Yale Psychiatry Grand Rounds: November 19, 2021

November 19, 2021

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"One Size Does Not Fit All: Transitioning to a Community Engaged Approach in Cultural Adaptation."

A. Kathleen Burlew, PhD, Professor, University of Cincinnati.

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00:00I I don't know if you can see me I I
00:03guess a little little box on this side,
00:05so this is John Crystal and I
00:09want to welcome you to the 2021 E
00:12Morton Jellinek Memorial Lecture.
00:15Before I introduce Doctor Angela Haney,
00:17who will introduce our speaker today?
00:19Doctor burlew.
00:20I I thought it would be good after
00:23several decades of having the Morton
00:26Jellinek Memorial Lecture to actually
00:29tell you a little bit about the Morton
00:32Jellinek so that you can learn more
00:34about the history of our department.
00:37Because it's a remarkable history
00:39with extraordinary people who've made
00:42important contributions to our field.
00:45So, uh. Add. Eat E.
00:50Morton Jellinek,
00:51known to his friends as Bunky,
00:53was born in 1890 in New York City,
00:56but he spent his early life in Hungary.
00:59He studied at the University of Berlin
01:02Biostatistics in Physiology and
01:05simultaneously at the universities
01:07of Grenoble, Grenoble and Light.
01:11Sick multiple topics concurrently.
01:14He was said to be fluent in nine
01:17language and converse is conversant
01:20in four more languages.
01:22919 twenty under a period of time of of.
01:27I, I believe, financial difficulty.
01:30He engaged in illegal currency
01:32speculation in Hungary,
01:33and there was a warrant out for his arrest.
01:36And so he fled,
01:38uh,
01:39to Sierra Leone first and then Haiti aware.
01:43He studied bananas and actually wrote papers
01:47on bananas for the United Fruit Company,
01:50which as you know,
01:51has a very infamous and and troubled history.
01:56Nonetheless, at the end of the
02:00at the end of the period of
02:01time of his arrest warrant,
02:03he got a job as a psychiatrist
02:05at Worcester State Hospital,
02:07which at the time was a trailblazing.
02:11Program of in psychiatry. Uhm?
02:17He came to Yale in 1939 and I'm
02:21going to talk about those years.
02:24In just a little bit and stayed
02:27at Yale until 1946 when he took a
02:29job in Geneva as part of the World
02:33Health Organization where he led the
02:35Subcommittee on the Committee of Sub Alcohol,
02:37Subcommittee of the Committee
02:39of Mental Health.
02:40After his time with the
02:41World Health Organization,
02:42where he had also had a significant impact
02:45on the field of alcohol and addictions,
02:48he went to Canada,
02:49where he was Simon simultaneously the head
02:51of the Alcohol foundation of Roberta.
02:53And the Alcohol Research Foundation Ontario.
02:56And if you know Canada,
02:58you know that Alberta is far
03:00West and Ontario is Far East,
03:03so he was covering and playing an
03:07enormous national role related
03:09to addictions in Canada.
03:11He concluded his career at
03:15Stanford University.
03:16Where he died in 1960,
03:19completed his career and died in 1963.
03:23So I wanted to say in particular a
03:25little bit about the Yale Center
03:27for Alcohol Studies,
03:28because in some ways it's the foundation
03:31for what has developed in our communities.
03:35And been sustained,
03:37particularly with the revitalization
03:39of the substance abuse program,
03:41by her cleaver and then 1960s,
03:44and continues to this day.
03:48The Yale Center for Alcohol Studies
03:50was driven in in part by the
03:54repeal of Prohibition in 1933.
03:58The Carnegie Corporation created
04:00something called the Research
04:01Council on the problems of alcohol
04:04with Jellinek as its leader,
04:06and this was the first major
04:10multidisciplinary alcohol
04:11related program in the world.
04:14Yale recruited Jelinek
04:16and this program in 1935,
04:20establishing the Laboratory of Applied
04:23Physiology which I was surprised to
04:26learn was located in Pierson College,
04:30one of the undergraduate colleges on campus.
04:34The center funded also and created
04:37the National Council of Alcoholism,
04:40which persists to this day under
04:42the name the National Council on
04:44Alcoholism and Drug Dependence,
04:46a nonprofit advocacy organization.
04:50As I mentioned, Jelinek left Yale in 1946,
04:53although he moved to Texas Christian
04:56University from Yale and established
04:59the Yale Center for Alcohol Studies
05:02at at Texas Christian University.
05:05The fine after Jelinek left the Yale
05:09Center for Alcohol Studies continued at Yale.
05:13Although under very difficult
05:16financial situations,
05:18conditions and in 1960.
05:23The Yale President,
05:24then a Whitney Griswold began.
05:29Pushing for the alcohol
05:32center to move elsewhere,
05:34and in fact in 1962,
05:37that center moved to Rutgers,
05:39where it continues in in
05:41in a version to this day.
05:46So let me say
05:46a little bit about the the five
05:48pillars of the Yale Alcoholes
05:50Center for Alcohol Studies,
05:51and this is on the right hand side.
05:53You can see an actual page from
05:56one of the papers on the Yale
05:58Center for Alcohol Studies.
06:01The first pillar was research physiological,
06:04psychological, cultural, legal,
06:06educational, economic and medical.
06:10Really multidisciplinary initiative
06:12which would have been unheard of.
06:16Uhm, elsewhere at that time.
06:21Uhm, Jelinek became the editor of the
06:25Quarterly Journal of Studies on alcohol,
06:28the First journal devoted
06:31to alcohol research,
06:32and that journal continues to this day
06:35as the Journal on Studies of Alcohol and
06:39substance abuse or something like that.
06:42The third pillar was education and as part
06:45of the Yale Center for Alcohol Studies,
06:47they established the summer
06:49School of Alcohol Studies,
06:50which was a major national
06:53educational initiative for which
06:55the center was very highly regarded.
07:00And then the the the Research Center had
07:04within it a a clinical research program
07:08which was also a multidisciplinary,
07:11very sophisticated approach,
07:13quite groundbreaking for its time,
07:16who was called the Yale plant for Diagnosis,
07:20treatment, research and training.
07:22So a really cutting edge clinic embedded
07:26in an educational and research initiative.
07:29And they provided other services
07:32to this field so.
07:33Uhm,
07:34this kind of initiative exists
07:37only in a few places.
07:39Yale continues to be one of those places,
07:42but only in a very few places
07:45around the country.
07:46Now you can imagine how transformative
07:49was as the first major initiative
07:52of its kind in its day.
07:54One of the things that Jelinek
07:57is best known for, UM,
07:59was a book that he published in 1960,
08:02which was called the disease
08:05concept of alcoholism.
08:06And and what Jellinek was trying
08:09to do was to combat the idea.
08:12Uh, that?
08:13Uh,
08:14addiction and particularly alcohol
08:16use disorders were a moral lapse.
