Community-Based Health Interventions: An Ethical Approach to Bringing Healthcare to the Marginalized
AdvisorRocco, Providenza Loera
Community based health care
Community based interventions
Community based participatory research
Permanent link to this recordhttp://hdl.handle.net/20.500.12613/7783
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AbstractCovid-19 shed a light on how disparities, influenced by institutional racism and social determinants of health, led to negative healthcare outcomes. This inspired community organizations such as the Black Doctor’s COVID-19 Consortium to take matters into their own hands and play their part in meeting the needs of the community. With evident gaps in healthcare for marginalized communities, I believe that community-based health interventions are an ethical approach to ensure care for marginalized communities. To ensure that a proper intervention is being crafted for these communities, it is important to define what community-based means. This paper explores four models for categorizing community-based: community as setting, target, resource, and agent. While traditional research focuses on the voice of the academic, using Community Based Participatory Research amplifies and recenters the voice of the community, while providing a means to increase their capacity, fostering agency, and promoting solidarity. This paper explores local community-based health interventions in North Philadelphia and emphasizes partnering with the community to determine their needs before creating an intervention. Using community-based interventions to increase access to healthcare for marginalized communities in tandem with existing models of healthcare, follows a utilitarian approach to ensure that the greatest number of individuals can benefit. Community-based health interventions are the most ethical approach to bringing healthcare to marginalized communities.
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Implications of Community Prosecution for Prosecutors and Community: A Case Study of the Community Prosecution Initiative in Red Hook, Kings County, New YorkGoldkamp, John S.; Harris, M. Kay; Taylor, Ralph B. (Temple University. Libraries, 2009)Prosecutors are powerful actors in the criminal justice system. Scholars make the argument that prosecutors exercise far more control over criminal matters than any other agency (Thomas and Fitch, 1976, p. 509; McDonald, 1979, p. 18-19, Wickersham, 1931) . Over time, various changes have augmented prosecutorial power, ranging from the decision to make the office of the prosecutor an elected one, thereby affording prosecutors independence in carrying out their duties (Misner, 1996, p. 729), to the advent of determinant sentencing, resulting in shifting sentencing discretion away from the courts to the prosecutor (Vorenberg, 1981, p. 1525, 1529). This research hypothesized that community prosecution represents another development that will result in increasing the influence of the office of the prosecutor. Traditionally, prosecutors have been oriented toward successful case disposition. The case-by-case methodology has involved little contact with the community. In addition, the prosecutorial focal point is on felony cases, while lower level offenses generally receive little time or attention. The emergence of community prosecution challenges the traditional prosecution role and its emphasis on the more serious matters and winning cases, and promises positive effects for the "communities" targeted. Through a case study of its application in Kings County, New York, this dissertation explores community prosecution and its impact on the role of the prosecutor and for the community, in the context of a community court implemented in Red Hook, Brooklyn. Focusing on the Red Hook example, the study drew on three principal sources of data to examine the community prosecution innovation, including: a) arrest data, aggregated monthly, for the three police precincts that handle cases originating in Red Hook, covering the years 1998 through 2001 (46 months per precinct, n=138 ); b) precinct level arrest and court case filings for criminal incidents that took place in Red Hook and other Kings County locations for two distinct time periods (the third quarter of 1998, (n = 19,296) and the first quarter of 2001, (n = 22,988)); and c) court case data from the Red Hook Community Justice Center (hereafter, RHCJC) 2000 through 2001 (51 weeks, n=4,088). Several different types of complementary analyses, including HLM, contrasted changes in case types and defendant characteristics in the study locale over time associated with this community-oriented form of prosecution. The analyses also compared these changes to the caseloads from neighboring communities that did not have access to this innovation, where cases were processed in the traditional manner. Specific hypotheses tested about the effects of the community prosecution innovation included the following: 1) Implementation of the community prosecution initiative via the community court will result in an increase in the volume and/or proportion of arrests for minor offenses in precincts operating within the community court's jurisdiction. That increase will not be experienced by precincts not involved with the court. 