Outreach for Community Development

BackgroundThe United States (US) is one of the most affected countries by the COVID-19 pandemic. A disproportionate burden of COVID-19 deaths is seen in Black, Asian, and Latinx groups. COVID-19 vaccines are the primary mitigation strategy to reduce morbidity and mortality. However, vaccine hesitancy is high in these communities due to factors such as low health literacy, language barriers, and other health inequities. Our objective was to implement a culturally sensitive, multi-lingual, community outreach model to promote vaccine education and facilitate vaccine administration.MethodsCommunity healthcare workers or “promotoras” were deployed to high traffic areas such as supermarkets, laundromats, churches, and commercial hubs from February-May 2021. The promotoras provided culturally sensitive vaccine counseling to individuals in their preferred language and facilitated vaccine appointments at our hospital. Our data was compared with publicly available data from other facilities organized by ZIP codes defined by the Department of Public Health as low, medium, or high-vulnerability to COVID-19.ResultsA total of 109 outreach workers were hired, of which 67% (73) were Latinx, 27% (29) Black and 6% (7) Asian. Overall, 8,806 individual encounters led to 6,149 scheduled appointments and 3,192 completed first doses (Figure 1). A total of 14,636 individuals were vaccinated. Average age was 45.5 (range 12-98). Preferred language was 54% Spanish, 38% English, and 8% Chinese. Ethnicity was mostly Hispanic (66%) with race mostly white (54%) (Figure 2). High and medium-risk ZIP codes represented 69.4% of vaccinations at our facility (Figure 3).Figure 1. Education encounters and appointments made by community outreach workers and associated vaccinations.Figure 2. Racial distribution of vaccinated individuals at our facilityFigure 3. Comparative vaccinations by zip codes from hospitals in our area.ConclusionWe successfully implemented a culturally sensitive community outreach model which resulted in higher vaccination rates from at risk ZIP codes when compared to other hospitals. Promotoras encouraged vaccination in native languages, thereby increasing vaccine awareness and appointment faciliation. Barriers to vaccine access remain in these vulnerable communities. This model educated the community via its own members and may help reduce barriers, increase vaccine awareness and vaccination rates.DisclosuresAll Authors: No reported disclosures

Substance abuse treatment entry, retention and effectiveness: out-of-treatment opiate injection drug users

Quality improvement (QI) has been widely implemented in health services but has not been widely applied in HIV prevention research. Most prevention research centers have commonly employed traditional approaches (e.g., checklists) to quality control that document what has been done but not the quality of what has been done. Unlike other health settings, prevention research settings have unique characteristics and ethical requirements that require the development or adaptation of specific quality indicators. A QI model for health services was adapted for use in prevention research settings and was piloted between August 2006 and July 2007 at three research centers in East Africa. Four hundred and twenty-six volunteers exit interviews were administered in two cycles. Quantitative and qualitative data were analyzed using Excel worksheets. QI meeting reports and QI plans were used to complement data from exit interviews. On average, 52% of total enrolled volunteers participated in the exit interview. The designed QI plans successfully helped reduce volunteers’ reported waiting time to see counselors (p<0.001) and pharmacists (p<0.001). It also increased the percentage of interviewed volunteers who reported being counseled on family planning at clinical trials (from 66 to 93%; p=0.02) at follow-up visits, and who were refreshed on informed consent at follow-up visits (from 90 to 96%; p=0.009). The percentage of interviewed volunteers that expressed satisfaction with services received from counselors increased (from 87 to 94%; p=0.009) while the percentage of volunteer satisfied with services from trial physicians remained constant (93%). The majority of volunteers interviewed reported satisfaction with other major components of research such as confidentiality, understanding of trial objectives, benefits and risks of participation, and risk reduction counseling. However, satisfaction with services from community outreach workers and other staff at research centers dropped over the course of the study (from 88% in Cycle 1 to 74% in Cycle 3; p= < 0.001). Increased commitment to QI is crucial in ensuring quality of services and ethical conduct of HIV prevention research centers.

