Introduction to Multi-Level Community Based Culturally Situated Interventions

This introduction to a special issue of the American Journal of Community Psychiatry is the result of a symposium at the Annual Meeting of the Society for Applied Anthropology, 2006, that brought together anthropologists and psychologists involved in community based collaborative intervention studies to examine critically the assumptions, processes and results of their multilevel interventions in local communities with local partners. The papers were an effort to examine context by offering a theoretical framework for the concept of “level” in intervention science, and advocating for “multi‐level” approaches to social/behavioral change. They presented examples of ways in which interventions targeted social “levels” either simultaneously or sequentially by working together with communities across levels, and drawing on and co‐constructing elements of local culture as components of the intervention. The papers raised a number of important issues, for example: (1) How are levels defined and how should collaborators be chosen; (2) does it matter at which level multilevel interventions begin; (3) do multilevel interventions have a greater effect on desired outcomes than level‐specific interventions; (4) are multilevel interventions more sustainable; (5) are multilevel interventions cost effective to run, and evaluate; (6) how can theories of intervention be generated and adapted to each level of a multilevel intervention; (7) how should intervention activities at each level coordinate to facilitate community resident or target population empowerment? Many of these questions were only partially addressed in the papers presented at that time, and are more fully addressed in the theoretical papers, case studies and approach to evaluation included in this collection.     

Measuring Time Costs in Interventions Designed to Reduce Behavior Problems Among Children and Youth

The economic evaluation of psychosocial interventions is a growing area of research. Though time costs are central to the economist's understanding of social costs, these costs generally have been ignored by prevention scientists. This article highlights the need to measure such costs and then reviews the principles economists use in valuing time. It then considers the specific time costs that often arise in interventions designed to reduce behavior problems among children and youth. These include classroom time devoted to program activities, the time of parents or other caregivers, the time of teachers (outside of the classroom), and the time of volunteers. We consider the economic principles that govern how economists value these inputs and then apply these principles to data from an evaluation of a prominent intervention in the field, the Incredible Years Program. We find that the time costs are potentially rather large and consider the implications for public policy of ignoring them.     

The Role of Neighborhood Context and School Climate in School‐Level Academic Achievement

In recent years, the quality of education available to children has become increasingly dependent on the social and economic demographics of neighborhoods in which the children live. This study assesses the role of community violence in explaining the relation between socio‐economic status (SES) and academic outcomes and the potential of positive school climate to promote academic achievement. With a sample of 297 Chicago public elementary schools, we examine community‐level and school‐level data and use Geographic Information Systems (GIS) mapping to illustrate how school academic achievement coincides with neighborhood economics and crime statistics. Results support the hypothesized mediation, such that lower SES was associated with lower academic achievement, and violent crime partially mediated this relation. School climate was positively associated with academic achievement, and student safety significantly moderated the relation between SES and academic achievement. Implications for theory, research, and intervention are discussed.     

The Role for Public Funding of Faith-Based Organizations Delivering Behavioral Health Services: Guideposts for Monitoring and Evaluation

The paper reviews policies promoting faith-based organizations' (FBO) participation in publicly-funded programs since the Charitable Choice statute was enacted during the Clinton administration and then additional faith-based initiatives were implemented by the Bush administration. The paper focuses on research findings on FBO participation in publicly-funded human service programs under these policies. It then proposes a framework for evaluation to assess the appropriateness of public funding for behavioral health services delivered by FBOs, in order to address: (1) the programmatic and systemic effects resulting from the infusion of new players from the faith community, and the consequences to the profile of services and who gets served; and (2) the content and effectiveness of faith-infused services as a basis for identifying interventions appropriate for public funding. The analysis considers classification issues, theoretical bases of measured effects of faith-infused services, and the transferability of faith-based interventions across religious and secular applications in order to satisfy constitutional issues and client choice.     

Construing Consumer Decision Making

Understanding how consumers represent outcomes and weigh different decision criteria is critical to consumer behavior research. Construal‐level theory articulates how psychological distance alters the mental representation of inputs and the effective weight given to “high‐level” and “low‐level” criteria. Trope, Liberman, and Wakslak (2007) provide a review of this literature. In this commentary, we illustrate the relevance of construal‐level theory to issues in consumer psychology, particularly consumer decision making. We highlight specific questions that researchers could address by considering consumer behavior within the framework of changes in construal. We focus our discussion on how construal levels affect consideration sets and how shifts in weight from high‐level to low‐level features might lead to consumer regret and dissatisfaction. Construal level can help us understand follow‐through on stated intentions for “really new” products and illuminate public‐policy issues such as consumer saving for retirement and nonredemption of rebates. We identify open issues related to how construal levels for the same object evolve over time and whether resources differ in terms of how susceptible they are to psychological distance effects.     

