Editor’s note: The John A. Hartford Foundation, the Administration for Community Living (ACL) and The SCAN Foundation fund the Aging and Disability Business Institute, led by USAging. The mission of the Aging and Disability Business Institute is to build and strengthen partnerships between aging and disability community-based organizations (CBO) and the healthcare system. As partners in the Institute, ASA and USAging are collaborating on a series of articles and case studies in Generations Now that highlight community-based integrated care networks.
Twice retired, across her career Viviana Criado has focused on serving the underserved, so when her second retirement didn’t take, she found herself working in aging for a second time, now as project director for the Los Angeles Alliance for Community Health and Aging (LAACHA). “It was just impossible for me to walk away [from a job in aging] because you see the stigma and the discrimination that exists against older adults,” said Criado.
Criado’s background is in mental health recovery and rehabilitation, in which she worked for 25 years in San Diego County, where she ran recovery and rehabilitation programs, supervised the After-hours Elder Abuse Reporting Line, and eventually led San Diego’s Older Adults Mental Health System of Care.
The Department of Aging and Independent Services in San Diego was active in promoting aging and mental health and supporting efforts to develop a Mental Health and Aging task force. Criado reached out to Laura Trejo, at that time General Manager of the City of Los Angeles’ Department of Aging (she now directs LA County’s Aging and Disabilities Department) to help San Diego County Mental Health Department launch said task force.
In 2014, when Criado retired from her advocacy work with the California Elder Mental Health and Aging Coalition (CMHAC), a member-driven advocacy coalition she co-founded and directed, she moved to Florida and started a doctorate in organizational leadership. But soon she found herself being Deputy Operations Director for the Central Florida Hillary for President Campaign, during which time, she said, “I got really activated, because the next thing I said to myself, ‘I’m not ready to sit here in Florida,’ so I came to LA.”
We are conveners, connectors, and the group that does the big push to put people into action and achieve specific goals.
Criado took her background in mental health, aging, cultural diversity, and cultural competency, plus her personal connection to Laura Trejo who was working on this new alliance called LAACHA, to join the organization. “It was starting to grow and I’d done work around coalition building for so long, I thought, I’ll just go and do this gig for a little bit, and now it’s going on seven years,” said Criado.
LAACHA is an alliance that brings together multisector partners, including government, such as the departments of public health, aging and disabilities health services and mental health; community-based organizations from national to statewide to neighborhood-based; and academia (almost all nearby universities are LAACHA members). LAACHA also has advocacy organizations as members, such as the Alzheimer’s Association, Justice in Aging, AARP, and other nonprofit partners. Philanthropic organizations like the LA Foundation on Aging are members, too. Criado oversees an active university internship program for LAACHA, in the hopes that it will foster workforce capacity in aging.
The group works in the arenas of chronic disease self-management training, workforce development, innovations in technology, social isolation, loneliness, family caregiving, and digital inclusion programming. Evolving work includes capacity strengthening for members on how to incorporate a racial justice lens into services delivery; and with a national partnership it is building educational programming on how to develop advocacy tools for family members and older individuals living with cancer (held first for the African American population in LA and looking into similar work with Latino and Asian communities).
LAACHA leadership is fostering health equity in all its efforts and programming. One test program is Shape2Fit, a culturally tailored chronic disease program with Latinos and African Americans which addresses cultural and linguistic gaps in the traditional program and gives participants an opportunity to speak with physicians about their needs.
Criado would like to see LAACHA’s membership expand to include more older adults and to give more ownership to all the communities involved. “The recipients of our services need to be at the table, they have to be included,” said Criado. To that end she has brought in more representation from older adults via committee leadership, and from family caregivers, all with the goal of opening opportunities for everyone to be in leadership, while ensuring continuity with sustained members.
