STAYING AT THE TABLE: BUILDING SUSTAINABLE COMMUNITY-RESEARCH PARTNERSHIPS

Abstract

In this study, the authors identify three guiding principles or relational strategies for developing successful community partnerships and building an alliance for systemic change. These principles were derived from their work over 4 years with an urban public school system, which was focused on generating a series of interventions for improving the behavioral and academic functioning of immigrant students. In their process, they developed an analysis and monitoring system of students’ progress, which allowed for earlier targeted effective support.

By identifying relevant problems and generating solutions together with community partners, community-based participatory research (CBPR) methods are proposed as an effective means of developing and integrating sustainable interventions to improve mental health outcomes (McAllister, Green, Terry, Herman, & Mulvey, 2003; Stoiber & Kratochwill, 2000; Wallerstein, 2000). Community-based participatory research provides strategies for facilitating the implementation of viable interventions in community settings (Jensen, Hoagwood, & Trickett, 1999; Tervalon & Murray-Garcia, 1998; Trickett & Espino, 2004). The utilization of community-based partnership models has been advocated as a way to establish “equitable partnership” between communities and researchers to develop a research topic of importance to the community with the aim of combining knowledge with practical feasible action (Israel, Schulz, & Parker, 1998; Israel et al., 2003). However, little is known about what actually works in developing successful CBPR partnerships. A recent review of CBPR notes that, “there is, at present, more theology than conclusion, more dogma than data, about the varied claims for what collaboration can accomplish” (Trickett & Espino, 2004, p. 62). The same authors note there is limited evidence bearing on mechanisms or “ingredients” for successfully building collaborations (Trickett & Espino, 2004). For community collaboration and research to be sustainable, testable mechanisms to build successful collaborations need to be identified.

In this commentary, we (a community-based research group that includes a practicing child psychiatrist, two researchers, and a school principal) identify three guiding principles or relational strategies for developing successful community partnerships and building an alliance for systemic change. These principles were derived from our work over 4 years with an urban public school system, which was focused on generating a series of interventions for improving the behavioral and academic functioning of immigrant students. In the process, we developed an analysis and monitoring system of the students’ progress that allowed for earlier targeted effective support.

As our first step, we worked on defining problems in collaboration with the school staff, then developing and piloting systems interventions that would improve immigrant children’s school outcomes. We initially designed pilot interventions, which included discussions of case studies and identifications of barriers to these students’ successful academic achievement. We also performed a mapping of the school resources, and conducted in-depth qualitative interviews with 11 project participants to understand the barriers in serving these students and the leverage points to enhance the school’s response to these youth. The empirical aspects of the first 2 years of the project are described in detail elsewhere (Mulvaney-Day, Rappaport, Alegría, & Codianne, 2006).

During the course of the participatory research project, we experienced setbacks that threatened to undermine an evolving constructive collaboration. Interpersonal challenges (including conflicts) are an integral part of relationship development in collaboration (Wallerstein & Duran, 2006). Such personal challenges together with systemic limitations (e.g., financial, structural, and educational barriers) can undermine progress. Yet the guiding principles we describe can nonetheless be a useful approach to building alliances and consensus and to developing successful collaborative research and interventions.

We start from the vantage point of practicing “cultural humility,” a practice involving self-evaluation and examining assumptions about the dynamics and context of a viable working relationship (Tervalon & Murray-Garcia, 1998; Wallerstein & Duran, 2006). As professionals entering communities, by maintaining cultural humility, we encourage the community members to teach us their knowledge and practical insight about their efforts to address problems. This can enhance crafting viable sustainable solutions that incorporate their wisdom. In our commentary, we delineate lessons we learned from our community participatory exchanges in the hopes that by sharing our mistakes and growth, this will help others to “stay at the table” when participants face similar challenges. We have found three different conceptual frameworks—characterized by attachment, authentic self, and learned optimism—helpful in our understanding of what may increase the success of a collaborative relationship. This set of principles may be useful to other investigators as they explore the active ingredients of community-based participatory research.