The role of affect in UK commuters' travel mode choices: An interpretative phenomenological analysis

Previous research has suggested that the choice between public transport and private car use is not solely based on utility considerations, such as time and cost. However, affective considerations tend not to be targeted in policy interventions to reduce car use. This may be due, in part, to a lack of clarity about which affective responses to car use are important and how they may affect willingness to switch to public transport. This study sought to clarify the role of affective responses in transport mode choice. An interpretative phenomenological analysis (IPA) of car users' accounts was conducted to (i) explore affect associated with decisions to drive or use public transport to get to work; and (ii) describe the role of affect on such transport decisions, and its relationship to utility considerations. Semi‐structured interviews were conducted with 18 car users employed at a medium‐sized UK university. Four affect themes were identified: These were journey‐based affect (JBA), personal space, autonomy and identity. Typical ‘utility’ factors such as time, cost and reliability had important affective effects, and these were considered alongside utility components (e.g. getting to work on time). However, these effects were not always additive, and the role of affect depended on participants' own assessment of their circumstances. Implications for interventions are discussed.     

Promoting happiness: The malleability of individual and societal subjective wellbeing

Is it possible to enhance the subjective wellbeing of individuals and societies? If so, what are the mental health interventions and economic mechanisms by which subjective wellbeing could be enhanced? We address these questions in our review of the literature on subjective wellbeing. Research now shows that although subjective wellbeing is heritable and stable, it can change substantially over time. Long‐term changes can be affected by positive or negative life events; subjective wellbeing interventions have also proved to be effective for boosting wellbeing for as long as six months. At the societal level, economic factors matter for the subjective wellbeing of citizens. Economic wealth is shown to be a predictor of societal wellbeing across countries and over time. Also, high unemployment severely lowers the wellbeing of individuals and has spillover effects on other societal members, such as the employed. Given the weight of evidence, we are optimistic that subjective wellbeing can be enhanced. For practitioners, policy makers, and economists interested in the wellbeing of individuals, we propose that these findings have implications for mental health practice and economic policies. Future research and methodological issues are discussed.     

Taking a Stand: The Next 50 Years of Community Psychology

On the occasion of the 50th anniversary of community psychology, the author looks backwards in community psychology literature and to each side in other allied disciplines to suggest three fundamental issues that are in need of critical reflection and re‐evaluation as we move toward the next 50 plus years of our field. These fundamental issues are: Defining community psychology, Doing community psychology, and Perfecting community psychology.     

THE SCIENTIST AS STATESMAN: BIOLOGISTS AND THIRD WORLD HEALTH

One of the most threatening problems the world faces is the growing poverty crisis and the related human rights inequalities and the spread of diseases in underprivileged areas. Human rights and relief organizations try hard to contain the devastation of these interconnected difficulties. What is the role of the biomedical scientist in this endeavor? The challenges that biomedical scientists face in their research lead us to question whether scientists can go beyond the time‐consuming realm of experimental investigation and engage the issues of society in a more public way. I suggest how the scientist's role can be expanded in our complex and precarious world, introducing the idea of the modern biomedical researcher as scientist, scholar‐philosopher, and statesman for the scientific community and the larger human rights community. I provide examples of where the scientist can interface with human rights organizations, medical doctors, political and civic leaders, and the science‐religion dialogue. My argument reveals the emerging role of the biomedical scientist as one of public service in addition to and beyond the realm of the experimental investigator. This role, however, is formidable, and I list some of the obstacles it entails.     

