Johns Hopkins Medical Institutions and the East Baltimore Community

Transcription

1 This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this site. Copyright 2011, The Johns Hopkins University, Archie Golden, and Lee Bone. All rights reserved. Use of these materials permitted only in accordance with license rights granted. Materials provided AS IS ; no representations or warranties provided. User assumes all responsibility for use, and all liability related thereto, and must independently review all materials for accuracy and efficacy. May contain materials owned by others. User is responsible for obtaining permissions for use from third parties as needed.

2 Johns Hopkins Medical Institutions and the East Baltimore Community Archie Golden, MD, MPH Lee Bone, RN, MPH Johns Hopkins University

3 Section A Historical Perspective Image source:

4 Who Is the East Baltimore Community? Demographic Population between 50,000 to 70,000 Reduced with construction of biotech park Poverty, crime, and education 1/3 below poverty level 1/3 on public assistance 50% of men have had contact with criminal justice system 50% of youth do not graduate high school Assets and strengths Community s commitment to improve citizens well-being Strong church outreach beyond congregations There are 60 churches within one-half mile of the Johns Hopkins Hospital 4

5 Academic Medical Centers As a minimum, Johns Hopkins has a medical school and teaching hospital Johns Hopkins also has Schools of Nursing and Public Health Nationally, there are 126 academic medical centers in the United States Three-quarters are located in poor minority areas 1876: Johns Hopkins University founded 1889: Johns Hopkins Hospital founded 1893: Johns Hopkins Medical School formed 1916: Johns Hopkins School of Public Health began Funded by International Board of the Rockefeller Foundation Photo by WISUCProject via flickr.com. Creative Commons BY-SA. 5

6 Early Tensions Medicine and public health Social and biologic bases for public health Curative and preventive care Research-oriented versus practice-oriented education Research versus providing mass education to the public Research on virology, bacteriology, and epidemiology 6

7 Early Efforts to Work with the Community Washington County relationship began in the 1920s Was six hours away; now two and a half hours away on the interstate Dr. George Comstock revived the effort in the 1960s 1923 plan was for the School of Public Health to operate the Eastern Health District with the City of Baltimore, but... personalities and money interfered! Dr. C. Hampton Jones, Baltimore City health officer Disliked Rockefeller Family and Sun Oil Company Dr. Huntingdon Williams succeeded Dr. Jones in

8 Eastern Health District Established 1932 on Wolfe and Monument Streets Successful field studies of surrounding communities 60,000 population Community research Training of public health nurses Physician services for selected conditions Sexually transmitted infections New building built after 25 years Four blocks away from main school on Caroline and Monument Streets symbolized the separation Has logos of both Johns Hopkins and the City of Baltimore beside the doors NIH funding shifted focus away from community work to more national and international research 8

9 Civil Rights 1968 assassination of the Reverend Martin Luther King Baltimore riots surrounded Johns Hopkins medical campus Academic/community discussion, or charrette created the East Baltimore Development Corporation 18 community members and two physicians from Hopkins Purpose: housing, community and economic development Also had a health and social services focus Clarence Du Burns, first CEO of the corporation, became mayor of Baltimore, so had a political dimension also 9

10 East Baltimore Medical Center Located on Aisquith Street Opened in 1971 by East Baltimore Community Corporation with guidance from Hopkins Funded by Office of Economic Opportunity Currently part of the Johns Hopkins Medical Institutions 10

11 Community Health Advocates Initial training for community health workers from the surrounding community Trained 12 in a one-year program to work with doctors and nurses in the health center Training included how to assist in the health center; also included home monitoring and home care methods Intent was to link the care provided in the health center with the care provided at home However, those community outreach skills were never utilized by the incoming medical director The medical director was not a part of the planning He did not feel a part of the process The community health advocates were not able to use all the skills they had 11

12 Heart, Body, and Soul The Heart, Body, and Soul Project developed community health workers linked with community organizations such as churches, hospitals, and other community centers Volunteers and medical students were trained to conduct blood pressure monitoring out in the community Community health workers functioned as: Health educators and care monitors Helpers to navigate the system State health department was suspicious Conducted randomized trials of nurse-supervised services to provide evidence of their efficacy 12

13 CURE: Clergy United for Renewal of East Baltimore Over 200 churches belonged; active members Vision for community renewal Crime prevention and vacant lot clean-up Renewal of Body, Heart and Spirit Smoking cessation specialists in churches were trained At a CURE meeting to improve opportunities for home ownership, researchers argued that people needed to be healthy to be retained in jobs CURE: Presented the researcher s proposal to a group prayer meeting Prayed Appointed a leader 13

14 CURE: Clergy United for Renewal of East Baltimore Over 200 churches belonged; active members Vision for community renewal Crime prevention and vacant lot clean-up Renewal of Body, Heart and Spirit Smoking cessation specialists in churches were trained At a CURE meeting to improve opportunities for home ownership, researchers argued that people needed to be healthy to be retained in jobs CURE: Presented the researcher s proposal to a group prayer meeting Prayed Appointed a leader 14

15 What Hopkins Learned Through Heart, Body, and Soul, researchers learned how to perform collaborative research with the churches They had frank conversations with the community about the need, utility, and benefit of randomized trials This brought up latent hostility from the community For many years, the community had been subjects for Johns Hopkins research projects Community members resented grants which gave more to the researchers than to the community groups 15

