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Implementation strategies are methods or techniques used to adopt, implement, and sustain evidence-based practices (EBPs). Implementation strategies are dynamic and may require adaptation to fit implementation contexts, especially in low-resource settings, which are most likely to serve racially and ethnically diverse patients. The framework for reporting adaptations and modifications to evidence-based implementation strategies (FRAME-IS) was used to document adaptations to implementation strategies to inform an optimization pilot of Access to Tailored Autism Integrated Care (ATTAIN; an integrated care model for children with autism and co-occurring mental health needs) in a federally qualified health center (FQHC) near the United States/Mexico border. Quantitative and qualitative data were collected from 36 primary care providers who participated in the initial ATTAIN feasibility pilot to inform adaptations. Adaptations were mapped to the FRAME-IS through an iterative template analysis to inform an optimization pilot at a FQHC 1-year from the start of the COVID-19 pandemic. Four implementation strategies (training and workflow reminders, provider/clinic champions, periodic reflections, and technical assistance) were employed during the feasibility pilot and were adapted for the optimization pilot to fit the needs of the FQHC and service delivery changes prompted by the pandemic. Findings demonstrate the utility of using the FRAME-IS to systematically inform EBP optimization in a FQHC providing care to underserved communities. Findings will inform future research studies implementing integrated mental health models in low-resourced primary care settings. Implementation outcomes and provider perceptions of ATTAIN at the FQHC are also reported. [ABSTRACT FROM AUTHOR]

Background: Promoting uptake of evidence-based innovations in healthcare systems requires attention to how innovations are adapted to enhance their fit with a given setting. Little is known about real-world variation in how programs are delivered over time and across multiple populations and contexts, and what motivates adaptations.Methods: As part of the BeneFIT study of mailed fecal immunochemical tests (FIT) to increase colorectal cancer screening, we interviewed 9 leaders from two participating Medicaid/Medicare health insurance plans to examine adaptations to their health plan-initiated mailed FIT outreach programs in the second year of implementation. We applied an adaptation and modification model developed by Stirman and colleagues to document content and context modifications made to the two programs.Results: Both health plans made substantial changes to their programs in the second year; adaptations differed substantially across health plans. In Health Plan Oregon, adaptations generally targeted health centers and member populations, most content adaptations involved tailoring program components, and the program was expanded to four additional health centers. In contrast, Health Plan Washington's second-year content adaptations were primarily at the level of members, and generally involved adding program components. Moreover, Health Plan Washington undertook large-scale context adaptations to the setting where the program was led (local vs. national), the personnel who administered the program (vendor and staffing), and the population selected for outreach (limiting outreach to dual-eligible members).Conclusions: Both programs implemented a variety of adaptations that reflected the values and incentives of the broader health plan contexts. Financial incentives for screening allowed Health Plan Oregon to expand but led Health Plan Washington to offer more targeted outreach to a subset of eligible enrollees. The breadth of changes made by each health system reflects the necessity of evaluating programs in context and adjusting to specific challenges as they are identified. Further research is needed to understand the effects of these types of adaptations on program efficiency and enrollee and health system outcomes. [ABSTRACT FROM AUTHOR]

Background: Childhood obesity is highly prevalent in the United States and disproportionately impacts communities of color and low-income populations; these disparities have worsened during the COVID-19 pandemic. Adoption of effective pediatric weight management interventions (PWMIs) that have been evaluated among low-income diverse populations is needed. The Healthy Weight Clinic PWMI, a package co-developed by the American Academy of Pediatrics and Massachusetts General Hospital, helps health centers establish multidisciplinary Healthy Weight Clinics based on previous randomized controlled trials which demonstrated effectiveness. We sought to identify the factors influencing successful adoption of this PWMI and understand adaptations needed prior to implementation in new sites., Methods: We interviewed 20 stakeholders, 10 from two health centers in Mississippi where the Healthy Weight Clinic PWMI will be piloted (pre-implementation sites) and 10 from health centers that have previously implemented it (sites in maintenance stages). Separate interview guides informed by the Consolidated Framework for Implementation Research (CFIR) were developed for the pre-implementation sites and those in maintenance stages, including questions related to adaptations of the PWMI in response to the COVID-19 pandemic. Qualitative data analysis was conducted using directed content analysis based on CFIR constructs. Adaptations in response to the pandemic were categorized using Framework for Reporting Adaptations and Modifications-Expanded (FRAME)., Results: In pre-implementation sites, an inner setting facilitator mentioned was a positive learning climate. Characteristics of individuals that can facilitate adoption include staff willingness to learn, valuing evidence-based care for childhood obesity, and culturally and weight-sensitive staff. In terms of patient needs and resources (outer setting), social drivers of health are barriers to adoption, but creative solutions were suggested to mitigate these. Other facilitators related to the intervention included its multidisciplinary model and adaptability. Similar themes were elicited from sites in maintenance stages; adaptations brought on by the pandemic, such as telehealth visits and content modification to align with distancing guidelines and the effects of social isolation were also described., Conclusion: Understanding the factors influencing adoption of an evidence-based PWMI informs necessary adaptations and implementation strategies required to facilitate nationwide dissemination of PWMIs, with the goal of reaching the populations most at-risk., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Sierra-Velez, Gundewar, Persaud, Simione, Castro, Perkins, Lindros, Salmon, Smith, Taveras and Fiechtner.)