Diversity Challenges in Community Research and Action: The Story of a Special Issue of AJCP

This story explores an intervention conducted in a Catholic parish community in New York City. The intervention, conducted by the author and a Jesuit priest, focused on issues of unity and diversity among the various Chinese immigrant subgroups in the parish (primarily Cantonese‐ and Mandarin‐speakers). Issues of class, power, and a history of colonialism in the Catholic Church are explored as central to the relations among culturally diverse Chinese American community members and between the members and the practitioners and the church authority. The author especially focuses on how the dynamics that played out in the intervention reflected wider issues of economics, labor practices, and political elitism in the wider Chinatown community. A central part of the author's argument is about power relationships between this parish community and Chinatown and how these power relationships are embedded within broader racial and economic oppression within the United States.     

Conceptualizations of Social Class in Afrtican American Women:

This article addresses the multiple definitions of social class in African American people and how the therapist's understanding of these definitions is important in therapeutic interventions with African American women. The article discusses: (a) the traditional ways in which social class has been defined in social science and the limits of these conceptualizations; (b) the multiple definitions of class within the African American community; and (c) treatment concerns for African American women based on class issues. Clinicians working with African American and other women who vary by class should be able to assess how class variables influence their therapeutic interventions with these women.     

Participation, Power, and the Role of Community Psychology in Environmental Disputes: A Tale of Two Nuclear Cities

This paper examines public participation and the role of community psychology in an emerging environmental dispute relevant to global climate change (GCC)-whether nuclear power represents a "green" solution. From a dialectical position, we explore the nuclear debate as it is linked to GCC, and more specifically, how participation in related federally-mandated processes may be shaped by power. We present qualitative data from public meetings in two nuclear communities and analyze these data through a lens of social power and environmental justice, including an examination of nukespeak and telepolitical appeals to highlight the complexity of the issues, how the appearance of successful participation may be deceptive, and how consensus may be manipulated. We argue that CP should consider GCC to be one of the most significant social problems of our time and make every effort to be involved in the search for truly "green" solutions.     

Public self‐consciousness disposition effect on reactions to waiting in line

In this paper, we investigate how high public self‐conscious subjects may display specific reactions while waiting in line with strangers at a movie theatre. Results suggest that, when compared with low public subjects, high public self‐conscious subjects will have an attentional focus directed toward time, will attribute more control to service managers for the cause of the wait and will evaluate the service more negatively. Results concerning relationships between attribution of control, behavioural intentions and service evaluation support those of previous studies and are both directly and indirectly moderated by the public self‐consciousness disposition. This research opens the way to conducting future studies attempting to link other personality dispositions with consumer behaviour in the services domain. Copyright © 2003 Henry Stewart Publications.     

Personal autonomy in group‐based interventions

Marginalized individuals are often caught in a vicious cycle of economic or health problems, a lack of social connection and disempowerment. The present research examines interventions that provide opportunities for social inclusion to break this cycle. Specifically, in two longitudinal field studies, we examined the effect of social inclusion on self‐efficacy and hope in two vulnerable groups, namely, 68 residents in a drug and alcohol rehabilitation centre (Study 1) and 48 marginalized adults taking part in activities organized by a community organization (Study 2). Although somewhat counterintuitive, we hypothesized that social inclusion would affect self‐efficacy by fostering feelings of personal autonomy. The hypothesis was supported by results from both studies revealing an indirect effect from social inclusion via personal autonomy on self‐efficacy and hope. The findings are discussed in relation to how group inclusion may stimulate the development of personal autonomy in disadvantaged adults, an important factor in their recovery and mental health.     

Considering Community Psychology Competencies: A Love Letter to Budding Scholar-Activists Who Wonder if They Have What It Takes

Recently, community psychologists have re‐vamped a set of 18 competencies considered important for how we practice community psychology. Three competencies are: (1) ethical, reflexive practice, (2) community inclusion and partnership, and (3) community education, information dissemination, and building public awareness. This paper will outline lessons I—a white working class woman academic—learned about my competency development through my research collaborations, using the lens of affective politics. I describe three lessons, from school‐based research sites (elementary schools serving working class students of color and one elite liberal arts school serving wealthy white students). The first lesson, from an elementary school, concerns ethical, reflective practice. I discuss understanding my affect as a barometer of my ability to conduct research from a place of solidarity. The second lesson, which centers community inclusion and partnership, illustrates how I learned about the importance of “before the beginning” conversations concerning social justice and conflict when working in elementary schools. The third lesson concerns community education, information dissemination, and building public awareness. This lesson, from a college, taught me that I could stand up and speak out against classism in the face of my career trajectory being threatened. With these lessons, I flesh out key aspects of community practice competencies.     

