Public Housing and ProSerEs Project

Public housing projects were undertaken to face the far reaching effects of poverty and unemployment in the 1940s and 50s and under two assumptions: (1) remove impoverish people from the arrabales (slums) spaces where crime and disease emanate, to erase any trace or memory of the past and give way to progress, in other words, will be eliminating poverty in the island (^{Diaz Quinones, 1993}), and (2) that the poor had to be purged from any former tie with their rural past or with the spaces and community interactions of their former slum (because slums overcrowding represent a primarily menace to public health and results in family instability and moral laxity) (^{Puerto Rico Housing Authority [PRHA], 1949}).

Currently, Puerto Rico has 325 public housing projects across the island, this is a subsidized system housing unit that are provided for low-income families and is mainly financed by US federal funds. Over half the population lives below the poverty line and faced a myriad of social, economic, and psychological problems associated with chronic multigenerational poverty. One of the objectives of this public housing projects was to make it transitory and to promote ownership, but instead it has become permanent communities. As stated by ^{Oliver-Didier (2016)} criminality and drugs related activities are still the main discursive agents employed in the media and day-to-day conversations to stigmatize the communities that live inside public housing. This highly prejudice misconception justified the police raids, occupations, and fences built in and around the project's perimeters mainly during the 90s making it look like more as a prison instead of a community.

ProSerEs (for its Spanish acronym) was a project that offered psychological, occupational, speech-language, and art therapies to children with disabilities (diverse abilities) in an impoverish community in San Juan (capital of Puerto Rico). In addition, we offered a variety of theatrical techniques and a school garden that allowed us to evaluate their clinical and school progress. Through therapy sessions the need to include their parents became important to improve the quality of life of the children and their families and to reinforce or increase their support network. The endeavor took place in one of the largest Public Housing Project in Puerto Rico, built in 1955, with a population of 12,000 inhabitants (unofficially the account of inhabitants is estimated around 25,000) (^{Puerto Rico Public Housing Administration, 2014}). Local school's social workers and/or teachers referred the children to our project.

ProSerEs was a project financed by the local Department of Education and the University of Puerto Rico (UPR, which is a public university, the most prestigious one in the island but with their own mark of political polarization). Both institutions have a history of administrative bureaucratic dynamics that not always facilitate the continuity of services needed, leading to serious consequences for the clinical and school's progress.

ProSerEs had a profound effect on our thought process and practices, especially because there are no sufficient studies about CSP and people with disabilities (diverse abilities) in Puerto Rico. Moreover, because of its focus on changing the social environment that substantially affects their lives instead of changing people with disabilities (^{McDonald et al., 2017}). In one hand, independence, rugged individualism, and belief in self-reliance are qualities that stand out in the US culture, at least for an external observer (^{Bryan, 2001}). On the other hand, dependency denotes lack of initiative, laziness, and a burden to society. In a colonial system, the US people, in general, see the Puerto Rican people as lazy, lack of initiative, and a burden to the US economy, basically the exact same words used, in a recent tweet, by former President Trump (September, 2017) just before his visit to Puerto Rico after the hurricanes Irma and Maria.

Context and Psychosocial Conditions

We found out the majority of children came from nontraditional families, from women as only responsible for their care, and with no presence or continuous absenteeism of men (to take care, as fathers, of their children development). Families were dependents economically of governmental assistance programs as well as a variety and complex health and mental health problems. In addition, the families reside in a Housing Project infrastructure designed to imprison their members with constant police vigilance and public areas ruled by illegal exchanges. But also, there are clear displays of solidarity and mutual support mixed with a strange feeling of internal neighborhood rivalry and a strong sense of community belonging.

