Developing trauma resilient communities through community capacity-building

Updating the Chronic Illness and Disability Payment System

BACKGROUND

Of the 38 Medicaid programs that risk adjust payments to Medicaid managed care organizations (MCOs), 33 of them use the Chronic Illness and Disability Payment System (CDPS). There has been recent interest in adding social determinants of health (SDH) into risk-adjustment models.

OBJECTIVE

To update the CDPS models using recent MCO data based on the International Classification of Diseases version 10 coding system and to explore whether indicators of SDH are predictive of expenditures.

RESEARCH DESIGN

Data from 3 national Medicaid MCOs and 8 states are used to update the CDPS model. We test whether spending on Medicaid beneficiaries living in economically and socially deprived communities is greater than spending on similar beneficiaries in less deprived communities.

SUBJECTS

Medicaid beneficiaries with full benefits and without dual eligibility under Medicare enrolled in Medicaid MCOs in 8 states during 2017-2019, including 1.4M disabled beneficiaries, 9.2M children, and 6.4M adults.

MEASURES

Health care eligibility and claims records. Indicators based on the Social Deprivation Index were used to measure SDH.

RESULTS

The revised CDPS model has 52 CDPS categories within 19 major categories. Six major categories of CDPS were revised: Psychiatric, Pulmonary, Renal, Cancer, Infectious Disease, and Hematological. We found no relationship between health care spending and the Social Deprivation Index.

CONCLUSIONS

The revised CDPS models and regression weights reflect the updated International Classification of Diseases-10 coding system and recent managed care delivery. States should choose alternative payment strategies to address disparities in health and health outcomes.

Interorganizational collaboration in a trauma-informed community: A network analysis of cohesion and change

Strengthening interorganizational collaboration is critical to mitigate the impact of adverse childhood experiences (ACEs) and improve community health. We examined change in interorganizational collaboration around ACEs within Peace4Tarpon's network and investigated factors influencing collaboration. We conducted a community-wide social network analysis among 32 trauma-informed organizations in 2016 and 2018, using network analysis methods to examine interorganizational cohesion (density, transitivity, triad census) over time, and multiple regression quadratic assignment procedure to investigate factors influencing collaboration. Network cohesion measures indicated small increases in collaboration level and greater network cohesion over time. Conducting ACEs screenings was a significant factor (b = 0.237; p < 0.01) predicting likelihood of interorganizational collaboration in 2016. No assessed ACEs practices predicted collaboration in 2018, suggesting variables assessed predicted a small proportion of variance in collaboration change. Results provide a foundation for understanding how ACEs/trauma-informed practices influence collaboration and highlight implications of interorganizational collaboration. Peace4Tarpon's 2-year progress provides insights for other trauma-informed communities.

The development of trauma-informed community partnerships: A mixed method social network study

Trauma-informed communities establish cross-sector coalitions that advocate for the use of trauma-informed practices. Whether and how communication occurs within newly established trauma-informed communities is unclear. We collected qualitative data and social network data from six trauma-informed community partnerships that received funding to build community capacity to address trauma across a range of special populations in Los Angeles county. We identified three communication network sub-types and highlight contributions of network leadership in setting the tone for cross-partnership communication. While partnership leaders shared the goal of strengthening cross-organizational communication, social network results illustrated a need to develop strategies that target these goals.

Engagement With Mental Health Services Among Survivors of Firearm Injury

Importance

Despite the prevalence of posttraumatic stress symptoms after firearm injury, little is known about how firearm injury survivors connect with mental health services.

Objective

To determine facilitators and barriers to mental health care engagement among firearm injury survivors.

Design, Setting, and Participants

A qualitative study of 1-on-1, semistructured interviews conducted within a community setting in Indianapolis, Indiana, between June 2021 and January 2022. Participants were recruited via community partners and snowball sampling. Participants who survived an intentional firearm injury, were shot within Indianapolis, were aged 13 years or older, and were English speaking were eligible. Participants were asked to discuss their lives after firearm injury, the emotional consequences of their injury, and their utilization patterns of mental health services. Data were analyzed from August 2022 to June 2023.

