THRIVE: Community Tool for Health and Resilience In Vulnerable Environments

US National Center on Minority Health & Health Disparities (Wikipedia)

by Prevention Institute: http://www.preventioninstitute.org/component/jlibrary/article/id-96/127.html

A Community Approach to Address Health Disparities

Prevention Institute has updated its Community Approach to Addressing Disparities in Health with the revision of THRIVE: Toolkit for Health and Resilience in Vulnerable Environments.

A centerpiece of THRIVE is a set of community level factors that are linked to Healthy People 2010 Leading Health Indicators. It now features a simplified list of thirteen factors to facilitate use of the tool at the local level. 

Advancing a Community Resilience Approach to Improve Health Outcomes 

Poor health and safety outcomes, including chronic disease, traffic-related injuries, mental illness, substance abuse, teen pregnancy, and violence, are disproportionately high among low-income people and people of color in the United States.

In addition, the impact of racism and oppression increases numerous risk factors for illness and injury, including reduced access to fresh nutritious foods, fewer opportunities for physical activity, greater exposure to environmental toxins, and substandard housing and neighborhood conditions.

With the increased recognition of existing health disparities in the United States, there has been an emphasis on treatment and intervention. However, there is also a need to prevent health disparities before the onset of injury, illness, or death. Focusing on underlying factors, both risk and resilience, can save lives and money and reduce suffering.

Resilience, defined here as the ability to thrive and overcome risk factors, merits attention in order to achieve health and safety outcomes. Studies show that resilience factors can counteract the negative impact of risk factors and that effective approaches need to include attention to both. Given the preponderance of attention to risk factors, this project will highlight resilience factors that support health and safety outcomes.

Resilience approaches have tended to focus on individual measures; attention to community-level factors is also important. For example, the building blocks of healthy communities include marketing and availability of healthy foods as opposed to fast food and tobacco, safe parks, effective education, health and social services, community gathering places, and locally owned businesses.

Research confirms the relationship between such factors and health and safety outcomes. For instance, social cohesion corresponds with significant increases in physical and mental health, academic achievement, and local economic development, as well as lower rates of homicide, suicide, and alcohol and drug abuse.

Other examples of community resilience factors include environments that promote walking, bicycling, and other forms of incidental or recreational activity, jobs, a willingness to take action for the common good, positive intergroup relations, and positive behavioral norms. By strengthening such factors, communities have significant capacity to enhance health and safety.

Measuring Community Resilience

The goal of this project was to develop a tool to assess community-level resilience factors that serve as benchmarks for the Leading Health Indicators of Healthy People 2010. The tool, which is informed by research, included an environmental scan and piloting in Del Paso Heights, California; Hidalgo County, New Mexico; and East Harlem, Central Brooklyn, and the South Bronx in New York City.

A diverse, national expert panel provided guidance throughout the process. The pilot process confirmed the tools utility in rural and urban settings and for community members as well as practitioners and local policy makers. This tool can help local decision-makers close the health gap. It includes collateral materials such as training materials and preliminary guidelines to translate the THRIVE results into concrete changes in local policies, programs and priorities. 

THRIVE Overview and Background

THRIVE (Tool for Health and Resilience in Vulnerable Environments) was created to answer the question, "What can communities do to improve health and safety and reduce inequities?" Developed with funding from Department of Health and Human Services Office of Minority Health, THRIVE is:
1) a process for engaging community members and practitioners in changing community conditions to achieve better health and safety outcomes; and
2) a tool for assessing the status of community conditions and prioritizing them for action to improve health, safety, and health equity.

This overview and background document is organized in a question and answer format to respond to frequently asked questions about THRIVE, such as: Why do health inequities occur? How does THRIVE promote health equity? Why does THRIVE focuses on the community level? What's the relationship between THRIVE and the social determinants of health? What is the role of health care in reducing health inequities? 

THRIVE Assessment Worksheet

The THRIVE (Tool for Health and Resilience in Vulnerable Environments) Assessment Worksheet enables organizations and coalitions to rate and prioritize 12 THRIVE factors in their community in order to take action to improve daily living conditions, enhance health and safety and reduce inequities.