16 Trust Relationships Evolved over Time One strategy was to have the research result in small service projects to meet community needs and strengths Students, faculty, and community members all learn together; responding to each other s educational needs Students go out into the community to learn Faculty respond to requests for information Community members serve as guest lecturers in class In tobacco control, there was mutual learning The community became more informed 16

17 Lack of Knowledge Is Killing My People Formed basis for other programs Asthma Diabetes Cancer Partnerships are sustained over time Partnerships ebb and flow Either side gets busy and looses touch 17

18 Factors on the Academic Side The community still perceives a disconnect The students want to be out in the community Faculty face competing demands Time is stated as a factor but may not be the reason Many do not have the skills and commitment 18

19 Academic Priorities Priorities are different in academic medical centers Johns Hopkins has leveraged 1.6 billion dollars in the community The Johns Hopkins Hospital formed a community outreach office in the early 1990s to build partnerships 19

20 1990s Collaboration In 1993, the Historic East Baltimore Community Action Coalition was formed as a non-profit Focus on employment and housing opportunity Political factions can impede the success of partnership efforts They can also facilitate partnerships In 1998, Johns Hopkins University formalized a council 65 individuals were brought together Might have been more inclusive than it was Led to forming the Urban Health Institute 1990: JHSPH created the InterAction Community Outreach Program Work-study students ran the program 2001: full-time staff hired January, 2005: became SOURCE supporting SOM, SON, and JHSPH: The Community Service and Service-Learning Center 20

21 Urban Health Institute Over one and a half years, the Council prepared a report and a plan Initial priorities Substance abuse prevention Substance abuse treatment Urban Health Institute to coordinate Hopkins action Initial focus on community-based participatory research Student training Faculty developed proposals First interim director moved away Now on third director, still listening to the community 21

22 Summary: Learning from History This section has provided anecdotes about Hopkins historical relationship with its community Examples of projects which succeeded or not Ideas about the important factors in partnerships The next section will address lessons learned What works and doesn t work Why things can be very tough 22

23 This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this site. Copyright 2011, The Johns Hopkins University, Archie Golden, and Lee Bone. All rights reserved. Use of these materials permitted only in accordance with license rights granted. Materials provided AS IS ; no representations or warranties provided. User assumes all responsibility for use, and all liability related thereto, and must independently review all materials for accuracy and efficacy. May contain materials owned by others. User is responsible for obtaining permissions for use from third parties as needed.

24 Section B Lessons Learned

25 Mobilizing out of a Crisis A crisis can be a time to begin sustained change Following the 1968 riots after the assassination of Martin Luther King, Jr., both sides took advantage of the situation The East Baltimore Community Corporation met health and housing needs but helped advance political careers 3

26 Taking Advantage of Opportunities Donors were interested in stimulating partnerships with churches as social institutions in touch with the people Appreciate the perspectives of all partners Build on each other s capacities and strengths 4

27 Mutual Interests Communities, especially churches, were interested in: Resources (money) coming to the community Relationships which provide access to key leaders Action to deal with the problems Academics and donors interests lie in scholarship and generating new knowledge Both parties want rewards and recognition 5

28 Hopkins Magazine on Community Health Issues 6

29 Benefits of Trusted Relationships The leaders on both sides acquire political power in their respective systems The relationships built among faculty are similar to the trust and friendships formed between community members Both may result in career advancement 7

30 Balance the Interests of Many Groups Can you be all-encompassing in the partnership? No community is homogeneous Academics need to be conscious of the competing interests in the community Community leaders need to understand the career advancement needs of faculty Competitiveness is both a blessing and a curse Groups are fending for money and/or access Can stimulate extra effort Divisions may need to be honored and reflected in how the program is run This may require there to be multiple community projects run by different faculty, but coordinated 8

31 Rewards of Partnership Faculty need to have scholarly publications Community members should be listed as co-authors In creating and disseminating information, there needs to be appropriate attribution of partner contributions Results of research needs to be translated and communicated appropriately to the public 9

32 Collaboration as Partners 10

33 Rewards of Partnership Faculty need to have scholarly publications Community members should be listed as co-authors In creating and disseminating information, there needs to be appropriate attribution of partner contributions Results of research needs to be translated and communicated appropriately to the public 11

34 Sustaining Partnerships Sustaining partnerships is difficult and dirty Needs strong leaders and champions Trust is essential to sustained partnerships Must be able to tell the other partner when things are not going well Conflict resolution is an essential skill Keep our eye on the prize a common goal Lay aside ego and personal interests in power 12

35 Funding Partnerships Fiscal resources are essential to sustaining partnerships Communities expect academics to provide the funding However, funding is not constant Partnerships can become dormant 13

36 The Heart-Work in Partnerships Persistence is a key characteristic of successful partnerships It does not always take the same individuals A really successful partnership figures out how to nurture new leadership for new projects Academicians need to mentor new faculty and expand the infrastructure 14

37 Partners: Community and Hopkins Younger generation respectful of prior leadership, but they also want to create a new dynamic to reflect new attitudes and circumstances Important to incorporate as many faculty as possible Infrastructure and support are essential 15

38 Bringing in the Next Generation It is difficult for faculty to get away from their desks to go out and work in the community Students need to be engaged in the importance of this community work, at least for some of their career 16

39 Active Listening Is an Essential Skill Communication involves both talking and listening Community health advocates for the East Baltimore Medical Center were trained for in-home care However, the leadership of the corporation did not understand the role they were being trained to do The medical director they selected did not have a vision for working outside the clinic walls Frequently the future challenges are not anticipated by the leadership 17