The overall aim of the Partnered Research Center for Quality Care is to study how to improve mental health care quality and outcomes through authentic community-academic partnered research that responds to community priorities and builds community capacity using principles and strategies of community engagement. The framework guiding our center is illustrated in . At the top of the figure are principles of authentic partnerships under the CPPR Model30,31
used to initiate a community engagement process and to develop a network among key stakeholders. Also at the top of the figure, we highlight policy and research inputs into this process as they inform issue selection, and may affect the availability of resources for the work. The network is supported in identifying issues that are good fits of academic and partner priorities, resources and opportunities. The engaged network is supported by academic and community resources and capacities, in discovering or developing interventions at policy, practice, or local community levels that may plausibly improve quality of care in communities. Academic and community resources also result in partnered intervention implementation and evaluation, providing data on intervention outcomes for relevant stakeholders, including policymakers, networks, providers, consumers/survivors, and the broader community. Further, the lessons learned and capacities developed through the work increase capacity for partnered research and yield a library of priorities addressed, strategies developed, and a supported, vibrant partnership. This framework integrates prior models for improving access to quality care, community-based intervention research, and partnered participatory research.31,34–37
Framework for partnered research center for quality care
To support this capacity-building enterprise, the executive committee, comprising core leaders, meets once a month to discuss center progress, potential new directions, and allocation of resources to advance center work. Through this monthly meeting, new ideas and priorities from each core and those generated through center activities such as book clubs or conferences feed back to the executive committee and decisions are made by majority vote (). The executive committee also receives feedback, to assure direction and impact, from the policy advisory board, which consists of academic and community institutional and policy leaders. At the suggestion of a key community partner, and with consensus from the executive committee, it was decided that the policy advisory board’s role be modified to allow for a bidirectional information exchange rather than a unidirectional provision of information, which characterizes a traditional advisory board meeting. Under the revised plan, the center will not only share accomplishments and obtain feedback, but also provide feedback to advisory board members through a knowledge exchange forum. The role of the partnered research expert review panel, which includes both expert scientists and their expert community partners, is to support rigor in application of scientific and community perspectives on partnered research, as well as to support application of this approach to research development across other programs, in a two-way exchange of approaches, strategies, findings, and programs.
Partnered research center for quality care structure*
As seen in , our center is composed of four cores, each structured to assure that the core values of CPPR are upheld, yet each serving a unique function designed to provide resources and facilitate the flow of information and relationships among all partners. Reflecting CPPR principles, each core consists of community and academic co-leads. The operations core provides administrative and technical support to partnered projects and to investigators who are developing projects under a CPPR framework. Through this core, and with approval from the executive committee, support is provided for the formation of working groups, which serve to build partners’ knowledge base in a new research area and have the potential to develop into independent projects. The methods core provides statistical consultation from experts in the field on design, measures, and analyses issues. This core also oversees the Partnership Evaluation Study, which replaced the original networking pilot when the executive committee voted to reallocate resources in support of this project that aims to describe center partnerships and make recommendations for more effective future partnerships. The principal research core provides guidance to junior investigators and to developing projects, such as the pilot assessing the sustainability of Cognitive Behavioral Intervention for Trauma in Schools and the Peer Intervention to Improve Treatment Decision-Making. Finally, the network core provides support for establishing and maintaining healthy partnerships and effectively engaging community partners and consumers/survivors. This core serves a convening function and sponsors regular book club meetings and a yearly community quality forum to generate new research initiatives informed by partner priorities.
Despite having a distinct role in the center, each core aims to promote research that is conducted in partnership in order to address priority areas in mental health and there is much cross-collaboration among the cores. For instance, the community quality forum obtains broad academic and community input to jump-start new partnered initiatives, which are supported in their development through the methods core for technical matters and network core for partnership development. Being responsive to partner priorities necessitates a flexible center structure whereby activities may lead to unanticipated activities, which then may reshape the existing center structure. For instance, the network core-sponsored book club, which provides partners the opportunity to come together on a bimonthly basis and have an open discussion on readings selected by community and academic partners, led to the unanticipated activity of expanding a small book club into a community outreach event around resilience and recovery. This in turn led to the reshaping of the center structure via the formation of a consumer/survivor board and greater consumer/survivor participation in the executive committee. These unanticipated activities are expected to occur due to the nature of CPPR, but they are an unknown at the outset and become part of the center structure with approval from the executive committee.
The aims of the four center cores are aligned with the core values of CPPR: respect for diversity, openness, equality, empowerment, and asset-based approach. Respect for diversity highlights the importance of respecting and honoring that both academics and community members have skills to contribute and experiences that can help shape the research. Openness acknowledges the fact that there will be questions or disagreements that arise through the course of research and the best way to address these is by being open to listening to or expressing new perspectives, asking for clarification, and open to thinking outside of the box. Equality emphasizes that community and academic members of the group must share equally in decision-making power in all phases of research. Empowerment reminds us that all groups have power and that this power can be redirected to bring forth the strengths of each group. This is a two-way process; community members can be empowered through trainings prior to group meetings and academics can be empowered through inclusion in community events. One example of such a two-way process is the network core-sponsored book club, which is conducted informally as compared to a traditional journal club. For instance, one of our book clubs consisted of a collection of readings ranging from poetry to peer-reviewed journal articles and allotted time for sharing musical selections pertinent to the theme that each participant contributed. Partners discussed how the music related to the theme and, at the same meeting, discussed rigorous scientific methods that might not be thought feasible for discussion in such diverse groups. Through such activities, community leaders for methods work groups are developed, thus empowering community partners, and academic members are exposed to expressions of culture, thus empowering academic partners. Finally, it is important to have an asset-based approach that recognizes the strengths of both community and academic members in order to build capacity and remind everyone that each and every member has something to bring to the table. lists several of the key principles of community engagement that are central to the CPPR model and provides examples of how the center structure facilitates the application of those principles, how these principles have led to new ideas, and how these ideas have in turn led to activities not initially planned.
Examples of community engagement (CE) principles as applied to center work