tillery

Community-Built Practice:
A Working Partnership with the Community of Tillery

Under the direction of
Dr. Beth Velde, Ph.D., OTR/L

Latest Work

Dr. Velde's and Dr. Wittman's work is currently funded by a four year grant from the National Institute of Environmental Health Sciences to work on a project designed to enhance environmental justice. Money has been used to complete a new needs assessment of the community, linking environmental issues with health concerns.

The People's Occupational Therapy Wellness Center is staffed by an occupational therapist who will provide needed occupational therapy service to community residents. These will include individualized health promotion and wellness assessments and intervention services as well as a summer camp for children.

Please see this website for information on environmental justice: http://www.mapcruzin.com/environmental_justice.htm

Definitions of Community-Built and Community-Based Practice

To be effective in establishing a role for the provision of occupational therapy services in the community, the definition of community practice must be examined. Literature in community-building suggests the following definitions to clarify perspective from which services are offered.

Community-based practice refers to skilled services delivered by health practitioners using an interactive model with clients. This model emphasizes the strengths of a specific profession in eliminating or remediating the problems of the client. Typically, this type of practice is medical system initiated, relies on referrals from other professionals, and is on-going over time.

Community-build practice is defined when skilled services are delivered by health practitioners using a collaborative and interactive model with clients. This model emphasizes the strengths of the client and is wellness oriented. Typically such a practice eliminates or resolves client issues by providing expert knowledge that is not otherwise available to the client, is issue based, and ends when the client-defined community has effectively built the capacity for empowerment.

Thus, differences between community-based and community-built models reside in the theory bases, strategies and skills needed to be effective, and the outcomes of participation in services. Community-built practice grounds itself in health promotion and wellness theory and draws from literature in health education, urban planning, and public health. It addresses the person, the community, and environmental factors interacting to support occupational engagement.

(Taken from Wittman, P.P. & Velde, B. P. (2001b). Occupational therapy in the community: What, why, and how. Occupational Therapy in Health Care, 13 (3/4), 1-5.)

Introduction to Tillery

Tillery, North Carolina is a “cross roads” rural community located in one of the poorest counties of the state. Three thousand people live in a 5 mile radius of the community center and the residents are predominately older African Americans. Younger people were usually unable to find work in the local area and moved to northern cities to find jobs and raise their families. The community has a long history dating back to Franklin D. Roosevelt's presidency when it was one of several resettlement communities. Settlers were promised “40 acres and a mule” as well as a small house and some chickens in exchange for farming the land (Concerned Citizens of Tillery, undated). Direct descendents of the original resettlement farmers still live in the area and are proud of their unique heritage and history. Residents speak proudly of their continuing efforts to challenge the system through legislative actions, efforts for healthcare reform, and solicitation of funding and collaborative relationships with nearby universities.

Academic Partnership for Community-Built Practice

The Occupational Therapy Department at East Carolina University has provided services to the Tillery community since 1996 when the University received funding from a Learn and Serve America grant. Faculty and students conducted a community health needs assessment. Based on the results of this assessment, a link between health care and the environment became a focus of the occupational therapy team's efforts and a need to develop cultural competence was identified. Originally referred to as “The Tillery Project” over the years the name was changed by students to “The Tillery Experience” to reflect the opportunity for growth and development that resulted from their experiences.

Teaching, Learning, and Writing About The Tillery Experience

To read more about the work Dr. Wittman and Dr. Velde have done in Tillery, please see the following publications:

Tillery References
Baity, C. (Winter 2004-2005). Community empowerment: mind, body and soul. Alliance, 14, No 1 , pp. 6-7, 25.

Baity, C. (April, 2005). ECU, UNC Students Assess Health of Tillery Residents.

Barnard, S., Dunn, S., Reddic, E., Rhodes, K., Russel, J., Tuitt, T., Velde,B. Walden, J., Wittman, P., & White, K. (2004) April-June 2004. Wellness in Tillery: A Community-Built Program. Family and Community Health. 47, 151-157. (3202)

Dryer, N., Dreyer, K. Shaw, D. & Wittman, P. (2001). Efficacy of telemedicine in occupational therapy: A Pilot Study. Journal of Allied Health, 30, 29-42.

