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Platt R, Polk S, Barrera AZ, Lara-Cinisomo S, Hirschhorn LR, Graham AK, Musci RJ, Hamil J, Echavarria D, Cooper L, Tandon SD. Mothers and Babies Virtual Group (MBVG) for perinatal Latina women: study protocol for a hybrid type-1 effectiveness-implementation randomized controlled trial. Trials 2024; 25:606. [PMID: 39261967 PMCID: PMC11391742 DOI: 10.1186/s13063-024-08423-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 08/23/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Immigrant Latinas (who are foreign-born but now reside in the USA) are at greater risk for developing postpartum depression than the general perinatal population, but many face barriers to treatment. To address these barriers, we adapted the Mothers and Babies Course-an evidence-based intervention for postpartum depression prevention-to a virtual group format. Additional adaptations are inclusion of tailored supplemental child health content and nutrition benefit assistance. We are partnering with Early Learning Centers (ELC) across the state of Maryland to deliver and test the adapted intervention. METHODS The design is a Hybrid Type I Effectiveness-Implementation Trial. A total of 300 participants will be individually randomized to immediate (N = 150) versus delayed (N = 150) receipt of the intervention, Mothers and Babies Virtual Group (MB-VG). The intervention will be delivered by trained Early Learning Center staff. The primary outcomes are depressive symptoms (measured via the Center for Epidemiologic Studies-Depression Scale), parenting self-efficacy (measured via the Parental Cognition and Conduct Towards the Infant Scale (PACOTIS) Parenting Self-Efficacy subscale), and parenting responsiveness (measured via the Maternal Infant Responsiveness Instrument) at 1-week, 3-month, and 6-month post-intervention. Depressive episodes (Structured Clinical Interview for DSM-V- Disorders Research Version) at 3-month and 6-month post-intervention will also be assessed. Secondary outcomes include social support, mood management, anxiety symptoms, perceived stress, food insecurity, and mental health stigma at 1-week, 3-month, and 6-month post-intervention. Exploratory child outcomes are dysregulation and school readiness at 6-month post-intervention. Intervention fidelity, feasibility, acceptability, and appropriateness will also be assessed guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. DISCUSSION This study will be one of the first to test the efficacy of a group-based virtual perinatal depression intervention with Latina immigrants, for whom stark disparities exist in access to health services. The hybrid effectiveness-implementation design will allow rigorous examination of barriers and facilitators to delivery of the intervention package (including supplemental components) which will provide important information on factors influencing intervention effectiveness and the scalability of intervention components in Early Learning Centers and other child-serving settings. REGISTRATION ClinicalTrials.gov NCT05873569.
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Affiliation(s)
- Rheanna Platt
- Department of Psychiatry and Behavioral Sciences & Division of Child and Adolescent Psychiatry, Johns Hopkins University/Johns Hopkins Bayview Medical Center, 5500 East Lombard St, Baltimore, MD, 21224, USA.
| | - Sarah Polk
- Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA
- Centro SOL, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA
| | - Alinne Z Barrera
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94304, USA
| | | | - Lisa R Hirschhorn
- Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Andrea K Graham
- Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Rashelle J Musci
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Jaime Hamil
- Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Diane Echavarria
- Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA
| | - Lindsay Cooper
- Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA
| | - S Darius Tandon
- Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
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Yamaoka Y, Ochi M, Fukui M, Isumi A, Doi S, Fujiwara T, Nawa N. Home visitors' needs and perceptions of the benefits of a home visiting program for childcare support in Japan: A qualitative study of home visitors. CHILD ABUSE & NEGLECT 2024; 153:106853. [PMID: 38749149 DOI: 10.1016/j.chiabu.2024.106853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 03/28/2024] [Accepted: 05/08/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND The Home Visiting Program for Childcare Support (HV-CCS; "Yoiku Shien Homon Jigyo" in Japanese) has targeted families in need of parenting support and those at risk of child maltreatment in Japan. OBJECTIVE The aim of this study was to explore the needs and perceptions of benefits of home visitors in HV-CCS. PARTICIPANTS AND SETTING Sixteen home visitors agreed to participate in the interview. METHODS This study conducted 1-hour semi-structured interviews with 16 home visitors and analyzed approximately 18 h of interview data using thematic analysis. RESULTS The findings suggested that home visitors required training to enhance individual skills and knowledge about mental health of caregivers or children. Additionally, they required environmental support, particularly for transportation expenses and parking places. Multidisciplinary communicative support is also necessary, as well as system to improve the process of support. Home visitor perceived the HV-CCS as beneficial in preventing child maltreatment by improving parenting skills and home environment, providing psychological support for mothers, and entering families' intimate spaces. CONCLUSIONS To ensure the continuity and improvement of home visits for parents and children in Japan, it is essential to address the identified needs of home visitors.
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Affiliation(s)
- Yui Yamaoka
- Department of Global Health Promotion, Tokyo Medical and Dental University, Japan; Research Institute for Children's Social Care, Waseda University, Japan.
| | - Manami Ochi
- Department of Health Policy, National Center for Child Health and Development, Japan
| | - Mitsuru Fukui
- Family Welfare Section, Fukuoka City Child Affairs Bureau, Japan; Research Institute for Children's Social Care, Waseda University, Japan
| | - Aya Isumi
- Department of Health Policy, Tokyo Medical and Dental University, Japan
| | - Satomi Doi
- Department of Health Policy, Tokyo Medical and Dental University, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Japan
| | - Nobutoshi Nawa
- Department of Global Health Promotion, Tokyo Medical and Dental University, Japan
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Albanese AM, Geller PA, Steinkamp JM, Elwy AR, Frank HE, Barkin JL. The education of experience: Mixed methods evidence demonstrates the benefit of multiparity. Midwifery 2024; 134:104015. [PMID: 38688050 PMCID: PMC11423283 DOI: 10.1016/j.midw.2024.104015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 03/29/2024] [Accepted: 04/22/2024] [Indexed: 05/02/2024]
Abstract
PROBLEM Existing quantitative data is conflicting concerning whether multiparous birthing parents (individuals with an older child(ren)) experience an easier postpartum transition compared to primiparous birthing parents (first time parents). AIM This convergent mixed methods study leverages the depth of qualitative inquiry to seek a clearer understanding of the way in which acquired parenting experience contributes to observed quantitative differences in outcomes between parity groups. This work can serve as a first step in planning for supportive interventions that effectively address the postpartum needs of both parity groups. METHODS Thirty birthing parents (43.3% multiparous; 46.7% racial minorities) completed measures of postpartum functioning, perceived stress, anxiety symptoms, and depression symptoms as well as an interview inquiring about factors impacting postpartum functioning. Scores on postpartum functioning and emotional wellbeing were compared between parity groups, and these findings were merged with the qualitative data on firsthand parenting experience to clarify how acquired experience impacts functioning and emotional wellbeing during the postpartum transition. FINDINGS Primiparous parents reported significantly: worse postpartum functioning, higher perceived stress, higher levels of depression symptoms, and higher levels of anxiety symptoms. Participants' qualitative report of how acquired parenting experience impacts wellbeing suggests that experience grants parents skills, knowledge, and the opportunity to disconfirm maladaptive cognitions about parenting which allows for increased comfort and confidence in the parental role. CONCLUSIONS The practical and psychological resources gained from acquiring parenting experience during one's first postpartum period appear to be brought forward into subsequent pregnancies and protect against threats to functioning and emotional wellbeing.
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Affiliation(s)
- Ariana M Albanese
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Pamela A Geller
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA 19104, USA
| | | | - A Rani Elwy
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Hannah E Frank
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jennifer L Barkin
- Department of Community Medicine, Mercer University School of Medicine, Macon, GA 31207, USA
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Zhang Y, Larson M, Ehrhart MG, King K, Locke J, Cook CR, Lyon AR. Inter-organizational alignment and implementation outcomes in integrated mental healthcare for children and adolescents: a cross-sectional observational study. Implement Sci 2024; 19:36. [PMID: 38802827 PMCID: PMC11129427 DOI: 10.1186/s13012-024-01364-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/01/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Integrated care involves care provided by a team of professionals, often in non-traditional settings. A common example worldwide is integrated school-based mental health (SBMH), which involves externally employed clinicians providing care at schools. Integrated mental healthcare can improve the accessibility and efficiency of evidence-based practices (EBPs) for vulnerable populations suffering from fragmented traditional care. However, integration can complicate EBP implementation due to overlapping organizational contexts, diminishing the public health impact. Emerging literature suggests that EBP implementation may benefit from the similarities in the implementation context factors between the different organizations in integrated care, which we termed inter-organizational alignment (IOA). This study quantitatively explored whether and how IOA in general and implementation context factors are associated with implementation outcomes in integrated SBMH. METHODS SBMH clinicians from community-based organizations (CBOs; nclinician = 27) and their proximal student-support school staff (nschool = 99) rated their schools and CBOs (clinician only) regarding general (organizational culture and molar climate) and implementation context factors (Implementation Climate and Leadership), and nine common implementation outcomes (e.g., treatment integrity, service access, acceptability). The levels of IOA were estimated by intra-class correlations (ICCs). We fitted multilevel models to estimate the standalone effects of context factors from CBOs and schools on implementation outcomes. We also estimated the 2-way interaction effects between CBO and school context factors (i.e., between-setting interdependence) on implementation outcomes. RESULTS The IOA in general context factors exceeded those of implementation context factors. The standalone effects of implementation context factors on most implementation outcomes were larger than those of general context factors. Similarly, implementation context factors between CBOs and schools showed larger 2-way interaction effects on implementation outcomes than general context factors. CONCLUSIONS This study preliminarily supported the importance of IOA in context factors for integrated SBMH. The findings shed light on how IOA in implementation and general context factors may be differentially associated with implementation outcomes across a broad array of integrated mental healthcare settings.
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Affiliation(s)
- Yanchen Zhang
- College of Education, University of Iowa, 240 S Madison St, Iowa City, IA, 52242, USA.
| | - Madeline Larson
- Center for Applied Research and Educational Improvement, University of Minnesota, Minneapolis, USA
| | - Mark G Ehrhart
- Department of Psychology, University of Central Florida, Orlando, USA
| | - Kevin King
- Department of Psychology, University of Washington, Seattle, USA
| | - Jill Locke
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, USA
| | - Clayton R Cook
- Department of Educational Psychology, University of Minnesota, Minneapolis, USA
| | - Aaron R Lyon
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, USA
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Williams EC, Frost MC, Danner AN, Lott AMK, Achtmeyer CE, Hood CL, Malte CA, Saxon AJ, Hawkins EJ. "The Only Reason I Am Willing to Do It at All": Evaluation of VA's SUpporting Primary care Providers in Opioid Risk reduction and Treatment (SUPPORT) Center. J Addict Med 2024; 18:248-255. [PMID: 38385548 DOI: 10.1097/adm.0000000000001277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
OBJECTIVES Medication treatment for opioid use disorder (MOUD) is effective and recommended for outpatient settings. We implemented and evaluated the SUpporting Primary care Providers in Opioid Risk reduction and Treatment (SUPPORT) Center-a quality improvement partnership to implement stepped care for MOUD in 2 Veterans Health Administration (VA) primary care (PC) clinics. METHODS SUPPORT provided a dedicated clinical team (nurse practitioner prescriber and social worker) and stepped care ([1] identification, assessment, referral; [2] MOUD induction; [3] stabilization; and [4] maintenance supporting PC providers [PCPs] to initiate and/or sustain treatment) coupled with ongoing internal facilitation (consultation, trainings, informatics support). Qualitative interviews with stakeholders (PCPs and patients) and meeting notes identified barriers and facilitators to implementation. Electronic health record and patient tracking data measured reach, adoption, and implementation outcomes descriptively. RESULTS SUPPORT's implementation barriers included the need for an X-waiver, VA's opioid tapering policies, patient and PCP knowledge gaps and PCP discomfort, and logistical compatibility and sustainability challenges for clinics. SUPPORT's dedicated clinical staff, ongoing internal facilitation, and high patient and PCP satisfaction were key facilitators. SUPPORT (January 2019 to September 2021) trained 218 providers; 63 received X-waivers, and 23 provided MOUD (10.5% of those trained). SUPPORT provided care to 167 patients, initiated MOUD for 33, and provided education and naloxone to 72 (all = 0 in year before launch). CONCLUSIONS SUPPORT reached many PCPs and patients and resulted in small increases in MOUD prescribing and high levels of stakeholder satisfaction. Dedicated clinical staff was key to observed successes. Although resource-intensive, SUPPORT offers a potential model for outpatient MOUD provision.
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Affiliation(s)
- Emily C Williams
- From the Health Services Research & Development (HSR&D), Seattle Center of Innovation for Veteran-centered and Value-driven Care, Veterans Affairs (VA), Puget Sound Healthcare System, Seattle, WA (ECW, MCF, AND, AMKL, CAM, EJH); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA (ECW, MCF); Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, WA (AND, AMKL, CEA, CLH, CAM, AJS, EJH); and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA (AJS, EJH)
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Dickson KS, Holt T, Arredondo EM. Enhancing Behavioral Health Implementation in a Care Coordination Program at a Federally Qualified Health Center: A Case Study Applying Implementation Frameworks. Health Promot Pract 2024:15248399241237958. [PMID: 38504420 DOI: 10.1177/15248399241237958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Federally Qualified Health Centers are charged with providing comprehensive health care in traditionally underserved areas, underscoring their importance in caring for and promoting health equity for the large portion of historically marginalized communities in this setting. There is a significant need to ensure Federally Qualified Health Centers are equipped to appropriately address the immense behavioral health needs common among patients served. Care coordination is an evidence-based model that is increasingly utilized in Federally Qualified Health Centers to improve care equity and outcomes. Addressing and supporting behavioral health needs is a key aspect of such care coordination models. Context-specific considerations and programmatic supports, particularly those that address the needs of care coordinators and the complex patients they serve, are needed to ensure such models can appropriately meet and address the behavioral health concerns of the diverse populations served. The goal of this study was to present a mixed-methods case study that systematically applies implementation frameworks to conduct a needs and context assessment to inform the development and testing of evidence-based practice strategies and implementation support as part of a care coordination program within a partnered Federally Qualified Health Center.
