 Good morning, welcome to the Orange County Alliance for Community Health Research Workshop Series. I am Jacqueline Tran and I'm with the OCACHR as well as the Orange County Asian Pacific Islander Community Alliance, OCAPICA. And welcome here to the UCI campus. I wanna take just a quick minute to debrief on the exercise and then we can get started. But I have to say that this is the fastest group to ever sit down. When I said, oh, we have a whole minute left. Everyone's like, okay, I'm done. And I thought that was very interesting. I had a couple of comments. One was, are we supposed to like this? Which I said, I don't know. I also heard that we were the most obedient group, totally following rules, and then that it was a little eerie to walk into the room and you're not sure if you're in the right place or not. Any other thoughts, comments? Couple of people said I cheated or they're really good lip readers, or lip speakers. Okay. Someone else said they whispered, right? Lot of folks seemed to have a really hard time not speaking, which I thought was great. Any other? What's that? It was Maui, because you feel like you want to say something. Okay, that's a great comment. Right? And I, yeah, no, that's a great comment. And that is ironic since we're on a university campus where we read an awful lot of information. So that kind of cues into some of the discussion we'll have today. Any other thoughts, comments? Yeah, no, that's great. Any other thoughts or comments? Yeah, and some folks went back and added information after they met a few people. They wanted to inform them more, which is a great thing. Yeah, so there's no right or wrong answer and we will actually continue this dialogue a little bit later, but for an observer, I actually thought there was actually eerie and quietness, but there was a lot of positive energy, lots and lots of smiles, lots of waving as a greeting, lots of like, Mo said, bowing, just different body language, but people were also very open. People approached each other, people didn't kind of act standoffish, right? And people who didn't have a partner actually sought out someone to speak to and you didn't want to stand alone with just a card. So maybe the words were missing, but for an observer, there were some other things that were going on that we may not have been aware of, but that I also thought were very positive in lieu of the use of words. But I think the comment about reading the cards is really great, but I didn't retain any of who I met is actually a key point that we'll keep discussing later today. So thank you for engaging in that. So you're here for the building successful partnerships workshop. And as I mentioned, it's part of a series of workshops from the Orange County Alliance for Community Health Research. This is the third in the series. And if you are a return participant, thank you so much for continuing on this journey with us. I wanted to highlight the space that we're in. We're here on the UCI campus as you're well aware and we're here in the university club, which as you can see is a beautiful space. It was established in 1967 and is actually a very busy hub for the university in terms of community gatherings and events. And if you didn't know, you can also have a wedding and a wedding reception here. So it's a wonderful resource. I also wanted to highlight that UCI is one of the 10 UC campuses in California. And I didn't know this, but it's Orange County's second largest employer. And we've also had three Nobel prize winners from the university. So that's super exciting and something to be very proud about. And if you all didn't know, the first law school cohort will be graduating this spring, 2012, a couple of buildings over from UCI. So if you've been here and seen UCI grow over the years, it has really become one of the premier UC campuses with an MBA program, a law school, public health, pharmaceuticals, it really is a great resource for our community. And so I know we're meeting here in this space with each other, but I really hope that you do see UCI as a larger resource in terms of faculty and researchers. And as we talk about community engaged research that we can help build some of those bridges with the resources, the rich resources that are here on the campus. This is an overview for some of you. As I mentioned, this is a series of workshops. And really the goal of the workshops is to increase opportunities for community and academics to partner in health research here in Orange County. And the goal is really to build community academic participatory and participatory action research. And the goal of the group of workshops is to skills build, to network, and then also provide opportunities for technical assistance and support. And as part of the participants of this workshop series, there is support from individuals like myself, as well as faculty mentors from both of the academic partners that are a part of this partnership to help you either strengthen your own organization's program evaluation, or even look at opportunities to partner for future funding opportunities. Again, the Alliance is, who is supporting this opportunity. These are the partner agencies here in Orange County. The Alliance was established in 2011 as a collaborative partnership. And the goal is to really bring Bench to bedside sooner, faster, and better for our communities. And we are housed here at UCI under the Institute for Clinical and Translational Sciences, which is one of 60 programs across the country. And we really hope that these workshops are helping to engage the conversations around community-engaged research, and how do we create a healthier community here in Orange County. So this is the training objectives and outline for today. We're gonna focus not only on the opportunities to build successful partnerships, but also some of the challenges of working in partnerships. We're gonna talk a lot about communication. We're gonna discuss some suggestions for protocols or procedures in terms of structure and decision-making that may help to foster successful partnerships. We also provided some resources for you for those types of protocols and policies in your packet. And then we're also gonna get a great treat later in the morning in terms of hearing from those who are engaged in community and academic partnerships at various stages in the partnerships and hear from them what the strengths and challenges in working in partnerships are, okay? And then of course, hopefully we'll network in a way that helps you better retain the information about who's in the room. So I'm gonna get you up and out of your seats already. We're gonna do another group activity. And I'm gonna start by having you number off from one to six and then you're gonna get together at a table with your group, okay? So Amal, you're one. So how does everyone feel? Like, I think relieved you can talk for one. Everyone's like, oh my God, can I talk now? So this was my favorite look all morning. So if you could describe the game in one word, what would it be? Confusing, frustrating, fun, okay. I felt like learning a new job every time I went to a different table. How about non-observers? Non-participants, sorry, some folks trickled in a little bit late who just were watching you all. Yeah, there was some angst in some folks, yeah, yeah. What did you guys expect at the beginning of the game? Better instructions, okay. Order, yeah. I can share that on some of the instructions folks numbered things because they felt they were not in order or in an order that worked for them. More communication. And verbally. And verbally. Consistency. Did it help that you did have some time at the beginning to read instructions together and talk? And at what point did you realize that something might be different? Right? Because they might have a different idea when they write a different table and then they come to our table. They might think differently. So it's like the complex of understanding. Right? It's okay, because you get a public written apology for everybody. Yeah. So I have to say you guys got resourceful really quick and started using whatever equipment was around you which I thought about banning but it was actually very interesting because people were like. You know? So there was some strong feelings behind the written word. And how did, well how did you deal with it when you realized there might be something different? I'm gonna pick on Vitana a little bit because he said when the new person came in they had a different idea. So then if you were a new person, what did you do? Okay? Some folks definitely did. Some folks observed for a little bit before. They were like, I don't know what these people are doing but all right, following the rules. Okay? It was sort of once you're sitting back and you just sort of play out the other one and sort of get engaged. All right. So of the folks you said it was fun, how did it feel like? Clearly a little different than some other people who didn't think it was so fun. Right. So let me ask, when you wrote notes did it help or did it confuse more? But how did you feel? Did you feel like? Okay, confused. Did you feel outnumbered a little bit? Intimidated? Right? Okay. Teresa, here we go. Julianne. Any other thoughts? So folks didn't like that you didn't get to talk but you guys were quite creative and started writing very fast big worded notes. Some of you were like, no. Hearts, you know. Was that, you know, emphatically, right? Hey, pay attention. This is what I'm trying to tell you, right? And some folks, a lot of movement, a lot of facial expressions. Some folks just sat back and said, whatever you want to do, smine with me. I don't know, Laura, if you have any other comments as an observer or you guys came up, you know, you're like, what the heck? It's okay. And then are there ways that this could have been improved besides talking, you think? Order, someone said, right? Rules. But did you have time to do that? Chandra had her hand up. Yeah, I was gonna say. On the time that everyone plays and that everyone trades together. Cause people were moving tables like mid-hand and just sitting there and, you know, one person we dealt in and then the two more people sat down. Right. Right. Teresa, you had your hand up. I was in Iowa, when I moved to the new table, I just kind of talked to one of those next to me or not talk to the two people down there. And then I'm gonna, the third person, or the other person came from the other team came over. I started talking to them. So we just kind of had a side conversation about everything else was going on and then we all kind of came over to the stage. Right. I don't know about other people, but I didn't figure out that there was a different instruction until I actually got back to my seat. Oh. So I didn't know, you know, there are different things going on. So once you don't know, it's how you can be prevented. Right. But what was it that cued you when you got back to your seat that there were different instructions? Right. Ernesta? Individuals were still at the table. So the new people that came in, it would be interesting to find out if the new people take charge when they came to the new table or was it the people who was at the table was in charge. That would be interesting to find out the dynamics that who was in control of the table if you were still there or those who moved to the table. Right. It would be interesting to find out. Right. Yeah. The Vitana. I think that should be a person who was in charge of the coordination of the whole table instead of everyone jump and throw out all the ideas. There should be an agreement and a person who could coordinate all the partnerships. This is the sort of procedure that you'll have to follow and only that person in charge instead of the whole table can choose the person who gets you at the table. Okay. In the back. I was trying to wait and see what was going on and see if I could use the wait but I noticed it was too late so I was waiting for the wait. For me, the whole is high, it's not whatever. So I was trying to stand up for someone else who I thought should have won. You got stared down? I was like, wait a minute. That's when I really realized not just the, I thought the difference was five minutes versus five rounds but then I realized, no, it's more than that. The actual instructions are completely different too. So, usually I'll stand up for that person but that table is not going to let me stand up. So you felt intimidated by your group? Going with the flow. I usually don't do, but it's hard to live. But that's interesting. You said that, right? That's not what you usually would do but put in a position where you were a little bit outnumbered that you couldn't speak. Okay. Cause some people spoke very loudly with their words. Sorry, so you had your hand up. Julianne? Okay. So this is fabulous. And think about then all the things you shared with me and how that may apply to partnerships. Right? So there were lots of assumptions. We all got instructions and they were in English. I did not trick you in that sense but even people at the same table read the instructions very differently, right? I would say that 80% of the rules were the same and then the high card, if there was a high card or a low card was different and then in which direction to go. And if you remember, we numbered off one, two, three, four, five, six. I don't know how you decided which way was up or down or the next table. And some people were shunned away from tables. People walked up to a table and they weren't welcomed in. So they went to another table. They still were not welcomed in at some other tables. So it was really interesting, right? And again, there were no right or wrong rules in terms of what was a winner or a loser per se but if you think about it, the instructions were in English. I think you're all pretty proficient in English. You had a chance to talk about your interpretation of the instructions and you even had a chance to try out your instructions. Chandra, go ahead. No, so Ace was high at some tables. So all the cards, there were no face cards, right? But Ace was high at some, Ace was low at others and then Trump cards were different at various tables. So at some tables, the heart was Trump, everything and in other it was Spades, okay? But those are some pretty key minutia that change the dynamics of the game, right? And at first, like you said, new people, some new people jumped right in and said, whatever, you're wrong, these are my rules and some new people said, and it depended on the size of the table too. Some tables were pretty big and some people actually didn't even have a space to sit down when they walked up to a table. So they kind of observed and then took a little time before they decided if I want to sit down or not. Weren't sure if I want to join the group, right? And I want to go back to Vitana's comment about could someone, even without words, take in charge and help to coordinate the group? Like at some point, people started pointing out suit cards, right, to help people understand, no, this is Trump or this is high. There's some very infabic, you know, communication going on, right? And