Community-Based Health Interventions in an Institutional Context (eBook)

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