| | Engaging Latino Residents to Build a Healthier Community in Mid-City San DiegoAbstractFaculty and staff from the University of California, San Diego Academic Center of Excellence on Youth Violence Prevention partnered with a local collaborative, the Mid-City Community Advocacy Network, to build the capacity of the community to identify quality of life issues and advocate for change. In an effort to train and mobilize community residents effectively in the skills needed to engage in advocacy and systems change, the traditional delivery model of community engagement (surveys, focus groups, large and small forums, health fairs, and street fairs) was replaced with culturally specific, active engagement strategies. Engaging diverse communities in Mid-City (Latino, Somali, and Vietnamese) required an approach that included hiring bilingual, bicultural staff recruited from those communities, hosting meetings in residents’ homes, and providing extensive leadership training and support for residents. This community resident leadership initiative, piloted in the Latino community of mid-city San Diego, was successful in engaging resident participation in the process. This paper outlines the lessons learned from this initiative. Introduction  Growing evidence shows that capable communities are key to the success of community-based interventions and an important goal of public health.1, 2, 3, 4 According to Goodman et al., community capacity “is a necessary condition for the development, implementation, and maintenance of effective, community-based health promotion and disease prevention programs.”5 Poland recommended that the community be involved in project decision making, and public health practitioners agree that engaging the community in a project is instrumental to its success.6, 7 There are growing efforts to involve communities in the design and implementation of public health programs, and what little community-focused research exists supports the centrality of community in prevention efforts.4, 8 In the field of violence prevention, grassroots community organizing and development are being recognized as critical for success in reducing crime and improving neighborhood safety.9, 10 This can be seen in a longitudinal study of violence in Chicago where collective efficacy among residents of a public housing project was found to be an effective form of violence prevention.9 Researchers concluded that community building and resident engagement are critical strategies for prevention.8 Yet community-based organizations and other public health practitioners often struggle to sustain active participation by residents in public health initiatives targeting their communities. It can be especially challenging to engage residents as leaders in the effort, not just as clients or consumers. For disadvantaged or underrepresented minority groups, community participation is relatively poor in the United States.11 Boyce found that participation of disadvantaged groups in community initiatives was significantly influenced by bureaucratic rules, minority group rights and relationships, and agency reputations.3 Additional barriers to participation can include child care needs, transportation, and linguistic isolation.11 Therefore, it is important to design community-based interventions that engage diverse community residents both as leaders and participants, and incorporate culturally sensitive and culturally specific outreach and intervention strategies.10, 12 To address the need for more active, sustained resident participation in its initiatives, a community collaborative in San Diego, California, the Mid-City Community Advocacy Network (Mid-City CAN), in partnership with the University of California, San Diego’s Academic Center of Excellence on Youth Violence Prevention (UCSD ACE), developed a community mobilization process to build collective capacity among the Latino community of Mid-City San Diego. Background Mid-City CAN was founded in 1989 by community residents and organizational representatives concerned about the decreasing quality of life in City Heights and the adjacent neighborhoods of East San Diego, called “Mid-City.” Since then, Mid-City CAN has grown into one of the most successful community collaboratives in the county. Its core membership includes representation from San Diego city schools, law enforcement, social services, county health services, probation, healthcare providers, community health educators and advocates, faith community representatives and residents, and UCSD ACE. Because of the relationships created through this diverse membership, Mid-City CAN is able to facilitate the development of new collaborative efforts, the coordination and integration of the various services already existing within Mid-City, and the leveraging of new funding and other resources to continually address emerging issues affecting the community. Today, Mid-City CAN continues to run a variety of initiatives focused on improving the quality of life in Mid-City, such as asthma and air quality, substance abuse prevention, the impact of liquor license density in a low-income community, domestic and youth violence prevention, and the civic engagement of immigrant and refugee residents. Besides these efforts, Mid-City CAN is a member of a variety of coalitions addressing welfare reform and the end of poverty, affordable housing, and livable wages. Increasingly, the collaborative is also addressing access to healthcare and health disparities. Community Description Mid-City is an area with boundaries on all sides created