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Affiliation(s)
- Kelsey S Dickson
- San Diego State University, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Tana Holt
- San Diego State University, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
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Olakunde BO, Itanyi IU, Olawepo JO, Liu L, Bembir C, Idemili-Aronu N, Lasebikan NN, Onyeka TC, Dim CC, Chigbu CO, Ezeanolue EE, Aarons GA. Comparative effectiveness of implementation strategies for Accelerating Cervical Cancer Elimination through the integration of Screen-and-treat Services (ACCESS study): protocol for a cluster randomized hybrid type III trial in Nigeria. Implement Sci 2024; 19:25. [PMID: 38468266 PMCID: PMC10926605 DOI: 10.1186/s13012-024-01349-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/03/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Despite the increased risk of cervical cancer (CC) among women living with HIV (WLHIV), CC screening and treatment (CCST) rates remain low in Africa. The integration of CCST services into established HIV programs in Africa can improve CC prevention and control. However, the paucity of evidence on effective implementation strategies (IS) has limited the success of integration in many countries. In this study, we seek to identify effective IS to enhance the integration of CCST services into existing HIV programs in Nigeria. METHODS Our proposed study has formative and experimental activities across the four phases of the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Through an implementation mapping conducted with stakeholders in the exploration phase, we identified a core package of IS (Core) and an enhanced package of IS (Core+) mostly selected from the Expert Recommendations for Implementing Change. In the preparation phase, we refined and tailored the Core and Core+ IS with the implementation resource teams for local appropriateness. In the implementation phase, we will conduct a cluster-randomized hybrid type III trial to assess the comparative effectiveness of Core versus Core+. HIV comprehensive treatment sites (k = 12) will be matched by region and randomized to Core or Core+ in the ratio of 1:1 stratified by region. In the sustainment phase, we will assess the sustainment of CCST at each site. The study outcomes will be assessed using RE-AIM: reach (screening rate), adoption (uptake of IS by study sites), IS fidelity (degree to which the IS occurred according to protocol), clinical intervention fidelity (delivery of CC screening, onsite treatment, and referral according to protocol), clinical effectiveness (posttreatment screen negative), and sustainment (continued integrated CCST service delivery). Additionally, we will descriptively explore potential mechanisms, including organizational readiness, implementation climate, CCST self-efficacy, and implementation intentions. DISCUSSION The assessment of IS to increase CCST rates is consistent with the global plan of eliminating CC as a public health threat by 2030. Our study will identify a set of evidence-based IS for low-income settings to integrate evidence-based CCST interventions into routine HIV care in order to improve the health and life expectancy of WLHIV. TRIAL REGISTRATION Prospectively registered on November 7, 2023, at ClinicalTrials.gov no. NCT06128304. https://classic. CLINICALTRIALS gov/ct2/show/study/NCT06128304.
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Affiliation(s)
- Babayemi O Olakunde
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Ijeoma U Itanyi
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Community Medicine, College of Medicine, University of Nigeria Nsukka, Enugu, Nigeria
| | - John O Olawepo
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Health Sciences, Northeastern University, Boston, MA, USA
| | - Lin Liu
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Chinenye Bembir
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Ngozi Idemili-Aronu
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Sociology and Anthropology, University of Nigeria Nsukka, Enugu, Nigeria
| | - Nwamaka N Lasebikan
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Oncology Center, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Tonia C Onyeka
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Anaesthesia/Pain & Palliative Care Unit, College of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Cyril C Dim
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Obstetrics and Gynecology, College of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Chibuike O Chigbu
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Obstetrics and Gynecology, College of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Echezona E Ezeanolue
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- HealthySunrise Foundation, Las Vegas, NV, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093-0812, USA.
- UC San Diego ACTRI Dissemination and Implementation Science Center, La Jolla, CA, USA.
- Moores Cancer Center, University of California San Diego, La Jolla, CA, 92093, USA.
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Lane G, Xinico S, Monroy-Valle M, Cordón-Arrivillaga K, Vatanparast H. Intergenerational Food Insecurity, Underlying Factors, and Opportunities for Intervention in Momostenango, Guatemala. Nutrients 2024; 16:470. [PMID: 38398796 PMCID: PMC10892790 DOI: 10.3390/nu16040470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/13/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
Achieving sustainable food security in Guatemala, where nearly half the population is food insecure and 50% of children face chronic malnutrition, is challenging. This mixed-methods study aimed to identify the impacts of climate change on food production, community food security, and household food security. Twelve agricultural group leaders in six communities were interviewed using semi-structured guides. Key informant interview themes included subsistence agriculture, commercial production, challenges related to climate, capital, market, and capacity, as well as sustainable opportunities. Fifty-five mothers from 13 distinct communities around Momostenango were surveyed and interviewed. A significant finding is that 85% of households were food insecure, with 93% relying on agriculture. Food-secure families mostly worked on their own or leased land, whereas food-insecure ones combined farming with day labor. In times of food scarcity, strategies such as altering food consumption and reducing expenses were common. Severely food-insecure families were significantly more likely to reduce portion sizes (72%), whereas food-secure families typically resorted to less preferred foods. Overall, food insecurity was notably linked to larger families, older mothers with limited education, and reliance on agricultural day labor. Food insecurity is a long-term issue in rural areas, deeply rooted in structural socioeconomic constraints, and recurring across generations.
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Affiliation(s)
- Ginny Lane
- Margaret Ritchie School of Family and Consumer Sciences, University of Idaho, Moscow, ID 83843, USA
| | - Silvia Xinico
- Alianza Nacional de Organizaciones de Mujeres Indigenas por la Salud Reproductiva Nutrición y Educación (ALIANMISAR), Guatemala City 04001, Guatemala
| | - Michele Monroy-Valle
- School of Public Health, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada
| | - Karla Cordón-Arrivillaga
- Unidad de Investigación en Seguridad Alimentaria y Nutricional (UNISAN), Escuela de Nutrición, Facultad de Ciencias Químicas y Farmacia, Universidad de San Carlos de Guatemala, Guatemala City 01051, Guatemala
| | - Hassan Vatanparast
- School of Public Health, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
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Buccini G, Gubert MB, de Araújo Palmeira P, Godoi L, Dal’Ava dos Santos L, Esteves G, Venancio SI, Pérez-Escamilla R. Scaling up a home-visiting program for child development in Brazil: a comparative case studies analysis. LANCET REGIONAL HEALTH. AMERICAS 2024; 29:100665. [PMID: 38235370 PMCID: PMC10793162 DOI: 10.1016/j.lana.2023.100665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/19/2024]
Abstract
Background In 2016, Brazil scaled up the Criança Feliz Program (PCF, from the acronym in Portuguese), making it one of the largest Early Childhood Development (ECD) programs worldwide. However, the PCF has not been able to achieve its intended impact. We aimed to identify barriers and facilitators to achieving the PCF implementation outcomes across the RE-AIM dimensions (Reach, Effectiveness or Efficacy, Adoption, Implementation and Maintenance) during the COVID-19 pandemic. Methods This comparative case study analysis selected five contrasting municipalities based on population size, region of the country, implementation model, and length of time implementing the PCF. We conducted 244 interviews with PCF municipal team (municipal managers, supervisors, home visitors), families, and cross-sectoral professionals. A rapid qualitative analysis was used to identify themes across RE-AIM dimensions. Findings Families' limited knowledge and trust in PCF goals were a barrier to its reach. While the perceived benefit of PCF on parenting skills and ECD enabled reach, the lack of referral protocols to address social needs, such as connecting food-insecure families to food resources, undermined effectiveness. Questions about whether the social assistance sector should be in charge of PCF challenged its adoption. Implementation barriers exacerbated by the COVID-19 pandemic included low salaries, temporary contracts, high turnover, infrequent supervision, lack of an effective monitoring system, and nonexistence or non-functioning multisectoral committees. The absence of institutionalized funding was a challenge for sustainability. Interpretation Complex intertwined system-level barriers may explain the unsuccessful implementation of PCF. These barriers must be addressed for Brazil to benefit from the enormous reach of the PCF and the evidence-based nurturing care principles it is based upon. Funding NIH/NICHD.
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Affiliation(s)
- Gabriela Buccini
- Department of Social and Behavioral Health, University of Nevada Las Vegas, School of Public Health, Las Vegas, NV, United States
| | - Muriel Bauermann Gubert
- Department of Social and Behavioral Health, University of Nevada Las Vegas, School of Public Health, Las Vegas, NV, United States
- Department of Nutrition, University of Brasilia, Brasilia, DF, Brazil
| | | | - Lídia Godoi
- University of São Paulo, Graduate Program in Public Health, São Paulo, Brazil
| | | | - Georgiana Esteves
- Department of Social and Behavioral Health, University of Nevada Las Vegas, School of Public Health, Las Vegas, NV, United States
| | | | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale University, School of Public Health, New Haven, CT, United States
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Masiello I, Fixsen DL, Nordmark S, Mohseni Z(A, Holmberg K, Rack J, Davidsson M, Andersson-Gidlund T, Augustsson H. Digital transformation in schools of two southern regions of Sweden through implementation-informed approach: A mixed-methods study protocol. PLoS One 2023; 18:e0296000. [PMID: 38113198 PMCID: PMC10729980 DOI: 10.1371/journal.pone.0296000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND The enhancement of-or even a shift from-traditional teaching and learning processes to corresponding digital practices has been rapidly occurring during the last two decades. The evidence of this ongoing change is still modest or even weak. However, the adaptation of implementation science in educational settings, a research approach which arose in the healthcare field, offers promising results for systematic and sustained improvements in schools. The aim of this study is to understand how the systematic professional development of teachers and schools principals (the intervention) to use digital learning materials and learning analytics dashboards (the innovations) could allow for innovative and lasting impacts in terms of a sustained implementation strategy, improved teaching practices and student outcomes, as well as evidence-based design of digital learning material and learning analytics dashboards. METHODS This longitudinal study uses a quasi-experimental cluster design with schools as the unit. The researchers will enroll gradually 145 experimental schools in the study. In the experimental schools the research team will form a School Team, consisting of teachers/learning-technologists, school principals, and researchers, to support teachers' use of the innovations, with student achievement as the dependent variable. For the experimental schools, the intervention is based on the four longitudinal stages comprising the Active Implementation Framework. With an anticipated student sample of about 13,000 students in grades 1-9, student outcomes data are going to be analyzed using hierarchical linear models. DISCUSSION The project seeks to address a pronounced need for favorable conditions for children's learning supported by a specific implementation framework targeting teachers, and to contribute with knowledge about the promotion of improved teaching practices and student outcomes. The project will build capacity using implementation of educational technology in Swedish educational settings.
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Affiliation(s)
- Italo Masiello
- Department of Computer Science and Media Technology, Linnaeus University, Växjö, Sweden
| | - Dean L. Fixsen
- Active Implementation Research Network, Chapel Hill, NC, United States of America
| | - Susanna Nordmark
- Department of Computer Science and Media Technology, Linnaeus University, Växjö, Sweden
| | | | - Kristina Holmberg
- Department of Education and Teachers’ Practice, Linnaeus University, Växjö, Sweden
| | - John Rack
- Department of Pedagogy and Learning, Linnaeus University, Växjö, Sweden
| | - Mattias Davidsson
- Department of Computer Science and Media Technology, Linnaeus University, Växjö, Sweden
| | | | - Hanna Augustsson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden
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11
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McKay V, Carothers B, Graetz D, Malone S, Puerto-Torres M, Prewitt K, Cardenas A, Chen Y, Devidas M, Luke DA, Agulnik A. Sustainability determinants of an intervention to identify clinical deterioration and improve childhood cancer survival in Latin American hospitals: the INSPIRE study protocol. Implement Sci Commun 2023; 4:141. [PMID: 37978404 PMCID: PMC10657009 DOI: 10.1186/s43058-023-00519-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND More than 90% of children with cancer live in low-resourced settings, where survival is only 20%. Sustainable evidence-based (EB) interventions yielding ongoing beneficial patient outcomes are critical to improve childhood cancer survival. A better understanding of factors promoting intervention sustainability in these settings is urgently needed. The aim of this study is to provide an empirical understanding of how clinical capacity for sustainability, or the resources needed to sustain an intervention, impacts the sustainment of Pediatric Early Warning System (PEWS), an EB intervention that improves pediatric oncology outcomes in low-resource hospitals by detecting clinical deterioration and preventing the need for more intense treatment. METHODS We will conduct a prospective, longitudinal study of approximately 100 resource-variable hospitals implementing and sustaining PEWS participating in Proyecto EVAT, a quality improvement collaborative of Latin American pediatric oncology centers. Aim 1: We will evaluate how clinical capacity for sustainability changes over time through 5 to 9 prospective measurements of capacity via survey of clinical staff using PEWS (approximately n = 13 per center) during the phases of PEWS adoption, implementation, and sustainability using the Clinical Sustainability Assessment Tool (CSAT). Aim 2: We will determine the relationship between capacity and a) PEWS sustainment and b) clinical deterioration mortality among pediatric oncology patients at centers sustaining PEWS for 2 to 10 years using chart review and an existing patient outcomes registry. Aim 3: We will develop novel strategies to promote sustainability by gaining a deeper understanding of perceived challenges to building capacity and PEWS sustainment. In combination with quantitative outcomes, we will conduct 24 focus groups with staff (doctors, nurses, and administrators) from hospitals with both high (n = 4) and low capacity (n = 4). We will then use implementation mapping to generate theoretically driven, empirically-supported sustainability strategies. DISCUSSION This study will advance implementation science by providing a theoretically driven, foundational understanding of factors that predict sustainability among a large, diverse cohort of hospitals. We will then use this knowledge to develop sustainability evidence-informed strategies that optimize capacity and promote long-term sustainment of PEWS and improvements in patient outcomes, thus promoting equity in childhood cancer care globally.
