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Purpose: Maternal substance use and deaths due to overdoses are increasing nationwide. Evidence suggests that the rate of resumed substance use, and fatal and non-fatal overdose is greatest in the first year after birth, particularly around six months postpartum, compared to other parts of the perinatal period. Doula care has been linked to improvements in perinatal health and outcomes. Description: In response to the opioid epidemic, the Philadelphia Department of Public Health developed and implemented the Doula Support Program (DSP), with a focus on one year of postpartum care for birthing people with a substance use disorder (SUD). In this paper, we describe the program and its formation and report on the early challenges and successes of the program implementation, based on information we received from program founders and managers in a group interview. Assessment: Early successes of the program include partnering with local community-based programs to recruit and retain doulas, supplementing traditional doula education with perinatal SUD-specific trainings, and maximizing client referrals by collaborating with local organizations and treatment centers that serve birthing people with SUD. Client retention, however, has proven to be challenging, especially during the COVID-19 pandemic. Conclusion: The DSP continues to grow, and lessons learned will facilitate program improvements. The goal of this paper is to outline the development and launch of the DSP and to act as a model for other state and local health departments interested in providing doula care for birthing people with SUD. Significance: Maternal substance use and fatal overdoses are increasing in Philadelphia, Pennsylvania. In response to this crisis, the Philadelphia Department of Public Health's Division of Maternal, Child and Family Health developed the Doula Support Program (DSP), offering doula care to pregnant people with a current or past SUD history up to one-year postpartum. To our knowledge, this is the only doula program in Pennsylvania offering one-year postpartum support to birthing people affected by SUD. [ABSTRACT FROM AUTHOR]

This paper explores the perception of African, Caribbean, and Black (ACB) religious leaders on HIV vulnerability and their role in HIV prevention among ACB communities in Windsor, Ontario. We conducted one semi-structured focus group discussion with nine Black religious leaders, most of whose congregants are members of the ACB community. Most religious leaders in the focus group had a negative perception of the transmission of HIV, but they acknowledged their own important role in HIV prevention strategies. This role is collaborative in nature, from the stage of designing HIV prevention strategies to implementing prevention messages. The religious leaders noted, however, that some challenges, such as church doctrine and congregational culture, are likely to impede their HIV prevention efforts. [ABSTRACT FROM AUTHOR]

Background To reduce the burden of low back pain (LBP) in the Netherlands, a multidisciplinary guideline for LBP has been implemented in Dutch primary care using a multifaceted implementation strategy targeted at health care professionals (HCPs) and patients. The current paper describes the process evaluation of the implementation among HCPs. Methods The strategy aimed to improve multidisciplinary collaboration and communication, and consisted of 7 components. This process evaluation was performed using the Linnan and Steckler framework. Data were collected using a mixed methods approach of quantitative and qualitative data. Results 128 HCPs participated in the implementation study, of which 96 participated in quantitative and 21 participated in qualitative evaluation. Overall dose delivered for this study was 89 %, and the participants were satisfied with the strategy, mostly with the multidisciplinary approach, which contributed to the mutual understanding of each other's disciplines and perspectives. While the training sessions did not yield any new information, the strategy created awareness of the guideline and its recommendations, contributing to positively changing attitudes and aiding in improving guideline adherent behaviour. However, many barriers to implementation still exist, including personal and practical factors, confidence, dependence and distrust issues among the HCPs, as well as policy factors (e.g. reimbursement systems). Conclusions The data presented in this paper have shown that the strategy that was used to implement the guideline in a Dutch primary care setting was feasible, especially when using a multidisciplinary approach. However, identified barriers for implementation have been identified and should be addressed in future implementation. [ABSTRACT FROM AUTHOR]