rules change. Does that ever happen in your job? For me, it's daily these days, especially working with the federal government, like daily, like yesterday, two days ago daily. Rules change. We don't all necessarily have all the information and we don't always have all the information. We can choose to play. We can choose to wait until the next round if there's a next round, right? There are lots of different things that are going on there. So I think it's amazing how hard it is for this group not to talk, which is a wonderful thing. But even if we did talk, right, I think Vitana's point was, well someone should coordinate. Does that mean that with words, things necessarily become clearer or does that also cloud? And how do you use your choice of words to communicate with folks, right? So some people chose very emphatically to draw bigger signs. Bigger signs means this is really important. You know, some folks chose to explain with as much possible detail as they could fit on that card so that someone else could have as much information as possible. But each one of you functions differently, right? I think the first example was perfect. It was nice to read everyone's card, but I retained absolutely nothing. So I feel very bad about that networking opportunity for you, so I'll make it work. But, so some of us are auditory learners. I'm a very auditory person and even webinar recordings don't work for me. If I am in the space and I can hear, I retain what I've learned a lot longer and a lot faster. Some folks are very visual, right? They need some sort of image, something to associate with for them to retain the information. So it might be a voice, but it might be a face. Like reading is nice, but I read a lot of words all the time, whether I'm gonna remember that or not. And then some folks are really kinesthetic, right? Doers. And then some of us, as we grow and age, also become a little bit of all of that, right? Some may be more than others, but we may need a little bit of all of those things. It's kind of like the quote where they say, if you teach a man to fish, right? Versus just giving him a fish, he will feed the village forever. But if you just give him a fish once, how will he know to go find the fish next time? Or where the river is if you didn't help him find it, right? So remember, this was in English. And we had rules and instructions. We even had a chance to chat and talk about that. And yet we still struggled a lot with how to communicate and negotiate how to move forward with change. And but change happens all the time. And wouldn't it be a surprise if a funder gave you some guidelines that you didn't necessarily fit right into? Does that mean you just don't play? Right? So, thanks for entertaining me. You guys have been such a wonderful group this morning. In a very good way, really. Yeah. Right. Right. So I was gonna ask that. People were bold enough not to break the rules. But what if someone did? And how do people decide it was okay to start writing notes? Did you see other people writing notes? Or what compelled you to say, well, I'm gonna become very resourceful. And I might not have my voice right now, but I do have a way to communicate with you with my words. I'm gonna ask the folks who started writing to share how they felt that, I'm not breaking the rules! Because Jackie's watching, but I am helping to facilitate more information flow. Right? Anyone wanna be brave enough to share? Not calling you out that you broke a rule, but we don't always have all the resources, right? So we don't always have a voice. We may not always have a million dollars. And I can tell you, I can spend a million dollars pretty quickly. Right? But we still have to make do. So why did folks start writing notes? Were there no rules about it? Was that why it was okay? I didn't say you could or you couldn't? Okay, there's some nodding. Yay, yay. It's like a trick question. And you felt you weren't because the rules had said, yeah. Okay. And even though they all said, go! Good luck! Next level! You were like, no, thanks. That's actually important too. I mean, folks have talked about a new person coming into the table. And I shared with you, not everyone was welcomed. Right? They followed the rules, but they weren't invited in. Right? And then some people were supposed to leave and didn't want to leave. And they're like, I don't know what's out there. Right? We would not know what to do if we did not have over here. Found a way to try and create that sort of sense of cooperation or, you know. Yeah, yeah. I mean, we didn't acknowledge this, but laughter was kind of a cue that it was okay. Right? And when someone just disagreed and they couldn't speak, some people were, mm! You know, like, that's mine! Or, I won! Yeah! Right? But we, you guys all created a norm. Right? And then when it wasn't a norm or someone disagreed, there was emphatic communication to let you know that. And everyone kind of was like, oh wait. Right? That's always very helpful, yeah. It's kind of like the first activity. A lot of folks said it was a little eerie walking in with nobody talking but people moving around. Right? But again, it's sometimes we walk into a different space. Sometimes we walk into a different community. And maybe I have a PhD in all the skills training in the world, but I don't know all of the nuances within this group. And it might be the building next door. It doesn't have to be 3,000 miles away. Right? Or it might be the CBO down the street, serving the same exact population, in fact. But if we don't communicate and talk, there can be a lot of differences and assumptions and rules that we play by. And I like how much people want rules. It's amazing, it's great. And then I bet you there are people in this room who are like, no more rules. The less rules, the better. Like, one rule is do what you need to do. Right? I don't want a sheet with 10, 20 things. But it's very interesting. Actually, that's perfect for later. Chancellor, go ahead. So you became more informed. More information to make a better decision. Right? And that's what a lot of you do for your clients. Right? Not telling someone what's right or wrong, but giving them more resources to make a better informed choice. Right? Sometimes you're stuck between a rock and a hard place. And there isn't a winning choice, but you still have to make a choice. Right? But the more information you have may help you make a better choice. Any other thoughts, comments? You guys are so quiet again. So I want to thank you. I hope you don't feel that I put you into uncomfortable a space. But a lot of today, and it's nothing you don't know, that I wanted to talk about was really about communication. And not by cutting off your tongues was that the best way to show that. But I also wanted you to remember how important that communication is with your body language. You had tones, even if you didn't have a voice in that last exercise. And then things like how closed off we can be. Right? How open we are. I remind you in the first activity, everyone was tasked with meeting new people. Very open, approaching people, welcoming. And then in the second one, you were so concentrated on a task connectivity, you kind of forgot some of that. Some of you did. Right? And so sometimes we get very tunneled in what we do, which is not necessarily a bad thing. But we don't then get to see all the things around us. And that may influence and affect the work that you're doing or the opportunity to build partnerships, because you might miss somebody while you're going down that pathway. Right? Any other comments, thoughts? I really want to thank everyone for being so participatory. Go ahead, Madonna. The one who is a dealer. So they have to have a, not like this the way you have to see that, or your role is real. It's something similar to the founder that said that you have a project plan, whatever you have to do, build partnerships, stuff. And they said that I want you to do this way. You have to move your purchase suddenly to different directions. And that makes the whole project, the whole plan, change and also affect the whole result of outcome that they have. Right. Definitely. Any other thoughts, comments? Yeah. I do want to ask folks who were dealers, did you feel more empowered with control of the group? Or did you feel, well, if I'm tasked with doing something, people may not look at me for instruction, because I'm already doing something, facilitating something, but not necessarily having to tell people right and wrong. Ernesta? But that's important, because you felt I'm contributing. Right? Right. If you weren't a dealer, did you feel like I didn't have as much control, maybe? Maybe, maybe not. Don't care. So did you feel maybe that with your original group, you had trust and understanding? But then when you approached a new group, you're like, not sure what's going on yet? What was it about that table? Was it people who weren't looking at you, or? Right. Conflict, yes. Because we don't have competing timelines ever, right? We all have due dates on the same day. Mine is always the most important due date. And you over there, that never happens, right? We're not caught in the middle of things sometimes, right? OK, go ahead. And he's like, really? Yeah, he was like, really? How does that coordinator get decided? Is it automatically, there should be a process. Is it majority votes? Loudest person in the room? I joke about that a lot, that in community settings, there are some great advocates and vocal folks. But the loudest voice isn't always the right voice. So it's important to identify individual and community assets and strengths and work on that, right? Having rules might help with decision making, right? Order, OK? That is often an area with a lot of challenge. And it can be whether they're power differentials or money differentials. That sometimes really complicate whether or not decisions can be made. I was just speaking to someone yesterday about sometimes decisions have to be made in a split second. And you don't have the opportunity to have a Democratic vote. So do you go ahead and make that decision? Or do you maybe lose out on the opportunity because you respect the process and feel that you need to ask everybody? So I work on a lot of collaboratives and coalitions. And I am the biggest proponent of acting and doing what we say. But I will tell you that many days democracy is not a good thing. It is challenging to actually really get everyone's voice. And silence is not necessarily no, although sometimes I do clarify that silence will be understood as a no. But silence isn't necessarily a no, right? In some cultures, it's disagreement with, many cultures, it's disagreement with what you said. We do proxy votes by email. Just because you didn't respond didn't mean you didn't care. You just didn't get to that 500 email after you were on travel all last week and still catching up on whatever it is you need to do, right? And so a decision making process is also really important. Quantifying maybe a timeframe in which we have to hear from you. Otherwise we will make an assumption, which may not be good, that you're not responding for ABC reason. And maybe be clear about that, right? But I need to vocalize that, my words, or put that on paper so that we have a common understanding about that, right? Otherwise, assuming that I function the same way a doctor's office does, that if you don't show up, you're no show, well, I may be two minutes late, but I want that appointment, might be very problematic, right? And you may lose a lot of trust and respect that isn't easily gained. Conflict, so I'm one to say that conflict is a good thing because I think it brings out some really great conversations and hard questions that actually make us stronger. But to actually breach that conversation can be very difficult, right? And we, I'm the first to say it's okay to disagree, but I'm also the first to tell you that sometimes it takes a lot for me to be okay with disagreeing with someone, right? And what does it mean to disagree? You know, there's their consensus by 80% rule, which doesn't mean that 80% of the room votes for it, but that you can be 80% behind something, right? You're not gonna be 100%, but if you're at least at 80, you're saying, we're gonna support this. And there may be an unknown, or I'm not sure, but I'm in it with good intentions, support what's gonna happen, right? But how do we breach conversations about conflict? Do we just sweep it under the rug and hope it goes away and doesn't come back again? Because some of us in our organizations do that. And sometimes it's okay, but sometimes it comes back and bites us in the butt. There are resources nowadays that come in and do conflict resolutions, so neutral parties that come up to help facilitate dialogue so that the folks involved have a neutral space to have discussion and Jackie might have power and be the boss and say, what's the problem here? You know, why don't you like me? Well, that's not very neutral ground for someone to share what's going on, right? So conflict resolution is actually really important in the way that the group wants to address that might be very important to think about. And around budget, that might be a really huge, huge issue or expertise. So maybe an NIH grant says that unless you have a PhD, there is no way you're gonna be a principal investigator. That's a reality. Do we negotiate that or do we just say, well, Jackie's got the PhD, so automatically she's the right researcher for this project. Maybe I'm in the room, but I'm not the right researcher. Right, so those are really important things to consider. So communication, we've talked about it a lot, right? The goal is to deliver a message, right? Simple enough, there's a sender, there's a receiver, and there's a message. But is what is sent always what is received, right? Or is what is said actually what is heard, right? And that's really key. So there's a lot of noise. There's a lot of different things in between the delivery of the message and the receipt of the message. There's your physical environment. Maybe I can't hear you. That is always very problematic if I'm not speaking clearly and loudly enough for you to hear me. That's a simple barrier, but it happens, right? Have you ever been on conference calls where you're like, oh, just tune out. Don't hear anybody, muffled, but I don't wanna disturb anybody. So I'll just multitask on my computer. The assumptions we come with, right? The information that we come with is not necessarily the same information as the person we're speaking to has, right? So how do we communicate that information? And then the expectations. So like we've been talking about, we come with good intentions and good hopes, but maybe along the way that changes, maybe along the way I've done something that causes you to question my words. And so even though I'm careful and thoughtful with my words and my tone, it doesn't have the same meaning to you because I've done something that has caused you not to trust those words when I say them anymore, right? So as simple as that is, every piece of this link is actually very, very important. Time