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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: Measuring, assessing and managing outcomes in school practice environments is difficult due to the complex nature of school communities as well as the recent shift in service‐delivery models towards tiered approaches. In tiered approaches, multiple levels of service are offered to better match students' needs. Each level of service may require different outcomes and management techniques. Research to date on outcomes has focused on measuring outcomes in medical settings, leaving a substantive gap in the literature regarding practice in schools. Aims: The first aim was to explore how school‐based speech–language therapists approached outcomes management as their clinical programmes transitioned to tiered service‐delivery models The second aim was to describe the successes and challenges in outcomes management reported by clinicians in this context. Methods & Procedures: A secondary deductive‐inductive content analysis was performed using qualitative interviews with 24 clinical managers and senior therapists from schools across Ontario, Canada. Using a framework of outcomes measurement, assessment and management in schools based on previous research studies, data were grouped into broad categories deductively, and then the content of each category was further explored using inductive coding. Iterative peer debriefing and reflexive journaling were key strategies to increase the trustworthiness of the results. Findings & Results: Participants reported measuring and qualitatively assessing seven key outcomes for school‐based practice. These included: (1) student progress and achievement, (2) student participation and inclusion in the school community, (3) stakeholder perspectives, (4) 'buy‐in', (5) expanded capacities, (6) responsiveness to needs and (7) accountability to systems. Participants reported more challenges than successes in outcomes management during this transition to tiered services. Challenges were attributed to idiosyncratic organizational barriers, the transition to tiered models and the philosophy of working within the educational system. Conclusions & Implications: School‐based speech–language therapists measure, assess and manage multiple outcomes relevant to school‐based practice in tiered service‐delivery models. Many challenges remain. Solutions to support meaningful, systematic and proactive outcomes management in schools should address the broader set of outcomes relevant to tiered service‐delivery models and the unique practice context of the educational system, while remaining responsive to idiosyncratic organizational factors. Sustained clinical–research collaboration and knowledge exchange is recommended. What This Paper Adds: What is already known on the subject: Systematic, proactive collection and interpretation of outcomes has long been encouraged within speech–language therapy. However, implementing outcomes management in clinical practice remains a substantial challenge. Additionally, research on outcomes to date has focused on medical practice environments, to the exclusion of school‐based practice. What are the potential or actual clinical implications of this work?: Outcomes management is valued in school practice environments; however, the current repertoire of techniques for outcomes management are a poor match for school‐based practice. Clinicians in schools would benefit from the development of contextually relevant, meaningful and feasible outcomes management tools. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Oncology Nursing Journal is the property of Pappin Communications and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We developed and implemented a person-centered navigation model integrated in primary care where patients were referred to the Access to Resources in the Community (ARC) study by their primary care provider (PCP). The purpose of this paper is to explore the lay navigators' learning experience as reflected in their journals and present implications for education and health promotion practice. Sixty-six journal entries from two navigators were analysed. To code the data, we used a newly developed framework based upon the theory-informed lay navigator training programme. Five unique themes were identified: 1) Gaining and Building Trust, 2) Developing Empathy, 3) Experiencing Hope and Optimism, 4) Feeling Helplessness and 5) Celebrating Gains and Successes. The five themes identified paint a sequential picture of the journey of leading individuals from primary care to health and social community resources. This innovative approach has expanded our understanding of how navigators learn in practice, more specifically how they learn from patients and how they develop knowledge and skills in person-centered care. Incorporating reflective journaling as a regular practice provides situational awareness and leads to enhanced learning. Practising person-centered care also develops when a trusting and empathetic relationship is established. [ABSTRACT FROM AUTHOR]

Introduction: In response to the challenges of the traditional mental health system for youth both in Canada and abroad, models of integrated youth services (IYS) that span the integration of mental health, health, substance use, eucation, employment, peer support, and navigation into ‘one-stop shops’ are being established nationally and internationally. IYS models, however, need to be better described and evaluated to inform the replicability of this approach in other jurisdictions. Description: This paper describes the implementation of an IYS in a small urban city and rural county in Ontario, Canada, including insights from key informants into barriers, facilitators, and lessons learned. Discussion: This evaluation identified a number of barriers and facilitators to the implementation of the IYS model in this specific context. Implementation facilitators included youth and family engagement, network partner collaboration, leadership, governance structure, community enthusiasm and support, and collaborative funding models. Barriers to implementation included the COVID-19 pandemic and related public health restrictions, the diverse needs of youth, change management, sustainable funding, and transportation. Lessons learned: By establishing a shared vision of delivering youth services across the integrated network, and engaging youth early in the process of model development, IYS have the potential to transform the service system for youth and their families. Meeting the diverse needs and challenges of youth who live in rural or small urban communities will enhance service delivery and experience for young people. [ABSTRACT FROM AUTHOR]

Purpose:To describe the development and implementation of an organizational framework for client and family-centered research. Method:Case report. Results:While patient-centered care is now well established, patient-centered research remains underdeveloped. This is particularly true at the organizational level (e.g., hospital based research institutes). In this paper we describe the development of an organizational framework for client and family centered research at Holland Bloorview Kids Rehabilitation Hospital in Toronto, Canada. Conclusion:It is our hope that, by sharing our framework other research institutions can learn from our experience and develop their own research patient/client/family engagement programs.Implications for rehabilitationFamily engagement in rehabilitation research•Rehabilitation research is crucial to the development and improvement of rehabilitative care.•The relevance, appropriateness, and accountability of research to patients, clients and families could be improved.•Engaging clients and families as partners in all aspects of the research process is one way to address this problem.•In this paper, we describe a framework for engaging clients and families in research at the organizational level. [ABSTRACT FROM PUBLISHER]

Objectives: The objectives of this paper were to identify and compare clinical prediction models used to assess the risk of venous thromboembolism (VTE) in ambulatory patients with cancer, as well as review the rationale and implementation of a pharmacist-led VTE screening program using the Khorana Risk Score model in an ambulatory oncology centre in Sault Ste. Marie, Ontario, Canada. Data Sources: PubMed was used to identify clinical practice guidelines and review articles discussing risk prediction models used to assess VTE risk in ambulatory patients with cancer. Data Summary: Three commonly used VTE risk prediction models in ambulatory patients with cancer: the Khorana Risk Score, Vienna Cancer and Thrombosis Study (CATS) and Protecht Score, were identified via literature review. After considering guideline recommendations, site-specific factors (i.e. laboratory costs, time pharmacists spent calculating VTE risk) and evidence from the CASSINI and AVERT trials, a novel pharmacist-led VTE risk assessment program using the Khorana Risk Score was developed during a fourth-year PharmD clinical rotation at the Algoma District Cancer Program (ADCP) [ambulatory cancer care centre]. ADCP patients with a Khorana Risk Score of ≥ 2 were referred to the hematologist for a full VTE workup. Considering limitations, inclusion and exclusion criteria of the CASSINI and AVERT trials, the hematologist and pharmacy team decided on appropriate initiation of thromboprophylaxis with a direct oral anticoagulant (DOAC). Conclusions: The Khorana Risk Score was the chosen model used for the pharmacist-led VTE risk assessment program due to its user-friendly scoring algorithm, evidence from validation studies and clinical trials, as well as ease of integration into pharmacy workflow. More research is needed to determine if pharmacist-led VTE risk assessment programs will impact patient outcomes, such as morbidity and mortality, secondary to cancer-associated thrombosis. [ABSTRACT FROM AUTHOR]

The objective of this study was to optimize a planned audit and feedback (A&F) intervention for home and community care through incorporating user-centered design principles. Phase 1 comprised the development of a paper prototype, followed by testing of the prototype using semistructured interviews and focus groups. Phase 2 involved the development of a revised and online prototype based on the results of Phase 1, followed by user testing. A total of 39 participants across Phase 1 (n = 33) and Phase 2 (n = 6) provided input into the design of the A&F intervention. Key changes included improving clarity of the variables, reducing cognitive load, and highlighting opportunities for action. Preliminary findings suggest potential usefulness in this approach to optimize home care management. [ABSTRACT FROM AUTHOR]