Developed with funding from the Department of Health and Human Services Office of Minority Health, the 12 THRIVE factors are based on extensive research linking medical conditions to community-resilience factors that can be strengthened for better health and safety outcomes.

The 12 factors are community-level determinants of health and safety, grouped in 3 interrelated clusters: 1) the social/cultural environment (people), 2) the physical/built environment (place), and 3) the economic/educational environment (equitable opportunity).

The Assessment Worksheet is also flexible, and allows communities to add, rate, and prioritize factors that they consider important. THRIVE has demonstrated utility in urban, rural, and suburban settings, as described in the American Journal of Public Health 2005 article, A Community Resilience Approach to Reducing Ethnic and Racial Disparities in Health.

Funding

This project is made possible by funding from the Office of Minority Health, U.S. Department of Health and Human Services.

Reviews

Like many Prevention Institute tools, THRIVE serves as a useful supplement to health-related academic programs. Feedback from MPH students includes:

"... it was enlightening to consider such factors as willingness to act for the common good or what is sold and how it is promoted."
"There were many useful asides about how to collaborate or how to prioritize problems. I also appreciated the practical examples of real results in real communities."
"I found the THRIVE tool very useful and intriguing in its simplicity, effectiveness, and broad scope of application. 'Change comes from within' applies not only to people, but to communities, and the people of the community need to be empowered to do so. Then they have a chance of bringing lasting change. THRIVE seems to be a tool that could be used by lay people and professionals alike."
"I really liked the THRIVE tool. I found it empowering for communities and for health care providers. It is also simple to navigate and easy to understand. The entire site was informative and has potential applications in the future, both in school and beyond. The resources offered were invaluable; it can be difficult to find resources if you don't have anyone pointing you in the right direction."
"I felt that the tool was very useful in breaking down what some of the key issues are within a given community." 

Associated File(s) (click to download): 

THRIVE: Community Tool for Health & Resilience In Vulnerable Environments Executive Summary

THRIVE Overview and Background

THRIVE Assessment Worksheet

References: "How THRIVE Was Developed"

THRIVE Advisory Panel

References: "The Place"

References: "The People"

References: "Priorities, Impacts, Indicators"

References: "Equitable Opportunity

Health Disparities and Community Health Glossary of Terms

 

Author(s): Prevention Institute 

Date Published: November 2003 

Media Type: pdf

"Remember when we...?"; Why Sharing Memories is Soul Food

Christmas Memories (Photo credit: Wikipedia)

by Amanda Barnier and Penny Van Bergen, The Conversation: http://theconversation.com/remember-when-we-why-sharing-memories-is-soul-food-35542

Families and friends share memories all the time; “You’ll never guess …”, “How was your day?”, and “Do you remember when …” are rich daily fodder.

Sharing memories is not only a good way to debrief and reminisce, we’re beginning to realise the process plays an important role in children’s psychological development and protects our memories as we advance in age.

Telling stories draws us together

We share memories of the past for many reasons. By telling a sad or difficult story - perhaps a fond memory of someone we have lost since last Christmas - we strengthen shared connections, offer sympathy and elicit support.

By telling a funny or embarrassing story - perhaps the time the dog stole the Christmas ham - we share feelings of joy or recognition of difficulties overcome, large or small. By sharing similar or not-so-similar experiences, we empathise with and understand one another better.

Talking about the past also helps create and maintain our individual and shared identities. We know who we are - whether as individuals, groups or communities - because our memories provide a database of evidence for events we have experienced and what they mean to us.

Even when some people missed out on an event, sharing a memory of it can shape their identity. Developmental psychologist Robyn Fivush and her team demonstrated this when they asked American adolescents to recount “intergenerational” stories: events from their parents’ lives they learnt via memories shared within the family, often around the dinner table.

Fivush found that the adolescents she tested could easily retell many of their parents’ memory stories. Most importantly, they made strong connections between these second-hand family memories and their own developing sense of identity: “my dad played soccer when he was young, so that got me started”.

Children who showed these kinds of family memory-self identity connections reported higher levels of well-being.

Teaching children how to remember

For young children, telling memory stories teaches them how to remember. From as young as two years of age children begin to show signs of autobiographical memory: memories of themselves and their lives.