constraints, culture, identity, environment and experience, it all contributes to how we convey and communicate. And everyone today kept telling me over and over, I have to talk, I have to talk. And it's so natural for us, but there actually is a lot of thought into communicating with your words. Have you guys ever played telephone? So some folks shook their heads and said no. So it would be as if I started a conversation on this side and I asked that to be passed across to you and then finding out if what you hear is what I said. Yeah, and we'll actually maybe do that in a little bit so we can find out how that works. So communication, while it sounds so mundane, is such a pivotal part of relationship building and partnerships. And partnerships are relationships. They're relationships between people, they're relationships between organizations, and the communities that we represent, right? So it really is important to have the dialogue. So we've covered a lot of this. What makes communication difficult? So even though we were using the same language in Barnga, we had a very difficult time understanding each other, right? So proficiency, maybe if you were Barnga experts, that would have been a breeze. You would have been like, I've done this before, I know how to rotate, I'll tell you which way to go, right? Literacy, right? I think I'm pretty fluent in English as a first language, but you know, and I work in healthcare. If you throw a user's manual to someone, there's a lot of language that you have to look up. And I will challenge you by saying that law, legalese, is a whole different language as well. I understand the law, I can read propositions, I can read legislation, but if you gave, well I can speak to that. An actual case with all of the legalese in there, I would be googling every other word and trying to understand not just the definition, but then how does that actually apply, right? So even though we're all speaking English, there's a lot of complexity in the language. Communication styles, this room is filled with talkers, which is very exciting. But there was a lot of nonverbal communication today that was also very powerful, very, very powerful. And so not to forget that, right? Appropriate topics, we just talked about power and decision making around budgets. In some communities, that's not an appropriate topic to start the dinner table discussion with. And in surveys, we talk about this a lot in the work that we do, a lot of times we want demographics up front. Question three should not be about anybody's income. I just met you, I have no idea who you are, I don't know what family you come from and you wanna know how much my family makes? I know it's anonymous, but I don't really care. But maybe if you put it at question, maybe not 56, that's a lot of questions, I will actually be very honest with you about what that is and I will actually tell you all of my family's business by question 50. But income at question number three with the communities we work with is not a very good place to put that. Even though lots of surveys have shown that that's an appropriate place for demographic information, right? We talked about conflicts, styles of dealing with conflicts, I'm a head on, like you should see me in my partner Dave. It infuriates me when I'm angry and he's done talking. And the worst is when I'm talking and he goes, are you done? Those are fighting words, right? I may be so done, but I have something more to say because he asked that question, right? So different ways of dealing with conflict, different ways, right? And then we talked from the very beginning, different styles of learning, auditory, visual, kinesthetic, and maybe some of all of that in between. And then we talked an awful lot about assumptions and expectations. So just a reminder again, that all the links in the communication chain is very important. And there are studies that have been done that actually say that we're a choice, good. Sure. Yes. And also email some people don't read them. Yes. They keep it short. There's so many cultural ways of communicating across professions, racial ethnic groups, it always helps to just ask. Right. How do you prefer for me to stay in touch with you? Most definitely. And not make the assumption that email because all of us basically use email is the better way to go. Right. So I want to thank Heng for sharing that. And I actually do bring that up later that maybe participation expectations should be communicated in that manner. Is email the best mode? Is face-to-face? Do conference calls suffice? You know, some projects work across the country and face-to-face is not. But I will tell you that in most projects that I've worked with that are, there is at least a one time once a year face-to-face because there is still so much value and richness in that process. So I think it is important. And I don't think any of us should make the assumption that it's just a racial ethnic thing or a generational thing. That email is not a friend to everybody. And in email, a lot is also gained, but a lot is also lost in communication. Sometimes you have to bold your words to be emphatic. Right. The tone, you lose tone in emails. And that's actually really important. So I appreciate pointing that out. And I was just going to reference that. Studies have been done where they say, you know, we talked a lot about word choice. And I imagine that all of you have done presentations and you spent tedious hours picking out what you're going to say on your slides. 8% of the meaning of a message. That's not to discourage you to keep working well on your slides, but think about that, right? Tone of voice, which I just said, we lose a little bit in email, 28% of the meaning of the message. So I could yell at you, but if I'm really sincere, you might not be as mad at me, right? I know someone who's really good at that. Really good at that. I'm like, wow, okay, I can't do that. And then body language is 64% of the meaning of a message. So if I spend the rest of today talking to you like this, many of you probably will not think much of me when you leave here, might not already. But it wouldn't help my cause to spend the rest of the day talking to you like this. Right. So there's so many pieces to communication. Heng just pointed out, we communicate with ease. We speak very eloquently. We write very expediently, but there's so much that cues into the meaning behind your words. So just a little reminder. And the most important thing is checking in to see that, what you're saying is actually what's being heard. You know, just because I think I was clear doesn't mean that I was clear. And that's by asking questions is important, asking for clarity is important. If you don't ask, sometimes it's like you don't care, right? You didn't care enough to then inquire and get more information as to what's going on or why. So we're gonna do a little active listening exercise. So just grab a partner next to you. Someone's gonna have to decide who's the first person. And within these 90 seconds, you're gonna talk about a favorite place, a high point this week, maybe some feelings about work, something that you're comfortable sharing. And the second person cannot speak until the 90 seconds is up, okay? And when the 90 seconds is up, the second person must paraphrase and restate what the first person said in the hopes that you got the message that they were sending, and then you'll swap, okay? So what motivates you, right? What drives you to do the work? But that's part of assumptions, right? Like you all come here with an open heart and an open mind hoping Jackie has good intentions, that she's doing this for some reason. Maybe I'm not, we'll have to wait two more hours to find that out, right? But with good intentions, right? And I was gonna bring this up later. I think when we enter into all partnerships, we assume good intentions. But even though we assume that, good intentions alone aren't gonna get you to the finish line, right? And then what is the finish line? For you, at some point she's gonna say stop and I can be like, okay, this is over, right? But you're right, in serving community, however you define that, there may not be a finish line. And when we say health and wellbeing might be the goal, what you define as health and wellbeing may not be what Amal defines as wealth and wellbeing for her community. And those assumptions, when you come to the table, I've been telling you weeks on end, let's partner, let's be friends, let's work together. But I don't know for sure that you all have the same goals. I don't know that you all have the same desired outcomes. And because you're in the room, I'm hoping with good intentions that that's what we want together, whether it's a racial ethnic community, a geographic community, right? But those are assumptions before I come to the table to know why we're here. And some people may be like, I don't even know what she's doing up there, right? So those are all really important things to think about not just today, but like you said, in the real world, when maybe you don't get reminded of these different assumptions that we have, but how do we keep applying that to the work that we do and the people that come to the table? And sometimes the new person isn't new in terms of not being a partner organization, they just might be a new staff person, but they may have 20 years of experience, but they're new to the table today, right? Thank you for sharing that. Right, I actually was going to, but I appreciate you sharing that, right? So we come to the table and we all took what was mine, and then we left, but is there anything left at the table? Does that ever happen? Gotta hold on to what I need to make sure my project's successful, but maybe Annette's didn't have any, but I got what I needed, but I am here with good intentions, right? And I'm not making a mockery of that, but like I said, good intentions alone aren't always gonna be clear as to why we're here at the table, right? So you guys have taken me through all my slides, are you practically? So I kind of use Jen's comment as a segue to talk about trust, right? And there's been a lot of research about CBPR and partnerships and what works and what doesn't, and some key areas, and we're starting with problem-solving today challenges in building participatory relationships is trust, right? We also talked about power differences, we talked about decision-making and then conflict and conflict resolution, and trust is thrown around a lot, you know? It's kind of like respect. We actually have a lot of admiration for both words, but what's the tangible piece of trust, you know? If you were to come here today and ask me how do I build trust with Laura Riley because she's here, how does that happen, right? And I'll be guilty of having written articles and read articles that say trust is key, but then what is trust? Is it a word scribbled on a piece of paper and really big letters, all caps? Is it knowing that we all play by the same rules and so I trust that you will hold me accountable to those rules? Or is it trusting that when you walk into any group wherever you are with good intentions that people will help guide you, right? And when we work in communities, whether it, again, racial, ethnic, academic, geographic, we don't know what has happened in the past that might have been transgressions to these communities. Some of you were a part of the first training where we talked about the Havasupai Indians, right? If we talk about historical injustices, most of you have heard of Tuskegee, right? And I don't know how you feel, but would you be comfortable to walk into an African-American community and say that was a really long time ago? Should get over it. Oh, okay, just checking, right? So just because it happened, quote, it's not that long ago actually, a long time ago, and it didn't happen yesterday, doesn't mean it doesn't still have importance and value in that community. So I'm coming to the table, I'm gonna be a researcher with good intentions, but if I walk in and I just said what I did about Tuskegee, I don't think one of you would work with me. I was educated enough to know about Tuskegee, right? But the choice of words I just had really devalued the respect you would have for me as a researcher, right? That however doesn't mean I don't have the capacity to learn how to better do that next time, but that's a reality, right? It doesn't mean we don't have the resources to Google. I love Google and Wikipedia, but because I can read the information, doesn't necessarily mean I know what to do with that information, right? So when we build partnerships and we walk into the CBO that needs our help or the community academic researcher who needs our community, we're making a lot of assumptions about what we know about what's going on now, let alone what has gone on in the past that leads us to believe in or trust in the opportunity to work together, right? And I full of heart believe that we all come with good intentions, but people have had difficult experiences or exposures and so just because you have good intentions doesn't mean I should play in the sandbox with you, right? You might steal my toy later, but you had good intentions, you wanted a play buddy. So in this workshop here, as we've talked a lot about research, right? And I'm the first to say that I love the search for knowledge and the search for knowledge is important, but for what purposes, right? And we keep pushing CBPR, not because it's the best thing since sliced bread, but because CBPR and CBPAR is really about the search for knowledge to create social change, right? We wanna do needs assessments to understand why the Chamorro community isn't accessing screening services. If you're gonna tell me they're not educated enough to understand there's a hospital down the street, that's kind of a misnomer, right? But what is going on? And maybe there have been past experiences that prevent them from wanting to approach the public health hospital down the street. I may be a family member of someone who was killed in the Cameroonge. And so when you tell me to trust governments, I might not feel the same way you do about the American government, right? So it's not to say that you have to go do research on every single body and figure out what that history is so that you know everything about everyone, but you gotta walk into the room and be open-minded enough to understand how that may influence what we're doing. And we're funded by NIH and I will say that NIH has come a very long way in understanding that when you work with community, it's not asking them after you get the grant funds to go recruit people to get surveyed and then to walk away and not tell them what you did with that survey data, right? And it's not for lack of good intentions, but there have been past methodologies that seem to work well that helped to ensure the significance and the validity of the data. But as you work more and more with people and culture as you find that that validity is not just in a tube or in a controlled setting and as you said in the real world, you can't control what's gonna come down the street next even if you've