Engaged Against the Machine: Institutional and Cultural Racial Discrimination and Racial Identity as Predictors of Activism Orientation among Black Youth

The current study examines how experiences of institutional and cultural racial discrimination relate to orientations toward activism in the Black community among Black adolescents and emerging adults. Furthermore, we investigate the role of racial identity (centrality, public regard, nationalism) as moderators of those relations. In a national sample of 888 Black adolescents and emerging adults, we found that experiences of cultural racial discrimination, racial centrality, and nationalism ideology were related to a greater orientation toward low‐risk Black community activism. For high‐risk activism, nationalism was associated with a greater likelihood to participate in future social action in the Black community. The relation between experiences of institutional racial discrimination and high‐risk activism orientation was moderated by public regard. For Black adolescents and emerging adults who believe others view Black people negatively, more experiences of institutional racial discrimination were related to a greater high‐risk activism orientation. Findings highlight the importance of investigating racial discrimination as a multidimensional construct that extends beyond individual interactions and microaggressions. Furthermore, these findings underscore how phenomenological variation in experiences of racial discrimination and racial identity differentially influence adolescent and emerging adult orientations toward social action in and for the Black community.     

REDUCTION OF SEVERE BEHAVIOR PROBLEMS IN THE COMMUNITY USING A MULTICOMPONENT TREATMENT APPROACH

Problem behavior often prevents community integration of people with developmental disabilities. Therefore, we evaluated a multicomponent approach for remediating problem behavior in public community settings (specifically, supermarkets). We selected treatments based on hypotheses about the variables controlling the problem behavior (hypothesis-driven model). The multicomponent intervention included choice making, embedding, functional communication training, building tolerance for delay of reinforcement, and presenting discriminative stimuli for nonproblem behavior. Treatment progress was monitored using measures of latency and task completion rather than traditional measures of frequency and time sampling. Results showed substantial increases in task completion and duration of time spent in supermarkets without problem behavior. Outcomes were socially validated by group-home staff and cashiers. We discuss how the intervention approach taken can resolve some of the issues involved in assessing, measuring, and treating problem behavior in the community.     

“This is My Community”: Reproducing and Resisting Boundaries of Exclusion in Contested Public Spaces

The way that public space is structured has significant implications for identity, social interaction, and participation in society. For those experiencing homelessness, with no or limited private space, survival hinges on the accessibility and livability of public space. However, the increasing privatization of public space in the United States has contributed to the implementation of anti‐homeless ordinances in cities, restricting sitting, standing, panhandling, and sleeping in public. This study analyzes data from interviews with housed and unhoused community members, text from a local policy document, and ethnographic observations to explore how boundaries between “insiders” and “outsiders” are drawn in public space and mediated through individual discourse. Our findings suggest that boundaries of exclusion are constructed through dominant narratives that portray the unhoused as a threat to safety and economic vitality, thus justifying the need for regulation and punishment through the criminalization of homelessness. Yet, informants also demonstrate resistance to this narrative by discussing how criminalization of homelessness perpetuates dehumanization, violence, and economic inequality. Policy implications for the regulation of public space are discussed.     

A Social Ecological Model of Syndemic Risk affecting Women with and At-Risk for HIV in Impoverished Urban Communities

Syndemic risk is an ecological construct, defined by co‐occurring interdependent socio‐environmental, interpersonal and intrapersonal determinants. We posited syndemic risk to be a function of violence, substance use, perceived financial hardship, emotional distress and self‐worth among women with and at‐risk for HIV in an impoverished urban community. In order to better understand these interrelationships, we developed and validated a system dynamics (SD) model based upon peer‐reviewed literature; secondary data analyses of a cohort dataset including women living with and at‐risk of HIV in Bronx, NY (N = 620); and input from a Bronx‐based community advisory board. Simulated model output revealed divergent levels and patterns of syndemic risk over time across different sample profiles. Outputs generated new insights about how to effectively explore multicomponent multi‐level programs in order to strategically develop more effective services for this population. Specifically, the model indicated that effective multi‐level interventions might bolster women’s resilience by increasing self‐worth, which may result in decreased perceived financial hardship and risk of violence. Overall, our stakeholder‐informed model depicts how self‐worth may be a major driver of vulnerability and a meaningful addition to syndemic theory affecting this population.