2) The community prosecution strategy will draw defendants into the Red Hook criminal justice system who would not otherwise have been involved in the system, specifically including greater proportions of young minority males and individuals with no prior criminal histories. This research also involved a limited inquiry into how community members were responding to the community prosecution initiative. Given the purpose of community prosecution, to engage the community in handling its unique crime problems in an effort to make them feel safer, it was of interest to know whether there was any evidence that this happened in Red Hook. To that end, the research drew upon qualitative data, including: a) a series of non-probability based community surveys performed within the Red Hook jurisdiction in 1999 (n=980), 2000 (n=1,744) and 2001 (n=1,169) and b) two focus groups (n=12; n=18) conducted by this researcher in May of 2003. These other data sources provided context, allowing for better understanding the results of the analyses. Findings indicated slight effects of community prosecution in the anticipated direction: The volume of arrests from the Red Hook precincts (Data Set 1) increased slightly after the court was implemented. In addition, findings from the RHCJC caseload (Data Set 3) indicated that post-implementation, misdemeanor cases increased slightly but significantly. Comparisons of the post-implementation caseload filed from Red Hook precinct arrests with the control group (consisting of pre-implementation, Red Hook filings and both pre-and post-implementation filings from the arrests made by the rest of the Kings County precincts (Data Set 2)) indicated that the caseload proportion of misdemeanors in post-implementation Red Hook filings increased significantly when compared with the control group filings. In addition, analysis of Data Set 2 (comparison of caseload characteristics) indicated both a significant increase in the proportion of the post-implementation, Red Hook cases made up of Hispanic defendants, and a significant increase in the caseload proportion consisting of defendants with no prior record of criminal convictions. The primary findings from the qualitative data (Survey and Focus Group Data) indicated that community respondents appeared to be more satisfied with the court system and seemed to feel safer after the RHCJC was implemented. There was also some indication of race based differences in responses: White respondents seemed generally more positive about perceived post-implementation changes in Red Hook than minority respondents.
Putting the Community back into Therapeutic Community: Examining the Role of the Treatment Group in Prison-Based Substance Abuse TreatmentWelsh, Wayne N., 1957-; Hiller, Matthew L.; Taylor, Ralph B. (Temple University. Libraries, 2012)This dissertation conceptualized and evaluated the moderating effect of the treatment group on treatment responsiveness and recidivism among a sample of drug-involved offenders who received in-prison substance abuse treatment. Few studies of drug treatment simultaneously consider individual level variables and the context of group treatment. Those that have typically operationalize the treatment context with organizational indicators such as attributes of the staff, staff perceptions of the program, therapeutic orientation, and program accreditation. In contrast, the current work operationalized context from the perspective of the participant using as indicators client-based measures of treatment progress and satisfaction. The study expands existing theoretical models and extends what is known about treatment effectiveness by considering how the social group - the collection of individuals that constitute the prison unit in which the inmates received their 12 months of substance abuse treatment - may or may not moderate the influence of psychosocial functioning and treatment process variables and later outcomes. Such moderating impacts have theoretical implications for understanding the connections between treatment context, individual differences, and outcomes. Moderating impacts also have implications for the ways practitioners monitor treatment group climate and processes, thereby potentially improving service delivery. Finally, the present study contributes to the treatment literature by examining group influences of treatment on measures of recidivism - reincarceration and rearrest - that are of particular interest to practitioners and policymakers. The research was guided by three central questions: 1) Do significant differences on recidivism exist between treatment groups? 2) Does the treatment group moderate the impacts of psychosocial and treatment process variables on recidivism? 3) Does treatment modality have an effect on recidivism? To examine these questions, data from an evaluation of the treatment programs at the State Correctional Institution (SCI) at Chester, PA, were used (Welsh, 2006). The sample consisted of 618 adult male offenders who were randomly assigned to either the therapeutic community (TC) or the less-intensive group counseling treatment modality, each of which was 12 months in duration. A multilevel framework was applied to the data, as the offenders (level-1) were nested within 12 treatment units (level-2) in a single prison. The level-2 grouping was the prison unit where the offenders were housed and where they participated in the 12 months of treatment, and these units can be considered self-contained treatment programs. The predictors of primary importance were treatment responsiveness measures that were collected in the last month of the treatment experience. These included second-order factor analysis scores of measures of depression, anxiety, hostility, therapeutic engagement, trust in the treatment group, and peer support among others. Each was theoretically and empirically related to group functioning and later outcomes. Controls for other factors related to reoffending included time at risk, prior substance abuse and criminal history, age and race/ethnicity of the offender. These variables were all entered at level-1. A single level-2 variable was entered to examine and control for the effect of the type of treatment received (TC or group counseling). The data were analyzed using hierarchical