got a stoplight on the corner. But the stoplight will help make sure that when they come down the street next, it's not at 60 miles per hour, right? So research, I'm here to tell you I'm a proponent of that but not every community is gonna find value in research, right? And even though I'm encouraging CBPA and CBPR as a method to help ensure that research isn't just about taking information and walking away, people might still not feel that's the most important thing. If I don't have clean water to give to my kids, filling out a survey about clean water may not be my priority, right? And so how do we have conversations about then if it is a priority and we want to actually help serve, how do we make that more salient? I don't actually have all the answers to that but I think that's part of building trust, right? The other piece that I think is really important with trust is the congruency of your words with your action, right? You can come in with a PhD which is a well-earned degree and have lots of nice things to say but if then what you do thereafter is not so flowery like your presentation when you came that day and you don't keep coming back to the community, then what does that tell me about whether I should trust you or not? The next time you come around and say, there's this great research, it's really gonna benefit your community. You haven't been studied before but we really wanna make you a priority but that's the one time I show up and I don't come back again. And I wanna say that this is not an attack on PhDs. I'm just using this example. But the same is true of a community partner who comes to the table and says, we've got all these needs and we wanna work with you and then when you reach out to work with us, well, I'm too busy to talk to you right now, right? So the congruency and the consistency someone had said that with the activity is actually really important and I will challenge you in actually doing that every day in your work within your own organization with the colleagues that you have as well as outside of your organization. I find that to be the biggest challenge that the words if I speak them are delivered like I promised them. Otherwise all the money in the world can't buy back that trust and respect. Power differences. So we may not all have experienced discrimination or we may not have identified it as that but that might be something that folks have experienced. It might be something that may influence whether or not they trust and wanna participate with us. I put this quote that I've heard a lot from community members that the community doesn't care what you know until they know how much you care, right? And then they're vested in being your partner for life whether there's money or no money. And how that happens sometimes it happens overnight and sometimes it takes years of commitment to build. And I put the MPH and the PhD up there as my colleague in San Diego who works with the Samoan and Pacific Islander community has spent many, many years sweeping church floors opening up buildings so the youth can come play in order to build trust in his community. And he has found that partnering with academic institutions has been very valuable to bringing resources and information into his community as well as then bringing that information out to others so they can understand the community that he lives in and works in. And he was like, you know, people keep coming to the church and talking and they have all these initials after their names and people are like, what does that mean? And so most of you know that an MPH is masters in public health and what a PhD is. But folks in the community had been volunteering with him for as long as he's been doing this for over 20 years and they didn't necessarily have an MPH or a PhD but they certainly did have it in some senses in terms of the life commitment they'd made to serving their community. And so not to make fun of the degrees and the titles and how hard it is to earn them they started tagging it on in a funny way to support and honor the people who were serving their communities. And so in his community, an MPH is my people's helper and I know the spelling is wrong on the next one PhDs but people who deliver and I love that. I got an MPH and I hope I'm somebody's people's helper. That's how I hope my degree is helping to serve the community. And I think that all folks who do have degrees really do have that intention. And I like that everyone said, ah, so I'm in the right crowd. Like I said, we're not mocking the degrees, you know but for the same value the people who have lived 20 years and been serving the communities also bring expertise and value to the table. And that is really important. And so maybe I don't have a PhD behind my name but you know, I think I might have know a little bit about the community I come from. I may not have graduated high school but having worked with all these researchers and faculty for the last 20 years I might have a little knowledge and experience. And so making assumptions again might get us in a little bit of trouble, right? This is a tough one. The budget. There, and maybe it's not culturally appropriate to talk about the budget but in a partnership there needs to be some transparency, right? And maybe if you're the one holding the purse strings, if you will you might have more control than you think you do. You might not think it that way but you actually might have control. And so it might be important to have a discussion about is a partnership truly 50-50? If it's not, is there transparency so that there's agreement across the board on how much is allocated to different things? This is a really tricky one these days with federal grants but culturally food is a very important part of who we are and how we gather. It's not an allowable fund right now but are there ways that we can look at finding resources to provide for that? Otherwise you just can't come in and say I wanna talk to you and I wanna take three hours of your time we're not gonna provide you even water, right? If you talk to some of our community partners you may wanna go in for a 30 minute survey but if you approach the house of an elder native Hawaiian you had hoped that you will be coming inside chatting and asking about the family having a little bite to eat hopefully getting in your 30 minute interview and then staying for dinner. And then getting an invitation, you know for not just yourself but your family to come to the Loo Out next week to meet the other elders who you're gonna wanna interview, right? And maybe we budgeted only 10 hours for Jackie to go do that but she just spent 10 hours on her first and only interview, right? Now I challenge you to say it's not a valid interview, right? And to get the other 49 she needed to spend that 10 hours on that first one because if she didn't she'd still be searching for the next 49 but now she's at the Loo Out on Saturday as she finished all 49, right? So there's some truth to thinking about that and it's not just cultural it's really kind of community the way that we function is just like in academia or doctor's offices how many of you truly respect the time you have with your doctor and after 15 minutes you can't ask any more questions? I know I come with a list I do not waste my 15 minutes I come with a list because I know that if we've gotten to the point where it's nice to see you Jackie we'll see you next year I miss the boat and if I really want their valued time and I didn't have that on my list I have to wait 12 more months to ask my question I won't but you might, right? And so within different organizations and agencies there is a protocol there is a culture in the way we work there's reasons for some of it but understanding that and maximizing how that will benefit your partnership is actually very important, right? So we talked about a lack of respect for the expertise of all so definitely we honor and value the academic partners and their degrees we also honor and value life experience bless you the school of life is a very good teacher and there's a lot of richness in that sometimes folks who have power don't think they have power, right? And they're not trying to impose but you behave and respond in a way that gives them power over you, right? I'm still a student and so my faculty have a lot of power I work with some of them and here in the community it would be Hang and Chris but in school it would be Dr. Tannis and Dr. Fulm and I wear those hats also culturally, right? In my community I didn't grow up calling my friend's parents Judy I called her Mrs. Nikelski even though she told me for 20 years to call her Judy and so there's also that, right? In the roles that you have I'm a little bit older now but I still see myself as one of the younger people in the community but I've had positions where I've had a little bit more hierarchy in the organization and I've moved up on the ladder but I felt culturally inappropriate I worked in a Vietnamese clinic and everyone was calling me I'm like I am the youngest person here and have no business being called that but because we were in a workspace folks were calling me that because I was their boss, right? I didn't feel that way but that's how they treated me, right? And maybe sometimes we aren't aware of that but becoming aware is actually very important whether or not we will have a successful relationship, right? And then the role of leaders we talked a lot about titles, the NPH the doctors, the nurses there's a lot of reverence for folks with education and rightfully so you know in different communities it may be an elder like I said if you don't get permission from the elder to enter the community you can ask for as many services you want you're not getting any in another community it may be very matriarchal, right? If you want access to the community the family you've got to talk to the female leadership in a congregation you might need to talk to the minister, right? We've done a lot of work with faith-based organizations for us we've done work in breast and cervical health but we need permission from the male pastors and ministers and then we get access to their wives who then help have us reach the 600 continents that they have but we couldn't just walk in and just say I have an NPH and a PhD and I'm here to help your community and so I'm just gonna come on Sunday and everyone's gonna talk to me about their breasts and their cervix right? Sometimes there is permission that is needed and sometimes the time to ask that is not the appropriate time but you need to still honor and respect that and recognize it and oftentimes even if you make mistakes the fact that you do recognize it goes a really long way So any thoughts, questions? Elinda? I was gonna be for you I've done uneducated you know illiterate people and with that attitude if they never verbalize it it's that they are masters that convey their feelings or I don't know but people pick up on it in a way and they will not be it would not be conducive to the research because you're not gonna have a very receptive population right? already they've already blocked you off Right, yeah and I think that's true I will say that all of us come with best intentions and we do wanna help but how we convey that we wanna help is very different and it can be very condescending and like I said with my colleague if he were to go tell his boss that he had to go sweep the floor at the church his boss would say that's not your job but he came back and said if I don't do this there's no way we're getting in that organization you know and I if that's who we wanna work with we're gonna have to understand what their organizational culture is and how respect works there and one of our community partners is you know be careful cause you gotta volunteer first to prove you wanna know how much you care before we know how much you know right because we can always help you learn more and do the things we need you to do but we can't teach you always how to care and have compassion for people you can but that's a litmus test for a lot of communities so it's really important how you come in and approach the community and even the choice of words like you said, right? as learning about a culture before you do something wrong and then try to fix it I think that volunteering or being at community events and coming to the community and being in the community is very helpful I know that volunteering can be very time limiting but it's not a commitment of a thousand hours before they give you the okay card you know it is how sincere you are when you show up to these events as well and I think for anybody even as an organization that's my biggest pet pee like to expect everyone to come to Ocapacca or the Alliance you've got to be kidding, right? I think we're kind of centrally located but the reality is centrally located to whom? to me because I drive to work there every day so it's easy but for some people we just talked about this yesterday took three buses to get there for five minutes of my time so sometimes it is important to go out in the community and be in the community to identify community leaders and leaders often aren't the people with the titles necessarily, right? They're people who are doers often and they have a real pulse on what's going on in the community and they can help you understand and it's okay to ask the silly questions is it appropriate to dress this way? Is it appropriate to bring food? Is it appropriate, you know and some of those things aren't always in your control but asking and trying to understand and recognizing what those things are are really important, right? Like if you were to work with the Thai community and show up in shorts and a T-shirt good luck. You've already disrespected the culture and the belief system but you are the brightest person in the world, right? So, but if you could ask someone you know is there something I should consider, right? That's not necessarily cultural garb it's actually just what they wear that's their clothes, it's not an outfit that might be very meaningful and important to whether or not you may disrespect somebody. Organizations so that they know that like the example you gave of spending 10 hours for an interview that that's actually time well spent but sort of that accountability that there's trust in your assessment of what work needs to be done. Right. So it's the other balance. Right, so I think that's a perfect example too of working with groups that do have relationships with the communities you're serving whether they're racial, ethnic or whatnot has a lot of value in terms of validation and reputation and trust building, right? Excellent. Mm-hmm. Yeah, definitely an open heart and an open mind definitely helps a lot. What you said that they have to see that you're genuinely caring and interested person and that you have, like you said, everybody has a good intention but you have to gave or convey that. Right, definitely, yeah. So we talked a little bit about decision making in the game that you played by the way it was called Barnga if you ever want to look it up. It actually is used to kind of illuminate the complexity of culture and