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Affiliation(s)
- Virginia McKay
- Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - Bobbi Carothers
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Dylan Graetz
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sara Malone
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Division of Population Health Science, Washington University in St. Louis School of Medicine, St Louis, MO, United States
| | - Maria Puerto-Torres
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kim Prewitt
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Adolfo Cardenas
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Yichen Chen
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Douglas A Luke
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
- Division of Critical Care, St. Jude Children's Research Hospital, Memphis, TN, USA
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12
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Siantz E, Lansing AE, Center K, Gilmer TP. The development of trauma-informed community partnerships: A mixed method social network study. HUMAN SERVICE ORGANIZATIONS, MANAGEMENT, LEADERSHIP & GOVERNANCE 2023; 48:1-18. [PMID: 39055065 PMCID: PMC11271692 DOI: 10.1080/23303131.2023.2260432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Trauma-informed communities establish cross-sector coalitions that advocate for the use of trauma-informed practices. Whether and how communication occurs within newly established trauma-informed communities is unclear. We collected qualitative data and social network data from six trauma-informed community partnerships that received funding to build community capacity to address trauma across a range of special populations in Los Angeles county. We identified three communication network sub-types and highlight contributions of network leadership in setting the tone for cross-partnership communication. While partnership leaders shared the goal of strengthening cross-organizational communication, social network results illustrated a need to develop strategies that target these goals.
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Affiliation(s)
- Elizabeth Siantz
- University of Utah College of Social Work, 395 S. 1500 E. Salt Lake City, UT 84106
- Hebert Wertheim School of Public Health and Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093
| | - Amy E. Lansing
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093
| | - Kim Center
- Hebert Wertheim School of Public Health and Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093
| | - Todd P. Gilmer
- Hebert Wertheim School of Public Health and Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093
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13
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Nayak SS, Scoglio AAJ, Nandi S, Anderson K, Mirand D, Roper K, Méndez-Peñate L, Moulin C, Arty M, Molnar BE. Implementing Integrated Early Childhood Mental Health Services in Primary Care: Relationships, Vision, and Sustainability. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:763-772. [PMID: 37273121 PMCID: PMC10359204 DOI: 10.1007/s10488-023-01275-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/06/2023]
Abstract
The Massachusetts Multi-City Young Children's System of Care Project was a federally funded program to provide integrated early childhood mental health (ECMH) services in primary care for families of very young children (birth-six years old) with Serious Emotional Disturbances across three cities in Massachusetts, U.S.A. This study describes lessons learned from the implementation of this program and makes recommendations for best practices to improve the delivery and efficacy of ECMH services in primary care settings. Staff and leadership (n = 35) from 11 agencies (primary care practices, community service agencies, and local health departments) that co-implemented this program participated in focus groups and semi-structured key informant interviews. Thematic analysis was used to characterize specific facilitators and barriers to successfully implementing system-wide programming for ECMH. Four main themes were identified: (1) Strong multilevel working relationships are critical for integration, (2) Capacity-building activities can be leveraged to improve implementation, (3) Financial challenges are a primary barrier to building efficacious systems of care, and (4) Flexibility and resourcefulness can help overcome logistical challenges in integration. Implementation lessons learned may serve as guidance for other states and institutions in the U.S. seeking to improve the integration of ECMH services into primary care. They may also provide strategies to adapt and scale these interventions to improve the mental health and well-being of young children and their families.
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Affiliation(s)
- Sameera S Nayak
- Department of Sociology, Anthropology, and Public Health, University of Maryland Baltimore County, Baltimore, MD, USA
| | - Arielle A J Scoglio
- Department of Applied and Natural Sciences, Bentley University, Waltham, MA, USA
| | - Shurobhi Nandi
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Kayla Anderson
- Institute for Health Equity & Social Justice Research, Northeastern University, 360 Huntington Avenue, Mail Stop INV 314, Boston, MA, 02215, USA
| | - Daphney Mirand
- Institute for Health Equity & Social Justice Research, Northeastern University, 360 Huntington Avenue, Mail Stop INV 314, Boston, MA, 02215, USA
| | - Kate Roper
- Massachusetts Department of Public Health, Bureau of Family Health and Nutrition, Boston, MA, USA
| | - Larisa Méndez-Peñate
- Massachusetts Department of Public Health, Bureau of Family Health and Nutrition, Boston, MA, USA
| | - Christy Moulin
- Early Childhood and Family Mental Health Program, Boston Public Health Commission, Boston, MA, USA
| | - Malika Arty
- Early Childhood and Family Mental Health Program, Boston Public Health Commission, Boston, MA, USA
| | - Beth E Molnar
- Institute for Health Equity & Social Justice Research, Northeastern University, 360 Huntington Avenue, Mail Stop INV 314, Boston, MA, 02215, USA.
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14
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Tsui J, Sloan K, Sheth R, Ewusi Boisvert E, Nieva J, Kim AW, Pang RD, Sussman S, Kirkpatrick M. Implementation planning for equitable tobacco treatment services: a mixed methods assessment of contextual facilitators and barriers in a large comprehensive cancer center. Transl Behav Med 2023; 13:539-550. [PMID: 36940412 PMCID: PMC10848232 DOI: 10.1093/tbm/ibac122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Abstract
Tobacco use among cancer patients is associated with an increased mortality and poorer outcomes, yet two-thirds of patients continue using following diagnosis, with disproportionately higher use among racial/ethnic minority and low socioeconomic status patients. Tobacco treatment services that are effectively tailored and adapted to population characteristics and multilevel context specific to settings serving diverse patients are needed to improve tobacco cessation among cancer patients. We examined tobacco use screening and implementation needs for tobacco treatment services to inform equitable and accessible delivery within a large comprehensive cancer center in the greater Los Angeles region. We conducted a multi-modal, mixed methods assessment using electronic medical records (EMR), and clinic stakeholder surveys and interviews (guided by the Consolidated Framework for Implementation Research). Approximately 45% of patients (n = 11,827 of 26,030 total) had missing tobacco use history in their EMR. Several demographic characteristics (gender, age, race/ethnicity, insurance) were associated with greater missing data prevalence. In surveys (n = 32), clinic stakeholders endorsed tobacco screening and cessation services, but indicated necessary improvements for screening/referral procedures. During interviews (n = 13), providers/staff reported tobacco screening was important, but level of priority differed as well as how often and who should screen. Several barriers were noted, including patients' language/cultural barriers, limited time during visits, lack of smoking cessation training, and insurance coverage. While stakeholders indicated high interest in tobacco use assessment and cessation services, EMR and interview data revealed opportunities to improve tobacco use screening across patient groups. Implementing sustainable system-level tobacco cessation programs at institutions requires leadership support, staff training, on routine screening, and intervention and referral strategies that meet patients' linguistic/cultural needs.
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Affiliation(s)
- Jennifer Tsui
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Kylie Sloan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rajiv Sheth
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Jorge Nieva
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
- Department of Medicine, Division of Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anthony W Kim
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Raina D Pang
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Steve Sussman
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Matthew Kirkpatrick
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
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15
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Ramanadhan S, Weese M, Rosas SR, Cruz JL, Chwa C, Rivard MK, Kirk S, Whitaker A, Kirk J, Peterson K, Eisenkraft A. Priority skills for equity-focused, evidence-based cancer control in community-based organizations: A group concept mapping analysis with academics and practitioners. J Clin Transl Sci 2023; 7:e164. [PMID: 37588678 PMCID: PMC10425867 DOI: 10.1017/cts.2023.586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 06/14/2023] [Accepted: 06/27/2023] [Indexed: 08/18/2023] Open
Abstract
Introduction Community-based organizations (CBOs) are important equity-promoting delivery channels for evidence-based interventions (EBIs). However, CBO practitioners often cannot access needed support to build EBI skills. Additionally, the capacity-building literature is hindered by inconsistent definitions, limited use of validated measures, and an emphasis on the perspectives of EBI developers versus implementers. To address these gaps, we explored commonalities and differences between CBO practitioners and academics in conceptualizing and prioritizing core EBI skills. Methods We utilized Group Concept Mapping, a mixed-methods approach connecting qualitative data (e.g., regarding the range of critical EBI skills) and quantitative data (e.g., sorting and ranking data regarding unique skills) to create conceptual maps integrating perspectives from diverse participants. A total of 34 practitioners and 30 academics working with cancer inequities participated in the study. Results Participants nominated 581 core skills for EBI use, and our team (including practitioners and academics) identified 98 unique skills from this list. Participants sorted them into conceptual groups, yielding five clusters: (1) using data and evaluation, (2) selecting and adapting EBIs, (3) connecting with community members, (4) building diverse and equitable partnerships, and (5) managing EBI implementation. The ordering of importance and presence of skill clusters were similar across groups. Overall, importance was rated higher than presence, suggesting capacity gaps. Conclusions There are helpful commonalities between practitioners' and academics' views of core EBI skills in CBOs and apparent capacity gaps. However, underlying patterns suggest that differences between the groups' perceptions warrant further exploration.
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Affiliation(s)
- Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Maggie Weese
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Scott R. Rosas
- Concept Systems, Inc., Ithaca, NY, USA
- SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jennifer L. Cruz
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Cindy Chwa
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Madison K. Rivard
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | | | - Albert Whitaker
- American Heart Association, Waltham, MA, USA
- St. Mark Congregational Church, Boston, MA, USA
| | - Judi Kirk
- Boys and Girls Club of Worcester, Worcester, MA, USA
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16
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Machado JG, Buccini G, Recine E. An Analysis of Key Actor Networks for Scale-Up Strategies for Childhood Obesity Prevention and the Care of Children with Obesity in Brazil. Curr Dev Nutr 2023; 7:101961. [PMID: 37396061 PMCID: PMC10310469 DOI: 10.1016/j.cdnut.2023.101961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 07/04/2023] Open
Abstract
Background Effective scale-up of multisectoral strategies aimed to prevent and treat childhood obesity has been a challenge in Brazil, the largest country in Latin America. Implementation Science methods, such as Net-Map, can identify key actors and opinion leaders (OLs) to advance the implementation and promote sustainability. Objectives This study aimed to analyze power relations between key actors and OLs who influence the scale-up of Brazilian strategies for childhood obesity at the federal and state/municipal (local) levels. Methods A mixed method study, applying the Net-Map method, collected data through virtual workshops with federal and local level stakeholders. The Net-Map included key actors mapping, power mapping, and identification of OLs. Four domains of power were analyzed: command, funding, technical assistance, and dissemination. Network cohesion and centrality measures were calculated. A qualitative analysis was conducted to qualify power relations according to ∗ gears for a successful scale-up (i.e., coordination, goals, and monitoring; advocacy; political will; legislation and policy; funding and resources; training; program delivery; communication; and research and technical cooperation). Results A total of 121 federal key actors and 63 local key actors were identified across networks, of which 62 and 28 were identified as OLs, respectively. Whereas the command domain of power had the highest number of key actors, the funding domain had the least. The health sector executive branch emerged as an OL across all domains of power. Conclusions Barriers that threatened successful scale-up include the lack of coordination between domains of power, missing leadership within key actors, and lack of mechanisms to manage conflict of interest. Governance strategies to enhance multisectoral coordination and communication are needed to effectively scale-up and sustain childhood obesity strategies in Brazil.
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Affiliation(s)
- Juliana Gonçalves Machado
- Human Nutrition Graduate Program, School of Health Science, University of Brasília (UnB), Federal District, Brazil
| | - Gabriela Buccini
- Department of Social and Behavioral Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, United States
| | - Elisabetta Recine
- Human Nutrition Graduate Program, School of Health Science, University of Brasília (UnB), Federal District, Brazil
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McGuier EA, Aarons GA, Wright JD, Fortney JC, Powell BJ, Rothenberger SD, Weingart LR, Miller E, Kolko DJ. Team-focused implementation strategies to improve implementation of mental health screening and referral in rural Children's Advocacy Centers: study protocol for a pilot cluster randomized hybrid type 2 trial. Implement Sci Commun 2023; 4:58. [PMID: 37237302 PMCID: PMC10214641 DOI: 10.1186/s43058-023-00437-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Children's Advocacy Centers (CACs) use multidisciplinary teams to investigate and respond to maltreatment allegations. CACs play a critical role in connecting children with mental health needs to evidence-based mental health treatment, especially in low-resourced rural areas. Standardized mental health screening and referral protocols can improve CACs' capacity to identify children with mental health needs and encourage treatment engagement. In the team-based context of CACs, teamwork quality is likely to influence implementation processes and outcomes. Implementation strategies that target teams and apply the science of team effectiveness may enhance implementation outcomes in team-based settings. METHODS We will use Implementation Mapping to develop team-focused implementation strategies to support the implementation of the Care Process Model for Pediatric Traumatic Stress (CPM-PTS), a standardized screening and referral protocol. Team-focused strategies will integrate activities from effective team development interventions. We will pilot team-focused implementation in a cluster-randomized hybrid type 2 effectiveness-implementation trial. Four rural CACs will implement the CPM-PTS after being randomized to either team-focused implementation (n = 2 CACs) or standard implementation (n = 2 CACs). We will assess the feasibility of team-focused implementation and explore between-group differences in hypothesized team-level mechanisms of change and implementation outcomes (implementation aim). We will use a within-group pre-post design to test the effectiveness of the CPM-PTS in increasing caregivers' understanding of their child's mental health needs and caregivers' intentions to initiate mental health services (effectiveness aim). CONCLUSIONS Targeting multidisciplinary teams is an innovative approach to improving implementation outcomes. This study will be one of the first to test team-focused implementation strategies that integrate effective team development interventions. Results will inform efforts to implement evidence-based practices in team-based service settings. TRIAL REGISTRATION Clinicaltrials.gov, NCT05679154 . Registered on January 10, 2023.
