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To increase community health knowledge, the El Paso Health Education and Awareness Team (EP-HEAT) was established at Paul L. Foster School of Medicine. The Medical Student Run Clinic (MSRC) emphasizes community health care access. "Promotores de salud" (community health workers) increase health care awareness and connect predominantly underserved communities with resources. Surveys were conducted to determine how EP-HEAT and MSRC patients' communication with promotores affected their access to health care and communication skills. Surveys demonstrated that 91% of EP-HEAT members agreed that working with promotores improved their communication ability. All MSRC patients surveyed stated interacting with promotores helped improve health care communication in various ways.

This report presents an evaluation of students' experiences in a student-run clinic project in Aotearoa New Zealand, aiming to provide interprofessional learning opportunities and accessible health services to the community. Qualitative focus group interviews were conducted with students' post-clinical placement. A six-step thematic data analytic approach guided identification of three key themes: placement preparation and understanding expectations, interprofessional relationships and collaboration, and learning experience and value. Students reported positive experiences in this student-run clinic placement, including in respect to collaborative experiences, the development of interprofessional relationships, and value of the learning experience. This report highlights the need for enhanced pre-placement preparation and clarification of expectations regarding a community-based interprofessional placement experience, particularly for first year students. The student-run clinic model has potential to address healthcare disparities and enhance learning through community-engaged experiences. Results provide insights for educational institutions and healthcare providers looking to implement similar initiatives, emphasising collaborative partnerships and student-centred interprofessional education.

University of Maryland, Baltimore CURE Connections (UMB CURE) connects West Baltimore high school students with STEM enrichment including hands-on research and community outreach. This study's purpose was to describe successes and challenges of implementing the virtual Community Health Worker curriculum during the summer programming for UMB CURE high school scholars. This certificate-based program was designed to teach students about the community health field while providing training that demonstrates competence as a community health worker. The training was implemented over two summer sessions (2020 and 2021). Scholars completed a survey to assess program satisfaction. A subset of scholars completed qualitative interviews that focused on scholars' summer program experience and recommendations for program improvement. Engagement metrics (scholar participation, retention) were compiled. Overall themes from qualitative interviews included: (1) overall summer program experience, (2) about the Morehouse curriculum, (3) advice for future scholars, (4) in-person versus virtual summer program, and (5) recommendations for the program. While the program was generally well-received, scholars required more instruction and guidance than anticipated. Many found the required assignments challenging to navigate, citing virtual instruction as a reason. Scholars also requested more hands-on synchronous STEM-focused activities. These data will be used to modify future programming to engage scholars in out-of-school-time STEM initiatives.

Community health workers (CHWs) are increasingly being required to perform complex health care activities, especially in community cardiovascular disease and stroke prevention. However, currently, there are no psychometrically validated instruments for assessing CHW competencies in these roles. This article describes the development and validation of the stroke literacy assessment test (SLAT)--pertaining to the Life's Simple Seven (LS7) risk factors for stroke--for evaluating CHWs' competencies in the context of education and training programs. The SLAT was developed using an iterative instrument design protocol, followed by empirically testing the instrument in 68 CHWs from the Columbia University Institute for Training Outreach and Community Health (InTOuCH) in New York. Data collection began in March 2021 and continued through May 2021. The evaluation was based on four types of validity evidence: (a) content validation with expert reviews of items and overall domain, (b) validation on examinee response processes with cognitive interviews, (c) item validation and diagnostic analysis, and (d) validity evidence based on expected directional group differences. In addition, the internal consistency reliability of the total test scores, with the best functioning items, were evaluated. Two such iterative cycles yielded a 34-item, written structured response test that assesses the "factual knowledge" and "application" levels of cognition, and demonstrates sufficient validity and reliability (Cronbach's [alpha] = 0.69) for use with CHWs specializing in stroke prevention efforts. The SLAT is a novel, valid, and reliable instrument that contributes to filling a critical gap in rigorous competency assessments for CHWs deployed in chronic disease prevention.

The burden of childhood visual impairment and disparities in access to pediatric vision care remain pressing issues in the United States. School-based vision programs (SBVPs) serve as one approach to advancing health equity. Operating at the intersection of schools and healthcare, SBVPs can increase access to pediatric vision services, improve academic performance, and facilitate referrals to community vision care providers. To maximize their impact, SBVPs must tailor their services to the individual needs and resources of local school communities. School nurses, who have strong ties to school health care services and the school community, are trusted partners in building SBVPs. This article aims to facilitate SBVP development, implementation, and sustainability processes by offering guidance for school nurses and other stakeholders who aim to build a SBVP, support local programs, or learn more about how SBVPs operate.

