Small Wins Matter in Advocacy Movements: Giving Voice to Patients

In this article, the various players are delineated in a story of a contested illness and patient advocacy, played out within the corridors of federal power. It is suggested that the mistreatment and negative attitudes that health care providers and others have towards those with chronic fatigue syndrome (CFS) is possibly due to the social construction of this illness as being a "Yuppie flu" disease. Institutional factors are identified that created these norms and attributions, as well as the multiple stakeholders and constituent groups invested in exerting pressure on policy makers to effect systemic change. This article also provides examples of how the field of Community Psychology, which is fundamentally committed to/based on listening to and giving voice to patients, is broadly relevant to patient activism communities. This approach focused, over time, on epidemiological studies, the name, the case definition, and ultimately the change in CFS leadership at the Centers for Disease Control and Prevention. Keys to this "small wins" approach were coalition building, use of "oppositional experts" (professionals in the scientific community who support patient advocacy goals) to challenge federal research, and taking advantage of developing events/shifts in power. Ultimately, this approach can result in significant scientific and policy gains, and changes in medical and public perception of an illness.     

Exposure to Violence and Socioemotional Adjustment in Low-Income Youth: An Examination of Protective Factors

Using a sample of 391 low-income youth ages 13–17, this study investigated the potential moderating effects of school climate, participation in extracurricular activities, and positive parent–child relations on associations between exposure to violence (i.e., witnessing violence and violent victimization) and adolescent socioemotional adjustment (i.e., internalizing and externalizing problems). Exposure to violence was related to both internalizing and externalizing problems. High levels of participation in extracurricular activities and positive parent–child relations appeared to function as protective factors, weakening the positive association between exposure to violence and externalizing problems. Contrary to prediction, school climate did not moderate associations between exposure to violence and socioemotional adjustment. Further, none of the hypothesized protective factors moderated the association between exposure to violence and internalizing problems.     

Assessing the Impact of Relative Social Position and Absolute Community Resources on Depression and Obesity Among Smokers

We tested two competing hypotheses-relative social position and community resources-in regards to their effect on two co-occurring health problems (depression, and obesity) in a sample of smokers participating in an online smoking cessation intervention. Income and education data at the zip code level from the 2000 Census was linked with individual level data. Logistic regression models were used for each co-occurring problem to determine how each SES variable (individually and interactively) was associated with the presence of co-occurring health problems. We found that lower individual education was related to poorer health for all outcomes (Depression: OR = 1.25; Obesity: OR = 1.24; Both: OR = 1.46), lower community education was only related to obesity (OR = 1.20). Lower individual income was related to higher rates of depressive symptoms (OR = 1.64) and both health problems (OR = 1.55); a significant interaction of individual and community income (Wald = 6.13, p < .05) revealed that high income individuals were less likely to be depressed if they lived in lower-income communities and became more likely to be so as community income increased. Relative social position was confirmed for depression, whereas community resources were prominent only for obesity. Higher individual education most consistently predicted positive health outcomes, making it a potentially powerful target to reduce health disparities.     

An Intervention to Help Community-Based Organizations Implement an Evidence-Based HIV Prevention Intervention: The Mpowerment Project Technology Exchange System

Considerable resources have been spent developing and rigorously testing HIV prevention intervention models, but such models do not impact the AIDS pandemic unless they are implemented effectively by community-based organizations (CBOs) and health departments. The Mpowerment Project (MP) is being implemented by CBOs around the US. It is a multilevel, evidence-based HIV prevention program for young gay/bisexual men that targets individual, interpersonal, social, and structural issues by using empowerment and community mobilization methods. This paper discusses the development of an intervention to help CBOs implement the MP called the Mpowerment Project Technology Exchange System (MPTES); CBOs’ uptake, utilization and perceptions of the MPTES components; and issues that arose during technical assistance. The seven-component MPTES was provided to 49 CBOs implementing the MP that were followed longitudinally for up to two years. Except for the widely used program manual, other program materials were used early in implementing the MP and then their use declined. In contrast, once technical assistance was proactively provided, its usage remained constant over time, as did requests for technical assistance. CBOs expressed substantial positive feedback about the MPTES, but felt that it needs more focus on diversity issues, describing real world implementation approaches, and providing guidance on how to adapt the MP to diverse populations.     