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Affiliation(s)
- Elizabeth A McGuier
- Department of Psychiatry, School of Medicine, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA.
| | - Gregory A Aarons
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- UC San Diego ACTRI Dissemination and Implementation Science Center, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Jaely D Wright
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - John C Fortney
- Division of Population Health, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Department of Veterans Affairs, HSR&D Center of Innovation for Veteran-Centered and Value Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
- Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, USA
| | - Scott D Rothenberger
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Laurie R Weingart
- Tepper School of Business, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Elizabeth Miller
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David J Kolko
- Department of Psychiatry, School of Medicine, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
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Mustanski B, Saber R, Jones JP, Macapagal K, Benbow N, Li DH, Brown CH, Janulis P, Smith JD, Marsh E, Schackman BR, Linas BP, Madkins K, Swann G, Dean A, Bettin E, Savinkina A. Keep It Up! 3.0: Study protocol for a type III hybrid implementation-effectiveness cluster-randomized trial. Contemp Clin Trials 2023; 127:107134. [PMID: 36842763 PMCID: PMC10249332 DOI: 10.1016/j.cct.2023.107134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/13/2023] [Accepted: 02/21/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND Despite evidence that eHealth approaches can be effective in reducing HIV risk, their implementation requirements for public health scale up are not well established, and effective strategies to bring these programs into practice are still unknown. Keep It Up! (KIU!) is an online program proven to reduce HIV risk among young men who have sex with men (YMSM) and ideal candidate to develop and evaluate novel strategies for implementing eHealth HIV prevention programs. KIU! 3.0 is a Type III Hybrid Effectiveness-Implementation cluster randomized trial designed to 1) compare two strategies for implementing KIU!: community-based organizations (CBO) versus centralized direct-to-consumer (DTC) recruitment; 2) examine the effect of strategies and determinants on variability in implementation success; and 3) develop materials for sustainment of KIU! after the trial concludes. In this article, we describe the approaches used to achieve these aims. METHODS Using county-level population estimates of YMSM, 66 counties were selected and randomized 2:1 to the CBO and DTC approaches. The RE-AIM model was used to drive outcome measurements, which were collected from CBO staff, YMSM, and technology providers. Mixed-methods research mapped onto the domains of the Consolidated Framework for Implementation Research will examine determinants and their relationship with implementation outcomes. DISCUSSION In comparing our implementation recruitment models, we are examining two strategies which have shown effectiveness in delivering health technology interventions in the past, yet little is known about their comparative advantages and disadvantages in implementation. The results of the trial will further the understanding of eHealth prevention intervention implementation.
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Affiliation(s)
- Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 446 E. Ontario Street, Floor 7, Chicago, IL 60611, United States of America.
| | - Rana Saber
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Justin Patrick Jones
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Kathryn Macapagal
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 446 E. Ontario Street, Floor 7, Chicago, IL 60611, United States of America
| | - Nanette Benbow
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 446 E. Ontario Street, Floor 7, Chicago, IL 60611, United States of America
| | - Dennis H Li
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 446 E. Ontario Street, Floor 7, Chicago, IL 60611, United States of America
| | - C Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 446 E. Ontario Street, Floor 7, Chicago, IL 60611, United States of America
| | - Patrick Janulis
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, 295 Chipeta Way, Williams Building, Salt Lake City, UT 84108, United States of America
| | - Elizabeth Marsh
- Boston Medical Center, Section of Infectious Diseases Crosstown Building, 801 Massachusetts Avenue, Boston, MA 02118, United States of America
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medicine, 425 East 61(st) Street, Suite 301, New York, NY 10065, United States of America
| | - Benjamin P Linas
- Boston Medical Center, Section of Infectious Diseases Crosstown Building, 801 Massachusetts Avenue, Boston, MA 02118, United States of America
| | - Krystal Madkins
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Gregory Swann
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Abigael Dean
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Emily Bettin
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Alexandra Savinkina
- Boston Medical Center, Section of Infectious Diseases Crosstown Building, 801 Massachusetts Avenue, Boston, MA 02118, United States of America
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Sherwood K, Smith MJ, Ross B, Johnson J, Harrington M, Blajeski S, Dawalt L, Bishop L, Smith JD. Mixed methods implementation evaluation of virtual interview training for transition-age autistic youth in pre-employment transition services. JOURNAL OF VOCATIONAL REHABILITATION 2023; 58:139-154. [PMID: 38881791 PMCID: PMC11178120 DOI: 10.3233/jvr-230004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Autistic transition-age youth are employed at rates far lower than their non-disabled peers as well as youth with other disabilities. Meanwhile, very few studies have evaluated the implementation of job interviewing practices within pre-employment transition services. OBJECTIVE We conducted an initial implementation evaluation as part of a Type I hybrid randomized controlled effectiveness-implementation trial where we trained teachers to deliver Virtual Interview Training for Transition-Age Youth (VIT-TAY) within five pre-employment transition services programs. METHODS We used mixed methods to evaluate leader (n=5), teacher (n=15) and autistic transition age youth (n=48) perceptions of VIT-TAY. We used descriptive statistics and thematic network analysis to evaluate survey data. Mixed methods integration was then performed to make comparisons between quantitative and qualitative results. RESULTS Quantitative survey data revealed that leaders and teachers found VIT-TAY to be highly acceptable and appropriate for pre-employment transition services; findings which were confirmed via thematic network analysis of qualitative interview data. Autistic students reported via quantitative surveys that VIT-TAY was acceptable and usable, which was confirmed via thematic network analysis of open-ended survey data. CONCLUSIONS This initial implementation evaluation can be used to inform a larger scale implementation evaluation of VIT-TAY in schools.
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Affiliation(s)
- Kari Sherwood
- School of Social Work, University of Michigan; Ann Arbor, MI
- Department of Psychology, University of Michigan; Ann Arbor, MI
| | | | - Brittany Ross
- School of Social Work, University of Michigan; Ann Arbor, MI
| | - Jeffery Johnson
- School of Social Work, University of Michigan; Ann Arbor, MI
| | | | | | - Leann Dawalt
- Waisman Center, University of Wisconsin; Madison, WI
| | - Lauren Bishop
- Waisman Center, University of Wisconsin; Madison, WI
- Sandra Rosenbaum School of Social Work, University of Wisconsin; Madison, WI
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Chang JC, Sears C, Bitencourt N, Peterson R, Alperin R, Goh YI, Overbury RS, Sadun R, Smitherman E, White PH, Lawson EF, Carandang K. Implementation of Rheumatology Health Care Transition Processes and Adaptations to Systems Under Stress: A Mixed-Methods Study. Arthritis Care Res (Hoboken) 2023; 75:689-696. [PMID: 34806346 DOI: 10.1002/acr.24822] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/26/2021] [Accepted: 11/16/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Despite poor health care transition outcomes among young adults with pediatric rheumatic diseases, adoption of transition best practices is low. We sought to understand how structured transition processes were operationalized within pediatric rheumatology practices and what factors were perceived to enable adaptations during a global pandemic. METHODS We conducted a mixed methods study of team leaders' experiences during an interim analysis of a pilot project to implement transition policy discussions at sites in the Childhood Arthritis and Rheumatology Research Alliance Transition Learning Collaborative. We combined quantitative assessments of organizational readiness for change (9 sites) and semistructured interviews of team leaders (8 sites) using determinants in the Exploration, Preparation, Implementation, Sustainment Framework. RESULTS Engagement of nursing and institutional improvement efforts facilitated decisions to implement transition policies. Workflows incorporating educational processes by nonphysicians were perceived to be critical for success. When the pandemic disrupted contact with nonphysicians, capacity for automation using electronic medical record (EMR)-based tools was an important facilitator, but few sites could access these tools. Sites without EMR-based tools did not progress despite reporting high organizational readiness to implement change at the clinic level. Lastly, educational processes were often superseded by acute issues, such that youth with greater medical/psychosocial complexity may not receive the intervention. CONCLUSION We generated several considerations to guide implementation of transition processes within pediatric rheumatology from the perspectives of team leaders. Careful assessment of institutional and nursing support is advisable before conducting complex transition interventions. Ideally, new strategies would ensure interventions reach youth with high complexity.
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Affiliation(s)
- Joyce C Chang
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, and Boston Children's Hospital, Boston, Massachusetts
| | - Cora Sears
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Rosemary Peterson
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, and Dell Children's Medical Center, Austin, Texas
| | | | - Y Ingrid Goh
- The Hospital for Sick Children, Toronto, Ontario, Canada, and SickKids Research Institute, Toronto, Ontario, Canada
| | | | - Rebecca Sadun
- Duke University Medical Center, Durham, North Carolina
| | | | - Patience H White
- Got Transition, The National Alliance to Advance Adolescent Health, and School of Medicine and Health Sciences, George Washington University, Washington, DC
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Natale R, Agosto Y, Bulotsky Shearer RJ, St George SM, Jent J. Designing a virtual mental health consultation program to support and strengthen childcare centers impacted by COVID-19: A randomized controlled trial protocol. Contemp Clin Trials 2023; 124:107022. [PMID: 36442806 PMCID: PMC9694403 DOI: 10.1016/j.cct.2022.107022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The COVID-19 pandemic has had negative psychosocial impacts on young children; teachers in childcare centers continue to be overwhelmed by how to address the downstream psychological effects children are experiencing. This randomized controlled trial will study the role of a community-based, childcare center-support system in improving resilience and mitigating the long-term impacts of COVID-19 on children's development. METHODS This study will be modeled on a successful Early Childhood Mental Health Consultation (ECMHC) intervention which utilizes mental health consultants to deliver a Jump Start+: COVID 19 Support (JS + CS) virtual toolkit to childcare centers in Miami-Dade County via a Kubi robot. The toolkit comprises four strength-based strategies likely to be effective in improving resiliency following disasters: Safety Planning, Effective Communication, Adult Self-Care, and Trauma-Informed Behavior Support. Our first aim will utilize a cluster randomized trial to examine the effectiveness of JS + CS on improving the psychosocial functioning of young children, as compared to an obesity prevention intervention control group. Children will be followed at 6, 12, 18, and 24 months. The second aim will examine the mechanisms that contribute to effective uptake by teachers of the JS + CS support strategies on child outcomes. The third aim will explore implementation barriers/facilitators as well as potential societal contextual factors (e.g., vaccine uptake) to help centers serving disproportionately affected minority communities recover from and prepare for future crises. CONCLUSION This design will inform the refinement and scaling of JS + CS and generalize impacts to other childcare center interventions in the context of disasters.
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Affiliation(s)
- Ruby Natale
- University of Miami Miller School of Medicine, Department of Pediatrics, 1601 NW 12(th) Ave, Miami, Florida 33136, USA.
| | - Yaray Agosto
- University of Miami Miller School of Medicine, Department of Pediatrics, 1601 NW 12(th) Ave, Miami, Florida 33136, USA.
| | - Rebecca J Bulotsky Shearer
- University of Miami, Department of Psychology, 5665 Ponce de Leon Blvd, Coral Gables, Florida 33146, USA.
| | - Sara M St George
- University of Miami Miller School of Medicine, Department of Public Health Sciences, 1120 NW 14(th) St, Miami, Florida 33136, USA.
| | - Jason Jent
- University of Miami Miller School of Medicine, Department of Pediatrics, 1601 NW 12(th) Ave, Miami, Florida 33136, USA.
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22
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Hossain S, O’Neill S, Strnadová I. What Constitutes Student Well-Being: A Scoping Review Of Students' Perspectives. CHILD INDICATORS RESEARCH 2022; 16:447-483. [PMID: 36405573 PMCID: PMC9668225 DOI: 10.1007/s12187-022-09990-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
Student well-being has recently emerged as a critical educational agenda due to its wide-reaching benefits for students in performing better at school and later as adults. With the emergence of student well-being as a priority area in educational policy and practice, efforts to measure and monitor student well-being have increased, and so has the number of student well-being domains proposed. Presently, a lack of consensus exists about what domains are appropriate to investigate and understand student well-being, resulting in a fragmented body of work. This paper aims to clarify the construct of student well-being by summarising and mapping different conceptualisations, approaches used to measure, and domains that entail well-being. The search of multiple databases identified 33 studies published in academic journals between 1989 and 2020. There were four approaches to conceptualising student well-being found in the reviewed studies. They were: Hedonic, eudaimonic, integrative (i.e., combining both hedonic and eudaimonic), and others. Results identified eight overarching domains of student well-being: Positive emotion, (lack of) Negative emotion, Relationships, Engagement, Accomplishment, Purpose at school, Intrapersonal/Internal factors, and Contextual/External factors. Recommendations for further research are offered, including the need for more qualitative research on student well-being as perceived and experienced by students and for research to be conducted in a non-western context.
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Affiliation(s)
- Saira Hossain
- School of Education, UNSW Sydney, Sydney, 2052 Australia
| | - Sue O’Neill
- School of Education, UNSW Sydney, Sydney, 2052 Australia
| | - Iva Strnadová
- School of Education, UNSW Sydney, Sydney, 2052 Australia
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23
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Espeleta HC, Peer SO, Are F, Hanson RF. Therapists' Perceived Competence in Trauma-Focused Cognitive Behavioral Therapy and Client Outcomes: Findings From a Community-Based Learning Collaborative. CHILD MALTREATMENT 2022; 27:455-465. [PMID: 33783257 DOI: 10.1177/10775595211003673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study examined therapists' perceived competence in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and its association with youth treatment outcomes (posttraumatic stress and depression). Participants included 99 community therapists enrolled in a TF-CBT-focused Learning Collaborative (LC), along with one of their randomly selected TF-CBT training cases. Analyzed data included: 1) caregiver/youth-reported posttraumatic stress and depressive symptoms, pre- and post-treatment, and 2) therapist-perceived competence with TF-CBT components across treatment delivery. Youth- and caregiver-reports indicated large, significant pre- to post-treatment decreases in youth posttraumatic stress (ds = 1.10-1.30, ps < .001) and depressive symptoms (d = 1.01, p < .001). Higher therapist-perceived competence with TF-CBT predicted positive treatment responses for posttraumatic stress (ds = 0.38-0.39, ps = .03) and depression (d = 0.25), though only the former association was significant (ps = .03 vs. p = .15). Findings highlight the need to monitor and improve therapists' competencies to enhance clinical outcomes for trauma-exposed youth and suggest that LCs may be an effective training/implementation model to help achieve those critical goals.