As a result of the evaluation of the ProSerEs project, we found out that the 85% of the children experienced clinical progress and 52 % of the children experienced academic progress. However, two of the psychological challenges of the children were their inability to identify their emotions and any positive characteristics about themselves. On one hand, the psychosocial factors helping the clinical progress were: (1) uninterrupted therapies, (2) involvement of the parents, (3) school cooperation, (4) sensitive teachers about the children's disabilities, (5) regular case discussions between multidisciplinary therapists, and (6) good communication between therapists and school personnel. On the other hand, we identified psychosocial factors that worsen the children and youth's conditions and the clinical progress as: (1) no participation of parents in the therapies, (2) lack of disciplinary skills from the parents, (3) children constant therapies absenteeism, (4) change of therapist, (5) constant nonattendances to school by the teachers, and (6) the father missing in the life of the children (^{Vázquez- Rivera et al., 2015}).

To be coherent with the refortalecimiento approach we made a conscious effort to identify the fortalezas (strengths) of the children and focusing them throughout the project. Among the fortalezas (strengths) identified we can mention: (1) sense of independence, (2) perseverance, (3) cooperation, (4) leadership, (5) tolerance to finish the therapeutics tasks, (6) affections, (7) motivation, and (8) the management of their emotions. What caught our attention was the principal protective and non-protective psychosocial factors confirmed by the interviews and discussion groups. The principal protective factors for the clinical progress were the continuous presence of mother and father like persons at home and the continuity of therapeutic services. The principal non-protective factors were problems with reading and writing skills and the absence of the father like person at home.

Throughout ProSerEs, we experienced the transformative force of the people with disabilities (diverse abilities), including physical and mentally, from the children to the parents, from the parents to the community, from the community to the organizations (including ourselves), and from the organizations to the children as a continual spiral of forces, challenges, successes, setbacks, and struggles. The people with disabilities are seen by the general public as a burden to society, dependent, and as if they had fewer rights than the nondisabled. Nevertheless, the people with disabilities (diverse abilities) are one, and probably, the only group that through their will, forces, and fortalezas (strengths) can truly change our surroundings (architecture, streets, buildings, technologies, communications) to be included in a society that constantly exclude them as persons, citizens, and community members. In closed collaboration with the schools, community organizations, parents, and professionals we decided to implement and evaluate our Intervention - Investigation (I-I).

Framework: Community Social Psychology (CSP) and refortalecimiento

We can begin by saying that the construction of knowledge in the CSP is a conversation. But the important part to understand the CSP is its intent to comprehend the interrelation of people in their communities, the concern to enhance their quality of life taking into account the historic, cultural, and social context of communities. Also, promoting the social justice, equality, and diversity through participation, collaborative research, forging alliances, and community-based interventions, among others (^{Reich et al., 2007}).

We understand the csp as a way to create psychology (as a reflexive look on how the ecology of knowledge takes form) from a social perspective (surpassing the individual ideology for the person perspective) and community because the other five layers of "involvement" converge there and the web of relations that are co-forming us as people are established. CSP is a standpoint, a continuous way of being, contributing to the creation of social systems where we produce and transform knowledge, taking place in a world giving and co-creating conditions for transformation. This require a continue process of refortalecimiento where the discipline opens itself to a variety of methods to produce knowledge coming from diverse sources and focusing its attention in comprehending the web of relations in which we all are immerse (^{Vázquez-Rivera, 2016}).

The framework of our project was the refortalecimiento strategy where we re-evaluated key concepts related to the CSP to lead our work to achieve social justice for the children with disabilities and their families. In the late 90s, we proposed to re-think the concept of empowerment and its limitations as a notion to guide our discipline (^{Vázquez-Rivera, 2004}). The concept of empowerment was transplanted from the US Community Psychology (CP) to CSP in Puerto Rico, we usually translated it as empoderamiento or used it the original word in English. Meanwhile, colleagues from Latin America were also struggling with its translation naming it apotestamiento, po-tenciación, or fortalecimiento. They tried to adapt empowerment with the contributions of many Latin-Americans authors (Freire, Martin-Baró, Gutiérrez, Fals Borda, Dussel, among others) who were already influencing our point of views even before the discipline was named in our countries.