08:19In other words,
08:21that drunkenness was a problem
08:23simply of the moral.
08:28Limitations of people who
08:30developed alcohol problems.
08:31And he did in many ways contribute to
08:35the medicalization of addiction which
08:38has in some ways progressed with the.
08:42Bro, science studies of addiction.
08:44But Jellinek himself was actually
08:47quite a nuanced and clever
08:50clinician sensitive clinician.
08:53He tried to subtype alcohol
08:55into different versions,
08:57only some of which were that he were
08:59forms that he considered to be diseases
09:02characterized by loss of control.
09:05Uhm, and he also believed very much
09:09in in social and cultural aspects.
09:13Influencing alcohol consumption
09:14and he did not draw a clear line
09:18between healthy levels of drinking
09:20and pathological levels and drinking.
09:23Instead,
09:23he tended to view levels of drinking
09:26as being important to norm with respect
09:29to cultural and other social factors.
09:31So he was quite a sophisticated
09:34and thoughtful researcher,
09:35although he did of course
09:38create the disease concept.
09:41Uhm, it is said of Jelinek.
09:44With the help of EM Jellinek,
09:47the modern era of addiction
09:49science was launched with the
09:51physical infrastructure and the
09:53intellectual capital needed to form an
09:56interdisciplinary field of basic research,
09:58applied science and clinical practice.
10:01His impact is so significant
10:05that foundation or not nonprofit
10:08was created to recognize.
10:11His impact on the field of addiction,
10:13which is called the EM at
10:16EM Jellinek Memorial Fund.
10:18And every year the EM Jellinek
10:21Memorial Fund presents one of the most
10:24coveted awards in addiction research,
10:26which is the EM Jellinek Memorial
10:29War which comes with this.
10:31Extremely heavy statue.
10:35And but it's very nice one.
10:38So this is Yale addiction.
10:42This is the history of of one of
10:44the ways that our department has
10:47contributed to the emergence of the
10:50modern field of of of addiction,
10:53and a legacy that all of you share
10:55as being part of the Yale community.
10:58So I thought it would be was important
11:00for all of you to know about this and
11:03to be proud of the ways in which.
11:06Yale Department of Psychiatry
11:08has helped to kind of create the
11:11modern field of addiction.
11:13So with that I'm going to stop.
11:15I'm going to stop sharing my screen and.
11:20And maybe Doctor Haney can begin
11:23her recorded presentation.
11:25I will start that for her.
11:44Good morning everyone.
11:45It is with great pleasure
11:47that I introduce doctor Kathy Berliew to
11:50give the Jellinek Memorial lectures back.
11:54Lose professor emeritus at
11:56the University of Cincinnati,
11:57and her research focuses on substance use,
11:59disorder, treatment and HIV prevention
12:01with a focus on people of color.
12:04She first received her doctorate
12:06in social psychology from the
12:07University of Michigan and later a
12:10trained in clinical psychology at
12:11the University of Miami in Ohio.
12:14Doctor Burlew was selected to be our
12:17distinguished lecture this year.
12:18Given her extensive work on culturally
12:20appropriate research methods in general,
12:22and specifically within the field
12:24of addiction research.
12:25If you haven't already,
12:27please check out one of our recent
12:29articles entitled Best Practices
12:30for research in diverse groups,
12:34Doctor Blue,
12:34the champion of ensuring people of
12:37color equitably benefit from research.
12:39She has chaired the Minority interest
12:41group of the Night in Clinical
12:43Trials Network for several years.
12:44And is currently Cokie.
12:46Honesty and grant to assess the
12:48comparative efficacy of multiple substance
12:50use treatment interventions for black
12:53people in substance use disorder.
12:54She has published numerous articles
12:56on cultural adaptation of evidence
12:59based treatments among her recent
13:01publications include her model community
13:03collaborative cultural adaptation for
13:05implementing academic and community
13:07partnerships to address community
13:09problems which we'll hear more about today.
13:12I first met Doctor Birlew when
13:14I was a graduate student.
13:16She was assigned as my mentor through
13:18the Psychology Summer Institute,
13:20and in addition to her many accolades.
13:23Dr Blues,
13:24very passionate about supporting
13:26early career researchers,
13:27including researchers of color and
13:30she's intentional about sharing
13:31opportunities that support career
13:33advancement and using her position of
13:35power within the night of Clinical
13:37Trials Network to ensure the needs of
13:39early career researchers are heard.
13:41And so I continue to benefit tremendously
13:43from Doctor Burlew's mentorship.
13:46And so it truly is an honor for me to
13:48introduce her today and to acknowledge the
13:51impact that her work has had on the field.
13:54So, without further ado,
13:55I will turn it over to
13:57Doctor Who to present one.
13:59Size does not fit all transitioning
14:02to a community engaged approach
14:04to cultural adaptation.
14:06Thank you.
14:09Good morning, let me just share my screen.
14:30Hold on just a second here.
14:41Might be able to just say cancel for now.
14:51Be with you in a minute here. Having trouble.
14:57Kathy, if you just say cancel on that
15:00little pop-up, it might be OK. Cancel
15:03on the little popup where oh OK. OK,
15:08be able to start from the
15:10beginning. Oh, there we are.
15:15Uhm? Thank you everyone for
15:19joining and thanks first to uh,
15:23to doctor Angela Haney for
15:26that Nice introduction.
15:28We do go way back to when she
15:31was a doctoral student at
15:33University of Missouri and then,
15:36as she said, we we were paired.
15:39I was her AP, a mentor at the Psychology
15:44Summer Institute and over the years.
15:48We have become colleagues and
15:51she's actually LED some projects
15:53that that I've been a part of.
15:56Thank you to the group for inviting
15:59me to speak at this memorial lecture.
16:03I too did a little research on
16:09Doctor Jelenik and I came away
16:13both impressed and intimidated.
16:17That along with his work in.
16:20Addiction sciences.
16:21He was also a biostatistician
16:24as Doctor Crystal,
16:25said Anna physiologist and anyone
16:29who could speak nine languages
16:32and communicate and for others.
16:35That's just a very impressive.
16:38How does one person do that
16:41much in one lifetime?
16:43So, uhm, I'm showing on the screen now.
16:47My research team and you'll see
16:50that my research team includes both
16:53academic members and Community members,
16:57and I'm going to have an opportunity
17:00to share quite a bit on that today.
17:03And I have no no conflicts to disclose.
17:09Let me just ask across the screen
17:12as I see it, there's a banner.
17:14That says I'm screen sharing just
17:17as long as you're not seeing that.
17:19Sure,
17:19sure you're not seeing that right
17:21that banner that says screen sharing.
17:28I'll assume that your
17:29slides. Your slides look perfect. Thank you.
17:31Alright, thank you so.
17:35What planted the seeds for the work that
17:39I'm doing today were planted years ago?
17:43As Angela mentioned, I started out
17:47my career as a social psychologist.
