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Title X clinics provide access to a wide range of contraceptive options for individuals of all income levels and documentation statuses. As Title X continues to face political uncertainties, it is important to provide up-to-date information about its clients' use of contraception. This study used recent nationally representative data to compare contraception received by Title X clients with that received by clients of other providers. This article draws on 2015–2017 and 2017–2019 waves of the National Survey of Family Growth. The sample was restricted to 15- to 44-year-old women needing contraception. Logistic regressions estimated associations between receiving services at Title X clinics versus at other providers (including private) and use of a range of contraceptive options, as well as number of months' supply for those using oral contraceptives. In 2015–2017, Title X was associated with using any contraception (adjusted odds ratio [AOR], 4.11; p =.004). In both waves, Title X clients were more likely to use long-acting reversible contraceptives (AOR, 1.78 in 2015–2017 [ p =.023] and AOR, 2.59 in 2017–2019 [ p =.003]) and hormonal methods other than oral contraceptives (AOR, 2.31 in 2015–2017 [ p =.007] and AOR, 3.04 in 2017–2019 [ p =.001]). In both waves, Title X clients using oral contraceptives were also more likely than non-Title X clients to receive more than a 3-month supply (AOR, 3.54 in 2015–2017 [ p =.008] and AOR, 2.61 in 2017–2019 [ p =.043]). Title X was not associated in either wave with use of barrier or time-based methods, such as periodic abstinence or withdrawal. Patterns of contraceptive use by Title X clients compared with those of clients of other providers indicate that the Title X program has allowed access to a wide range of contraceptive methods. Ongoing research is necessary to see whether these patterns change over time. [ABSTRACT FROM AUTHOR]

Objective: The literature review reports on programs and interventions that address postpartum depression (PPD) in African American women. African American women are at a higher risk of developing PPD compared to white women. The review will highlight and recommend approaches that may render positive outcomes in the future for this population. Methods: A systematic scoping literature review was conducted using Academic Search Complete, CINAHL, APA PsycArticles, APA PsychInfo, PubMed, Social Services Abstracts, and Social Work Abstracts. Keywords used in the search included "postpartum depression," "African American," and "interventions OR programs OR therapy OR treatment." Fourteen studies were selected, analyzed, and included in the review. Results: Group psychosocial, individual psychosocial, internet-based, and integrated care interventions were included. While many articles noted within group changes in depression symptoms, fewer studies documented between group differences. Studies that investigated subsamples of "high risk" participants or those that used "culturally tailored" approaches showed promise. Conclusion: The literature review yielded some examples of programs/interventions that target postpartum depression in African American women; however, results were mixed. More research is needed to confirm the most effective interventions to address postpartum depression in African American women. Significance: The data shows a limited number of public health interventions tailored to address and reduce postpartum depression in this marginalized population. The recommendations included in the review highlight the need for public health professionals to develop programs to support African American women during the postpartum period. [ABSTRACT FROM AUTHOR]

Purpose: State Title V programs collaborate with diverse partners to improve maternal and child health. Since 2014, the National Maternal and Child Health Workforce Development Center has trained Title V leaders in facilitating system change. This article describes aspects of initial collaborative readiness differentiating state and jurisdiction teams that later reported meeting their goals to greater or lesser degrees. Description: We used quantitative data from initial team leader reports to characterize readiness to collaborate with external partners, and their responses twelve months later to a prompt about how fully they had accomplished their goals. In addition, we coded excerpts from team leader accounts six and twelve months into their work with the Center, and retrospective coach perspectives, to identify collaborative readiness patterns. Assessment: Teams whose leaders reported higher goal accomplishment twelve months after beginning work with the Center had initially reported higher levels of collaboration with key partners. Our analyses suggest that such teams were also better able to use their cohort experience with the Center to improve collaboration, including information sharing with external stakeholders. Challenges working with Medicaid were reported both by teams with more and less goal accomplishment. Conclusions: Title V teams with lower levels of initial collaborative readiness may benefit from additional support in skill development, connections to key partners, and convening power. Given the crucial and increasing role of Medicaid in maternal and child health systems, more attention may be warranted to supporting all Title V programs in partnering with this funder. Significance: What is already known on this subject?: Prior research has identified the ability to convene diverse stakeholders as key to achieving partnership synergies, and in turn improved community outcomes. What this study adds: State and territorial Title V programs may achieve greater synergies with external partners by initially assessing and strategically enhancing collaborative readiness. Training and technical assistance providers might enhance partnership synergies through focused assistance to states with lower initial levels of external collaboration. Title V leaders may improve outcomes by leveraging their strongest collaborations to foster relationships with additional stakeholders. Title V programs in general could benefit from support cultivating relationships with Medicaid. [ABSTRACT FROM AUTHOR]