BackgroundEffective care for persons living with HIV (PLWH) requires a coordinated, multi-disciplinary approach that includes social workers, physicians, advanced practice providers, pharmacists, social workers and community outreach workers. Unfortunately, these individuals often work and train independently of one another without a full sense of the responsibilities and contributions of others. Too often, this results in fragmented or ineffective care.MethodsIn response to the need to improve exposure to both HIV and coordinated interdisciplinary care, the Kentucky AIDS Education and Training Center at the University of Kentucky developed the HIV Interprofessional Education (IPE) Program in 2016. This dynamic IPE links students in multiple professional training programs (including pharmacy, medical, social work, and physician assistant students) to a year-long curriculum designed to acquire advanced skill sets for the treatment of HIV/AIDS. This curriculum includes inpatient and outpatient shadowing opportunities with multiple departments, didactic seminars, flexible mentored learning, and a collaborative capstone project designed to impact the local HIV community.ResultsWe report on the development of this program as well as a comprehensive assessment of the quantitative and qualitative experiences of our trainees. Participants reported significant improvements in their understanding of not only the complexities of the continuum of care for PLWH but also on how to improve care by enhancing collaboration between disciplines. They also reported development of critical and generalizable skills including taking a social history, addressing co-morbid mental health and substance abuse issues, cultural competency, screening and prevention strategies for HIV. ConclusionAs we strive to provide comprehensive and effective care for PLWH aimed at achieving the goals of universal test and treat and retention in care, we must find way to improve crosstalk and understanding of the interdisciplinary nature of modern medical care. Ideally, this begins during training. We present our experience in the development of a novel and highly effective program which has spanned multiple departments and has substantially impacted the approach to HIV care in our trainees.DisclosuresAll authors: No reported disclosures.

From May 23 to June 23 2011 Kaye, Fitzpatrick and Kappers directed a team comprising four staff members from England, The Netherlands and the U.S., together with 27 students from various American universities and UCL's Institute of Archaeology, to conduct the sixth season of archaeological investigation at the coastal site of Grand Bay, Carriacou (fig. 1). Our major goal this year was to finalise the excavation of three previously opened 5×5 metre trenches (nos 592, 415 and 446) (fig. 2) (see summaries in Fitzpatrick et al. 2009a , 2009b ; Kaye et al. 2009 ), while training students in fieldwork techniques and continuing our community outreach work by encouraging site visits, giving talks to schools, organising an exhibition of small finds for a public open day and conducting a series of television, radio, and newspaper interviews in order to raise public awareness and encourage interest in the archaeological heritage of the island. The Carriacou Historical Society (CHS) also requested us to prepare a report on the possible impact of a proposed Free Port coastal development on archaeological sites along the southeastern part of the island. The brief results of the 2011 project are presented in the following.