17:50There was always this part of me
17:52when I was in the PhD program
17:54at the University of Michigan,
17:56there was always this part of me that
17:58had an interest in clinical work as well,
18:00and so for my first sabbatical,
18:02that was my opportunity to take 2 1/2.
18:06Years and retrain in clinical psychology.
18:08And I mentioned that because the seeds
18:11for the work that I'm talking about
18:14today were planted during that time.
18:17One of my classmates when I was
18:20retraining in clinical psychology
18:22mentioned that he treats everybody
18:25the same and he took a lot of pride.
18:29Justin saying that I treat everybody
18:31the same and and even back.
18:33Then before I was doing the cultural
18:36adaptation work that felt a little
18:39strange to me that everybody
18:41might not respond the same way to
18:44to treatment so later.
18:47Come in the early years of and
18:49I'm assuming people know the
18:51night of clinical trials network.
18:53I'll say a bit about it later on.
18:57Later, Bill Miller was a member,
19:00active member of CTN for a number of
19:03years and in one of his publications he
19:06said suppose your physician says to you,
19:08I really don't pay much attention
19:10to medical research.
19:11I've been treating people like you
19:13for 30 years and I know what works.
19:15Would you go back or would you
19:18find yourself another doctor?
19:20We quoted that that statement by Bill
19:24Miller in one of our publications.
19:27And really kind of added to it.
19:30Now imagine that you also learn that
19:33your physician uses the same dose of
19:37the same medication for all clients
19:40with the same medical disorder.
19:43Ah,
19:43without even considering whether
19:46available scientific evidence
19:48suggests certain types of patients
19:50are more or less likely to respond
19:53to that medication now,
19:55what's the chance that you would
19:57go back for for for a second visit?
20:01Uhm?
20:03We have evidence that that statement
20:05is consistent with evidence within
20:08the night of clinical trials network.
20:11We have evidence in multiple studies
20:15that behavioral interventions don't
20:17always work the same across groups
20:20and across in particular across
20:23racial ethnic groups.
20:26So right now I have some work
20:28going on in my house.
20:30My bank, my basement,
20:32had a a flooding problem.
20:34Ah, and the contractor.
20:35I told the contractor not to
20:38come today because, you know,
20:39I didn't want that.
20:40Banging was presenting and so he
20:42asked me about my presentation
20:45and I was sharing with him.
20:48I was talking about how different
20:50treatments don't work the same across
20:52different groups and he had a very
20:54puzzled look on his face on wide treatments.
20:57Would work differently across
20:59different racial ethnic groups.
21:02My answer to him is a little different.
21:04Then the answer that I'll give to you,
21:07but my answer to you is
21:10that we have evidence
21:11that different groups are affected by
21:15contextual factors bring different
21:18contextual factors to treatment
21:20and that those contextual factors
21:23affect their response to treatment.
21:26Things like their pathway to treatment,
21:30patterns of treatment, engagement,
21:32cultural attitudes, all those maybe.
21:35Yeah, uh, issues that affect
21:38their response to treatment,
21:40and for that reason some of us
21:43have concluded that behavioral
21:45interventions developed for one
21:47target group cannot be assumed.
21:49They have to be tested.
21:51They cannot be assumed to be as
21:54effective for a different target group.
21:57And when it turns out that they are
22:01not working as well for a different
22:03target group cultural adaptation.
22:06Is one strategy for improving
22:09effectiveness and.
22:12My definition that I got from
22:14one of my readings,
22:16I didn't develop it myself,
22:18is that cultural adaptation is
22:21modifying an evidence based
22:24intervention to be more appropriate
22:27for a specific target group,
22:29and we're making it more appropriate
22:33by incorporating aspects of the
22:35group's culture that are related
22:38to their substance use.
22:39And so we say well why?
22:42Why would we pick that strategy
22:44of culturally adapting when an
22:46intervention isn't working well?
22:48Well, we have some evidence.
22:50Some of the most some of the strongest
22:54evidence comes from a meta analysis
22:58that Doctor Nagayama Hall published
23:01and in his meta analysis he he.
23:04He reviewed a number of studies
23:07and found that in many cases
23:10the culturally adapted version.
23:13Was more effective for a specific target
23:16group than the generic version had been.
23:19And so,
23:20uhm.
23:21When we say cultural adaptation,
23:24we're we're talking about us,
23:27a broad group of activities,
23:32and so I wanted to say something
23:34just a just a little something about
23:37some of the types of adaptations
23:39that that might be considered
23:42Resnik al at at at Michigan,
23:46differentiated between what he
23:48called surface adaptations and deep.
23:52Structural adaptations surface
23:53adaptations are pretty much what
23:56the way they sound that the
23:59core curriculum is unchanged,
24:01but you alter the presentation.
24:03You might bring in different names
24:05for the role plays or share the role
24:07plays or or modify the role plays a
24:10bit so that they fit the cultural group,
24:12but deep structural adaptations.
24:14You're also keeping the core
24:17components of the intervention,
24:20but you're incorporating the culture.
24:22Social experiences and values of the
24:26target group that might be related to
24:30substance use within the night of CT,
24:33and we have examples of both.
24:35We have examples of surface
24:37interventions and of deep structural.
24:39The one surface intervention that
24:41I'll talk about is CTN 21 and that
24:44was a Spanish language version of
24:47motivational enhancement therapy where
24:50a sensually they translated the.
24:53Generic intervention into Spanish and
24:56then recruited Spanish speaking staff,
24:58but now CTM 33 which was a Met
25:03study among American Indians.
25:08They took a different approach
25:10and I see and in that case in that
25:14particular study they looked at
25:16what role does the communities
25:18culture play in the prevention of
25:21substance use and in response to
25:25substance use treatment,
25:26and then the second question
25:28was how best to address those
25:31cultural issues in an intervention.
25:33So it's their preliminary research that was.
25:38Uh, I see as an example of
25:42deep structural modifications.
25:46So when we are culturally
25:49adapting an intervention,
25:51there's evidence to suggest that
25:55community engagement might be helpful,
25:58just involving the group, the target group.
26:01That's the focus of the
26:04cultural adaptation our team.
26:08Ah, it is.
26:11Likes to think of this on a continuum
26:14on a continuum that ranges from
26:17very little community engagement to
26:20quite a bit of community engagement.
26:23You'll see it at the top
26:27investigator research.
26:28In this continuum has little
26:31community involvement,
26:33but as we move through the continuum,
26:36community based participatory research,
26:38the Community ends up having oftentimes
26:42has some decision making power,
26:45and in community driven,
26:48the research implementation
26:50is actually at least partly
26:53controlled by community members,
26:56so we're going to see.
26:58This continuum throughout
27:00my presentation and then,
27:02and as it applies to my research,
27:06and this is just a different way
27:09of displaying it from investigator
27:11driven to community driven.