Care coordination is an increasingly popular strategy to help patients with complex health conditions manage their diseases more effectively. The purpose of the current study was to assess associations between patient-reported receipt of care coordination and their experiences of health, health care quality, and cost-related outcomes. Regression analyses of data from 431 patients across 13 Texas providers indicate that patients who reported receiving care coordination had higher odds of perceiving having enough information about how to manage their conditions (OR 2.02, P < .01), having information about education and treatments available (OR 1.87, P < .01), and reporting better access to care (beta = .27, P < .01). Receipt of care coordination was not associated with patients' reports of how up-to-date their doctors were about care from other providers, patients' health-related functioning, or patients' intention to return to the emergency department. Patients' reasons for intending to return to the emergency department included the speed of care there relative to alternatives and satisfaction with the quality of care they had received previously in the emergency department. Results suggest that care coordination in usual practice may improve patient preventive care, but not some other health or cost-related outcomes. [ABSTRACT FROM AUTHOR]

Objectives As the U.S. healthcare system shifts toward collaboration, demand for leaders with interdisciplinary skills increases. Leadership competencies guide interdisciplinary training programs; however, identifying cost-effective methods for evaluating leadership competencies is challenging, particularly when interdisciplinary trainees have different areas of expertise and professional goals. Traditional pre-/post-testing, a common method for evaluating leadership competencies, is subject to response-shift bias, which can occur when participants' understanding of a construct changes between pre- and post-test. As a result, participants may rate their knowledge of the construct lower at post-test. Retrospective pre-tests are one method thought to reduce response-shift bias in pre-/post-tests. The current study explores the use of a retrospective pre-test to control for response-shift bias in an interdisciplinary training program. Methods Over three cohort years, thirty-four trainees from an interdisciplinary leadership program completed a self-assessment aligned with MCH leadership competencies. The traditional pre-test self-assessment was completed at the beginning of the training program. The retrospective pre-/post-test self-assessment was completed at the end of the training program. Results Retrospective pre/post-test scores indicate significant self-reported increases in all 24 leadership areas (p ≤ .001). Furthermore, participants' self-ratings were significantly higher on the traditional pre-test for all 24 areas than on the retrospective pre-test (p ≤ .001). Conclusions for Practice Retrospective pre-tests appeared to control for response-shift bias and may be a cost-effective way to evaluate trainee change within an interdisciplinary leadership program. These findings suggest the methodology's usefulness in interdisciplinary training and its potential use in the broader world of community-based MCH training initiatives. [ABSTRACT FROM AUTHOR]

