Monday, April 3, 2017

Why is April Sexual Assault Awareness Month?

Why is April Sexual Assault Awareness Month?
Martina Todaro, MA, Research Associate

As a non-profit that supports community-based solutions to complex public health challenges through research and evaluation, ICH partners with local organizations on a variety of relevant projects. While some are in the traditional realm of public health, others were not until recently. Homelessness and housing issues are examples of areas that were outside the sphere of this science before their intersection with health was widely understood. Most recently, sexual violence has also appeared on the list of public health issues, and for tragic reasons.

Data published by the Centers for Disease Control and Prevention in 2012 tells us that 1 in 5 adult women are raped at some point in their lives. 37.4% of them are first raped by the age of 24[1] . Let’s not be misguided by what we’ve become conditioned to believe sexual violence means (for example, a stranger jumping out of a bush in the middle of the night). Between 1995-2013, according to the US Department of Justice, 80% of female survivors knew their perpetrator[2]. While women are disproportionately victimized if compared to men, individuals with physical or intellectual[3] disabilities, regardless of their sex or gender identity, represent a disturbing 11.5% of victims of sexual violence.

In recent years, sexual violence prevention efforts have focused on engaging the public by raising awareness about the magnitude of the problem, and empowering individuals to be active bystanders. The Obama’s administration sent a clear message in this regard with the It’s on Us campaign. On a smaller scale, we can find programs that aim to change the conversation about sexual violence nationwide. Locally, for example, the Boston Area Rape Crisis Center provides training on active bystanding on college campuses, in efforts to advocate for social responsibility. Similarly, Jane Doe Inc., among other initiatives, engages men and fathers to promote positive masculinity and prevent teenage boys’ perpetration of a first sexual assault.

ICH recently worked with Triangle Inc, a local non-profit that empowers youth and adults with disabilities to enjoy independent, fulfilling lives in the community. Through the evaluation of their IMPACT:Ability program, a training on safety and self-advocacy for special education students in the Boston Public School system, ICH found increases in participants’ safety and self-advocacy knowledge, their confidence to defend themselves, their beliefs in their personal abilities, their sense of safety, and their likelihood to speak up to stop potentially abusive situations. Many of these changes were shown to be sustained even one year after the students first participated in the training, when ICH administered a follow-up survey.

We hope that this study paves the road for other efforts to identify effective, long-lasting interventions enabling individuals, especially the most vulnerable ones, to recognize and get out of unsafe situations. Surprisingly, there is not a comprehensive body of literature on the intersectionality of abuse, including the ones of a sexual nature, level of ability, gender, and other factors such as race, class, and immigration status. Our hope is that, by acknowledging their interconnected nature, we can help ourselves become a more civically engaged, supportive community ready to step out of our comfort zone to make everyone feel safe.

If you want to know more about ICH’s IMPACT:Ability study check out: Dryden EM, Desmarais J, Arsenault L. Effectiveness of IMPACT:Ability to improve safety and self-advocacy skills in students with disabilities—follow-up study. J Sch Health. 2017; 87: 83-89.


Wednesday, January 18, 2017

Exploring Trends in Your Local YRBS or Student Health Survey Data

By Lisa N. Arsenault, PhD and Stefanie Albert, MPH

The CDC’s Youth Risk Behavior Surveillance System (YRBS) has provided data on health-related behaviors of U.S. high school students for over 25 years.  Results have been used to monitor progress toward national health objectives and to support the modification or development of programs and policies that promote health among high school aged youth.

Individual school districts across the country have recognized the utility and power this type of data provides and many choose to implement local-level versions of the YRBS (or other similar type of student health survey).  Most districts hire external contractors or organizations to conduct the data cleaning and analyses of their local data. Many districts also use external contractors to generate summary reports, tables, and charts.  But even with external help it can be overwhelming to decide how best to examine the results.