27:17Research. So we do as as Angela said,
27:23we do sexual health research and
27:26we we ask ourselves the question,
27:29how do researchers actually involve
27:32the Community when they label their
27:36projects as CBPR and so we did?
27:39A review paper.
27:41A review of literature search
27:43and a review paper.
27:44Just trying to address that that question.
27:49We did a.
27:50Aprisma search and started out
27:52with many more articles than
27:55been our category criteria and
27:58finally in the end we were down
28:01to 24 that met our criteria of.
28:07Labeling their projects as CBPR
28:11and they were looking at sexual.
28:14The development and adaptation
28:17of sexual health interventions.
28:19Let me tell you a little bit about
28:21those findings and and and what the
28:25different researchers were doing
28:27when they said they were doing CPR.
28:30Eight of those 24 involved representatives
28:34of agencies serving the target group.
28:38So their community partners
28:40were not target group members,
28:42but they were representatives of
28:44agencies once studied by Romero,
28:46for example.
28:49Worked with Planned Parenthood staff.
28:53Now there was another group of
28:55four that said they were using
28:57CBPR and they didn't really tell
28:59in their articles exactly how
29:02the community was involved,
29:03so I'm I'm not going to list any of
29:07those studies, but there there were.
29:10Twelve were members of the target
29:13group were directly involved.
29:15One of those was by Rios Ellis,
29:18and in that case.
29:19Uh,
29:20they actually added peer
29:22educators to the research team,
29:25and like the other eleven in that category,
29:29the commute,
29:30the target group members were involved
29:33in preliminary research design they were
29:36involved in in choosing the instruments.
29:40Partnering.
29:40Of course, with the academic team,
29:43they're involved in recruitment,
29:45facilitating the intervention
29:47data collection and data.
29:49Analysis,
29:50and so we concluded that some people
29:56are some teams that say they are
30:00doing community engaged research,
30:02like the level one on the previous slide.
30:06While we're doing something that,
30:07at least on this continuum would be
30:11called community placed research
30:13and Romero was an example of that.
30:16But others, and and real zealous.
30:20I was doing something where the
30:23community had real decision making
30:25was involved in decision making
30:27and some role in the implementation
30:30of the research and so others
30:32were doing something called CBPR.
30:36So we could we concluded that.
30:40At people implement CBPR in multiple ways,
30:45and so when you hear it's a CBPR study,
30:47you have to look more closely just
30:51to see how the how the community
30:54was involved and how the target
30:56group was involved.
30:58So I'm going to move now to our journey.
31:01Our journey is a trend we we had a
31:05transition towards a community engaged
31:08approach to cultural adaptation.
31:10And there's several stops in our journey.
31:14And it's it's an evolution.
31:16The evolution of RRRR of our work.
31:22It starts with rimas. Real men are safe.
31:26And then we're going to go briefly
31:28to safer sex skill building,
31:31SSSB and then a teen version of of SSSB.
31:37So our journey started with a Naida
31:40national drug abuse treatment,
31:42clinical trials network intervention.
31:45I've mentioned the CTN several times
31:48and I think probably most people are
31:51familiar with it, but just in case,
31:53there's someone who's not.
31:55It's a collaboration of researchers and
31:58providers to test substance use treatments
32:01in large multi site clinical trials.
32:05One of those trials was rimas.
32:09Real men are safe and it was led
32:12by the late Doctor Don Callsen,
32:15and I'm I'm really addicted to him for
32:19getting me started on on this path.
32:22Doctor Coulson.
32:25Implemented and evaluated real men
32:28are safe within the clinical trials
32:32network across several sites and
32:35his findings were quite positive
32:39compared to the comparison group.
32:42The men who participated in
32:45real men are safe.
32:47Reported more condom use in
32:50their sexual encounters.
32:51They reported less sex with drugs.
32:55And the intervention was.
32:58Was strong enough to be added to the
33:02CDC Compendium of HIV prevention,
33:05evidence based interventions,
33:07but when Doctor Coulson looked more
33:11closely at the Black men in his his sample,
33:15he he found that the outcomes were
33:18working better for white than black men.
33:22And that's when and I'm always
33:24be thankful to him,
33:25that's when he invited me into to.
33:29Think some about the patterns
33:31that we were seeing.
33:32This was from the generic version.
33:35This was what he was finding that the
33:39Y axis is the percentage of men who are
33:44reporting condom use 80% of the time.
33:47The bars on the left or baseline and
33:50the bars on the right are at the I
33:53think it was a three month follow up.
33:56And the blue bars are white men,
33:58and the orange bars are black men
34:01and you could see a baseline.
34:03There was not much difference.
34:05Neither group was reporting that
34:08they were using condoms.
34:1080% of their sexual encounters.
34:13But now if we look at follow up,
34:15you see that the white men seem to
34:18be benefiting much more from the
34:22intervention than the black men.
34:24And so doctor Carlson.
34:27Was concerned about that and
34:30invited me to work with him on.
34:33Trying to develop a better version
34:36of the intervention that would
34:38be more effective for black men.
34:41And again we knew about Doctor Nagayama
34:46Hall's work that cultural adaptation
34:49might be a strategy that we would
34:52consider for improving the outcome.
34:55Improving the intervention for black men.
34:59So this was new to us and so we look even.
35:03Ourselves,
35:04we published and we did some review and
35:07and published an article on cultural
35:10adaptation and in at that time we
35:13were calling it substance abuse treatment.
35:16And what did we learn for?
35:19From our review,
35:20we learned that there were maybe
35:24three methods of cultural adaptation
35:27that groups were were using.
35:30One method was to incorporate
35:33the literature review.
35:34A second was to involve experts,
35:37and a third was to involve the target
35:39or the Community group and many times
35:43people were using some combination
35:45of these. So our aim was to ensure
35:48that we were including deep
35:51structural strategies in our approach.
35:53You remember the deep in the deep
35:57structural approach where actually
35:59incorporating some of the cultural
36:02context into the intervention.
36:05So we wanted to ensure
36:06that we were doing that,
36:08but the question is how best to incorporate
36:13a deep structural approach into our work.
36:18We weren't sure exactly how to
36:21go about doing that and what we
36:25finally agreed on were the first
36:29four steps that are described here.
36:32We had activities.
36:33We had preliminary.
36:34Work that we did review of
36:36the existing literature,
36:38then we did some work on the generic
36:41intervention itself and what we did
36:44was a Delphi process and I'll say
36:46a little bit more about that later.
36:49What we did with it,
36:50and we developed then first draft
36:54of a culturally adapted version.
36:57Then we did a second round of the
37:01Delphi process and develop a second
37:04draft of the adapted version.
37:06And then we pilot tested the intervention.
37:09You'll see that you remember
37:11from our literature review,
37:13red is whether it incorporated
37:15existing research and blue is
37:17whether it involved experts and
37:19green is whether it involved
37:22the target or community groups.
