School Parent Attitudes and Perceptions Relating to Animals, Animal-Assisted Interventions, and the Support of Children’s Mental Health

Growing awareness of the negative effects of trauma has led San Antonio, TX, school districts to expand efforts that can help mitigate these effects and support mental health. Given the literature around the psychological benefits of human–animal interactions, the concept of incorporating animals in treatments or interventions is not a new one. While schools have begun considering or utilizing animal-assisted interventions (AAIs), there have been limited efforts to understand existing perceptions relating to animals and AAIs among school parents in this Hispanic community. To address this gap, a cross-sectional study consisting of a 34-item survey was conducted to explore attitudes, knowledge, and perceptions relating to animals (i.e., pets), AAIs, and the need for supporting young children’s mental health among parents. A total of 187 surveys from two school districts were completed and utilized for analysis. The study’s findings demonstrate that parents acknowledged the importance of addressing mental health issues early on and were aware of the health benefits human–animal interactions can provide. Furthermore, parents had positive attitudes toward pets and positive perceptions toward AAIs in schools. Some implementation concerns were expressed relating to safety and well-being. Overall, these findings suggest there is existing parent support in using AAIs as a trauma-informed strategy and school innovation.

The Healthy Native Youth Implementation Toolbox: Using Implementation Mapping to adapt an online decision support system to promote culturally-relevant sexual health education for American Indian and Alaska Native youth

Background

American Indian and Alaska Native (AI/AN) youth experience serious disparities in sexual and reproductive health, including the highest teen birth rate among racial/ethnic groups, and disproportionate rates of sexually transmitted infections (STI), including HIV. A growing number of evidence-based programs (EBPs) that integrate the strengths and cultural teachings of Native communities exist. Yet, multiple factors, including lack of trained personnel, limited resources, and geographic isolation, may hinder their adoption and implementation. Innovative implementation strategies that facilitate the adoption and implementation of sexual health EBPs in Native communities may help reduce these disparities.

Methods

We applied Implementation Mapping, a systematic planning framework that utilizes theory, empirical evidence, and community input, to adapt a theory-based, online decision support system, iCHAMPSS (CHoosing And Maintaining Effective Programs for Sex Education in Schools), to support underlying dissemination and implementation processes unique to Native communities. We used an iterative design process, incorporating input from Native practitioners and academicians, to ensure that the adapted decision support system reflects cultural identification, community values, and experiences.

Results

Grounded in diffusion of innovations, organizational stage theory, and social cognitive theory, the Healthy Native Youth Implementation Toolbox supports Native practitioners through five phases (Gather, Choose, Prepare, Implement, and Grow) to adopt, implement, and maintain a culturally-relevant, age-appropriate sexual health EBP. The Toolbox provides tools, ready-to-use templates, and guidance to plan, implement, and grow a culturally-relevant adolescent health program with their Tribe or community. Hosted within the Healthy Native Youth website (www.healthynativeyouth.org), the Toolbox comprises: (1) a curriculum portal with access to 15 culturally-relevant, age-appropriate evidence-based health promotion programs for AI/AN youth; (2) a "resource library" comprising 20+ support tools, templates, and links to external resources, and (3) "stories from the field" comprising testimonials from experienced Native educators, who have implemented sexual health programs.

Conclusion

There is a continued need to design, test, and evaluate D&I strategies that are relevant to Native communities. The Healthy Native Youth Implementation Toolbox contributes to the dissemination and implementation of evidence-based, culturally-relevant sexual health education programs in diverse Native communities. Implementation Mapping provided a systematic approach to guide the adaptation process and integrate community voice with the ultimate goal of enhancing sexual health equity among AI/AN youth.

Exploring School Staff Perceptions Relating to Animals and Their Involvement in Interventions to Support Mental Health

Given the growing awareness of the health benefits of human–animal interactions, the use of animal-assisted interventions (AAIs) in educational settings has increased over the years. While many school districts are now considering or utilizing AAIs, the literature investigating AAI-related perceptions among school stakeholders is limited with previous studies focusing on evaluating specific programs. To address this gap, a qualitative exploratory study was conducted using semi-structured interviews with school staff in the San Antonio, TX community. A total of 11 interviews were completed with staff serving preschool and elementary school age children. Data collected from interviews were analyzed using thematic analysis. Findings demonstrated that participating staff had some knowledge of the potential benefits of human–animal interactions and perceived the involvement of animals in interventions to be beneficial to children’s emotions and social-emotional skills. While perceptions of AAIs were generally positive, concerns around children’s safety and well-being were expressed as potential barriers in the adoption of AAIs in schools. These findings are preliminary and provide a segue to future research that can help expand our understanding of how school staff perceive AAIs, their impact on children’s mental health, their compatibility with school values, and their advantage relative to other interventions.