Several states have invested in 1915(c) Home and Community Based Service (HCBS) Medicaid policies to improve outcomes and reduce costs for children and youth with significant behavioral health needs, or Severe Emotional Disturbance (SED). However, little is known about these programs and the children they serve. Through a retrospective cross-sectional analysis, this study aimed to understand if the program was successfully reaching its target population: children and youth with the highest clinical need, at the greatest risk for out-of-home care, and who may not otherwise be eligible for Medicaid through other avenues. Results describe the demographic, clinical, and service use characteristics of children and youth enrolled in one SED Waiver program, comparing them with those of similar, non-waiver enrolled children with behavioral health needs. Findings report that the waiver program examined rarely served children and families not otherwise eligible for Medicaid, but that waiver-enrolled children and youth had substantially more severe clinical need, were at higher risk for out-of-home placement and incurred greater public expenditures for service use. Findings suggest the program studied is serving children with more significant psychiatric needs, as the program intends, but points to the need for further research to understand the impacts of such programs on system and clinical outcomes.

This short take presents the process of a learning circle, underpinned by Dadirri (Ungunmeer-Baumann 1988). This method was used for the purposes of critical reflective practice and data collection activity with non-Indigenous participants. Dadirri is a First Nations (Australian) term for "deep listening." The learning circle research occurred with social and welfare workers in a regional health service. We found, through privileging Indigenous knowledges in the activity, that this method can enable a generation of learnings and critical reflection and assist workers to apply theory to practice. This method can also be used as a data collection tool to evaluate these aims.

Service engagement is critical when working with children and families experiencing chronic adversities because of their socially marginalized status. Further, sociodemographic disparities exist in service engagement within service systems including Community-Based Behavioral Health; likely in part, a result of structural issues driving unresponsive service systems. Despite this knowledge, a large proportion of the family engagement literature continues to be approached through a deficit-based and family-centric lens leaving out important systemic considerations and furthering health inequities. Drawing from a Socio-Ecological Framework (Stokols, 1996), this study focuses on exploring the value of peer support providers (PSPs) to understand how sociocultural responsiveness functions under this service model. Individual interviews and focus group data were collected from both families and PSPs. Thematic analysis (Braun & Clarke in Qualitative Research in Psychology, 3(2), 77-101, 2006) was utilized to code and synthetize the data collected. Findings highlight the importance of capitalizing on meaningful and trusting relationships to foster family engagement in services. These findings solidify the understanding that family engagement is a function of crucial relationships between family, provider, and systems. This work also illustrates how PSPs organic embodiment of sociocultural responsiveness through cultural humility is an avenue through which family engagement can be sustained.

This study explored predictors of community-based providers' adherence to MATCH, a modular cognitive behavioral therapy for children and adolescents. Provider-reported adherence to MATCH was measured using three increasingly strict criteria: (1) "session content" (whether the session covered MATCH content consistent with the client's target problem), (2) "session content and sequencing" (whether the session covered MATCH content in the expected sequence for the client's target problem), and (3) "session content, sequencing, and participant" (whether the session covered "MATCH content" in the expected sequence and with the expected participant(s) for the client's target problem). Session, client, provider, and organizational predictors of adherence to MATCH were assessed using multilevel modeling. Results revealed that nearly all providers delivered MATCH content that corresponded to the target problem, but only one-third of providers delivered MATCH "content" in the expected "sequence" and with the expected "participant" for the client's target problem. This difference underscores the need for nuanced adherence measurement to capture important implementation information that broad operationalizations of adherence miss. Regardless of the criteria used providers were most adherent to MATCH during sessions when clients presented with interfering comorbid mental health symptoms. This suggests that the design of MATCH, which offers flexibility and structured guidance to address comorbid mental health problems, may allow providers to personalize treatment to address interfering comorbidity symptoms while remaining adherent to evidence-based practices. Additional guidance for providers on managing other types of session interference (e.g., unexpected events) may improve treatment integrity in community settings.

Multilevel interventions (MLIs) are appropriate to reduce health disparities among Indigenous peoples because of their ability to address these communities' diverse histories, dynamics, cultures, politics, and environments. Intervention science has highlighted the importance of context-sensitive MLIs in Indigenous communities that can prioritize Indigenous and local knowledge systems and emphasize the collective versus the individual. This paradigm shift away from individual-level focus interventions to community-level focus interventions underscores the need for community engagement and diverse partnerships in MLI design, implementation, and evaluation. In this paper, we discuss three case studies addressing how Indigenous partners collaborated with researchers in each stage of the design, implementation, and evaluation of MLIs to reduce health disparities impacting their communities. We highlight the following: (1) collaborations with multiple, diverse tribal partners to carry out MLIs which require iterative, consistent conversations over time; (2) inclusion of qualitative and Indigenous research methods in MLIs as a way to honor Indigenous and local knowledge systems as well as a way to understand a health disparity phenomenon in a community; and (3) relationship building, maintenance, and mutual respect among MLI partners to reconcile past research abuses, prevent extractive research practices, decolonize research processes, and generate co-created knowledge between Indigenous and academic communities.

Greater Hazelwood, a neighborhood located in Pittsburgh, Pennsylvania, saw a decline in residents, businesses, and services at the steel industry's decline. Residents, philanthropic organizations, advocates, health centers, schools, universities, and community-based organizations continue collaborating to revitalize the Greater Hazelwood neighborhood by following the Greater Hazelwood Neighborhood Plan. Duquesne University Center for Integrative Health was engaged by a place-based grant-making strategy in Greater Hazelwood to explore the creation of a collaborative partnership between a university, federally qualified health center, school, residents, and community-based organizations to create a framework to improve access to comprehensive and quality healthcare in Greater Hazelwood. This collaboratively designed health and wellness programs based on community-identified health priorities to improve health outcomes. These programs provide opportunities for multi-sector partners and interdisciplinary health professionals to meet residents where they are, decrease disease disparity, and promote health equity.

