Fairness First Episode 2

Community Campus Partnerships: Maternal and Infant Health Equity

With Carmenlita Chief

Episode Introduction

MARCA: through my work at the guidance center I noticed the problem of women who are struggling with addiction losing their kids after their kids were born which prompted the idea of what would it be like if we kept mother and baby together during addiction treatment?

ALEXANDRA: That was Marca McCallie, Founder and Board Chair of the non-profit organization, Sage Home in Flagstaff, Arizona. Sage Home is dedicated to fostering healthy family attachments through the challenges that come with substance abuse addictions. According to Marca, only 1 % of substance abuse treatment facilities in the U.S. keep families together during recovery, even when re search shows that keeping children with their parents during treatment is a vital factor for ensuring successful long-term treatment outcomes.

In this episode, how community organizations like Sage Home are partnering with researchers at Northern Arizona University to address pressing health equity issues.

I am Alexandra Samarron, your podcast host.

ALEXANDRA: From the Southwest Health Equity Research Collaborative and the Media Innovation Center at Northern Arizona University, this is Fairness First, a podcast dedicated to exploring issues of health equity in the Southwest – with a special focus on health equity in Northern Arizona. Here, we believe that good health starts in our homes, neighborhoods, schools, work, and other places that we find ourselves spending time in our communities. Most importantly, everyone deserves a fair opportunity to be as healthy as possible in their community despite where they live. I’m Alexandra Samarron, your podcast host.

\Co-host Carmenlita Chief

ALEXANDRA: Hi welcome back. I’m joined today by my co-host, and dear work BFF, Carmenlita Chief, who I will be referring to as Carm, Hey Carm!

CARMENLITA: Hey Alexandra, ya’at’eeh. I’m so happy to be here and co-hosting with you today.

ALEXANDRA: Yes, thank you. Please tell our listeners a little about yourself and the amazing work you do.

CARMENLITA: I’m a senior program coordinator here at SHERC and one of my main  roles is helping to promote community-engaged research, which is research that is co-led by community groups such as non-profits, city programs, and Indigenous nations, for example.

ALEXANDRA: I know that one of the ways that you do this work is through the CCPS program. Could you describe more of what that is?

CARMENLITA: Yeah! Sure, so the CCPS stands for Community-Campus Partnership Support, and it is this incredible resource provided through SHERC that helps to nurture the development of new partnerships between a community partner and an NAU researcher.

ALEXANDRA: Okay, so it sounds like the CCPS program is focused on relationship building, but I’m wondering, how exactly does it support this process?

CARMENLITA: In a nutshell, this program provides funding support up to $5,000 for new partners to meet in-person several times over the course of 1 year to get to know each other better. We look at these meetings as opportunities for the community and NAU partners to discuss 1) mutual areas   of interest, 2) community health needs and 3) how they might be able to address specific areas of need through collaborative research.

ALEXANDRA: That’s such a cool resource, Carm!

CARMENLITA: I know huh?! I’m laughing because my rez just came out [LAUGHS]

ALEXANDRA: Nice, let it out.

CARMENLITA: Okay, so because I have this opportunity to stand on my soap box, or AKA my milk crate because that’s how we do on the rez [LAUGHS], I just quickly want to mention that since 2018, SHERC has funded 12 of these CCPS partnerships. And, holy cow! These partnerships are doing amazing and much needed community-engaged work to advance health equity. We have folks who used the CCPS program to inform and develop health interventions, some evaluated programs, while others created deeper community connections, built coalitions and did work to inform policy as well.

ALEXANDRA: Ah yes! That sounds great. I do know that later in this episode you’ll be guiding us further into dialogue about community-campus partnerships but what can we expect before we get to that?

CARMENLITA: Well, I do want to make sure we provide our listeners with a more solid understanding of how SHERC’s CCPS program helps to build community-campus partnerships like the one that Sage Home, who you mentioned earlier in your introduction, now has with NAU. But also why this step of partnership building is often overlooked or not given enough weight in a collaborative research process.

ALEXANDRA: Okay! Sounds good, Carm. You know what I was thinking as you were saying  that? All of that partnership talk sounds kind academique, so how do you think we could ground this conversation?

