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4. The Community Health Improvement Collaborative (CHIC): Building an Academic Community Partnered Network For Clinical Services Research

Background: In 1992, CDC funded Healthy African American Families (HAAF) to study 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, including preterm delivery, mental health, diabetes, asthma, and kidney disease, as well as to look at 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). The purpose of 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. 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; the Los Angeles Unified School District; the Department of Veterans Affairs Greater Los Angeles Health Care System; Community Clinical Association of Los Angeles County; HAAF; and QueensCare Health and Faith Partnership.

Methods:
A CBPR approach using the principles of community engagement was employed to develop 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 and develop 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, assessment of the community context, development of health information technology, and initiation of practical trial designs. Key challenges to addressing those priorities included (1) obtaining funding for community partners; (2) modifying evidence-based programs for underserved communities; (3) addressing diverse community priorities; (4) achieving the scale and obtaining the data needed for evaluation; (5) accommodating competing needs of community and academic partners; and (6) communicating effectively, given different expectations among partners.

Comments:
With strong leadership and collaboration based on the principles of community engagement, it is feasible to develop an infrastructure that supports community engagement in clinical services research through collaboration across NIH centers and the sharing of 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. The engagement process of first forming the partnership between the convening academic researchers and the community organizations and then deciding on health priorities together demonstrates Principle 5, and knowledge of community needs demonstrates Principle 2. Community participation demonstrates Principle 3, and the convener’s flexibility in meeting the needs of the community demonstrates Principle 8. After four tracer conditions were established (depression, violence, diabetes, and obesity), 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).

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.

Website

http://haafii.org/HAAFsHistory.html

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