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1 Call for Applications Due Friday October 12 th 2nd National Community Partner Forum on Community-Engaged Health Disparities Research December 5-7, 2012 ~ Washington Court Hotel ~ Washington, DC As members of the planning team for the 2 nd National Community Partner Forum, we invite community partners involved in community-engaged research to apply to participate in the 2 nd National Community Partner Forum, December 5-7, 2012 in Washington, DC. Introduction: Community engagement in research is central to understanding and addressing racial, ethnic and socioeconomic disparities in health. Research funding agencies are supporting faculty members and institutions to engage communities as partners in conducting research. As more community organizations enter into research partnerships with institutions as well as initiate and conduct research, it is clear that we need our own networks for professional development, mentoring and advocacy in order to advance the social change through knowledge and power sharing that must happen if we are to achieve health equity in this country. At the inaugural National Community Partner Forum in December 2011 in Boston, an agenda for change emerged: For research to have any hope of moving the needle on health disparities, communities of color and low-income communities need to have (1) power in decisions made about research (2) the capacity and infrastructure to engage as equal research partners with institutions and conduct their own research and (3) significant roles in building the capacity of academic institutions to engage and partner with communities. As community leaders who are passionate about health equity and social justice, participants quickly came together around the need for research equity and justice through the co-production of knowledge and building democracy in the shared governance of their partnerships. Inaugural forum participants 77% people of color and 80% involved in federally funded research established a leadership structure, formed workgroups for peer learning and resource development and pledged to gather again a year later in Washington DC. The 2 nd National Community Partner Forum seeks to advance community-engaged research as a tool for eliminating health disparities by: 1. Deepening the knowledge and skills needed by community partners to successfully conduct community-engaged research, negotiate community-academic research partnerships and serve in national leadership roles; 2. Disseminating innovative work of community partners that others can learn from and build on; 3. Engaging in constructive dialogue between community partners and key stakeholders in academic, government and philanthropic sectors to foster mutual understanding and supportive action; and 4. Growing and deepening a national network of community partners that facilitates professional development and has a significant voice in decisions about research practice and policy Forum Agenda: The forum agenda is designed to provide time and space for community partners to learn and strategize together as peers before their academic partners and other key stakeholders join the conversation. On Wednesday December 5 th, afternoon skill-building workshops will cover such topics as the basics of community-based participatory research, addressing challenges in partnerbased research, applying for and managing research grants, preparing to serve on federal research advisory committees and grant review panels, and developing community IRBs and community research review boards. On Thursday December 6 th, workgroups will report on their progress and engage new community members in determining their future plans. Small group sessions will tap into the knowledge in the room by drawing out successes, failures, lessons learned and promising practices in community-engaged research. That evening, academic partners, policy makers and funders will join the forum for a reception and poster session. On Friday December 7 th, community partners will report on their deliberations and engage academic partners, policy makers and funders in a dialogue around the actions that are needed. The forum will conclude that day at 12 pm. 1

2 Application Details: Applications must be submitted online no later than Friday October 12 th (see pages 4-5 for the application questions). Applicants will be notified by Thursday November 1 st. We are seeking experienced and novice community partners involved in research who are committed to social justice, willing to share their challenges and successes, and eager to both enhance their impact at a local level and contribute to a broader research and advocacy agenda. Individuals from community-based organizations are especially encouraged to apply. Inaugural forum participants do not need to re-apply but must complete an online registration form at by Friday October 12 th. Community partners who are involved in partnerships with academic institutions are encouraged to invite an academic partner to apply to attend the forum evening reception and poster session on Thursday December 6 th and the dialogue on Friday December 7 th. Only applications from academic partners that have a corresponding community partner application will be considered. In deciding whom to invite, the forum planning committee encourages consideration of these questions: 1. Which academic partner best exemplifies a commitment to authentic partnership and community engagement? 2. Which academic partner is in the best position to strategically advocate for supportive policies and practices? In making final selections, we will strive for diversity among participants in terms of their geographic location, race/ethnicity and research experience. In order to maximize opportunities for dialogue, active learning and subsequent action, the forum will be limited to about 150 community-based participants and 50 academic partners, policy makers and funders. Click here for the community partner application form: Click here for the academic partner application form: Forum Logistics: Registration for all forum participants is free of charge, supported by a grant from the National Institutes of Health. A block of rooms is being held at the Washington Court Hotel, 525 New Jersey Avenue NW in Washington DC at the government rate of $183 plus tax for a single or double room ( Assistance will be provided to connect participants who would like to share a room. Limited scholarship funds will be available for selected community partners who would otherwise be unable to attend. Information on how to apply will be provided when application decisions are sent out. We are also happy to provide official letters of invitation or other documentation that may help in raising funds to attend the forum. We encourage our allies in academic institutions, government and philanthropy to consider supporting community partner travel expenses to the extent possible. Individuals and organizations that provide such support will be recognized by name on the forum website and in the forum program with their permission. For More Information: If you have any questions or would like to be added to the forum list, please write us at programs@ccph.info Funding for the forum is made possible (in part) by 1R13MD from the National Institute on Minority Health and Health Disparities, the Eunice Kennedy Shriver National Institute of Child Health & Human Development, and the National Institute of Environmental Health Sciences awarded to Community-Campus Partnerships for Health ( and the Center for Community Health Education Research and Service ( The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention by trade names, commercial practices, or organizations imply endorsement by the U.S. Government. 2

