An Innovative Collaboration is Transforming Price Hill’s Health One Doorstep at a Time
by Tom O’Neill
“Having the qualitative along with the quantitative gives us a more robust picture of what and how we impact lives in Price Hill.” – Chellie McLellan, Executive Director at Healthy Homes
The October morning draped a fog blanket over Price Hill, a Cincinnati neighborhood where 52 percent of households live below the poverty line.
Here, health statistics have historically cast a long shadow. That is changing, driven by an unusual, two-way approach to scientific research, in which Cincinnati Children’s and residents are co-investigators, actively shaping the direction—and execution—of research projects designed to improve health in Price Hill.
Healthy Homes, an initiative started in 2010 by Santa Maria Community Services and Cincinnati Children’s, employs and empowers community leaders, called block captains, who live and work in the neighborhood.
Price Hill’s children suffer from disproportionately high rates of preterm birth, infant mortality, and medical and psychiatric hospitalization. To improve these disparities, Healthy Homes engages in the community by providing familiar faces to families who rarely, if ever, go to clinics or public health agencies.
“For most people,” says Carley Riley, MD, MHS, of the Division of Critical Care Medicine, “including academics and community members alike, this kind of partnership and way of working is entirely new.”
The collaborative structure has been an invaluable part of its success.
Residents as researchers
“A community of families that are able to solve problems for themselves and each other, you cannot unlearn something like that,” says Rachel Smith, a Price Hill mother of three and an integral member of the community-academic research team led by Riley.
Co-researchers in their Price Hill street-level element: (from left, Chellie McLellan, Executive Director at Healthy Homes; Carley Riley, MD, MHS, of Cincinnati Children’s Division of Critical Care Medicine, and block captains Rachel Smith and Valerie Perez. The team focuses its research projects on pregnant women and those with children 6 and younger. The key, they say, is to meet people where they live, elevating “door-to-door science” from theory to practice.
Recently, Riley’s team has brought block leaders and other neighbors into the research sphere, training them to serve as “peer researchers.” In this role, block leaders co-conduct in-depth interviews of residents, and help Cincinnati Children’s experts interpret responses.
Since July 2016, the team has been conducting a mixed-methods study “Eliminating Health Disparities Block by Block,” thanks in part to a Diversity and Health Disparities Research Award from Cincinnati Children’s.
The aim is to identify the factors that can help block captains best identify and engage the most at-risk families, and develop trusting relationships with them.
Each family’s “pilot package” includes identifying a safe place for every infant to sleep, offering information on safe-sleeping practices, providing smoke detectors and other home-safety equipment, and at least 15 age-appropriate books for every child in the home.
The group also provides contact information for prenatal and pediatric medical resources.
Riley’s team—including parents—is also co-creating a community-based research network, through a series of co-learning sessions and shared experiences that have researchers and community members learning with and from each other to co-produce research of relevance to the community.
The network is supported, in part, by a Eugene Washington Engagement Award from the national Patient-Centered Outcomes Research Institute (PCORI).
Healthy Home’s team members from Cincinnati Children’s include a research assistant, a post-doctoral fellow and a clinical investigator. The community-based members include Executive Director Chellie McLellan and block captains such as Smith and Valerie Perez.
Progress has taken root. The Healthy Homes Block by Block initiative continues to grow its neighborhood-based social net-work, connecting families with pregnant women and children 6 and younger to resources and to each other.
“This type of research brings greater depth and meaning to statistical information,” McLellan says. “Having the qualitative along with the quantitative gives us a more robust picture of what and how we impact lives in Price Hill.”
In the first three years, the program grew from five blocks and 52 households to 18 blocks and 105 households. The ultimate goal is to identify and serve every at-risk household across Price Hill’s 145 blocks. Neighborhood stats based on data from U.S. Census Bureau, American Community Survey.
“For Price Hill, it’s of huge importance,” says Perez, a mother of four. “More families need to be reached and educated on the health risks of not seeing a doctor can take on them and their children.”
The power of stories
Such data, gathered through stories, helps inform the larger Cincinnati Community Health Initiative.
The network of block leaders and captains has been instrumental in overcoming skepticism among Price Hill residents about important health messages. Their involvement also enriches how health care providers understand the people behind the label “at risk.”
“What’s interesting,” Smith says, “is the sense of community you get by living here and how the residents do not see themselves as living in poverty, even though from a societal standpoint, they by all means are. If they are rich in religion and in family, they do not see it as poverty.”
For Riley, her involvement in the program brings a range of rewards.
“It has brought greater richness of understanding, increasing urgency for action, and a greater breadth and depth of potential solutions to our work,” she says. “Seeing this evolution is deeply motivating and inspiring.”