CARMENLITA: Yeah, that’s a good point. I was starting to think that myself because in my role as a community-engaged researcher I often have to go back and forth in between research speak and community speak especially when I’m in Indigenous communities talking about research. And sometimes, it’s not easy. It’s not cut and dry because I have to be able to relate to the issue as someone who belongs to a community that’s been disenfranchised, marginalized, and underserved.

ALEXANDRA: Yes! I can relate to that as a Mexican immigrant. As you said, I also need to connect personally to whatever health equity work I decide to engage in, and in this case we’re having a conversation about partnerships between community and research, but we are also wanting to highlight how such partnerships have a direct impact in the community. For instance, the partnership that Sage Home has with NAU is focused on keeping children together with their parents during substance abuse recovery, which is an issue that many of us can relate to.

CARMENLITA: Totally! This is why you’re my work BFF. We get each other.

ALEXANDRA: [LAUGHS] Awww. That’s sweet! [LAUGHS]

CARMENLITA: No, but seriously! I think this is so important to hear. I want to pause for a bit because we need to be able to recognize that we can’t completely detach ourselves and our role as people who are in academia, who we really are at the end of the day, you know every day, you know, I’m Navajo and you’re Latina and that’s who we are because that’s specific life, lived experiences go along with those identities and so I’m really personally interested on how you relate to the issues that sage home is trying to address?

ALEXANDRA: Yeah! Well, Carm, when it comes to substance abuse that’s a very personal experience that I have and that I am very familiar growing up, you know my dad had a drug addiction issue, which resulted in my mom separating from him because that drug addiction created some violent dynamics that made things kind of unsafe for my mom and I to navigate and so at that point my mom decided to just separate from my dad so that her and I could have a safer life and so but I think that it is important to highlight that when we talk about substance abuse especially in communities of color we need to consider different historical events that have perpetuated trauma in a lot of communities of color that has resulted in substance abuse being a coping mechanism, which then contributes to the detriment of family and that family unit, which is what happened in my case. And often something else to add to that when it comes to substance abuse in communities of color we’re trying to make the point to not criminalize substance abuse, but actually see it as a health equity issue.

CARMENLITA: exactly, I really appreciated you sharing that because I have a similar experience also with my father. So when i was a young girl about kindergarten age. I specifically remember how common it was for my mom to take myself along with her and drive around, sometimes she brought a friend with her, to look for my dad because of you know he was struggling with some substance abuse addiction at that point and i thought that was a common experience that was shared with my classmates and my friends you know I thought that everybody’s mom had to do that and everybody was looking for their dad =on the weekend, which later i found that not necessarily to be the case so in relating our experience on this topic what i started to notice here is that the main characters in this particular situation is it has been our fathers, and so that makes me think about the situation in which the family member who is dealing with substance abuse addiction is the mother because in both of our cultures you know our mothers are the ones who hold it down they hold down the family and make sure that everything gets done and things are taken care of so what they could treatment programs look like for mothers who are going through this experience and what kind of support you know adequate support do they have to get through that wh8le also keeping their family together.

ALEXANDRA : YEAH i agree to a lot of what you just said i think especially there is exciting to see that there is community leaders that are trying to work together to end that cycle and really tend to the needs of mother who are struggling with substance abuse and making sure that families are kept together.

Segment #1: CCPS Dr. Teufel-Shone

CARMENLITA: So Alexandra, bringing this back to research partnerships. You spoke with Dr. Nicolette Teufel-Shone who is a public health researcher and co-director at SHERC. She co-leads the Community Campus Partnership Support program alongside me.

ALEXANDRA: Yes! So in my conversation with Dr. Teufel-Shone, she provided more information about the focus of CCPS, and the components to think about when building partnerships between community leaders and researchers. Let’s go to that conversation.

TEUFEL-SHONE: So I serve as a co-director for the community engagement core of SHERC and one of the things that we as folks who are focused on community campus partnerships have noted it’s often times difficult for investigators and communities to figure out where their common interests are how they might be able to work together and so the purpose of the community campus partnership support program is to provide some resources to both communities and university investigators to sort of nurture that relationship. [1:56]  

ALEXANDRA: Yeah I think that’s awesome because I think that’s a step that in research tends to be skipped a lot of the times and you know building relationships and trust is such an essential element to research and especially in health equity research.

