)....Pages 63-72 Creating a Community Health Worker Training Program (Dawn Graham, Kerri Shaw, Lesli Johnson)....Pages 73-89 Is the Affordable Care Act Encouraging Hospitals to Engage their Communities? Experiences from Appalachian Ohio (Berkeley Franz, Daniel Skinner, Danielle Dukes)....Pages 91-107 Community-Based Political Interventions (Karie Jo Peralta, Krista McCarthy Noviski)....Pages 109-123 Re-examining the Role of Patients in Community-Based Interventions (Khary K. Rigg, Amanda Sharp, Kyaien O. Conner, Kathleen A. Moore)....Pages 125-138 Work as Health: Tensions of Imposing Work Requirements to Medicaid Patients in the United States (Elaine Hsieh, Eric Kramer)....Pages 139-157 Overcoming Institutional Barriers Faced by Community-Based Healthcare Institutions (Airín D. Martínez)....Pages 159-178 Conclusion: A Re-evaluation of Institutionalized Health Care (Steven L. Arxer)....Pages 179-184 Back Matter ....Pages 185-190 "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." -- Prové de l'editor