BACKGROUND: Comprehensive workplace return-to-work policies, applied with consistency, can reduce length of time out of work and the risk of long-term disability. This paper reports on the findings from a qualitative study exploring managers‘ and return-to-work-coordinators‘ views on the implementation of their organization‘s new return-to-work program. OBJECTIVES: To provide practical guidance to organizations in designing and implementing return-to-work programs for their employees. METHODS: Semi-structured qualitative interviews were undertaken with 20 managers and 10 return-to-work co-ordinators to describe participants‘ perspectives on the progress of program implementation in the first 18 months of adoption. The study was based in a large healthcare organization in Ontario, Canada. Thematic analysis of the data was conducted. RESULTS: We identified tensions evident in the early implementation phase of the organization‘s return-to-work program. These tensions were attributed to uncertainties concerning roles and responsibilities and to circumstances where objectives or principles appeared to be in conflict. CONCLUSIONS: The implementation of a comprehensive and collaborative return-to-work program is a complex challenge. The findings described in this paper may provide helpful guidance for organizations embarking on the development and implementation of a return-to-work program. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Community Mental Health is the property of Canadian Periodical for Community Studies Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Forensic mental health programs (FMHPs) in Ontario, Canada provide rehabilitation and supervision services. However, models available to guide their delivery are primarily adapted from fields outside of forensic mental health. To partially fill this gap, this paper aims to provide a general review of the process a multi-professional team took to develop the Integrated Forensic Program [IFP]-Ottawa Model of Risk Management & Recovery. Design/methodology/approach: Working groups were initiated to identify the needs of patients in their local setting, conduct a literature review on care delivery models in forensic mental health and build a service delivery model specific to forensic mental health. Findings: The resulting model places patient engagement at its centre and encompasses eight domains of need that contribute towards the patient's recovery and the management of the safety risk they pose to the public, namely, the basic needs, diversity and spirituality, social, occupational, psychological, substance use, physical health and mental health domains. Practical implications: The IFP-Ottawa Model of Risk Management & Recovery provides a framework to which therapeutic group services for persons in FMHPs can be aligned. Originality/value: The leadership teams in FMHPs could use this framework and the method used for its development to ensure group services provided at their FMHPs are evidence-informed and coincide with their patients' specific needs. [ABSTRACT FROM AUTHOR]

Research has demonstrated the benefits of mental healthcare interventions that ensure a safe transition of clients throughout the discharge and community integration process. This paper reports on qualitative data from focus groups with health professionals collected as part of a larger a mixed method study designed to examine the effectiveness and sustainability of implementing the transitional discharge model. Data collection involved two sets of focus groups, which were held at six months and one‐year post‐implementation. There were 216 health professional participants from nine (9) hospitals across the Province of Ontario, Canada. Data analysis used a four‐step ethnographic framework by Leininger (1985) to identify descriptors and recurrent and major themes. The study identified four major themes, including healthcare professionals' roles and positive experiences in implementing the transitional discharge model; perceived benefits of the model; challenges to implementing the model; and suggestions for sustaining the model's implementation. Healthcare professionals felt that the implementation of the transitional discharge model has the potential for increasing their awareness of the process of clients' integration, serving as a framework for discharge planning, and reducing hospital readmissions. The study findings may provide healthcare providers with information on pragmatic ways to plan clients' discharge, to bridge the gap between hospital and community care, and to positively impact client health outcomes. [ABSTRACT FROM AUTHOR]

Choosing Wisely (CW) campaigns globally have focused attention on the need to reduce low-value care, which can represent up to 30% of the costs of healthcare. Despite early enthusiasm for the CW initiative, few large-scale changes in rates of low-value care have been reported since the launch of these campaigns. Recent commentaries suggest that the focus of the campaign should be on implementation of evidencebased strategies to effectively reduce low-value care. This paper describes the Choosing Wisely De-Implementation Framework (CWDIF), a novel framework that builds on previous work in the field of implementation science and proposes a comprehensive approach to systematically reduce low-value care in both hospital and community settings and advance the science of de-implementation. The CWDIF consists of five phases: Phase 0, identification of potential areas of low-value healthcare; Phase 1, identification of local priorities for implementation of CW recommendations; Phase 2, identification of barriers to implementing CW recommendations and potential interventions to overcome these; Phase 3, rigorous evaluations of CW implementation programmes; Phase 4, spread of effective CW implementation programmes. We provide a worked example of applying the CWDIF to develop and evaluate an implementation programme to reduce unnecessary preoperative testing in healthy patients undergoing low-risk surgeries and to further develop the evidence base to reduce low-value care. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: The period between hospital discharge and community reintegration is a vulnerable time for people with mental illness due to a lack of continuity of care. They are at a high risk of undesired outcomes, including return to hospital.Many transitional models have been developed. It is important to continue evaluating models for improvement and adaptability to different contexts.The transitional discharge model (TDM) is an intervention that incorporates both continued support from hospital staff after discharge and peer support to facilitate a smooth transition. Previous studies have reported positive outcomes such as increased discharges, decreased readmissions, reduced inpatient length of stay and improved quality of life. What the paper adds to existing knowledge?: Health service use outcomes were examined separately for acute and tertiary care psychiatric units. Previous TDM studies in Canada only examined tertiary care units, but many patients also receive care in acute care units.Although recent studies of different interventions generally reported decreased readmissions, the current study found readmissions increased after TDM and then decreased over time for acute care units, whereas no change was observed for tertiary care units. What are the implications for practice?: Transitional discharge model evidence supports nursing practice based on interpersonal relations and strategies. Nurses need to be aware of peer support resources to facilitate this part of the model.The effectiveness of TDM may be increased by considering the differences in needs of distinct patient groups, such as those discharged from acute versus tertiary care units. Introduction: The transitional discharge model (TDM) bridges hospital discharge and community living for people receiving psychiatric services. TDM, based on Peplau's theory of interpersonal relations, ensures continued support from hospital staff until a therapeutic relationship is established with community providers and formal peer support. Aim: To compare temporal trends in psychiatric health services use before and after TDM implementation within acute and tertiary care psychiatric units in Ontario, Canada. Method: Using health administrative databases, monthly discharges from psychiatric units 3 years prior to 2 years after TDM implementation were identified. Median inpatient length of stay (LOS), psychiatric readmission rates and mental health‐related emergency department visit rates were compared using segmented regression analyses. Results: Among acute care units, median LOS decreased significantly below the projected historical trend following TDM implementation, while readmissions increased significantly and declined thereafter. No significant changes were found for tertiary care units. Discussion: Studies on various interventions have shown decreased readmission rates, whereas the trend differed between acute and tertiary care units in this study. Possible reasons include different patient needs and staff practices. Implications for Practice: Needs of people from different unit types should be considered when implementing TDM. Nurses should recognize the development of therapeutic relationships and availability of peer support resources. [ABSTRACT FROM AUTHOR]