TEUFEL-SHONE: Let me address why this funding is needed. As you said Alexandra, a lot of the times when you look at ongoing collaborative research projects , they just start from the point of being partners and then they move through how they may have worked together to come up with a plan how they’re gonna collect data, how are they going to implement their plan and there’s little attention spent on how did that partnership get rolling and there’s a lot of different way partnerships get started between universities and communities.

If you’re fortunate you can slide in on someone else’s partnership and so you become an additional collaborator, but if your research or your as a community agency staff member, if your interests are something different that has not been addressed before then you’re really in the position of starting something new.

ALEXANDRA: Dr. Teufel Shone also described how CCPS supports community and research partners when they are not located in the same place.

TEUFEL-SHONE: It may be that here in Northern Arizona a lot of the times potential partners are actually geographically distant from each other. We have partnerships from many of the Northern counties in Arizona, so all the way over to Mohave county and Apache and Navajo county so these funds can help support travel time. Maybe even an overnight stay for either the university or the community partner, so that you have the essentially the support to get to know someone.

ALEXANDRA : While listening to Dr. Teufel-Shone, I wondered about who takes the lead in the CCPS partnerships. She said that either the community partner or research partner can take the lead in the collaboration. We can think about this in terms of any relationships that we engage in, right? Like with friends, co-workers, even lovers, and when I think of relationships the first thing I think about is trust. Do I fully trust this particular individual to engage in health equity work? Do we share the same values? How will then decision making look like when thinking about roles and who takes the lead? Let’s see what Dr. Teufel-Shone had to say about trust.

TEUFEL-SHONE: what we do know about effective health equity efforts and research is that most of them are grounded in really solid trusted relationships and we also know that it’s often times difficult for community and university partnerships to initiate the relationship in a trusted…in a trusted aaah… in a trusted process that allows them the time to get to know each other. So we’re really hoping this mechanism can offset the potential for distrust between community and university partners and that we can really contribute to a strong foundation for community and university partners to build an effective idea and to be able to launch that idea within a year of them working together. 

Segment #2: Sage Home and NAU Partners

MARCA : What would it be like if we kept mother and baby together during addiction treatment?

ALEXANDRA: I want to remind our listeners that that was Marca McCallie who posed this important question at the very beginning. It was THIS question which ultimately encouraged Marca to explore a possible research collaboration with NAU partners and doing that through the CCPS program.

At this point, we want to wrap up this episode by tying everything  we talked about so far into this conversation Carm had with Marca and her NAU partners who gave us insight about their CCPS experience and re-imagining ways to keep mother and baby together during substance abuse recovery programs. Take it away Carm!

Carmenlita Chief: Introduction to Partnership

CARMENLITA: Ok. Well with that, let’s jump right in! Marca McCallie founded Sage Home because she, as a licensed therapist, wanted to create a place where moms and babies could stay together while mom received addiction treatment and recovery support in a safe and trauma-informed community. She also wanted Sage Home to be a place where moms could connect to the community and be assisted in finding stable work and housing.

When Marca previously worked for a community mental health center in Flagstaff, she noticed women struggling with addiction were losing their babies right after birth. The separation is stressful for both mom and baby, which can hamper the healing process and even reverse it dramatically. In Northern Arizona, there are no family-centered residential treatment centers and it’s something that’s desperately needed in the region. Here’s Marca:

 MARCA: Yeah, and that’s a national trend. Less than 1% of treatment facilities in the country keep families together during treatment.

CARMENLITA: But in order to enhance services that Sage Home could provide to this unique population, Marca says she needed a more solid understanding of how the state child welfare agency operated and that’s where Rita Wright happened to step in.

RITA: My background is child welfare so I worked for child protective services in different capacities for about 10 years so my experience is working with parents who’ve lost custody of their children because of their addiction and so Marca and I had aligned interests in how can we prevent women from losing their children due to addiction issues.

CARMENLITA That was Rita. She is an assistant clinical professor in the Social Work Department at NAU. It was Rita who first found out about the CCPS program and thought it would help get a conversation going between Sage Home’s Board of Directors and NAU about possible collaborating. Rita proposed the idea to NAU colleague, Emery Eaves, because she saw the value of what Emery as a researcher could contribute.

 EMERY: My name is Emery Eaves, I’m an assistant professor at NAU in the Anthropology Department. I’m a medical anthropologist.