by major highways The community is densely populated (with 4.62% of the city land mass and 13% of the city’s population), and consists of an extremely diverse multi-ethnic populace. It is in rapid transition: home to more than 160,000 residents, many are recent immigrants and refugees and 37% are under 19 years old. About 40 primary languages are spoken in the schools feeding the two area high schools and 49.4% of Mid-City households do not speak English at home.13 The median household income in Mid-City is $29,777 while for the City of San Diego it is $52,192. In Mid-City, 28.4% of residents are below the poverty level compared with 12.6% region-wide.13 Identified Barriers to Community Engagement A core value of Mid-City CAN is encouraging and facilitating community residents’ participation in policymaking and planning in the community, ranging from sitting on boards of directors for local nonprofits to the local city planning committees. Community residents, however, have been difficult to recruit for participation in public health promotion activities and seem resistant to the degree of engagement necessary to effect real neighborhood change. Over the years, Mid-City CAN has used a variety of strategies to engage residents and increase their involvement in the collaborative, such as surveys, focus groups, and community forums. These efforts, both school-based and community-wide, include community health fairs, street fairs, attending neighborhood associations, and reaching out to faith communities and ethnic organizations. Although these efforts educated residents and raised awareness about specific issues, they did not produce a cohesive group of community resident members to participate fully in the collaborative and its initiatives. When the community or school events were finished, staff and volunteers were tired, the funding was depleted, and the residents went home. No sustainable relationship between residents and Mid-City CAN was created from these efforts. Mid-City CAN and UCSD ACE have come to call community outreach events that take so much time and resources for such limited outcomes, “photo-op community development.” While they look good and photograph well, they do not encourage residents to become involved in the organization on a long-term basis. If anything, they perpetuate a cynicism within the community that residents are merely “wallpaper” for these events that satisfy service providers and event sponsors but provide no apparent improvements to the community. These big events and photo-ops do serve a limited purpose in increasing visibility around particular initiatives, but practitioners must work to develop relationships with community residents within existing community structures and take into consideration cultural and social norms operating in the community.14 From these many failed efforts, Mid-City CAN identified several barriers that limited participation of community residents, including: •Time: The scheduled time of meetings usually caters to service providers, but not to residents. •Language: In a community where over 40 languages are spoken, it became quickly apparent that two monolingual English-speaking staff lacked the capacity to engage residents effectively. A secondary issue is the use of jargon by service providers. Even when residents do speak English, the professional vernacular of service providers can be indecipherable. •Culture: The concepts of advocacy and leadership are manifest and valued differently in different cultures. The theory of community organizing espouses equality of voice and participation, yet many cultures have formalized, specific, and different gender and generational roles that are incompatible with this strategy. Advocacy and policy change efforts are intrinsically about change and a shift in the status quo, yet many cultures do not value change, or are uncomfortable challenging authority. •Economics: Meetings are not a high priority for people with basic unmet needs. As the Institute for Community Peace found in its model of developmental stages of community change, communities are not able to move to collective action, much less primary prevention, without first attending to their needs.8 Community residents are not interested in policy and systems change when they cannot find affordable child care or are working several jobs to make ends meet. Mid-City CAN also learned that it is extremely difficult to engage community residents effectively with large numbers of participants. Relationship building is key to a sustainable capacity to mobilize effectively. According to Mittelmark,15 creating conditions for involvement by residents—and the potential for social change—is often not done well because it requires a high level of skill and a lengthy time commitment, often incompatible with funding timelines and staffing limitations.16 To be effective, community change requires a gradual and systematic approach, and community resident participation should be more than merely token involvement in the bureaucratic process.14 Based on Mid-City CAN’s and UCSD ACE’s experience and research, staff and faculty were determined to redesign the collaborative’s community mobilization efforts and revise the focus to develop the leadership capacity of community residents. Based on conceptual frameworks illustrated by other initiatives for violence, tobacco, and obesity prevention, the new strategy was to identify a small, cohesive core group of residents who would share ownership of the collaborative to recruit and mobilize others in the community.3, 