Tying it Together: Education-Focused Community Change Initiatives

Policymakers make many demands of our schools to produce academic success. At the same time, community organizations, government agencies, faith-based institutions, and other groups often are providing support to students and their families, especially those from high-poverty backgrounds, that are meant to impact education but are often insufficient, uncoordinated, or redundant. In many cases, these institutions lack access to schools and school leaders. What’s missing from the dominant education reform discourse is a coordinated education-focused approach that mobilizes community assets to effectively improve academic and developmental outcomes for students. This study explores how education-focused comprehensive community change initiatives (CCIs) that utilize a partnership approach are organized and sustained. In this study, I examine three research questions: 1. Why and how do school system-level community change initiative (CCI) partnerships form? 2. What are the organizational, financial, and political structures that support sustainable CCIs? What, in particular, are their connections to the school systems they seek to impact? 3. What are the leadership functions and structures found within CCIs? How are leadership functions distributed across schools and agencies within communities? To answer these questions, I used a cross-case study approach that employed a secondary data analysis of data that were collected as part of a larger research study sponsored by a national organization. The original study design included site visits and extended interviews with educators, community leaders and practitioners about community school initiatives, one type of CCI. This study demonstrates that characteristics of sustained education-focused CCIs include leaders that are critical to starting the CCIs and are willing to collaborate across institutions, a focus on community problems, building on previous efforts, strategies to improve service delivery, a focus on education and schools in particular, organizational arrangements that create shared leadership and ownership for the CCI, an intermediary to support the initial vision and collaborative leadership groups, diversified funding approaches, and political support. These findings add to the literature about the growing number of education-focused CCIs. The study’s primary recommendation—that institutions need to work across boundaries in order to sustain CCIs organizationally, financially, and politically—can help policymakers as they develop new collaborative approaches to achieving educational goals.

Predictors of Patient Activation Among Underserved Patients in a Nurse-managed Health Center: A Pilot Study

The concept of patient activation has gained traction as the term referring to patients who understand their role in the care process and have “the knowledge, skills and confidence” necessary to manage their illness over time (Hibbard & Mahoney, 2010). Improving health outcomes for vulnerable and underserved populations who bear a disproportionate burden of health disparities presents unique challenges for nurse practitioners who provide primary care in nurse-managed health centers. Evidence that activation improves patient self-management is prompting the search for theory-based self-management support interventions to activate patients for self-management, improve health outcomes, and sustain long-term gains. Yet, no previous studies investigated the relationship between Self-determination Theory (SDT; Deci & Ryan, 2000) and activation. The major purpose of this study, guided by the Triple Aim (Berwick, Nolan, & Whittington, 2008) and nested in the Chronic Care Model (Wagner et al., 2001), was to examine the degree to which two constructs– Autonomy Support and Autonomous Motivation– independently predicted Patient Activation, controlling for covariates. For this study, 130 nurse-managed health center patients completed an on-line 38-item survey onsite. The two independent measures were the 6-item Modified Health Care Climate Questionnaire (mHCCQ; Williams, McGregor, King, Nelson, & Glasgow, 2005; Cronbach’s alpha =0.89) and the 8-item adapted Treatment Self-Regulation Questionnaire (TSRQ; Williams, Freedman, & Deci, 1998; Cronbach’s alpha = 0.80). The Patient Activation Measure (PAM-13; Hibbard, Mahoney, Stock, & Tusler, 2005; Cronbach’s alpha = 0.89) was the dependent measure. Autonomy Support was the only significant predictor, explaining 19.1% of the variance in patient activation. Five of six autonomy support survey items regressed on activation were significant, illustrating autonomy supportive communication styles contributing to activation. These results suggest theory-based patient, provider, and system level interventions to enhance self-management in primary care and educational and professional development curricula. Future investigations should examine additional sources of autonomy support and different measurements of autonomous motivation to improve the predictive power of the model. Longitudinal analyses should be conducted to further understand the relationship between autonomy support and autonomous motivation with patient activation, based on the premise that patient activation will sustain behavior change.