EMERY: My research has mainly focused on chronic pain in the past and lots of different substance use. And recently I’ve been getting more and more interested in neonatal opioid withdrawal syndrome…

CARMENLITA: Briefly, neonatal opioid withdrawal syndrome is a group of health problems that occur when infants withdraw from  opioids that they were exposed to in the womb before birth. Here’s Rita and Emery describing the goals they had going into the partnership with Sage Home.

RITA:  We all want to produce better outcomes for this population, so it was really sorta natural to connect practice and research. And it’s nice that we’re all in Flagstaff…in this  community that so desperately needs this intervention…so my default is typically to think about how like, “Well, how can we change policies to address this?” But Marca was already, you know, starting this program that’s really a hands-on intervention in this community. So I think our interests just aligned really naturally and it was supportive of Sage Home to have NAU on board, and it was supportive of my interest to be able to partner with some practical intervention…

EMERY: Like Rita said, we just kinda naturally have similar…a similar motivation for why we were all wanting to be interested in this topic which is ultimately some policy change and being able to show that something like this could work. That maybe child removal isn’t the best option so we were all kind of thinking about   ‘How could you look at something like what Marca is doing, really grounded in the community, but also make sure that it has the biggest policy impact in the future?”

Benefits of Partnering & CCPS

CARMENLITA: For Marca, Rita and Emery, the benefits of partnership building through the CCPS program were substantial. Let’s listen to them share what they experienced to be the highlights of their journey….a journey to combine practice and research to advance policy change.

RITA:  I think that’s a huge issue across the board between like addiction treatment, the medical field and the child welfare system. They’re all so siloed. And they are all working with the same client but towards different outcomes and so it’s really to the detriment of the family system so it’s really fortunate that we happened to have 3 people with expertise in those 3 different systems who can hopefully really effect change on a bigger scale.

MARCA: I think that it’s been MASSIVELY helpful in the realm of Sage Home, the nonprofit. Because of the partnership, because of the interdisciplinary health team, we qualified for the final round of a really big addiction grant that would fund…basically our whole programming budget called the Vitalyst grant, so we are interviewing for that in February and this team at NAU was a big reason why we were considered for that grant because not only are we wanting to provide a service that we think it’s necessary, but we also want to make sure that we’re researching that service to be intentional about how we work with this population.

CARMENLITA:  Emery pointed out that a huge part of their partnership building success was the result of getting to know each other outside of formal conference calls and meetings. The team used part of their CCPS funding for them all to attend a behavioral health conference, allowing them to spend more casual time together – from travel to eating to attending sessions. Here’s Rita chiming in on why this was so meaningful.

RITA: It also gave us time to sort of know what drives us to do the work that we do and sometimes that gets missed when you’re just all working on a grant proposal. You don’t really get to understand the passion behind why everyone is doing the work so I think that helped to develop the relationship also.

CARMENLITA:  And the team appreciated the conference opportunity because it helped them to meet others who were doing similar work across the state and this expanded their resource network as Marca alludes to here:

MARCA: When it comes to Sage Home, this project has and partnerships has filled a lot of gaps that we had in our planning. We didn’t have a lot of perspectives on DCS. We didn’t have a lot of perspectives on the medical side, all the different connections we had made had given us a chance to really make a simple idea a lot more deep and complex. Whereas without this opportunity, it would have been limited to a degree that maybe it could have done harm so I was very thankful for the opportunity to get the other perspectives and the research and the participants from other viewpoints around the table.

Next Steps

CARMENLITA: In June 2019, Sage Home and NAU completed its 1- year of supported funding through the CCPS Program – a timeframe that Emery said felt very short, which is a testament to the time investment needed for developing quality partnerships between community and university. Beyond CCPS, here’s what the trio has been working on, according to Emery.

EMERY: We submitted a grant to the Arizona Biomedical Research Commission  last spring  it’s still technically under consideration because they didn’t have funding last year so we haven’t heard yet about that one but it was a decent size grant that we’re hoping if we got that we would partner on the development of an app that would sort of support women and families in Marca’s program.

The idea for an app came from observation of the… just the burden of how many appointments people are having to go to, so living in a house could reduce some of that and the idea is to maybe sorta try to reduce a little more of the need for transportation and the need to take time while you’re at work to try to go to an appointment or take time away from your child in the evening that you had at daycare all day or something like that. We’ve been working on little projects like that as we sort of try to work toward this bigger thing, too.

