What to know
The purpose of Community Health Improvement Collaborative (CHIC) was to encourage shared strategies, partnerships, and resources to support rigorous, community-engaged health services research within Los Angeles that was designed to reduce health disparities.
Building a Partnered Network for Clinical Services Research
The Community Health Improvement Collaborative (CHIC): Building an Academic Community Partnered Network for Clinical Services Research
In 1992, CDC funded Healthy African American Families (HAAF). This program studied the reasons for high rates of low birth weight and infant mortality among African Americans in Los Angeles. The success of this collaboration led to the expansion of HAAF to investigate other health issues. This included preterm delivery, mental health, diabetes, asthma, and kidney disease, as well as various women's health projects. The academic component of HAAF evolved into the development of a research infrastructure, the Los Angeles Community Health Improvement Collaborative (CHIC). CHIC's purpose was to encourage shared strategies, partnerships, and resources to support rigorous, community-engaged health services research within Los Angeles. These health services were designed to then reduce health disparities.
Partners in the collaborative were
- The RAND Health Program
- The University of California, Los Angeles (UCLA), branch of the Robert Wood Johnson Clinical Scholars Program at the David Geffen School of Medicine;
- The UCLA Family Medicine Research Center
- Three NIH centers (at UCLA, RAND, and Charles R. Drew University of Medicine and Science)
- The Los Angeles County Department of Health Services and the Los Angeles Unified School District
- The Department of Veterans Affairs Greater Los Angeles Health Care System, and Community Clinical Association of Los Angeles County
- HAAF, and QueensCare Health and Faith Partnership
Methods
- Employed a CBPR approach using the principles of community engagement.
- Developed a community-academic council to coordinate the efforts of several research and training programs housed at three academic institutions.
Results
The conceptual framework developed for CHIC emphasizes the use of community engagement to integrate community and academic perspectives. It also emphasizes developing programs that address the health priorities of communities while building the capacity of the partnership. Priorities for developing the research infrastructure included enhanced public participation in research and assessment of the community context. They also included development of health information technology, and initiation of practical trial designs.
Key challenges to addressing those priorities included
- Obtaining funding for community partners
- Modifying evidence-based programs for underserved communities
- Addressing diverse community priorities
- Achieving the scale and obtaining the data needed for evaluation
- Accommodating competing needs of community and academic partners; and
- Communicating effectively, given different expectations among partners
Comments
Strong leadership and collaboration based on the principles of community engagement are crucial. With these elements, it is feasible to develop an infrastructure that supports community engagement in clinical services research. This can be done by collaborating across NIH centers and sharing responsibilities for infrastructure development, conceptual frameworks, and pilot studies.
Applications of Principles of Community Engagement
Interventions developed by CHIC are designed to meet research standards for effectiveness and community standards for validity and cultural sensitivity.
Principle 5 is demonstrated by first forming the partnership between the convening academic researchers and the community organizations. The engagement process is in then deciding on health priorities together. Principle 2 is demonstrated by the knowledge of community needs. Community participation demonstrates Principle 3, and the convener’s flexibility in meeting the needs of the community demonstrates Principle 8.
Four tracer conditions were established. These were depression, violence, diabetes, and obesity). Afterwards, the CHIC presented four areas for development of research capacity in line with several of the community engagement principles
- Public participation in all phases of research (Principle 5),
- Understanding community and organizational context for clinical services interventions (Principles 2 and 3),
- Practical methods for clinical services trials (Principle 8), and
- Advancing health information technology for clinical services research (Principle 7)
Principle 5 is demonstrated by first forming the partnership between the convening academic researchers and the community organizations. The engagement process is in then deciding on health priorities together. Principle 2 is demonstrated by the knowledge of community needs.
References
Jones L, Wells K. Strategies for academic and clinician engagement in community-participatory partnered research. JAMA 2007;297(4):407-410.
Wells KB, Staunton A, Norris KC, Bluthenthal R, Chung B, Gelberg L, et al. Building an academic-community partnered network for clinical services research: the Community Health Improvement Collaborative (CHIC). Ethnicity and Disease 2006:16(1 Suppl 1):S3-17.