3 FORUM PLANNING TEAM Forum Planning Committee Willie Mae Bennett-Fripp, Executive Director, Committee for Boston Public Housing, Boston, MA Grace Damio, Director of Research and Service Initiatives, Hispanic Health Council, Hartford, CT Susan Gust, Community Activist & Small Business Owner, Minneapolis, MN Ernest Hopkins, Founder & CEO, The Phoenix Group Foundation, Atlanta, GA Loretta Jones, Founder & CEO, Healthy African American Families, Los Angeles, CA Ogonnaya Dotson Newman, Director of Environmental Health, West Harlem Environmental Action, Inc. (WE-ACT), New York, NY Ann-Gel Palermo, Chair, Harlem Community & Academic Partnership, New York, NY Fernando Pineda-Reyes, Executive Director, Community, Research, Education & Awareness (CREA) Results, Denver, CO Alex Pirie, Coordinator, Immigrant Service Providers Group/Health, Somerville, MA Angela Reyes, Executive Director, Detroit Hispanic Development Corporation, Detroit, MI Al Richmond, Director, Healthy Workplace Initiatives, North Carolina Institute of Minority Economic Development, Durham, NC Zachary Rowe, Executive Director, Friends of Parkside, Detroit, MI Jean Schensul, Senior Scientist & Founding Director, Institute for Community Research, Hartford, CT Raquel Trinidad, Member, Institutional Review Board, Special Service for Groups, Los Angeles, CA Eric Wat, Director, Research and Evaluation Unit, Special Service for Groups, Los Angeles, CA Gayle M. Woodsum, President, Action Resources International, Laramie WY Forum Principal Investigators Elmer Freeman, Executive Director, Center for Community Health Education Research and Service, Boston, MA Sarena D. Seifer, Executive Director, Community-Campus Partnerships for Health, Seattle, WA and Toronto, ON Canada Forum Consultants & Staff Nancy Shore, Associate Professor, University of New England School of Social Work and Senior Consultant, Community-Campus Partnerships for Health Faye Ziegeweid, Administrative Coordinator, Community-Campus Partnerships for Health 3

4 APPLICATION INSTRUCTIONS Please note: Applications must be submitted online no later than Friday October 12 th We encourage applicants to type out their responses to the open-ended questions and cut and paste them into the online form (unfortunately, it is not possible to save a partially completed form and return to complete it later). The form is not available on Wednesdays from 8-10 am eastern time when the website is undergoing routine maintenance For each open-ended question below, the maximum number of characters allowed in the answer is included in parentheses Please don t hesitate to contact us at programs@ccph.info if you have any questions! COMMUNITY PARTNER APPLICATION Applicant Contact Information Name, Title, Organization, Street Address, City, State, Zip, Phone, , Website (if applicable) Brief Bio Please provide a 1-2 paragraph bio about yourself. The bio should include some information about your involvement in community-engaged research. Please note that if you attend the forum, your bio will be shared with other participants (see p. 6 of the call for application for examples) (1500) Questions Why do you want to participate in the forum? (1500) Please describe your personal interest and involvement in community-engaged research. (1500) If you are representing an organization at the forum, please tell us about it and describe why and how it is involved in community-engaged research (if you are not representing an organization, just write "N/A") (1500) Reflecting on your experiences with community-engaged research, what have been your most significant successes and challenges? (1500 What ideas or plans do you have for sharing what you learn at the forum with others? (1500) Are you inviting an academic partner to apply to attend the forum evening reception and poster session on Thursday December 6th and the dialogue on Friday December 7th? Please indicate your academic partner's name and organizational affiliation in the space below. Please indicate your academic partner's address in the space below. Are you interested in presenting information about your community-engaged research at the forum through a poster, table-top exhibit or video/digital story? Please indicate the preferred format for your proposed presentation. Please use the space below to describe the content of your proposed presentation. (1500) Please use the space below for any questions, comments or concerns you may have about the forum (500) Checklists with multiple options for to choose from How long have you been involved in community-engaged research? What roles have you had in community-engaged research? (check all that apply) In what settings does your research currently take place? (check all that apply) What groups of people are the current focus of your research? Have you participated in any of these research programs, now or in the past? (whether funded by them or not). Please check all that apply. 4