Using a paradigmatic framework, this paper examines ideas of John M. Perkins, a visionary of central city neighborhood renewal in community development tradition and a co-founder of Christian Community Development Association. Perkins' model of redevelopment is qualitatively different than those offered to date because of its emphasis on parish church, long-term relationships, relocation of leaders to community, reconciliation of people across race and class and a redistribution predicated on a prior relocation and reconciliation. Keywords: Community development, John Perkins, urban poverty, church In chapter one of Principles of Economics we find Alfred Marshall's judgment that the two great forming agencies of world's history have been religious and (1920: 1). Max Stackhouse, a Princeton University ethicist, also accords economics and religion prominent roles in shaping society. In paraphrasing Pope John Paul II, in Centesimus Annus, Stackhouse writes that: The two key forces likely to have most direct bearing on future are corporations and religion. Corporations are instrument of economic productivity for foreseeable future, and religion is bearer of those decisive values by which we guide our production, distribution, and consumption of whatever wealth is generated. (1996: 40) The United States began its modem response to poverty during Great Depression. Starting with Title IV of path breaking Social Security Act (1935), which created Aid to Dependent Children (changed to Aid to Families with Dependent Children in 1962), we have seen evolution of a welfare system. [1] Although welfare programs contribute to alleviation of poverty, we must be clear that they were not necessarily designed to end [2] The Civil Rights Movement and attendant legal rulings, such as Brown v. Board of Education in 1954, Civil Rights Act of 1964, and Fair Housing Act of 1968, also contributed to a decline in incidence of Additionally there have been a number of private and/or public sector site-specific programs emphasizing urban renewal. These include, Gray Areas, Mobilization for Youth, Model Cities, Enterprise/ Opportunity Zones, and community-based organizations, inclusive of community development corporations, many of which were products of War on P overty (Halpern 1995). Despite these efforts William Julius Wilson claims there is a 'new urban poverty' [characterized by] segregated neighborhoods in which a substantial majority of individual adults are either unemployed or have dropped out of labor force altogether (1996:19). This reality garners attention of politician and social scientist alike, each searching for answers to a seemingly convoluted problem. The apparent intractability may well call for perspectives. The purpose of this paper is to examine ideas of John M. Perkins as they pertain to new urban poverty. In late 1940s he left racial oppression of Mississippi for opportunities of California, but returned to address injustices of his people. Perkins became a visionary of central city neighborhood renewal in community development tradition and a co-founder of Christian Community Development Association. His life corroborates Marshall's and Stackhouse's observation regarding primacy of religious and economic thought and institutions in molding society. The presentation and assessment of Perkins' model contributes to public policy debate on efforts to improve well-being of many residing in impoverished urban communities. The model is qualitatively different than those offered to date because of its emphasis on a parish church, long-term relationships, relocation of leaders to community, reconciliation of people across race and class, and a redistribution predicated on a prior relocation and reconciliation. …

