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Objective Research has demonstrated that early intervention for children with autism can lead to improvements in core symptoms and enhance cognition, adaptive functioning, and quality of life. Unfortunately, most children are diagnosed too late to fully benefit from these services. Even in regions where diagnosis of autism can reliably be made, families often face additional barriers in accessing quality services. This article describes case examples in which Autism Speaks' Global Autism Public Health ( GAPH) Initiative partnered with communities to facilitate a process of multi-stakeholder collaboration to better understand local autism priorities related to awareness activities, early diagnosis, and developing autism surveillance systems. Method This paper utilised a nested case study to demonstrate how GAPH employs multi-stakeholder collaboration, community-based participatory research (CBPR) and consensus building to enhance early identification in low-resource settings. Each of these processes influenced different phases of the projects. Results In the first example, Autism Speaks adopted a CBPR approach to understand and address barriers to help-seeking behaviour among the Korean community affected by autism in New York City. The second example describes an international effort to develop open-source screening and diagnostic tools for autism that can be delivered by non-specialists in low-resource settings. The last example describes efforts to facilitate the development of an autism registry in Ireland to inform health policy decisions. Conclusions Collectively, these examples outline approaches the GAPH initiative uses to support global communities in working to overcome challenges related to the needs of individuals with autism and their families. [ABSTRACT FROM AUTHOR]

NY State community health center sites were surveyed in 2012 to assess the availability of alcohol, tobacco, and other drug services for the underserved. Surveys were completed from 156 of 251 adult primary care clinical sites (62% response rate). Seventy-one percent of sites had guidelines requiring screening for mental health problems while less than half (46%) had guidelines for substance use disorders. In practice, 55% of clinics reported nearly all adults were screened for mental health disorders compared to 32% of adults for substance use disorders (SUD). Forty three percent of sites that screened patients for SUD did not use a standard screening instrument. More than three quarters of sites offered tobacco cessation services while 17% reported offering SUD treatment. Findings from multi-level analyses suggested that FQHC organizations influence sites' SUD screening requirements but not the provision of on-site treatment. Analyses further suggested that neither geographic setting (urban/rural) nor the size of the FQHC organization influenced screening requirements or on-site treatment availability. Although more research is needed to explore differences between site and organizational level reporting, this study suggests that SUD screening rates remain low among FQHC primary care sites, but that FQHC organization could improve rates across sites by requiring SUD screening using a standard instrument. [ABSTRACT FROM AUTHOR]

Primary objective: To gather information about brain injury (BI) survivors' long-term healthcare needs, quality, barriers and facilitators. Research design: Qualitative content analysis of data gathered in focus groups using semi-structured interviews. Methods: Forty-four community-dwelling adults participated at two clinical research centres in Seattle, Washington and New York, New York. Participants were asked open-ended questions about their experiences with healthcare in the community with regard to care needs, utilization, access, barriers and facilitators to health management. Results: Central themes emerged across three categories: 1) barriers to healthcare access/utilization, 2) facilitators to healthcare access/utilization, and 3) suggestions for improving healthcare after BI. The importance of communication as both a facilitator and barrier to care was mentioned by most participants. Compensatory strategies and external tools were identified as key facilitators of medical self-management. Finally, improving clinicians' knowledge about BI emerged as a potential solution to address health needs of individuals with chronic BI. Conclusions: Additional efforts need to be made to improve access to appropriate healthcare and increase the ability for individuals to successfully navigate the healthcare system. Findings suggest several specific, low-cost modifications to healthcare delivery and strategies for improving medical selfmanagement that can maximize long-term health maintenance for BI survivors. [ABSTRACT FROM AUTHOR]

The Affordable Care Act mandates that public health data be made available for community agency use. Having access to such data allows community agencies to tailor interventions, evaluations, and funding requests more effectively. This study, jointly undertaken by Syracuse University faculty and students with the New York State Perinatal Association, sought to understand community agencies’ access to requests for governmental data, as well as to identify areas for improving data access. Results from this survey of administrators from 43 agencies in New York State found that only one-half of their requests for data were successful. Difficulties in obtaining access to needed data included fiscal and staffing constraints of the state-level agencies that house the data, as well as possible overinterpretation of confidentiality policies. In addition, some of community agency respondents reported that their staff lacked skills in data analysis and would benefit from training in epidemiology and quantitative evaluation. [ABSTRACT FROM PUBLISHER]

Primary objective: To determine if individuals with brain injury can modify heart rate variability (HRV) through biofeedback and, if so, enhance its pattern to improve emotional regulation and problem-solving ability. Design: A quasi-experimental design with repeated measures was employed. Thirteen individuals aged 23-63 years with severe brain injury (13-40 years post-onset) participating in a community-based programme were enrolled. Main outcomes: Response-to-treatment was measured with HRV indices, Behavior Rating Inventory of Executive Function (BRIEF-A-Informant) and attention/problem-solving tests. Results: At post-treatment, HRV indices (Low Frequency/High Frequency [LF/HF] and coherence ratio) increased significantly. Increased LF/HF values during the second-half of a 10-minute session were associated with higher attention scores. Participants who scored better (by scoring lower) in informant ratings at pre-treatment had highest HRV scores at post-treatment. Accordingly, at post-treatment, families' ratings of participants' emotional control correlated with HRV indices; staffs' ratings of participants' working memory correlated with participants' HRV indices. Self-ratings of the BRIEF-A Task Monitoring scale at post-treatment correlated with family ratings at pre-treatment and post-treatment. Conclusions: Results demonstrate an association between regulation of emotions/cognition and HRV training. Individuals with severe, chronic brain injury can modify HRV through biofeedback. Future research should evaluate the efficacy of this approach for modifying behavioural problems. [ABSTRACT FROM AUTHOR]