The DeKalb County Board of Health has recruited students from Clarkston High School for three summers to participate in Photovoice: a youth empowering program. The audience is the stakeholders of Clarkston, including residents, the boards of health and education, representatives of Clarkston, its law enforcement officers and the business community. Today one-third of Clarkston's population is made up of immigrants and refugees. Over the years, students have participated in the Photovoice program representing approximately 5% of the Clarkston High School student body and affecting 100% of the student population and the community.
The goals of Photovoice are for Clarkston High School students to 1) document community health-related strengths and challenges through participatory research; 2) reflect, think critically, and dialogue about their research; 3) present their findings persuasively to pertinent stakeholders. During Photovoice Clarkston students determined their priority health issues, including Education, Pollution and the Environment, Teenage Pregnancy, Substance Abuse, Rental Property Management and Community Health. After researching these issues through the internet, surveys, interviews and photographs, the students prepared Power Point presentations and presented their results, conclusions and recommendations to county boards of health and education, other community officials and interested people. Due to their advocacy Clarkston High School became a Hands-on-Atlanta project resulting in much needed repairs and restoration, the City of Clarkston started a recycling program and an anti retaliation bill was submitted to the state legislature.
Replication of the Photovoice program requires from $30,000-$40,000, depending upon how many students are enrolled. It requires a ratio of one adult facilitator to six youth. The adult facilitators must have a background in public heath and popular education methodologies. A partnership between the local board of health, school, community agencies and the community itself is key to the success of the program.
Clarkston, Georgia has experienced a major influx of immigrants and refugees from around the world. Newcomers face language, cultural and economic barriers that prevent their full access to health information and health care. The health disparities experienced by immigrants and refugees are most striking among women and children who are marginalized throughout the adaptation process. Photovoice addresses Clarkston's needs as identified by its high school students. The students determined four health topics they have strong feelings about and are important to them. Over the four years these topics have been Education, Pollution and the Environment, Teenage Pregnancy, Substance Abuse, Rental Property Management and Community Health, all critical issues for them and their communities. Through the Photovoice process, they are able to identify and move to action to do something about these issues and improve their community. The process also builds skills and improves the attitudes among a previous silent population in Clarkston, its minority high school students. They, through the use of research and photography, act as recorders of and catalysts for social change in their community's health.
Since 1993, the DCBOH has been working in Clarkston through the formation and facilitation of the Clarkston Health Collaborative. The issues identified by the students are issues of constant discussion among the residents and agency personnel who regularly attend the collaborative. The relevancy of their chosen issues is further supported by the findings of their research, which clearly documents the reality of their environment.
Photovoice responds to the Clarkston community by training high school students from that community to identify strengths and weakness of health issues, come to conclusions, formulate recommendations, and encourage the community to take action. The community has responded to these findings and recommendations by implementing new programs, such as recycling, which benefit the entire community.
Photovoice is an innovative way to create the participation of community members through photography and participatory research. Photovoice was developed by Dr. Caroline Wang working with women in a remote Chinese village. Photovoice has been used in other venues worldwide enabling participants to identify and prioritize their concerns, discuss problems, and determine solutions.
Innovations of the DeKalb County Board of Health 's Photovoice program include giving a public voice to voiceless youth, preparing the research, conclusions and recommendations in a Power Point presentation, and taking these presentations before key community stakeholders with the power to implement change. Part of the innovation is bringing refuge, immigrant and American youth together as a united community to determine community solutions. Another innovation is the multi-level youth development that occurs through the use of university fellows to work on a day-to-day basis with high school youth while being mentored by public health professionals.
Students found the use of popular education instead of the usual, formal health education model to which they were accustom both innovative and challenging. Popular Education, as developed by Brazilian educator, Paulo Freire, is a highly effective strategy for listening to a community, identifying their most important issues and facilitating their moving towards self-determined actions. In the context of Photovoice, the process begins in the first week with the students building a sense of community and developing their abilities to think critically using popular education methods of analysis and discussion. The weekends with their identification of four strong concerns they have about their community's health and well-being. They divide into four groups based on these concerns. Each topic group researches their topic, and identifies and interviews stakeholders
Agency Community RolesPhotovoice would not be possible without a collaborative relationship between the Board of Health and the Clarkston community. There have been six major partners in this collaborative:
The Clarkston Health Collaborative: a grassroots community coalition to improve the health of the people who live, work, and playing in Clarkston, GA; one of the most diverse communities in the Southeast United States.
Clarkston High School: the local high school in Clarkston, GA; one of the most diverse public high schools in the Southeast United States.
IMAGE Clarkston: the local group acting as a chamber of commerce.
The DeKalb County Board of Education: the local county education agency.
Kenneth Cole Fellowship of Emory University: a fellowship program sponsored by Emory University and The Kenneth Cole Foundation.
The DeKalb County Board of Health: local county pubic health agency.
DeKalb County Workforce Development: county workforce assistance.
All seven partners work together to disseminate the findings and recommendations of the students and to finally take action. The DCBOH directed the program, trained the high school students and undergraduate fellows in popular education methods, paid the students a summer stipend, and evaluated the students. Clarkston High School took responsibility for recruitment of the students; Photovoice was one of the students' choices for summer youth jobs. The DeKalb County Workforce Development contributed towards the payment of those students who fell below poverty levels. Kenneth Cole fellows, funded through the Kenneth Cole Foundation, were assigned to the DCBOH, and supported and facilitated the high school students' activities during the remaining 7 weeks of the summer project and evaluated the students at the end of the project in Photovoice 2003. The Clarkston Health Collaborative supported the students' community activities of interviews and photography. The Clarkston Health Collaborative, IMAGE Clarkston, staff of the DeKalb County Board of Education, elected officials, Clarkston law enforcement officers, Emory University and the Centers for Disease Control and Prevention provided venues for the students to present their findings and recommendations.