The global response to the HIV pandemic since the 2000s has been an unprecedented success, with rapid scale-up of HIV prevention and antiretroviral treatment (ART) programs [1]. Although most low-and-middle-income countries are transitioning towards domestic public funding because of shrinking donor funding, Official Development Assistance (ODA) remains an essential component of HIV financing, especially in sub-Saharan Africa [2]. The coronavirus disease 2019 (COVID-19) pandemic produced an economic crisis characterized as the worst since the Great Depression in the 1930s [3]. The International Monetary Fund (IMF) estimates that reduced economic output and trade because of COVID-19 -- and its impactful countermeasures, such as lockdowns and curfews -- will shrink the world gross domestic product (GDP) by 4.4% in 2020, and will only gradually recover over the next years [4]. These declines can have devastating effects on donor and domestic healthcare financing for the years to come, including for HIV. We estimated the potential impact of the global recession on HIV financing in the 10 countries with the largest ART programs in sub-Saharan Africa -- Ethiopia, Malawi, Mozambique, Tanzania, Uganda, Kenya, Nigeria, Zambia, Zimbabwe, and South Africa -- over the next 5 years to illustrate potential gaps due to the economic crises, and propose urgent mitigation strategies to ensure continued service delivery. Together, these countries account for roughly 70% of HIV-infected people worldwide [5] and spend an estimated US$7.5 billion on HIV annually, of which almost two-thirds (i.e. about US$ 4.7 billion) comes from ODA [6]. We used IMF economic projections on GDP growth and published estimates of current domestic spending and ODA for HIV in each country [4,5]. We first calculated the share of GDP spend on HIV from domestic sources, and the proportional share of ODA from donor countries. We then developed four scenarios to reflect possible effects of GDP declines and political choices in HIV financing, and calculated the net difference to a no-COVID-19 counterfactual using IMF country-specific economic projections from before the pandemic (Fig. 1).Fig. 1: Estimated impact of the coronavirus disease 2019-related global recession on HIV financing in the 10 countries with the largest HIV programs in sub-Saharan Africa.Figure 1 shows the projected net difference in country-specific HIV/AIDS budget over the next 5 years for four scenarios, compared with a no-COVID-19 counterfactual, for Ethiopia, Malawi, Mozambique, Tanzania, and Uganda (low-income), Kenya, Nigeria, Zambia, and Zimbabwe (lower-middle-income), and South Africa (upper-middle-income). Estimates were generated using data on projected country-specific GDP growth from the IMF [4], and latest data on country-specific domestic and donor funding for HIV/AIDS as provided by the Joint United Nations Programme on HIV/AIDS (UNAIDS) [5]. All estimates are reported in 2019 US$. If the share of GDP designated for HIV in both domestic and donor countries remains unchanged, we estimate a gap of about US$1.9 billion over 2020–2024, a decline of about 5% compared with funding over 2015–2019 (Fig. 1, scenario 1). If the share of GDP designated for HIV falls by an initial 10% in both domestic and external sources in 2020 and 5% in the subsequent years -- representing a shift of funding to other sectors, such as COVID-19-related healthcare, economic relief funds, or payment of government debts -- we estimate a cumulative gap of US$4.1 billion, amounting to a decline of about 11% in total funding for HIV (Fig. 1, scenario 2). Compensating for gaps in ODA would require substantial increases in domestic HIV funding: by roughly 10% (upper middle-income countries), 15% (lower middle-income countries) or 20% (lower income countries) (Fig. 1, scenario 3). Even in an extremely optimistic scenario, in which the absolute amount of donor funding remains unchanged, domestic HIV spending would need to increase by about 5% to maintain current funding levels (Fig. 1, scenario 4). Such increases appear unlikely, as most of these countries already struggled to expand domestic HIV funding in the pre-COVID-19 era [6]. Although it is challenging to speculate which of these scenarios will predominate, current events suggest that our most pessimistic scenario, including additional cuts in donor funding on top of the budget declines caused by GDP fluctuations (scenario 2), is at least partly unfolding. The UK government recently announced to consider temporarily cutting foreign aid spending from 0.7% to 0.5% of gross national income [7], a decline of over 25%, and other donor countries may follow suit. For nine out of the 10 countries studied, 77--94% of funding for care and treatment comes from ODA [6]; making these political decisions a direct threat to continuation of ART programs. The only exception is South Africa, where only 18% of the HIV budget stems from ODA and continuation largely depends on local political decisions. However, as South Africa has been severely affected by the pandemic, reprioritization of domestic resources may well be necessary to finance the COVID-19 response and economic recovery. If we assume scenario 2 to unfold, we can roughly calculate the detrimental effects on service provision for HIV-infected people. For the 10 countries in our analysis, about US$3 billion [6], enabled 13.6 million people to receive life-saving ART pre-COVID-19 [5]. If relative funding distributions between treatment and prevention are maintained, the most extreme funding shortfalls of $850 million for 2021 (11% compared with 2019) in scenario 2 could, therefore, mean that approximately 1.5 million people enrolled in HIV care could not be served any longer. Interruption of ART could have direct implications for the health of HIV-infected people: potentially resulting in increased incidence of AIDS-defining illnesses, treatment resistance, and AIDS-related mortality. Moreover, extended lockdowns could lead to decreased ART adherence because of poor access and drug stock-outs, and many key-population outreach programs have been reduced or halted. Several mathematical modelers forecast that, of all interventions currently in place for HIV prevention and control, interruption of ART delivery because of COVID-19 will have the biggest impact on relative changes in mortality, and, together with interrupted condom availability, the biggest impact on relative changes in incidence [8]. Whereas shifting funding within limited HIV budgets away from prevention programs to ensure treatment continuation during the crisis might seem to be an attractive short-term solution, this could have a detrimental impact on the HIV epidemic in the long-run. The complex nature of HIV financing makes creating accurate predictions challenging, and our estimates should thus be interpreted as cautionary rather than predictive. In our analyses, we explored the effects of the COVID-19-related recession on HIV financing by making a simplified assumption of a linear relationship between country-specific GDP and HIV financing. Although this seems reasonable, validating our assumption against past observations (e.g., trends in GDP versus trends in HIV financing) is complex, as detailed yearly country-level data is not always available. Next to the direct GDP-dependent effects of COVID-19 countermeasures, several political decisions and indirect economic disruptions might further adversely affect HIV financing. First, aid distribution for HIV might increasingly be prioritized for low-income countries alone. Although this might mean that the poorest countries in the world are slightly more protected, lower middle-income and upper middle-income countries would need an accelerated process towards country-ownership. Second, several non-governmental financing schemes will be disproportionally affected by the pandemic. For instance, the air tax levy used to finance Unitaid, accounting for approximately 6% of the Global Fund to Fight AIDS, Tuberculosis and Malaria budget [9], will be severely affected by air travel restrictions. Third, financial gaps and shifts in sources indirectly supporting the HIV response, such as international research funding or the announcement by the USA to halt funding to the WHO [10], might adversely affect the HIV response and its financing for years to come. Fourth, domestic funding for HIV may be affected by the severity of the COVID-19 pandemic in the African nations and the political response. The proportion of the population infected with COVID-19, the strength and resilience of the local health system to respond to the COVID-19 pandemic, and the political structure and leadership in a country are all factors that are likely to influence the level of funding appropriated to fight HIV. Regardless of how the financial and political complexities unfold and affect prevention and treatment programs in the individual countries, it is critical to implement mitigation strategies to compensate for the financial gaps. First, continuation of HIV service delivery could be ensured and efficiency improved through accelerated implementation of differentiated care -- by enabling less frequent ART pick-ups [11], shifting tasks to community health workers [12], integrating HIV/COVID-19 prevention [13], and focusing on prevention for key populations. Second, resources could be pooled at regional level (facilitated for instance through the Southern African Development Community) to better leverage emergency funding, sharing of human capital and knowledge, and expertise in health program management. Third, integration with other health services could improve efficiency, and simultaneously accelerate progress towards universal health coverage [14,15]. Integration will also force a conversation about reprioritization across all health areas, essential to overcome the broader health system challenges introduced through the COVID-19 pandemic. Most importantly, mitigation strategies should strengthen the HIV response by using existing resources more efficiently, rather than shifting funding from other resources to fill gaps, so that health service provision for other population needs is not endangered. The COVID-19 pandemic is putting acute pressure on HIV programs in high-burden countries. With potential declines in funding of as much as 5% or 11%, the scale-up of HIV prevention and treatment in sub-Saharan Africa could come to halt or even reverse. But, as with any major crisis, the pressure to innovate under challenging circumstances could ultimately result in an HIV response and general health system that is more integrated, efficient and sustainable, improving resilience to future crises, and bolstering efforts to end the HIV pandemic by 2030. Acknowledgements Conflicts of interest There are no conflicts of interest.