generalized linear modeling (HGLM). This was the appropriate method because the data were nested and the outcomes were the binary measures of reincarceration and rearrest. Notably, multilevel models revealed significant variation on the reincarceration outcome across treatment units (level-2), controlling for treatment modality. This supported the first hypothesis that treatment effects could be attributed to something other than individual level variables or type of treatment received. A similar significant finding across treatment units (level-2), however, was not detected for the rearrest variable. Further, this method allowed for the examination of treatment group impacts on the individual psychosocial functioning and treatment process measures controlling for the type of treatment received. The second hypothesis stated that the treatment group would differentially affect the impact of these variables on recidivism. To reduce the number of individual-level predictors, the various subscales were entered into a second order principal components factor analysis. Three factors emerged: negative affect, positive attitude, and treatment satisfaction. Controlling for the composition of the group, the negative affect factor had a significant, positive direct effect on reincarceration. When the slopes of the three factors were allowed to vary, the model with treatment satisfaction and positive attitude as random effects fit the model best, as the treatment group significantly affected the impact these variables had on reincarceration. With regard to the third research question, in no analyses conducted did the treatment modality have a significant effect on the outcome. The third hypothesis that stated TC participants would have lower rates of reincarceration and rearrest, therefore, was not supported. This was a surprising result, as TCs have been found to be effective at reducing recidivism in previous research. In none of the existing studies, however, did the comparison group receive professional treatment services as the group counseling participants at SCI-Chester received. Several findings have implications for treatment research and policy. First, reincarceration significantly varied across the treatment units, even when controlling for the treatment modality and time at risk in the community. Second, the analysis of level-2 group impacts on individual level variables and recidivism were new contributions to the research in this area. These findings have implications for both theory (macro-to-micro theoretical effects of substance abuse treatment) and treatment delivery to those in prison. This research supported the first and second hypotheses that the group-level dimensions of prison-based substance abuse treatment have not been adequately considered in prior studies. This study takes an important first step in the direction of a more complete view of treatment experiences and outcomes that considers individuals nested within treatment groups.
PAN-AFRICAN STUDIES COMMUNITY EDUCATION PROGRAM: THE INSTITUTIONALIZATION OF A COMMUNITY EDUCATION PROGRAMKeith, Novella Zett; Davis, James Earl, 1960-; Cucchiara, Maia Bloomfield; Jordan, Will J.; Sanders, Rickie (Temple University. Libraries, 2013)ABSTRACT This is a case study of how a community education program became institutionalized at Temple University. The Pan-African Studies Community Education Program (PASCEP) has been located at Temple since 1979. The research illuminates the events that led to PASCEP coming onto Temple University's campus. The main research question was: "Why and how did Pan-African Studies Community Education Program develop from a Community Education Program in North Central Philadelphia to a Temple University campus-based program, and what were the important factors contributing to its development and institutionalization within Temple University?" The research used a qualitative case study method. Data were collected from archival repositories at Temple University and the City of Philadelphia as well as from original documents provided by the Community Education Program and participants in the study. Documents included newspaper articles, letters, reports, and organizational histories as well as transcripts from thirty semi-structured participant interviews. Semi-structured interviews were held with 30 participants who were involved or familiar with the movement and the university between 1975 and 1979. The research indicates that the Community Education Program acted as a local movement center connected with the Civil rights movement. I employed Social Movement theories and Aldon Morris's Indigenous perspective to examine the trajectory of the Community Education Program from the neighborhood to the University. Much of the organizing, mobilizing, and planning done by the members in the Community Education Program/local movement center was managed by Black women. Therefore, the research employed Belinda Robnett's perspective on Bridge Leaders and Toni King and Alease Ferguson's standpoint on Black Womanist Professional Leadership Development to illuminate the leadership styles of the Black women in the local movement center, and their relationships with Temple University faculty and administrators, as well. Results from the inquiry demonstrate that community activism constituted social movement collective action behavior as the Community Education Program and its supporters became an effective local movement center. The study indicates that leadership, political opportunity, resource mobilization, and participation during the tenure in the Program in the community as well as after the introduction of the Community Education Program to the University were indispensable factors in the institutionalization of the Community Education Program.