Background: Historically transgender adults have experienced barriers in accessing primary care services. In Ontario, Canada, health care for transgender adults is accessed through primary care; however, a limited number of practitioners provide care, and patients are often waiting and/or traveling great distances to receive care. The purpose of this protocol is to understand how primary care is implemented and delivered for transgender adults. The paper presents how the case study method can be applied to explore implementation of health services delivery for the transgender population in primary care. Methods: Case study methodology will be used to explore this phenomenon in different primary care contexts. Normalization Process Theory is used as a guide. Three cases known to provide transgender primary care and represent different Ontario primary care models have been identified. Comparing transgender care implementation and delivery across different models is vital to understanding how care provision to this population can be supported. Qualitative interviews will be conducted. Participants will also complete the NoMAD (NOrmalization MeAsure Development) survey, a tool measuring implementation processes. The tool will be modified to explore the implementation of primary care services for transgender individuals. Documentary evidence will be collected. Cross-case synthesis will be completed to compare the cases. Discussion: Findings will provide an Ontario perspective on the implementation and delivery of primary care for transgender adults in different primary care models. Results may be applicable to other primary care settings in Canada and other nations with similar systems. Barriers and facilitators in delivery and implementation will be identified. Providing an understanding and increasing awareness of the implementation and delivery of primary care may help to reduce the invisibility and disparities transgender individuals experience when accessing primary care services. Understanding delivery of care could allow care providers to implement primary care services for transgender individuals, improving access to health care for this vulnerable population. [ABSTRACT FROM AUTHOR]

Purpose: An integrated care system identified quality improvement (QI) capacity as a gap in advancing their integrated quality care priorities and improvement efforts. Here we describe the design and implementation of a QI capacity building program that aimed to (1) build QI capacity amongst diverse integrated care system members and (2) apply QI principles to advance integrated quality care priorities. Design/methodology/approach: The integrated care system leaders, including community members, partnered with the University of Toronto Centre for Quality Improvement and Patient Safety to co-design and deliver the QI capacity building program focused on improving cancer screening rates. An existing acute care capacity building program was adapted. Content included QI tools, data to identify and monitor QI priorities, equity considerations, and empowering participants as change agents. Findings: Participants were satisfied with the content and delivery of the program. Some described using QI tools and strategies in practice following the workshop. Challenges to using the tools included the current pressures facing primary care and the health system, resources, and data availability. Practical implications: This QI capacity building program was challenging but feasible. Clarifying the target audience, being attentive to co-design, acknowledging post-pandemic system challenges and proactively addressing variable knowledge and barriers to QI work in practice will inform future iterations of this program. Originality/value: While many examples of QI education programs exist, the majority target a single healthcare sector. We describe a novel QI capacity building model that bridges healthcare sectors and includes patient partners and community members as teachers and participants. [ABSTRACT FROM AUTHOR]

Background: Workplace violence and harassment are commonplace for healthcare workers and most incidents are unreported. Normalization of these experiences, lack of confidence in reporting systems, and fear of the consequences of reporting contribute to the invisibility of these experiences. Challenges are exacerbated in homecare settings and for precarious workforces including Personal Support Workers (PSWs). We created, piloted, and evaluated an intervention to enhance safety culture and encourage reporting of workplace violence and harassment. Methods: A multi-stakeholder steering committee designed an intervention combining policy changes, a pre-visit screening tool, education, and brief end-of-visit reporting. This was piloted with a PSW care team which provided >55,000 client visits during the 32-week intervention. Operational metrics characterized screening, education, and reporting uptake. Pre- and post-intervention surveys characterized PSWs' experiences with workplace violence and harassment, reporting experiences, training history and intervention feedback. Findings: PSWs reported increased comfort discussing workplace violence and harassment, and increased confidence managing client-to-worker incidents. The screening went smoothly with most clients in private homes. Most PSWs (75%) engaged at least once with end-of-visit reporting and nearly half submitted reports regularly. During the pilot, 21% of PSWs reported incidents and 52% of reports shared client-specific strategies for managing these situations. Application to Practice: Changes in comfort and behavior with reporting indicated a shift toward a more open culture surrounding workplace violence and harassment. Tools created for this intervention and lessons for implementation are shared for consideration by occupational health practitioners throughout the homecare sector. [ABSTRACT FROM AUTHOR]

Background: We initially reported on the cost-effectiveness of a 6-month randomized controlled implementation trial which evaluated Health TAPESTRY, a primary care program for older adults, at the McMaster Family Health Team (FHT) site and 5 other FHT sites in Ontario, Canada. While there were no statistically significant between-group differences in outcomes at month 6 post randomization, positive outcomes were observed at the McMaster FHT site, which recruited 40% (204/512) of the participants. The objective of this post-hoc study was to determine the cost-effectiveness of Health TAPESTRY based on data from the McMaster FHT site. Methods: Costs included the cost to implement Health TAPESTRY at McMaster as well as healthcare resource consumed, which were costed using publicly available sources. Health-related-quality-of-life was evaluated with the EQ-5L-5L at baseline and at month 6 post randomization. Quality-adjusted-life-years (QALYs) were calculated under an-area-under the curve approach. Unadjusted and adjusted regression analyses (two independent regression analyses on costs and QALYs, seemingly unrelated regression [SUR], net benefit regression) as well as difference-in-difference and propensity score matching (PSM) methods, were used to deal with the non-randomized nature of the trial. Sampling uncertainty inherent to the trial data was estimated using non-parametric bootstrapping. The return on investment (ROI) associated with Health TAPESTRY was calculated. All costs were reported in 2021 Canadian dollars. Results: With an intervention cost of $293/patient, Health TAPESTRY was the preferred strategy in the unadjusted and adjusted analyses. The results of our bootstrap analyses indicated that Health TAPESTRY was cost-effective compared to usual care at commonly accepted WTP thresholds. For example, if decision makers were willing to pay $50,000 per QALY gained, the probability of Health TAPESTRY to be cost effective compared to usual care varied from 0.72 (unadjusted analysis) to 0.96 (SUR) when using a WTP of $50,000/QALY gained. The DID and ROI analyses indicated that Health Tapestry generated a positive ROI. Conclusion: Health TAPESTRY was the preferred strategy when implemented at the McMaster FHT. We caution care in interpreting the results because of the post-hoc nature of the analyses and limited sample size based on one site. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Community Mental Health is the property of Canadian Periodical for Community Studies Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Knowledge translation has been defined as the synthesis, dissemination, exchange and ethically sound application of knowledge to improve health, resulting in a stronger health-care system. Using KT activities to aid in the adoption of evidence into practice can address current health-care challenges such as increasing organizational practice standards, alleviating the risk for adverse events and meeting practitioner needs for evidence at the bedside. Two general forms of KT have been identified. These being integrated KT and end-of-grant KT. Integrated KT involves the knowledge users in the research team and in the majority of stages of the research process. End-of-grant KT relates to the translation of findings through a well-developed dissemination plan. This paper describes the process of using an integrated knowledge translation approach to design a research protocol that will examine the effectiveness of a web-based patient educational intervention. It begins with a description of integrated knowledge translation, followed by the presentation of a specific case example in which integrated knowledge translation is used to develop a nursing intervention. The major elements of integrated knowledge translation pertain to need for a knowledge user who represents the broad target user group, and who is knowledgeable in the area under investigation and who as authority to enact changes to practice. Use of knowledge users as equal partners within the research team; exploring all feasible opportunities for knowledge exchange; and working with knowledge users to identify all outcomes related to knowledge translation are the other major elements of integrated knowledge translation that are addressed throughout this paper. Furthermore, the relevance of psychosocial or educational interventions to knowledge translation is also discussed as a source of knowledge. In summary, integrated knowledge translation is an important tool for the development of new interventions, as it helps to apply science to practice accurately. It supports the elaboration of the design while enhancing the relevance of the intervention through the validation of feasibility and acceptability with clinicians and patients. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Oncology Nursing Journal is the property of Pappin Communications and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Discussions of integrated care have ranged in focus from large-scale health system transformations, to discrete interventions intended to enhance local continuity of care. Beyond these variations in scale and focus, literature on integrated care has used a variety of conceptual frameworks to explain various activities and elements necessary to achieve integrated care. Existing frameworks have helped to advance research and practice; yet the complexity of changing practice required to achieve integrated care across the policy, organizational, and clinical levels complicates efforts to represent or implement these innovations in straightforward ways. Aims Objectives Theory or Methods: In this paper, we present a novel strategy for conceptualizing integrated care as developing through a series of milestones observable at the organizational level. Based on analysis of four integrated care organizational case studies in Canada and New Zealand, we outline how this approach to conceptualizing integrated care both resolves the tension of crossing the macro, meso, and micro levels of analysis, and generates new practical insights to guide policy and practice. Methods consist of qualitative interviews, observation, and document analysis across cases, and qualitative data were analyzed temporally to identify milestones as indicated by participants over time. Highlights or Results or Key Findings: We define a milestone as the occurrence of a salient event that is perceived by respondents to facilitate or disrupt efforts towards the development of integrated care. We synthesize these events at the organizational level, suggesting that the organizational level of analysis is the most appropriate level to represent the significance of these milestones. Our analysis identified six categories of milestone: (1) Strategic relational milestones, referring to building relationships between stakeholders. (2) Strategic process change milestones, referring to efforts to improve quality in practice. (3) Structural (intra-organizational) milestones, referring to changes in organizational structure. (4) Structural (inter-organizational) milestones, referring to changes in the legal, operational, or leadership structures that facilitate relationships between organizations. (5) Environmental milestones, referring to changes in the social or natural environment. (6) Political milestones, referring to changes in the control and allocation of resources. Conclusions: Our results generate a new conceptual framework for understanding the achievement of integrated care as occurring through a series of milestones. This approach enhances the focus on achieving integrated care "in the wild", in the actual environments in which leaders, clinicians, policymakers, patients, and caregivers work to implement integrated care. Implications for applicability/transferability sustainability and limitations: Our model emphasizes two practical points. First, that there is no single series of sequential steps that must be taken to achieve integrated care. Second, that policy efforts to support integrated care ought to encourage organizations and their collaborators to work toward milestones that facilitate the development of integrated care. [ABSTRACT FROM AUTHOR]