This article presents a case study on perceived conflict and its outcomes on implementing a system of programs and services for child development support. A multi-level collaboration model is used to deeply examine aspects of conflicts perceived by professionals responsible for implementing the system at the national, state, and local levels. This research adopted a single case approach with qualitative methods using semi-structured interviews and exploratory thematic analysis. A total of 29 professionals working at social development and health ministries, state departments, and one municipality participated in this study. The results show that professionals perceive one main unresolved conflict at each of the ecological levels. These conflicts are related to an informalized collaboration agreement between the Ministry of Social Development and the Ministry of Education, an interrupted resource flow from the national level to local level, and an unmanageable internal pressure at the state level. Furthermore, the compensatory strategies they use to deal with these conflicts are ineffective and lead to negative implementation outcomes. We suggest that future research should explore systemic conflict for the collaboration processes among the professionals to improve, thus increasing the quality of system implementation. Highlights: Professionals perceive one main unresolved conflict at each of the three ecological levels examined. Conflicts are related to informalized agreements between ministries, interrupted resource flow from the national level, and pressure from the local level. Professionals use compensatory strategies to cope with unresolved conflicts. The compensatory strategies identified are ineffective and lead to negative implementation outcomes. Findings reveal opportunities for future research to explore systemic conflict to better understand and improve collaboration processes. [ABSTRACT FROM AUTHOR]

This paper describes a feasibility study of a peer-delivered prevention intervention to identify mothers at high risk for depression and facilitate engagement in mental health services for their emotional health. Sixteen family peer advocates and their supervisors partnered with academic researchers over a period of 6 months to develop a four-session intervention that focused on identifying symptoms of depression, providing education about depression and treatment, actively linking caregivers to treatment for their own emotional health, and assisting caregivers in becoming active participants in their mental health care. Collaborating with peers to develop the model enhanced its perceived relevance and utility, and resulted in an intervention that was complimentary to their roles and the mission of peer-delivered support services. Peer/professional partnerships may be beneficial for enhancing the feasibility and acceptability of research efforts; the impact of peers' participation in the current project and the need for future research to develop and study peer-delivered models is discussed. [ABSTRACT FROM AUTHOR]

The goal of this paper is to document and evaluate the process of implementing an evidence-based depression intervention in community settings through the use of community-academic partnered approaches. We discuss how and to what extent the goals of community engagement and collaborative planning were achieved in the intervention arm of the Community Partners in Care study that aimed to adapt evidence-based depression care toolkits for diverse agencies in Hollywood and South Los Angeles. We find that partnered research strategies have a potential to effectively engage community members around depression and involve them in intervention planning activities. Our results suggest that successful collaboration among diverse agencies requires that they understand what is expected of them, are comfortable with the role they choose to perform, and have organizational support to contribute to the project. To facilitate the development of collaborative relationships, time and effort should be devoted to explaining how collaboration among diverse agencies may take place. [ABSTRACT FROM AUTHOR]

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Background: Preterm birth, defined as birth at gestational age before 37 weeks, is a major public health concern with marked racial disparities driven by underlying structural and social determinants of health. To achieve population-level reductions in preterm birth and to reduce racial inequities, the University of California, San Francisco's California Preterm Birth Initiative catalyzed two cross-sector coalitions in San Francisco and Fresno using the Collective Impact (CI) approach. Purpose: The purpose of this study is to compare two preterm birth-focused CI efforts and identify common themes and lessons learned. Methods: Researchers conducted in-depth interviews (n = 19) and three focus groups (n = 20) with stakeholders to assess factors related to collaboration. Transcripts were coded and analyzed using modified grounded theory. Findings were compared by year of data collection (first and second cycle in each location) and geographic location (Fresno and San Francisco) and discussed with CI participants for input. Results: Although both communities adopted the core tenets of CI to address preterm birth and racial inequities, each employed distinct organizational structures, strategic frameworks, and interventions. Common themes emerged around the importance of authentic community engagement, transparency in the process of prioritization and decision-making, addressing racism as a root cause of disparities in birth outcomes, and candid communication among partners. Conclusion: Future CI efforts, particularly those catalyzed by academic institutions, should ensure community members are active partners in program development and decision-making. CI efforts focused on combatting racial health inequities should center racism as a root cause and build capacity among coalition partners. [ABSTRACT FROM AUTHOR]