Background: East Toronto Health Partners (ETHP) Ontario Health Team serves 400,000 people, with a population consisting of 50% immigrants. There is significant variation in cancer screening rates across our 2 different neighbourhoods, in which neighbourhoods with higher rates of newcomers and lower-socioeconomic status have 5-25% lower cancer screening rates. Analysis shows the key barriers for our underserved populations include difficulty accessing services, language constraints, and lack of knowledge about the importance of screening. Demographics and culture also play a role in health practices and there is a need to address misinformation about screening. Approach: In 2023, ETHP worked with eHealth Center of Excellence to create and launch;Poppy-bot- a robotic process automation tool that uses primary care electronic medical records (EMRs) to identify and segment people who are due or overdue for screening. With an equity perspective we segmented people by postal code and language in order to build targeted outreach and access to screening. In East Toronto, Poppy-bot has identified over 5,000 people for screening.Flemingdon Health Centre (FHC), is located in the middle of two underserved neighbourhoods with lower cancer screening rates. FHC is also the lead agency for our multi-agency, peer-based, community health ambassadors (CHA) program, which hires local residents from equity-deserving neighbourhoods to act as peer support and outreach workers. These CHAs are a highly effective at bridging the gaps that disproportionately impact our communities.ETHP was inspired to combine the strengths of two separate initiatives to address cancer screening rates by ) using Poppy-bot to flag people due for cancer screening with 2) our CHAs to conduct targeted outreach to residents in communities with lower cancer screening rates.Given the cultural sensitivity needed for outreach to different communities, we worked with CHAs and community members to co-design educational material. Through focus groups and workshops, we leveraged behavioral science, conversational receptiveness and motivational interviewing. Engaging consultants from Behavioural Insights Team and Health Commons Solution Lab, we co-designed a Cancer Screening Guide used by the CHAs to have conversations with community members in Arabic, Bengali, Dari, Pashto, Slovak, and Urdu.Using lists of individuals generated by Poppy-bot and segmented by language, CHAs had 5 training sessions around communications and cultural competency and used the guide to call individuals to discuss the importance of cancer screening. CHAs explained how to get a screening completed, what to expect at the screening and how to interpret results when they are available. Access to nursing staff was available if the CHAs needed. Results: The team received an innovation award (from MARS Canadian Cancer Society) which helped fund the creation of the Cancer Screening Guide, which will be shared for use in other jurisdictions. This project demonstrated the success of combining digital tools in primary care with community outreach to make an impact to local communities. Over a month period, CHAs had one-to-one conversations with 375 individuals. Implications: ETHP further learned the value of co-designing outreach and education materials with community members to help shape and build programming.While the calls were focused on cancer screening, residents also had other health-related questions. The learning from this process is enabling us to further develop the CHA program, including understanding barriers to access for community members and how to support difficult conversations about health issues within our diverse communities.Person contacted by a CHA testimonial: It was helpful to be reminded of the fact that I was due for screening. They talked to me about the specific test I needed and answered my questions. Usually other doctors offices don't even call you or tell you that you are due, so I appreciated it.

