This summer, Michigan Forward in Enhancing Research and Community Equity will launch the Health Access Initiative, a free quality-improvement program for clinics and health centers in Southeast Michigan aimed at providing better care for LGBTQ youth.

MFierce was founded in September 2014 with the aim of dealing with societal health disparities via a participatory, community-based approach of structural change. It is funded by the Centers for Disease Control and Prevention.

MFierce Project Director Triana Kazaleh Sirdenis said the organization focuses on systemic problems rather than individual interventions.

“Besides being participatory, the other part that makes MFierce different is that it is involved with structural change,” Sirdenis said. “Currently there are a lot of programs focused on changing individual behavior, for example how to use a condom, how to have safer sex negotiations — but these are more on the person-to-person level.”

“So this structural change works to impact the bigger systems and policies, as well as take into account existing policies that could be affecting quality of care,” she added.

MFierce is a three-part coalition, according to Sirdenis. The first entity is the steering committee, composed of different community leaders, CEOs, AIDS service organizations, LGBTQ groups, state and county health departments. Also involved are public health researchers in the Center for Sexuality and Health Disparities, or the SexLab. The final piece is the Youth Advisory Board, which is made up of LGBTQ youth from all over Southeast Michigan.

Marcos Carrillo, biology junior at Henry Ford Community College, is a member of the Youth Advisory Board. He said his decision to join MFierce was deeply motivated by personal experiences of stigma and inadequate accessibility to quality health care, which he saw to be outgrowths of the larger system.

“Imagine facing stigma every day with your friends and family, and just understanding that changing transgender perspective is not necessarily an individual person’s problem but also a structural thing,” Carrillo said. “Places that have increasing rates of sexually transmitted infections (STIs) are often the same places where people lack access to health care because they don’t know how to apply for Medicaid, or service providers aren’t creating a safe environment for people who seek help, or money isn’t going toward helping them. Accessibility is a big issue because it is related to a lot of other pressures — social, economic, psychological.”

Sirdenis said engaging the Youth Advisory Board was a core part of the organization’s programming.

“Often public health programs are created in isolation without input, guidance, leadership and wisdom from the people most impacted by it,” she said. “The youths are here to help us understand what is going on, what they would like to see in terms of STI treatment and access. They are our reality check.”

The Health Access Initiative is a two-part engagement with individual clinics and health centers. The first part is cultural humility and cultural responsiveness for staff — from medical personnel such as doctors and nurses to front desk and administrative staff. This includes equipping them with inclusive language and practices to serve LGBTQ patients more comprehensively.

The second component of the HAI is technical assistance, which aims to support clinics and health centers with creating and revising protocol and policies. This includes re-examining current practices and other aspects of the patient experience that could impact quality of care. All training and support is provided for free.

Sirdenis said conceptualizing the Health Access Initiative involved significant groundwork and community engagement. Twelve town halls throughout Southeast Michigan — encompassing Flint, Ypsilanti, Ann Arbor and Detroit — were conducted to survey public opinion and facilitate open conversations on how to best meet the needs of the population of interest.

Jack Andrzejewski, a second-year Master’s student in the School of Public Health, works as a research assistant for MFierce. Part of his job involves literature review and data evaluation. He said the program development phase was both challenging and fulfilling.

“The town halls engaged community members via process-oriented activities, to gather their input on what they felt was important and salient. This really helped the coalition to make future decisions,” Andrzejewski said. “Time is always an issue. Community-engaged participatory approach to research requires a lot of time. Nonetheless, outcomes are better, engagements are better and there is more buy-in from community members.”

Sirdenis emphasized the efforts devoted to ensuring the Health Access Initiative was directed at meeting the needs of its target population.

“We looked over the data gathered by SexLab and talked it through with the Youth Advisory Board; we asked them what they thought, and if the research resonated with their personal experience,” she said. “Using existing data, as well as everything else gathered from the town hall ideas, we went from 100 ideas and whittled down to two ideas.”

Aside from the Health Access Initiative, MFierce is also working on the Advocacy Collective, aimed at providing advocacy and professional development training for the Youth Advisory Board so that members can go on to do consulting work.

Carrillo said he hoped the Health Access Initiative would ultimately affect large-scale change.

“I think that the cool thing about this project is not only that we’re hoping to increase awareness and reduce STI rates, we are also involving institutions that would otherwise not be involved, and challenging them to consider what they can improve, what has been working, what hasn’t been working, who is being left out and how do we make whatever we are doing more accessible to people,” he said.

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