Costs and ExpendituresThe DCBOH provides part-time stipends for the high school students during the 8-week long summer project. They are hired as Research Assistants and paid for 20 hours a week for 8 weeks at $9 per hour for a total of $1,440 per student. Additional costs are the costs of supplies and processing. Use of computers was provided by the DeKalb County Board of Health. The Fellows were an in-kind contribution by Emory University's program. The Program Director was paid by the DeKalb County Board of Health. The programmatic costs are estimated at $30,000-$40,000 without personnel salaries.
The summer project is funded by DCBOH and a grant with the Kenneth Cole Fellowship. The Kenneth Cole Fellowship grant provides in-kind four students, at 30 hours per week for 10 weeks. The DeKalb County Workforce Department also contributed by covering much of the stipend cost for youth whose family incomes fell below the poverty level.
ImplementationOver 50 high school students have been recruited and selected for the 3 years of Photovoice.
Week 1: The first week is the most critical and seeks to engage the high school students in building a sense of community and developing their abilities to think critically. This is met by involving the high school students and undergraduate fellows in a Transformation for Health workshop of DCBOH. The workshop prepares participants to listen for key issues within their own community facilitating a critical thinking process to identify and implement action solutions. The students and fellows participate in interpersonal exercises designed to both increase their self-esteem and foment community. The DCBOH staff utilizes problem-posing educational tools to stimulate critical thinking skills. At the end of the workshop, the high school students determine the four topic areas about which they have strong feelings and which are important to them.
Week 2: The high school students divide into four groups according to selected topic areas. These smaller groups are created to give each student the opportunity to participate fully. Each small group goes through a process of researching their topic using the Internet and locally available material, determining where they want to focus their efforts, and deciding what approach to use.
Week 3: The students formulate survey instruments for community residents to complete and select sites to photograph. They identify and interview stakeholders for each of the issues, and ask them to attend the final week presentations.
Weeks 4 & 5: These two weeks are for the fieldwork of the project. The students are in the community taking pictures and using their surveys to interview community residents.
Week 6: Pictures are developed, and surveys and interviews completed. The students then organize their pictures, compile their findings, and draft their presentation. As they pull things together, they engage in a refection process to ascertain recommended actions to remedy what they had seen and heard.
Week 7: This week is dedicated to synthesizing all their data, pictures, and information into an electronic presentation. A great deal of time also is spent in preparing and practicing their presentations.
Week 8: The final week is presenting their findings and recommendations to community residents and stakeholders.
Throughout the 8-week program, each day begins with one participant or facilitator sharing something from his/her culture with the group. When all the students are assembled, they are randomized into small groups for different activities and exercises to increase participation of all students. In addition, many games are played at break times to encourage physical activity and to build community.
In 2003, the students secured the Clarkston high school as a Hands-On-Atlanta site resulting in much need repairs and restoration at the school.
Shortly after the students presented to the Clarkston Health Collaborative, the city began enforcing its public safety ordinances. The mayor pledged to bring a recycling program to the city, which began by January 2004 with providing recycle bins. With the help of the Clarkston Health Collaborative, an antiretaliation bill was introduced to the Georgia legislature.
In addition to visible community changes, other outcomes were measured using pre- and post-training surveys and open-ended interviews were conducted at the summer's end. The summer project was evaluated through the assessing skills gained and attitudes changed.
In the pre- and post-training survey, the students gained significant improvement in the self-rated skills of camera use and public speaking. In the interviews, they were found to also change their attitudes by meeting and making of friends from other cultures and learning to work in groups. In addition, the students with assistance from the fellows started a Photovoice Club at Clarkston High School for academic year 2003-2004.
All of these changes, including the changes in the community, can be directly attributable to the findings and presentations of the Photovoice students to community stakeholders.
Not only the students and fellows, but also the adults and professionals at local government boards, academic institutions, and CDC saw self-confident high school students present their findings and recommendations. This observation alone makes the project worth the resources. In addition, the bridging of cultural differences and the participation of the students in their community's health show how the project is worth the investment. Value can be found in the students deepening awareness and knowledge of community health issues as well as their increased self-confidence and determination to advocate for the improvement of their community.
The students were committed and enthusiastic about their new role in their community as catalysts for change. They started a Photovoice Club at Clarkston High School for academic year 2003-2004. The response from the community has also been favorable, as the mayor, the school, and law enforcement have taken actions. The Clarkston High School principle and other faculty strongly support the program and have expressed an interest in its continuity. The Mayor, city officials, residents, Emory Faculty and students, members of the Board of Health Board and the Board of Education as well as the County CEO and County Commissioners all have participated in the student presentations, giving them full support and encouraging the continuation of such a rich opportunity for high school youth.
The commitment of the students and the partners involved will sustain the program. Additional support as being sought for the continuation of the program through grants for future summers, especially for funding undergraduate fellows. Although the DCBOH has experienced budget cuts and tightening, the administration is committed to the program and is seeking to continue to conduct a Photovoice by funding another set of high school students. This expresses a profound commitment on the part of the DCBOH.