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Affiliation(s)
- Hannah C Espeleta
- College of Nursing, 15895Medical University of South Carolina, Charleston, SC, USA
| | - Samuel O Peer
- Department of Psychology, 6640Idaho State University, Pocatello, ID, USA
| | - Funlola Are
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rochelle F Hanson
- Institute of Psychiatry, 2345Medical University of South Carolina, Charleston, SC, USA
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Alghamdi AKH, Al Ghamdi KS, Kim SY. Epidemiology in Middle School Science Curricula: a COVID-19 Pre-post Intervention. JOURNAL OF SCIENCE EDUCATION AND TECHNOLOGY 2022; 31:583-593. [PMID: 35730014 PMCID: PMC9188273 DOI: 10.1007/s10956-022-09975-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
It is of great importance that science educators teach COVID-19 and related pandemics to boost students' scientific literacy. A mixed methods research design (pre-post test instrument [N = 86] and semi-structured interviews [N = 11]-August 2020 to June 2021) evaluated the ability of an intervention (12 h, three-session, 3-day, online workshop) to augment middle school inservice science teachers' (Eastern Saudi Arabian province) ability to teach about medical terminology and the epidemiology of diseases. Teachers' cognitive gains were measured through evaluating their knowledge, comprehension, and application of workshop content before and after the intervention. Descriptive statistics and inferential t tests revealed statistically significant cognitive differences overall (p < .01) (posttest mean = 26.26/30, SD 2.83, t value 18.51) and along knowledge (posttest mean = 5.72/7), comprehension (mean = 7.50/8), and application (mean = 13.05/15). A high effect size coefficient n2 indicated a large effect on cognitive gains. Thematic analysis about participants' subsequent efforts teaching workshop content to students revealed positive and negative experiences. The former included improved student engagement with the curriculum, community connections via project-based learning, and opportunities to teach colleagues about COVID-19. The latter concerned insufficient time, an obligation to teach the current curriculum without adding COVID-19 content, and administrative resistance. Recommendations pertain to augmenting the workshop curriculum and likeminded research initiatives.
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Affiliation(s)
- Amani Khalaf H. Alghamdi
- College of Education, Curriculum and Pedagogy, Imam Abdulrahman Bin Faisal University, PO Box 1982, Dammam, 31441 Kingdom of Saudi Arabia
| | - Kholoud S. Al Ghamdi
- College of Medicine, Higher Studies & Scientific Research, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Sun Young Kim
- Department of Biology Education, College of Education, Chosun University, 61452 Gwangju, South Korea
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Canada's Colonial Genocide of Indigenous Peoples: A Review of the Psychosocial and Neurobiological Processes Linking Trauma and Intergenerational Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116455. [PMID: 35682038 PMCID: PMC9179992 DOI: 10.3390/ijerph19116455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 12/04/2022]
Abstract
The policies and actions that were enacted to colonize Indigenous Peoples in Canada have been described as constituting cultural genocide. When one considers the long-term consequences from the perspective of the social and environmental determinants of health framework, the impacts of such policies on the physical and mental health of Indigenous Peoples go well beyond cultural loss. This paper addresses the impacts of key historical and current Canadian federal policies in relation to the health and well-being of Indigenous Peoples. Far from constituting a mere lesson in history, the connections between colonialist policies and actions on present-day outcomes are evaluated in terms of transgenerational and intergenerational transmission processes, including psychosocial, developmental, environmental, and neurobiological mechanisms and trauma responses. In addition, while colonialist policies have created adverse living conditions for Indigenous Peoples, resilience and the perseverance of many aspects of culture may be maintained through intergenerational processes.
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Garcia SF, Smith JD, Kallen M, Webster KA, Lyleroehr M, Kircher S, Bass M, Cella D, Penedo FJ. Protocol for a type 2 hybrid effectiveness-implementation study expanding, implementing and evaluating electronic health record-integrated patient-reported symptom monitoring in a multisite cancer centre. BMJ Open 2022; 12:e059563. [PMID: 35504641 PMCID: PMC9066503 DOI: 10.1136/bmjopen-2021-059563] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/18/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Cancer symptom monitoring and management interventions can address concerns that may otherwise go undertreated. However, such programmes and their evaluations remain largely limited to trials versus healthcare systemwide applications. We previously developed and piloted an electronic patient-reported symptom and need assessment ('cPRO' for cancer patient-reported outcomes) within the electronic health record (EHR). This study will expand cPRO implementation to medical oncology clinics across a large healthcare system. We will conduct a formal evaluation via a stepped wedge trial with a type 2 hybrid effectiveness-implementation design. METHODS AND ANALYSIS Aim 1 comprises a mixed method evaluation of cPRO implementation. Adult outpatients will complete cPRO assessments (pain, fatigue, physical function, depression, anxiety and supportive care needs) before medical oncology visits. Results are available in the EHR; severe symptoms and endorsed needs trigger clinician notifications. We will track implementation strategies using the Longitudinal Implementation Strategy Tracking System. Aim 2 will evaluate cPRO's impact on patient and system outcomes over 12 months via (a) a quality improvement study (n=4000 cases) and (b) a human subjects substudy (n=1000 patients). Aim 2a will evaluate EHR-documented healthcare usage and patient satisfaction. In aim 2b, participating patients will complete patient-reported healthcare utilisation and quality, symptoms and health-related quality of life measures at baseline, 6 and 12 months. We will analyse data using generalised linear mixed models and estimate individual trajectories of patient-reported symptom scores at baseline, 6 and 12 months. Using growth mixture modelling, we will characterise the overall trajectories of each symptom. Aim 3 will identify cPRO implementation facilitators and barriers via mixed methods research gathering feedback from stakeholders. Patients (n=50) will participate in focus groups or interviews. Clinicians and administrators (n=40) will complete surveys to evaluate implementation. We will graphically depict longitudinal implementation survey results and code qualitative data using directed content analysis. ETHICS AND DISSEMINATION This study was approved by the Northwestern University Institutional Review Board (STU00207807). Findings will be disseminated via local and conference presentations and peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04014751; ClinicalTrials.gov.
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Affiliation(s)
- Sofia F Garcia
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Justin D Smith
- Department of Population Health Sciences, The University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Kallen
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kimberly A Webster
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Madison Lyleroehr
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sheetal Kircher
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Bass
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Frank J Penedo
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami Health System, Miami, Florida, USA
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Study protocol of a randomized controlled trial comparing two linkage models for HIV prevention and treatment in justice-involved persons. BMC Infect Dis 2022; 22:380. [PMID: 35428213 PMCID: PMC9013109 DOI: 10.1186/s12879-022-07354-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Persons involved in the justice system are at high risk for HIV and drug overdose upon release to the community. This manuscript describes a randomized controlled trial of two evidence-based linkage interventions for provision of HIV prevention and treatment and substance use disorder (SUD) services in four high risk communities to assess which is more effective at addressing these needs upon reentry to the community from the justice system. Methods This is a 5-year hybrid type 1 effectiveness-implementation randomized controlled trial that compares two models (Patient Navigation [PN] or Mobile Health Unit [MHU] service delivery) of linking justice-involved individuals to the continuum of community-based HIV and SUD prevention and treatment service cascades of care. A total of 864 justice-involved individuals in four US communities with pre-arrest histories of opioid and/or stimulant use who are living with or at-risk of HIV will be randomized to receive either: (a) PN, wherein patient navigators will link study participants to community-based service providers; or (b) services delivered via an MHU, wherein study participants will be provided integrated HIV prevention/ treatment services and SUD services. The six-month post-release intervention will focus on access to pre-exposure prophylaxis (PrEP) for those without HIV and antiretroviral treatment (ART) for people living with HIV (PLH). Secondary outcomes will examine the continuum of PrEP and HIV care, including: HIV viral load, PrEP/ ART adherence; HIV risk behaviors; HCV testing and linkage to treatment; and sexually transmitted infection incidence and treatment. Additionally, opioid and other substance use disorder diagnoses, prescription, receipt, and retention on medication for opioid use disorder; opioid and stimulant use; and overdose will also be assessed. Primary implementation outcomes include feasibility, acceptability, sustainability, and costs required to implement and sustain the approaches as well as to scale-up in additional communities. Discussion Results from this project will help inform future methods of delivery of prevention, testing, and treatment of HIV, HCV, substance use disorders (particularly for opioids and stimulants), and sexually transmitted infections for justice-involved individuals in the community. Trial registration: Clincialtrials.gov NCT05286879 March 18, 2022.
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Brillon P, Philippe FL, Paradis A, Geoffroy M, Orri M, Ouellet‐Morin I. Psychological distress of mental health workers during the COVID-19 pandemic: A comparison with the general population in high- and low-incidence regions. J Clin Psychol 2022; 78:602-621. [PMID: 34453328 PMCID: PMC8656408 DOI: 10.1002/jclp.23238] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/10/2021] [Accepted: 07/17/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Despite their essential role during this health crisis, little is known about the psychological distress of mental health workers (MHW). METHOD A total of 616 MHW and 658 workers from the general population (GP) completed an online survey including depressive, anxiety, irritability, loneliness, and resilience measures. RESULTS Overall, MHW had fewer cases with above cut-off clinically significant depression (19% MHW vs. 27%) or anxiety (16% MHW vs. 29%) than the GP. MHW in high-incidence regions of COVID-19 cases displayed the same levels of depressive and anxiety symptoms than the GP and higher levels compared to MHW from low-incidence regions. MHW in high-incidence regions presented higher levels of irritability and lower levels of resilience than the MHW in low-incidence regions. Moreover, MHW in high-incidence regions reported more feelings of loneliness than all other groups. CONCLUSION Implications for social and organizational preventive strategies to minimize the distress of MHW in times of crisis are discussed.
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Affiliation(s)
- Pascale Brillon
- Department of PsychologyUniversité du Québec à MontréalMontrealQuebecCanada
| | | | - Alison Paradis
- Department of PsychologyUniversité du Québec à MontréalMontrealQuebecCanada
| | - Marie‐Claude Geoffroy
- Department of Educational and Counselling PsychologyMcGill UniversityMontrealQuebecCanada
- McGill Group for Suicide Studies, Department of PsychiatryMcGill UniversityMontrealQuebecCanada
| | - Massimiliano Orri
- McGill Group for Suicide Studies, Department of PsychiatryMcGill UniversityMontrealQuebecCanada
| | - Isabelle Ouellet‐Morin
- Department of CriminologyUniversity of MontrealMontrealQuebecCanada
- Research Center of the Montreal Mental Health University InstituteMcGill UniversityMontrealQuebecCanada
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Kolko DJ, McGuier EA, Turchi R, Thompson E, Iyengar S, Smith SN, Hoagwood K, Liebrecht C, Bennett IM, Powell BJ, Kelleher K, Silva M, Kilbourne AM. Care team and practice-level implementation strategies to optimize pediatric collaborative care: study protocol for a cluster-randomized hybrid type III trial. Implement Sci 2022; 17:20. [PMID: 35193619 PMCID: PMC8862323 DOI: 10.1186/s13012-022-01195-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implementation facilitation is an effective strategy to support the implementation of evidence-based practices (EBPs), but our understanding of multilevel strategies and the mechanisms of change within the "black box" of implementation facilitation is limited. This implementation trial seeks to disentangle and evaluate the effects of facilitation strategies that separately target the care team and leadership levels on implementation of a collaborative care model in pediatric primary care. Strategies targeting the provider care team (TEAM) should engage team-level mechanisms, and strategies targeting leaders (LEAD) should engage organizational mechanisms. METHODS We will conduct a hybrid type 3 effectiveness-implementation trial in a 2 × 2 factorial design to evaluate the main and interactive effects of TEAM and LEAD and test for mediation and moderation of effects. Twenty-four pediatric primary care practices will receive standard REP training to implement Doctor-Office Collaborative Care (DOCC) and then be randomized to (1) Standard REP only, (2) TEAM, (3) LEAD, or (4) TEAM + LEAD. Implementation outcomes are DOCC service delivery and change in practice-level care management competencies. Clinical outcomes are child symptom severity and quality of life. DISCUSSION This statewide trial is one of the first to test the unique and synergistic effects of implementation strategies targeting care teams and practice leadership. It will advance our knowledge of effective care team and practice-level implementation strategies and mechanisms of change. Findings will support efforts to improve common child behavioral health conditions by optimizing scale-up and sustainment of CCMs in a pediatric patient-centered medical home. TRIAL REGISTRATION ClinicalTrials.gov, NCT04946253 . Registered June 30, 2021.
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Affiliation(s)
- David J Kolko
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Elizabeth A McGuier
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Renee Turchi
- Department of Pediatrics, Drexel University College of Medicine and St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Eileen Thompson
- PA Medical Home Program, PA Chapter, American Academy of Pediatrics, Media, PA, USA
| | - Satish Iyengar
- Department of Statistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shawna N Smith
- Department of Health Management & Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Kimberly Hoagwood
- Department of Child and Adolescent Psychiatry, New York University Langone Health, New York, NY, USA
| | - Celeste Liebrecht
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ian M Bennett
- Departments of Family Medicine and Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Kelly Kelleher
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
- Nationwide Children's Hospital Research Institute, Columbus, OH, USA
| | - Maria Silva
- Allegheny Family Network, Pittsburgh, PA, USA
| | - Amy M Kilbourne
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Aalsma MC, Aarons GA, Adams ZW, Alton MD, Boustani M, Dir AL, Embi PJ, Grannis S, Hulvershorn LA, Huntsinger D, Lewis CC, Monahan P, Saldana L, Schwartz K, Simon KI, Terry N, Wiehe SE, Zapolski TC. Alliances to disseminate addiction prevention and treatment (ADAPT): A statewide learning health system to reduce substance use among justice-involved youth in rural communities. J Subst Abuse Treat 2021; 128:108368. [PMID: 33867210 PMCID: PMC8883586 DOI: 10.1016/j.jsat.2021.108368] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/27/2021] [Accepted: 03/12/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Youth in the justice system (YJS) are more likely than youth who have never been arrested to have mental health and substance use problems. However, a low percentage of YJS receive SUD services during their justice system involvement. The SUD care cascade can identify potential missed opportunities for treatment for YJS. Steps along the continuum of the cascade include identification of treatment need, referral to services, and treatment engagement. To address gaps in care for YJS, we will (1) implement a learning health system (LHS) to develop, or improve upon, alliances between juvenile justice (JJ) agencies and community mental health centers (CMHC) and (2) present local cascade data during continuous quality improvement cycles within the LHS alliances. METHODS/DESIGN ADAPT is a hybrid Type II effectiveness implementation trial. We will collaborate with JJ and CMHCs in eight Indiana counties. Application of the EPIS (exploration, preparation, implementation, and sustainment) framework will guide the implementation of the LHS alliances. The study team will review local cascade data quarterly with the alliances to identify gaps along the continuum. The study will collect self-report survey measures longitudinally at each site regarding readiness for change, implementation climate, organizational leadership, and program sustainability. The study will use the Stages of Implementation Completion (SIC) tool to assess the process of implementation across interventions. Additionally, the study team will conduct focus groups and qualitative interviews with JJ and CMHC personnel across the intervention period to assess for impact. DISCUSSION Findings have the potential to increase SUD need identification, referral to services, and treatment for YJS.