 Here we briefly illustrate one of the most powerful ways to explore student health survey data, the trend over time. Our goal is to provide some useful suggestions for exploring and reporting data from your own surveys so that you can be better informed on the health needs of your students. 

 Example 1:  The Basic Trend

Here is a simple table of results that shows the rate of one risk behavior among all students over three different years.  In this format it is easy to see and report if the rate of the behavior is increasing or decreasing over time. In our example, the rate of marijuana use in the prior 30 days has declined from nearly 27% in 2012 to about 19% in 2016.   

You can also visualize this data in a very simple bar chart, as shown below. You can opt to add some text boxes that highlight extra information that might be important for your audience to understand about the data such as the state rate, total number of students surveyed, etc. 

In this example, we added the approximate number of students the current year’s rate represents.  We find this is often helpful when trend data show a decrease over time because it’s easy to forget you are talking about actual students in your school.  So highlighting how many students are still at risk is a good way to balance the ‘big picture’ with the real personal value of the data. 

 Examining the overall trend in your data is absolutely the essential first step.  However, the trend you see might not represent what is going on for all sub-populations of students!  For this reason, we highly recommend exploring and comparing the trends among sub-groups of students to gain a more accurate picture of the health of your student population. 

Example 2:  Trend by Sub-Group

Here is a second table of results that shows the rate of one risk behavior over three different years and stratified by grade level. In this format it is easy to see and report if the rate of the behavior is increasing or decreasing for each sub-group.  In our example, the rate of marijuana use in the prior 30 days has steadily declined between 2012 and 2016 for 9th and 12th grade students.  But the rate has increased since 2012 among 11th graders and it has increased since 2014 for 10th grade students.  Had we stopped exploring our data after looking at the overall trend, we would have missed this very important finding!


Visualizing the trends by sub-group can really help you ‘see’ the differences, particularly when many years of data make reading summary tables full of numbers more difficult. In our example below, the dramatic drop in 30-Day marijuana use among 9th graders is very clear.  Likewise, you can easily see the steady decline in use among 12th graders.  And the less encouraging results for the 10th and 11th grade students are shown in a more understandable way that can foster discussion with stakeholders or audiences. 

 Trend data is one of the most powerful ways to explore your student health survey data.  But overall trends may be hiding some very important differences between sub-groups of students.  At ICH we always encourage school districts to look at data trends by grade level and by gender.  Additionally, for districts with a diverse student population looking at data by race/ethnicity is also important.  Ultimately, the goal of collecting YRBS or student health survey data is to inform programs and policies that will improve the health and wellbeing of all students.  We hope that our suggestions here will help you achieve that goal.   


 ICH has supported the development and implementation of both middle school and high school student health surveys in multiple school districts in MA. We have also provided technical assistance to numerous school districts, public health agencies, and substance abuse coalitions around the analysis, interpretation, and dissemination of survey results.  Our goal is always to aim for results that are understandable, useful, and actionable and this has led us to explore many different ways to visualize student health survey results over the years.


Thursday, December 15, 2016

What’s in a word? The challenge of “infrastructure” funding

By Lise E. Fried

Status of nonprofits
Donors and funders often want to know how much of a nonprofit’s revenue was spent on “infrastructure” or “overhead.” Donors and foundations want to fund “programs” not “infrastructure.”  But, how can programs exist without infrastructure?  At home you pay for heat, light, furniture, etc, and we have to do so at nonprofits too.  Restaurants have to pay for staff to order supplies as well as produce pizza.   It is the same for nonprofits.
I participated in a recent webinar by Guidestar 1 that showed some fascinating data on nonprofit status collected by Bridgespan.2  Some of the data are based in an important article, “The Nonprofit Starvation Cycle,” published in 2009 in the Stanford Social Innovation Review .3  It did not surprise me that in 2014, 24% of nonprofits were “in the red.”  What was more compelling was that the twenty nonprofits that Bridgespan studied spent between 21% and 89% of direct costs on “infrastructure.”  Back in the 1950s, the federal government believed that 15% of direct costs should be the overhead (infrastructure) goal for nonprofits. It was a myth and the federal government no longer believes 15% is appropriate.  It is a rare organization that can survive on that percent.  And, more importantly, as shown in the article mentioned above “infrastructure drives impact.”  So, spending little likely means accomplishing less than the organization could if it were better funded for core dollars.