37:24And you're probably noticing that
37:26there's no green on our procedures
37:30in the first stop of of our journey.
37:33Doctor Kolson knew that we needed to
37:37involve experts other than ourselves
37:39and I'm I should be putting expert
37:42in quotation marks because the
37:45experts that we reached out to were
37:48acada missions and practitioners.
37:50That's who we thought of as
37:52experts at that point.
37:54And you know,
37:55probably from your undergrad days
37:57about the Delphi that it's a controlled
38:00method for obtaining feedback.
38:02So what we did was to.
38:03Ask our experts.
38:05We we provided them with our
38:09intervention and we found some mod.
38:12Some other interventions that were
38:15developed for black men that had
38:18some of the same content as our
38:22interventions and we asked them to
38:24come to evaluate our intervention
38:28and the other interventions on
38:31appropriate language expressions.
38:34Whether the activities enhanced
38:36ethnic identity,
38:37whether it was consistent with the
38:40norms and knowledge of the target group,
38:42and whether it communicated
38:45an understanding of the social
38:47context surrounding the behavior.
38:50So,
38:51let's say one of our one of our
38:54modules was negotiating safer sex and.
38:59Support and and assume that that are
39:03rimas is the purple bar in the middle.
39:07In each of these and on either side
39:10are the are two other interventions
39:12that had similar content for
39:15working with with black men.
39:17If the experts told us that none of
39:22those were working very effectively
39:25for black men, we didn't get much help.
39:29From the other interventions on
39:32how to modify that intervention,
39:35'cause they were doing,
39:37they weren't doing any better
39:39than than Remus was.
39:40On the other hand,
39:42there might have been another module where
39:45all three were rated very positively,
39:48and in that case it was nice to see.
39:51But it told us that maybe we didn't
39:53even need to modify that particular
39:55activity because Remus was doing
39:57OK on the criteria that we were.
40:00Uhm, using for the evaluation,
40:02but let's look at the category 3 where Remus,
40:06which is in the center and the other
40:09blue were not rated very favorably,
40:11but the green,
40:13which was another intervention on
40:14the same with the same content,
40:17was rated very favorably that
40:19todat that gave us an idea,
40:21both that we needed to modify our
40:24intervention and some ideas about
40:26how we might modify it was not
40:29that we copied that intervention.
40:31That was rated more favorably,
40:34but it gave us some ideas about
40:37how we might modify.
40:39We did this in two rounds
40:41in the generic version, we,
40:43as I said,
40:44we were comparing rimas to of
40:46similar intervention modules,
40:49but in the second round they were just
40:53rating rimas on the same criteria
40:55that we had used in in round one,
40:59and this was useful for us
41:01because the relative ratings.
41:03Or telling us which activities that
41:06needed would benefit modification
41:08and giving us some ideas of
41:10sometimes giving us some ideas
41:12of what might be more effective.
41:15And I know I've gone
41:17through that pretty quickly,
41:18but we actually have an article
41:21where we talked in detail about
41:24the process for modifying Remus.
41:27If anybody's interested.
41:29We ended up with both.
41:32Surface and deep structural UM.
41:37Modifications and see that we added
41:40some cultural sessions that seem to
41:45speak to Neil female relationships
41:47in the communities in which the
41:51men were living and made some
41:53other deep structural changes.
41:56Next, we actually conducted a small trial.
42:00We went back to four sites in the
42:02night of Clinical Trials Network,
42:04conducted a small trial where we
42:07compared Remus, culturally adapted to.
42:11The generic greimas on UM.
42:16On risky sexual behaviors and
42:18our findings were positive quite
42:21positive at the three month follow
42:25follow up relative to participants
42:27in the generic version.
42:30Participants in Rimas culturally
42:33adapted were behaving differently
42:35with casual partners.
42:37They were engaging and less sex reporting.
42:40Fewer unprotected sexual occasions
42:42when they did engage in sex
42:45and they were more likely to.
42:47Report using condoms.
42:48At least 80% of their sexual
42:51occasions and they also had better
42:54attendance and once again you
42:56know gone through that had to
42:57go through that fairly quickly.
42:59But we actually wrote that study up
43:02in the American Journal of Public Health.
43:05So uhm,
43:06Dr Callsen presented our work at
43:09CIPD to an academic audience and
43:13the feedback was quite positive.
43:17He sent me to a community oriented
43:21conference and in a very diplomatic
43:25but straightforward way.
43:27They shared with us that they
43:30thought it was a big mistake that
43:33we had not included the community.
43:35In our cultural adaptation,
43:37and in fact I think that they were
43:40telling they they were very accurate.
43:43There was little community involvement
43:45and little decision making from
43:48the community in what we had done,
43:50and so we would argue that.
43:55Remus then on our continuum falls
43:58under investigator driven research.
44:00We said to ourselves,
44:02if we're ever culturally adapting again,
44:04we're going to involve the community,
44:07and we had the sex that takes me
44:09to the second stop of our journey,
44:11and we thought, well,
44:13how do we go about engaging the community?
44:17So we had the opportunity with
44:20the female counterpart of Rimas,
44:23which is called safer Sex Skill building.
44:26And so that was our first attempt
44:29really at community engagement and.
44:31And one thing we did know was that
44:34the Delphi process that we had
44:37used for Remus was probably not the
44:39best way to approach the community,
44:42at least not the way we use
44:45the Delphi process.
44:46So then it was well,
44:48if we're not going to use a Delphi process,
44:50what should we use?
44:52How do we?
44:54Involve the community and about
44:57that time we were introduced to some
44:59work by Gina Wingood at Columbia.
45:02Now she's at Columbia.
45:04She did.
45:05She developed a model called adaptive
45:07and in her model called adapted.
45:10There's several steps,
45:11but one step is theater,
45:14something that she calls theater
45:16testing and and in theater testing.
45:19Your essentially asking the target group.
45:22These are group interventions.
45:25Now you're asking the target group to
45:28participate in a mock demonstration of
45:31the intervention and give feedback,
45:34and so we decided that we would add
45:37this theater testing to our second
45:39round and in the theater testing.
45:41Then we recruited members of Target
45:44Group to volunteer to participate
45:46in the mock demonstration.
45:49We had the experts again,
45:51but now they were observers of
45:54the mock demonstration.
45:55And we did it in and in the second
45:58step up theater testing everybody.
46:01The target group members and the
46:05the experts would sit together and
46:08critique the modules of the intervention
46:11as a way of helping us to modify.
46:15And we did this in two rounds as well.
46:17First on the generic version and then
46:21second on the first adapted version,
46:26and.
46:26And based on the first and their
46:28response to the first adapted version,
46:31we came up with a version that
46:34we felt pretty good about,
46:36and that version added structural changes,
46:41but also our surface changes,
46:43but also added some deep
46:46structural modifications as well.
46:48The women told us that we should
46:50include something on domestic violence
46:52because that was an issue with the
46:55target group that we were serving.