Objectives: Since 2013 the MCH Bureau has supported the National MCH Workforce Development Center to strengthen the Title V MCH workforce. This article describes the Center's Cohort Program and lessons learned about work-based learning, instruction, and coaching. Description: The Cohort Program is a leadership development program that enrolls state-level teams for skill development and work-based learning to address a self-identified challenge in their state. Teams attend a Learning Institute that teaches concepts, skills, and practical tools in systems integration; change management and adaptive leadership; and evidence-based decision-making and implementation. Teams then work back home on their challenges, aided by coaching. The Program's goals are for teams to expand and use their skills to address their challenge, and that teams would strengthen programs, organizations, and policies, use their skills to address other challenges, and ultimately improve MCH outcomes. Methods: This process evaluation is based on evaluation forms completed by attendees at the three-day Learning Institute; six-month follow-up interviews with team leaders; and a modified focus group with staff. Results: Participants and staff believe the Cohort Program effectively merges a practical skill-based curriculum, work-based learning in teams, and coaching. The Learning Institute provides a foundation of skills and tools, strengthens the team's relationship with their coach, and builds the team. The work-based learning period provides structure, accountability, and a "practice space" for teams to apply the Cohort Program's skills and tools to address their challenge. In this period, teams deepen collaborations and often add partners. The coach provides accessible and tailored guidance in teamwork and skill application. These dimensions helped teams in develop skills and address state-level MCH challenges. Conclusions for Practice: Continuing professional development programs can help leaders learn to address complex state-level MCH challenges through integrated classroom-based skills development, work-based learning on state challenges, and tailored coaching. [ABSTRACT FROM AUTHOR]

The study reports the results of a qualitative study on the views and experiences of non-peer mental health providers on working together with peer colleagues in mental health. Semi-structured interviews were conducted with 20 providers in different mental health settings. Data were systematic analyzed using thematic analysis and resulted in three overall themes: (1) The relationship and collaboration between the mental health providers and their peer colleagues, (2) The benefits of working with peers, and (3) The challenges of working with peers. In analyzing the data material, the theme of the relationship and collaboration between the non-peer mental health providers and their peer colleagues could be organized into two subthemes on the differences that the providers perceived between themselves and their peer colleagues. One subtheme was on differences when the providers perceived the differences as positive and meaningful. The other subtheme was on differences between themselves and their peer colleagues when the providers perceived the differences as concerning. This study's findings show that the attitudes and experiences of peer support in mental health providers are in general positive, but also that mental health providers in the early phases of peer support implementation could have many concerns and may find the perceived and mainly valued differences between themselves and their peer support colleagues also distressing. The implications for practice include a need to address possible barriers to peer support, including frustration or feelings of injustice among mental health providers, especially as such issues are not easy to pinpoint or address by formal guidelines on peer support. [ABSTRACT FROM AUTHOR]

Person-centered care remains a high priority within community mental health services. Clinical supervision is an embedded resource for professional development and promotion of high quality care. This study examined supervisory strategies during the implementation of person-centered care planning (PCCP) across two northeastern US States. A criterion sample of supervisor-provider teams participated in qualitative interviews (N = 34) and direct observation from 2016 to 2017. Modified grounded theory analyses were conducted and three supervisory strategies were identified. Supervisory attunement to providers (knowing their audience), active collaborative engagement with providers (practicing together), and infusing reminders and opportunities for feedback (chipping away) were critical strategies to engage providers in adopting PCCP. These strategies changed providers' practice patterns by improving supervisors' calibration to dynamic contextual and individual needs during implementation and communicating supervisors' expectations of PCCP enactment. Workplace-based clinical supervision holds promise as a key intervention point to embed high quality care. [ABSTRACT FROM AUTHOR]

Introduction: New Heights is a voluntary school-based program that provides a well-defined system of supports for expectant and parenting students in Washington, DC, and was found to be effective at improving educational outcomes. This study explores the program elements and practices that, when used together, improved academic outcomes for New Heights participants and define a possible roadmap for service providers interested in replicating the program's success. Methods: The study team collected data through site visits, key informant interviews, staff surveys, program observations, case files, and program materials. Results: The core design and implementation elements of the New Heights program are (1) placing a trained staff member in the school to provide advocacy, case management, education, and in-kind incentives; (2) bringing community-based service providers into the school; (3) giving trained staff autonomy and a strong grounding in local context; and (4) using a highly collaborative process to hire and support school-based coordinators. Discussion: Staff and funders interested in improving outcomes for young parents in school could use the experience of New Heights and the key practices that were critical to its success as a guide: (1) ensure that the program is well defined but can be tailored to the needs of schools and students, (2) engage community partners to bring services to participants, (3) hire and train the right staff who are committed to "do whatever it takes," (4) actively cultivate a culture of collaboration among program staff, and (5) develop buy-in with school staff and illustrate program value. [ABSTRACT FROM AUTHOR]