Measuring impact

The Institute for Community Health (ICH) is a sixteen-year old participatory evaluation and innovative research nonprofit creating sustainable community health. ICH is moving from a primarily donor-funded infrastructure to infrastructure funded as part of the cost of doing business on grants and contracts.  For ICH, funding for infrastructure has always been an issue.  We struggled for years to show our donors the impact of their dollars. Their dollars paid for the organization to exist, lead, manage, pay rent, and more, all of which drives impact.  Moving to explaining this same issue to foundations and other funders, we have a similar challenge.  Again, it is not that different from a restaurant that needs staff to make food and management to run the restaurant.  We need staff to run our programs and staff to manage the organization.

Language of impact

I agree with other participants on that recent webinar that part of the problem is the word “infrastructure.”  We all agreed that some other terms might be better – “core funding” got the most votes.  Federal (and other) grants call it “indirect”, some call it infrastructure, but it all means the same thing.  Terms that highlight the fact that these costs are part of the work and not a separate set of costs make more sense.


Ultimately, what matters is impact.  Has a nonprofit organization helped anyone?  If so, how many people and in what ways?  Have we met our goals? If yes, then organizations funding the work that led to that impact should help pay the core funding dollars that made it happen.

1.       Tips, Tricks & Secrets to a Successful GuideStar Profile  (

2.       Eckhart-Queenan J, Etzel, M, Prasad S.   Pay-What-It-Takes Philanthropy, Bridgespan

3.        The Nonprofit Starvation Cycle, Stanford Social Innovation Review, Fall 2009


Thursday, October 27, 2016

Using photovoice to engage participants in qualitative data collection

By Ranjani Paradise

My Camera. Paul Reynolds, 2006, (Flickr).
Used under Creative Commons Attribution 2.0
Here at ICH, we do a lot of qualitative data collection as part of our research projects, program evaluations, and needs assessments. While we often use traditional methods such as interviews and focus groups, we also use photovoice as a creative and fun alternative to traditional qualitative data collection approaches.

What is photovoice?
Photovoice is a method that originally came from the world of participatory action research. It was first used by Caroline Wang and Mary Ann Burris in 1992 to empower women in a rural Chinese village[1] and is now used to explore myriad topics in a variety of fields. With photovoice, participants take photos to represent their perspectives about a particular issue, and the photos are used to stimulate discussion, reflection, and action.
What are some of the unique advantages of photovoice?

Photovoice is a great method for engaging participants and creating a safe space for open discussion. In our experience, photovoice can help you:

  Empower participants and give them a unique mode of expression

  Catalyze dialogue and reflection about personal and community issues

  Understand issues from others’ points of view

  Share participants’ stories in a compelling, visual way with leaders, policymakers, or others

How have we used photovoice at ICH?

At ICH, we have used photovoice as part of our evaluations of several programs, including:
  • GRO: A gardening program for immigrant and refugee families in the Boston area
  • Pathways to Family Success: A program for immigrant parents in Cambridge, MA to help them better understand the U.S. school system and support their children’s education
  • Young Men Matter Too!: A sexual health program for young men of color in Springfield and Holyoke, MA