46:57They told us that we should talk
47:00more about gender roles and that
47:03empowerment was an issue for black
47:06substance using women and that we
47:09should include some activities
47:11on empowerment.
47:12So we had pilot data on that group
47:17where we compared SSSB culturally
47:20adapted to the generic and once
47:23again the findings we haven't.
47:25We have an article not.
47:27Quite ready to go out yet,
47:29but the finding suggests that SSSB
47:32culturally adapted though the
47:34women in that were more likely to
47:37report condom use the last time
47:39they had vaginal sex
47:41than the women in the generic version.
47:43And then we pulled out just
47:46the women who at baseline,
47:49denied that they had used condom use.
47:53In their last vaginal.
47:56A sexual experience and for that
48:00group to DSSSB culturally adapted,
48:04were more likely to report condom
48:08use than the generic version.
48:10So where are we now on the continuum?
48:14We think it occurs in a
48:17community setting the need,
48:19but the need didn't come from the community
48:23the community was participating, but.
48:27A minimally and limp.
48:28Then the community had limited role in
48:32the implementation of the research,
48:35and so here for for the
48:39SSSB culturally adapted,
48:41we believe that that one falls
48:46under community based research
48:48that we've achieved community
48:50based research with that.
48:52So we're moving in the right direction.
48:54But we're we're not satisfied with.
48:57With where we were.
48:58We felt like something was still
49:01missing and what was missing for us
49:03was that we wanted more community
49:06involvement in the implementation
49:08and in the decision making.
49:10And that brings us to our the
49:14third stop of our journey where
49:17we had the opportunity to modify
49:20SSSB into a team version.
49:22And when the teen version,
49:24we weren't so much interested
49:26anymore about substance use,
49:28but risky sexual behaviors among
49:31black teen girls are the aim of our
49:35intervention was to reduce risky sexual
49:38behaviors among girls living in low
49:42income public housing communities
49:45where they are often exposed to
49:48risky sex at two often exposed to.
49:52Risky sex at at an early age,
49:55so here we recruited community partners
49:59to our research team and so we created
50:04an academic community research team.
50:07The academics were faculty and
50:09students like you might expect,
50:12but for the community partners
50:13we had some residents we had the
50:16President of the Residents Council.
50:17We had teen girls who were a little older
50:20than the girls who were our target group.
50:23They were already mothers,
50:24but they were residents in the community.
50:28Then we had a social worker
50:30and the director of a social
50:33service agency and together.
50:35Then we created this academic
50:38community research team.
50:41A picture of our research team in
50:44our in our community and if if you
50:49remember that green suggests that we're
50:52involving the target or the Community group,
50:56and here we were involving the
50:59target group and the Community
51:02Group in the recruitment.
51:05Well, first we recruited community
51:07representatives to the team,
51:09but then as a preliminary
51:11step we trained each other.
51:13They trained us on how to work
51:15more effectively in the community.
51:17They said,
51:18for example,
51:18don't come in here using that term
51:21intervention because people have
51:22seen that on TV and they'll think
51:24that you're trying to change them.
51:27Use program instead of intervention
51:29and other things like that that they
51:33were training us on their community.
51:35And of course we had to provide some
51:38training on on the research design itself.
51:42Then we.
51:44In in for the generic version,
51:46once again we did the theater testing
51:50and they were quite involved in
51:52conducting the theater. Testing.
51:54This time they were the community members
51:57were the experts who were observing.
52:00We recruited teen girls to participate in
52:03a mock demonstration and the community
52:06members of the research team were
52:09experts at that point and then together
52:12we developed a first draft of the team.
52:15Version and then once we had a a first
52:19draft of the of the of the adapted version.
52:23The community members said
52:25they thought that they had.
52:27They knew the intervention well enough
52:29that they actually carried out.
52:32They actually contributed to
52:34facilitating the intervention,
52:36and when we did the adapted version,
52:40they of course helped would recruitment
52:42and they were they were they are
52:44expert observers for the second round.
52:46When we were doing a mock demonstration
52:49of the adapted version and then
52:52afterwards they gave us feedback.
52:54To help us.
52:56Prepare the the the next version of it.
53:00We could.
53:01They participated in the pilot
53:03test at the pilot test stage.
53:05They meaning the community members
53:07of the research team and we actually
53:10ended up with a publication that
53:12was Co authored by the academic and
53:15the Community research team members.
53:17And once again we had both surface and
53:22deep structural changes to the intervention.
53:24There were things that
53:26just weren't appropriate.
53:2714 girls that we took out for the
53:30team for the teen version that was
53:32part of our deep structural but there
53:35were things that we added to like the
53:38Community and the literature said
53:40that sometimes young girls are need
53:43more information on what behaviors
53:47actually constitute physical abuse.
53:49So include something in there
53:52about physical physical abuse and
53:56domestic violence.
53:57We only have some preliminary
53:59findings on this.
54:01Our third stop of our journey,
54:03but our preliminary findings are
54:07promising that our girls from and it's
54:11only pre post at this at this stage,
54:14but they're reporting improvement on
54:17their condom use skills on a condom
54:20use skills, checklist and more HIV.
54:25A better scores on an HIV knowledge scale.
54:29So where are we now? On our continuum?
54:33We believe if you look at the green
54:36and and the role that says CBPR,
54:39the community had some decision
54:41making power as being members of
54:44the research team and they were
54:47somewhat involved.
54:47They were involved in the
54:50implementation of the research process,
54:52so we believe that we are approaching.
54:57Can't say that we're actually
54:58there that we meet.
54:59The full criteria,
55:01but that we have approached community
55:04based participatory research in the
55:06team project and just want to say
55:08that if you're doing this kind of work,
55:11you can't just show up and say,
55:12join our research team.
55:14We had to have an ongoing
55:16relationship with this community.
55:18You see,
55:19we had a coat drive or women's
55:21retreat voter registration,
55:22so we had to have a presence in
55:25the Community and that's one of
55:28the issues that need to be clear
55:30about if you're doing.
55:32Community engaged
55:34research. I'll talk maybe during the
55:36question and answer about the next steps,
55:39but I just want to move to that.
55:42We see that there were lots of
55:45advantages to community collaboration.
55:50We believe that, uh,
55:52we were strengthening capacity
55:53building in the Community community,
55:56empowerment that the Community would be
56:02more empowered to do studies and they have
56:06done a some work on their own without us.
56:10It would contribute to the sustainability
56:12of the intervention if we had community
56:15collaboration and so that you remember
56:18that all the way on the right.
56:20On our continuum is community driven,
56:23and that sustainability allows them to do
56:26the work after we're no longer around.
56:30So we think that community collaboration
56:34increases sustainable sustainability
56:37and also perhaps most importantly,
56:39the intervention itself might be
56:41more effective if we involve the
56:43target group in the Community and it,
56:45but that's not to say that we
56:48didn't face some challenges.
