Joining Forces: The Benefits and Challenges of Conducting Regulatory Research With a Policy Advocate

ABSTRACT

Community-engaged research (CEnR) is experiencing a resurgence as a way of informing community-level change and policymaking. Yet the rules and regulations that are crucial to policy implementation and success are relatively understudied through CEnR. This case study of CEnR on a Medicaid service definition for tenancy supports illustrates the benefits of engaging a policy advocate in regulatory research. These include the advocate’s relationships with stakeholders; her knowledge of the regulatory domain, process, and context; and her visibility as a team member. The case also illustrates challenges to advocate–researcher collaboration, including time demands, differing goals, risks to advocate relationships, and the politicized nature of advocacy. The case depicts strategies that address these challenges, including advocate compensation time, early engagement, discussions of motivations and expectations, and proactive attention to the advocate’s role.

KEYWORDS:

• Housing
• tenancy support services
• permanent supportive housing
• community engaged research
• interdisciplinary research
• Medicaid

Acknowledgments

The authors acknowledge the Duke Council on Race and Ethnicity for their support of this work.

Disclosure Statement

No potential conflict of interest was reported by the authors.

Notes

1. Throughout this article, the term regulatory research is used to encompass both rules as informal administrative conventions and regulations as formal requirements.

2. TSS are also a part of Rapid Rehousing—the provision of short-term financial assistance and TSS to obtain housing. Because direct assistance is time-limited for Rapid Rehousing, TSS in this model is also limited in nature, with any long-term consumer needs dealt with through referrals to service providers outside of the TSS arena. Receipt of Medicaid-funded TSS in North Carolina, the focus of our study, requires that the beneficiary have a disability, making it most likely that these individuals will have complex needs and therefore will be served through PSH rather than Rapid Rehousing. Although some of our study findings may be relevant for Rapid Rehousing as well, there are distinct differences between what is needed for these two approaches. Therefore, we focus in this article and in our study design on TSS associated with PSH.

3. For example, a review of two documents providing instructions and examples of community-based participatory research for social and policy change shows that research designed specifically to inform regulations has been utilized but is not prominent (Minkler, et al, 2009; Minkler, Garcia, Rubin, & Wallerstein, 2012).

Additional information

Funding

This work was supported by the Robert Wood Johnson Foundation.

Notes on contributors

Mina Silberberg

Mina Silberberg, Ph.D., is an associate professor in the Department of Community and Family Medicine at Duke School of Medicine, vice-chief for research and evaluation in the department's Division of Community Health, and a faculty affiliate in the Duke Council on Race and Ethnicity. Prior to coming to Duke, she was a senior policy analyst at the Rutgers Center for State Health Policy. Her research focuses primarily on program and policy evaluation for community health. Dr. Silberberg received her doctorate in political science from the University of California at Berkeley.

Donna J. Biederman

Donna J. Biederman is an associate professor at the Duke University School of Nursing (DUSON) and the Director of the DUSON Community Health Improvement Partnership Program (D-CHIPP). Biederman’s research and programmatic interests intersect with housing and health care including transitional care for homeless people exiting institutional settings and the health correlates of eviction. Biederman is a co-Principal Investigator for the Durham Homeless Transitions Care program where she is the research, evaluation, and education lead. She was an Emergency Department nurse and then a case manager at a federally funded Health Care for the Homeless Clinic prior to completing her DrPH at the University of North Carolina Greensboro.

Emily Carmody

Emily Carmody joined the North Carolina Coalition to End Homelessness (NCCEH) in May 2010, a statewide membership nonprofit that works to end homelessness by creating alliances, encouraging public dialogue, securing resources and advocating for systemic change. Emily is the state lead for the NC SOAR program and advises on projects including health and human services and technical support for continuums of care. Prior to working at NCCEH, Emily worked in homeless services for ten years in Connecticut, Washington, DC, Michigan, and North Carolina and received her Master’s in Social Work from the University of Michigan in 2007.