CARMENLITA: And not only that, but Marca also plans to organize support groups in the next 6 months.

MARCA: These moms do really need support right now as we’re gathering up the funding you know to open our doors, so we are starting a support group for parents that had their kids removed, so we’re trying to implement that in the spring. we’re pretty close to starting that and we’re ready to open up our doors. We have a few more things that need to get done and hopefully that Vitalyst grant that we’re all a part of will be a big piece to opening the doors. It does seem that trust matters a lot when moving forward on a huge partnership like this.

Advice for Future CCPS Applicants

CARMENLITA: I asked the partners what advice they had to share with others who might be interested in applying to the CCPS program.

MARCA: Take the time to build the relationships. You know, we’re very eager to jump in and just do what we’re passionate about right away but we really need the foundation. And just having that year to build the relationships, to really think through with intention how we want to move forward has been really helpful.

EMERY: I think I would say, building in a conference or some kind of team building retreat or something like that right at the beginning is very helpful. I think, maybe we still would have gotten as far as we did but we’re all so busy. We have so many things going on, so many irons in the fire that I think just having that weekend time to sit down together was a really big deal when we didn’t all and we all have children, we all have lots and lots of things going on so being able to have multiple moments over the course of the conference to be able to just be face-to-face and kind of share our interest in a very not formalized way you know we have one hour and we have to have this meeting and it’s part of our whole grant  it was a nice informal way to build that team potential right at the beginning, i think I would recommend that.

Conclusion

CARMENLITA: So we’ll let Rita and Marca wrap-up, in their own words, how CCPS strengthened their collaborative work.  

RITA:  It really helped to bridge connections like within the university and within the community and even across the state because we’re dealing with so many different systems …so us meeting kind of started our own network. Like we were the nucleus of a bigger network. [MARCA LAUGHING].

MARCA: No, definitely nucleus, yes. It’s a really exciting field in that we really are breaking through and doing some new things that could potentially change how we operate. It’s exciting.

Wrap up

ALEXANDRA: Carm, thank you so much for having this meaningful conversation and for co hosting this episode.

CARMENLITA: Yeah, no problem.

ALEXANDRA: Before we go, if researchers or community leaders want to learn more about the CCPS program, or  want to apply, where can they do this?

CARMENLITA: The easiest way to get more information about applying for the program is to visit the SHERC website, which is at NAU.EDU/SHERC.

ALEXANDRA: Spectacular! Thank you Carm. Thank you so much for guiding us through this conversation today.

CARMENLITA: Alexandra, It was my pleasure. Ahehee’. Thank you for giving me this opportunity and I’m looking forward to having more conversations about this. And to our listeners, if you have any questions for me regarding CCPS, you can find my contact information in the show notes for this episode.

ALEXANDRA: BYEEEEEEEEE!

ALEXANDRA: You’ve been listening to Fairness First, dedicated to Health Equity in the Southwest. A podcast to explore what are the social determinants of health, and what can we do to build healthier, fair and inclusive communities in the Southwest. Brought to you by the Southwest Health Equity Research Collaborative Initiative and the Media Innovation Center at Northern Arizona University.

We want to hear from you. Visit us on Facebook at NAUCHER. Instagram at NAU.CHER. Follow us on twitter at CHERArizona or send us an email at SHERC@nau.edu (Spell SHERC). Tell us what you like, what can we do better, or tell us what topics you want to listen to in our podcast.

The Southwest Health Equity Research Collaborative Community Engagement Core and the Media Innovation Center at NAU, produced this episode. It was edited by Aldric Meints. Music from https://filmmusic.io, song titled “Fearless First” by Kevin Macleod, Licensed by http://creativecommons.org . Special thanks to NIMHD grant # U54MD012388 and Northern Arizona University’s Southwest Health Equity Research Collaborative, for funding this podcast. Thanks to our Fairness First team, Carmenlita Chief, Dulce Jimenez, and Kelly McCue, from the Community Engagement Core, and Brian Rackham Director of the NAU Media Innovation Center. Thanks for making this podcast possible. I’m Alexandra Samarron. Thanks for listening.