that different cultures come with different backgrounds and different knowledge and information and when a different person comes into the mix what happens, so it's a great interactive activity if you're interested. But decision making, so Vatana said it would have been great if we had a coordinator who kind of told us what to do and how to do it and that would have helped a lot, right? But how do you decide who that coordinator is? Is it automatically Jackie because she's standing in the front of the room? Because he did ask me, can you help with instructions and I walked away from him. I did, I was like, I smiled though. I said no but I smiled and I shook my head and I walked away and he was not happy with me. All right, I feel very guilty for cutting you short. This room is definitely talkers that there's a different buzz and energy in here. Are you guys good listeners? Speed day, yes, yes. I'm going to use that right now. Stop, stop, let's wrap it up. Was there anything comfortable or uncomfortable about the situation? A lot warmer feeling and a buzz than not talking earlier, right? But you didn't feel so bad breaking the rules, did you? Because it was getting to know someone. Yeah, so, no. But I love what Teresa said. I genuinely was interested in getting to know the person. And then Vitana pointed out something really important. It was nice to be heard. You ever get cut off? I cut people off all the time. Do you ever, my mom and I have in conversations a funny little endeavor, cutting people off, like not intentionally, but you get so excited about what they're saying you want to jump in but being heard is actually really important. Being acknowledged, right? So engaging. Yeah. 90 seconds is a long time. Some of you are like, what do I say next? But a lot of you also used your body. Folks talked with their hands when they were excited about things. There were smiles. You engaged, people moved in to hear. So you actually used a lot of your nonverbal communication skills as well. There's a hand back there. So I would agree that a voice is a powerful thing and we all are here and empower voices for our communities. But listening and it is a skill is actually very important. Are any of you parents? You guys have great listening skills, right? You also know how to hone into like what you don't need to hear too, right? That's a skill. There's a hand in the back. Okay, there's a hand in the back. Oh, would you like to take a back? Yes, yes, yes. Definitely. My future mother-in-law says that I have a total different pitch when I talk to the nieces and nephews and when I want something from them is very different. It definitely is. Comment in the back. Actually, there is a conflict. We want to get on it and then there's no chance of talking about it. So at some point, I think there's authority also. So where do you draw your line? Right, yeah. So that was a great point, right? She actually said, well, there was no conflict, right? So I want to remind everybody in this room and I will hold you accountable. I'll pop up on your shoulder and you don't even know it. That when you have conflict or disagreement that if you can help vocalize it, it might actually help clear the air. But that sometimes if you pent some of that up and you hold that against that other person and they don't even know it, you may be unintentionally destroying that relationship and not giving them an opportunity. And I'll be the first to say, if I don't know I'm doing it, I don't know how to fix it. Please? Yes. What is it about these rules of the full transfers at a five? Yeah. April. The major difference though between listening and learning about a person is that you're really truly tapping in and listening to them because you have a responsibility to keep back and show them that you've heard them. And I think sometimes when we're in a conflict situation in our head, we're too busy thinking about our rebuttals or what we want to say in our point to really listen to what that, I think it's a really, it's a huge challenge for anyone and it's a difficult thing but I think if you're right, if you just focus in on what that person is saying and trying to think about it, a lot of times it can help diffuse this situation. Right. That's a really hard thing to do. It is. Yeah. To be with a teenager knows it's really hard to do. Yeah. And I would say, you know, that's why I challenge all of us to do that. I'm gonna leave you with this acronym, which is weight. And I'm the first to tell you, I always have an opinion that also doesn't mean I always have to share it. So weight means, why am I talking? So because you have an opinion, doesn't always mean you need to share it. And sometimes if you actually listen to someone else, you might not need to share that feeling or opinion or it might be nice to support someone else having that thought or opinion, right? Not judging it, I'm just, and I will use Heng's guidance with my arguments with Dave in the future to give him two minutes to talk before I go on for another 15. But I do like that. Having shared expectations, right? And understanding might help clear the air, like April just said. And as wonderful speakers as you all are, active listening is actually a really great skill and we should try to practice it. God. And although we're practicing in the microcosm of things in the macrocosm, it's really a color. It sets the tone for the music, it sets the pace. And somehow I think we just ignore it in the final. That's why this conversation can go so easy, whether you're comfortable or not. So I think that's a really good point. We talked a lot today about assumptions, right? And so how we come to the table and how open we are about having that conversation. Cause I can come to the table with all my guns, radio to fire, and that is a very different way, not as open of a mind or a heart to hearing what somebody else has to say. And I think that you do point out some things that we all need to address in terms of power differentials that don't easily just go away because we sit on the same level even, right? So those are things, I don't have an answer to immediate, but I think we have to look at and address and have those negotiations, discussions about how that works. And if we say we're truly equal in this partnership, how does that weigh out in decision making, finances, things of that nature? I think that's all very important. Yeah, so I'm gonna take a few more quick minutes and then we'll take a break and then you're gonna have a great panel. We talked a lot about trust today and you guys covered a lot of this, right? Be open, be honest, but be tactful. And we don't always have the same opinions. That doesn't mean that the minority opinion is not a good one, right? Maybe different, but different can also be very good. So have the open mind and open heart to hear that. Building trust for successful partnerships is about relationships with people, right? It's not about talking to some cyborg or some computer, you may talk through the computer, but it's working with people. So genuinely, sincerely take the time to hear people and what they have to offer. Discuss openly prior negative and positive experiences like the research experiences we talked about. Try to identify priorities for each partner and respective agencies and identify clear goals. Relationships is the foundation for a successful partnership and you really have to take some time to invest in that. We also talked about the importance of representing your community and who do you represent and who identifies that and negotiating how that works. And as a partnership, is it Jackie who always goes because she's the coordinator or is it important to have representation physically as well as in voice of all the community partners and how does that work? And if Jackie carries the voice of all partners, how is that conveyed? Have discussions about that, right? These are some possible roles that we all have. These are things I've seen in all of you in the various workshops and even today advocating for your communities, whether that's university, academic or a racial ethnic group or an underserved community. Advocate for the use of the data, right? Research for knowledge sake is a great thing, but really we're here to talk about research for social change and how do we empower our communities by giving back the information that they've shared with us. And also identify appropriate venues to share the information because you've never authored a manuscript before, does not mean that you cannot. And there are elegant writers in the room who may not have a PhD but are a crux in the project. And so they also have a voice in disseminating. And you know, it's easy to kind of be polite and say, well, no, it's the academic faculty that they should be on there. But if you're a community organization that has resources and needs and you're not publishing but other people are publishing about you, where do you think future resources may go? Just something to consider, right? And if you're an equal partner at that table, that's something to consider as well. And it's also a great opportunity if you don't have the writing experience for faculty to share that. And it's a skill that we all have in some form, we just haven't practiced it. Inside your packet under additional tabs are some suggested protocols in terms of establishing structure. I know folks like immediately off the bat DeBarga said, I want rules and I want to be clear and I want some order. So this is how you would go about doing that, right? Setting up some sort of leadership and management structure expectations even about who's gonna set the agenda? Do we just assume it's gonna be the person who does it all the time? Or is it something that everybody participates in establishing because the time we share together is important? Heng highlighted is emails the only way we communicate? Do we vote by email and is it the same as if we vote when we're all present? Those are all important things. Decision making, conflict resolution, even participation guidelines. I didn't stick that in there, but you can look online. What does it mean to be an active participant by coming once a year when we meet monthly? And I only show up once. When I show up, what are expectations, right? Attendance, voting power, representation power. If I'm not there and Harold's coming in my place, does he have the power to vote on behalf of our agency? And if he goes in my place, have I informed him enough to empower him to make that decision, right? That's a lot of work. Again, different types of boards, executive boards, steering committees, advisory boards. Could be a mix of community and academic. Could be students, could be the people you're serving. 501C3s and FQHCs have to have a diversity of board members, right? And for a lot of our community clinics, the communities they serve actually need to have a seat on the board. That's empowering in some ways, but also ensuring that in that seat, they know what their roles and responsibilities are, so they can contribute meaningfully, right? Talked a lot about that. Conflict resolution, folks said talking is key. Listening is also key. We also share that there are groups that do conflict resolution, and sometimes it doesn't require bringing in this big organization, but maybe a colleague at an organization that has a neutral space but could help facilitate the dialogue. And so under your, I think neon green tab, are some resources that I'll share with you. Conflicts of interest, right? Having that established up front. Because folks have conflicts, don't mean they can't participate, but maybe being transparent about what those are is important. Participation expectations, like we said, whether it's face-to-face, attendance, the frequency of participation. We also shared a data dissemination policy in there, so if you're collecting data and you're doing research, is it automatically owned by the university? And if it's not, what are the processes and procedures by which others can access your information? For our project, you gotta go through the partnership and get permission, whether you're a master's level student and a PhD or a faculty, right? We talked about sharing co-authorship, right? So we have policies around that as well, so we gave you some templates. And then we're part of the ICTS here at UCI and they have guidelines for partnerships. So that's actually a nice little checklist for both community and academic partners for things to consider, for things that you should consider talking about, the budgets, the roles, you guys said it. How do we define who the coordinator is? Is it an automatic assignment or do we Rochambeau or how do we decide who's the appropriate person? Is it the assets that they bring to the table? But those are actual practical tools that you can use as a guideline for building future projects and relationships. And then we don't have time for a group exercise, but we're gonna take a 10-minute break and then when you come back, we're gonna have a wonderful panel of community-based participatory partners here in Orange County to speak with you. Okay, thanks everyone. Hi, my name's John Billomack. I'm an assistant professor in the Department of Medicine here at UCI. I mostly do research in diabetes care and trying to improve diabetes care for underserved populations. And I've been involved in a community partnership with St. Jude's Neighborhood Health Center working on doing a long-term evaluation of an ongoing pediatric obesity prevention program they've been having going on and I've learned a great deal from the experience. Hi, my name's Elliot Quay. I'm an assistant professor in biomedical engineering here at UC Irvine. And my research is in the use of micro-technology for point-of-care diagnostics. So we've been interested in seeing if new technology actually has an impact in the clinic. I always partnered with Marian Huntsman in SOS, which is a local clinic serving a lower-income underserved population. Trying to see if pain-free pain-free devices for self-monitoring of blood decors will have a positive impact on patient compliance in testing themselves. If when they prick themselves, it hurts less. We were interested in seeing if the new technology actually ever helped us study based on bringing new technology into a clinic. There was actually a person in my lab that was also monitoring SOS at the time and that's how the partnership was formed. We used a different idea to monitor on one glucose testing. So people are supposed to go home with one prick-a-kid or prick-a-finger every day or three times a day and there's a glucose monitoring kit. And the problem that is faced with these systems is people don't prick themselves, it hurts. And especially in the SOS population there is particularly low compliance. Recently, kits have gotten more advanced that the glucose sensors need much less for them because it's a tippy-siner. And so we've been able to come out with the Lansing systems that are more or less pain-free because they take much less blood than the needles are small. So we wanted to see if we incorporated that into the patient population, and I thought, what