Community-engaged patient navigation safety net programs are established as an evidence-based approach to address cancer prevention and early detection efforts, but barriers to expand and sustain such programs persist. In addition, few studies describe how these programs impact buy-in among communities and policy change within health care systems and government. We describe how we used the Capacity for Sustainability Framework to guide efforts for program sustainability and community, institutional, and policy level change in a breast cancer screening and patient navigation safety net program. The nine domains of the Capacity for Sustainability Framework were used to develop program logic models, to inform program implementation and quality improvement agendas, and to guide multi-level partner and stakeholder engagement, outreach, and dissemination of outcomes. The program is currently in its seventh year and continues to be annually funded by a city public health department. In 2021, additional 5-year renewable funding from a state public health department was secured. In addition, institutional program support was expanded for patients diagnosed with breast cancer. Program leaders worked with policymakers to draft legislation to support training certification and third-payor reimbursement for patient navigators and community health workers. The program is well-known and trusted among community members, community-based organizations, and providers. Community, organizational, and policy-level outcomes demonstrate that community-engaged patient navigation safety net programs can influence more than individual and interpersonal outcomes and can be sustained over time.

This chapter discusses how community-based narrative encounters can enhance medical students' narrative humility, the practice of recognizing the value of multiple narratives of health and reducing narrative privileging. The study in this chapter suggests that through exposure to individuals' lived experience of health, medical students are able to recognize both professional and personal narrative bias, leading to reflection on improved patient-centered care centered on testimonial justice and narrative respect.

Background: While barriers to participation in physical activity are well documented, there is no consolidated evidence on strategies promoting participation of people with intellectual disability in physical activities. Methods: We conducted a scoping review to examine initiatives used to facilitate the inclusion of people with intellectual disability in community-based sporting and recreation activities. We searched Medline, Embase, CINAHL+ and PsycINFO for articles published in English between 2000 and 2022. Results: Eight articles were included. Initiatives included: (1) building knowledge, awareness and attitudinal change (2) organisational alliances/partnerships (3) relationship-building (4) modifications/adaptions to activities/environment (5) organisational policy (6) engagement with people with disability. Initiatives were implemented through international collaborations, in local fitness/recreational facilities and public spaces, and targeted athletes, coaches, volunteers and organisational leaders. Conclusion: While some increase in awareness and inclusion of people with intellectual disability was reported, no longitudinal data reported on the impact of initiatives on sustained social inclusion for people with intellectual disability.

The impact of community-wide teen pregnancy prevention initiatives (CWIs) on local U.S. birth rates among adolescents aged 15 to 19 years was examined using synthetic control methodology within a quasi-experimental design. CWIs were implemented in 10 U.S. communities from 2010 to 2015. Each initiative implemented evidence-based teen pregnancy prevention interventions at local organizations and enhanced best practices in adolescent reproductive health care at local health centers, while engaging diverse community sectors. The synthetic control method was used to estimate the impact of each CWI on overall and race- and ethnicity-specific teen births relative to rates in synthetic control communities. Additionally, we estimated the overall effect of CWIs across communities by pooling results from the 10 synthetic control case studies using the mean percentile rank. Pooled data across all 10 communities indicated an estimated average of 6.6 fewer births per 1000 teens per year overall during the initiative relative to each community's synthetic control (p = 0.001). By race and ethnicity, there were an estimated average of 6.4 fewer births per 1000 teens per year among Black teens (p = 0.03), 10.7 fewer births among Hispanic teens (p = 0.03), and 4.2 fewer births (p = 0.10) among White teens. Results from individual communities indicated an intervention effect on overall and/or race/ethnicity-specific teen birth rates in five communities. This study demonstrates the value of synthetic control methods in evaluating community-level outcomes of programmatic efforts. Findings indicate the CWIs had a positive impact on teen birth rates and have the potential to address racial and ethnic disparities in those rates.

This article presents an immediate evaluation of a professional development course in community health literacy for Brazilian nurses. An evaluation based on an applied thematic analysis of the accounts of 63 attendees in three Brazilian cities (January 2020) was guided by the following themes: (a) expansion of understanding about community health literacy as a pillar for planning and providing health care; (b) encouragement of innovation in research and/or practice; and (c) plans to incorporate the information shared in the course into professional projects. The evaluation disclosed the complexity of social contexts for health literacy, which is intertwined with ethnocultural diversity and deep socioeconomic disparities, such as restricted access to essential public health services for socially deprived and vulnerable individuals. Expanded understanding about community health literacy is a pillar for care planning and delivery, as well as innovation in research and practice projects. Participants' evaluations revealed ideas to improve nurses' practice in promoting community health literacy and empowerment, as well as quality of life and social well-being. Future knowledge dissemination may impact nurses' clinical practice and management actions, bringing changes in various areas of practice to redesign more socially inclusive actions for clientele.

