<run head>Working through Bound Liberation
<run author>McDowell et al.
<T>Working through Bound Liberation: A Community Engagement Framework for Health
Partnerships
<author>Tiffany L. McDowell, PhD1, Nataka Moore, PsyD1, and Juandalyn N. Holland, PsyD2
<info>(1) Adler School of Professional Psychology; (2) Teamwork Englewood
<abstract subhead>Abstract
<abstract>Background: A community–academic partnership was developed to implement a
community-based participatory research project within Chicago’s Englewood community.
Objectives: We explain how Mental Health Impact Assessment (MHIA) ensures that mental
health and health inequities are considered in decision making by using a systematic process that
engages populations most likely to be impacted by those decisions.
Methods: We report on the process of developing an MHIA by engaging community partners to
evaluate and predict potential mental health outcomes of an employment policy.
Lessons Learned: We describe the principle of working through bound liberation, resulting in a
bidirectional engagement between academics and community partners. We highlight lessons and
challenges of our engagement process.
Conclusions: Effectively joining in solidarity with community partners was critical for project
success, but community capacity needs to be increased to support future projects.
<abstract subhead>Keywords
<abstract>Community-based participatory research, community health partnerships, health
disparities, power sharing, process issues,
<info>Submitted 14 January 2013, revised 6 May 2012, accepted 6 August 2013
1
<N>Englewood is a community on the Southside of Chicago with a variety of cultural, civic, and
professional assets and organizations. In recent years, however, Englewood has been beset by
many social and economic problems such as homelessness, unemployment, and violence, and
broader challenges such as exclusion, racism, and inequitable distribution of income and
wealth.1,2 A robust body of empirical evidence links these determinants to such poor mental
health outcomes as anxiety, depression, and alcohol and drug abuse.3,4 Addressing sources of
these social conditions may shift the focus from intervention to prevention to address the root
causes as opposed to the symptoms of poor mental health.5
The sources of these social conditions are often rooted in policies, planning projects, and
other public decisions, which can have significant impacts on the physical and mental health of
communities, particularly for vulnerable populations.6,7 An MHIA is a Health Impact
Assessment that focuses explicitly on the mental health implications of public decisions. MHIA
is a valuable tool for stimulating the development of socially just policies and proposals that
robustly and transparently consider and manage the multiple ways in which communities are
affected.8 MHIA assesses the potential impacts public proposals (e.g., laws, policies, programs,
or projects) have on the social determinants of health and mental health, that is, where people are
"born, grow, live, work, and age.”7 MHIA uses a systematic process to evaluate positive and
negative impacts of potential policies and proposals on health equity. A balance must be struck
between securing the greatest health gain for the population as a whole, and protecting and
promoting the health of marginalized groups. Integral to the success of MHIA is community
engagement and capacity building, so that community input informs potential policy
recommendations and ongoing monitoring of future physical and mental health outcomes. The
remainder of this paper describes the background and process of MHIA, including development
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of research procedures and recruitment strategies. We also highlight our overarching frame of
community engagement rooted in strong partnerships based in solidarity.
<A>MHIA
<N>MHIA, conceived by researchers and faculty at the Adler School of Professional
Psychology, grows out of established Health Impact Assessment practice, but advances the
practice in two ways. First, it expands the practice beyond its traditional focus on physical health
to include a focus on mental health. Second, it moves beyond assessment of planning, land use,
and built environment proposals (e.g., zoning changes; residential, commercial, and
transportation projects) to include a broader range of proposals (e.g., labor, education, social
welfare, and public safety) relevant to the needs of disadvantaged communities. Thus, the MHIA
provides new information and a new frame (i.e., mental health impacts) by which to determine
whether or not a proposed policy, program, or project should be implemented.
Similar to Health Impact Assessment,9 MHIA methodology involves six specific steps: 1)
Screening determines whether a proposal is likely to have mental health effects and whether the
MHIA will provide information useful to the stakeholders and decision makers; 2) scoping
establishes the potential mental health effects that will be assessed in the MHIA, the populations
affected, members of the MHIA team, sources of data, methods to be used, and alternatives to be
considered; 3) assessment involves a two-step process that first describes the baseline health
status of the affected population and then assesses potential impacts; 4) recommendations
suggest alternatives to the policy or proposal that could be implemented to improve health or
actions that could be taken to manage the health effects, if any, that are identified; 5) reporting
presents the findings and recommendations to stakeholders and decision makers; and 6)
monitoring and evaluation tracks the adoption and implementation of MHIA recommendations
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and following the changes in health or health determinants. Authentic efforts to partner with a
community can be time consuming but well worth the investment to maintain community
interest and engagement in the MHIA process. The project team wanted to ensure that the policy
at the center of the MHIA was relevant to the Englewood community and reflective of resident
concerns. Often, researchers approach community members with rigidly defined goals and
objectives, leaving little room for community input. Applying community-based participatory
research within the MHIA process allowed for shared power and responsibility among partners.8
The authors of this paper include two researchers from the Adler School and the Executive
Director of Teamwork Englewood, the primary community partner on this project. We chose to
form a writing team to accurately describe our partnership with one another.