Fogerty, E., Lynch, A., Katana, B., McCloskey, J., Montouro , Va. , Velde, B.P., & Wittman, P. (Writers) (2001). Comin' Home. (Videotape). Greenville , NC : Brody School of Medicine

Velde, B.P., & Wittman, P.P. (2001). Helping occupational therapy students and faculty develop cultural competence. Occupational Therapy in Health Care, 13 (3/4), 23-32.

Velde, B.P., Wittman, P., Flowers, A., Stinson, M., & Balent, P. (2002). Providing services for elders in a community setting: Mrs. Scotland . In B. Velde & G. Fidler. Lifestyle Performance: A Model for Engaging the Power of Occupation (pp. 113-124). Thorofare , NJ : Slack.

Velde, B.P., Wittman, P. P., & Bamberg , W. R.. (2003). Cultural competence of faculty and students in a School of Allied Health . Journal of Allied Health, 32, 189-195.

Velde, B. P., Wittman, P.P., Lee, H., Lee, C., Broadhurst, E., & Caines, M. (2003). Quality of life of older African American women in rural North Carolina . Journal of Women and Aging, 15 (4), 69-82.

Wittman, P., Conner-Kerr, T., Templeton, M.S., & Velde, B. (1999). The Tillery Project: An experience in an interdisciplinary, rural health care service setting. Physical & Occupational Therapy in Geriatrics, 17(1), 17-28.

Wittman, P.P., & Velde, B.P. (Fall, 2001). Celebrating Tillery Survivors. The Delta Kappa Gamma Bulletin, 68, 16-18.

Wittman, P.P. & Velde, B. P. (2001). Occupational therapy in the community: What, why, and how. Occupational Therapy in Health Care, 13 (3/4), 1-5.

Wittman, P., & Velde, B. P. (2002). The Issue Is: Attaining cultural competence critical thinking and intellectual development: A challenge for occupational therapists . American Journal of Occupational Therapy, 56 , (454-455).

Additional Information

For information about situated cognition: http://www.exploratorium.edu/IFI/resources/museumeducation/situated.html

For information about cultural competence: http://gucchd.georgetown.edu/nccc/

For information about a group that works to foster partnerships between communities and education institutions, much like the collaborative work of East Carolina University and the Tillery community: http://depts.washington.edu/ccph/scholarship.html

For information about Service Learning: http://www.servicelearning.org/

Tillery Photographs

Tillery Community Center

The Curin' House

Friends

Collections as Meaningful Objects

Waiting for Group Members to Arrive

Parachute Activity

Under the Parachute

Getting to Know Each Other

A building in Tillery

Rural Eastern North Carolina

Relaxing at home

Preparing Nutritious Food

The Community Speaks

Parachute Activity Continues

The Community Center

Group Activities Promote Wellness

Alumni of the Tillery Experience

Dr. Beth Velde and Dr. Peggy Wittman attended the annual grantee meeting of the National Institute of Environmental Health Science in September 2005 in Talkeenta, Alaska as members of the Community Health and Environmental Reawakening project. They met with representatives from 25 other community-university research projects to learn about these and to discuss sustainability.

View from the Talkeetna Lodge in Alaska where the NIEHS meeting was held

Eagle River Flats outside of Anchorage Alaska, home of native fishing and hunting.

Members of the Community Health and Environment Reawakening Project Team

Amy Lowe, Peggy Wittman, Doris Davis
September 2006, Talkeetna, Alaska

Dr. Velde and Dr. Wittman presented with their colleague from the Tillery community, Ms. Doris Davis, Director of the Area Wide Health Committee, on Saturday, October 22, 2005 at the annual state-wide Environmental Justice Summit in Ensfield , NC . The focus of their presentation was on the relationship between environmental, social, and occupational justice.