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Medical Family Therapy in Community Engagement

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Book cover Clinical Methods in Medical Family Therapy

Part of the book series: Focused Issues in Family Therapy ((FIFT))

Abstract

“Community engagement” has been defined in a variety of ways over the years, ranging from petition and protests by disenfranchised groups against powerful others (e.g., businesses, governments) who have hurt or neglected them to purposeful partnerships advanced by lay community members and professional organizations. In healthcare, we have seen community engagement evolve from early efforts in peer support that do not directly involve professionals (e.g., Alcoholics Anonymous, Al-Anon) to those that are positioned within communities—but are professionally led (e.g., community-oriented primary care). Today, cutting-edge efforts in community engagement are gaining ground through community-based participatory research (CBPR); this manner of partnering communities and professionals is driven by the wisdom that everyone involved—patients, family members, community leaders, healthcare providers, administrators, etc.—has something to contribute. Collectively, this mosaic of expertise and energy is far more powerful than the sum of its parts.

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Notes

  1. 1.

    Note: References that are prefaced with an asterisk are recommended readings.

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Author information

Authors and Affiliations

  1. Department of Family Social Science, University of Minnesota, Saint Paul, MN, USA

    Tai Mendenhall & William Doherty

  2. Department of Indian Work, Family Education Diabetes Series, Interfaith Action of Greater Saint Paul, St. Paul, MN, USA

    Elizabeth “Nan” LittleWalker

  3. Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA

    Jerica Berge

Authors
  1. Tai Mendenhall
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  2. William Doherty
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  3. Elizabeth “Nan” LittleWalker
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  4. Jerica Berge
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Corresponding author

Correspondence to Tai Mendenhall .

Editor information

Editors and Affiliations

  1. Department of Family Social Science, University of Minnesota, Saint Paul, Minnesota, USA

    Tai Mendenhall

  2. Department of Human Development and Family Science, East Carolina University, Greenville, North Carolina, USA

    Angela Lamson

  3. Department of Human Development and Family Science, East Carolina University, Greenville, North Carolina, USA

    Jennifer Hodgson

  4. Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA

    Macaran Baird

Appendices

Source: Doherty, W., Mendenhall, T., & Berge, J. (2010). The families & democracy and citizen healthcare project. Journal of Marital and Family Therapy, 36, 389–402. https://doi.org/10.1111/j.1752-0606.2009.00142.x

Source: Doherty, W., & Mendenhall, T. (2006). Citizen health care: A model for engaging patients, families, and communities as co-producers of health. Families, Systems, & Health, 24, 357–362. https://doi.org/10.1037/1091-7527.24.3.251

Additional Resources

Literature

Blumenthal, D. S., & DiClemente, R. J. (Eds.). (2013). Community-based participatory health research: Issues, methods, and translation to practice. New York, NY: Springer.

Coughlin, S., Smith, S., & Fernandez, M. (Eds.) (2017). Handbook of community-based participatory research. New York, NY: Oxford University Press.

Hacker, K. (2013). Community-based participatory research. Los Angeles, CA: Sage.

Ivankova, N. V. (2014). Mixed methods applications in action research. Los Angeles, CA: Sage.

Minkler, M., & Wallerstein, N. (Eds.). (2011). Community-based participatory research for health: From process to outcomes. Hoboken, NJ: Wiley.

Organizations/Associations

Colorado School of Public Health’s Rocky Mountain Prevention Research Center . http://www.ucdenver.edu/academics/colleges/PublicHealth/research/centers/RMPRC/training/Pages/CBPR.aspx

Detroit Community-Academic Urban Research Center . http://detroitcenter.umich.edu/projects/detroit-community-academic-urbanresearch-center

University of Chicago’s Institute for Translational Medicine . http://itm.uchicago.edu/community-based-participatory-research/

University of Minnesota’s (UMN) Citizen Professional Center . www.citizenprofessional.org

University of New Mexico’s (UNM) Center for Participatory Research . http://cpr.unm.edu/

Appendix 1: Strategies for CBPR and Citizen Health Care

Source: Doherty, W., Mendenhall, T., & Berge, J. (2010). The families & democracy and citizen healthcare project. Journal of Marital and Family Therapy, 36, 389–402. https://doi.org/10.1111/j.1752-0606.2009.00142.x

  1. 1.

    Get buy-in from key professional leaders and administrators.

    These are the gatekeepers who must support the initiation of a project based on its potential to meet one of the goals of the healthcare setting. However, we have found it best to request little or no budget, aside from a small amount of staff time, in order to allow the project enough incubation time before being expected to justify its outcomes.

  2. 2.

    Identify a health issue that is of great concern to both professionals and members of a specific community (clinic, neighborhood, cultural group in a geographical location).

    Stated differently, the issue must be one that a community of citizens actually cares about—not just something that we think they should care about. The professionals initiating the project must have enough passion for the issue to sustain their efforts over time.

  3. 3.