Abstract Despite a growing body of evidence that adaptations of evidence-based interventions (EBI) are ubiquitous, few studies have examined the nature and rationale for modifications to the components of these interventions. The primary aim of this study was to describe and classify common local adaptations of the Transitional Care Model (TCM), an EBI comprised of 10 components that has been proven in multiple clinical trials to improve the care and outcomes of chronically ill older adults transitioning from hospitals to home. Guided by Stirman's System of Classifying Adaptations, 582 transitional care clinicians in health systems and community-based organizations throughout the U.S. completed a survey between September 2014 and January 2015; interviews were then conducted with a subset of survey respondents (N = 24) between April and December 2015. A total of 342 survey respondents (59%) reported implementation of the TCM in distinct organizations. Of this group, 96% reported a mean of 4.4 adaptations to the 10 TCM components (40%, one to three; 43%, four to six; and 17%, seven to nine). Nine of ten respondents (94%) reported contextual adaptations while content adaptations were less frequently reported (58%). The top three reported adaptations all related to context (i.e., delivering services from hospital to home, relying on advance practice nurses, and fostering care continuity); interviews clarified a diverse set of reasons for such modifications. Findings reinforce the need for investment in adaptation science and suggest hypotheses to guide rigorous examination of the association between adaptations of TCM components and desired outcomes. Highlights • Describes adaptations of an evidence-based intervention (EBI). • Advances the case for investment in adaptation science. • Reinforces need to achieve balance between fidelity and adaptation. • Offers hypotheses to assess effects of an EBI in the health care sector. [ABSTRACT FROM AUTHOR]

We studied a type of Californian ultramafic chaparral to determine functional groups which can help reduce the complexity of ecosystem management. The study was realized in McLaughlin Reserve, State of California, USA. We analysed the species of a serpentine plant association previously phytosociologically described in the area: Ceanotho albiflori-Quercetum duratae for their functional traits and functional groups. Traits per species were measured building a trait database. We used Principal Component Analysis to identify the combination of functional traits with major weight and a neighbor-joining clustering to define functional groups for this vegetation association. Our results indicated that the studied association is dominated by phanerophytes, with low degree of spinescence. Leaves were mainly malacophyllous with high degree of tomentosity, reduced size and a partial shedding of leaves was observed during summer. We considered six functional groups as the optimum number of clusters in a total of 18 species. The two first functional groups were composed of chamaephytes with brachyblasts and dolichoblasts with differences in the degree of tomentosity. The rest of the functional groups were composed of phanerophytes where the differences between them were based on traits in relation to the branches, leaf size and the horizontal development of the root system. The functional groups obtained show that this serpentine chaparral is composed of species with a wide range of functional traits. The study of other Mediterranean serpentine ecosystems in California and elsewhere could contribute to create new perspectives of functional ecology and help in the management of these valuable ecosystems. [ABSTRACT FROM AUTHOR]

One hundred twenty-five primary-grade teachers randomly selected from across the United States indicated how frequently they made 20 instructional adaptations for the struggling writers in their classroom. The measure of frequency ranged from never, several times a year, monthly, weekly, several times a week, and daily. Using a 6-point Likert-type scale, they also rated the acceptability of each of the 20 adaptations on five dimensions: suitability, effectiveness, negative effects, time to apply, and implementation know-how. Teachers reported making 13 different adaptations monthly or more often. The most common adaptations were extra encouragement and extra time to complete writing assignments, whereas the least common adaptations involved technology or dictation. Teachers viewed all of the adaptations as acceptable, and their views on acceptability made a unique and statistically significant contribution to predicting reported use of adaptations after variance due to student and other teacher variables was first controlled. [ABSTRACT FROM AUTHOR]