Objective Our objective was to assess the safety, feasibility, and effects of the standardized 8-week mindfulness-based stress reduction ( MBSR) course in adults with migraines. Background Stress is a well-known trigger for headaches. Research supports the general benefits of mind/body interventions for migraines, but there are few rigorous studies supporting the use of specific standardized interventions. MBSR is a standardized 8-week mind/body intervention that teaches mindfulness meditation/yoga. Preliminary research has shown MBSR to be effective for chronic pain syndromes, but it has not been evaluated for migraines. Methods We conducted a randomized controlled trial with 19 episodic migraineurs randomized to either MBSR (n = 10) or usual care (n = 9). Our primary outcome was change in migraine frequency from baseline to initial follow-up. Secondary outcomes included change in headache severity, duration, self-efficacy, perceived stress, migraine-related disability/impact, anxiety, depression, mindfulness, and quality of life from baseline to initial follow-up. Results MBSR was safe (no adverse events), with 0% dropout and excellent adherence (daily meditation average: 34 ± 11 minutes, range 16-50 minutes/day). Median class attendance from 9 classes (including retreat day) was 8 (range [3, 9]); average class attendance was 6.7 ± 2.5. MBSR participants had 1.4 fewer migraines/month ( MBSR: 3.5 to 1.0 vs control: 1.2 to 0 migraines/month, 95% confidence interval CI [−4.6, 1.8], P = .38), an effect that did not reach statistical significance in this pilot sample. Headaches were less severe, although not significantly so (−1.3 points/headache on 0-10 scale, [−2.3, 0.09], P = .053) and shorter (−2.9 hours/headache, [−4.6, −0.02], P = .043) vs control. Migraine Disability Assessment and Headache Impact Test-6 dropped in MBSR vs control (−12.6, [−22.0, −1.0], P = .017 and −4.8, [−11.0, −1.0], P = .043, respectively). Self-efficacy and mindfulness improved in MBSR vs control (13.2 [1.0, 30.0], P = .035 and 13.1 [3.0, 26.0], P = .035 respectively). Conclusions MBSR is safe and feasible for adults with migraines. Although the small sample size of this pilot trial did not provide power to detect statistically significant changes in migraine frequency or severity, secondary outcomes demonstrated this intervention had a beneficial effect on headache duration, disability, self-efficacy, and mindfulness. Future studies with larger sample sizes are warranted to further evaluate this intervention for adults with migraines. This study was prospectively registered ( identifier NCT01545466). [ABSTRACT FROM AUTHOR]

Given high costs of hospital encounters, providers have increasingly turned to patient-centered health care programs to improve cost-effectiveness and population health for patients with high needs. Yet, evidence is mixed about program effectiveness. This pre–post comparative analysis assessed whether the number of hospital encounters and related costs decreased for patients who received care coordination services funded through Texas's 1115(a) Medicaid waiver incentive-based payment model, under which providers created new programs to improve care quality, population health, and cost-effectiveness. This study compared hospital records for patients who were frequent emergency department users at 4 urban safety net hospitals in Texas and state data for hospital encounters for the calendar years 2013 through 2015. The study included 9061 patients who frequently used emergency departments: 4117 patients who received waiver-funded care coordination services at 2 hospitals and 4944 patients who received usual care at 2 comparison hospitals. Regression models compared changes in patients' hospital use and length of stay for the 2 groups. Patients receiving waiver-funded care coordination had a 19% lower probability of hospitalization after receiving care coordination relative to patients who received usual care, for a mean savings of approximately $1500 per year per patient. Receiving care coordination was not associated with a change in length of stay. Care coordination developed by hospitals to meet the needs of their most vulnerable patients can reduce their use of hospital resources through better preventive care. These findings bolster the business case for care coordination, which may help ensure service continuation. [ABSTRACT FROM AUTHOR]

This study elicited the perspectives of youth, caregivers, service providers and researchers to explore how communities can best support the transition to adulthood for youth ages 16–21 with mental health and functional impairments, who are at risk of disconnecting from health and human services. Framed by Relational Systems Evaluation (RSE) and Positive Youth Development (PYD), our study demonstrates the importance of engagement with youth experts. Group Concept Mapping (GCM), a collaborative multiphase mixed-methods approach, was used as a systematic process for participants to make meaning of qualitative data using multidimensional scaling and hierarchical cluster analysis (Kane and Trochim in Concept mapping for planning and evaluation, Sage Publications Inc., Thousand Oaks, 2007). Across all participant groups, Life Skills were perceived as highly important and highly feasible for a successful transition to adulthood. However, Positive Social Support & Connectedness were viewed as less important and less feasible by all groups. When examined closely, youth perspectives differed from caregiver and provider perspectives in the factors they prioritized and deemed feasible. Our findings have implications for community mental health services and positive youth development program practitioners. [ABSTRACT FROM AUTHOR]