FRAMEWORK 1: ATTACHMENT THEORY

The first framework is attachment theory (Bowlby, 1980; Moss et al., 2006). Attachment constructs contribute to understanding interpersonal adaptation in highlighting the importance of security when dealing with perceived dangers and exposure of vulnerabilities. This perspective typically addresses ways caregivers and children deal with threats to security, such as separation, abandonment, and neglect (Cassidy & Shaver, 1999; Pearson, Cohn, Cowan, & Cowan, 1994; Roisman, Pardron, Sroufe, & Egeland, 2002; Sroufe, 2005; Sroufe, Carlson, Levy, & Egeland, 1999). Attachment theory posits that throughout the life course, humans are able to be productive when they are confident that there are others who can provide support and protection (Bowlby, 1980). Creating a secure attachment is critical for promoting a sense of agency, the belief that one’s actions can make a difference and interventions can be effective (Bandura, 2006). When researchers and community partners experience a secure attachment with one another they can more easily take risks, assume appropriate responsibility for problematic situations, and be more self-reflective and willing to seek help in changing behavior or attitudes. Such attachment depends on empathic interactions among the collaborators; encouragement of self-reflection, particularly when conflicting views of a problem surface; honesty about motives and tensions; and persistence in the face of uncomfortable or emotionally charged situations. As trust grew, our group developed an arena for constructive discourse leading to a more fruitful examination of how teachers and administrators (both members of our collaborative group) approached struggling immigrant students.

Case Example: Challenges to Creating Secure Attachment in the Collaboration

Having a stable set of participants over time is crucial for evolving and sustaining secure attachments or in the words of the school’s principal (and the fourth author) “buy in.” One of the greatest challenges we experienced was inconsistent and changing membership of our group over the course of the project, especially during the first year. Eventually over a 2-year period, we became a stable group of consistent participants. These varied changes in membership led to participants’ holding different pictures of how our group was addressing the immigrant students’ achievement gap. Exacerbating conflicts accompany these varied and sometimes confusing perceptions. Consequently, there was the emotional toll that led to disappointment and misattributions that some individuals were included in meetings, while others were excluded, often making the formation of trusting attachments difficult. For example, during the evaluation meetings in the middle of the project, a discouraged teacher said, “At the beginning, I was participating (in the meetings); at the end, I was not invited to be part of the meetings.…. Maybe they felt there’s nothing I could do to help, that I wasn’t necessary.”

Fortunately, in the course of our meetings, the authors grew to understand that the group’s changing membership was a consequence of its evolving goals. In retrospect, we surely needed to clarify and more explicitly communicate how decisions were made about participation and try to create a stable group. For example, the principal recognized that “building a partnership” also created a sense of shared urgency allowing the group to take more decisive action. She described the group’s evolution:

When we first met our goals were very different from where we ended up and thus the players changed. Also, when we began I was an assistant principal—and new to the school. I was in a learning phase myself—I was overwhelmed, scared of making a major mistake and very unsure of myself. Our group was not really sure what our goals were (at least in my mind), but this was a very valuable part of our process because as we continued to meet, reluctantly at times on my part, we gained a clear focus that something needed to be done immediately (we created a sense of urgency) regarding our immigrant population. This is also when we began to expand the team. I’m not sure that without the sense of urgency the partnership would have continued.

The principal appreciated that the evolving team generated space in which one could be reflective in a nonthreatening way about changes that needed to be made and not merely as an add-on, thus allowing the educators to ask the tough questions themselves by looking at the data. The dialogue of the group was about how to change practice and make a difference, which she saw as critical for buy-in. Buy-in from teachers can be difficult if the implicit message is that the intervention requires doing more with the same level of resources and time. Taking into account the limited resources of the school may help investigators better understand how a school community embraces or resists interventions due to their relevance, feasibility, or acceptability within a particular context. Teacher buy-in is only created by careful attention to building commitment between school personnel, families, and administrators, and by advocating for the viable conditions that can enable teachers and other school personnel to make sustainable improvements in school systems. Thus, despite the challenges of shifting participation, alliance-building moved forward, succeeding because of the joint contributions of everyone on the team working to foster secure attachment within the group.

FRAMEWORK 2: USE OF AUTHENTIC SELF

The second framework is “understanding the use of authentic self ” (Heffron, Ivins, & Weston, 2005). The main lesson in this perspective involves going “beyond explicit content and knowledge about a situation to include awareness and explorations of (one’s) reactions and deeply held beliefs” (Heffron, Ivins, & Weston, 2005; p. 323). This guiding principle is invaluable in developing community partnerships in that it leads partners to explore the relational experience with other team members, using one’s own thoughts, feelings, and behaviors. Awareness of internal experience is a valuable source of information for how personal emotions and beliefs might shape participants’ judgments, assumptions, or expectations in relation to others. Creating an alliance that builds and sustains commitment for systemic change is seldom linear, and often includes shifting involvement and complicated emotions, where collaborators may need to be open about their reactions, feelings, judgments, and expectations to move forward (Wallerstein & Duran, 2006).