Refortalecimiento is a strategy for transformation and action that started with a debate with the empowerment theory and prevention models. Then it continued towards the necessary metamorphosis from a deficits and weaknesses paradigm to forces and fortalezas (strengths) paradigm (^{Vázquez-Rivera, 2015}). From the refortalecimiento point of view we see the person (not individuals; connected and socially constructed within the society itself) as webs of relations (as strong and fragile as the web itself). Some of the elements that are included in the refortalecimiento perspective are: (a) comprehending our sociocultural inheritance, (b) understanding power as a relation, (c) making emphasis in the fortalezas (strengths), abilities, resources, and skills of people and communities, (d) acknowledging reality as a social construction, (e) comprehending social history as a tool to re-connect the community with the persons social origins, (f) realizing that the person is a collective process in motion, a collage of experiences, (g) that people are active constructors of its own social realities, (h) work from an involvement (implicación) perspective, and (i) that we need to comprehend the social webs, to develop new knowledge and stimulating new relations (^{Vázquez-Rivera, 2015}). To implement this project, we chose an Intervention - Investigation method because of its flexibility and its interchangeable process of research and action.

Method: Intervention - Investigation

Intervention-Investigation is situated in the tradition of action research and Participatory Action Research. We understand intervention and investigation as a continuum. Every intervention has elements of a research, formal or informal, evaluation, literature review, questionnaires, and focus groups, among others techniques were used throughout the duration of the project. Research has the effects on intervention, formal or informal as: challenging established ways of thinking and provoking new questions among participants and researchers beyond the original goals, changes in attitudes, and reevaluating cultural practices. We started ProSerEs as an intervention, offering services, and then we raised the question of what practical and psychosocial elements are needed to create a support network for the parents and their children?

During the implementation of the project, we developed an assessment of the historical conditions of the community and invited the participants to document their own personal stories from a non-individual and a fortalezas (strengths) perspective. We invited the participants to be part of the coordination of the support network since the beginning. The main objective was to co-create the conditions to transform the injustice environments of the children with disabilities (diverse abilities) and their parents.

The procedure we followed with the participants was: (1) invited mothers and fathers to form a support network (to the first meeting 25 parents participated but only 10 to 12 parents continuously came to the meetings); (2) collaboratively developed a support network (the participants chose the dates and place of the meetings and established their roles and responsibilities); (3) the participants selected the objectives of the support network and identified their needs, resources, abilities, and fortalezas (strengths); (4) systematically documented all the information about the living conditions of the children and their parents, the socioeconomics conditions of the community, and the practice of raising and disciplining the children; (5) started the planning of the activities; and (6) as a group implemented the plan and continuously evaluated the developed strategies.

We carried out two (2) discussion groups and ten (10) qualitative interviews with the parents and developed two major activities with the children: (1) an interdisciplinary evaluation of the children completing a variety of tasks related with a school garden, and (2) the painting of two (2) drawings, one representing a violence situation related to children with disabilities and the other a solution. A total of 22 drawings were evaluated and exhibited to the community at the Museum of Contemporary Arts in San Juan. The exhibition was called: The world through the eyes of special children.

Recruitment and Informed Consent

The initial invitation to mothers and fathers to participate in the creation of a support network was through the therapist. Initially the therapists talked and motivated the parents to form part of the group, sharing the benefits for them and their children. The next step was to coordinate and set a meeting in the community between the parents and the facilitators to organize the details. During the meeting the facilitators offered all the information regarding their participation, answered their questions and the positive impact we expected for the children therapy and for the parents' mental health. We discussed in detail the Informed Consent, objectives, and goal of the support network, that their participation was completely voluntary, that they could leave the group at any time without any consequences for them or their children, and that the whole process would be confidential. At the end of the meeting the parents whose confirmed their interest in participating signed the Inform Consent.

The I-I, as in the Participatory Action Research, means a continuous dialogue between the people involved in the whole process. When we talk about the results of the research and intervention, three concepts stand up among the others: the ideas, believes, and conceptualization between the parents, therapist, and researchers of the intervention, prevention, and empowerment. As a result, the notion of refortalecimiento was counterpointed in its conceptualization and practice with the concept of intervention (present in the discourses and expectations of the parents), the prevention model (present in the discourses and practices of the therapists), and empowerment theory (present in the background formation and past practices of the researchers). The reflections about the three concepts and the evaluation of the refortalecimiento strategy will be the core analysis in the discussion section of this article.