should we do? We could improve the rates of compliance. And then we wanted to compare that with just providing the people. So if you gave them $50 at the end of the month and they completed sort of the study. So that's sort of the basis of the study. Probably incentivize them. That's what they're going to do. But it's through bribes. But anyway, so I, Marianne, has been and I'm the director of classical pharmacy services at Cherisales. And I, our clinic and myself in particular is very passionate about improving the healthcare through the AAA, which is increasing patient experience, improving the patient's experience, maintaining or decreasing costs, and improving health outcomes. And so, and I'm also a diabetic educator. So when this was posed, it really meets two of those really important aims. And that's increasing the patient experience because they increase the compliance with what's with those more and more increased health outcomes. Because with that information, we can change their medications. We can help them have some different goals in mind that would help improve their diabetic care. So it sounded really interesting. And like I said, I was involved in this. So in fact, many of the middle people in this are no longer with us in a very good way. But it's been interesting and we're just beginning. Good morning, I'm Mary Ryan and I am executive director of research and development for the Institute for Healthcare Management. And that's in La Habra, which is the northern part of Orange County. And it provides management support services for also a community health clinic called Friends of Family, which has about a population of 7,000 predominantly low-income Latino patients. I enjoyed a very successful career for about 20 years and had an opportunity to go back and get my PhD. So I just did my new PhD two years ago and I returned to this position at IHA. And a lot of my role there is to help them use data more efficiently. Friends of Family was a very early adopter of the electronic medical record. And so they had access to lots of data. But as many of you may know, who work in community health clinics, the electronic health record really just replaced paper of an individual record. But it really didn't move us forward to doing population health, which is certainly everyone's goal in terms of improving the health of an entire patient population. So although guidelines have been released by the California Medical Association in concert with the California Association of Health Plans for the treatment, diagnosis, and treatment of pediatric obesity, we found that many of our providers weren't necessarily following those guidelines. A survey of our patients in 2010 found that we had a very, very high rate of overweight and obesity much higher than the county average was about a third. We were running about 50% plus. And so I had attended one of these workshops with ICTS and learned about the academic partnerships. And so I was the one who actually put out an email to Dr. Montoya seeking an academic partner because I didn't know how the process worked. So I said, you know, we have this problem. We really wanted to look, friends of family had gone to an electronic health record July of 2008. So we wanted to look at the weight trajectories over a 30 month period of time and their biometric profiles because we had an EHR, whether they had preventable testing with their lipids looked like they're A1Cs in order to provide data that might see a pilot intervention project. And Dr. Montoya introduced me to Dr. Steven Basson, which was a privilege and he's involved in the Department of Department of Cardiology and that began our partnership. So we actually analyzed the data and we're actually working on a paper. The outcome of the project was that we did initiate a pilot right now that's ongoing with 17 children and parents trying to do a family-based multi-component intervention to address the issue of pediatric overweight and obesity because what our findings basically found was and what we wanted to look at was what happens to these children over time in a usual community health clinic setting without specific intervention and what happens is that they don't get better. So it was less than a quarter of our children over a 30 month period of time actually improved their weight classification through the usual care. So we've extended the data through 2011 now and we are working on a paper to get the information out and we do hope that it would provide an opportunity at least to give additional funding to provide a more expanded multi-component intervention program that will be community-based. Right now we're looking at partnering with La Habra Boys and Girls Club and a private gym in the city of La Habra that's donating their certified trainers and karate instructors to the program. Dr. Bassett? I practice active listening. So, you heard Marian and I just have to say very much I just keep her focused on the right track. Glad we had this opportunity to work together. She found me as, I guess the old saying is I'm married up because I bring a lot from her and I just contributed some guidance up in the direction and some ideas as to what you can pursue and what you can do. With Jackie said earlier about equal partnerships and how to come together. This lady over here talked about high knowledge and low high communication. My experience has been changed over the period of the last two decades or so so that tells her long I've been in the field. So when I work with community agency or other groups, I consider it equal partnerships. So once you develop this relationship we can make sure she shared coming together. She shared what she could do well and I shared what I could do well and we were able to work out the working conditions. I looked at this very favorably that I could provide some guidance to an underserved population group that she would truly motivate to engage. I guess that was just my contribution to it. We were working together and made analysis. And other ideas, one of the interesting ideas that came out because my areas changed a little bit and expanded and was the notion of obesity being the core of many of our problems is the reading today about the weight of the nation in this major conference term that we see. And in our case, I was time now looking at asthma and obesity. Why is it that asthma? Children have this comorbid asthma disease. There's a number of different reasons and we think and speculate about it. So this was a great opportunity to work with the clinics because they had an impact population of Hispanics who are underserved, predominantly Hispanic underserved and they were for these kids. So looking at those kinds of changes could a nurse practitioner or doctor also take the right care at the same time? Care meaning, information, behavioral change to the parent and child with an asthma disease. Or a hasmatic disease. That was not what I was thinking about. So Marion did a great job and I'm pleased to work with her. Yeah, not in yet. So basically this was through the community engagement unit at UCI with one of the events. I was introduced to Barry Ross who's a vice president in the St. Joseph system under which the St. Jude Neighbor Health Center is involved. He's had this sort of turning question about how these programs that they put into place do they carry any sort of lasting benefit over years rather than just the months that the program is going on. So that was sort of his real question but as we talked about it we figured out that the question you have to answer before you can get to the real question is do we even have data that can help us see this? Does our organization even have the capacity to try to answer this question? And so we got together and applied for a campus community research incubator grant. I think this should be called the community campus research. It's CCR. And the purpose of the grant was to do a little pilot study and the first aim of it was to see can we demonstrate lasting changes in body composition that are involved in this program. But the secondary question in quotes which is really the first question has to be answered is to what degree do we have satisfactory follow-up data on these patients? And they do have an electronic health record as well. You know, electronic health records are designed for clinical application. It's a still relatively young technology that doesn't always give you data that's well set out to answer research questions. We've just completed data clouds. I literally had a packet FedEx to me last Thursday with the last bunch of de-identified data to begin looking at. And we're really going to see now what proportion of the participants in that program do we have this follow-up data for. And we're learning a lot about who with any organization can even extract this information. What kind of changes to the EHR and the baby need to be made and we're finding that's the most interesting stuff to look at. And by the way, we might be able to see this program having a lasting effect or not and are there additional resources that maybe need to be devoted to it. So Dr. Bill might share that they did get some funding support from the ICTS and CCRI and bigger grants. So funding did matter in this case. However, a lot of these partnerships started without any resources and together they partnered to seek out funding opportunities. And then there are various stages in the project in Dr. Ryan's case. They're going to be looking at more data and then in Dr. Bill makes this scenario I think the data they find will then provide them an opportunity to spring forward to larger grants for St. Jude. So there are lots of great opportunities. I like that Dr. Baskin City married up. Was it a perfect match in heaven though? You share some of the great successes and we're also here to learn what maybe some of the things we can do. Actually I have to share that I'm usually situated in a community health clinic because I did just recently earn my advanced degree and I'm very interested after spending a career in the trenches trying to make life better for populations of people. I took that change in my career because I wanted to start answering some of the questions more scientifically that I struggled to to fix while I was in the trenches doing the work. However I think I'm uniquely situated in a community health clinic but I have to say that my first meeting with Dr. Baskin I was extremely intimidated because he's very well published and I knew relatively to certainly the research world that he was extremely gracious and I think what worked well was the flexibility oftentimes because both of us have other schedules on this grant was really as he commented my SAS output was always you know 2 a.m. or 1 a.m. so it wasn't being produced during my work during my work day it was after hours of work so we were both trying to fit this into very busy schedules and I appreciated his flexibility in being able to reschedule a meeting oftentimes coming down the freeway from Mahogra I get stuck at that 57 going south where the 91 hits a cement wall and so I'd be oh my god I don't want him waiting and I'd call the operator and they were very good about that and now that I'm just going to be running late so I really appreciated that degree of flexibility but we had several meetings and I learned to copy my statistical output it made it easier for Dr. Baskin when I arrived he didn't have to go find an email and figure out where we were in the project so I made copies for him a couple of meetings I brought academic interns so I did have an academic intern on the project which was really key because again I had a million other jobs to be doing during my regular work day and she attended the meetings and found them to be extremely valuable and that's just an excellent learning opportunity for you know as we grow the next professionals of tomorrow which I think is everyone's responsibility so I think the challenges if I were to say what maybe some of the barriers might have been would be I because I had access to statistical software and to my own resources I'm a visiting scholar with my university with Brandeis on the U.S. Coast so I have access to the Boston Consortium of Libraries I was interested to know for other community partners how do they tap into the resources that UCI has in terms of how would I have gotten statistical help if that's what I needed and how would I have accessed the Wrench Medical Library at UCI so again in my situation I didn't need them but that might be a concern for other community partners that would need to be addressed but other than that I thought that the relationship went very well I was very pleased I'm happy that UCI stated this so I think one of the major barriers that we have here and this is a systemic barrier here is statistical consulting for community agencies and that's the end of the day we're going to go beyond the report stage so reports are great if you'd like to share as Jackie talked about earlier how do you share it and one way of sharing are these kinds of many conferences that you've got other nuggets ideas and presentations the second is some kind of something to consider a local orange county not the stone gazette that puts it out puts it out and not to that but some kind of publication of these findings that occur so you can improve your practices which is ultimately the outcome and that's what is important that Mary Ann and I worked out she was really motivated to improve the practice of her clinic so could we use this data that's there to analyze it to first improve the practice of her clinic which is ultimately the mission of this group to disseminate this and that helps that we can disseminate that out to the rest of the community so I think something you have to look at your mission and just ask what was the mission of her clinic what was her objective so I had my own objective I needed to fit mine with her objectives so if they were compatible date for live see if they're compatible and we could take the next step so it was easy because she was in the same neighborhood she had a degree she could do some statistical stuff that I suggested we could work that out together but if you don't have that benefit it creates a burden which needs to be addressed in some way or fashion through the university and that's a systemic issue that needs to be taken the next step beyond the start of years I think that's a huge barrier that I know the university thrives on and gets its recognition as Mary had said about papers being published so that's an objective of the university an objective of your clinics that you represent or to improve your practices and how can you connect and intertwine with each other and get both these things done they don't have to be uniquely different they kind of work together in a collaborative relation so that's really important and we did do that so all the output what was shared back to primary care providers and actually about four months into the project new clinical practice guidelines were released by our chief pediatrician because we found that in my data analysis only a third of the patient population hadn't had