Multilevel service delivery frameworks are approaches to structuring and organizing a spectrum of evidence-based services and supports, focused on assessment, prevention, and intervention designed for the local context. Exemplar frameworks in child mental health include positive behavioral interventions and supports in education, collaborative care in primary care, and systems of care in community mental health settings. Yet, their high-quality implementation has lagged. This work proposes a conceptual foundation for multilevel service delivery frameworks spanning diverse mental health service settings that can inform development of strategic implementation supports. We draw upon the existing literature for three exemplar multilevel service delivery frameworks in different child mental health service settings to (1) identify core components common to each framework, and (2) to highlight prominent implementation determinants that interface with each core component. Six interrelated components of multilevel service delivery frameworks were identified, including, (1) a systems-level approach, (2) data-driven problem solving and decision-making, (3) multiple levels of service intensity using evidence-based practices, (4) cross-linking service sectors, (5) multiple providers working together, including in teams, and (6) built-in implementation strategies that facilitate delivery of the overall model. Implementation determinants that interface with core components were identified at each contextual level. The conceptual foundation provided in this paper has the potential to facilitate cross-sector knowledge sharing, promote generalization across service settings, and provide direction for researchers, system leaders, and implementation intermediaries/practitioners working to strategically support the high-quality implementation of these frameworks.

Background: The Communicative Participation Item Bank (CPIB) is a patient-reported outcome measure (PROM) designed to measure the extent of interference, or difficulty, experienced by adults with communication disorders participating in their day-to-day communication activities. To date, there is limited evidence regarding sensitivity of the CPIB for capturing change with intervention in people with Parkinson's disease (PwPD). Aims: The purpose of this study was to examine the following measurement properties of the CPIB in PwPD who received community-based, standard care, speech-language therapy focusing on motor speech concerns: Change over time between treatment and observation groups, comparison to patient-defined ideal and satisfactory targets, comparison of static short form to computerised adaptive testing (CAT), comparison of self to proxy-rated scores, and comparison to other common PROMs. Methods and Procedures: Forty-six PwPD (20 treatment/26 observation) completed data collection upon enrolment (pre-treatment) and 6 months later. In addition to the CPIB, PROMs included the Voice Handicap Index 10-item short form (VHI-10), PROMIS Global Health-Related Quality of Life, Levels of Speech Usage, self-rated speech severity, and Patient Health Questionnaire-9 (PHQ-9). Participants also engaged in qualitative interviews. Forty-four family members completed proxy CPIB ratings. Outcomes and Results: There were no significant differences between treatment and observation groups on the CPIB pre-treatment, but there were significant differences post-treatment. The differences appeared to be largely due to significant gains in the treatment group. No participants reached their ideal CPIB target, and few reached their satisfactory target. Static CPIB short form and CAT scores were not significantly different, with an average of five CAT items administered per participant. Overall group similarities between patient and proxy scores may have obscured wide variability across individual patient-proxy pairs. Associations between CPIB and VHI-10, health-related quality of life, self-reported speech severity, and depression ranged from weak to moderate. Conclusions and Implications: The CPIB appears to be sensitive to capturing change with intervention, and similar results are obtained with the static short form and CAT formats. One clinical caution is that even with gains observed in the treatment group, no participants obtained their ideal communicative participation goals, and few obtained a satisfactory level of communicative participation. Thus, while current interventions are beneficial, they may not meet the full range of clients' communication needs. While responding to the CPIB through a proxy rater may be feasible, caution is warranted due to concerns about maintaining the autonomy of PwPD.

The COVID-19 pandemic has disproportionately impacted people of color, underscoring the importance of equity in the public health response. The Duquesne University Center for Integrative Health (DUCIH) is a university-wide center focused on training future practitioners and improving health equity in the Pittsburgh region. DUCIH's initial pandemic response included a virtual adaptation of community health programs and supporting partners' testing and vaccination efforts. In March 2021, the Allegheny County Health Department (ACHD) asked DUCIH to establish a vaccine Point of Dispensing (POD) at Central Baptist Church in Pittsburgh's Hill District, to reach underrepresented populations. DUCIH engaged the Schools of Health Sciences, Nursing, and Pharmacy and multiple university offices to recruit an interprofessional team of 263 volunteers. From March to June 2021, the POD administered 5,652 vaccines in an underserved neighborhood, with a majority of doses administered to people of color, meeting the POD's aim. This university-church partnership has continued with vaccine clinics and health screenings. This case study shares lessons for rapid response to public health emergencies through university-wide collaboration with community partners. Universities with health science schools should cultivate relationships with local health departments to promote awareness of these capabilities.