Introduction: Transfers between acute facilities and the community (namely long-term care homes) have long suffered from challenges to integrated care, often stemming from the current reliance on paper documentation, follow up phone calls, and discussions with the patient to enable transitions in care. Current processes are inefficient for staff and hinder quality care by increasing the risk of errors and readmissions. PointClickCare, the leading electronic health record (EHR) provider for senior's care, is working to support this challenge through digital innovation. Their new product, Harmony, creates a two-way, digital integration between a hospital EMR and the EHR in long-term care. Aims Objectives Theory or Methods: This presentation will provide an overview of Harmony, and its capabilities. It will focus on Harmony's benefits by highlighting the first implementation of Harmony in Canada, at St. Joseph's Healthcare Hamilton (SJHH). SJHH implemented Harmony beginning in the Spring of 2020. Their focus was on validating the potential of an acute-LTC integration, using the hospital's Epic HIS system, and St. Joseph's Villa, a healthcare system partner LTC home that uses PointClickCare. Key areas of focus for project evaluation included validating the clinician experience, timeliness of information being shared, and ease of access to the information within clinical workflows. Highlights or Results or Key Findings: Results from the project evaluation will be shared, including positive results from clinician surveys and interviews, as well as efficiency and time savings resulting from data integration incorporated into the admission and discharge processes. The presentation will also provide insights on the potential for tools like Harmony to enable integrated care coordination and population health management, which are key enablers of successful models of integrated care. Real-time population health dashboards can support the success of innovative approaches to integrated care, such as the Ontario Health Teams (OHTs) and Accountable Care Organizations (ACOs) in the United States. Conclusions: The ability to digitally integrate acute and long-term care can provide numerous benefits, including workflow efficiencies and improved clinical decision-making across the continuum. It also supports strengthening the relationship between hospitals and community providers, which are foundational to quality care as we begin to apply lessons from the COVID-19 pandemic. Implications for applicability/transferability sustainability and limitations: Compared to other digital innovations, this innovation has a unique opportunity to scale and spread across Ontario, particularly in support of the new OHT integrated care model. Harmony is also EMR 'agnostic' so it can be implemented at both Epic and non-Epic hospitals. [ABSTRACT FROM AUTHOR]

Introduction: Despite a wealth of strong evidence on the effectiveness of exercise and education for hip and knee osteoarthritis (OA), implementation of these interventions in healthcare settings is currently sub-optimal. An international physiotherapist-supervised education and exercise programme for hip and knee OA (Good Life with osteoArthritis from Denmark (GLA:D)) was chosen for implementation due to evidence on effectiveness for patient outcomes, the inclusion of a patient registry to collect outcomes and the ability to adapt to other cultural contexts.2 This paper captures the key methodologies used in the co-design, implementation, and evaluation of the IMPACT project to confront the problem. Aims Objectives Theory or Methods: Using a type III hybrid implementation-effectiveness design, work packages include: (1) ENGAGE key stakeholders to form a steering committee and survey stakeholders to inform development of the IMPACT implementation strategy based on the Consolidated Framework for Implementation Research (CFIR), (2) IMPLEMENT GLA:D Ireland by training physiotherapists across health settings (primary care, secondary care, private practice) during pilot testing, (3) EVALUATE short and long-term qualitative and quantitative implementation indicators, and patient outcomes related to pain, function, quality of life and healthcare utilisation from the patient registry up to 12-months post-programme, (4) SHARE results with engaged stakeholders and rollout the programme nationally. Highlights or Results or Key Findings: Key stakeholders including two patient representatives and one advocacy group member, five researchers, four physiotherapists, one GP and one orthopaedic consultant have been engaged to the form the IMPACT steering committee and co-design the implementation strategy. Key sources that informed this strategy include (1) theoretical framework adapted from CFIR constructs (patient, physiotherapist and intervention characteristics, inner and outer setting, process), (2) best evidence from a literature review of barriers, enablers and strategies for implementation of OA programmes, (3) local context from surveys distributed to Irish GPs, physiotherapists and patients with OA, (4) expert consensus from steering committee members. Some of the main strategies identified include development of learning tools for health care professionals and patients to improve referral pathways to exercise and education and dispel myths related to exercise safety for joint disease. To reduce barriers related to patient accessibility, evidence-based programmes should be available across multiple health settings. Conclusions: GLA:D Ireland delivery will result from comprehensive implementation strategy development using theory, evidence, knowledge of context and stakeholder consensus. Incorporating a participatory approach and including end-users in planning, co-design, implementation and evaluation is a critical approach to overcoming barriers and ensuring appropriate care is delivered to patients who need it. Implications for applicability/transferability sustainability and limitations: This model can act as a template for implementation of clinical practice guidelines for other chronic conditions across healthcare settings. This research has the potential to change practice and promote a policy of exercise and physical activity referral for chronic disease that utilises community engagement effectively and enacts change 'together'. [ABSTRACT FROM AUTHOR]

Background: Effectively addressing the social determinants of health and health equity are critical yet still-emerging areas of public health practice. This is significant for contemporary practice as the egregious impacts of health inequities on health outcomes continue to be revealed. More public health organizations seek to augment internal organizational capacity to address health equity while the evidence base to inform such leadership is in its infancy. The purpose of this paper is to report on findings of a study examining key factors influencing the development and implementation of the social determinants of health public health nurse (SDH-PHN) role in Ontario, Canada. Methods: A descriptive qualitative case study approach examined the first Canadian province-wide initiative to add SDH-PHNs to each public health unit. Data sources were documents and staff from public health units (i.e., SDH-PHNs, Managers, Directors, Chief Nursing Officers, Medical Officers of Health) as well as external stakeholders. Data were collected through 42 individual interviews and 226 documents. Interview data were analyzed using framework analysis methods; Prior's approach guided document analysis. Results: Three themes related to the SDH-PHN role implementation were identified: (1) 'Swimming against the tide' to lead change as staff navigated ideological tensions, competency development, and novel collaborations; (2) Shifting organizational practice environments impacted by initial role placement and action to structurally embed health equity priorities; and (3) Bridging policy implementation gaps related to local-provincial implementation and reporting expectations. Conclusions: This study extends our understanding of the dynamic interplay among leadership, change management, ideological tensions, and local-provincial public health policy impacting health equity agendas. Given that the social determinants of health lie outside public health, collaboration with communities, health partners and non-health partners is essential to public health practice for health equity. The study findings have implications for increasing our knowledge and capacity for effective system-wide intervention towards health equity as a critical strategic priority for public health and for broader public policy and community engagement. Appropriate and effective public health leadership at multiple levels and by multiple actors is tantamount to adequately making inroads for health equity. [ABSTRACT FROM AUTHOR]

