Environmental justice (EJ) seeks to correct legacies of disproportionately burdening low-income and Black, Indigenous, and people of color (BIPOC) communities with environmental hazards that contri...

Partnering across health clinics and community organisations, while worthwhile for improving health and well‐being, is challenging and time consuming. Even partnerships that have essential elements for success in place face inevitable challenges. To better understand how cross‐organisational partnerships work in practice, this paper examines collaborations between six primary care clinics and community‐based organisations in the United States that were part of an initiative to address late‐life depression using an enhanced collaborative care model (Archstone Foundation Care Partners Project). As part of an evaluation of the Care Partners Project, 54 key informant interviews and 10 focus groups were conducted from 2015 to 2017. Additionally, more than 80 project‐related documents were reviewed. Qualitative thematic analysis was used to code the transcripts and identify prominent themes in the data. Examining clinic and community organisation partnerships in practice highlighted their inherent complexity. The partnerships were fluid and constantly evolving, shaped by a multiplicity of perspectives and values, and vulnerable to unpredictability. Care Partners sites negotiated the complexity of their partnerships drawing upon three main strategies: adaptation (allowing for flexibility and rapid change); integration (providing opportunities for multi‐level partnerships within and across organisations) and cultivation (fostering a commitment to the partnership and its value). These strategies provided opportunities for Care Partners collaborators to work with the inherent complexity of partnering. Intentionally acknowledging and embracing such complexity rather than trying to reduce or avoid it, may allow clinic and community collaborators to strengthen and sustain their partnerships.

Background: National guidelines have called for greater integration of primary care and behavioral health services, with more recent attention to social care and community-based services. Under growing resource constraints healthcare organizations have tended to rely on referrals to external entities to address social care needs. Traditional referral models, however, may not be equipped to provide for the complex needs of older adults with depression. The Care Partners Project was designed to strengthen late-life depression care through integrated partnerships between primary care clinics and community-based organizations. We sought to understand how these integrated partnerships, with shared tasks and accountability across organizations, changed the nature of depression care for older adults. Methods: We conducted 65 in-depth, semi-structured interviews and six focus groups with service providers involved in the project, including care managers, primary care providers, and psychiatric consultants, and applied inductive and deductive qualitative thematic analysis to develop themes around participants’ experiences with the partnered initiative. Results: We found the partnerships established by the Care Partners Project reshaped late-life depression care in two ways: (1) bidirectional communication across organizations facilitated greater recognition among providers of intersecting medical and social needs associated with late-life depression; and (2) depression care became more coordinated and effective as care teams established or strengthened relationships across organizations. Conclusions: These findings highlight the ways cross-organizational health and social care partnerships that move beyond traditional referrals can strengthen late-life depression care and enhance organizational capacities.

Backed by decades of empirical research, there has been increasing acknowledgment in policy, practice and research of the importance of neighborhood opportunity in shaping well-being. This has led to the proliferation of opportunity maps in cities throughout the United States with the purpose of identifying low opportunity neighborhoods in need of investment and intervention and high opportunity neighborhoods that can offer access to resources and amenities to disadvantaged population groups. By explicitly linking investment to the identification of neighborhoods that are high or low in opportunity, opportunity indices have the potential to help transform local and regional landscapes of spatial inequality. Despite this common goal, indices rely on varying theoretical conceptualizations, data, variables, and statistical approaches. How much these opportunity definitions overlap has yet to be fully examined. In this study, we compared five approaches to measuring neighborhood opportunity in California. We found low to moderate overlap across the indices, with disagreement higher for low opportunity designations. As with any quantitative analysis, opportunity mapping is not a purely technical exercise and requires a series of subjective decisions. The only way to validate these decisions is for opportunity measures to be constructed transparently and vetted by the research community. This study is a first step in this process.

Historical redlining practices have been linked to a wide range of contemporary social, economic, and health outcomes, including poor mental health. Few studies, however, have investigated the contemporary factors which may explain these lasting associations. We examined features of contemporary housing markets-including property values, homeownership rates, and loan denial rates for home purchase-as possible mediators of historical redlining patterns and contemporary prevalence of poor mental health and assessed neighborhood racial composition as a moderator of these associations. Using data from the CDC PLACES Project (2020 release), American Community Survey (2013-2017), Home Mortgage Disclosure Act database (2013-2017), and Historic Redlining Scores Project, we studied 12,047 census tracts in the United States. We found significant indirect effects of historical redlining on contemporary prevalence of poor mental health via neighborhood property values, homeownership rates, and loan denial rates for home purchase. Further, the indirect effect of redlining via relative median property value was conditional on neighborhood racial composition. Our findings suggest properties in historically "A" graded neighborhoods are valued more than those in neighborhoods graded less favorably, and this apparent benefit to property values-and subsequently to residents' mental health-is greater in neighborhoods where Black residents are underrepresented.