This study explores factors associated with participation in moderate physical activity and muscle strengthening activity in adults with autism receiving state services (age: 18-78 years). Researchers analyzed the National Core Indicators-In Person Survey (2017-2018) data using multilevel mixed effects logistic regression. Older adults on the autism spectrum engaged in both moderate physical activity and muscle strengthening activity less often than younger adults on the autism spectrum (OR 0.99; p < 0.05; OR 0.98; p < 0.001). Individuals reportedly in fair/poor health had 50% lower odds of engaging in moderate physical activity and 30% lower odds of engaging in muscle strengthening compared to those in good/ excellent health (OR 0.50; p < 0.001; OR 0.70; p < 0.001). Moderate physical activity/muscle strengthening initiatives may help foster this group's healthy aging.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth of color experience high rates of mental health disorders, yet they experience challenges to accessing mental health services. Community health worker (CHW) models of care have potential to promote equitable mental health services among LGBTQ youth. Our aim was to understand how CHW models could be adapted to better support LGBTQ youth of color in accessing mental health services. Semi-structured qualitative interviews were conducted with LGBTQ youth of color (n = 16), caregivers of LGBTQ youth (n = 11), and CHWs (n = 15) in Massachusetts and California. Interviews were coded by 8 members of the research team. A Rapid Qualitative Analysis was conducted to identify themes. Caregivers, youth, and CHWs all endorsed the value of CHW models for this population. They also almost universally suggested multiple adaptations are needed for the model to be effective. Four main categories of themes emerged related to intervention adaptations: (1) Why adaptations are needed for LGBTQ youth, (2) Who should serve as CHWs providing care, (3) How CHWs should be trained, and (4) What content needs to be included in the intervention. Broadly, findings suggest the relevance of having CHW models for LGBTQ youth of color to address stigma and discrimination experienced, access to culturally and linguistically relevant services, and the need for caregiver support of LGBTQ youth. CHWs need increased training in these areas.

Project Extension for Community Healthcare Outcomes (ECHO) Nevada applied the ECHO virtual hub-and-spoke telementoring model over nine 6-week cohorts (between November 2019 and November 2021) supporting community health workers (CHWs) who advise clients with diabetes or pre-diabetes. This study describes the program implementation, including evaluation data collection efforts. Didactic topics included 'Intro to Healthy Eating and Easy Wins' to 'Grocery Shopping, Cooking Tips, Reading Labels, Meal Plans' and 'Reducing Bias and Being a Good Role Model'. Spoke participants signed up to review cases. Seventy-three of the enrolled participants (n = 100) attended three or more of the six sessions. Spoke participants completed 42 case presentations. The average self-efficacy increased from 2.7 [standard deviation (SD): 1.1] before completing the program to 4.1 (SD: 0.8) after completing the program. Average knowledge scores increased from 71 (SD: 16) before completing the program to 83 (SD: 14) after completing the program. Five group interviews drew actionable feedback that was incorporated into the program. Key elements of the ECHO model were successfully incorporated to support educational goals of a cohort of CHWs in nutritional coaching. Our program evaluation data tracking system shows non-significant but encouraging results regarding self-efficacy improvement and knowledge retention.

African Americans are disproportionately burdened by mental health issues (e.g., stress, chronic depression, and post-traumatic stress disorder). Upon review of mental health local/state/national data, a highly-engaged faith-based Community Action Board (CAB) raised concerns about the mental health needs of African Americans and addressed mental health as a priority health area in African American Kansas City churches. African Americans tend to experience barriers to mental health services (e.g., limited access, high cost, mental health-related stigma, non-culturally tailored mental health care). African American churches have many strengths that could increase reach, acceptability feasibility, and impact of mental health interventions tailored for African Americans. The CAB conducted a health needs assessment survey (N=463; 11 churches) to identify health concerns and potential strategies to inform the design of a church-based mental health intervention. Using a faith-community-engaged approach, the CAB developed the survey and used its findings to design a religiously-tailored, multilevel mental health intervention focused on prevention, screening, and linkage to care. The needs assessment identified intervention strategies (e.g., church-based screening, stress reduction/exercise programs, pastors promoting mental health) that were: (1) rated as highly important/feasible to implement, (2) included in the intervention design, and (3) successfully implemented in African American churches by faith leaders and university students and faculty.

Nursing faculty with expertise in community health are well poised to introduce nursing students to the rewarding experience of caring for vulnerable populations. Multiple partnerships have been established over the years within the central Connecticut region that have benefited both the university's nursing students and the affiliated agency, as well as the individuals served. Utilizing knowledge related to the common health issues faced by the homeless population, faculty worked with community partners to discuss needs and create a plan involving nursing students, which specifically focused on vision and foot health.

Purpose: The paper offers commissioners and practitioners insights into how a gender and culturally sensitive COVID-19 vaccination clinic was set up in a local area that was experiencing lower uptake rates. Design/methodology/approach: This paper seeks to examine and share a city-wide approach to improve vaccine uptake in a large metropolitan city in the UK. Findings: In mitigating inequalities and ensuring underserved populations have access to the COVID-19 vaccine, there is a need to work with communities to develop vaccine clinics that provide a local, convenient and trusted offer that meets the needs of residents. Originality/value: Developing a local COVID vaccine offer that meets cultural needs focusing on an area of low uptake in a large metropolitan city.