ABOUT US: We are a nonprofit, multi-service Community Health Centre (CCHC) that has played an active role in the down town community of Ottawa Ontario, Canada since 1969. We offer a full range of community services delivered by a diverse team of professionals. Our team includes doctors, nurse practitioners, nurses, social workers, counsellors, dietitians, community developers, health promoters, and outreach workers. CCHC has been offering teaching placements in Primary Care to medical students and residents, as well as nurse practitioners (NP), since 2002. CCHC Primary Care Team has also hosted learners from a variety of other disciplines including nursing (RN students), social workers and medical receptionists. The teaching began through the initiative of a few committed practitioners, with varying levels of support from the Primary Care Team and CCHC; the teaching continues to be primarily led by the Centre’s preceptors Approach: CCHC conducted a program review of its teaching placements in Primary Care. The scope of this program review includes CCHC’s teaching placements for medical students, NP students, and residents from the University of Ottawa (UOttawa). The focus of this review is on both the process (how the program is working) and the outcomes (what the program is achieving). Data were collected through a combination of focus groups, key informant interviews and surveys. All members of the team were involved in as well as past learners and key stake holders such as the University and other Community Health Centers. The review was done by One World INC, lead by Ken Hoffman and a team from Centertown CHC including 2 family doctors, one Nurse practitioner and a manager. The University of Ottawa offered evaluation and research guidance as well as conduction an extensive literature review of teaching in Community Health Centers. Results: CCHC has benefitted from the teaching, primarily through the ability to recruit physicians and NPs; as staff or locums; CCHC has had no difficulty in recruitment in recent years. oMany learners rate the CCHC placements and preceptors highly. A high percentage said they were able to address their learning goals for the placements; they cited their experiences working with vulnerable populations and in team-based care as important parts of their learning. Many learners who responded to surveys said their experience at CCHC contributed significantly to their consideration of a career in team-based primary care in a community setting. oUOttawa says the preceptors and placements at CCHC are evaluated highly by the learners. oThe other team members, nurses, reception, scheduling coordinator, mangers all identify some extra work and logistical issue with having learners, but on the whole felt that the benefits of the program out weigh the extra work. Implications: If we want our learners to practice in team based models, we need to teach them in such models. Our review showed that the educational program meets that goal. Expanding such teaching and learning and opportunities in our communities will support the growth of team work as we move forward

