April 14, 2015
Community-engaged research across the lifespan
How VCU is helping the community thrive from childhood to elderhood
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The meeting room at the Virginia Commonwealth University Medical Center’s Nelson Clinic on March 4 was surprisingly quiet. No louder than a conversation.
Seven babies — all born within the previous three months — slept, ate or smiled as the moms, dads and family members with them shared proud and playful birth stories.
“I said the whole time I wasn’t going to get an epidural, and I didn’t,” said one mother.
“I had a C-section, so I was half asleep the whole time,” said another.
“I was expecting everything to go crazy like in the movies,” said a father. “But it was over before I even put my phone in camera mode.”
Several months ago, in the dawn of their pregnancies, these mothers and fathers weren’t such comfortable characters. They sought out this group because they were afraid.
“I was scared to death of having a baby,” said Kendra Peterson, as she held her 3-month-old daughter Kimora. “I was so worried about everything, but I learned it was going to be OK because people were willing to teach me.”
The group is part of the Strong Start for Mothers and Newborns initiative, a VCU-led community-engaged research project that examines the effectiveness of the CenteringPregnancy model of care in reducing poor birth outcomes among high-risk Medicaid and Children’s Health Insurance Program beneficiaries. The model replaces traditional prenatal care with group care — eight to 12 women who have similar due dates meet regularly with a midwife or doctor and as a group.
Just two miles away from where the Strong Start group has worked for months to safely foster the newest of lives, another group from VCU has been working to finalize a therapy for a more seasoned group of souls.
VCU’s VoicingElder project is partnering with a local continuing care retirement community to pilot cutting-edge electronic arts research that aids in life review for older adults as a therapeutic technique. As participants speak about their lives, facial-recognition cameras and voice-signal technology automatically process facial feature interaction and lip movement, then the data are mapped in real time on the face of an on-screen virtual puppet, also known as an avatar.
The project strives to increase quality of life for the seniors by accessing their emotional engagement and hidden memories through a life review process. The virtual puppetry format also actively involves family members with the senior’s life review process, promoting intergenerational knowledge.
“Virtual puppetry allows the puppeteer to speak and reveal their hidden emotions and stories in an oral storytelling platform,” said Semi Ryu, associate professor of kinetic imaging in the VCU School of the Arts. “It is a journey of discovering lost selves.”
CenteringPregnancy and VoicingElder are just two of the hundreds of community-engaged research projects VCU has completed in the past several years. Community-engaged research holds the goal of contributing to both academic disciplines and the community by incorporating input from researchers and community members.
Between Jan. 1, 2011, and Jan. 26, 2013, VCU researchers began or completed 263 total projects involving community partners, and their findings benefited community members from every major point in the lifespan.
Of the 263 analyzed community-engaged research projects at VCU, 5 percent focused on infancy; 27 percent focused on childhood, adolescence, students or youth; 50 percent focused on adulthood; 8 percent focused on older adults; and 6 percent focused on the entire lifespan.
“At VCU, we are dedicated to improving the health and well-being of people across the lifespan in our community and beyond,” said Valerie Holton, Ph.D., director of community-engaged research in VCU’s Division of Community Engagement. “When we are asking questions that impact our communities, partnering with the community members increases the chance that we will ask the questions that are critical to the people that the research intends to impact.”
This commitment to community-engaged research across the lifespan is a key VCU characteristic that will support the university’s Center for Clinical and Translational Research in applying for its second Clinical and Translational Science Award. The CTSA program comprises more than 60 academic medical institutions across the country working to advance research from basic science to bedside treatments and into the community.
Focusing on specific age groups throughout the lifespan ensures the entire community is healthy, and addressing certain issues within those groups can have a domino effect.
“Our project reduces preterm birth, which is a precursor for infant mortality, and infant mortality is one of the major indicators of community well-being,” said Saba W. Masho, M.D., Dr.PH, VCU’s Strong Start principal investigator and associate professor in the Department of Family Medicine and Population Health, School of Medicine. “At the individual level, this program helps the children, the mothers and their families. The other thing is that it reduces health care costs and costs to taxpayers.”
By embracing the performative aspects of storytelling, VoicingElder incorporates aspects from research in gerontology, electronic arts, drama therapy, therapeutic puppetry and avatar therapy.
“The concept of lost selves is particularly apt to describe the older adult population,” Ryu said. “The aging psyche must grapple with a huge distance between the true self and the socially constructed self (how others perceive them), between the lived body and the biological body, and between the ageless body and the aging body. The senior’s perception of their own body, and their questioning of identity, has the potential to bring forth a dynamic transformation by using the alternative bodies available in virtual puppetry.”
Ryu, who works closely on the VoicingElder project with Tracey Gendron, assistant professor in the Department of Gerontology, VCU School of Allied Health Professions, plans to promote the art and value of these stories to the wider community through a public art exhibition of life stories.
“In the United States and elsewhere, we are being challenged to develop a whole new phase of life called ‘elderhood,’” Ryu said. “Today, millions of people can expect to live 25 or more years in relatively good health after retirement. We must shape elderhood in ways beneficial to both the individual and community, in order to promote intergenerational relationships, understanding and support.”
VoicingElder has received grant funding from the VCU Quest Presidential Research Fund and will pursue extramural grant funding upon completion of the pilot program. The project is in collaboration with the VCU Department of Gerontology, Theatre VCU and the Department of Computer Science at University of Rome.
Before the Strong Start Initiative began in Feb. 2013, CenteringPregnancy at VCU was a model of care sought out by few and offered primarily to patients under midwifery care.
“All that changed after the SS grant,” said Kirsten Olson, CenteringPregnancy coordinator at VCU. “There is a true benefit in offering this model of care to all patients. We have centering groups made up of women from all walks of life: different socioeconomic status, different educational backgrounds, different races and ethnicities, but they all come together with one truly universal feminine commonality: pregnancy.”
As the new mothers and fathers continued to share their stories on March 4, the Strong Start program’s impact on their lives — and their babies’ lives — became more apparent.
Peterson, for example, didn’t know she had diabetes until she first attended the program. Once she was diagnosed, she was started a treatment program with support from the group.
“At first I was worried most about going into labor in a strange place,” said Shawna Eldridge, 22, as she held 2-month-old Jordan. “But we learned to have a plan.”
Then, when Eldridge did go into labor in a strange place on Jan. 2 — in a parking garage at work – she was ready.
“It was fine,” she said. “I had a plan. I had a bag packed, I called my parents and I got to the hospital.”
Thanks to that plan and the months of Strong Start group counseling before it, Jordan and the other Strong Start children have all they need to grow into being those more seasoned souls of the world, and perhaps they can one day share their own life reviews with the next generation.
Feature image at top: Brittany Hubbard with her son, Kayden Paul, at a March Strong Start program reunion.
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