any pre-metabolic testing and yet by guidelines 100% of the children should have had pre-metabolic and a lot of middle people there was about five of us that were involved it's been a time effort or I shouldn't say time, it's been and so I'm pretty much there that was from the original group the two of us and I told him you dare leave this room I'm affectionately I think we work well together I think we just understand you know to be here upfront about requests and offers of what we can do and what someone else can do I think we're respectful of each other's expertise and I think it's a it's kind of a good relationship but we're not very far we haven't started I have a question can you just touch on the what does it say the contacts are expired they're based now in some kind of problem like he's stakeholder a key person that's going to be your champion and you have to really and that may shift and it may change but you really have to go in and figure out who's your champion who's your driver because you know our medical doctor left and that was a key champion however he left and he certainly passed on effectively where we were going and made sure that we had such a trail that could be followed well what's going to happen is they have their glucose meters at home and it stores all their readings and the end just gets down there's no there's no right we don't have any surveys involved in ours one thing I found one thing I found in working with the EHR with my partner is that there weren't any there really wasn't a dedicated person that was skilled in running queries on the data and to be able to extract data from the record so the ultimate solution and also there's sort of some kind of organizational procedural barriers to having an outside person coming right because they're looking at sensitive patient data and there was some funding but with limits to it so at the end of the day it was staff members doing I mean it felt so backwards but to be really doing chart reviews just like you would have done back in the paper chart days extracting key points of data that we're now using and so one lesson from this project is to improve the capacity of the organization to do this kind of research is we need to get to a point that they can extract queries of data at any of the sites including the standard site I pointed out a really important part which is transition and all of you know that that happens very regularly we talked about changing daily and you'll chuckle a little bit and that's a reality so I think in any work that we do program champions are very important and I think that there needs to be reciprocity in both sides so far I've been started as an example even though there's all this transition having a program champion who passed on information was important and I think as an academic supporter Dr. Akwai being able to give information to say it's moving forward so it's not just oh yeah it's a great project and it's happening but really supporting and saying this is where we're going this is the potential that's going to come out of data and I think on the academic side having the community partner saying yes this has value to what we're doing and being able to support each other is actually also very important and successful in the project and in part of the bill next case I don't know who we work with specifically the very most of the biggest program champions we can have but the type of leadership that he provides within St. Jude also has a big impact on whether or not the project has been successful just as everybody else here at the table so I think it's not putting the onus just on one person we talked a lot about well who's going to be that coordinator and if that person leaves what happens right but it is an investment and there is reciprocity in terms of the success of the project and it's moving forward and Dr. Huntsman was honest it's taking a long time and maybe it took 18 months to get there but then in the next 6 months the results that he yield are going to be still worthwhile that investment is worth it so it's having those conversations about maybe it takes 10 hours for that first survey but then you get the 15 if you need in the next weekend and so it's not always as simple as a work plan we all started out with but to be able to negotiate and have some flexibility with that is also really important so can you guys share any recommendations for developing collaborative partnerships? Well I had a couple tips if it's a little bit following up on some of the challenges that we face as well but one of the biggest difficulties that we've had in terms of why it's taken so long for the project to get started is I being an engineer had never done this before and actually neither of us had really official hair and so I think that I've learned that there's actually a lot of resources here on campus that you see that are helpful so one of the things that we hit on the statistical analysis was really important for the design of the study to be improved so in the ICTS we've done that there are statistical resources available for a small fee for design and assist so that was really helpful for us another thing was the there's a in the IRB process you're supposed to fill out these forms and then by the time you apply when you're actually putting your name in they tell you which you're supposed to take and so I filled out all the forms and at the end I started taking the training and I realized that it would have been good to take the training first but I just didn't know that which trainings were available until you actually tried to submit it so if you I guess if you start by trying to submit to something blank they'll tell you to train on it because these web classes you take it just explains kind of the history of where IRBs came from and what people can serve about and so then that actually after I took the training I rewrote all of it and the other thing I found was that we tried to screen our drafts and wrote different people on campus but what I found was people generally just gave us positive feedback and they said this looks good, this looks good but in the end when we finally submitted it we got huge amounts of negative feedback and this and this and this and so I think in retrospect I would have skipped all of the screening through kind of volunteers and just submit whatever you have as early as you can because that's once we started hearing back from the IRB that we could talk to them on the phone and they could work out the details of what was missing there and I think that a lot of those issues there was no way that we could have anticipated that. So there's skills building on both sides of the point as well which I think is great and then as we talked about the first thing this morning was the welfare resources that are here on campus as well because your Fullerton is also a university partner and there are also welfare resources there I know it's hard sometimes to physically get here but a lot of that information can be provided to you so that you know who is the chat so you have those conversations ready. We will also want to share some recommendations. Just a recommendation that I had that I think I've already put forward to Arda is that because we were struggling and that our clinic is going to have just applied and then next round CCRI grant applications to do an expanded version of our pilot and I was challenged to find again an academic partner to move us from the more analytical descriptive data to actual intervention. We want to use multi component intervention with some rich behavioral measurements so looking for more behavioral is probably in terms of an academic partner and being able to have those resources without just going on UCI's campus of course you can go and look at everyone's professors profile but number one it takes a lot of time and it may not be the most efficient or the most beneficial for our community partner so if ICTS had some type of way to help link community organizations with professors that are interested in building these community partnerships and disclose not just their area of research but maybe what they might be looking for from a community partner such as a particular patient population or a particular area of interest that these bridges might be able to be facilitated more efficiently and then ask trying to look and find somebody who is most suitable for carrying our work forward so and you all are like sighing perfectly the faculty mentor opportunity for the training workshops is actually what we're hoping to do as one of those faculty mentors we have four or five faculty over at Cal State and we're looking to bridge that opportunity to see if the interest is really now to be able to come together to work on projects and I know these are clinics that we're talking about also as a community clinic but I think the part of it is that a lot of your organizations have data lots and lots of data and so you don't have to have an electronic health record if you do it's great obviously they can work with it but if you have data that you want to mine and to find opportunities to enrich your program which is the mission of all of our work these are perfect examples of the type of opportunities where we can partner with faculty we don't all have to be using SAS but there is a capacity to do so there are a lot of different ways to look at your data and really tell folks you're so busy in the streets doing the work that you forget to pat yourself on the back and other people need to know the great work that you're doing and earlier Dr. Bastin has shared we need a space where we can learn from each other and we're so mired day to day in getting our jobs done that sometimes we don't get an opportunity to do that so the Alliance is also developing our web portal to house a lot of those types of community reports and to provide a space especially here at Orange County where we can have that dialogue and share the resources and see the richness through the great work that's going on there are some amazing stuff going on here that's the best kind of secret in Orange County and so we're hoping to facilitate both the partnering with faculty as well as the dissemination of information to help us advance our work as well I want to open it up this is a great group of people the faculty doing research and teaching they're working in community sites what kind of questions you might have I have a background in public health and urban planning and you guys are all dealing with diabetes and obesity that have much broader causes and groups than just what can be addressed in the clinical setting so I was wondering if any of your partnerships are collaborating and partnering with planning departments or community organizations that look at it from a more community based perspective offering more chances for exercise and better nutrition and you know the broader scope of those diseases I can just speak that this part of what we are doing not doing yet but plan to do is also we addressed that in a grant that we had the IHI and that of what we were doing and then how we hope to use that information to spread to a larger population so although we're not there we certainly identified it in a larger grant at a national level as something that we had very intentional about so although like I said we haven't started but we certainly identified it as important to spread and friends and family not a part of this academic partnership but they collaborated with the city of Lahagra to bring a Kaboom playground to Lahagra which is about a mile of our clinic site so there is a very large and active Lahagra city wide collaborative made up of a lot of 24 community organizations and it was done through that collaborative. There is an organization called NewPak familiar with NewPak and I think you find that on a larger scale you may be looking at the opportunity to environmental change is very interesting there are a few meetings actually this coming Thursday and they will partnership network and so on the Orange County Health Agency on 17th Street in the back there's a trailer in the back it's one o'clock for those interested in one o'clock. Questions? Are you frightened of IRBs? Really silence here that was IRBs it's dragging but it is it's a safety measure on the other side we're going to cardiology and this is a safety measure because not everyone should have access to health records or people's health records you want your privacy and this is your way of protecting you might be identified so on and so forth this is the way of protecting your privacy and it's going to become a more and more scrutinized as Google and Microsoft and all these other groups that want to store your records in the clouds and this and that and you have to be very, very careful for your clients, your patients whatever you're looking for making sure that the privacy does take place so even though we're not our best friend of the IRB but they really do provide a significant service and I guess a tip would be don't expect funding approval the first time you're going to get critical feedback which will help you be taken in a constructive way now I know your ego's in there because I've written over a year and a lot your ego's there, your shattered why did they see this after all you go get a scotch a couple my first beverage was choices so after that then look at what they have to say about it and some of this nitpicking is correct but other things that are really critical is to how to clarify how to express what you said in a better way and just understand how to fix shells it's going to take once or twice maybe three or four times I was in a slow movement to be about a half a dozen times to finally get the idea of what this is about and how to write this in a better way so other people the last first time through they hit the lottery but for them that's not my case so I think just understand that all of us had failures in taking the proposal to go for the IRB and based on the time critically analyzing it is it safe, is it effective is there a chance this is a useful thing and they're giving you feedback and I think just on that point I think starting early like Elliott mentioned is really important I remember when I was doing my doctor in my 20s I thought oh where am I doing with my 20s and someone said well listen you're going to be 30 someday one way or another you're going to be 35 you're going to be 75 one way or another but when you turn 30 or 40 where do you want to be with IRB it's sort of like listen this could take a year to get approved a year is going to pass whether or not you start on IRB today or not but in a year do you want to be doing research so kind of starting early I think it seems so disturbing if you think like there's no chance they're going to take this proposal the first time I do it but if you don't begin you'll never get this and one thing about IRB and I don't know how much is a recent change or something I just recently learned of that they've been offering workshops for their proposals and I had done a number of IRBs and I still attended this thing and realized wow no wonder I wasn't going to approve the