Background: Public health systems in Canada have undergone significant policy renewal over the last decade in response to threats to the public's health, such as severe acute respiratory syndrome. There is limited research on how public health policies have been implemented or what has influenced their implementation. This paper explores policy implementation in two exemplar public health programs -chronic disease prevention and sexually-transmitted infection prevention - in Ontario, Canada. It examines public health service providers', managers' and senior managements' perspectives on the process of implementation of the Ontario Public Health Standards 2008 and factors influencing implementation.Methods: Public health staff from six health units representing rural, remote, large and small urban settings were included. We conducted 21 focus groups and 18 interviews between 2010 (manager and staff focus groups) and 2011 (senior management interviews) involving 133 participants. Research assistants coded transcripts and researchers reviewed these; the research team discussed and resolved discrepancies. To facilitate a breadth of perspectives, several team members helped interpret the findings. An integrated knowledge translation approach was used, reflected by the inclusion of academics as well as decision-makers on the team and as co-authors.Results: Front line service providers often were unaware of the new policies but managers and senior management incorporated them in operational and program planning. Some participants were involved in policy development or provided feedback prior to their launch. Implementation was influenced by many factors that aligned with Greenhalgh and colleagues' empirically-based Diffusion of Innovations in Service Organizations Framework. Factors and related components that were most clearly linked to the OPHS policy implementation were: attributes of the innovation itself; adoption by individuals; diffusion and dissemination; the outer context - interorganizational networks and collaboration; the inner setting - implementation processes and routinization; and, linkage at the design and implementation stage.Conclusions: Multiple factors influenced public health policy implementation. Results provide empirical support for components of Greenhalgh et al's framework and suggest two additional components - the role of external organizational collaborations and partnerships as well as planning processes in influencing implementation. These are important to consider by government and public health organizations when promoting new or revised public health policies as they evolve over time. A successful policy implementation process in Ontario has helped to move public health towards the new vision. [ABSTRACT FROM AUTHOR]

This clinical concept paper overviews a program to facilitate access to postexposure prophylaxis ( PEP) for gay, bisexual, and other men who have sex with men. The project, which was a collaborative initiative involving the local School of Nursing, public health unit, AIDS service organization, hospital-based HIV clinic, and an outpatient pharmacy, was implemented to circumvent common barriers to care identified in the literature. In this project, persons who present to one of the two participating clinics after having come, or likely having come, into contact with HIV within the previous 72 hr, are offered rapid HIV testing, also known as point-of-care ( POC) testing, to rule out existing HIV infection, and provided with a follow-up appointment booked at the HIV clinic. Clients are also offered comprehensive STI testing, and HIV prevention counseling. The implementation of this collaborative community-based access-to- PEP project demonstrates the application of research to a real-world health care setting, and it is hoped that others will adapt this model to their local setting, enabling ease of access to PEP for members of groups that are disproportionately affected by HIV. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Oncology Nursing Journal is the property of Pappin Communications and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Narrative abilities are an important part of everyday conversation, playing a key role in academic settings, at home, and in social interactions. As narrative assessments are an effective method for identifying children falling below age expectations, it has been recommended they be included as a routine part of clinical language assessments. It is important that assessments meet the needs of clinicians and their practice. The current study is a practicebased research partnership, where research questions arose from a partnership with school-based speech-language pathologists (SLPs). Working together, SLPs and researchers evaluated a bespoke narrative retell assessment tool. The current study examined recall of events in two wordless picture books, in order to evaluate story equivalency and determine if the tool was appropriate for progress monitoring. These findings were then used to develop local norms. Method: Two hundred sixty-three students were recruited across 12 schools in kindergarten, Grade 1, and Grade 2. Students completed the narrative retell task, retelling either One Frog Too Many or Frog Goes to Dinner, followed by answering 10 comprehension questions related to story events. Results: A significant effect of story was found for both main and supporting events recalled, but not for total events recalled. Total events recalled were found to be predicted by grade only. An examination of percent events recalled revealed four main and four supporting events in each story that were potentially misclassified. Reanalysis following reallocation revealed no significant effect of story for main or supporting events recalled. Normative values for each grade were created using percentile ranks of total events recalled. Conclusion: Through a practice-based research partnership, researchers and clinicians worked collaboratively to evaluate a tool, adapt its use, and improve evidence-based practice in a manner that was appropriate and met the needs for the clinical context. [ABSTRACT FROM AUTHOR]

Anxiety and depression are complex mental health concerns affecting adolescents, and when experienced together the prognosis can be worsened. Current evidence based approaches used in social work interventions include cognitive behavioral therapy, dialectical therapy, and counselling incorporating psychotherapy and psychoeducation, however they do not work for all individuals and they are not holistic. This paper argues that spirituality is a missing element of current social work interventions for treating anxiety and depression. Yoga has emerged as one type of mind body spirit intervention that is more holistic in nature, and it is deemed to be a positive approach that can be included in social work interventions. Furthermore, the explicit incorporation of spirituality is seen as a necessary component of treatment. Literature pertaining to spirituality as an important dimension of life, mental health, coping and wellbeing provides a rationale for its inclusion into comprehensive multi-modal approaches. The HEALTHY group is highlighted as a comprehensive multi-modal mind body spirit approach that addresses the gap of explicitly attending to spirituality. Implications for practice are put forth regarding the need for research on this kind of comprehensive integrative mind body and spirit social work intervention on the outcomes for adolescents experiencing anxiety and depression. [ABSTRACT FROM AUTHOR]

This paper details how the Ontario child welfare community implemented he Bookworm Club, a province-wide literacy program for children residing in out-of-home care. The province utilized a UK-based, evidence-informed practice idea and moved it into full-scale provincial implementation, which has contributed to the growth of a strong commitment to evidence-informed practice (EIP), particularly as it relates to the improvement of educational outcomes for children and youth residing in out-of-home care placements. The Bookworm Club story is noteworthy; it provides insight into the process, challenges, and opportunities involved in undertaking such an endeavor and describes how the program was moved from an idea into practice. Opportunities, successes, and challenges are detailed, along with the future goals of the program. It is hoped that this conceptual paper will inspire others involved in promoting the welfare of vulnerable children and families in implementing such evidence-informed programs. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Occupational Therapy is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The ever changing needs of society have created a much needed shift in health care delivery from that of hospital to community. However, the role and process of community health nursing is foreign to most nursing students as the majority of nursing curricula continue to relate experiences and examples of nursing to the more familiar role of 'nurse clinician.' In contrast to undergraduate nursing programs where the use of simulation and technology has been widely adopted to emphasize the role of the nurse clinician, the use of such technology hasn't been widely used to address the learning needs of community health nursing students. Here, we present a descriptive paper on the development of an interactive, virtual learning environment (serious game) for acquisition of community health nursing skills. The serious game primarily presents a learner-centered, experiential learning and problem-based learning approach, addressing the learning needs of today's students. [ABSTRACT FROM AUTHOR]