Background: The US Department of Veterans Affairs (VA) has over 15 years of experience in delivery of evidence-based psychotherapies (EBPs). This paper describes strategies for using clinical documentation and administrative data to understand adherence and modifications to EBPs for Posttraumatic Stress Disorder (PTSD)., Methods: This study focused on two EBPs for PTSD, Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE). The sample included VA therapists from across the US who provided CPT and PE and the patients they treated over a 1-year period. The data sources for this study were templated EBP chart notes and VA administrative data. We used a manual review of note content and administrative data rules to code therapy adherence and modifications in 7,297 EBP sessions for 1,257 patients seen by 182 therapists. Two trained coders rated each therapy note and resolved discrepancies through consensus. To contextualize and explain variation in adherence and modifications, we conducted brief 30-45-min semi-structured interviews with a purposive subsample of these therapists ( n = 32)., Findings: Combining manual chart review and administrative data allowed for identification of 11 types of modifications. Raters disagreed on adherence for 30% of notes. The disagreement stemmed from the presence of therapy modifications that were not clearly documented, necessitating the development of decision rules and strategies for modification coding. Both therapists and patients contributed to the variance in the extent to which different modifications occurred. Therapist interviews demonstrated therapist awareness of modifying the protocols in the ways identified through chart review., Conclusion: Healthcare systems can use data collected as part of routine care to understand how and when EBPs are modified but need to develop scalable strategies to document adaptations and modifications to EBPs in routine care., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Wiltsey Stirman, La Bash, Nelson, Orazem, Klein and Sayer.)

The EPIC (Erosion Productivity Impact Calculator) crop model, developed by scientists of the United States Department of Agriculture (USDA), has been successfully applied to the study of erosion, water pollution, crop growth and production in the US but is yet to be introduced for serious research purposes in other countries or regions. This paper reports on the applicability of the EPIC 8120 crop model for the assessment of the potential impacts of climate variability and climate change on crop productivity in sub-Saharan West Africa, using Nigeria as the case study. Among the crops whose productivity has been successfully simulated with this model are five of West Africa's staple food crops: maize, millet, sorghum (guinea corn), rice and cassava. Thus, using the model, the sensitivities of maize, sorghum and millet to seasonal rainfall were demonstrated with coefficients of correlation significant at over 98 per cent confidence limits. The validation tests were based on a comparison of the observed and the model-generated yields of rice and maize. The main problems of validation relate to the multiplicity of crop varieties with contrasting performances under similar field conditions. There are also the difficulties in representing micro-environments in the model. Thus, some gaps appear between the observed and the simulated yields, arising from data or model deficiencies, or both. Based on the results of the sensitivity and validation tests, the EPIC crop model could be satisfactorily employed in assessing the impacts of and adaptations to climate variability and climate change. Its use for the estimation of production and the assessment of vulnerabilities need to be pursued with further field surveys and field experimentation. [ABSTRACT FROM AUTHOR]

Parents' perceptions of child development are influenced by complex interactions among cultural, social, and economic factors. Insights into how parents from culturally diverse societies perceive the development of their children might explain why different cultural groups foster or value the development of different skills in their children. In this study, we explored the perceptions of child development among low income Mexican American parents. A series of ethnographic interviews were conducted with eight Mexican American families who had preschool children. Qualitative data analyses yielded three main themes that were important to these parents: family attitudes and values, changes, and adaptations. For these parents, the development of social attributes in children, that will enable them to function within their own cultural group, was as important as the development of cognitive or motor skills. Service providers, such as school and mental health personnel, should take into account cultural differences in parents' perceptions of the importance of various developmental milestones for their children when suggesting interventions typically used by parents in the dominant culture. [ABSTRACT FROM AUTHOR]

Objective: The coronavirus disease 2019 (COVID-19) pandemic resulted in significant loss of radiologic volume as a result of shelter-at-home mandates and delay of non-time-sensitive imaging studies to preserve capacity for the pandemic. We analyze the volume-related impact of the COVID-19 pandemic on six academic medical systems (AMSs), three in high COVID-19 surge (high-surge) and three in low COVID-19 surge (low-surge) regions, and a large national private practice coalition. We sought to assess adaptations, risks of actions, and lessons learned., Methods: Percent change of 2020 volume per week was compared with the corresponding 2019 volume calculated for each of the 14 imaging modalities and overall total, outpatient, emergency, and inpatient studies in high-surge AMSs and low-surge AMSs and the practice coalition., Results: Steep examination volume drops occurred during week 11, with slow recovery starting week 17. The lowest total AMS volume drop was 40% compared with the same period the previous year, and the largest was 70%. The greatest decreases were seen with screening mammography and dual-energy x-ray absorptiometry scans, and the smallest decreases were seen with PET/CT, x-ray, and interventional radiology. Inpatient volume was least impacted compared with outpatient or emergency imaging., Conclusion: Large percentage drops in volume were seen from weeks 11 through 17, were seen with screening studies, and were larger for the high-surge AMSs than for the low-surge AMSs. The lowest drops in volume were seen with modalities in which delays in imaging had greater perceived adverse consequences., (Copyright © 2020 American College of Radiology. Published by Elsevier Inc. All rights reserved.)