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Affiliation(s)
- Matthew C. Aalsma
- Department of Pediatrics – Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Gregory A. Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States of America
| | - Zachary W. Adams
- Department of Psychiatry - Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Madison D. Alton
- Department of Pediatrics – Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Malaz Boustani
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Allyson L. Dir
- Department of Psychiatry - Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Peter J. Embi
- Department of Medicine, Indiana University School of Medicine, and Regenstrief Institute, Indianapolis, IN, United States of America
| | - Shaun Grannis
- Department of Medicine, Indiana University School of Medicine, and Regenstrief Institute, Indianapolis, IN, United States of America
| | - Leslie A. Hulvershorn
- Department of Psychiatry - Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | | | - Cara C. Lewis
- MacColl Center for Health Care Innovation, Kaiser Permanente Washington Health Research Institute – Seattle, Washington, United States of America
| | - Patrick Monahan
- Department of Biostatistics, Indiana University School of Medicine and School of Public Health, Indianapolis, IN, United States of America
| | - Lisa Saldana
- Oregon Social Learning Center, Eugene, OR, United States of America
| | - Katherine Schwartz
- Department of Pediatrics - Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, United States of America.
| | - Kosali I. Simon
- School of Public and Environmental Affairs, Indiana University Bloomington, Bloomington, IN, United States of America
| | - Nicolas Terry
- McKinney School of Law, Indiana University – Purdue University Indianapolis, Indianapolis, IN, United States of America
| | - Sarah E. Wiehe
- Department of Pediatrics, Division of Children’s Health Services Research, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Tamika C.B. Zapolski
- Department of Psychology - Adolescent Behavioral Health Research Program, Indiana University – Purdue University Indianapolis, Indianapolis, IN, United States of America
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Cabassa LJ, Stefancic A, Bochicchio L, Tuda D, Weatherly C, Lengnick-Hall R. Organization leaders' decisions to sustain a peer-led healthy lifestyle intervention for people with serious mental illness in supportive housing. Transl Behav Med 2021; 11:1151-1159. [PMID: 32949137 DOI: 10.1093/tbm/ibaa089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Healthy lifestyle interventions that increase physical activity and healthy dietary habits can help improve the physical health of people with serious mental illness (SMI). Yet, these interventions are not implemented in routine practice settings. This mixed methods study examined the decisions that leaders from three supportive housing agencies made as they planned to sustain a peer-led healthy lifestyle intervention for people with SMI at the end of a clinical trial. A combination of implementation strategies that addressed cost concerns, generated local evidence of the intervention's benefits, and provided ongoing training was identified as important for sustainability. A sustainability model illustrating implementation strategies and mechanisms for supporting three sustainability domains (funding, organizational capacity, and adaptation) was prioritized by participants. Study findings can inform future studies testing strategies and mechanisms to support the sustainability of interventions in routine practice settings to improve the physical health of people with SMI.
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Affiliation(s)
- Leopoldo J Cabassa
- Brown School of Social Work, Washington University in St. Louis Campus Box 1196, St. Louis, MO, USA
| | - Ana Stefancic
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | | | - Daniela Tuda
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Christopher Weatherly
- Brown School of Social Work, Washington University in St. Louis Campus Box 1196, St. Louis, MO, USA
| | - Rebecca Lengnick-Hall
- Brown School of Social Work, Washington University in St. Louis Campus Box 1196, St. Louis, MO, USA
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Mersky JP, Topitzes J, Janczewski CE, Lee CTP, McGaughey G, McNeil CB. Translating and Implementing Evidence-Based Mental Health Services in Child Welfare. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:693-704. [PMID: 31925601 DOI: 10.1007/s10488-020-01011-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Children in the child welfare system with mental health difficulties seldom receive evidence-based treatment (EBT) despite the abundance of validated interventions that exist. This manuscript describes two projects aimed at increasing access to EBTs. The first is a completed field trial of an adapted parent-child interaction therapy intervention with foster-parent child dyads. New findings are presented from variable- and person-centered analyses of impact on diverse symptom profiles. The second is an ongoing statewide initiative that is increasing access to multiple EBTs while navigating implementation barriers. Lessons learned for bridging gaps between children's mental health research, services, and policy are discussed.
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Affiliation(s)
- Joshua P Mersky
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, 2400 E. Hartford Ave., Milwaukee, WI, 53211, USA.
| | - James Topitzes
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, 2400 E. Hartford Ave., Milwaukee, WI, 53211, USA
| | - Colleen E Janczewski
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, 2400 E. Hartford Ave., Milwaukee, WI, 53211, USA
| | - Chien-Ti Plummer Lee
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, 2400 E. Hartford Ave., Milwaukee, WI, 53211, USA
| | | | - Cheryl B McNeil
- Department of Psychology, West Virginia University, Morgantown, WV, USA
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Collaborative care for depression management in primary care: A randomized roll-out trial using a type 2 hybrid effectiveness-implementation design. Contemp Clin Trials Commun 2021; 23:100823. [PMID: 34401595 PMCID: PMC8350002 DOI: 10.1016/j.conctc.2021.100823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/11/2021] [Accepted: 07/24/2021] [Indexed: 12/20/2022] Open
Abstract
Background The Collaborative Care Model (CoCM) is a well-established treatment for depression in primary care settings. The critical drivers and specific strategies for improving implementation and sustainment are largely unknown. Rigorous pragmatic research is needed to understand CoCM implementation processes and outcomes. Methods This study is a hybrid Type 2 randomized roll-out effectiveness-implementation trial of CoCM in 11 primary care practices affiliated with an academic medical center. The Collaborative Behavioral Health Program (CBHP) was developed as a means of improving access to effective mental health services for depression. Implementation strategies are provided to all practices. Using a sequential mixed methods approach, we will assess key stakeholders’ perspectives on barriers and facilitators of implementation and sustainability of CBHP. The speed and quantity of implementation activities completed over a 30-month period for each practice will be assessed. Economic analyses will be conducted to determine the budget impact and cost offset of CBHP in the healthcare system. We hypothesize that CBHP will be effective in reducing depressive symptoms and spillover effects on chronic health conditions. We will also examine differential outcomes among racial/ethnic minority patients. Discussion This study will elucidate critical drivers of successful CoCM implementation. It will be among the first to conduct economic analyses on a fee-for-service model utilizing billing codes for CoCM. Data may inform ways to improve implementation efficiency with an optimization approach to successive practices due to the roll-out design. Changes to the protocol and current status of the study are discussed.
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Taboada A, Ly E, Ramo D, Dillon F, Chang YJ, Hooper C, Yost E, Haritatos J. Implementing Goal Mama: Barriers and Facilitators to Introducing Mobile Health Technology in a Public Health Nurse Home-Visiting Program. Glob Qual Nurs Res 2021; 8:23333936211014497. [PMID: 34017901 PMCID: PMC8114238 DOI: 10.1177/23333936211014497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/22/2022] Open
Abstract
The present study explores barriers and facilitators experienced by public health nurses introducing a mobile health technology platform (Goal Mama) to the Nurse-Family Partnership home-visiting program. Goal Mama is a HIPAA-compliant goal-coaching and visit preparation platform that clients and nurses use together to set and track goals. Forty-two nurses across five sites, including urban, suburban, and rural communities, piloted the platform with clients for 6 months. The mixed method, QUAL+quan pilot evaluation focused on deeply understanding the implementation process. Data were analyzed via iterative content analysis and multivariate regression analysis, and triangulated to identify salient findings. Over 6 months of use participants identified critical areas for product and implementation improvement, but still viewed the platform favorably. Key opportunities for improving sustained use revolved around supporting the technological and programmatic integration needed to lower key barriers and further facilitate implementation.
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Affiliation(s)
| | | | - Danielle Ramo
- Hopelab, San Francisco, CA, USA.,Weill Institute for Neurosciences, San Francisco, CA, USA
| | | | | | | | - Elly Yost
- Nurse Family Partnership National Service Office, Denver, CO, USA
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Applying the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework to Safe Surgery 2020 Implementation in Tanzania's Lake Zone. J Am Coll Surg 2021; 233:177-191.e5. [PMID: 33957259 DOI: 10.1016/j.jamcollsurg.2021.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Access to safe, high-quality surgical care in sub-Saharan Africa is a critical gap. Interventions to improve surgical quality have been developed, but research on their implementation is still at a nascent stage. We retrospectively applied the Exploration, Preparation, Implementation, Sustainment framework to characterize the implementation of Safe Surgery 2020, a multicomponent intervention to improve surgical quality. METHODS We used a longitudinal, qualitative research design to examine Safe Surgery 2020 in 10 health facilities in Tanzania's Lake Zone. We used documentation analysis with confirmatory key informant interviews (n = 6) to describe the exploration and preparation phases. We conducted interviews with health facility leaders and surgical team members at 1, 6, and 12 months (n = 101) post initiation to characterize the implementation phase. Data were analyzed using the constant comparison method. RESULTS In the exploration phase, research, expert consultation, and scoping activities revealed the need for a multicomponent intervention to improve surgical quality. In the preparation phase, onsite visits identified priorities and barriers to implementation to adapt the intervention components and curriculum. In the active implementation phase, 4 themes related to the inner organizational context-vision for safe surgery, existing surgical practices, leadership support, and resilience-and 3 themes related to the intervention-innovation-value fit, holistic approach, and buy-in-facilitated or hindered implementation. Interviewees perceived improvements in teamwork and communication and intra- and inter-facility learning, and their need to deliver safe surgery evolved during the implementation period. CONCLUSIONS Examining implementation through the exploration, preparation, implementation, and sustainment phases offers insights into the implementation of interventions to improve surgical quality and promote sustainability.
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Abstract
Over the last several decades, significant progress has been made in the discovery of appropriate therapy in the management of infantile spasms (IS). Based on several well-controlled studies, the American Academy of Neurology and the Child Neurology Society have published the current best practice parameters for the treatment of IS. However, dissemination and implementation of evidence-based guidelines remain a significant challenge. Though the number of well-performed controlled trials and systematic reviews is increasing exponentially, the proportion of valuable new information subsequently embedding into the routine clinical care is significantly lower. Planned and systematic implementation of evidence-based interventions in a given health care structure may outstrip the benefits of discovering a new insight, procedure, or drug in another controlled setting. Implementation problems can be broad-ranging to hinder effective, efficient, safe, timely, and patient-centered care without significant variation. The first part of this review article provides a detailed summary of some crucial comparative treatment studies of IS available in the literature. In the second part, practical challenges to mitigate the gap between knowledge and practice to improve outcomes in the management of IS has been explored, and a consolidated framework approach for systematic implementation research methodology has been discussed to implement evidence-based guidelines for the management of IS. Although large multicenter controlled studies will help gather quality evidence in the treatment of IS, a more comprehensive range of scientific methodologies, including qualitative research and mixed research methodologies, will hold the more considerable promise for implementing evidence-based practices in the health care system.
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Affiliation(s)
- Debopam Samanta
- Child Neurology Section, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
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Biran N, Anthony Kouyaté R, Yucel E, McGovern GE, Schoenthaler AM, Durling OG, Unawane R, Schutt A, Panjabi S. Adaptation and Evaluation of a Symptom-Monitoring Digital Health Intervention for Patients With Relapsed and Refractory Multiple Myeloma: Pilot Mixed-Methods Implementation Study. JMIR Form Res 2020; 4:e18982. [PMID: 33200997 PMCID: PMC7709004 DOI: 10.2196/18982] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/10/2020] [Accepted: 09/30/2020] [Indexed: 01/09/2023] Open
Abstract
Background Relapsed and refractory multiple myeloma (RRMM) is a bone marrow cancer that requires systemic treatment, which often results in severe symptom burden. Recent studies have found that electronic patient-reported outcome (ePRO) interventions implemented in the clinic setting have had positive outcomes for other oncology populations. Evidence of the efficacy of a similar approach is lacking for patients with RRMM. Objective Recent recommendations for digital health interventions call for the publication of descriptions of iterative development processes in order to improve reproducibility and comparability. This study is an implementation pilot aiming to evaluate the acceptability and appropriateness of an ePRO intervention for patients with RRMM and to explore its impact on clinic workflow. Methods A total of 11 patients with RRMM were recruited from the John Theurer Cancer Center in Hackensack, New Jersey. Patients used a mobile app to report on 17 symptoms at 4 sessions, each a week apart. Patients could also report symptoms ad hoc. When reports met predefined thresholds, the clinic was alerted and patients received automated guidance. Study end points were assessed using qualitative and quantitative methods. Results A total of 9 patients (mean age 69.7 years) completed the study. Overall, 83% (30/36) of weekly sessions were completed. Patients found the frequency and time required to complete reporting acceptable. All patients agreed that the app was easy to use and understand. Providers felt the alerts they received required refinement. Patients and providers agreed it would be beneficial for patients to report for longer than 4 weeks. Patients felt that the training they received was adequate but contained too much information for a single session. All patients found the symptoms tracked to be appropriate; providers suggested shortening the list. All patients understood how to use the app for weekly reporting but had confusion about using it ad hoc. Providers felt the ad hoc feature could be removed. Neither patients nor providers viewed the in-app data reports but agreed on their potential value. Patients reported benefitting from symptom reporting through increased awareness of their symptoms. Clinic staff reported that app alerts were too numerous and redundant. They had difficulty responding to alerts within their existing workflow, partially because the data were not integrated into the electronic medical record system. Conclusions Overall, the intervention was found to be acceptable and appropriate for patients with RRMM. Points of friction integrating the intervention into the clinic workflow were identified. Clinic staff provided recommendations for addressing these issues. Once such modifications are implemented, ePRO data from patients with RRMM could be used to inform and improve clinical research and care. This study underlines the importance of an iterative approach to implementation that includes all stakeholders in order to ensure successful adoption.