    Identify potential community leaders who have personal experience with the health issue and who have relationships with the professional team.

    These leaders should generally be ordinary members of the community who in some way have mastered the health issue in their own lives and who have a desire to give back to their community. “Positional” leaders who head community agencies are generally not the best group to engage at this stage, because they bring institutional priorities and constraints.

  4. 4.

    Invite a small group of community leaders (3 to 4 people) to meet several times with the professional team to explore the issue and see if there is a consensus to proceed with a larger community project.

    These are preliminary discussions to see if a Citizen Health Care project is feasible and to begin creating a professional/citizen leadership group.

  5. 5.

    This group decides on how to invite a larger group of community leaders (10–15) to begin the process of generating the project.

    One invitational strategy we have used is for providers to nominate patients and family members who have lived expertise with a health issue and who appear to have leadership potential.

  6. 6.

    Over the next 6 months of biweekly meetings, implement the following steps of community organizing:

    1. (a)

      Exploring the community and citizen dimensions of the issue in depth

    2. (b)

      Creating a name and mission

    3. (c)

      Doing one-to-one interviews with a range of stakeholders

    4. (d)

      Generating potential action initiatives, processing them in terms of the Citizen Health Care model and their feasibility with existing community resources

    5. (e)

      Deciding on a specific action initiative and implementing it

  7. 7.

    Employ the following key Citizen Health Care processes:

    1. (a)

      Democratic planning and decision-making at every step. As mentioned before, this requires training of the professionals who bring a disciplined process model and a vision of collective action that does not lapse back into the conventional provider/consumer model, but who do not control the outcome or action steps the group decides to take.

    2. (b)

      Mutual teaching and learning among community members. Action initiatives consistent with the model first call upon the lived experience of community members, with the support of professionals , rather than recruiting community members to support a professionally created initiative.

    3. (c)

      Creating ways to fold new learnings back into the community. All learnings can become “community property” if there is a way for them to be passed on. Currently we have vehicles for professionals to become “learning communities,” but few vehicles outside of Internet chat rooms for patients and families to become learning communities.

    4. (d)

      Identifying and developing leaders. The heart of community organizing is finding and nurturing people who have leadership ability but who are not necessarily heads of organizations with turfs to protect.

    5. (e)

      Using professional expertise selectively—“on tap,” not “on top.” In this way of working, all knowledge is public knowledge, democratically held and shared when it can be useful. Professionals bring a unique font of knowledge and experience—and access to current research—to Citizen Health Care initiatives. But everyone else around the table also brings unique knowledge and expertise. Because of the powerful draw of the provider/consumer way of operating, professionals must learn to share their unique expertise when it fits the moment, and to be quiet when someone else can just as readily speak to the issue. A community organizing axiom applies here: Never say what someone in the community could say, and never do what someone else in the community could do.

    6. (f)

      Forging a sense of larger purpose beyond helping immediate participants. Keep the Big, Hairy, Audacious Goal (BHAG) in mind as you act in a local community. Citizen Health Care is not just about people helping people; it is about social change toward more activated citizens in the healthcare system and larger culture. This understanding inspires members of the Citizen Health Care project about the larger significance of their work. It also attracts media and other prominent community members to seek to understand, publicize, and disseminate Citizen Health Care projects.

Appendix 2: Lessons Learned in CBPR and Citizen Health Care

Source: Doherty, W., & Mendenhall, T. (2006). Citizen health care: A model for engaging patients, families, and communities as co-producers of health. Families, Systems, & Health, 24, 357–362. https://doi.org/10.1037/1091-7527.24.3.251

  1. 1.

    This work is about identity transformation as a citizen professional, not just about learning a new set of skills .

  2. 2.

    It is about identifying and developing leaders in the community more than about a specific issue or action.

  3. 3.

    It is about sustained initiatives, not onetime events.

  4. 4.

    Citizen initiatives are often slow and messy, especially during the gestation period.

  5. 5.

    You need a champion with influence in the institution.

  6. 6.

    Until grounded in an institution’s culture and practices, these initiatives are quite vulnerable to shifts in the organizational context.

  7. 7.

    A professional who is putting too much time into a project is over-functioning and not using the model. We have found that the average time commitment to be on the order of 6–8 hours/month, but over a number of years.

  8. 8.

    External funding at the outset can be a trap because of timelines and deliverables, but funding can be useful for capacity building to learn the model and for expanding the scope of citizen projects once they are developed.

  9. 9.

    The pull of the traditional provider/consumer model is very strong on all sides; democratic decision-making requires eternal vigilance.

  10. 10.

    You cannot learn this approach without mentoring, and it takes 2 years to get good at it.

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Mendenhall, T., Doherty, W., LittleWalker, E.“., Berge, J. (2018). Medical Family Therapy in Community Engagement. In: Mendenhall, T., Lamson, A., Hodgson, J., Baird, M. (eds) Clinical Methods in Medical Family Therapy. Focused Issues in Family Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-68834-3_14

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