Exploring the Use of the Interactive Systems Framework to Guide School Mental Health Services in Post‐disaster Contexts: Building Community Capacity for Trauma‐Focused Interventions

Over the past two decades schools have been identified as the de facto mental health system for youth. Therefore, improving and expanding school mental health (SMH) has become a pressing agenda item for researchers, practitioners, policy makers, and funders. Advancing this agenda includes not only translating intervention research into practice within schools, but building capacities for these interventions to occur. The interactive systems framework (ISF) of Wandersman and colleagues, and the focus of this special issue, provides guidance in bridging the gap between research and practice through multisystem capacity building. There is some evidence that application of the ISF has helped to build capacity for SMH in states, but this evidence is preliminary. In addition, application of the ISF has not occurred in SMH at the community level or in relation to the specific stresses a community undergoes in relation to a disaster. The purpose of this article was to conduct a preliminary attempt to connect these three areas—the ISF, SMH and strengthening SMH through the ISF to better address impacts of a community level disaster; in this case, we explore the impacts of Hurricane Katrina on New Orleans schools, their students and families, and SMH programming within them. Special Issue: Advances in Bridging Research and Practice Using the Interactive System Framework for Dissemination and Implementation; Guest Editors: Abraham Wandersman, Paul Flaspohler, Catherine A. Lesesne, Richard Puddy; Action Editor: Emilie Phillips Smith     

A community psychology of object meanings: Identity negotiation during disaster recovery

What do material goods intended for personal consumption mean to community? We use the extreme example of natural disaster recovery in a community to explore this question. Our work describes how members make sense of material objects that transition from private to public possessions (damaged goods) and public to private possessions (donated goods). By blending consumer and community psychology perspectives with our narratives, we employ a three-dimensional framework for analyzing object meanings: (1) material objects as agents of communitas (a shared sense of “we”), (2) material objects as agents of individualism (a focus on “me”), and (3) material objects as agents of opposition (the “we” that speaks for “me” and “us” versus “them”). This theoretical frame allows us to show how different conceptions of identity lead to conflicting meanings of objects within community, and to explain how and why object meanings shift as objects move across time and space from private to public and from scarcity to abundance. We also provide implications for coping with disasters that consider collective and individual identities as well as oppositional stances in between.     

Challenging the Frontiers of Community Psychology: A South African Experience

The development of community psychology is of vital importance in South Africa because of the historical context, questions about the relevance of mainstream western psychology and the current social change in the country in the post-apartheid era. Accordingly successful community psychology practices for a South Africa in transition need greater dissemination for access and utilization in the communities. This article draws on the community work conducted at the Itsoseng Clinic to show how and why community psychology could be made more relevant to the new South Africa. The Itsoseng Clinic is a psychology clinic that is situated in the township of Mamelodi. The clinic provides several services including counselling, psychometric assessment, psycho educational workshops, and HIV/AIDS pre and post-test counselling. The clients and community that the clinic serves are of low socio-economic status and struggle with a lack of material and personnel resources. The individuals working within the Itsoseng Clinic represent a diversity that is in itself a valuable resource for supporting the core activities of the clinic. This article explores various themes that were identified within the research study such as, making community, entering the ecology of life, closing the divide and bridging the boundaries.     

Hope and Burden among Latino Families of Adults with Schizophrenia

This study examined hope and family burden among Latino families of individuals with schizophrenia. The sample consisted of 54 family members, one family member per outpatient adult recruited from public mental health programs in a diverse urban community. Hierarchical linear regression analyses were used to test the hypothesis that the family member's increased hope for the patient's future would be associated with decreased family burden beyond effects explained by the patient's length of illness and severity of symptoms. Results supported the study hypothesis. Family hope for the patient's future was associated with four of five types of family burden. Findings point to the prominent role of hope as a source of resilience for Latino families dealing with severe mental illness of a loved one.     

How Has the Economic Downturn Affected Communities and Implementation of Science‐Based Prevention in the Randomized Trial of Communities That Care?

This study examined implications of the economic downturn that began in December 2007 for the Community Youth Development Study (CYDS), a longitudinal randomized controlled trial of the Communities That Care (CTC) prevention system. The downturn had the potential to affect the internal validity of the CYDS research design and implementation of science-based prevention in study communities. We used archival economic indicators and community key leader reports of economic conditions to assess the extent of the economic downturn in CYDS communities and potential internal validity threats. We also examined whether stronger economic downturn effects were associated with a decline in science-based prevention implementation. Economic indicators suggested the downturn affected CYDS communities to different degrees. We found no evidence of systematic differences in downturn effects in CTC compared to control communities that would threaten internal validity of the randomized trial. The Community Economic Problems scale was a reliable measure of community economic conditions, and it showed criterion validity in relation to several objective economic indicators. CTC coalitions continued to implement science-based prevention to a significantly greater degree than control coalitions 2 years after the downturn began. However, CTC implementation levels declined to some extent as unemployment, the percentage of students qualifying for free lunch, and community economic problems worsened. Control coalition implementation levels were not related to economic conditions before or after the downturn, but mean implementation levels of science-based prevention were also relatively low in both periods.