Senior Services Director of the Watts Labor Community Action Committee, Dr. Phyllis Willis chairs the LAACHA Steering Committee that created Shape2Fit. “Shape2Fit came out of my community experience, evidence-based diabetes self-management Master Training and belief in participant input. We believe it’s not just about the structure and data of the intervention. It’s also about the intention—what are you trying to achieve, and how are you trying to achieve it?” said Willis.
Attendance has been phenomenal, she pointed out, Shape2Fit is now at 158% of projected numbers.
“Shape2Fit recognizes and embraces the unique cultures, languages, traditions, foods, and neighborhoods of Black and Latino South Los Angeles older adults and family caregivers. Our expert facilitators and physicians have lived experience. The workshops begin and end by addressing diabetes health literacy gaps. They encourage participation in discussion, cooking demonstrations, and role-playing physician communication,” she added.
We felt evidence-based practices were not the answer because of the diversity we have— they haven’t been proven to work in every population.
These older adults with diabetes and their caregivers ask questions and make observations in their own language or cultural style to bring evidence-based diabetes education into the context of their lives.
“LAACHA intentionally includes providers of older adult healthcare and social services because we believe the two cannot be separated. Similarly, racial justice and health equity cannot be separated from other aging issues,” said Willis.
Criado agreed that it was critically important to “acknowledge the history of insufficient attention to communities of color, their health concerns, and their contexts. And we need to pay appropriate attention to those concerns and tailor our programs to them.”
“We see ourselves as conveners, connectors, and the group that does the big push to put people into action and achieve specific goals,” added Criado.
Why Is the Work So Necessary?
In 2007, LA County’s Department of Public Health Office of Women's Health (OWH) held a large convening of 450 women’s health leaders to get feedback and direction for the office. Given changing demographics, healthy aging was one of the key areas identified by participants as an area of focus. Having no expertise in this arena, Ellen Eidem, director of the OWH reached out to key aging network leaders and experts, including Laura Trejo, Cynthia Banks (then County Aging Director), June Simmons, Executive Director of Partners in Care Foundation, and a few key others who worked together to address the critical needs of women who are aging, with the goal of “adding value” and not duplicating the great organizational work that was already being done. Using a prevention and early intervention approach, the issue of addressing and combating chronic disease was selected as an initial focus, numerous aging conferences were held, a collaboration (LAACHA) was formed and grew.
Partners in Care had become the largest provider of chronic disease self-management programming, yet, Criado says, chronic conditions continued to increase, so in her first year at LAACHA she thought that to better address chronic conditions, they needed to start looking at health disparities and the social determinants of health, both of which are outside the scope of the classic chronic disease self-management training.
“We needed to address the root causes—food, transportation, education, historic racism—all the things that go into addressing chronic conditions,” said Criado.
“Then we felt that evidence-based practices many times were not the answer because of the diversity we have, they haven’t been proven to work in every population. There were community-informed practices that were working in the community already but hadn’t yet been deemed ‘evidence-based,’ and we needed to pay attention and support those culturally tailored programs.
“So, we moved from evidence-based practice to improving health equity and population health and we organized ourselves in different committees, activated the membership, promoted innovation and then the pandemic hit,” said Criado.
But, because LA is so huge and so diverse, LAACHA had already become quite facile at online platforms long before the rest of the country caught up. Before the pandemic we were already looking at tech as a way to cross the distances in LA and had already been meeting via Zoom. “We had tech partners who taught us how to do that, so when COVID hit we were able to bring people together to start sharing practices, giving recommendations on how to do virtual programming, how to support partners and information on COVID and vaccines, etc.,” said Criado.
“In those three years we did a tremendous amount of good work, in areas of capacity and resource development, innovation, outcomes and evaluation, racial justice, digital inclusion, family caregiving, and social isolation/connectivity.”
But, “you can only be as successful as the person who is receiving your services,” she added. “There’s no point to do it and no success unless the person who receives the services says it is working for them.”
Alison Biggar is ASA's Editorial Director.