Integrated early childhood development (ECD) programs boost child health and developmental outcomes. However, the factors contributing to the successful implementation of such programs in informal urban settlements are not well researched. We conducted 14 focus group discussions and 13 key informant interviews with 125 caregivers of children under the age of 5 years and stakeholders, exploring their views on enablers and barriers to implementing an integrated ECD program in an informal settlement in Kenya. Strategic engagement, capacity building, transparency, fair compensation of ECD workforce, communication skills, and the need to tailor ECD programs to local realities were discussed. An equity-focused implementation approach for integrated ECD programs is timely.

Children in low-income communities are at risk for developmental delays and sensory losses. mHealth screening tools enable community health workers to detect developmental delays and sensory losses. This study aims to describe a combined (developmental and sensory -- hearing and vision) mHealth-supported screening programme conducted by community healthcare workers with children aged four-six years (n = 63) at early childhood development centres in a low-income community. Early childhood development practitioners (n = 5) assisted with developmental screening. Referral rates were 30% (n = 19) for development, 6% (n = 4) for hearing and 5% (n = 3) for vision. The average screening time for combined screenings was 11.72 min (SD 3.45 min). Post screening questionnaires probing participants' perspectives and experiences of the combined screening were positive. A combined mHealth-supported screening programme conducted by community health workers and early childhood development practitioners appears viable, supporting early detection of developmental delays and sensory losses in children from low-income communities.

Background: Equitable healthcare outcomes are compromised in the absence of strong medical care and social services linkages. In May 2019, Children's Health, the largest health system for pediatric care in North Texas, initiated a three-pronged social determinants of health (SDOH) quality improvement (QI) project that included: (1) baseline and ongoing clinical team training; (2) implementation of an electronic health record (EHR)-embedded SDOH screening tool; and (3) patient referrals to community resources in three inpatient hospital units and one outpatient specialty clinic serving medically complex patients. The purpose of the study is to identify hospital unit/clinic-level implementation factors associated with effective utilization of a SDOH screening tool newly introduced into the clinical setting and outcomes associated with this screening such as referrals to community-based organizations. Methods: A mixed-methods, descriptive study was conducted in the following four pediatric care settings: (1) intensive care unit (PICU); (2) acute, long-term hospitalized patients (LTP); (3) inpatient multi-specialty step-down facility serving patients with special healthcare needs (SHCN); and (4) cystic fibrosis clinic (CF). Quantitative measurement tools (i.e. clinical care team pre/post surveys, EHR data) were merged with focus groups to elucidate factors influencing implementation. The Consolidated Framework of Implementation Research guided assessment. Results: Of the 506 eligible patients, SDOH screening rates (PICU=42%; CF=76%; LTP=85%; SHCN=93%) and referral to community resources rates (PICU=20%; CF=46%; SHCN=52%; LTP=91%) significantly differed across the various hospital units. Among the clinical care team surveys, PICU clinical team members reported significantly lower baseline confidence to discuss SDOH (mean=2.93; SD=0.95) and significantly lower knowledge of SDOH (mean=2.66; SD= 0.88) compared to the three other clinics. Qualitative data indicated that all hospital units prioritized the intervention, had clinical champions, and used thoughtful planning. Screening and referral rate differences were attributed to several factors: (1) settings (e.g., inpatient vs. outpatient setting, resistance to change); (2) individual characteristics (e.g., self-efficacy, baseline confidence, licensure of implementer); and (3) intervention characteristics (e.g. adaptability, compatibility). Conclusions: Results suggest that the successful implementation of a SDOH screener in pediatric health care settings serving medically complex patients is a multifaceted process involving multilevel factors. These findings can guide feasibility of further dissemination and scalability efforts in particular.

Objective: The Bridging the Gap Between Physical and Mental Illness in Community Pharmacy ("PharMIbridge") randomised controlled trial (RCT) aims to test the effectiveness of a pharmacist-led support service in improving medication adherence, and the physical and mental health of people living with severe and persistent mental illness compared to a standard medication review service. Method: Using the six-step intervention mapping (IM) framework, this paper describes the development and content of the "PharMIbridge" pharmacist training programme, an integral part of the RCT implementation, and continuous adaptations made to the process to keep pace with the evolving severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in Australia. A Training Working Group comprising health educators, practitioners, mental health consumers and researchers, refined the programme objectives and assisted with developing content and troubleshooting issues related to training delivery for pharmacists randomised to the RCT intervention arm. Results: A 2-day training programme was developed, which included Mental Health First Aid, simulated patient role-plays, and four pre-recorded modules using lectures, demonstration case vignettes, role-play activities and discussion. The programme, co-facilitated by project team members and mentors (pharmacist and consumer educators), aims to enhance pharmacists' mental health literacy, skills and confidence and empower them to engage with this vulnerable population using a strengths-based approach. Pre- and post-training questionnaires and interviews will be used to evaluate the impact of the "PharMIbridge" training programme. Conclusion: The systematic stepwise method provided by the IM framework highlights the solution-focused approach adopted by the project team and characteristics including adaptability and resilience which enabled training development and implementation across four Australian regions during the SARS-CoV-2 pandemic.