Although these earliest memories often are fleeting (it is not until our third or fourth birthday that we start forming memories that last into adulthood), they are important because they show that children are learning how to be a rememberer.

Research by developmental psychologists consistently shows that the way parents and others talk to young children about the past is crucial for their memory development.

One of the best ways is to use what we call a “high elaborative” style. This involves prompting the child’s own contributions with open-ended questions (who, what, why, how) and extending on and adding structure to the child’s sometimes limited responses. Together, the parent and child can then jointly tell a memory story that is rich, full and comprehensible.

Children whose parents use this elaborative reminiscing style subsequently show stronger and more detailed memories. sean dreilinger/Flickr, CC BY-NC-SA

Consider this example from one of our studies where a mother and her four-year-old son reminisce about a favourite Christmas ritual:

Mother: … and you and Daddy put the Christmas tree up together, and then you put on decorations! What decorations did you put on?
Child: Um … the Christmas balls!
Mother: That’s right! Daddy bought Christmas balls and stars to hang on the tree. What colours were they?
Child: Red and gold.
Mother: Red and gold. Pretty red balls, and gold stars.
Child: And there was the paper circles too.

Notice how the mother guides the progress of her son’s recollections. She is mindful too of letting him contribute as much as he is able, scaffolding his memories with appropriate, open-ended and informative cues. She also reinforces and praises his contributions.

Not surprisingly, children whose parents use this elaborative reminiscing style subsequently show stronger and more detailed memories of their own past experiences.

Preschool children who are exposed to this style of reminiscing also develop stronger comprehension, vocabulary and literacy skills. And because we tend to remember and talk about emotionally meaningful events - events that make us happy, sad, scared - elaborative reminiscing helps children understand and learn to navigate difficult emotions and emotional memories.

These early practices have long-term consequences. Older children whose families narrate and discuss emotion-rich stories around the dinner table report higher levels of self-esteem and show greater resilience when faced with adversity.

It’s fine to disagree

Conversations about the past often require some degree of negotiation. Many studies highlight the value of collaborating in recall. That is, giving everyone a voice rather than letting one narrator dominate; particularly one voice that narrates other people’s memories as well as their own.

But what if someone seems to be telling the memory wrong? You’ve probably experienced the frustration of a brother, sister or cousin down the other end of the Christmas table mixing up the details of an event you both experienced. Or worse yet, claiming and recalling a childhood experience that you know happened to you and not to them.

It’s fine to disagree so long as everyone gets a voice. Evgeni Zotov/Flickr, CC BY-NC-ND

With young children still learning to remember, contradicting or ignoring their memory contributions - even if they contain source errors or inaccuracies - can shut the conversation down and discourage joint remembering.

But as we get older, we realise that others may have a different perspective on events. We realise that 100% accuracy is not the only or even the most important goal of remembering. As adults, disagreements about the past may in fact be a sign of a robust remembering system.

Scaffolding memory as we age

Sharing memories may also “scaffold” or support memory as we age. In a study just published, we first asked older adult couples (aged 60 to 88 years old) to individually remember various events experienced with their spouse over the past five years. All had been married for over 50 years, making them long-term, intimate life and memory partners.

One week later, we asked half of the couples to talk in detail with their spouse about their events and half to talk in detail with just the experimenter.

Compared with young adults, older adults working alone typically find it difficult to recall autobiographical memories in great detail. But when our older couples remembered with their spouse their memory stories were more detailed than the stories of couples who remembered alone.

Although collaboration did not lead young couples (aged 26 to 42 years old) to remember more, those who reported closer relationships with their spouse tended to recall more details of events shared with that spouse, even when they remembered alone. In other words, at this earlier stage of life, shared experiences and memories might primarily be serving intimacy and identity goals.

For older couples who have invested in strong, intimate relationships, they increasingly might need and look for external memory scaffolding as their internal memory abilities decline. These older couples may then start to reap the cognitive benefits of what they sowed with their partner, families and friends in a long life of living and remembering together.

If you have no immediate kin close by or close, do not despair. This research shows that it is how we talk about the past with loved ones that counts, not simply the biology of who we talk to. So this Christmas, come together with your “families”, whoever they are, and share one of the greatest, uniquely human, gifts of all: the gift of memory stories.


This article was originally published on The Conversation. Read the original article.