Aim: Population-level prevention initiatives are the cornerstone of public health practice. However, despite this normative practice, sexual health programming within public health has not utilized this approach to the same extent as other public health programs. Understanding requirements to put a population-level approach into practice is needed. The objective of this study was to explore the barriers and facilitators experienced by sexual health programs and services within public health when implementing a population health approach. Subject design and methods: The principles of qualitative description guided all sampling, data collection and analysis decisions. Data collection involved in-depth semi-structured interviews with 12 sexual health managers and/or supervisors from ten Ontario public health units. Directed content analysis was used to code and synthesize the data. Data collection and analysis was guided using constructs from the Consolidated Framework for Implementation Research. Results: Factors that served as either barriers and facilitators to implementing a population health approach, were mainly in the inner and outer setting domains of the Consolidated Framework for Implementation Research. Participants identified the presence of community partnerships, adequate staff training on population health, and access to data on population health served as facilitators. In comparison, barriers to implementation included a lack of resources (human, financial) and clinicians' value of and preferences for delivering services at the individual clinic level. Conclusion: Some clear barriers and facilitators influenced if staff in sexual health programs and services could implement a population health approach. Results indicate where public health resources need to be enhanced to move toward a population health approach and provide insight into what worked and should be considered by public health organizations. [ABSTRACT FROM AUTHOR]

The literature pertaining to community-based hospice wellness centres, especially concerning program evaluation, is sparse. This article describes the development and implementation of a mixed-method, rapid needs assessment for a nonprofit community-based hospice wellness centre in Ontario, Canada. As part of the needs assessment, a survey and focus groups were performed to elicit responses from service users. Individuals registered for services and wellness centre attendees were asked about their needs, opinions, and preferences to help guide future program and service options. Findings and recommendations are presented for programming and service options, and implications for future program evaluation projects are discussed. The methodology of this time and cost-efficient evaluation provides insights that can be utilized by other hospice wellness centres facing similar challenges of time, money, and program evaluation expertise constraints. The findings and recommendations may inform program and service offerings at other Canadian hospice wellness centres. [ABSTRACT FROM AUTHOR]

Indigenous women encounter increased stressful life experiences such as socioeconomic insecurities as well as inequities in health services and outcomes. These stress inequities, which stem from the historical and ongoing effects of settler colonialism, also worsen health outcomes for those women living with HIV. As a part of a broader research project on the impacts of stress-reducing interventions for indigenous women, this study examines the experiences of the women who facilitated the intervention. This research was conducted to evaluate the impacts of a biweekly stress-reducing intervention conducted in Thunder Bay, Ontario. The facilitators of the intervention participated in a focus group in 2019 where they detailed the reach, effectiveness, adoption, and implementation of the intervention. The results suggest that effective stress-reducing interventions should strive to be accessible and inclusive and that doing so can increase program engagement with the service organization hosting the intervention. Further, the results highlight the strengths and challenges of the intervention, including how it helped foster leadership skills and increased indigenous cultural learning among facilitators. These findings demonstrate the strength of community-led interventions and subsequent opportunities for facilitators to grow as leaders. Further, the study highlights how this style of intervention can also encourage participants to engage in other health and wellbeing programs offered by the community partner hosting the intervention. These findings suggest that interventions aimed at reducing stress among indigenous women facing socioeconomic insecurities, including those living with HIV, are both feasible and beneficial for participants, facilitators, and the nonprofit service organizations delivering them. [ABSTRACT FROM AUTHOR]

Background Using the comparatively new environmental scan methodology, a protocol was developed and conducted to inform the co-design and implementation of a novel intervention to promote mobility among older adults in Hamilton, Ontario, Canada. The EMBOLDEN program seeks to promote physical and community mobility in adults 55 years and older who face barriers accessing community programs and who reside in areas of high inequity in Hamilton, and to address the following areas of focus: physical activity, nutrition, social participation, and system navigation supports. Methods The environmental scan protocol was developed using existing models and drew insights from census data, a review of existing services, organizational representative interviews, windshield surveys of selected high-priority neighbourhoods, and Geographic Information System (GIS) mapping. Results A total of 98 programs for older adults from 50 different organizations were identified, with the majority (92) supporting mobility, physical activity, nutrition, social participation, and system navigation. The analysis of census tract data identified eight high-priority neighbourhoods characterized by large shares of older adults, high material deprivation, low income, and high proportion of immigrants. These populations can be hard to reach and face multiple barriers to participation in community-based activities. The scan also revealed the nature and types of services geared toward older adults in each neighbourhood, with each priority neighbourhood having at least one school and park. Most areas had a range of services and supports (i.e., health care, housing, stores, religious options), although there was a lack of diverse ethnic community centres and income-diverse activities specific to older adults in most neighbourhoods. Neighbourhoods also differed in the geographic distribution number of services, along with the number of recreational services specific to older adults. Barriers included financial and physical accessibility, lack of ethnically diverse community centres, and food deserts. Conclusions Scan results will inform the co-design and implementation of the Enhancing physical and community MoBility in OLDEr adults with health inequities using commuNity co-design intervention--EMBOLDEN. [ABSTRACT FROM AUTHOR]

Background: Primary care is often the first point of contact when community-dwelling older adults experience subjective cognitive decline (SCD) or mild cognitive impairment (MCI). Living with SCD or MCI can be life-altering, resulting in low mood and increased anxiety, further exacerbating cognitive decline. However, there is scant literature on interventions that interprofessional primary care providers can provide to support those living with SCD or MCI. Practicing mindfulness-based stress reduction (MBSR) in an interprofessional primary care setting may support emotional health and well-being for those with cognitive decline, but it has not been studied in an interprofessional primary care context. Objectives: This study's primary aim was to determine the feasibility of, and perceived benefits to and satisfaction with, a 9-Week MBSR program delivered in a team-based primary care setting. The secondary aim was to examine the acceptability of using technology (computer tablet and App Insight Timer®) for program delivery and home practice. Methods: A convergent mixed-methods, single-blind pilot randomized controlled trial (RCT) study design was used. A quantitative strand was used to evaluate the feasibility of the MBSR program. The qualitative strand used a focus group with older adult participants with SCD or MCI. Individual semi-structured interviews with occupational therapists who are qualified-MBSR teachers were conducted to explore the acceptability of using computer tablets for program delivery and home practice. Results: 27 participants were randomized (14 MBSR; 13 Control) with retention rates of 64.3% (9/14 completed ≥6 sessions), true adherence rates of 50% (7/14 met ≥19.5 hrs of home practice), 21.4% attrition rates, and 100% post-intervention follow-up. No participants who used computer tablets at the beginning of the intervention switched to low technology. Older adult participants found the use of computer tablets in the MBSR course acceptable and appreciated the portability of the tablets. Conclusions: Based on the lower-than-expected rates of recruitment, retention, and adherence, our study, as designed, did not meet the feasibility benchmarks that were set. However, with minor modifications to the design, including changing how participants who drop-out are analyzed, extending recruitment, and adding multiple sites, this intervention would be well suited to further study using a full-scale RCT. However, we found that embedding MBSR in an interprofessional primary care setting was feasible in practice and qualitative data highlighted the satisfaction and perceived benefits based on the intervention. The use of technology was acceptable and portable, as participants utilized their computer tablets consistently until the study's end. Our study showed that older adults living with SCD or MCI were highly receptive to learning how to use technology, and future group intervention programs in interprofessional primary care settings may also incorporate tablet use. Trial registration: This study was reviewed and approved by the Research Ethics Board in Toronto, Ontario, Canada (REB# 2017–0056-E); Queen's University (REB# 6026418) in Kingston, Ontario, Canada, and Clinicaltrials.gov (08/03/2019; NCT03867474). [ABSTRACT FROM AUTHOR]