Resistance to change is considered by many in the field of organizational development to be the most common initial reaction to any innovation (Rogers, 1995). Only by close attention to one’s internal reactions and honest expression of one’s feelings, judgments, and expectations can a participatory research group support an environment conducive to change. The components of using one’s authentic self include naming the problem and the feeling or judgment; and with that knowledge, working towards resolving the problem, or at least creating awareness of how the problem is making others feel or react.

Case Example: Challenges to Using One’s Authentic Self

In our project, we examined how special needs educators and general educators collaborated to look at the needs of immigrant students who were not making academic progress in school. The teachers asked the researchers to help with generating baseline data detailing how the students performed in math and reading. The researchers then confirmed startling findings for the school personnel—the students in seventh and eighth grade who spoke English as a second language were reading significantly below grade level. Based on these data, the group highlighted the strong priority to emphasize fundamental reading and writing skills. Yet when the teaching staff looked at this recommendation, they believed that they could not provide the necessary intensive resources to help these children adequately. The teachers were wary of taking responsibility for the problem because they felt relatively powerless to make substantive progress. The researchers were frustrated when they themselves could not provide adequate academic support to address this achievement gap.

After working for a year in identifying needs and planning coordinated special education and school staff service interventions, one of the researchers found out that key strategic meetings were being held without any of the researchers’ participation. One researcher felt dismissed and puzzled when the principal said at the end of one meeting, “We can take it from here.” This situation represented a critical turning point—a “make or break” point in terms of the collaboration. The researcher was then able to understand what others were articulating in previous meetings as “feeling excluded.” The researcher voiced her frustration in a private meeting with the principal. In doing so, she took the risk of exposing her “authentic self ” by expressing her experience of feeling excluded after participating in a year of assessing the problem. In having an understanding of use-of-self, and using this capacity to be aware of her own internal experience, the researcher was able to truly empathize with an experience that was endemic throughout the system, and experience first-hand how this dynamic derailed positive momentum in decision-making.

Building on this new knowledge, the researcher and school staff now acknowledged a breakdown in communication. The researchers appreciated the principal’s urgency to forge forward on her own and fix the problem. By acknowledging the breakdown in communication and sharing genuine feelings about it, there was an opportunity to examine key ingredients for continued commitment to the relationship between the school staff and researchers. This striking acknowledgement and review enabled the continuation of a partnership that under other circumstances might have dissolved. Recognizing one’s own feelings and reactions and using that information to enlighten the work of participatory research was a key component to building alliances within our collaborative group. This may entail the researchers sharing authentically how they are observing the repetitive patterns that may perpetuate inertia in the school system as well as community participants revisiting the effectiveness and usefulness of participatory research methods (Stein et al., 2004).

Sharing of explicit personal motivations for behavior enables the team to build trust. But many aspects of work within school systems make developing this awareness difficult. Educators may be discouraged about how to respond effectively to their students’ shortcomings and apparent lack of consistent effort. The school personnel may be reluctant to examine how the school structure or their own attitudes or reactions to these issues perpetuate students’ problem behavior. In retrospect, the principal shared her reasons for backing off from the research partnership:

I was afraid that I could not meet the demands and take on extra meetings when I was having a difficult time finding enough planning time to meet with my school teams. As a new principal, I was totally frustrated at other demands on my time and the challenges of dealing with the daily work—it took time for me to be able to relax enough to look at the big picture. I did not see, at the time, that the work we were doing together IS the work, and once the team stepped in and set up the meetings and gave the whole thing structure, I was ready to move forward. The personal relationships that have developed allowed me to hang in there and maintain the clear focus and having a structure in place really gave our work together the teeth it needed.

Building trust enables honest expression of the experience of the partnership as difficult and demanding within the overburdened context of school and other health and service system settings. Understanding temporary breaks in the relationship, not as resistance to change, but rather as part of the partnership development can lead to increased empathy for the particular situations of the partners on the team, especially those who work in different and unfamiliar settings to their own. Meeting these challenges requires sensitivity, honesty, and recognition that the partnership development is not a one-shot deal but is ongoing and a constant work in progress.