8, 12, 14, 17 These initiatives illustrated that community mobilization efforts with leadership development activities for residents ensured a continuous base of resident engagement. As community networks expanded, they provided a forum for residents to practice leadership skills and strengthened residents’ and agencies’ shared commitment to common goals. Rethinking Community Engagement: Developing Leadership Capacity in the Latino Community The UCSD ACE staff and faculty, trained in both violence prevention and community development, became an essential part of this effort. For example, previous collaborative work in family violence prevention among refugee and immigrant communities in Mid-City demonstrated that, to work with specific subgroups in the community, it was critical to hire staff from within the community, especially bilingual, bicultural staff.11 These staff members were required to demonstrate cultural competency skills through previous work experience, as well as understanding of and identity with their own cultures.12 This became one of core strategies used in Mid-City CAN’s community mobilization efforts. This process of community resident engagement began with a small group of multicultural residents and staff and has evolved to include a specific new initiative that meets the needs of Latino residents in the community and is linked to their cultural heritage and life styles in San Diego, called Latinos y Latinas en Acción: The Latino Leadership Project (LLEA). The Latino community is the fastest growing and largest ethnic group in Mid-City, where approximately 77% of the children in the playgrounds of the neighborhood elementary schools are of Hispanic descent. As described by Boyce,3 immigration status, cultural and language barriers, and racism (both external and internalized) all play a role in the marginalization the Hispanic community. The Mid-City CAN intensive outreach effort, LLEA, focused on three goals: 1.Increase Latino resident involvement in the collaborative. 2.Help Latinos advocate effectively for issues most important to them. 3.Create a core Latino leadership that will participate in the decision-making bodies of the community. The strategies used for LLEA outreach were specifically designed to be culturally appropriate for the Latino community. For example, they emphasized a collective approach, not the hierarchical or patriarchal approach often used in institutional settings, which focus on individuality and self-development. Because the extended family, not just the nuclear family, is critical in the Latino community, LLEA involved the whole family, and even toddlers were part of all meetings. In the LLEA model, outreach to the community began by leveraging existing relationships within the community, including the relationships within an extended family. The meetings were culturally appropriate: participants sat in a circle, doing exercises that built relationships and emphasized a collective, not an individual, environment. LLEA also accommodated the cultural attitudes and needs related to time, particularly for low-income families. Although staff attempted to start meetings on time, we learned to incorporate meals at the beginning of the meeting so that people arriving late were not late for the actual meeting. When the meeting was over, everyone stayed behind to socialize. LLEA required a community organizer who was bicultural, bilingual, from the Latino community in Mid-City, and had good social skills. Once hired, our community organizer, Aixa Quiros, recruited Latino residents to host house meetings in target neighborhoods. During the first two months of the initiative, she used Mid-City CAN’s extensive network of programs to reach potential hosts. For example, she contacted each local school-based and community-based Family Resource Center and spoke with project coordinators about clients who might be hosts. She also created a house meeting format, primarily consisting of simple activities, where the goals were to create a simple “needs assessment” of the community and to identify nascent leaders willing to participate in a multi-week leadership training process. Participants were invited to draw a picture of the neighborhood, emphasizing what they liked most about it and what they did not like. They were then invited to share and discuss their drawings. Hosts were offered incentives of $100 gift certificates to a local grocery store if they could recruit 10 neighbors from their block. The collaborative provided funding to cover food and refreshments. In the pilot stage of the project, 10 house meetings were implemented. Approximately 80 people participated in the process. Although Mid-City CAN has been ambivalent about the use of cash incentives to encourage participation in collaborative initiatives, this project demonstrated that it can be an important tool for initiating a community engagement project. To sustain such a long-term initiative, cash-based incentives should be gradually phased out of the project. If cash incentives are needed to sustain resident participation, the collaborative has failed to foster leadership skills and a commitment to social change and community health promotion. At least 10 people participated in each of the initial 10 meetings, which ended with an invitation to participate in a Leadership Development class. Approximately 30 people initially participated in the weekly leadership trainings. By the end of the first year, about 15 members were still participating in the trainings. Participants were quick to embrace the