Discussion: Beyond Intervention, Prevention and Empowerment

The prevention model and the empowerment theory shared the idea of intervention as its specific form of action. Interventions, in many ways, are related to interfere, come between, or to hinder actions by creating artificial scenarios to interrupt the social and/or cultural course of actions. By artificial scenario we meant that the intervention imposes new conditions in the way the people relate with themselves, and others relying in two dominant concepts: individual and problem. The idea of individual (indivisium in se) as undivided by itself and (divisum a quolibet alio) separated from everything else and introduces him/herself as self-sufficient with no link to anyone or anything else (^{Guareschi, 2008}); and the idea of problem with its tendency to overload and magnify our interpretation of life events provoking us a paralyzing effect that inhibit our actions (^{Vázquez-Rivera, Escabi, Quinones & Pacheco, 2012}).

^{Gergen (2007)} pointed out one of the problems with the concept of empowerment, is its "self-contain individualism" which is part of the characteristic to decentralize the person moral and social context and making the assumption that control resides more in the individual than in their relations. In addition, the use of the idea of intervention has become polemic because of its relation with the classic notion of power, with a unilateral action and a predominant role of the professionals (^{Moreno, 2008}; ^{González-Rey, 2014}). Through our experience in ProSerEs we became more and more aware about the need of changing the intervention approach; instead, we joined other colleagues in the use of an "involvement" (implicación) approach, because it highlights to connection, to immersion, to commitment. Also, "involvement" intends to rethink the idea of the subject-object separation, the expert, facilitator, collaborator, and agent role as an external one. "Involvement" was one of the challenges that the children and their parents had, not an intervention, because they were tired of interventions. Professionals and agencies with a predetermined agenda who are looking to deliver their solutions to the community in the shape of better practices or evidence-based programs. Actually, if we really conceptualize our work from an ecological point of view there should not be an external role or position, looking for evidence-based interventions without context in the same spirit of the prevention model.

Prevention Model

The concept of prevention has been criticized in different disciplines, principally because its "vagueness is largely dysfunctional". As a matter of fact, if someone rethinks the concept, he/she should conclude, strictu sensus, that there is no such thing as prevention in the sense that it does not prevent the manifestation of an illness, or problem, but to avoid other individuals to be affected. Immediately the general health system structure put in motion the whole apparatus of intervention techniques built in to reduce the further development of one particular illness or problem. That's why the principal venue to evaluate a prevention program is basically if it is capable to reduce problems no matter the context where the problem emerged. Following that logic, it makes sense to talk about best practices or evidence-based interventions, or programs, because they do not need to know the context where those practices are implemented. Allowing us to see how one of the principles of the positivist paradigm reveals itself: the existence of natural laws that we need to discover which existence is ahistorical and its scope is universal (^{Lincoln et al., 2011}).

As indicated before, the prevention model does not prevent (avoid in the population sense) but reduce in the individual sense. We should not be surprised when professionals talk about risk groups, in part, because their belief that individuals (despite their idea to be "unique") has the tendency to "look alike" (in the behavioral and/or socio-demographic sense). The prevention model is designed on an individualistic logic, with practically no regard to the context where people live and interact, that's not supposed to be the case in an ecological perspective, as the empowerment theory argued to position its interventions. But theorists and researchers recognized that even from the empowerment point of view, a great extent of studies have been at the individual level (^{Keys et al., 2017}). The dark side of the prevention model is its interest in marketing solutions (in the form of medicine, treatment, or interventions) once the illness or problems already exist.

The prevention model is built under the domain of a positivist paradigm, basically because from the beginning was constructed under the belief that we can predict what was coming next, in other words, is embedded in the principle of causality (cause and effect). Coherent with that principle is the prevention model that does not need to know any social, economic, political, or environmental circumstances to operate, because as part of a positivist paradigm, we need to isolate variables (dependent and independent) to guarantee a proper causality conclusion. In real life (meaning groups, communities, organizations, society in general) we all know very well that the isolation of kind of variables is not only unreasonable but also impossible. The ironic part is the strong acceptance in the capability of the prevention model to predict the necessary elements, or steps, to stop the problem before it happens in any new individuals (primary prevention), or target individuals who fit an specific groups that are at risk for developing a problem (secondary prevention), or contain complications in individuals as a result of an existing problem (tertiary prevention) or actions taken to identify individuals at high risk of over-medicalization (quaternary prevention). But also, we need to remember that the concept of prevention had a very long history along with the idea of illness (^{Starfield et al., 2008}; ^{Hage & Romano, 2010}).