FRAMEWORK 3: LEARNED OPTIMISM

“Learned optimism” (Seligman, Steen, Park, & Peterson, 2005) is a concept that helps to counteract feelings of despair by challenging the belief that a situation is permanent and pervasive. Maintaining optimism in the face of negative experiences requires a capacity to examine habitual explanations for why things happen and the ability to use effective problem-solving strategies. At the start of a partnership, there is usually the perspective of the researchers and the perspective of the community. The tensions involved in integrating these two perspectives can be helped with learned optimism.

Case Example: Learned Optimism

When the participatory research team actively engages in outlining conflicts, expectations and obstacles, they gain enhanced understanding of the school context. As participants describe the repetitive cycle of children’s problems, the team can be pulled into the sense of despair and as a researcher observed, “Without clarity, it can feel like whiplash.” School staff often felt most immobilized when confronted with structural constraints that thwarted their ability to meet the needs of the children. One teacher lamented, “Can you imagine what it is like to know you are going to fail before you have started?” The immigrant students initially were in a small English immersion classroom, where they had the curriculum tailored to their ability. They progressed, but when they transitioned into regular classes from the immersion classroom, they experienced predictable anxiety and task avoidance as they became aware that they were not able to perform at the same level as their classmates. They would often divert attention from their inability to perform by “acting up” in class. A perpetual catch-up game contributed to the students’ sense of alienation and withdrawal.

The challenge of the community participatory research group in this context was to persist in the face of overwhelming systemic inertia. The group needed to be undaunted by the seemingly all-encompassing nature of the problems and slow incremental progress; sustaining faith that their efforts would produce change so as not to withdraw constructive efforts in the face of anticipating defeat. One teacher explained, “The (participatory) process greased the wheels, sometimes we can spin our wheels and feel pushed down and this keeps us from getting the job done. You can’t always jump to being productive; and little nudges and seeing the bigger picture created momentum.”

In a school meeting to review a student’s progress, the teachers expressed that not much had been accomplished. The researchers were able to provide perspective on the slow nature of behavioral change. This optimism developed from the researchers’ appreciation that the teachers were already disappointed: Holding a critical questioning stance without judgment or expectation allows the community members to develop the capacity for self -assessment and problem solving. The fact that some children started to engage actively in reading and class participation was incremental evidence that the hard efforts of the teachers were slowly paying off. After the year ended, several teachers saw progress in some of the children that reinforced their sense of agency. It reinforced the idea that even with tremendous challenges it was worth the teachers’ effort to strive harder for these students. Bringing awareness to ongoing small victories as part of learned optimism is a way to leverage systemic change when the challenges seem monumental.

At times, the teachers can encourage the researchers. The researchers sometimes worried that the partnership was time consuming with no “deliberate speed” and worried about achieving measurable progress. At times like this, the teachers helped the researchers develop a growing appreciation of the realistic barriers that the school members confronted and helped them understand the necessity of developing realistic problem-solving expectations. The act of mirroring an optimistic, positive stance shifted back and forth over time across members of the group, and was an essential component of continuing the momentum. As the principal described,

The pot boiled in the meetings. All these ideas, solutions, and strategies were talked about and this provided a catalyst for us to take it another step. The think tank approach allowed us to develop trust, listen to each other and no one was the “authority with the answer.” But the thoughtful reflection affected how we made decisions.

Self-reflection and building an organizational capacity for optimism and hope may be an essential ingredient to generate viable solutions in CBPR. This requires that the participants look for positive points of leverage. A focus on learned optimism spotlights the small individual changes the group uses to sustain itself, within the context of an extremely large and entrenched problem, and this tactic encourages a realistic assessment of how to address difficult problems at a systemic level.

Creating secure attachments may foster a capacity to reflect and acknowledge tensions that may undermine collaboration and create increased self-agency and accountability. Using one’s authentic self may allow a growing recognition of one’s own assumptions and encourage feelings of empathy and curiosity about guiding motivations. Learned optimism may foster an ability to reframe disappointments and identify incremental positive change. There is increasing interest in how communities adopt evidence-based treatment and careful attention to how we cultivate shared reflective relationships that may advance our understanding of the active ingredients to foster buy in so that interventions are not abandoned. In summary, proposing these relational strategies as guiding principles is an effort to analyze the components/obstacles to a viable community-based research partnership. If we are able to link what we do to whether it has a positive impact in creating models for seemingly intractable problems, we may make sustainable progress.