The novel coronavirus has created a challenging, difficult, and chronic period of unhealthy stress for everyone associated with today's schools: teachers, parents, students, counselors, and administrators alike, both in the United States and globally. This article offers psychologists in the schools a resource for information on what to consider before a colleague, family member, friend, or they themselves make a first appointment with a community-based mental health provider. The article also offers a few suggestions on ways to maximize the effectiveness once community-based mental health counseling services begin.

Evidence-based maternal, infant, and early home visiting (EBHV) is a potential strategy to support parent and child health and well-being among families headed by a parent with an intellectual disability (ID). Little is known about the capacity of EBHV programs to meet the needs of parents with ID effectively. This study examined home visitor practices and perceptions of services for parents with ID. Home visiting staff recruited from a national practice-based research network participated in web-based surveys. Practices and perceptions varied widely across sites and were associated with home visitor knowledge and self-efficacy and site implementation supports, such as policies, curricula, and community collaboration. More work is needed to understand and strengthen EBHV services for parents with ID.

Background: Adolescents often experience discomfort due to individual experiences and the influence of their environment. This discomfort sometimes leads to mental health problems. Education is pivotal in promoting adolescents' mental health through dedicated prevention interventions and through everyday educational practice, both at school and in the community. Objective: To develop an overview of the types of educational interventions aimed at promoting the mental health of adolescents and young adults, providing helpful guidance and insights to teachers/educators. Methods: We conducted a scoping review developed through searches in the CINAHL, Eric, PsycINFO and PubMed databases. We summarised data using descriptive analysis, grouping educational interventions category according to their goals and purposes. Results: Of the initial 704 articles identified, 19 met the study inclusion criteria. Consistent with Dewey's educational theory, most of the interventions reported in the selected studies can be viewed as genuine 'educational' interventions, in that they involved experiential and interactive activities such as discussion groups, role-play and art-based activities. Fewer interventions involved less participatory and more 'information-based' activities, such as lessons. However, in many interventions, the role of teachers/educators in promoting young people's mental health was underestimated; indeed, in only a few cases were they the providers/co-providers of the activities described, and rarely was there continuity/alignment between the interventions and everyday school activities. Conclusions: Conducting a greater number of formal/informal educational interventions to promote adolescents' mental health is imperative, especially in the current socio-historical context, but this enterprise must acknowledge, value and support the important role of teachers/educators as leaders and participants in this endeavour.

This study presents a critical exploration of one of the "ACRL Framework" concepts by examining it in the context of professional practice. Semi-structured interviews were conducted with health and human service professionals at a community health centre to explore how information literacy (IL) is experienced in the workplace. Value emerged as the dominant theme in participants' descriptions of their information practices. This concept was conceived of predominantly in the context of personal and professional relationships that existed within the systems and structures of the physical workplace, professional practice and the health and social care system. Using phenomenography as a methodological approach, this study presents a lens through which to see the nature and significance of information value in various contexts beyond academia, and invites librarians to consider how evidence from workplace and professional settings may inform IL instruction to students, especially those entering health and human service professions.

Background: A strengths-based lens is essential for the pursuit of health equity among Indigenous populations. However, health professionals are often taught and supported in practice via deficit-based approaches that perpetuate inequity for Indigenous peoples. Deficit narratives in healthcare and health education are reproduced through practices and policies that ignore Indigenous strengths, disregard human rights, and reproduce structural inequalities. When strengths are recognised it is possible to build capacities and address challenges, while not losing sight of the structural factors impacting Indigenous peoples' health. Objective: In this paper, we examine Indigenous strengths-based approaches to policy and practice in healthcare and health professions education when delivered alongside teachings shared by Elders from the Cree, Blackfoot and Métis Nations of Alberta, Canada. Method: Literature and Elders' teachings were used to shift strengths-based approaches from Western descriptions of what might be done, to concrete actions aligned with Indigenous ways. Results: Four pointers for future action adopting a strengths-based approach are identified--enacting gifts: focusing on positive attributes; upholding relationality: centring good relationships; honouring legacy: restoring self-determination; and reconciling truth: attending to structural determinants of health. Conclusion: Identified directions and actionable strategies offer a promising means to advance Indigenous health equity through strengths-based actions that change existing narratives and advance health equity.

A foundational strategy to promote implementation of evidence-based interventions (EBIs) is providing EBI training to therapists. This study tested an online training system in which therapists practiced observational coding of mock video vignettes demonstrating family therapy techniques for adolescent behavior problems. The study compared therapists ratings to gold-standard scores to measure therapist "reliability" (consistency across vignettes) and "accuracy" (approximation to gold scores); tested whether reliability and accuracy improved during training; and tested therapist-level predictors of overall accuracy and change in accuracy over time. Participants were 48 therapists working in nine community behavioral health clinics. The 32-exercise training course provided online instruction (about 15 min/week) in 13 core family therapy techniques representing three modules: Family Engagement, Relational Orientation, Interactional Change. Therapist reliability in rating technique presence (i.e., technique recognition) remained moderate across training; reliability in rating extensiveness of technique delivery (i.e., technique judgment) improved sharply over time, from poor to good. Whereas therapists on average overestimated extensiveness for almost every technique, their tendency to give low-accuracy scores decreased. Therapist accuracy improved significantly over time only for Interactional Change techniques. Baseline digital literacy and submission of self-report checklists on use of the techniques in their own sessions predicted coding accuracy. Training therapists to be more reliable and accurate coders of EBI techniques can potentially yield benefits in increased EBI self-report acumen and EBI use in daily practice. However, training effects may need to improve from those reported here to avail meaningful impact on EBI implementation.