5 Are you currently a member of any of these organizations? (check all that apply) How would you describe your primary organizational affiliation (check all that apply) What is your organization's annual budget? (if applicable) What demographic information applies to you? (check all that apply) ACADEMIC PARTNER APPLICATION Applicant Contact Information Name, Title, Organization, Street Address, City, State, Zip, Phone, , Website (if applicable) Brief Bio Please provide a 1-2 paragraph bio about yourself. The bio should include some information about your involvement in community-engaged research. Please note that if you attend the forum, your bio will be shared with other participants (see p. 6 of the call for application for examples). (1500) Questions Why do you want to participate in the forum? (1500) Please describe your interest and involvement in research. (1500) If you are representing an organization at the forum, please tell us about it and describe why and how it is involved in community-engaged research. (1500) Reflecting on your experiences with community-engaged research, what have been your most significant successes and challenges? (1500) At the inaugural National Community Partner Forum in December 2011, an agenda for change emerged: For research to have any hope of moving the needle on health disparities, communities of color and low-income communities need to have (1) power in decisions made about research (2) the capacity and infrastructure to engage as equal research partners with institutions and conduct their own research and (3) significant roles in building the capacity of academic institutions to engage and partner with communities. Please describe any actions you have taken that demonstrate your commitment to this agenda. (1500). What ideas or plans do you have for sharing what you learn at the forum with others? (1500) Please provide the name and organizational affiliation (if any) of the community partner who is applying to attend the forum. Please indicate the address of the community partner who is applying to attend the forum. Please use the space below for any questions, comments or concerns you may have about the forum. (500) Checklists with multiple options to choose from How long have you been involved in community-engaged research? What roles have you had in community-engaged research? (check all that apply) In what settings does your research currently take place? (check all that apply) What groups of people are the current focus of your research? (check all that apply) Have you participated in any of these research programs, now or in the past? (whether funded by them or not). Please check all that apply. Are you currently a member of any of these organizations? (check all that apply) How would you describe your primary organizational affiliation (check all that apply) What demographic information applies to you? (check all that apply) 5

6 Below are examples of brief bios of several members of the forum planning committee Susan Ann Gust is a community activist and small business owner of a thirty-four year old construction management, consulting and community development company. Her work in construction and economic/environmental justice led her to founding the ReUse Center in Minneapolis. She was a University of Minnesota Public Policy Fellow in Susan was the co-founder of the Phillips Neighborhood Healthy Housing Collaborative and is a consultant to the Family Sustainability Collaborative, a Blue Cross Blue Shield Foundation funded project that grew out of the original collaboration. She is teaching community-based participatory research training to junior faculty, graduate students and community partners as part of a University of Minnesota grant received from the National Cancer Institute to address the cancer burden in racial/ethnic minorities and other underserved communities. She recently completed 9 years of service on the Board of Community University Health Care Center and 6 years as an appointee on the City of Minneapolis Public Health Advisory Committee. She serves as Board Chair for Community-Campus Partnerships for Health and as a member of the Cultural Wellness Center s Law and Policy Committee. Additional civic responsibilities include participating in these local efforts: Healthy Homes, Healthy Kids; Phillips Environmental Steering Committee Initiative and Allina s Backyard Initiative. Susan also eagerly spends time in activities involving her school-aged daughter and her grandchildren. Ann-Gel S. Palermo has worked in the area of community-based public health over ten years, with a principal focus on issues related to social determinants of health using a community-based participatory research approach. Since 1999, Ms. Palermo has served as the chair of the Harlem Community & Academic Partnership (HCAP), a diverse partnership of representatives from community and academic organizations committed to identifying social determinants of health and implementing community-based interventions in Harlem. HCAP evolved out of the CDC-funded Harlem Urban Research Center, a partnership developed to establish credibility in the Harlem community, demonstrate a true commitment to improving the health of its residents, and create a platform from which to address local health issues. When core funding ceased, Ms. Palermo led a major transition to reinvent the collaboration so that it could continue its important work as HCAP. Formerly housed in the Center for Urban Epidemiologic Studies at the New York Academy of Medicine, HCAP is currently in transition towards becoming an independent community-based research organization. Ms. Palermo also serves as a board member of the East Harlem Community Health Committee and is chair of the board of directors for the Manhattan-Staten Island Area Health Education Center. She is a fellow of the New York Academy of Medicine. In addition to her public health activities, Ms. Palermo is the Associate Director of Operations at the Center for Multicultural and Community Affairs at New York City's Mount Sinai School of Medicine. In this role, she is responsible for overseeing and managing programs in the areas of community engagement, medical education and training, and research to improve the health of all populations by diversifying the health care workforce and influencing health policy and research. Ms. Palermo earned a Master of Public Health degree (majoring in health policy) from the University of Michigan in She is currently a doctoral student in public health at the City University of New York Graduate Center. Eric Wat is the director of the Research and Evaluation Unit at Special Service for Groups, or SSG, which directly operates about 20 different programs primarily in Los Angeles County. At SSG, he and his team seek to increase the capacity among SSG programs and community partners to conduct community-based action research and program evaluation. He also administers the community-based IRB at SSG, which was established in 2004 to give community partners more parity in the human subject and community protection review process. He has co-authored several peer-reviewed journal articles based on his involvement in community-based action research projects, most recently on Pacific Islanders and higher education as well as health needs assessment of the lesbian and gay South Asian community in Southern California. Eric received his M.A. from California State University, Fullerton in 1999 and has taught classes, including research methods, at UCLA, CSU Fullerton, CSU Northridge, and CSU Long Beach. 6

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