Describing and Evaluating Pathways for Marginalized Youth-Driven Public Health Practice, Policy and Systems Change in Washington, D.C.
Open Access DepositedBlack Youth, Power, and Change
Background
DC Health Matters, 2016, Annual Epidemiology & Surveillance Report, 2021). They have higher rates of suicide attempts, prevalence of being obese, prevalence of being diagnosed with HIV and are exposed to violence more than youth in the United States overall (CDC, 2024
Utilizing a qualitative case study methodology and the Empowerment Evaluation framework, in Aim 1 we sought to understand and describe BSA’s current theory of change for marginalized youth-driven practice, policy and systems change. In Aim 2, we incorporated and assessed the utility of implementing community-based systems dynamics modeling (CBSDM) into BSA programming as a tool to engage marginalized youth in public health practice, policy and systems change. A cross-cutting focus of this study was to explicitly understand and describe how BSA shares power with marginalized youth in both Aims 1 and 2.A series of in-depth interviews, focus groups, CBSDM post-session surveys, as well as a collection of documents and photography artifacts, were collected and analyzed in order to answer the research aims. Nine adult staff from BSA participated in semi-structured, in-depth interviews. 14 high school BSA youth participated in two focus group regarding an Empowerment Evaluation focus group and another in BSA’s overall engagement with youth. 4-10 BSA high school youth completed CBSDM post-session surveys after the three sessions. Approximately 55 photography artifacts, as well as 27 documents relevant to BSA policies and engagement with marginalized youth were coded and analyzed. A reflexive thematic analysis (RTA) using the Nvivo 14 software was utilized for all qualitative data analysis. Descriptive statistics, such as means, standard deviations and scale scores from the quantitative CBSDM post-session surveys, were performed using STATA16. Results
BSA adult staff were all Black, previous youth organizers, ranged in age from 20 to 38 years old and were BSA employees for 1-6 years. BSA high schoolers were all Black, an average age of 16 years old, and had been a part of BSA for 3-6 years. Results for Manuscript 1, indicated that BSA engages youth in a series of developmentally appropriate activities based on three organizational pillars of pride, purpose and power which promote civic leadership. As BSA youth engage with civic leadership activities, they are equipped with the skills needed to have a sense of confidence in themselves and their ethnicity, a sense of community and, ultimately, collective power to change policies, practices and systems that often criminalize marginalized youth instead of systems that enhance health for all. Results for Manuscript 2, indicated that both BSA youth and adult staff considered CBSDM to be a useful tool for engaging marginalized youth in conversations related to the social determinants of health. Incorporating CBSDM into BSA’s process offered benefits for youth who participated at the individual, interpersonal and advocacy levels of the socioecological model. Findings across both Manuscripts detailed the ways in which BSA adults share power with youth through relationship building and validating BSA youths’ lived experiences, while also sharing knowledge about how adult systems work. Ultimately, BSA adults help to build power among youth by ensuring they have the skills, resources and knowledge needed to advocate for positive social change and health equity within their communities. Discussion
This qualitative case study highlights potential pathways and tools for marginalized youth to engage in youth-driven public health practice, policy and systems change. This study documents explicit examples of ways that adults can share power with marginalized youth. These findings are specific to Washington D.C. but may be transferrable to similar urban city contexts, with significant inequalities. These findings can continue to build on best practices for engaging marginalized youth in decision-making processes to improve policies, practices and systems impacting their health outcomes.
DC Health Matters, 2016, Annual Epidemiology & Surveillance Report, 2021). The myriad health challenges that marginalized youth in Washington D.C. face shines a harsh light on the social structural barriers, such as oppressive policies, practices and systems, that they are living in and that are contributing to their negative health outcomes (DC Health, 2018).Despite these challenges, marginalized youth have many strengths and prior research has demonstrated the value of these strengths through positive youth development (PYD) approaches. PYD considers youth as having assets and encourages skill building, adult mentorship, positive peer interactions, youth leadership and empowerment to overcome their challenges (Medina, et al., 2020). PYD programs with marginalized youth are often delivered through community-based organizations (CBOs) that have a commitment to working with youth that are often overlooked or failed by current systems (Ginwright, 2007). While research shows that CBO PYD programs focused on marginalized youth are helpful in their well-being, few studies describe the pathways or theory of change for how they produce PYD outcomes (Tuck & Yang, 2013). In addition, limited research to date has described, in-depth, the nuances of what it means to share power with youth (Bertrand & Lozenski, 2021) and less is known about the tools utilized within CBOs to engage youth in thinking about systematic issues impacting their health and well-being (Felmingham, et al., 2023). Therefore, an academic-community research partnership was formed with Black Swan Academy (BSA), a DC CBO that focuses on empowering Black youth to navigate their challenges through PYD and civic leadership. Methods
In Washington, D.C. (DC), youth of color, those of low socioeconomic status, as well as youth who identify as sexual and gender minorities in grades 9-12, have increased mental, physical, social and environmental stressors that disproportionately and negatively impact their health (CDC, 2021
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