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Abstract Background Communities across the U.S. and globally confront the challenge of transforming negative social determinants of health (SDOH) into positive ones. To address this complex social problem, the collective impact (CI) approach has promise but has been critiqued for insufficiently challenging structural inequities. Research applying CI to SDOH is limited. This mixed-methods study examined early adoption of CI in the 100% New Mexico initiative that aims to address SDOH population-wide in a state with strong cultural identity and assets but also persistent socio-economic inequality. Methods A web-based survey, interviews and focus groups were conducted with initiative participants in June and July 2021. Survey participants rated agreement on a 4-point scale with six items assessing CI foundation adapted from the Collective Impact Community Assessment Scale. Interviews and focus groups centered on motivation to engage, progress achieved in model components, CI core conditions, and contextual factors influencing experiences. Surveys were analyzed using descriptive means and proportions. Qualitative data were analyzed using thematic analysis and an inductive approach followed by stratified analyses and co-interpretation of emergent findings with model developers. Results Fifty-eight participants completed the survey, and 21 individuals participated in interviews (n = 12) and two focus groups (n = 9). Survey mean scores were highest related to initiative buy-in and commitment, and lower related to shared ownership, having multiple perspectives and voices involved, and adequate resources. Qualitative results showed that the framework’s cross-sector emphasis helped motivate participation. Participants embraced the focus on leveraging existing community assets that is characteristic of CI and the current framework. Counties implemented effective engagement and visibility strategies including mural projects and book clubs. Participants expressed communication challenges across county sector teams which influenced feelings of accountability and ownership. Participants did not report challenges lacking relevant, available, and timely data or tension between funder-driven and community-driven desired outcomes, in contrast with previous CI research. Conclusion Multiple foundational conditions of CI were supported in 100% New Mexico, including evidence for support of the common agenda addressing SDOH, shared measurement framework, and mutually reinforcing activities. Study results suggest that efforts to launch CI to address SDOH, which is by nature multi-sector, should include robust strategies to address communication needs of local teams. The use of community-administered surveys to identify gaps in SDOH resource access contributed to ownership and a sense of collective efficacy that may portend sustainability; however, relying on volunteers in the absence of other resources extensively also threatens sustainability.

Objectives: This study investigates how family profiles of risk and resilience established prior to COVID-19 are associated with changes in caregiver depression and stress 1 year after the pandemic onset, and how these associations are moderated by experiences of social loneliness.Methods: A sample of 243 caregivers in four risk and resilience profiles interviewed pre-COVID-19 were interviewed virtually in December 2020–February 2021 (during pandemic). Multi-level models were used to examine changes in mental health.Results: All caregivers reported increases in extreme stress during the pandemic. Caregivers with less relative adversity pre-pandemic showed significantly greater depression and loneliness in the pandemic compared to caregivers with higher pre-pandemic adversity. Social loneliness was a moderator of the association between pre-pandemic adversity and mental health.Conclusion: The study suggests families with more pre-pandemic adversity demonstrate coping that buffers the negative impact of social loneliness on mental health, emphasizing the strengths of these families that are assets to build upon in crisis. Families with more relative advantage pre-pandemic likely need assistance to reduce feelings of stress and depression in the face of increased social loneliness.

Abstract Background Health care administrators must establish and promote effective partnerships with community agencies to address social determinants of health, including reducing exposure of infants and young children to chronic stress. Because infants’ experiences are inextricably tied to their caregivers, an important target for mitigating “toxic” stress exposure in early childhood is through reducing parents’ experiences of chronic stress in addition to protecting children from direct experiences of harm such as physical or sexual abuse. Conducting screening to identify when children are exposed to early life adversity is a first step; connecting families to needed support services is an essential component to addressing identified challenges. This paper presents the methodology of a three-year study of health care systems innovations designed to engage and support parents of infants to prevent and mitigate children’s toxic stress exposures. Methods Key study features included: 1) multi-component study in five U.S. communities and nine pediatric health care clinics and the families they serve, 2) a developmental evaluation approach to describe how innovations are experienced over time at three levels—community systems, pediatric providers, and families, and 3) rapid cycle feedback conducted with communities, clinics and families to co-interpret data and findings. Data sources included: 1) focus groups and interviews with community stakeholders, clinic staff, and families, 2) electronic health record and Medicaid services data extracted to assess health care quality, utilization, and financial impact, and 3) clinic-recruitment of 908 parents of infants in a longitudinal survey. Results. The sample is briefly characterized based on responses to the enrollment phase of the parent survey. Conclusions We discuss the study design elements’ contribution to generating evidence needed by innovators, communities, and clinics to modify and sustain investments in these innovations to prevent or mitigate the effects of exposure to toxic stress on young children.