Objective: To understand the mechanisms of mindfulness' impact on migraine. Background: Promising mindfulness research demonstrates potential benefit in migraine, but no data‐driven model exists from the lived experiences of patients that explains the mechanisms of mindfulness in migraine. Methods: Semi‐structured qualitative interviews were conducted with adults with migraine who participated in two mindfulness‐based stress reduction (MBSR) clinical trials (n = 43). Interviews were audio‐recorded, transcribed, and summarized into a framework matrix with development of a master codebook. Constructivist grounded theory approach was used to identify themes/subthemes. Results: Participants who learned mindfulness techniques through MBSR experienced altered pain perception, altered response to migraine attacks and disease, increased awareness of external and internal experiences, improved overall well‐being, and group benefits. Mindfulness resulted in earlier stress‐body awareness and increased interoceptive awareness resulting in earlier attack recognition, leading to earlier and more effective management. Interictal factors of self‐blame, guilt, and stigma decreased while migraine acceptance, hope, empowerment, self‐efficacy, and self‐compassion increased. Improved emotion regulation resulted in decreased fear of migraine, pain catastrophizing, anticipatory anxiety, and pain reactivity. Although taught as prevention, mindfulness was used both acutely and prophylactically. We created a conceptual model hypothesizing that MBSR skills led to an infusion of mindfulness in daily life, resulting in altered pain perception and experience, ultimately leading to improvement in overall well‐being, which may positively feed back to the infusion of mindfulness in daily life. The therapeutic benefit of learning mindfulness in a group setting may moderate these effects. Conclusions: This study identified several new potential mechanisms of mindfulness' effect on migraine. After learning MBSR skills, participants reported altered pain and migraine perception and experiences. Increased stress‐body and interoceptive awareness resulted in earlier migraine awareness and treatment. Mindfulness may target important interictal factors that affect disease burden such as fear of migraine, pain catastrophizing, and anticipatory anxiety. This is the first data‐driven study to help elucidate the mechanisms of mindfulness on migraine from patient voices and can help direct future research endeavors. [ABSTRACT FROM AUTHOR]

Human service agencies serve a growing number of adults with behavioural health needs. Despite these agencies' key role in identifying need and facilitating services, many individuals do not receive care or end services prematurely. Few studies have explored the experiences of families referred to behavioural health services by such agencies or the extent to which families' perceptions of service need align with those of treatment providers and frontline workers. This study presents findings from a qualitative study of caregivers involved with child welfare agencies who were referred to behavioural health services. Researchers reviewed agencies' case records and conducted in-depth interviews with 16 caregivers, 9 child welfare caseworkers and 12 behavioural health treatment counsellors. Findings suggest that when deciding to engage in services, caregivers weigh not only their individual and family behavioural health needs but also potential agency intervention, including loss of child custody. Many professionals reported that involvement with a child welfare agency hindered the caregiver's disclosure of behavioural healthcare needs. Implications for managers and practitioners are discussed. [ABSTRACT FROM AUTHOR]

Objective: This article systematically reviews the empirical literature examining the efficacy of digital headache management interventions for patients with a primary headache disorder. Background: Digital headache management interventions provide opportunities to improve access to behavioral headache interventions to underserved groups. Methods: A systematic search of PubMed, Scopus, and EBSCO (PsycInfo, Education Research Complete, ERIC, Health Source: Nursing/Academic Edition, Psychology and Behavioral Sciences Collection) and reference review was conducted. Included studies had to recruit a sample with a primary headache diagnosis, be a randomized controlled trial including a digital component, assess a headache outcome (i.e., frequency, duration, severity, intensity, disability) or quality of life, and be published in English. Two authors independently extracted data for included studies. The methodological quality of studies was assessed using the revised Cochrane risk‐of‐bias tool. Results: Thirteen studies with unique interventions met inclusion criteria. More than half of the studies were pilots; however, nearly 70% (9/13) demonstrated significant between‐group or within‐group improvements on one or more headache‐related outcomes. All interventions included some form of relaxation training and the majority were delivered via interactive website. While fewer than half the studies report participant race and/or ethnicity, of those that do, 83% (5/6) reported a predominately White/Caucasian sample. Conclusions: Efficacy testing of digital headache interventions is in its infancy with the majority of these studies relying on pilot studies with small samples comprised of homogenous patient populations. Interactive websites were the most common digital medium to deliver digital headache management interventions and have demonstrated promising results. Further testing using large‐scale randomized controlled trials and exploration of other digital tools is warranted. Future studies with more diverse samples are needed to inform health equity of digital headache interventions. [ABSTRACT FROM AUTHOR]