Background: Psychosocial oncology (PSO) is an interdisciplinary field that is often practised and researched in disciplinary silos. The Interdisciplinary PSO Research Group and Laboratory (IPSORGL) was developed in Ottawa (Ontario) to foster interdisciplinary collaboration and training amongst trainees, healthcare professionals (HCPs), and researchers. Methods: The research team conducted an implementation and outcome evaluation of the IPSORGL. Data were collected using sequential mixed methods, including surveys and interviews. Results: Eight trainees, six HCPs, and five researchers completed the survey. Six trainees and four HCPs participated in an interview. Benefits of the IPSORGL included establishing interdisciplinary connections and collaborations and obtaining unique training in a supportive environment. Challenges included members' differing preferences for meeting formats and content, and difficulties prioritizing the IPSORGL over other academic or clinical demands. Conclusions: The IPSORGL fosters essential interdisciplinary training and collaboration, which bolsters psychosocial oncology research and practice. The sustainability of such initiatives, however, requires formal institutional support. [ABSTRACT FROM AUTHOR]

Background: The literature supports the effectiveness of self-management support (SMS) to improve health outcomes of patients with chronic spine pain. However, patient engagement in SMS programs is suboptimal. The objectives of this study were to: 1) assess participation in self-care (i.e. activation) among patients with spine pain, 2) identify patients' barriers and enablers to using SMS, and 3) map behaviour change techniques (BCTs) to key barriers to inform the design of a knowledge translation (KT) intervention aimed to increase the use of SMS. Methods: In summer 2016, we invited 250 patients with spine pain seeking care at the Canadian Memorial Chiropractic College in Ontario, Canada to complete the Patient Activation Measure (PAM) survey to assess the level of participation in self-care. We subsequently conducted individual interviews, in summer 2017, based on the Theoretical Domains Framework (TDF) in a subset of patients to identify potential challenges to using SMS. The interview guide included 20 open-ended questions and accompanying probes. Findings were deductively analysed guided by the TDF. A panel of 7 experts mapped key barriers to BCTs, designed a KT intervention, and selected the modes of delivery. Results: Two hundred and twenty-three patients completed the PAM. Approximately 24% of respondents were not actively involved in their care. Interview findings from 13 spine pain patients suggested that the potential barriers to using SMS corresponded to four TDF domains: Environmental Context and Resources; Emotion; Memory, Attention & Decision-Making; and Behavioural Regulation. The proposed theory-based KT intervention includes paper-based educational materials, webinars and videos, summarising and demonstrating the therapeutic recommendations including exercises and other lifestyle changes. In addition, the KT intervention includes Brief Action Planning, a SMS strategy based on motivational interviewing, along with a SMART plan and reminders. Conclusions: Almost one quarter of study participants were not actively engaged in their spine care. Key barriers likely to influence uptake of SMS among patients were identified and used to inform the design of a theory-based KT intervention to increase their participation level. The proposed multi-component KT intervention may be an effective strategy to optimize the quality of spine pain care and improve patients' health-outcomes. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to describe the preliminary development and validation of an instrument to measure the extent that a population health approach was applied in sexual health by public health units in Ontario, Canada. Design: Preliminary scale development and administration occurred in two phases that included item development and validity testing. Measurement and Sample: Two phases of development included: (1) using literature and expert input (n = 6) to develop items; and (2) validation of items by content experts (n = 5) and pre‐testing (n = 3). Results: The validated scale consisted of 69 items across the eight key elements of a population health approach. 15 out of 35 health units completed the survey, representing 43% of health units. Instrument administration revealed that Focus on the Health of Populations and Address the Determinants of Health and their Interactions were implemented more frequently compared to Collaborate Across Sectors and Levels and Employ Mechanisms for Public Involvement, which were infrequently implemented. Conclusion: This preliminary scale is a way for sexual health programs to measure the extent that a population health approach is implemented by their organization. Further testing with a broader sample is needed to strengthen generalizability and address reliability. [ABSTRACT FROM AUTHOR]

In Ontario, new home care clients are screened with the interRAI Contact Assessment and only those expected to require longer‐term services receive the comprehensive RAI‐Home Care assessment. Although Ontario adopted this two‐step approach in 2010, it is unknown whether the assessment guidelines were implemented as intended. To evaluate implementation fidelity, the purpose of this study is to compare expected to actual client profiles and care co‐ordinator practice patterns. We linked interRAI CA and RAI‐HC assessments and home care referrals and services data for a retrospective cohort of adult home care clients admitted in FY 2016/17. All assessments were done by trained health professionals as part of routine practice. Descriptive analyses were used to evaluate congruency between recommended and actual practice. Adjusted cause‐specific hazards and logistic approaches were used to examine time to RAI‐HC assessment and being a high‐priority client. Of 225,989 unique home care clients admitted to the publicly funded home care program, about three‐quarters of clients were assessed with the interRAI CA only (27.9% completed the Preliminary Screener only and 46.6% completed both the Preliminary Screener and Clinical Evaluation). There was substantial agreement between the skip logic and completion of the Clinical Evaluation section (Cohen's kappa = 0.67 [95% CI: 0.66–0.67]). One‐quarter of clients were assessed with both the interRAI CA and RAI‐HC. As expected, RAI‐HC assessed clients were older, reported more health needs, and often received home care services for >6 months. Clients in higher Assessment Urgency Algorithm (AUA) levels were significantly more likely to receive a RAI‐HC assessment and be assigned to a higher home care priority level; however, 28.3% of clients in the highest AUA level did not receive a RAI‐HC assessment. We conclude that the use of the interRAI CA and RAI‐HC balances the investment of time and resources with the information and tools to deliver high‐quality, holistic, and client‐centred care. The interRAI CA guides the care co‐ordinator to screen every client for a broad range of possible needs and tailor further assessment to each client's unique needs. We recommend integrating the AUA into provincial assessment guidelines as well as developing a new quality indicator focused on measuring access to the home care system. [ABSTRACT FROM AUTHOR]

Despite the increasing demand for cognitive behavioural therapy for psychosis (CBTp), the existing literature is lacking in terms of models for sustainable implementation. The aims of this study were to: (a) describe the development of a specialized CBTp Service; (b) report demographic characteristics and referral patterns over 1 year to examine feasibility; and (c) review feedback from participants in group-based CBTp to examine acceptability. Data were analyzed from 126 referrals (M = 35.52, SD = 13.06, 59.5% men) to an outpatient CBTp Service at the Centre for Addiction and Mental Health (Toronto, Ontario) between January 2019 to January 2020. Anonymous feedback was obtained from 54 individuals who completed group-based CBTp. Positive symptoms and distressing emotions were the main reasons for referral. Over half of eligible referrals scheduled an intake assessment and 70% of individuals who completed this assessment attended further treatment. Primary reasons for service refusal were scheduling conflicts and illness-related barriers. The total service wait-time was two months, with the longest delay between dates of referral and initial contact. Satisfaction with the quality of CBTp and its components was rated high among group members. Although variable wait-times and engagement levels were identified across stages of the referral process, the CBTp Service demonstrates preliminary feasibility and acceptability, and provides a model of service delivery to incorporate within future CBTp implementation efforts in Canada. [ABSTRACT FROM AUTHOR]

• Organizations need empirical data to inform service delivery and resource allocation decisions. • Assessment tools co-developed with clinicians can be usable and useful in practice and research. • By engaging clinicians, the barriers to implementing new assessment tools can be understood. • The Profile of Preschool Communication can support clinical data collection across large programs. . This study aimed to pilot test, assess usability and utility of, and identify barriers to implementation for the Profile of Preschool Communication (PPC) - a new data collection tool designed to support outcome monitoring in preschool speech-language programs and practice-based research.. This pilot study was conducted with three sites in the Ontario Preschool Speech and Language (PSL) program. Twenty-three speech-language pathologists used the PPC for all outcome monitoring assessments for 2–3-months and provided feedback about their experience using it in practice. Then, 18 of the 23 speech-language pathologists completed online surveys to rate usability and utility, and report their perceived implementation barriers and facilitators.. Speech-language pathologists reported difficulties completing some sections of the PPC, most notably obtaining data related to maternal education and family history of mental health concerns. Usability and utility were generally rated favorably with some items rated as neutral. Barriers to implementation included the paper format, completion time, requirement to ask personal questions, and the perception by some that data were useful for outcome monitoring but not practice. Facilitators included ease of use, an improvement over the existing tool, and the collection of data to support service planning.. The PPC shows potential as an outcome monitoring data collection tool in preschool speech-language pathology programs. Findings will be of interest to researchers engaged in practice-based research and those interested in engaging end users to develop clinically meaningful tools. [ABSTRACT FROM AUTHOR]