Using Implementation Mapping to Build Organizational Readiness

Organizational readiness is essential for high-quality implementation of innovations (programs, policies, practices, or processes). The R = MC² heuristic describes three readiness components necessary for implementation—the general functioning of the organization (general capacities), the ability to deliver a particular innovation (innovation-specific capacities), and the motivation to implement the innovation. In this article, we describe how we used the Readiness Building System (RBS) for assessing, prioritizing, and improving readiness and Implementation Mapping (IM), a systematic process for planning implementation strategies, to build organizational readiness for implementation of sexual assault prevention evidence-based interventions (EBIs). While RBS provides an overarching approach for assessing and prioritizing readiness constructs (according to the R = MC² heuristic; Readiness = Motivation x general Capacity × innovation specific Capacity), it does not provide specific guidance on the development and/or selection and tailoring of strategies to improve readiness. We used the five IM tasks to identify and prioritize specific readiness goals and develop readiness-building strategies to improve subcomponents described in the R = MC² heuristic. This article illustrates how IM can be used synergistically with the RBS in applied contexts to plan implementation strategies that will improve organizational readiness and implementation outcomes. Specifically, we provide an example of using these two frameworks as part of the process of building organizational readiness for implementation of sexual assault prevention EBIs.

Communication Preferences and Satisfaction of Secure Messaging Among Patients and Providers in the Military Healthcare System

Introduction

Use of electronic secure messaging (SM) is rapidly growing in various healthcare settings. However, there is a large number of patients that choose not use SM or use it minimally. Thus, understanding preferences for patient-provider communication modalities is critically important, particularly among military healthcare beneficiaries. The purpose of this study was to assess preferences for patient-provider communication modalities (in person, telephone, SM, or mail) among a sample of patients, providers, and staff located at five Air Force military treatment facilities across the USA.

Methods

We recruited patients, providers, and staff, from five family health clinics to complete a short survey. We measured participants' preferences for communication modality for various healthcare concerns, such as responses to non-urgent medical questions, test results, and medication renewal information. We also measured satisfaction with MiCare, the Air Force's SM system. We conducted chi-square analyses and Fisher's exact tests to assess differences in communication preferences by patients, providers, and staff and we computed frequencies in satisfaction responses.

Results

We found that while providers and staff (N = 70) prefer to communicate with patients about various healthcare concerns online through MiCare, patients (N = 1,260) prefer to communicate in-person or through the telephone. Patients were generally satisfied with MiCare; however, there was a large proportion of patients who were undecided about MiCare's impact on the quality of care they received (40.3%). Additionally, although the majority of providers and staff believed MiCare improved their efficiency (58.0%) and communication with patients (72.3%), 65.7% of providers and staff believed MiCare had increased their workload.

Conclusion

MiCare is a promising tool to improve patient-provider communication. However, future studies are needed to better understand why patients within the military healthcare system prefer communication modalities other than MiCare and to identify strategies to decrease provider and staff workloads while using MiCare.

The Context of Sexual Decisions and Intrapersonal and Interpersonal Factors Related to Sexual Initiation Among Female Military-Dependent Youth

Despite the sizable population of military-dependent youth (MDY) in the United States and the military stressors they experience (e.g., relocations, parental deployment), little is known about MDY's sexual behavior, especially about the perceived role that military stressors play in their sexual decisions, such as the decision to initiate sex. We conducted 25 semistructured, in-depth interviews with sexually experienced female MDY aged 15 to 19 years to (a) describe MDY's general perceptions of military life and (b) identify intrapersonal and interpersonal characteristics related to MDY's sexual initiation, including the perceived impact of military stressors. We analyzed life history grids and transcripts to identify common and unique themes across participants' experiences. Most participants reported having positive experiences related to military life, and most did not believe that military stressors influenced their decision to initiate sex. Common intrapersonal and interpersonal characteristics related to sexual initiation were having an older first sexual partner, being in a dating relationship, receiving sexual health education prior to their first sexual experience, and discussing sex with a parent prior to their first sexual experience. These intrapersonal and interpersonal characteristics should be considered when developing sexual health programs for MDY, which should focus on building supportive peer and parental relationships.