56:50We faced a number of challenges.
56:53One is that in CBPR,
56:56one of the things is that you'd
56:58like to have a balance of power.
57:01But there was an imbalance.
57:02Inherent imbalance of power in
57:05our relationships and the money
57:07had a lot to do with that.
57:09The community members of the
57:11research team were paid,
57:13but we we had the university
57:15required us to be in charge of
57:18payroll and and access to the funds.
57:20Uh,
57:21and so that created somewhat of an imbalance,
57:24and we thought that if we were
57:25to do it again,
57:26maybe we'd house some of the funding
57:28in a Community organization to take
57:31away that part of the imbalance.
57:33But the educational differences created
57:36was an inherent power differential as well.
57:40A second challenge was different
57:44levels of responsibility that
57:46the university looked to us,
57:49the research, the ACADA missions.
57:52To make sure that certain
57:55requirements were met,
57:57the sorry I missed that.
57:59So so the so the buck the buck
58:02stopped with us in in many cases
58:06and so that was a challenge for us,
58:10whereas the community members
58:12oftentimes had other priorities that
58:15they were that they were facing and
58:18not always able to give to prioritize.
58:22Their work with us.
58:24The IRB procedures we had to work
58:26with some the ethics training.
58:28Sometimes doing the city training is
58:31is intimidating to community members.
58:34Thankfully,
58:34our IRB let us modify that some in our
58:39group was not that easily intimidated,
58:41but that can be intimidating.
58:44Once we had IRB approval,
58:46as you know,
58:47there's inflexibility in the procedures.
58:49So if if the community members
58:52wanted to suggest.
58:54Made some really good suggestions.
58:56We couldn't always do it because
58:58it would delay our procedures to go
59:01back our study to go back to the IRB
59:04and also privacy concerns because
59:07the IRB expects that what's said
59:09in the group stays in the group,
59:11but we had less control over that
59:14with our community members.
59:15A fourth challenge was increasing the
59:18utility of the feedback from Target
59:21Group participants even though we asked for.
59:24Oral and written feedback.
59:26Sometimes the feedback wasn't that relevant.
59:30Wasn't that useful to us?
59:32For example, the teen girl said,
59:34oh, this is good for us,
59:36but you need to do something for the boys.
59:38But that was outside the
59:40scope of of our study.
59:41So we thought about if we did it again,
59:43maybe we'd have a focus group where
59:46we could structure the feedback more.
59:48And as I suggested before,
59:50the unique life circumstances
59:52of the Community members.
59:54Was a sometimes a challenge that further
59:57women in substance use treatment.
59:59Sometimes they were being discharged from
01:00:02treatment and from treatment and trying
01:00:05to establish their new living situations,
01:00:07reunite with their families and so those were
01:00:12competing responsibilities and further girls.
01:00:15We had young mothers as I said
01:00:18on our on our research team.
01:00:21If they couldn't find daycare
01:00:23than then they couldn't come so.
01:00:25Uh, we had to work through a lot of those.
01:00:28So just as I start to wind down,
01:00:31I just want to show the evolution
01:00:33of our model that we started out.
01:00:35Remember,
01:00:36we started out with just incorporating
01:00:39existing research and using academic
01:00:43experts in the Delphi process.
01:00:46Then we moved to involving the community
01:00:50some by using the theater testing.
01:00:53But the but even then.
01:00:56The target group had limited involvement in
01:01:02decision making and finally we moved to.
01:01:06Our third model with the teen girls,
01:01:08which we developed as a model that
01:01:12we're calling community collaborative
01:01:14cultural adaptation and you can
01:01:16see from the green which represents
01:01:19Target group involvement,
01:01:21that the we moved to where the target
01:01:23group and the Community was involved
01:01:26throughout the course of the project,
01:01:28so that that's kind of the evolution
01:01:31of of of our work from limited
01:01:34to much more community.
01:01:36Involvement and we actually
01:01:39then with the Community,
01:01:41published an article on our model called
01:01:45Community Collaborative Cultural adaptation,
01:01:48and again,
01:01:49I've gone through this real quickly.
01:01:51But we've actually published an
01:01:54article that kind of describes in
01:01:57J set that describes the evolution
01:01:59from limited community involvement.
01:02:02Too much more Community involvement,
01:02:06so I'll close just by saying and.
01:02:08And Doctor Hany mentioned this that
01:02:11we're doing some work in the CTN
01:02:14that is related to this project.
01:02:18We're doing a secondary data analysis on
01:02:21nine studies that were conducted in the CTN.
01:02:25Looking at the comparative efficacy
01:02:28for for black substance users and
01:02:31we hope to learn which entered which
01:02:34interventions work best and for whom and.
01:02:38Which interventions would benefit
01:02:40from cultural adaptation?
01:02:42And I wanted to mention this because
01:02:44three of our three members of our
01:02:47research team are actually members of
01:02:49the Yale can community, Dr Haney, Dr.
01:02:53Ashley Jackson, and Doctor Ayana, Jordan.
01:02:57So we look forward to doing that.
01:03:00We're just at the initial stages
01:03:02of that study,
01:03:04and so my summary is that generic versions.
01:03:09Of evidence based interventions
01:03:11may not be as effective.
01:03:14Across all target groups,
01:03:17cultural adaptation may improve
01:03:21intervention effectiveness,
01:03:22including the community may increase
01:03:25intervention effectiveness and
01:03:27sustainability of the intervention,
01:03:29and finally, that multiple models of
01:03:34Community involvement are available.
01:03:36So I have my references,
01:03:38but I'll stop there and thank
01:03:40you for your attention and I
01:03:42hope we have a few minutes left.
01:03:44Or some discussion.
01:03:48Yes, we do. Thank you so much.
01:03:49Doctor burlew.
01:03:50That was an amazing presentation.
01:03:52It really outlined in ways that I think
01:03:56we can understand and value the process
01:03:59of involving the Community and the
01:04:02different levels at which that could occur.
01:04:05And I think what you've done is
01:04:06something we can all aspire to.
01:04:08And it seems like it's been a heroic effort,
01:04:10but one that's got a big payoff.
01:04:12So thank you so much, you're welcome.
01:04:16So are there others that might
01:04:18have questions or comments
01:04:19that they'd like to make?
01:04:25I have a question, I am I,
01:04:28I'm a statistician,
01:04:28but in in the the other piece of my
01:04:31life I'm an activist and we have a
01:04:33saying that it's an old African proverb.
01:04:37If you want to go fast, go alone.
01:04:39If you want to go far,
01:04:40go together and I think that
01:04:42really fits with community based
01:04:44participatory research as well that
01:04:46it is really important to include
01:04:49people and even in the best of worlds,
01:04:51I think you know an academic
01:04:53setting is a very.
01:04:54Difficult place to include that,
01:04:56especially because it's going
01:04:58to impede productivity.