As you can see, photovoice can be used to explore many different topics with many different populations!
Photo from the GRO photovoice project
“I took this picture because this man was walking in the street and smelled the basil. He said that every time he pass by he smells the nice smell of the basil and he needs this green. He likes this green.”
Photo credit: Amina Osman, Refugee and Immigrant Assistance Center
Want to learn more?
For a great introduction to the photovoice method, check out Caroline Wang’s paper entitled “Photovoice: A Participatory Action Research Strategy Applied to Women’s Health” (Journal of Women’s Health 8(2), p. 185-192, 1999).  
ICH will be presenting our second photovoice webinar in the spring of 2017, which will include a practical, step-by-step guide to conducting photovoice projects. Here’s what participants had to say about our first photovoice webinar, which we presented last spring:
“It was a very informative and well conducted webinar.  Thank you so much!”
“The webinar was well organized and informative.”
“It was useful and well presented.”
We hope you’ll join us for the 2017 webinar - keep an eye on our website for more information in the coming months!!
[1] Wang, C., & Burris, M.A.. Chinese Village Women as Visual Anthropologists: A Participatory Approach to Reaching Policymakers. Social Science & Medicine, 42, p. 1391-1400, 1996.

Thursday, September 29, 2016

Behavioral Health Integration and the Workforce: the Cambridge Health Alliance Experience

By Leah Zallman, MD, MPH

Behavioral health integration has caught the national eye for its potential to improve patient outcomes and patient satisfaction, in addition to reducing costs.  Behavioral health integration is a healthcare delivery approach that is geared towards addressing mental and behavioral health concerns in primary care.   Early success of these programs has led to increased attention to the immense need for developing a sufficiently and adequately trained workforce to deliver integrated care. Indeed, these programs require large investments in the workforce, and the work of integration requires a cultural shift in how healthcare institutions care for their patients.  And yet, relatively little attention has focused on how the workforce is responding to the work of integration – to what degree the workforce feels more supported in caring for patients with mental health conditions, is more satisfied with their work, or alternatively, is more burned out by the high levels of effort this entails.

 Informed by 25 years of care integration, one of our partners, Cambridge Health Alliance, has embarked on an innovative and extensive behavioral health integration program.  We have been working with Cambridge Health Alliance to better understand how this program is affecting their workforce through annual surveys of their primary care and behavioral health staff. Together, we have learned that primary care providers feel more knowledgeable about how to care for these patients, across a variety of measures. We have also learned that staff report higher degrees of systems integration –for example, more primary care providers report talking with their mental health colleagues on a regular basis, which is mirrored by an increase in behavioral health providers’ report that they speak with their primary care colleagues on a regular basis. 

First and foremost, this experience has highlighted the power of a well conceived and enacted program, like Cambridge Health Alliance’s behavioral health integration team, to change the workforce experience.  And it has also highlighted how thoughtful, prospective evaluation of the workforce experience can provide programs like Cambridge Health Alliance with meaningful data that helps shed light on the workforce experience.

Monday, September 8, 2014

Meeting people where they are: How the radio is being used to eradicate health disparities among the Haitian population in Somerville, MA

As an ICH intern I have had the privilege of working on a number of projects, one of which was the Kwen Sante (Health Corner) radio show survey. This project, led by Marie-Louise (Malou) Jean-Baptiste, MD, an internist at Cambridge Health Alliance, sought to engage the Haitian population living in Somerville through radio segments about health-related topics such as hypertension, cancer, and HIV/AIDS. Traditionally, the radio has been a vehicle for providing important social and political information in Haiti. Therefore, by disseminating health information to this community via the radio in Haitian Creole, Dr. Jean-Baptiste is able to provide heath information to those with low literacy and limited English skills in a way that is relevant to this unique population. 

To help assess the effectiveness of Kwen Sante among Haitian individuals living in Somerville, Dr. Jean-Baptiste partnered with the Institute for Community Health (ICH) to conduct a one-time survey at a local church health fair event to evaluate whether residents were familiar with the radio show, what they had learned, and whether the show was improving their health. Out of the 43 respondents, 26 (60.5%) reported listening to Kwen Sante. Although the sample size was small, the results were positive overall, with most respondents citing that they had either learned something new about their health and/or applied their new knowledge to their lives. See the chart below for results from one question of the survey.