<B>Bound Liberation
<N>The key component of the MHIA process was to be very purposeful in engagement to
counter the negative perceptions of research in a community where residents have noted that past
academic partnerships have been challenging. Community residents perceived that the unclear
motives of previous researchers and their lack of relationship building with the community as
genuine partners have resulted in tenuous relationships. Aware of this, the authors practiced the
concept of bound liberation to foster development of a mutually beneficial relationship.
<quote>
If you have come here to help me, you are wasting your time. But if you have
come because your liberation is bound up with mine, then let us work together. (Lilla
Watson, Aboriginal Woman)
<N>This quote exemplified our principles for working within the community for the MHIA
project. As African-American females, we understood our liberation, health, and pursuit of social
justice were irrevocably intermingled with the predominantly African-American community of
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Englewood. This concept is deeply rooted within Black Feminist theory, which maintains that
liberation of an individual cannot occur until all oppression is eliminated.10 Stakeholder and
resident engagement followed a process that aligned with this guiding principle: Work through
bound liberation. All three authors have been trained in psychology and family systems, so we
understood the importance of “joining” or engaging with the members of the community in
solidarity toward eradicating oppression. Adapted from structural family therapy,11 the process
of joining includes being accepted by the community and remaining in that position throughout
the partnership.
As we moved through the six steps of the MHIA, we developed strong relationships
based in bound liberation, because our overarching goal throughout the project was to become
invested members of the community. We achieved this goal through three primary strategies.
First, we actively participated in various community events outside the scope of the MHIA
project, such as community cleanups, health fairs, town hall meetings, and movie nights, which
demonstrated that we were committed to the community needs beyond the research.
Additionally, the authors consistently used the words “we” and “our” in community settings. For
example, at a town hall meeting, the authors would say, “We need to advocate for ourselves in
addressing school closures.” As we discuss working in bound liberation, “we” in this paper
describes not only the three authors, but all community partners, residents, stakeholders, and
participants. Finally, the authors shared their activism in their residential communities, and the
shared linkages between their communities and Englewood, such as the commitment toward
improving school systems and increasing employability for residents in the respective
neighborhoods. In the end, this showed Englewood residents that we really were all connected in
fighting injustices that worsen health inequities.
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<B>MHIA Methods
<N>In January 2011, the Adler School of Professional Psychology received funding from Robert
Wood Johnson Foundation, W.K. Kellogg Foundation, and the Pierce Family Foundation to
conduct an MHIA in the Englewood community to inform the Equal Employment Opportunity
Commission of potential mental health impacts of the proposed revisions to the Policy Guidance
on Consideration of Arrest and Conviction Records in Employment Decisions Under Title VII of
the Civil Rights Act of 1964.8 Figure 1 details the research hypothesis of the project. The
pathway diagram illustrates hypothesized relationships between the proposed revisions and four
key social determinants of interest: Social exclusion, employment, income, and neighborhood
conditions. Anticipated changes in the social determinants were hypothesized to have important
impacts on both individual-level and community-level mental health outcomes. Arrows on the
pathway diagram indicate relationships between the policy, social determinants, and mental
health outcomes.
<T>ADD FIGURE 1 ABOUT HERE
<N>
The Adler School was able to begin this work through the 6-year relationship with
Teamwork Englewood, an organization formed in 2003 to serve as a vehicle for bringing
together residents, organizations, churches, and businesses in the community. Teamwork
Englewood, serving as lead community partner and subcontractor on the grant awards, assisted
with convening other community partners to join the project team. Partners included Imagine
Englewood IF, Resident Association of Greater Englewood (R.A.G.E.), Kennedy-King City
College of Chicago, Expanded Anti-Violence Initiative (E.A.V.I.), Greater Englewood Block
Club Coalition, St. Bernard Hospital, Cure Violence (formerly CeaseFire Chicago), and the U.S.
Bank-Englewood Branch. Through this partnership, the project team recruited more than 450
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community residents, employers, police officers, and policymakers to participate in the town hall
meetings, focus groups, and surveys over the course of the project. This research project was
approved by the Institutional Review Board of the Adler School for the protection of human
subjects.
During the Screening step, which is to screen for proposed policies that may have mental
health impacts on a community, we engaged in a series of conversations to assess community
strengths and challenges. For example, we used structured formats such as focus groups and
individual interviews to determine top priorities. However, we also used informal means such as
casual conversations with residents and stakeholders while participating in community events
and activities. Other organizations began to come to the table as they saw our alignment with
their goals. For our work to be bound to theirs, we along with several other community
organizations became a coalition of residents, students, politicians, and community organizers
where the MHIA became one of the collective strategies to improve neighborhood conditions.