idea of becoming more active leaders in their community. Initial plans for the project were to provide trainings twice a month for six months. Participants were so enthusiastic about the project, and so eager to move forward quickly, that they requested that the trainings be held on a weekly basis. The leadership training was built on the concept of the Medicine Wheel, a holistic illustration of how the individual and the collective (on the spiritual, mental, physical, and emotional planes) are affected by the political, social, cultural, and economic factors they experience. The first class introduced the concept of the Medicine Wheel as a means to look at individual leadership and issues of power. The community organizer developed weekly activities that trained residents on such diverse subjects as meeting facilitation, legislative advocacy, media relations, and collaborating with agencies. With facilitation from community experts and professional trainers, the participants also: •Created “ground rules” for the group; •Explored oppression and how it affects the participants and how it is defined. What is prejudice? What is institutionalized oppression and internalized oppression? How does it take place in our daily interactions and activities? What can we do and how can we respond effectively, instead of reacting to these conditions? •Created a Plan of Action; •Looked at the use of the media and participated in media advocacy trainings; and •Explored the local political process: who makes the decisions in San Diego and how can the group affect those decisions? During the second year, the participants hosted 10 additional house meetings that they organized, recruited, and facilitated with the support of the LLEA staff. Out of those meetings, an additional 15–20 people participated in the leadership trainings. Every year, LLEA hosts a two-day workshop on Transformational Leadership and Community Organizing and, when resources are available, a training on Undoing Racism. Although only about 15–20 core members participate regularly in Latinos y Latinas en Acción, LLEA has connected with more than 500 people in the community, and developed community organizing projects. These range from a Healthy Housing initiative to a Tobacco-Free Mid-City project, both focusing on mobilizing the Latino community to address community health advocacy. Lessons Learned Through this initial process, LLEA has quickly grown into a dynamic cohort with significant impact on the larger collaborative. The visibility of the initiative (as well as the collaborative as a whole) has increased significantly. After years of attempting various means of engaging residents in the collaborative, Mid-City CAN’s community resident membership is flourishing. Today, community residents are fully integrated into the leadership structure of Mid-City CAN, participating in subcommittees, task forces, and as elected members of the collaborative’s governing body, the Coordinating Council. The LLEA initiative has brought about many positive changes for Mid-City CAN and the community, but, as with all new projects, there have been struggles and pitfalls along the way. One of the key challenges has been how to keep connected with and sustain the base of LLEA, while still meeting the outcomes of all the programs that have grown as a result of the initiative. New programs must meet outcomes mandated by their funders, yet still remain faithful to the vision of the community. For some participants, it has been difficult to transition from community organizing to service delivery projects designed to address specific needs in the community. Also, as new projects are developed, LLEA members have moved from volunteer positions to staff or leadership positions, sometimes resulting in unclear or contradictory roles and bringing up issues of authority and accountability within the community. LLEA is now establishing governance guidelines to address these inherent conflicts. The guidelines address issues such as: What constitutes a member? Who is the core constituency of the group? Who are the “leaders” and who can be a considered a leader of LLEA? How does the group make decisions? What is the difference between the Community Organizer’s role (staff) and a Leader’s role (resident member)? These challenges and issues are a natural part of the growth of the initiative. LLEA members and staff continue to wrestle with maintaining a group process that honors the community culture and is structured enough to accommodate new projects and roles but flexible enough to remain responsive to community and individual needs. Because of the LLEA project, Mid-City CAN significantly expanded community resident participation throughout the collaborative. Suddenly, the collaborative was able to connect with previously unknown Latino organizations in the community, often run by Latino residents on a volunteer basis. These previously untapped community resources in turn created new opportunities to engage residents. Many of these organizations were already working with residents and the collaborative was able to learn from them as well as augment their efforts. These grassroots, resident-led organizations helped Mid-City CAN identify and recruit residents, while the collaborative linked them with the resources and potential partnerships within Mid-City CAN. The community mobilization effort has also led to political benefits for the collaborative. Mid-City CAN is one of the few community organizations successfully engaging residents. Latinos are a growing power base in San Diego