Employers claim managerial skills are more important for community public health students than specialist subject knowledge. However, to date, there is no valid and reliable instrument to measure these skills. Furthermore, employers' viewpoints are often not considered in developing such a measure. This study aimed to develop an instrument by considering employers' perspectives in health agencies to define the required managerial skills new graduates should possess. A cross-sectional study was conducted during the COVID-19 pandemic. A preliminary list of skills was developed based on the Delphi technique. The final list was then distributed to 410 employers who provided feedback. Exploratory and confirmatory factor analysis was employed to analyze the responses. The employers identified 19 items that indicate four types of managerial skills students need to possess: (a) vision-grounded skill, (b) collaboration skill, (c) systems thinking skill, and (d) health promotion and disease prevention skill. Each skill has a Cronbach's alpha coefficient ranging from 0.87 to 0.94. The ability to collaborate is the most crucial skill. The limited but valid and reliable tool is relevant in the Thai context because a few instruments are already measuring "competency" or "leadership" skills of community public health professionals. Educators and employers should prepare new practitioners with the four managerial skills identified in the study to perform their jobs effectively.

In South Africa, the mother-infant relationship is often conceptualized using international frameworks. Yet, contextual knowledge of mother-infant bonding is essential, as a strong mother-infant bond enhances a mother's capacity to care for her infant, and is associated with many positive child development outcomes. Community health workers work intimately with South Africa's mothers and infants, and are a valuable source of insight into local experiences. This study explored South African community health workers' perspectives of mother-infant bonding. Semi-structured interviews were conducted with 15 community health workers. A thematic analysis of the interviews suggests that the community health workers perceive mother-infant bonding as a central component of early development. Bonding was seen to improve mothers' care capacity, especially in poverty-stricken contexts. The benefits of bonding were characterized as being far-reaching, from pregnancy to adulthood. The community health workers described effective approaches to bonding as being simple, intuitive, and free.

Community health workers possess valuable insight into the experiences of South Africa's children and caregivers. However, their knowledge is often overlooked in efforts to understand local realities, inform interventions, and develop relevant policies. This study aimed to explore community health workers' perspectives of the first 1000 days of life, the critical period of development between conception and two years of age. Semi-structured interviews were conducted with 15 community health workers working with mothers and infants in Khayelitsha, Cape Town. A thematic analysis suggests that the community health workers view the first 1000 days as fundamental and foundational for children's development. Furthermore, the community health workers identified key needs for mothers/caregivers and infants within the first 1000 days. The findings provide contextual grounding for the importance of the first 1000 days within South African communities.

Nepalese Female Community Health Volunteers' (FCHVs) knowledge on social attention and communication development and the early signs of autism was evaluated before, immediately after, and 12-months following training on typical and atypical social-communicative development in infants/toddlers, early signs of autism, and monitoring of key "markers" of autism using Social Attention and Communication Surveillance. FCHVs (N = 60) significantly improved their knowledge about autism and reported increased perceived confidence in monitoring and referring young children at high likelihood of autism following training, which was sustained one year later. FCHVs also reported a positive impact of training on their work. These findings indicate the effectiveness of training in improving FCHVs' knowledge and perceived confidence to monitor and refer young children at high likelihood of autism.

Providing access to high-quality health services for all people is a national problem further compounded when the focus is mental health. Long-term primary prevention strategies and solutions, foundational to best practices in public health, are often considered at odds with short-term profit-driven private sector approaches within the capitalistic economy of the United States. Engagement scholarship, then, provides a uniquely viable, adaptable, responsive, customizable, and sustainable set of structures, mechanisms, and processes to address pressing societal needs. The CCERC model of engaged scholarship offers an example of community engagement, transformative and exceptional in addressing these societal and structural health care problems, with potential for customizable and contextual scalability. Specifically, world-class health care as a human right and an organizational value can be operationalized with engagement scholarship, which has the creativity and capacity to transform institutional values into purposeful and practical vehicles of community change.

Measurement-based care (MBC), an evidence-based approach that has demonstrated efficacy for improving treatment outcomes, has yet to be investigated in clients with Autism Spectrum Disorder. The current paper investigates the use of MBC in autistic (n = 20) and non-autistic (n = 20) clients matched on age, sex, and presenting problem. Results of change score analysis indicated that utilizing routine symptom monitoring can enhance treatment evaluation. Autistic clients participated in significantly more sessions, made significantly less progress, and were less compliant with MBC than non-autistic clients. Though hierarchical linear modeling demonstrated no significant differences in treatment slope, results indicated moderate effect size. These results inform the use of MBC in community clinics, highlighting policy implications and need for targeted measurement.