The prevention model is so deep-rooted that it has been requested by APA'S Society for Community Research and Action members for a greater focus on prevention as an area of scholarship and practice within psychology because prevention is inextricably woven into the field of Community Psychology in the US and continue to be a prominent area of emphasis (^{Hage & Romano 2010}; ^{DuBois, 2017}). The prevention model is defined as universal (appropriate for everyone), selective (for individuals at risk), and indicated (for individual at high risk) "to inoculate individuals against future difficulties and problems", but also has been added a dimension for health promotion and institutional change strategies, advocate for legislation and public policies (^{Romano & Hage, 2000}). The scope of the concept of prevention has changed over time; in the 60s was basically defined as averting the development of a pathological state; in the 70s was introduced the distinctions between types of prevention and expanded to include the promotion of health; and in the 90s the terminology of risk factors was introduced; according to that history we should not be surprised that prevention turned out to be pronounced as an exemplar of empowerment (^{Rappaport, 1987}; ^{Starfield et al., 2008}).

Empowerment Mania

One of the legacies of the miscarriage marriage between empowerment and prevention is considering prevention as an exemplar of empowerment, even when ^{Rappaport (1981)} was clear since the very beginning of the path we needed to follow: a "[...] call to arms and that it replaced prevention as our aim because the connotations, the meta-meanings, and the implications are different" (p. 16). But, for whatever reasons, he declared, a few years later, prevention as an exemplar of empowerment, although he "remain convinced that much of what is termed prevention suffers from the maladies [he] suggested several years ago" (^{Rappaport, 1987}: 128). We believe that we are not fully aware of the profound "maladies" of that miscarriage marriage: emphasizing on the individual, analysis based on problems, deficit model approach, frame in a biomedical ideal, and so on (many of these aspects may not be presented as part of the discourses to whom conceptualize the empowerment interventions but operate as a background in the designs, practices and even theorizations of more projects than we want to recognize). At the end, you can almost say that the empowerment prevention (if there is such thing), as a more popular concept, had increased the difficulties to distinguished empowerment from the prevention model. One of the results for the empowerment is its continuous "loss of power".

The empowerment theory, in practice, followed a similar path of the prevention model, looking to attend the problems in an individualistic way instead of a truly ecological one. Even though, as part of the discourse of empowerment theory clearly introduced it as centered on an ecological model, but it usually defined by placing individuals in a systems-within-systems model and/or like human's behavior influenced by context (^{Prilleltensky & Nelson, 1997}, 2002; ^{Nafstad et al., 2009}). Conceptualizing the ecological model from an anthropocentric point of view and discussing the context as a variable to be measured. It seems to us like ^{Riger (2017}: 134) stated, "although community psychologists espouse the ecological model, they may not follow it in practice". Empowerment has been criticized as overly individualistic and conflict oriented resulting in an emphasis on mastery and control rather than cooperation and community (^{Speer, 2000}; ^{Hur, 2006}). Some authors have tried to answer this critic distinguishing the individual from the psychological empowerment (^{Zimmerman, 1990}) but, in the long run, the tradition of the psychological, as a concept, hardly separates both: individual from the psychological. In fact, in relation to other disciplines, psychology represents, precisely, the one called to study the individual within the whole spectrum of the Social Sciences.