Using Intervention Mapping for Program Design and Production of iCHAMPSS: An Online Decision Support System to Increase Adoption, Implementation, and Maintenance of Evidence-Based Sexual Health Programs

In Texas and across the United States, unintended pregnancy, HIV, and sexually transmitted infections (STIs) among adolescents remain serious public health issues. Sexual risk-taking behaviors, including early sexual initiation, contribute to these public health problems. Over 35 sexual health evidence-based programs (EBPs) have been shown to reduce sexual risk behaviors and/or prevent teen pregnancies or STIs. Because more than half of these EBPs are designed for schools, they could reach and impact a considerable number of adolescents if implemented in these settings. Most schools across the U.S. and in Texas, however, do not implement these programs. U.S. school districts face many barriers to the successful dissemination (i.e., adoption, implementation, and maintenance) of sexual health EBPs, including lack of knowledge about EBPs and where to find them, perceived lack of support from school administrators and parents, lack of guidance regarding the adoption process, competing priorities, and lack of specialized training on sexual health. Therefore, this paper describes how we used intervention mapping (Steps 3 and 4, in particular), a systematic design framework that uses theory, empirical evidence, and input from the community to develop CHoosing And Maintaining Effective Programs for Sex Education in Schools (iCHAMPSS), an online decision support system to help school districts adopt, implement, and maintain sexual health EBPs. Guided by this systematic intervention design approach, iCHAMPSS has the potential to increase dissemination of sexual health EBPs in school settings.

Building academic-military research collaborations to improve the health of service members

BACKGROUND

Academic-military research collaborations are desirable for many reasons; however, little guidance in the literature exists to help researchers understand collaboration requirements.

PURPOSE

To describe the process for establishing academic-military research collaborations.

METHOD

Specific collaboration requirements researchers must be aware of are outlined, two case studies are provided, and opportunities for and challenges with collaborations are discussed.

DISCUSSION

Academic-military collaborations made it possible to conduct studies of stigma and barriers with mental health care among military nursing personnel and the utilization of secure messaging for health concerns with service members and healthcare providers. Planning these efforts began in the earliest stages of developing research proposals, and additional time was required to complete regulatory requirements prior to study implementation. Understanding military-specific considerations and establishing clear expectations and responsibilities were essential.

CONCLUSIONS

Despite the challenges involved, academic-military collaborations improve the quality of the research by enhancing access to funding, expertise, and resources.

iCHAMPSS: Usability and Psychosocial Impact for Increasing Implementation of Sexual Health Education

INTRODUCTION

Diffusion of sexual health evidence-based programs (EBPs) in schools is a complex and challenging process. iCHAMPSS ( CHoosing And Maintaining effective Programs for Sex education in Schools) is an innovative theory- and Web-based decision support system that may help facilitate this process. The purpose of this study was to pilot-test iCHAMPSS for usability and short-term psychosocial impact.

METHOD

School district stakeholders from across Texas were recruited ( N = 16) and given access to iCHAMPSS for 3 weeks in fall 2014. Pre- and posttests were administered to measure usability parameters and short-term psychosocial outcomes. Data were analyzed using descriptive statistics and the Wilcoxon signed-rank test.

RESULTS

Most participants reported that iCHAMPSS was easy to use, credible, helpful, and of sufficient motivational appeal. iCHAMPSS significantly increased participants' self-efficacy to obtain approval from their board of trustees to implement a sexual health EBP. Positive, though nonsignificant, trends included increased knowledge to locate EBPs, skills to prioritize sexual health education at the district level, and ability to choose an EBP that best meets district needs.

CONCLUSIONS

iCHAMPSS is an innovative decision support system that could accelerate uptake of EBPs by facilitating diffusion and advance the field of dissemination and implementation science for the promotion of sexual health EBPs.

Associations between parental deployment, relocation, and risky sexual behaviors among a clinic-based sample of military-dependent youth

Although sexual behaviors have been extensively studied among youth in general, they have been relatively understudied among military-dependent youth (MDY). Furthermore, the impact of unique military stressors, such as parental deployment and multiple relocations, on the sexual behaviors of MDY has not been assessed. In this pilot study, we estimated the prevalence of sexual behaviors among MDY, and examined the association between these behaviors and parental deployment and multiple relocations. Between June and September 2011, we recruited youth (N = 208; aged 15-19 years) who attended a military treatment facility in the southern United States, to complete a short, paper-based survey. We computed prevalence estimates and conducted Chi-square analyses, as well as logistic regression analyses, while adjusting for age, gender, and race/ethnicity. More than half (53.7 %) of the youth reported being sexually experienced, and many of these youth reported engaging in risky sexual behaviors. Parental deployment and multiple relocations were significantly associated only with having had sex in the past 3 months. Although with most sexual behaviors there was no significant association between parental deployment and multiple relocations, many MDY are sexually experienced and engage in risky sexual behaviors. MDY should thus be exposed to evidence-based strategies for sexually transmitted infection and pregnancy prevention, as well as provided with teen-friendly health care services and comprehensive sexual/reproductive health counseling.