{ 201 } BOOK REV IEWS Angels in the American Theater: Patrons, Patronage, and Philanthropy. Edited and with an introduction by Robert A. Schanke. Carbondale: Southern Illinois Press, 2007. xiv + 314 pp. $35.00 paper. As Robert Schanke points out early in his introduction to this engaging collection of essays, “research and writing on the history of arts philanthropy is meager and of fairly recent practice” (1). Angels in the American Theater serves as a corrective, or at least the strong foundation of a corrective, to this gap in theatre history scholarship. The sixteen artfully edited essays provide a panoramic view of American arts philanthropy from the turn of the century up to the current landscape of contemporary, corporatized Broadway. The mix of biographical, statistical, and historical“business”data provides a context for examining American theatre from a fresh and fascinating perspective that underscores the complex relationship of art and commerce in this country. Schanke opens with an introduction that provides a quick overview of theatre patronage in America as well as the bedrock information that provides context for the essays to follow. Many of us rarely stop to consider, for example, how the establishment of the federal income tax changed American theatre in unfathomable ways, as the wealthy sought to lower their tax burden, or how the Rockefellers saw, in the mid-1960s, how business and art benefited each other, establishing the Business Committee for the Arts. Because of size limitations of the volume, Schanke explains his decision to exclude essays that cover more familiar aspects of American theatre patronage, such as the Federal Theatre Project and the National Endowment for the Arts, and to include those that “reflect a wide range of styles of philanthropy” (11). To provide order to this “wide range,” he divides the selected essays into two sections of “angels”: those that examine individuals and those that center on institutions. { 202 } BOOK REV IEWS The range of individuals covered in part 1, the larger section of the book with nine essays, is quite remarkable. Opening the section is Teresa Collins’s essay on Otto Kahn, followed by Melanie Blood’s essay on the Lewisohn sisters, the copper heiresses indelibly connected with the Neighborhood Playhouse. Providing a contemporary bookend against those historical essays is Barry Witham ’s look at Seattle arts advocate and fund-raiser Peter Donnelly, who “created a conduit between wealth and the arts” (153). Between those seeming extremes are essays covering a fascinating array of angels. We learn that many of these angels centered their prodigious support on individual artists, such as Richard B. and Jeanne Donovan Fisher’s support of playwright Charles Mee (Jennifer Schlueter), Alice De Lamar and Mary Curtis Bok’s patronage of Eva Le Gallienne (Robert A. Schanke), and Grant Goodman’s support of Paul Stephen Lim and his English Alternative Theatre at the University of Kansas (David A. Crespy). Other essays focus on better-known and commercially influential angels , such as Alexis Greene’s essay on the titular “Queen of Off-Broadway,” Lucille Lortel, and John R. Poole’s look at David Geffen and the Geffen Playhouse in Los Angeles, which Poole identifies as a “model for regional theatres” (148) based upon its diversity of programming and community outreach. Finally , Dan Friedman reflects upon a different permutation of patronage as well as the blurred boundaries between art and political advocacy in his essay on the unique, grassroots fund-raising of the Castillo Theatre. What is interesting to note is the tangled tapestry woven from these life stories as old-world altruism and modern capitalism collide with personal ego and selfless generosity in a historical web of the Great Depression, the New Frontier, and the complications of rapid-growth technology and competing media. Part 2 includes six essays centered on significant institutions in American theatre, beginning with Sheila McNerney Anderson’s essay on W. McNeil Lowry and the behemoth Ford Foundation. The names of most of the institutions or corporations covered in this section are familiar to readers, such as the Rockefeller Foundation, discussed in Stephen D. Berwind’s essay, but the essays themselves have more organizational variation than those in part 1. This is not to suggest a weakness in...