Healthcare environments are not exempt from the impact of stigma against mental illness and addiction, which contributes to barriers to client access and appropriate treatment. To address this concern, healthcare organizations have a growing interest in mental illness and addiction anti-stigma anti-discrimination programming as part of their staff-wide professional development. Though standard interventions demonstrate effectiveness in the short and mid-term, the evidence for long-term change is inconclusive. A flexible, innovative intervention was developed in collaboration with community health care centres to reduce mental illness and addiction stigma and discrimination at an organizational level. A mixed methods approach was utilized to develop the intervention design and evaluate the effectiveness of the intervention. 137 people participated in the survey component of the study and five senior management staff in interviews. Quantitative results showed that the intervention was effective in changing attitudes toward mental illness (e.g. 5,9% improvement in OMS-HC score, p < 0,05) and substance use problems (e.g. 8.4% reduction in social distance for heroin dependence, p < 0.05). Qualitative findings were positive for indicators of observed improvement in mental health knowledge and behaviour. The implications for future research that allows for the further evaluation of multicomponent anti-stigma interventions in healthcare settings are discussed. [ABSTRACT FROM AUTHOR]

Youth in foster care who have histories of grief, loss, and placement disruptions need trauma-informed programs that can help them maintain stable and consistent connections with supportive adults. The purpose of this study was to explore the experiences of staff who implemented a trauma-informed model called Intensive Permanence Services (IPS). We conducted qualitative interviews with staff (N = 7) who developed and implemented the IPS model and reviewed agency documents to identify the key characteristics of the model, the strategies staff used in their work with youth, and the challenges they faced to implementing IPS. Findings highlight these critical components: (1) using a youth-driven approach that prioritizes accountability to the youth and youth empowerment; (2) adopting an organizational culture of well-being using strategies such as secondary traumatic stress education, peer support, and structured supervision; and (3) promoting systems change for improved collaboration with all stakeholders, including the youth, families, caregivers, and other service providers. Overall, our findings stressed the importance of adopting a more holistic, trauma-informed, and youth-driven approach to improve permanence and well-being for youth in care. [ABSTRACT FROM AUTHOR]

Purpose: We conducted a randomized controlled trial in partnership with a community-based organization (CBO) to examine the effects of peer mentoring to promote exercise among cancer survivors. At the end of the trial, to prepare for future program implementation on a larger scale, we obtained input from the CBO on the key elements that influenced the decision to collaborate, facilitators and challenges during the trial, and recommendations for program marketing. Methods: Structured telephone interviews were conducted with ten stakeholders at various job levels within the CBO. Notes of the interviews were coded, and themes were extracted independently by two study members. Results: Five themes were identified: costs of the partnership, its benefits, importance of communication, match of the trial goals with the CBO's mission, and achieving a balance between research and job tasks. Techniques to address these themes and improve implementation of the program are described. Conclusions: The themes identified can guide evidence-based programs in planning implementation that involves partnerships with CBOs. [ABSTRACT FROM AUTHOR]

Despite ongoing public calls for reform, the mental health needs of many children with psychological, emotional and behavioral disorders remain unmet. In response, providers continue to seek effective alternatives to institutional treatment by implementing comprehensive systems of care. The Children's Enhancement Project (CEP) is a collaborative effort to provide holistic, community-based mental health services for children with an individualized, flexible, family-driven approach. We conducted a process evaluation of CEP's early stage development and implementation utilizing both qualitative stakeholder interviews and quantitative survey components. The current article describes that evaluation and highlights the challenges and potential solutions encountered in developing a system of care. The lessons learned regarding system of care development, including the importance of a shared vision, establishing programmatic guidelines, achieving collaboration, and addressing sustainability concerns, are discussed. [ABSTRACT FROM AUTHOR]