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Affiliation(s)
- Noa Biran
- Division of Multiple Myeloma, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, United States
| | | | - Emre Yucel
- Amgen Inc, Thousand Oaks, CA, United States
| | | | | | | | - Rashmi Unawane
- Division of Multiple Myeloma, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, United States
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Hunter LJ, Bierman KL. Implementing a School Readiness Intervention in Community-based Childcare Centers: Director and Teacher Perceptions. EARLY EDUCATION AND DEVELOPMENT 2020; 32:1153-1173. [PMID: 35600504 PMCID: PMC9119566 DOI: 10.1080/10409289.2020.1833162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In the U.S., one-third of preschool children attend programs run by childcare centers. Childcare centers are generally isolated and under-resourced businesses, often challenged by high rates of teacher turnover and inconsistent financial support. Correspondingly, childcare centers often struggle to provide high-quality educational experiences for preschool children. This study introduced an evidence-based curriculum (REDI) to improve the educational experiences of preschool children in childcare centers and used a novel professional development (PD) model in which center directors were trained to serve as local coaches. Open-ended interviews with 45 teachers and 31 center directors evaluated the acceptability, feasibility, and effectiveness of the REDI intervention and coaching model. Participants also described their workplace and rated their intentions regarding future program use. Participants described multiple challenges in the workplace but generally positive perceptions of the REDI intervention. Perceptions regarding the feasibility of the coaching model were mixed. Workplace descriptions were associated with intervention experiences which, in turn, predicted intentions for future program use. Findings validate the importance of addressing the unique workplace challenges faced by childcare staff when designing classroom interventions and PD supports. Attending to program acceptability, feasibility, and perceived effectiveness in these settings may be critical to support sustained use.
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Deblinger E, Pollio E, Cooper B, Steer RA. Disseminating Trauma-Focused Cognitive Behavioral Therapy with a Systematic Self-care Approach to Addressing Secondary Traumatic Stress: PRACTICE What You Preach. Community Ment Health J 2020; 56:1531-1543. [PMID: 32318924 PMCID: PMC7529629 DOI: 10.1007/s10597-020-00602-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 03/06/2020] [Indexed: 11/29/2022]
Abstract
This pilot study evaluated the effectiveness of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) training programs augmented with a systematic "PRACTICE What You Preach" (PWYP) self-care focus, which has trainees personally utilize the coping skills they teach their clients. Participants were 115 clinicians/supervisors who completed a PWYP TF-CBT training program. Pre- to post-training analyses documented significant increases in participants' competency and fidelity in implementing TF-CBT (ps < .001), significantly more frequent use of coping skills including instrumental social support (p < .01), active coping (p < .001), humor (p < .01), and restraint (p < .01), and significant decreases in secondary traumatic stress (STS; p < .001). Children's symptoms of PTSD (ps < .001) and behavior problems (p < .05) also decreased significantly. This preliminary evidence suggests that training augmented with PWYP may enhance clinicians'/supervisors' personal coping and reduce their levels of STS without compromising treatment implementation efforts and client outcomes.
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Affiliation(s)
- Esther Deblinger
- CARES Institute, Rowan University School of Osteopathic Medicine (RowanSOM), 42 E. Laurel Road, Stratford, NJ, 08084, USA.
| | - Elisabeth Pollio
- CARES Institute, Rowan University School of Osteopathic Medicine (RowanSOM), 42 E. Laurel Road, Stratford, NJ, 08084, USA
| | - Beth Cooper
- CARES Institute, Rowan University School of Osteopathic Medicine (RowanSOM), 42 E. Laurel Road, Stratford, NJ, 08084, USA
| | - Robert A Steer
- Department of Psychiatry, Rowan University School of Osteopathic Medicine (RowanSOM), 42 E. Laurel Road, Stratford, NJ, 08084, USA
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Shobo OG, Okoro A, Okolo M, Longtoe P, Omale I, Ofiemu E, Anyanti J. Implementing a community-level intervention to control hypertensive disorders in pregnancy using village health workers: lessons learned. Implement Sci Commun 2020; 1:84. [PMID: 33024958 PMCID: PMC7531128 DOI: 10.1186/s43058-020-00076-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 09/17/2020] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Hypertensive disorders in pregnancy result in about 76,000 maternal deaths per year worldwide. Pre-eclampsia and eclampsia cause the most deaths. Interventions for managing these disorders are available in health facilities. We assess the effect of monitoring pregnant women's blood pressure (BP) in their homes using village health workers (VHWs) equipped with a BP-measuring device on hypertension in pregnancy, in a resource-poor setting. Also, we assess the VHWs' competence with the BP device, acceptability and appropriateness of the intervention, and factors that affect the implementation of the intervention. METHOD This is a mixed method study comprising quantitative and qualitative data collection. We implemented the intervention over 6 months across three local government areas in Gombe state, northeast Nigeria. The Replicating Effective Program (REP) framework guided the development of the implementation strategy. The quantitative data include routine measurement of pregnant women's blood pressure and observation of 118 VHW-client interactions. The routine data collection occurred between February and June 2019, and the observation occurred in January and June 2019. The qualitative data collection occurred via six focus group discussions with VHWs and ten in-depth interviews with community health extension workers in June 2019. We analyzed the data from the quantitative arm with SPSS version 23. For the qualitative arm, we transcribed the audio files, coded the texts, and categorized them using thematic analysis. RESULT Nine thousand pregnant women were recruited into the program. We observed a significant reduction in the prevalence of hypertension in pregnancy from 1.5 to 0.8% (Z = 4.04; p < 0.00001) after starting the program. Also, we found that VHWs can assess pregnant women's BP using a semi-automatic BP-measuring device. The intervention is acceptable and appropriate in resource-poor settings. Poor payment of VHW stipend and cooperation of local health staff are barriers to sustaining the intervention. CONCLUSION In resource-poor settings, health systems can train and equip non-technical people to identify and refer cases of high blood pressure in pregnancy to local health facilities on time. This may contribute to reducing maternal mortality and morbidity in these settings.
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Affiliation(s)
| | - Anselm Okoro
- Society for Family Health, 8 Port Harcourt Crescent, Area 11, Garki, Abuja, Nigeria
| | - Magdalene Okolo
- Society for Family Health, 8 Port Harcourt Crescent, Area 11, Garki, Abuja, Nigeria
| | - Peter Longtoe
- Society for Family Health, 8 Port Harcourt Crescent, Area 11, Garki, Abuja, Nigeria
| | - Isaac Omale
- Society for Family Health, 8 Port Harcourt Crescent, Area 11, Garki, Abuja, Nigeria
| | - Endurance Ofiemu
- Society for Family Health, 8 Port Harcourt Crescent, Area 11, Garki, Abuja, Nigeria
| | - Jennifer Anyanti
- Society for Family Health, 8 Port Harcourt Crescent, Area 11, Garki, Abuja, Nigeria
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Powell BJ, Patel SV, Haley AD, Haines ER, Knocke KE, Chandler S, Katz CC, Seifert HP, Ake G, Amaya-Jackson L, Aarons GA. Determinants of Implementing Evidence-Based Trauma-Focused Interventions for Children and Youth: A Systematic Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:705-719. [PMID: 31813066 PMCID: PMC7275881 DOI: 10.1007/s10488-019-01003-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A systematic review was conducted to identify determinants (barriers and facilitators) of implementing evidence-based psychosocial interventions for children and youth who experience emotional or behavioral difficulties due to trauma exposure. Determinants were coded, abstracted, and synthesized using the Exploration, Preparation, Implementation, and Sustainment framework. Twenty-three articles were included, all of which examined implementation of Trauma-Focused Cognitive Behavioral Therapy or Cognitive-Behavioral Intervention for Trauma in Schools. This review identified multilevel and multiphase determinants that can be addressed by implementation strategies to improve implementation and clinical outcomes, and suggests how future studies might address gaps in the evidence base.
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Affiliation(s)
- Byron J Powell
- Brown School, Washington University in St. Louis, St. Louis, USA.
| | - Sheila V Patel
- Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, USA
- RTI International, Durham, USA
| | - Amber D Haley
- Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, USA
| | - Emily R Haines
- Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, USA
- RTI International, Durham, USA
| | - Kathleen E Knocke
- Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, USA
| | - Shira Chandler
- Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, USA
| | - Colleen Cary Katz
- Silberman School of Social Work, Hunter College, City University of New York, New York, USA
| | | | - George Ake
- Duke University School of Medicine, Durham, USA
| | - Lisa Amaya-Jackson
- Center for Child and Family Health, Durham, USA
- Duke University School of Medicine, Durham, USA
| | - Gregory A Aarons
- Child and Adolescent Services Research Center, University of California at San Diego School of Medicine, San Diego, USA
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Smith JD, Mohanty N, Davis MM, Knapp AA, Tedla YG, Carroll AJ, Price HE, Villamar JA, Padilla R, Jordan N, Brown CH, Langman CB. Optimizing the implementation of a population panel management intervention in safety-net clinics for pediatric hypertension (The OpTIMISe-Pediatric Hypertension Study). Implement Sci Commun 2020; 1:57. [PMID: 32835224 PMCID: PMC7386167 DOI: 10.1186/s43058-020-00039-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/29/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Though clinical practice guidelines are available, the diagnosis of pediatric hypertension (HTN) is often missed. Management may not follow guidelines due to the measurement challenges in children, complexity of interpreting youth blood pressure standards that are dependent on height, age, and sex, familiarity with diagnostic criteria, and variable comfort with management of pediatric HTN among providers. Evidence suggests that wide adoption and adherence to pediatric HTN guidelines would result in lower cardiovascular disease and kidney damage in adulthood. The proposed project will develop an implementation strategy package to increase adherence to clinical practice guidelines for pediatric HTN within safety-net community health centers (CHCs). The centerpiece of which is a provider-facing population panel management (PPM) tool and point-of-care clinical decision support (CDS). Prior research indicates that multiple discrete implementation strategies (e.g., stakeholder involvement, readiness planning, training, ongoing audit and feedback) are needed to institute practice- and provider-level adoption of such tools. METHODS Using participatory research methods involving stakeholders from a practice-based research network of CHCs, with input from scientific advisors, the project aims to (1) employ user-centered design methods to tailor an existing CDS tool for use at the point of care and optimize cohort management with a PPM tool to support adherence to the latest pediatric HTN guidelines, and (2) use a stakeholder-driven method for selecting implementation strategies that support tool adoption and increase guideline-adherent physician behaviors. Multilevel process evaluation using surveys and key informant interview data will assess the acceptability, adoption, appropriateness, cost, and feasibility of the PPM tool and its multicomponent implementation strategy package. Usability testing will be conducted with the PPM tool to iteratively refine features and ensure proper functionality. DISCUSSION The proposed research has the potential to improve identification, diagnosis, and management of HTN in primary care settings for high-risk youth by assisting healthcare providers in implementing the American Academy of Pediatrics' 2017 guidelines using an EHR-integrated PPM tool with CDS. Should the strategy package for PPM tool adoption be successful for pediatric HTN, findings will be translatable to other settings and PPM of other chronic cardiovascular conditions affecting overall population health.
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Affiliation(s)
- Justin D. Smith
- Departments of Psychiatry and Behavioral Sciences, Preventive Medicine, Medical Social Sciences, and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Nivedita Mohanty
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Matthew M. Davis
- Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, and Departments of Pediatrics, Medicine, Medical Social Sciences, and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Ashley A. Knapp
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Yacob G. Tedla
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Allison J. Carroll
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Heather E. Price
- Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago and Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Juan A. Villamar
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Roxane Padilla
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Neil Jordan
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - C. Hendricks Brown
- Departments of Psychiatry and Behavioral Sciences, Preventive Medicine, and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Craig B. Langman
- Ann & Robert H. Lurie Children’s Hospital of Chicago and Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL USA
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Porteny T, Alegría M, del Cueto P, Fuentes L, Markle SL, NeMoyer A, Perez GK. Barriers and strategies for implementing community-based interventions with minority elders: positive minds-strong bodies. Implement Sci Commun 2020; 1:41. [PMID: 32885198 PMCID: PMC7427860 DOI: 10.1186/s43058-020-00034-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 04/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND By 2040, one out of three older adults in the USA are expected to belong to a racial/ethnic minority group. This population has an increased risk of mental and physical disability with significant barriers to access care. Community-based organizations (CBOs) often provide programming to serve minority and immigrant elders. Limited resources and other barriers such as lack of trained staff make it difficult to implement evidence-based interventions (EBIs) in CBOs for long-term adoption. Yet little is known about what factors can facilitate adoption of EBIs in CBOs serving minority elders. METHODS Positive-Minds-Strong Bodies (PM-SB), an evidence-based intervention offered in four languages, aims to reduce mental and physical disability for minority and immigrant elders through the efforts of community health workers and exercise trainers. The intervention consists of cognitive behavior therapy and exercise training sessions delivered over 6 months. During a recent clinical trial of this intervention, we elicited feedback from CBO staff to determine how best to facilitate the implementation and long-term sustainability of PM-SB within their agencies. We surveyed 30 CBO staff members, held four focus groups, and conducted 20 in-depth interviews to examine staff perspectives and to reveal factors or changes needed to facilitate long-term adoption in prospective CBOs. RESULTS Participants reported that staff motivation and implementation could be improved through the following changes: increasing patient compensation for treatment sessions, decreasing levels of organizational accountability, and reducing staff demands embedded in the intervention. Although most staff perceived that PM-SB improved their agency's ability to address the health and well-being of elders, capacity-building strategies such as a "train-the-trainer" initiative were identified as priorities to address staff turnover for sustainability. Adapting the intervention to get financial reimbursement also emerged as vital. CONCLUSIONS Augmenting financial incentives, streamlining procedures, and simplifying staff accountability were suggested strategies for facilitating the transition from a disability prevention clinical trial in minority and immigrant elders to a scalable implementation in routine services at CBOs. TRIAL REGISTRATION ClinicalTrials.gov, NCT02317432.