Working on this project through ICH taught me that even when the sample size is relatively small, you can still find something interesting to take away from the experience. For instance, even though the project was aimed at Haitians living in Somerville, 16 out of the 26 listeners lived elsewhere in the Boston area, telling us that Kwen Sante has attracted more listeners than those originally intended. Fantastic! Overall, ICH helped demonstrate that the Kwen Sante radio show is making a positive impact amongst Haitian residents, and from what I can tell, it has the potential to reach many more.

Janelle Mellor is a student at Boston University School of Public Health concentrating in Global Health. For more information on the ICH internship program and to apply for current intern positions, please contact Reann Gibson at


The views expressed on the Institute for Community Health blog page are solely those of the blog post author(s), and do not necessarily reflect the views of ICH, the author’s employer or other organizations with which the author is associated.

Tuesday, June 10, 2014

Using Creative Methods to Evaluate Youth Programs

By Kelly Washburn & Julie Carpineto 

We are the evaluators of an urban high school-based teen pregnancy prevention program in Everett, MA called “Empowering Youth in our Community”. Our partner, whom ICH has worked with for 9 years, is the Family Planning and Adolescent Community Services Division at the Cambridge Health Alliance.  

Each year, the program is required to conduct a site-specific evaluation. In previous years, we conducted focus groups with the high school students involved in the program to meet this requirement. However, two years ago - while reviewing the qualitative data from those groups - we realized the data was not that different than previous years. This realization led to discussions on how to conduct an evaluation to find new information, while continuing to ensure that the students could play an active, participatory role.  Together with the program partners, we developed a three-series collage project, drawing from the principles of Photovoice and other arts-based evaluation techniques. We aimed to engage participants in a discussion of a major theme addressed in the program: healthy relationships.

Developing the Evaluation Question
The first step in our process was to determine our evaluation question. We collaborated with the program coordinator to come up with “What does a healthy relationship look like to you?”  This question was chosen for a couple of reasons, the first being the timing of the evaluation with the program sessions. Students had recently completed a series of classroom sessions focused on healthy and unhealthy relationships, and we were interested in understanding how those sessions shaped their vision of healthy relationships. Furthermore, data from focus groups conducted in previous years revealed that the relationship sessions stuck out to students and had the most impact on them personally.  By asking this question, we were able to gain a more in-depth understanding of students’ opinions about this topic.

Collage Implementation
Over 90 high school students, in five separate classes, were asked to individually pull images from popular magazines that, from their perspective, represented healthy relationships. We left the type of relationship up to the individual students to think about, and many discussed a combination of romantic, friend, and family relationships. They were then led in large group discussions about why they chose their images.  Looking at their chosen images, students were asked to reflect on their thoughts, feelings, perceptions and experiences related to the different types of relationships. 

Afterwards, students were asked to work in small groups to combine their images to form a larger, collective collage poster. These posters served as visual representations of the students’ perceptions of healthy relationships.

Next Steps
The final phase of this project will include individual interviews with participating students to gather additional information about the collage process and their overall experience as program participants.

Lessons Learned:  
  • Magazine selection should be a part of initial planning. Examples of the magazines we used included: Glamour, People Magazine, Sports Illustrated, and Marie Claire.
  • Chose a diverse range of magazines. Make sure your selection of images is representative of your population!

Hot tip:
  • This project can be done with a small budget, limited time and with almost any participant population.
  • This project is a fun and creative way to engage young people in evaluation.

Cool Trick:
  •  If available, take notes from the large discussion on a white board. This serves as another visual representation and can help students develop their collages.  

ICH staff have expertise in a variety of program evaluation methods and strive to tailor each evaluation to meet the needs of individual clients and programs. Learn more about ICH's Program Evaluation services.

The views expressed on the Institute for Community Health blog page are solely those of the blog post author(s), and do not necessarily reflect the views of ICH, the author’s employer or other organizations with which the author is associated.