Objective To educate physicians about appropriate acute migraine treatment guidelines by determining (1) where headache patients were first prescribed opioids and barbiturates, and (2) the characteristics of the patient population who had been prescribed opioids and barbiturates. Background Several specialty societies issued recommendations that caution against the indiscriminate use of opioids or barbiturate containing medications for the treatment of migraine. These medications are still being prescribed in various medical settings and could put headache specialists in a difficult position when patients request these agents. Methods Patients presenting to a headache center comprised of eight physicians were asked to complete a survey that assessed headache types, comorbid conditions, and whether they had ever been prescribed opioids or barbiturates. If they responded affirmatively to the latter question, they were asked about the prescribing doctor, medication effectiveness, and whether they were currently on the medication. Data collection took place over a one month period. Results Two hundred forty-four patients were given the survey and 218 of these patients completed it. The predominant diagnosis was migraine (83.9%). More than half of the patients reported having been prescribed an opioid (54.8%) or a barbiturate (56.7%). About one fifth were on opioids (19.4%) or barbiturates (20.7%) at the time of completing the survey. Most patients reported being on opioids for more than 2 years (24.6%) or less than one week (32.1%). The reasons most frequently cited for stopping opioids were that the medications did not help (30.9%) or that they saw a new doctor who would not prescribe them (29.4%). Among patients who had previously been on barbiturates, 32.2% had been on these for over 2 years. Most patients (61.8%) stopped barbiturates because they did not find the medication helpful, while 17.6% said they saw a new doctor who would not prescribe them. The physician specialty most frequently cited as being the first prescriber for opioids was emergency medicine (20.2%) with family doctors and general neurologists the next groups at 17.7% each. General neurologists were the most frequent (37.8%) first prescribers of barbiturates. Conclusions Approximately 20% of patients presenting to a headache center reported current use of opioids and/or barbiturates. ED physicians were reported to be the most frequent first prescribers of opioids and general neurologists were the most frequent first prescribers of barbiturates. Taken as a whole, these data provide a useful snapshot of the wide variety of physician specialties that might benefit from additional education on the appropriate use of opioids and barbiturate-containing medications in patients with headaches. [ABSTRACT FROM AUTHOR]

Objective: To better characterize the ways that migraine affects multiple domains of life. Background: Further understanding of migraine burden is needed. Methods: Adults with migraine randomized to mindfulness‐based stress reduction or headache education arms (n = 81) in two separate randomized clinical trials participated in semistructured in‐person qualitative interviews conducted after the interventions. Interviews queried participants on migraine impact on life and were audio‐recorded, transcribed, and summarized into a framework matrix. A master codebook was created until meaning saturation was reached and magnitude coding established code frequency. Themes and subthemes were identified using a constructivist grounded theory approach. Results: Despite most participants being treated with acute and/or prophylactic medications, 90% (73/81) reported migraine had a negative impact on overall life, with 68% (55/81) endorsing specific domains of life impacted and 52% (42/81) describing impact on emotional health. Six main themes of migraine impact emerged: (1) global negative impact on overall life; (2) impact on emotional health; (3) impact on cognitive function; (4) impact on specific domains of life (work/career, family, social); (5) fear and avoidance (pain catastrophizing and anticipatory anxiety); and (6) internalized and externalized stigma. Participants reported how migraine (a) controls life, (b) makes life difficult, and (c) causes disability during attacks, with participants (d) experiencing a lack of control and/or (e) attempting to push through despite migraine. Emotional health was affected through (a) isolation, (b) anxiety, (c) frustration/anger, (d) guilt, (e) mood changes/irritability, and (f) depression/hopelessness. Cognitive function was affected through concentration and communication difficulties. Conclusions: Migraine has a global negative impact on overall life, cognitive and emotional health, work, family, and social life. Migraine contributes to isolation, frustration, guilt, fear, avoidance behavior, and stigma. A greater understanding of the deep burden of this chronic neurological disease is needed to effectively target and treat what is most important to those living with migraine. [ABSTRACT FROM AUTHOR]

Social work has long been identified with child welfare, and research has generally found that child welfare caseworkers with a social work degree are better prepared than caseworkers with other degrees. Little knowledge exists though about the relationship between caseworker professional background and caregiver behavioral health service use or their satisfaction with the caseworker. Using data from the National Survey of Child and Adolescent Well-Being, we found no significant relationships between having a social work degree and caregiver use of services or satisfaction with the caseworker. More research is needed to clarify how caseworker characteristics, including professional preparation, influence child welfare outcomes. [ABSTRACT FROM AUTHOR]