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Affiliation(s)
- Thalia Porteny
- Interfaculty Initiative in Health Policy, Graduate School of Arts and Science, Harvard University, 1350 Massachusetts Avenue, Suite 350, Cambridge, MA 02138-3654 USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114 USA
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215 USA
| | - Paola del Cueto
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114 USA
| | - Larimar Fuentes
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114 USA
| | - Sheri Lapatin Markle
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114 USA
| | - Amanda NeMoyer
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114 USA
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115 USA
| | - Giselle K. Perez
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215 USA
- Health Policy Research Center at the Mongan Institute, Massachusetts General Hospital, 100 Cambridge Street, Boston, MA 02114 USA
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Dickson KS, Aarons GA, Anthony LG, Kenworthy L, Crandal BR, Williams K, Brookman-Frazee L. Adaption and pilot implementation of an autism executive functioning intervention in children's mental health services: a mixed-methods study protocol. Pilot Feasibility Stud 2020; 6:55. [PMID: 32699642 PMCID: PMC7371471 DOI: 10.1186/s40814-020-00593-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 04/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Youth with autism spectrum disorder (ASD) represent a growing population with significant service needs. Prominent among these needs are high rates of co-occurring psychiatric conditions that contribute to increased functional impairments and often necessitate mental health services. Executive functioning deficits are associated with ASD as well as common co-occurring conditions (e.g., attention-deficit/hyperactivity disorder) and an evidence-based intervention has been developed and tested to address executive functioning within the school context. There is an urgent need to implement indicated evidence-based interventions for youth with ASD receiving care in community mental health settings. Interventions that optimally "fit" the mental health services context as well as the complex and co-occurring mental health needs of these youth have the potential to improve key clinical outcomes for this high priority population. METHODS This mixed-methods developmental study will apply the Exploration, Preparation, Implementation, Sustainment implementation framework and a community-academic partnership approach to systematically adapt and test an evidence-based executive functioning intervention for youth with ASD for delivery in community mental health settings. Specific aims are to (1) conduct a need and context assessment to inform the systematic adaptation an executive functioning evidence-based intervention; (2) systematically adapt the clinical intervention and develop a corresponding implementation plan, together entitled "Executive Functioning for Enhancing Community-based Treatment for ASD," (EFFECT for ASD); and (3) conduct a feasibility pilot test of EFFECT for ASD in community mental health settings. DISCUSSION Tailoring evidence-based interventions for delivery in community-based mental health services for youth with ASD has the potential to increase quality of care and improve child outcomes. Results from the current study will serve as the foundation for large-scale hybrid implementation and effectiveness trials and a generalizable approach for different service systems of care and clinical populations. TRIAL REGISTRATION Clinicaltrials.gov, NCT04295512.
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Affiliation(s)
- Kelsey S. Dickson
- San Diego State University, San Diego, CA USA
- Child and Adolescent Services Research Center, San Diego, CA USA
| | - Gregory A. Aarons
- Child and Adolescent Services Research Center, San Diego, CA USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA USA
| | - Laura Gutermuth Anthony
- University of Colorado School of Medicine, Aurora, CO USA
- Children’s Hospital of Colorado, Aurora, CO USA
| | - Lauren Kenworthy
- Center for Autism Spectrum Disorders, Children’s National, Washington, DC USA
| | | | - Katherine Williams
- Department of Psychiatry, University of California San Diego, La Jolla, CA USA
- Rady Children’s Hospital-San Diego, San Diego, CA USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, San Diego, CA USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA USA
- Autism Disovery Institute at Rady Children’s Hospital, San Diego, CA USA
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Fostering Health Literacy Responsiveness in a Remote Primary Health Care Setting: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082730. [PMID: 32316171 PMCID: PMC7215686 DOI: 10.3390/ijerph17082730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 01/03/2023]
Abstract
Primary healthcare organisations have an important role in addressing health literacy as this is a barrier to accessing and utilising health care. Until recently, no organisational development tool operationalising health literacy in an Australian context existed. This research evaluated the efficacy of the Organisational Health Literacy Responsiveness (Org-HLR) tool and associated assessment process in a primary healthcare organisation in the Pilbara region of Western Australia. This study utilised a sequential explanatory mixed methods research design incorporating the collection and analysis of data in two phases: (1) Pre- and post-survey data and; (2) seven semi-structured interviews. Survey results showed that participants’ confidence in core health literacy concepts improved from baseline following the intervention. Analysis of the interview data revealed participants’ initial understanding of health literacy was limited, and this impeded organisational responsiveness to health literacy needs. Participants reported the workshop and tool content were relevant to their organisation; they valued involving members from all parts of the organisation and having an external facilitator to ensure the impartiality of the process. External barriers to improving their internal organisational health literacy responsiveness were identified, with participants acknowledging the management style and culture of open communication within the organisation as enablers of change. Participants identified actionable changes to improve their organisational health literacy responsiveness using the process of organisational assessment and change.
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Ludden T, Shade L, Welch M, Halladay J, Donahue KE, Coyne-Beasley T, Bray P, Tapp H. What types of dissemination of information occurred between researchers, providers and clinical staff while implementing an asthma shared decision-making intervention: a directed content analysis. BMJ Open 2020; 10:e030883. [PMID: 32152153 PMCID: PMC7064133 DOI: 10.1136/bmjopen-2019-030883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 01/21/2020] [Accepted: 02/04/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To qualitatively analyse different types of dissemination of information during monthly group calls between researchers, providers and clinical staff used to establish best practices for implementing an asthma shared decision-making (SDM) intervention. Evaluating dissemination of information can provide a better understanding of how best practices are shared, informing implementation approaches to improve the uptake of new evidence and overcome barriers. SETTING 10 primary care practices in North Carolina. PARTICIPANTS Providers and clinical staff participated in monthly group phone calls with researchers to share best practices during implementation of a SDM intervention for asthma patients. DESIGN The research team transcribed and coded statements using content analysis into three different knowledge types: Knowledge Position, Knowledge Form and Knowledge Object. Knowledge Objects were further classified using directed content analysis where the research team interpreted the content objects through a classification process of identifying themes or patterns to describe three different types of dissemination of information: (A) Confirmation of Existing Knowledge, (B) Generation of New Knowledge and (C) Spreading of New Knowledge. RESULTS Across the 8 transcripts, 4 Knowledge Positions, 7 Knowledge Forms and 18 types of Knowledge Objects were identified. From the Knowledge Objects, Confirmation of Existing Knowledge occurred during the training of participating practices. The review also identified Generation of New Knowledge by providers and clinical staff raised in these calls. This Generation of New Knowledge was later documented being used by other practices with the identification of Spreading of New Knowledge. CONCLUSION The research team described the types of dissemination of information that occurred between researchers, providers and clinical staff during implementation of an asthma SDM intervention. Both Confirmation of Existing Knowledge and Generation of New Knowledge in response to barriers occurred. These exploratory dissemination of information results provide additional mechanisms for evaluating implementation science. TRIAL REGISTRATION NUMBER NCT02047929; Post-results.
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Affiliation(s)
- Thomas Ludden
- Department of Family Medicine, Atrium Health, Charlotte, North Carolina, USA
| | - Lindsay Shade
- Department of Family Medicine, Atrium Health, Charlotte, North Carolina, USA
| | - Madelyn Welch
- School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Jacqueline Halladay
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Katrina E Donahue
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tamera Coyne-Beasley
- Department of Pediatrics and Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Paul Bray
- Community Based Care, Vidant Medical Center, Greenville, North Carolina, USA
| | - Hazel Tapp
- Department of Family Medicine, Atrium Health, Charlotte, North Carolina, USA
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Powell BJ, Haley AD, Patel SV, Amaya-Jackson L, Glienke B, Blythe M, Lengnick-Hall R, McCrary S, Beidas RS, Lewis CC, Aarons GA, Wells KB, Saldana L, McKay MM, Weinberger M. Improving the implementation and sustainment of evidence-based practices in community mental health organizations: a study protocol for a matched-pair cluster randomized pilot study of the Collaborative Organizational Approach to Selecting and Tailoring Implementation Strategies (COAST-IS). Implement Sci Commun 2020; 1. [PMID: 32391524 PMCID: PMC7207049 DOI: 10.1186/s43058-020-00009-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Implementing and sustaining evidence-based programs with fidelity may require multiple implementation strategies tailored to address multi-level, context-specific barriers and facilitators. Ideally, selecting and tailoring implementation strategies should be guided by theory, evidence, and input from relevant stakeholders; however, methods to guide the selection and tailoring of strategies are not well-developed. There is a need for more rigorous methods for assessing and prioritizing implementation determinants (barriers and facilitators) and linking implementation strategies to determinants. The Collaborative Organizational Approach to Selecting and Tailoring Implementation Strategies (COAST-IS) is an intervention designed to increase the effectiveness of evidence-based practice implementation and sustainment. COAST-IS will enable organizational leaders and clinicians to use Intervention Mapping to select and tailor implementation strategies to address their site-specific needs. Intervention Mapping is a multi-step process that incorporates theory, evidence, and stakeholder perspectives to ensure that implementation strategies effectively address key determinants of change. Methods COAST-IS will be piloted with community mental health organizations that are working to address the needs of children and youth who experience trauma-related emotional or behavioral difficulties by engaging in a learning collaborative to implement an evidence-based psychosocial intervention (trauma-focused cognitive behavioral therapy). Organizations will be matched and then randomized to participate in the learning collaborative only (control) or to receive additional support through COAST-IS. The primary aims of this study are to (1) assess the acceptability, appropriateness, feasibility, and perceived utility of COAST-IS; (2) evaluate the organizational stakeholders' fidelity to the core elements of COAST-IS; and (3) demonstrate the feasibility of testing COAST-IS in a larger effectiveness trial. Discussion COAST-IS is a systematic method that integrates theory, evidence, and stakeholder perspectives to improve the effectiveness and precision of implementation strategies. If effective, COAST-IS has the potential to improve the implementation and sustainment of a wide range of evidence-based practices in mental health and other sectors. Trial registration This study was registered in ClinicalTrials.gov (NCT03799432) on January 10, 2019 (last updated August 5, 2019).
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Affiliation(s)
- Byron J Powell
- Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA.,Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amber D Haley
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sheila V Patel
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lisa Amaya-Jackson
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.,National Center for Child Traumatic Stress, Durham, NC, USA.,North Carolina Child Treatment Program, Center for Child and Family Health, Durham, NC, USA
| | - Beverly Glienke
- North Carolina Child Treatment Program, Center for Child and Family Health, Durham, NC, USA
| | - Mellicent Blythe
- North Carolina Child Treatment Program, Center for Child and Family Health, Durham, NC, USA.,School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca Lengnick-Hall
- Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA
| | - Stacey McCrary
- Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA
| | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
| | - Cara C Lewis
- MacColl Center for Health Care Innovation, Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Gregory A Aarons
- Department of Psychiatry, Child and Adolescent Services Research Center, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Kenneth B Wells
- Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,The Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Mary M McKay
- Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Hooley C, Winters AM, Pisciotta C, Gopalan G. Caregiver-relevant perspectives from a multi-stakeholder collaborative advisory board on adapting a child mental health intervention to be delivered in child-welfare settings. JOURNAL OF PUBLIC CHILD WELFARE 2020; 15:318-340. [PMID: 34248440 PMCID: PMC8261574 DOI: 10.1080/15548732.2020.1724238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/13/2020] [Accepted: 01/28/2020] [Indexed: 06/13/2023]
Abstract
Adapting evidence based mental health interventions (EBI) to be provided in child welfare (CW) settings by CW workers could reduce barriers to families receiving mental health care. In order to promote implementation success, the adaptation of EBIs should include the perspectives of those who deliver and those who receive the EBI. The following study uses qualitative methods to elicit and analyze caregiver-relevant perspectives and adaption recommendations from CW stakeholders about the 4Rs and 2Ss Strengthening Families Program, an EBI for youth disruptive behavior disorders, to be implemented in CW settings. Recommendations included adjusting curriculum to better fit the culture of recipients and conveying the importance of openness and respect to providers.
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Affiliation(s)
- Cole Hooley
- School of Social Work, Brigham Young University
| | | | | | - Geetha Gopalan
- Silberman School of Social Work, The City University of New York, Hunter College
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Naef R, Kläusler-Troxler M, Ernst J, Huber S, Dinten-Schmid B, Karen T, Petry H. Translating family systems care into neonatology practice: A mixed method study of practitioners’ attitudes, practice skills and implementation experience. Int J Nurs Stud 2020; 102:103448. [DOI: 10.1016/j.ijnurstu.2019.103448] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
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Kim ME. Shifting the Lens: An Implementation Study of a Community-Based and Social Network Intervention to Gender-Based Violence. Violence Against Women 2020; 27:222-254. [PMID: 31928341 DOI: 10.1177/1077801219889176] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Responding to the call to "shift the lens" and expand gender-based violence remedies beyond individualized direct services and law enforcement remedies, anti-violence providers have struggled to redefine and redirect intervention approaches. This implementation study leverages the framework of implementation science to investigate an exploratory statewide initiative based on the Creative Interventions model and aimed to build organizational and regional capacity to implement community-based or social network interventions within provider organizations. Using data from nine organizations, this mixed-methods study identifies factors related to implementation of this innovative approach including organizational motivation, capacity, and perceived needs related to adoption and implementation.
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Affiliation(s)
- Mimi E Kim
- California State University, Long Beach, USA
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