Objective: To explore factors influencing the implementation of patient navigator programs within a hospital for seniors with complex care needs. Methods: A qualitative descriptive design using in‐depth interviews was conducted. Participant interviews were conducted in Toronto, Ontario between September 2020 and February 2021. Data were analysed using thematic analysis. Results: Thirty‐five semi‐structured interviews were conducted with 38 participants from a large urban hospital (n = 21) and community healthcare organizations (n = 17), including organizational leaders, and acute care and rehabilitation providers. Follow‐up interviews occurred with 16 participants (7 from the community and nine from the hospital). This study identified five key factors influencing organizational readiness for successful implementation of a patient navigator program for seniors with complex conditions, which included: (a) vision from senior leadership, (b) technological infrastructure, (c) existing hospital‐community partnerships, (d) well‐established process for referrals, and (e) staff capacity. The overarching theme of communication was also identified. Conclusions: The findings of this study provide a better understanding of hospital and community professionals' needs and challenges when implementing patient navigator programs for seniors with complex care conditions. There are a number of factors that influence an organization's readiness for program uptake and delivery, with the need for clear communication being paramount. Further research to test the effects of readiness on successful implementation outcomes is warranted. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study is to: (a) describe public health nursing roles over the course of the COVID‐19 pandemic in Ontario, Canada; (b) describe the contextual factors that influence public health nursing role implementation; and (c) describe nurses' perceived impact of their roles on client outcomes and professional/personal nursing practice. Design: Descriptive multiple case study. Methods: Recruitment of public health nurses (PHNs), working in direct service or administrative leadership positions, in an Ontario public health unit will be conducted through purposive and snowball sampling. Nursing roles will be compared and contrasted across three cases differentiated by geographic setting: urban, urban–rural, northern. In each geographic case, a priori estimates of sample size will include 10 PHNs providing direct care and at least five nurses in an administrative leadership role; with an overall estimated study sample size of 45 individuals. Demographic data will be collected using an online anonymous survey. Individual semi‐structured interviews with PHNs, and focus groups with nursing administrators will be conducted via telephone and audio‐recorded. Individual interviews and focus groups will be transcribed verbatim. Reflexive thematic analysis will be used to generate emergent themes in each case and cross‐case synthesis will be used to compare and contrast patterns across geographic cases. Discussion: Expected findings will provide an in‐depth analysis of the rapidly evolving roles and functions of PHNs throughout the COVID‐19 pandemic and their impact on individuals, families and communities. As well, findings will provide a new understanding about the contextual barriers and facilitators of PHN role implementation in their working environments. Impact Study findings can support decision‐making in relation to funding, resource allocation and supportive work structures and processes at a public health system and/or individual public health organization level. [ABSTRACT FROM AUTHOR]

Our health care system is ill prepared for the growing number of older adults and their families/caregivers who live with responsive behaviours associated with cognitive impairment. Considering the burden of illness, quality of life issues, and escalating costs, system-wide redesign is warranted. The Behavioural Supports Ontario (BSO) project is a province-wide, regionally implemented, evidence-informed change strategy that utilizes quality improvement principles and knowledge translation best practices as critical enablers. This paper describes the project and key lessons learned in the implementation of this initiative that can be applied to other jurisdictions wishing to enable large-scale system redesign and sustainable system change. [ABSTRACT FROM AUTHOR]

This study examines whether increased interaction and observation of young children by school professionals leads to an increase in school-based reports to child welfare authorities and in the identification of child maltreatment victims. Comparing provincial-level data collected before and after full-day kindergarten implementation in Ontario, a doubling in rates of school-referred investigations involving 4- and 5-year-old children was found. There was no significant difference in the rates of maltreatment substantiation, service referrals made or transfers to ongoing services, but the rate of child functioning concerns noted in these investigations tripled. The findings suggest there are differences in how the school and child welfare systems define and respond to suspected child maltreatment. Implications for practice, policy and research are explored. [ABSTRACT FROM AUTHOR]

Background Urine culturing practices are highly variable in long-term care and contribute to overprescribing of antibiotics for presumed urinary tract infections. The purpose of this study was to evaluate the use of virtual learning collaboratives to support long-term care homes in implementing a quality improvement programme focused on reducing unnecessary urine culturing and antibiotic overprescribing. Methods Over a 4-month period (May 2018-August 2018), 45 long-term care homes were self-selected from five regions to participate in virtual learning collaborative sessions, which provided an orientation to a quality improvement programme and guidance for implementation. A process evaluation complemented the use of a controlled before-and- after study with a propensity score matched control group (n=127) and a difference-in-difference analysis. Primary outcomes included rates of urine cultures performed and urinary antibiotic prescriptions. Secondary outcomes included rates of emergency department visits, hospital admission and mortality. An 18-month baseline period was compared with a 16-month postimplementation period with the use of administrative data sources. Results Rates of urine culturing and urinary antibiotic prescriptions per 1000 resident days decreased significantly more among long-term care homes that participated in learning collaboratives compared with matched controls (differential reductions of 19% and 13%, respectively, p<0.0001). There was no statistically significant changes to rates of emergency department visits, hospital admissions or mortality. These outcomes were observed with moderate adherence to the programme model. Conclusions Rates of urine culturing and urinary antibiotic prescriptions declined among long-term care homes that participated in a virtual learning collaborative to support implementation of a quality improvement programme. The results of this study have refined a model to scale this programme in long-term care. [ABSTRACT FROM AUTHOR]

Introduction Improving the quality of self-management support (SMS) for treatment-related toxicities is a priority in cancer care. Successful implementation of SMS programmes depends on tailoring implementation strategies to organisational readiness factors and barriers/enablers, however, a systematic process for this is lacking. In this formative phase of our implementation-effectiveness trial, Self-Management and Activation to Reduce Treatment-Related Toxicities, we evaluated readiness based on constructs in the Consolidated Framework for Implementation Research (CFIR) and Normalisation Process Theory (NPT) and developed a process for mapping implementation strategies to local contexts. Methods In this convergent mixed-method study, surveys and interviews were used to assess readiness and barriers/enablers for SMS among stakeholders in 3 disease site groups at 3 regional cancer centres (RCCs) in Ontario, Canada. Median survey responses were classified as a barrier, enabler or neutral based on a priori cut-off values. Barriers/enablers at each centre were mapped to CFIR and then inputted into the CFIR-Expert Recommendations for Implementing Change Strategy Matching Tool V.1.0 (CFIR-ERIC) to identify centrespecific implementation strategies. Qualitative data were separately analysed and themes mapped to CFIR constructs to provide a deeper understanding of barriers/enablers. Results SMS in most of the RCCs was not systematically delivered, yet most stakeholders (n=78; respondent rate=50%) valued SMS. For centre 1, 7 barriers/12 enablers were identified, 14 barriers/9 enablers for centre 2 and 11 barriers/5 enablers for centre 3. Of the total 46 strategies identified, 30 (65%) were common across centres as core implementation strategies and 5 tailored implementation recommendations were identified for centres 1 and 3, and 4 for centre 2. Conclusions The CFIR and CFIR-ERIC were valuable tools for tailoring SMS implementation to readiness and barriers/enablers, whereas NPT helped to clarify the clinical work of implementation. Our approach to tailoring of implementation strategies may have relevance for other studies. [ABSTRACT FROM AUTHOR]