and California, and Mid-City CAN’s ability to work with this group and support their efforts at advocacy has enhanced its reputation among other service providers and stakeholders. For example, two San Diego City Council members recently partnered with Mid-City CAN to hold community forums, and were astonished and delighted when dozens of residents not only attended but also expressed their opinions and recommendations for local public health and safety improvements. In addition, the members of LLEA have identified “peace promotion” (their reframing of the issue of violence prevention) as one of the two key issues for the coming year and are in the process of developing an action plan. One of the key successes of the resident leadership development process has been the growth of individual and collective empowerment among both adult and youth participants. For the youth in particular, participation in LLEA has led to a greater connection to the community and many new positive relationships with adults, including law enforcement, school personnel, and local leaders. Several of these high-risk youth are now part of the leadership structure of Mid-City CAN, serving on the governing board and multiple advisory committees. Through these efforts, youth and adults have built cohesive relationships based on mutual accountability and a commitment to improving their community. These youth are now respected members of the community and are less likely to engage in such high-risk activities as violent behavior, gang membership, and drug use. From this process, Mid-City CAN and UCSD ACE have also learned to define success in terms of what will be meaningful for community residents involved in the project. Practitioners frequently define success in terms of a contract or grant-identified outcomes, but those may not be of interest to residents. It is important to have residents identify the projects’ successes and celebrate them together. Promising Practices As the literature suggests, effective community mobilizing can lead to genuine, sustained leadership from partnership with residents, but the process must begin with small steps and often take years to develop. The community development process takes time to mature. Many funding agencies and community leaders demand immediate results, and tend to prefer flashy, “photo-op” events that seem to demonstrate impact. The reality of relationship-oriented community building is that it is a long-term effort. The better measures of success are the individual relationships developed with community residents. A variety of mechanisms can be successful in building these relationships with residents in communities eager to begin the process (e.g., English as a Second Language or parenting classes, through schools or churches). Mid-City CAN chose leadership development training because the long-term goal of the project is to involve community residents in policy and systems change. Although funding requirements, staff turnover, and general resource limitations often make it difficult for organizations and collaboratives to follow these guidelines, building capacity requires practitioners to engage with individuals and communities in a way that fosters the leadership abilities and long-term commitment of residents to address public health concerns more effectively. Looking to the Future On a recent Monday evening, 30 community residents, including 4 teenagers, arrived at the City Heights Wellness Center for another weekly meeting of LLEA. They are beginning the third year of the initiative. That evening, they elected four representatives to the Coordinating Council, the governing body for the entire collaborative. Mid-City CAN has been in existence since 1989 and it took 16 years to finally achieve a sustainable resident leadership in the governing body. Each week, instead of receiving cash incentives, the members take turns providing food for the meeting. Their sense of ownership is healthy enough to withstand potential funding cuts. All of these are signs of the importance in developing relationships and building connections between the residents and the community collaborative. Hopefully, these relationships with Mid-City CAN and a diverse group of partners—including service providers, city government, and university faculty, staff, and students—and their commitment to peace promotion will lead to a healthier, more stable, more capable, and violence-free community. This work is supported by the Centers for Disease Control and Prevention (Grant Number R49/CCR918607); the San Diego EXPORT Center and the National Center of Minority Health and Health Disparities, National Institutes of Health (Grant Number P60 MD00220); the Waitt Family Foundation; and Price Charities. No financial disclosures were reported by the authors of this paper. References 1. 1Sabol WJ, Coulton CJ, Korbin JE. Building community capacity for violence prevention. J Interpers Violence. 2004;19:322–340. MEDLINE |
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a Mid-City Community Advocacy Network, San Diego, California b University of California, San Diego, Department of Pediatrics, Academic Center of Excellence on Youth Violence Prevention, San Diego, California  Address correspondence and reprint requests to: Vivian M. Reznik, MD, MPH, University of California, San Diego, 9500 Gilman Drive, MC 0602, La Jolla CA 92093-0602.
PII: S0749-3797(07)00751-9 doi:10.1016/j.amepre.2007.12.009 © 2008 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved. | |
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