标题：Applying Community Engagement to Disaster Planning: Developing the Vision and Design for the Los Angeles County Community Disaster Resilience Initiative
摘要：Community resilience (CR) is a priority for preparedness, but few models exist. A steering council used community-partnered participatory research to support workgroups in developing CR action plans and hosted forums for input to design a pilot demonstration of implementing CR versus enhanced individual preparedness toolkits. Qualitative data describe how stakeholders viewed CR, how toolkits were developed, and demonstration design evolution. Stakeholders viewed community engagement as facilitating partnerships to implement CR programs when appropriately supported by policy and CR resources. Community engagement exercises clarified motivations and informed action plans (e.g., including vulnerable populations). Community input identified barriers (e.g., trust in government) and CR-building strategies. A CR toolkit and demonstration comparing its implementation with individual preparedness were codeveloped. Community-partnered participatory research was a useful framework to plan a CR initiative through knowledge exchange. “We want information about how to identify resilience-building tasks and activities that communities can replicate. How can vulnerable communities fit into these activities to make sure they are also more resilient to disasters?” – Workgroup member Disasters such as wildfires, tropical storms, hurricanes, earthquakes, and epidemics pose temporary and long-term threats to public health. 1,2 Underresourced communities are at high risk for adverse outcomes owing to preexisting disparities in health, access to services, and environmental risks. 3–5 Large-scale events disrupt physical, social, and communication infrastructures posing challenges to response, and creating “surge burdens” that overwhelm care resources and strain social supports. 6 Events such as Hurricane Katrina, the H1N1 epidemic, and the Gulf oil spill have increased public awareness of the impacts of disasters and of gaps in communication, infrastructure, and resources that limit capacities to respond and recover. 3,7,8 One paradigm that has emerged in response is community resilience (CR). 9,10 Based on a community-systems model, 11,12 CR refers to community capabilities that buffer it from or support effective responses to disasters. 13,14 Such capabilities include effective risk communications, organizational partnerships and networks, and community engagement to improve, prepare for, and respond to disasters. These capabilities may improve outcomes such as access to response and recovery resources, or return to functioning and well-being. 15 Yet there are no operational models of how to build CR. 16,17 One potential model is community-partnered participatory research (CPPR), a manualized form of community-based participatory research 18 that emphasizes power sharing and 2-way knowledge exchange following principles of community engagement to support authentic partnerships. 19–21 We define a community as persons who work, share recreation, or live in a given area. A CPPR initiative has 3 stages: vision (planning), valley (implementation), and victory (products, dissemination). 22–24 Each stage involves organizing, action, and feedback. 20 Community-partnered participatory research was used to support post-Katrina mental health recovery in New Orleans 24–28 and to address chronic conditions. 29–33 Following successful application of CPPR in a postdisaster context, we proposed that it could support development of predisaster CR programs. We describe here the use of CPPR for the planning or vision stage of the Los Angeles County Community Disaster Resilience (LACCDR) initiative. As described elsewhere, LACCDR was initiated in 2010 by the Los Angeles County Department of Public Health (LACDPH) in collaboration with key academic and community partners based on principles from the National Health Security Strategy. 10 Representatives of these partners constitute the LACCDR Steering Council. The Council reviewed the policy background for CR 34 and developed a logic model 35 that emphasizes the importance of community engagement in developing organizational partnerships to build CR. This article focuses on how the Council then used community engagement principles and the CPPR model to develop the project’s CR intervention framework, propose and develop a toolkit containing training and other resources to improve CR, and design a demonstration to compare the effectiveness of implementing the CR toolkit with the enhanced standard approach that emphasizes individual or family preparedness. 15,36