One of the biggest assumptions of the empowerment theory is to think that we can empower others and by default we -facilitators, collaborators or experts- are empowered and/or cannot be empowered. ^{Christens (2012)} synthetized the psychological empowerment conceptual model as a latent construct with emotional, cognitive, behavioral, and relational components. Regarding the relational component he mentioned five elements linked to that component: collaborative competence, bridging social divisions, facilitating others' empowerment, mobilizing network, and passing on legacy. From the analysis presented by this author about the facilitating others' empowerment, we can identify more difficulties than possibilities: (a) "is not always possible for one person to empower another" (^{Gruber & Trickett, 1987}), (b) talk about "mutual empowerment" (^{Pigg, 2002}) implying a contradiction: a disempowe-red person can empower others, (c) mentioned "organic leadership" learning to support others' growth through listening and thoughtful questioning" (^{Preskill & Brookfield, 2009}) presented leadership as a condition to be empowered, and (d) "those who are more empowered" (^{Turró & Krause, 2009}) meaning there are levels or a way to quantify empowerment. ^{Gruber & Trickett (1987}; 353) clearly concluded, a long time ago, that "there is a fundamental paradox in the idea of people empowering others because the very institutional structure that puts one group in a position to empower also works to undermine the act of empowerment".

In addition, ^{Christens (2013)} shared the following question "has the term empowerment in fact been so abused and co-opted that needs to be discarded in favor of a new term? In my opinion is not only a question of terminology, instead of 'ideology'" or theory, because the term embodies the actions we take guided by the theory or "ideology" linked to the term. Other authors pointed out a central aspect that hunted the empowerment theory about the issue that individual empowerment does not consider or challenge the social determinants of people's health and does not constitute full empowerment in the sense of transforming the relations of power (^{Wallerstein, 2006}; ^{Woodall et al., 2012}).

Furthermore, close concepts to empowerment, as self-efficacy, agency, confidence, self-esteem, capacity, and/or mastery becoming close and interrelated to an intra-psychic experience (where the context plays some role, however, not a central one) but at the end is presented as an individual process. As ^{Woodall et al. (2012}: 743) said, "in reality, empowerment simply, at the individual level, does little to influence social change". Social change is the key concept to which we suppose to move toward to address social inequalities and discrimination. But what is social change anyway?

The realities, needs, resources, abilities, and fortalezas (strengths) of each country have put to the test methods, theories, approaches, and experiences that deal with the challenges that each context offers. We all speak of participation, research, analysis, methods, and social change, but our approach is not always very clear as to what we want to say and in what direction we want to go. Some countries seem to be satisfied with their institutions and governments, and social change means specific adjustments to the laws, improvement of organizations and services to citizens, particular modifications to health and mental health systems, economic development, and attention to vulnerable populations. Other countries seem to be completely dissatisfied with their institutions and governments, and social change means reorganizing the structure of government, reshaping institutions, reimagining relations between people and organizations, and giving economic systems a profound transformation (^{Vázquez-Rivera, 2009}).

Increasingly, many authors strongly doubt that empowerment can lead us to the social change we are looking for, as ^{Staples (1990}: 36) stated, individual empowerment is not now, and never will be, the salvation of powerless groups. To attain social equality, power relations [...] must be transformed. This requires a change in the structure of power. However, the concept of empowerment is still unsteady by a lack of precision surrounding its relationship to power. Although there is confusion regarding, precisely, what this connection looks like and we lack an integrative theory that explains the role of power in the process of empowerment (^{Prilleltensky, 2008}; ^{Neal & Neal, 2010}).

Finally, when we talk about power, we usually understand it as a possession, a place and/or a capacity but not as a relationship. In practice, an empowerment theory is not the exemption, the conceptualization of power as a possession/place/ capacity is predominant even for those who claimed to understand it as a relationship. When we used expressions like "equalization of power", "power deficit", "distribution of power", "power structure", "balance of power", "proliferation of powerlessness", "increased power", "access to power", "position of power", "power sharing", among others, only reproduces the traditional use of the concept of power (^{Vázquez-Rivera et al., 2012}). The entire idea behind the traditional conceptualization of power inherited by the empowerment theory is that we can empower others by something like a transfer of power to one person or group to another. Under this contextual, theoretical and practical circumstances refortalecimiento emerged as a strategy to rearticulate our thoughts and actions facing the challenges experienced by the children with disabilities and their families