Main Outcomes and Measures

Survivors' lived experience after firearm injury, sources of emotional support, mental health utilization, and their desired engagement with mental health care after firearm injury.

Results

A total of 18 participants (17 were Black [94%], 16 were male [89%], and 14 were aged between 13 and 24 years [77%]) who survived a firearm injury were interviewed. Survivors described family members, friends, and informal networks as their main source of emotional support. Barriers to mental health care utilization were perceived as a lack of benefit to services, distrust in practitioners, and fear of stigma. Credible messengers served as facilitators to mental health care. Survivors also described the emotional impact their shooting had on their families, particularly mothers, partners, and children.

Conclusions and Relevance

In this study of survivors of firearm injury, findings illustrated the consequences of stigma and fear when seeking mental health care, inadequate trusted resources, and the need for awareness of and access to mental health resources for family members and communities most impacted by firearm injury. Future studies should evaluate whether community capacity building, digital health delivery, and trauma-informed public health campaigns could overcome these barriers to mitigate the emotional trauma of firearm injuries to reduce health disparities and prevent future firearm violence.

Building trust: Leadership reflections on community empowerment and engagement in a large urban initiative

BACKGROUND

Trust is essential for healthy, reciprocal relationships; creating safe environments; engaging in transparent interactions; successfully negotiating power differentials; supporting equity and putting trauma informed approaches into practice. Less is known, however, about the ways that trust-building may be at the forefront of consideration during community capacity building efforts, what trust-building elements are perceived as essential for optimally engaging communities, and what practices might support these efforts.

METHODS

The present study examines an evolving understanding of trust-building over the course of 3 years, from qualitative data derived during interviews with nine agency leads from a large and diverse urban community, who are spearheading community-based partnerships to create more trauma-informed communities and foster resiliency.

RESULTS

Data reflected fourteen trust-building elements, captured by three themes: 1) Building relationships and engagement (e.g., behavioral practices such as meeting people "where they are at" and creating safe spaces), 2) Embodying core values of trustworthiness (e.g., traits such as being transparent and embodying benevolence), and 3) Sharing decision-making, championing autonomy, and addressing barriers to trust (e.g., collaborative practices such as creating a shared vision and goals and addressing systemic inequities). These trust-building elements are presented in the Community Circle of Trust-Building, which provides an accessible, visual format that can facilitate capacity building efforts within organizations and with the broader community; guide the selection of training opportunities that support healthy interpersonal relationships; and aid in the identification of relevant, supporting frameworks (e.g., health equity, trauma-informed practices, inclusive leadership models).

CONCLUSIONS

Community engagement and trust are essential for overall health and well-being, increasing equitable access to resources, and supporting an effective and connected citizenry. These data shed light on opportunities for trust-building and thoughtful engagement among agencies working directly with community members in large urban areas.

“A Voice to Uplift Other People”: A Case Study of Integrating Organizing Methods in an FQHC-Based COVID-19 Vaccine Initiative in Latinx Communities

The COVID-19 pandemic added another layer of trauma for working-class communities who have experienced trauma from systemic inequity and racism. Early pandemic response efforts failed to reach the most vulnerable Latinx communities in the United States due to historic disinvestment in these communities. Federally Qualified Health Centers (FQHCs) were uniquely positioned to respond to the pandemic through testing and vaccine implementation because of their footprint in these communities. However, to advance equitable COVID-19 recovery and long-term, trauma-informed community resilience, FQHCs need to expand their role beyond immediate response through testing and vaccine deployment. Applying Freirean principles of liberation to an integrated model for crisis recovery and community resilience-building, this article presents a case study of the implementation of a COVID-19 vaccine outreach and education initiative at AltaMed Health Services, one of the largest FQHCs in the United States. Findings suggest that leveraging organizing and empowerment strategies to implement COVID-19 vaccine distribution in working-class communities contributes to pathways for community health and well-being, infrastructure for crisis response and recovery, equitable service and information delivery ecosystems, and engaged and empowered communities. Lessons from this study can provide a blueprint for integrating strategies for long-term community resilience, capacity-building, and empowerment in crisis response and community harm mitigation initiatives. Findings from this study also present a model for enhancing the role of FQHCs to facilitate community organizing and engagement for health equity.