Faith-based institutions will have to display greater entrepreneurial acumen in their efforts to solve pressing societal problems in the years ahead. Entrepreneurial spirituality is a promising approach to addressing unmet social and economic needs. We illustrate how this concept is being used by two, predominantly black mega-churches to foster and facilitate local community economic development and present a concrete example of a church-based social entrepreneurial venture that is designed to reduce fall-related injuries and deaths among the black elderly. We conclude with a discussion of the challenges and opportunities to scale entrepreneurial spirituality approaches to poverty alleviation, job creation, and community development in America.

Rethinking localism in the broadband era: A participatory community development approach

The publication in 1938 of Lewis Mumford's book, The Culture of Cities, was one of the major events that led to the establishment of the Department of City and Regional Planning on the Berkeley campus of the University of California. At a time when the profes­ sion of city planning was in its infancy in the United States, it inspired a generation of Berkeley architecture and landscape archi­ tecture students to focus their idealism and energies on efforts to improve, protect, and enhance the cities and the natural environ­ ment of the San Francisco Bay region. Influenced and to a consid­ erable extent educated by the events and implications of the Great Depression and World War II, they seemed to have no difficulty during the 1930's and 1940's in finding or organizing useful things to do, and in a relatively short time their efforts led to the expan­ sion of city planning, housing, and community development pro­ grams in the San Francisco offices of FDR's New Deal administra­ tion and in the city and county governments of the Bay Area.

Establishing and Utilizing a Campus Community Garden to Foster Learning and Community Outreach

Objective: This study aims to characterise the visual acuity and stereoacuity of a sample of Indigenous (Orang Asli) primary schoolchildren. Additionally, the study investigates the relationship between these visual functions and their respective classroom-based assessment. Method: This cross-sectional study was carried out at one indigenous primary school in Petaling District, Selangor. The distance and near visual acuity were measured at 6 meters and 40 cm, using the Snellen Chart and N-notation chart, respectively. The stereoacuity level was measured using the Fly Stereo Acuity Test with Lea Symbols. The continuous Classroom-Based Assessment (Pentaksiran Bilik Darjah) was obtained retrospectively from the school teachers evaluating the mastery level (Tahap Penguasaan) of the schoolchildren. Results and Discussion: In a sample of 44 indigenous primary schoolchildren aged 9 ± 0.1 years from the Suku Temuan, 68.2% achieved habitual binocular distance visual acuity (DVA) of 6/6 or better, while 31.8% had reduced DVA (6/9 or worse). The majority of the students (97.7%, n=43) achieved habitual near visual acuity of N6 or better, with only 2.3% (n=1) achieving N8. In terms of stereoacuity, 52.3% demonstrated good stereoacuity (better than 40 seconds of arc), while 47.7% showed reduced stereoacuity (worse than 40 seconds of arc). Further analysis revealed no significant association between visual acuity or stereoacuity and classroom-based assessment. While the majority of children acquire optimum binocular and near visual acuity, almost one-third (31.8%) exhibit reduced binocular visual acuity, and nearly half (47.7%) have reduced stereoacuity. This indicates the need for routine vision screening programmes to detect and manage visual problems as early as possible. Although no significant link was found between visual function and classroom-based assessment, integrating vision care with educational support can help optimize learning outcomes. Research Implications: Increased community awareness and outreach are essential to promote regular eye examinations and access to corrective measures. Additionally, future research should explore the long-term effects of visual health interventions on academic success, guiding policy development and resource allocation for Indigenous communities. Originality/Value: This study provides valuable insights into the visual status of Indigenous schoolchildren and its potential impact on classroom-based assessment, which had not been reported elsewhere in Malaysia.