01:04:59It does take a lot longer come and
01:05:02and time is money and so how does how
01:05:06does that fit into your academic path?
01:05:10Yes,
01:05:11and that is an excellent point that for
01:05:15early career professionals, I'm not sure
01:05:19that they have the time to do these.
01:05:24Interventions that take a while to gain trust
01:05:27in the community and then to carry out the
01:05:31intervention and to collect follow up data.
01:05:34My advice to them is to join research
01:05:37teams as you were suggesting, but that
01:05:41we have learned that we could do we can.
01:05:45We can write up quite a bit on the baseline
01:05:50data and so they may need to design ways.
01:05:55Of developing the baseline data so
01:05:59they can get some publications out of
01:06:03that and not have to wait three or four
01:06:07years for the project to be finished.
01:06:09But I welcome any other comments on that,
01:06:11but that's a very good point of of how
01:06:15hard it is to do this kind of work in
01:06:18an academic setting where you're facing
01:06:21something like tenure and promotion.
01:06:34I think your comment about being involved
01:06:37in a team can go a long way because
01:06:40people sometimes need to be writing data,
01:06:43and I think the CTN CTN is a good example.
01:06:47Dr. Burlew about the work you've got guys
01:06:49have done doing secondary data analysis of
01:06:52existing clinical trials for productivity,
01:06:54while people gain, you know,
01:06:57the trust of the community and start
01:07:00established their own research agenda.
01:07:05Stephanie, there is a
01:07:07question in chat, right?
01:07:11I can't see the chat.
01:07:15You wanna read it out?
01:07:15I don't stand sure it's from
01:07:18Dan Shutler and when you
01:07:20have opposed suggestions from
01:07:22the community and research,
01:07:23how did you go about coming to a consensus,
01:07:27especially considering
01:07:28the power dynamics, yeah?
01:07:32Well, and it's not just the academic.
01:07:36Members of the team,
01:07:39but there's the IRB and there
01:07:42is and and and the community.
01:07:45I wish I could say on a case by case basis.
01:07:48We tried to to work it out,
01:07:50but I remember one project that different
01:07:53project that we were doing and we
01:07:57were randomly assigning teams to the
01:08:00treatment group or to the comparison
01:08:02group and the Community members had
01:08:05certain people that they had invited.
01:08:09To the meeting and they really invited
01:08:14them by telling them how good the
01:08:17intervention was going to be for their
01:08:20kids and then their kids got excited.
01:08:22Got a sign to the comparison group and
01:08:27they certainly wanted to just, you know,
01:08:31move those kids over to the treatment group,
01:08:34but we couldn't do that.
01:08:36And so in the end, that's where.
01:08:39The buck had to stop with
01:08:43the academic requirements,
01:08:47but I on the other hand,
01:08:50I think if we wait and present the
01:08:54project to the IRB after the Community
01:08:57members have had a chance to weigh in,
01:09:01then we might be able to include more
01:09:05of their suggestions than if we.
01:09:09That then,
01:09:10if it already has IRB approval when
01:09:13we recruit them to the research team,
01:09:16so I welcome other suggestions
01:09:19there 'cause we could use that
01:09:21those answers as well,
01:09:23but that's the best I can do on that.
01:09:28We have another question.
01:09:29Can you speak to how community
01:09:31members are compensated for
01:09:33their work in these programs?
01:09:35Are they paid for their time?
01:09:36Is there a specific process for
01:09:38securing funding for this? Yes.
01:09:42We, as academic members,
01:09:44were not compensated for
01:09:46our time on these projects,
01:09:49but both groups of community
01:09:52members were compensated.
01:09:54And when I say both groups,
01:09:55certainly the target group members each
01:09:59time they came to group they received.
01:10:03I think it was $2025 gift certificates.
01:10:09For the members of the research
01:10:12team who were community members,
01:10:14they were compensated as well for their
01:10:17participation on the project and I
01:10:20didn't get a chance to talk about it.
01:10:23But that was an issue as well,
01:10:25because the university payroll system
01:10:29may not meet their expectations.
01:10:32The worst example I have is
01:10:35that there was one member of the
01:10:37research team from the community.
01:10:40Who was depending on her funding to
01:10:45have her daughter's birthday party and
01:10:49the university didn't come through
01:10:52with the funding as she expected the
01:10:56the university was operating on a
01:10:59different schedule and so she ended
01:11:02up canceling the birthday party
01:11:03even though we offered the launder,
01:11:05the money or pay for it or whatever.
01:11:07She ended up canceling so that that wasn't.
01:11:10Issue for us and that was one reason
01:11:15I said that maybe placing some of
01:11:18the funding in a Community group in
01:11:22the the funding in the Community and
01:11:25a Community organization so that
01:11:27they're not as dependent on the
01:11:29university payroll system which you
01:11:32know sometimes people are getting
01:11:33paid once a month and that doesn't
01:11:36always work if you have low income
01:11:38community members.
01:11:41Thank you we have another question.
01:11:43First I want to just mention there
01:11:46several comments in the chat making
01:11:48you for an inspirational talk.
01:11:50My dog also appreciates it, I apologize.
01:11:54But one of the questions in the chat
01:11:56was can you please say more about
01:11:58how the educational differences
01:11:59between the academics and community
01:12:01members created the power imbalance
01:12:03given the specific expertise
01:12:04required for these different roles?
01:12:06Yeah. Uhm?
01:12:11What I would say is that they tended to see
01:12:15us as the experts in what we were doing.
01:12:20You come in and at least at first
01:12:24they're calling me Doctor Burlew.
01:12:26And so I make a suggestion,
01:12:29and they make a suggestion.
01:12:31But other people think, well, she's she.
01:12:34Doctor Blue has been doing this for years.
01:12:37She must know more about how
01:12:39to do this than we do. Uhm?
01:12:43Overtime that got a little better.
01:12:47I would welcome suggestions from this group
01:12:51on ways of of addressing that imbalance,
01:12:56but it was clearly there that since
01:13:00we were college professors and they
01:13:04were residents in low income housing,
01:13:08they tended to think that we knew
01:13:11more about what we were doing.
01:13:13Then they did.
01:13:23I do not see any additional.
01:13:27Questions and chat, or in a hands up.
01:13:32Is it possible for me to get a
01:13:34copy of the chat afterwards?
01:13:36I didn't get a chance to look at it.
01:13:38Will believe the
01:13:40grand rounds up so when the everybody
01:13:43starts to leave you are more
01:13:45than welcome to look at the chat.
01:13:47OK, alright thank you.
01:13:52Well, if there are no more questions,
01:13:53we really want to thank you for this.
01:13:56Your excellent presentation.
01:13:58It's inspiring and I hope it will
01:14:01help us as a department incorporate
01:14:03these practices into our own work,
01:14:06so thank you again for
01:14:08presenting to us today. Welcome.
01:14:11Thank you for having me.