REACH Detroit Staff

The low-income Latino families of Detroit's southwest side share many things with the African American community on the east side: they are more likely than the general population to have diabetes, and also suffer higher rates of infant mortality, certain cancers, cardiovascular disease, and HIV/AIDs. But with language, culture and geography dividing them, they don't often find themselves working together on solutions.

Over the past four years, with the help of a federal grant from the Centers for Disease Control, that has begun to change.

REACH Detroit Partnership [1]

The health disparities found in Detroit reflect a national problem. The CDC created Racial and Ethnic Approaches to Community Health (REACH) in order to eliminate these disparities by the year 2010, through local programs featuring meaningful community involvement.

Racial and Ethnic Approaches to Community Health (REACH 2010): Addressing Disparities in Health [2]

Gloria Palmisano is the project manager of REACH Detroit Partnership, one of 24 CDC REACH projects across the country. REACH Detroit staff is housed at CHASS, a bilingual health clinic that has served low-income Latino families on Detroit's southwest side for decades.

Zachary Rowe is the program director of Friends of Parkside, a grassroots organization serving low-income African-American families that is based in a public housing development on Detroit's east side. The two have been working together now for more than three years on REACH, and they agree the program offers a viable option for helping their two distinct communities deal effectively with diabetes.

A Seat at the Table
Creating meaningful community involvement in both communities was made easier by the existence of the Detroit Community-Academic Urban Research Center. Even before REACH began, the research center had established a cooperative relationship between the University of Michigan Schools of Public Health, Nursing, and Social Work; the Detroit Department of Health and Wellness Promotion; and nine community-based organizations, including CHASS and Friends of Parkside. So the center was well-positioned to serve as an anchor for the REACH effort.

"In a sense, the relationships necessary for strong collaboration were already in place," Rowe said. "The Detroit Urban Research Center engaged both communities to guide the data collection." Palmisano agreed. "Valuable time was saved at the beginning, four years ago, because the communities were already the table," she said.

Listening & Planning
Community input at the planning stage was critical. "This project has been built around the principles of community-based participatory research," Palmisano told me. "Data was gathered from focus groups made up of community people, men and women, from both sides of town. Both communities identified diabetes as the health issue they wanted to address."

In the focus groups, community members identified a number of problems they experienced with health care providers. Difficulty in communicating with health professionals was a problem for residents of both communities, and made worse for many Latinos by language barriers. Many found the clinic setting intimidating.

Photo by Edna Amparo Viruell-Fuentes

Residents with diabetes said they needed more support from their families. The need to prepare special meals for a diabetic family member, for instance, was a problem in many families, and those with diabetes said they would welcome efforts to help the entire family eat a healthier diet instead.

For Latinos, said Palmisano, "There is still a stigma attached to this disease. And our families, especially the women, tend to be very private about health matters."

For their part, health care providers surveyed by the project said they were frustrated by a lack of resources to help treat their diabetes patients, such as bilingual staff. However, none of the health providers surveyed saw a connection between culture and health.

Taking Action
The focus group and survey results guided the creation of a community action plan. "The community needs to be part of the decision-making," Rowe said. "We worked for total involvement, from the planning and advisory committees to the staffing."

The plan, developed in year two of the four-year CDC grant, looked at creating support for diabetes patients within their families, within the health care system, within groups of fellow patients, and within the community. Although the activities primarily target adults, entire families were recruited to participate because children are affected by, and often model, the behavior patterns of their parents.

A major element was the hiring and training of family health advocates, or FHAs. These were community health workers who received additional training in understanding and communicating about diabetes. Each family was assigned an FHA who would come to their home and discuss the treatment and management of diabetes. The advocates also would accompany families to medical appointments, to facilitate better communications between providers and patients, and to make sure family members were also informed.

Patient support groups were organized in both communities, and held in neighborhood locations where the participants would be likely to gather anyway, rather than in a clinic or other unfamiliar setting. And occasional community forums would be held to spread information about diabetes, risk factors, health and nutrition to the wider community.

Dealing with Diversity
Despite the careful groundwork, building a health care project for two distinct communities proved to be a challenge. Originally there were two staffs—one in the African American eastside community and one in the Latino community on the southwest side. When the staffs came together for training or other purposes, there would be problems. "Not only did we have conflicts between the two staffs, we also have intercultural conflicts among the Latinos," Palmisano said. "And we also learned about religious diversity."

Team building became a priority. REACH brought in an expert who made the staff members rethink issues such as language. "When the Latino staff spoke Spanish, the African American staff took offense," Palmisano noted. "And the way they responded showed disrespect to the Latinos." So they adopted a process to address those issues, including ground rules for when it was or was not appropriate to use Spanish in a setting that included non-Spanish speaking staff, and more staff meetings to build stronger relationships.

Last year, the two staffs were consolidated and moved to a downtown facility accessible to both neighborhoods involved in the project. That also helped. "We work very hard to sustain a good and respectful working relationship among our staff," Palmisano said.

"Overcoming cultural differences is a work in progress for us," Rowe said. "Communication is critical. We're learning to look at each community in terms of its uniqueness. Although we've identified common goals, the project has to be flexible enough to adapt to different circumstances."

Just knowing that other families were experiencing the same health problems was a big step. "Our REACH families have learned that on the other side of town, families that may speak another language are going through exactly the same thing," Rowe said. "They've discovered they have something in common. Not only the disease, but a way to deal with it. It's very empowering for the families."

2005 and Beyond
REACH Detroit is now in the final year of a four-year CDC grant. A total of 180 families completed two years with the program. A second round of CDC funding, supplemented by additional funds raised locally, means that a second group of families will soon begin to benefit from the lessons learned in round one.

One lesson is that more direct attention needs to be paid to children's health and nutrition. "We thought we'd get to the children through the families," Palmisano said. "What we've learned is that we need to expand our reach to children through the schools."

Palmisano says that they've scheduled monthly visits with a psychologist as an additional resource for the staff. "When you go out into the community, you see a lot of mental health issues, depression, anxiety, and so on," Gloria told me. "It gets a bit overwhelming for staff. The psychologist helps us with case management and building an awareness of mental health symptoms."

The community participants also said they'd like for REACH Detroit to provide more information and activities about diabetes for the communities and that there should be greater community access to these resources beyond the families in the project.

A preliminary evaluation conducted by the Urban Research Center shows that REACH participants made real gains in their understanding and knowledge of dietary behaviors and the importance of physical activity. They are also experiencing improvements in their health.

The project intends to build upon its success. Interviews with children in the next set of REACH families will ascertain their knowledge about diabetes before and after their participation. Outreach is being planned for schools in the communities.