The coalition gave credibility from community members’ perspectives to the MHIA project. The
coalition then developed a list of 62 potential policies addressing youth, violence, housing, and
employment issues. The coalition identified the EEOC policy as it addressed many of the top
priorities of the Englewood community.
Because the goal of the Scoping step is to outline research questions, community partners
held focus groups to define the parameters of the project. Because the policy involved employer
use of arrest records in making employment decisions, we were interested in understanding how
the amendment would impact young people in the community. “Resident-scientists” were trained
to conduct interviews with young people who were difficult to access—those who would be least
likely to participate in focus groups or surveys. In the Assessment step, the coalition of partners
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assisted in the recruitment of participants for survey, focus group, and interview data collection.
The Adler School shared a portion of project grant funding with Teamwork Englewood to hire a
resident to administratively support both the MHIA and Teamwork Englewood projects. To
communicate findings to Englewood residents, three town hall meetings were facilitated by
community partners for feedback on preliminary results, formulation of recommendations, and
reporting project outcomes. Teamwork Englewood consistently updated the Englewood Portal
website with MHIA project announcements and events.
To maintain partnerships developed with the coalition, we are currently implementing a
year-long Monitoring and Evaluation process in which community partners are trained to track
mental health and social determinants impacts of the policy. An overriding goal of this work will
be to equip Englewood residents with the knowledge, skills, and tools required promote the
health and well-being of children and families, including capacity for monitoring, civic
engagement, and participation in public decision-making processes that stand to impact their
health.
<A>Lessons Learned
<N>One of the fundamental lessons learned was that, for a community that had long been
excluded from public decision-making processes, partnership development had to be very
authentic and purposeful. The first two authors observed that, through using a bound liberation
approach, the level of engagement shifted beyond simple research partnership to one of mutual
respect and ownership of project targets and outcomes. Over the course of several months, a
bidirectional process of engagement took place. The community was open to the first two
authors joining, not just because of similar demographic backgrounds, but because of the
solidarity on community issues through bound liberation. As a leader of an influential
8
organization within Englewood, the third author on this paper noted that previous researchers
have exploited partnerships by making data inaccessible or by creating undue competition for
resources among community organizations. However, owing to our bound liberation, she views
our partnership more as a sisterhood, associated with joining as a family, where she felt
comfortable having mutually beneficial dialogue and shared leadership. She credited this as a
model for the community to observe and learn from to build capacity to work in partnership with
academic institutions in the future.
The MHIA provided an opportunity to engage Englewood residents and partners in a
project with meaningful, shared goals. Through observation and feedback from partners, we
learned that capacity-building processes need to be incorporated early in the project timeline.
Joining was critical to project success, but now that we are at the end of the MHIA process, we
face the difficult task of transferring primary responsibility of managing ongoing project goals to
the community. Englewood residents developed skills and tools during the course of the project;
however, these tools need to be strengthened to continue the work now that this phase of the
project is complete. This may be challenging because this project may have appeared nuanced to
community residents and they may find it difficult to find ways to strengthen and translate their
new tools for future initiatives within their community. The challenge of transferring skills to
residents was not a particular aspect the coalition considered when moving through the process;
however, as we transition into Monitoring and Evaluation, we will plan activities to ensure that
residents will understand how to apply this skill set for addressing other community issues.
Although joining with a community is a valuable means of supporting involvement, project plans
should include strategies for community-engaged researchers to encourage community members
to take the lead in achieving their research aims.
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<A>Conclusions
<N>Community-based participatory research is a collaborative approach to research allows
researchers to adapt best practices to the community's needs.12 Researchers often require a
conduit to engage community partners, and view engagement as inviting community to the table
to achieve project goals. In vulnerable communities, stakeholders may reasonably question what
motivation researchers have in the partnership. Working through bound liberation extends the
historical community-based participatory research practice of transforming power dynamics
toward the promotion of social change in community health partnerships.13 It requires academic
partners to align with the larger goals of the community, versus prioritizing research objectives
or professional agendas. This approach can repair community–academic relationships in
vulnerable communities owing to potential mistrust of researchers. In establishing a bound
liberation framework, future researchers and community partners should be mindful of creating a
space where all partners can generate shared goals. All partners should be encouraged to
participate in initiatives beyond the scope of the research to be fully invested in community
needs. Therefore, this concept should extend even after the research project is over. Critical to
project success is a sharing of resources so that the community considers the partnership to be
equitable. Ultimately, the community needs to know that research partners are connected and
working in solidarity.
<A>Acknowledgments
<N>The authors acknowledge the entire Mental Health Impact Assessment project team,
including community partners Teamwork Englewood, Imagine Englewood If, Resident
Association of Greater Englewood, and Cure Violence (formerly Ceasefire Chicago). Support for
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this project was provided by funding from the Robert Wood Johnson Foundation, W.K. Kellogg
Foundation, and Pierce Family Foundation.
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<table number>Figure 1. <table title>Hypothesized relationships between policy decision, social
determinants, and mental health. EEOC, Equal Opportunity Employment Commission.
13