first time there's simple tips and getting to know the people in the IRB can really help lower some of those barriers as well I have two separate questions the first one is the IRB process is there any guideline from the IRB to say that they have documented this kind of training they have to take in order for you to conduct this kind of research instead of submitting a blind application to them and they're going to say oh really we do this you have to be respectful of the training so there's a guideline instruction from the IRB hey this kind of human subject you have to take this kind of training in order for you to qualify for that kind of research and my second question is to Dr. John Berman it's about I'm very interested about your research on the on the why the chronic disease still happen even though they don't have a better access to healthcare so one of the reasons might be some ethnic population there's been a lot of health issues that if you address only one health issue it might not work in that setting so it's very interesting also to learn about how to have those kind of patients with the limited speaking to have a better communication so those kind of research but it's very good to know the underlying causes of factors of why those people have a better access to healthcare but in specific population by this step they are how come this is not getting better I can kind of take both questions the first one is a very easy question yes there are some guidelines on the UCI IRB's website I'm not really familiar with the links but that might be something our group can connect you to but they do sort of talk through although as Ellie pointed out sometimes you have to kind of go down the wrong road a little bit to find your way back to the right one and that's a very common experience but if these discuss there's only a handful of tutorials if you're not doing animal research you won't do the animal research but you will do the human subjects research tutorial you will do the hip-up health information on the website that helps you determine what's the level of risk that's involved in the study that helps determine what level of review is required is it a full committee review or an expedited review or an exempt protocol and also a little bit about which tutorials need to take I wish I had a bunch of time to talk about my research and we can talk more about it in general but I think the real challenge that comes with patients and underserved populations who even receive all the appropriate process of care they get paid for by CMS and are in all the guidelines they get all the annual tests and eye exams and food exams and all the things they're supposed to have done is exactly what you're talking about life is much more complex than just a series of biomarkers and physical signs and symptoms and we're just looking at ways even trying to help patients identify what these multiple issues are what's the responsibility is it living in an unsafe neighborhood that makes it difficult to exercise and I try to look at how can we help patients get their own heads around what is it that's making it tough for me and then can I have a better dialogue about that with my doctor so maybe they can help simplify or tailor a treatment regimen that is more responsive to those particular challenges have you also looked at the past experience they have faced let's say it's a population and past drama and then it's still being there after 20 years living in the United States so I had my looking at the past history they have experienced so it also can determine what kind of care, what kind of research should be done properly to address those kind of issues yeah that's an extremely important issue I think we often end up looking at it sort of what symptoms and experiences are they having today which often of course are a consequence of a whole lifetime of development although we are doing some work with individuals that have suffered extreme trauma and are seeking care and have their mental health symptoms go and treat it that you and I can talk about a little bit as well but that's a very important area my name is Arda I actually have worked at the ICCS in their community engagement unit but only because I'm intimately familiar with each and every one of your projects I'm just curious how did you guys navigate the field where there was a difference of opinion on how to proceed and which way the project should be going even though the end result is still the same of how you guys wanted to go there but perhaps the academic partner said we should go this way and the community partner said we can't do that but let's go this way how did you guys navigate where there was just a difference of opinion and how to move forward I can refer you to Dr. I can refer you to Dr. I can refer you to Dr. but Dr. Bassett in all honesty he suggested several additional structured variables that if we could find them in the data which I did so but you could have rejected it she said no I don't want to do this that's her call I think that was the interaction we had I think that's a fantastic interaction but a lot of no it is and a lot of partnerships that I'm privy to don't always have that or it might be that sometimes some partnerships say hey I got the money let's start so if you guys have not had any difficulties I mean if let's say somewhere down the line you do something happens and you guys don't agree how would you navigate that field and that sensitive relationship I just didn't want to talk too much in a row but we did have some difficulty a little bit so basically Barry Ross is really the champion of the project he and I into the partnership together but the person that all sort of came down to was the nurse practitioner that actually runs the clinic based program and she's like Captain America plus Superman you know she's just unbelievable I just want we need a million of you but because there's only one of her she's pulled in many many directions and sometimes she wasn't getting the support necessary from the other people in the organization that could have been pulling these so she ended up doing a lot of the data collection stuff which to me never seemed like the way to go because she had enough to do but at the same time I felt a little bit like Dr. Bassan is just kind of wanting to let the organization find their way and didn't want to step on any toes I didn't want to say like this isn't getting done fast enough because I don't want Captain America to get in trouble you know so of course you wouldn't have it so this was a very valuable learning experience to sort of figure out how to discuss some of these issues about holding each other accountable I held up in the process as well and in your packet there's actually this there's this pink salmon colored community and action academic partnership guidelines and suggested checklists which I was part of the community and gay community that helped develop some of these things and it brings up a lot of the questions surrounding IRV and funding and division of labor expectations and goals for the project and how do you communicate about this stuff and this will not solve every problem but at least it sort of establishes going through this together once the project sort of is starting to take shape is a good idea because I think it took me a little bit of you know I had some uncertainty about how do I raise these issues about getting the results done fast enough and I'm not sure if there was something that I wasn't doing right I don't even know what I heard about or I probably was doing things that they didn't like that maybe I never heard about because we didn't establish that and this kind of helps at least plant the seed for that a little bit and it might accelerate a little bit faster the development of that kind of frankness would be better you know so give it a look it might be useful so oftentimes that will be a problem or not existing data I mean I'm sorry we're going to become exempt so an exempt sort of sounds like you're exempt from looking at it but there is still a looking at it that occurs and so if you communicate with the IRB about the situation but in general if the data is de-identified so if you're not saying like what did Bill Smith think of smoking like if it's more looking in the aggregate at de-identified data you can still look at all kinds of correlations in advanced modeling on the data but as long as you can't link it back to a person it becomes much easier to obtain that exempt status which means an exempt means you don't need to acquire consent so a qualitative attitude to this would be absolutely not going on here at any point you're collecting if you obtain consent from those individuals that you're doing the qualitative data collection then that's fine but you can certainly start with the de-identified data I don't want to make a quant study but then the question will advance if we don't want to do a qualitative analysis so if you're involving if you're collecting new data that wasn't collected for any reason other than the research and if you're dealing with identifiable data especially health related data you'll have to go for the IRB but there's lots of projects that don't require those steps that you could have an exempt protocol that doesn't, it's very easy to start I mean relatively easy to start we learned another better about 1v2 but it's probably also at the beginning of the partnership too so to me it would have been a nice start if some people have ideas that they are looking for you know partnership so when we are you know I know we have a list that we can you know if you want to share your kind of information but at the same time if there are things that you are looking for and maybe between us there are some of us that are interested but they never knew how to reach out and the information has not been shared maybe it would be a good idea to have that connection I don't know how but I'm just opening an idea that maybe some of us can have those ideas and getting us together a little closer and have a better community organization perhaps in the future so aside from sharing participant information you guys are all prompting me today your evaluation today actually does prompt you to start putting down some of those thoughts and ideas and you know I was hoping to bring that back to the group in terms of letting folks know about potential partnerships and their community partnerships as well that could be fostered so I think since you brought it up there will be some great ideas that might be shared and that's also what we can prompt you to start considering it doesn't have to be the next project of the century it could be assessing your home current data like Dr. Vassen said and saying hey are we being effective and like Dr. Willeming said yeah that's the primary question but what do we need to do so we'll discuss how to share some of that first but I'm definitely requesting that so we can start so thank you thank you thank you too teams are people with diverse backgrounds that bring individual talents and resources teams are diverse groups that can provide a greater variety of solutions teams are groups that are more likely to have positive outcomes in the workplace a team with diverse teams that will be more productive I think you all buy into that you're aware of that but we walk through a lot of exercises today to do a little bit of self reflection on communication and how key that is to building successful partnerships and I like the team that broke out on their own for a little bit we're like we're vested in this and then even when you spell teammates not everyone was buying I don't know what you're doing but I'm not a part of that but really it was just to bring this full circle to the way of doing all this data but to remind you as the last comment during the panel was it's not just about community-academic partnerships but building relationships with others in the room and they really are people that you work with so communicating not only in using or spoken word but being an active listener and waiting it's also just as important and then helping you set some guidelines and understanding is really important to the communication process and to building a richer relationship so steps on successful partnerships established through communication learning common goals, roles, and goals of engagement make financial agreements clear recognize that we're not always agreeing and willing to talk to you all the time since the time and really time can be measured in a bottle every partnership is not built on the same amount of time some have to be broken in shape and become like 10 partnerships some 10 years to build so we don't have all of those key answers but it really is the investment in the process I also wanted to share that was our outline that was started with and I hope that after today we can answer some of these questions and that we've shared resources for you to help build more successful partnerships and then if you didn't have the opportunity to attend the first two workshops and if you did they are actually now available online to you the slides as well as the voice of your presenters are online at these links and so we hope that you will also legalize that as a resource to share that with others that you work with and engage with and then this session will also be available in a few weeks and then that is I really want to thank you for your time today I really enjoyed having the opportunity to speak with all of you I want to go and recognize our funder which is the National Institute National Center for Research Resources and really to be a part of you for engaging in all the activities and the ones that didn't feel so fun the smiles all day have been very warm and welcoming to me and that's been a great experience for me to receive that from all of you today so I want to thank you for that Yeah, well the following two workshops to be available online eventually as well Yes, so the entire series will be available online and as they come out we'll send them to you We also will have a second series of workshops that will start this fall and we're securing both dates and locations and we know others who are interested in one of the five or all five we also would encourage you to share that information which is something to oversee that The last question again that was brought up during the panel is really helping to foster these relationships and that is what I'm here to do there's no silly question there's no silly idea and there are resources that may be not grant funded that could help strengthen the work that you're doing with your organization so we really encourage you to share that information and we'll mobilize that either verbally or written so that we can help broker some of those relationships and partnerships and I hope you have different networking today not the usual but we also will send out the participants so that you can also follow up with one another if you didn't have as much time as you like to participate today so thank you very much and then our next workshop is a month from now at the Dalha Community Center and focuses on program evaluation