Community Ambassadors: A Community-Driven Approach to Resource Access for Elders

This thesis was a qualitative study of an unusual health-promotion program for elders. Fremont, CA is one of the most diverse cities in the U.S., by many different measures. One extraordinary aspect of Fremont's population is that many people have immigrated to Fremont in their old age, often to follow children who moved there decades ago. Several years ago, Fremont's Human Services Department conducted a needs-assessment of the city's elders (defined here as 60+), and found that many elders were not accessing basic resources such as health care and transportation. The needs-assessment determined that linguistic and cultural barriers were preventing elders from accessing these services, even in cases where elders had been in U.S. for years, paid into Social Security and Medicare, and otherwise established themselves. The Community Ambassador Program for Seniors ("CAPS") was created to respond to this need, by training volunteer "ambassadors" from several different ethnic and faith communities. Ambassadors were selected as largely multilingual, bicultural community members who could help elders understand and utilize social services. Ambassadors completed a 40-hour training covering the basics of many different services. Once active, they reported to a "site coordinator" at each of the participating community organizations, and the site coordinators reported to Human Services personnel in Fremont. Ambassadors from the different sites also had monthly training sessions, in which they traded advice and offered support from group to group. Since its creation in 2007, CAPS has served hundreds of elders.

I approached this research project with the goal of understanding CAPS as a novel social institution - one that was designed largely by community members, and gives community members considerable control over how they identify and access services. I was particularly interested in the community-building dividends of CAPS, as an organization that incorporated six, and then seven, and then eight, different community groups under one agenda. The core data sources for my study were ambassadors themselves; I interviewed 27 of them, including nearly all from the three participating South Asian communities (the focus of my study), and also observed trainings and meetings. In addition, I used program utilization data to provide quantitative reference points for ambassadors' individual observations about program function, clients served, and so forth. My core methodological approach was "grounded theory," which emphasizes using interviewees' own words and conceptions, over and over as data collection progresses, as the basis for an explanatory model.

In brief, my findings were, first, that elder immigrants experience a lot of stress within their own families as they acculturate, even though current models of "acculturative stress" often emphasize stressors outside the family; second, that in working with elders, ambassadors had to operate in three-person units ("geriatric triads") with elders and their children, not just with the elders themselves; and third, that as community members who trained in formal social service provision and then functioned in the way family members, themselves, would often function for elders, ambassadors embodied what I called "role hybridity," meaning that they were a combination of social service professional, community member, and adopted family member, without just being any one of these three.

I also used the program's model and my interview data to make a theoretical argument about "social capital," which is basically (as one theorist put it) "the idea that social networks have value." Social capital literature in public health contains a sometimes-bitter debate, with emphasis on resources on one side and emphasis on social networks, themselves, on the other. The former side might argue that community-building has little value if people are fundamentally resource-poor and structurally disadvantaged, and the latter side might argue that without social networks, no one can thrive. I argued in my thesis that CAPS brings these two sets of priorities together, by building social networks for the purpose of enhancing access to resources, which are still provided by the public sector (such as Social Security and Medicare). As such, the program illustrates a potential answer to a theoretical impasse in social capital literature: building community and building access to resources can be naturally complementary goals. I had a lot of support from faculty members, particularly Stephen Eyre, Susan Ivey, Andy Scharlach, and Len Syme, throughout this project. It's hard to imagine better mentoring resources than the ones JMPers enjoy.