Early Intervention Provider-Reported NDBI Use and Relationships with Provider- to System-Level Implementation Determinants.

An expanding evidence base has advocated for delivery of naturalistic developmental behavioral interventions (NDBIs) within community systems, thus extending the reach of these practices to young autistic children. The current study examined provider-reported use of NBDIs within a Part C Early Intervention (EI) system and the extent to which provider background, attitudes, and perceived organizational support predicted NDBI use. Results from 100 EI providers representing multiple disciplines indicated reported use of NDBI strategies within their practice despite inconsistent reported competency with manualized NDBI programs. Although NDBI strategy use was not predicted by provider experiences or perceived organizational support, provider openness to new interventions predicted the reported use of NDBI strategies. Future directions include mixed methods data collection across and within EI systems to better understand NDBI use and ultimately facilitate NDBI implementation.

Cross-Sector Intervention Strategies to Target Childhood Food Insecurity in North Carolina.

BACKGROUND: Childhood food insecurity increased considerably during the COVID-19 pandemic and is associated with compromised health. Health care systems are increasingly prioritizing food insecurity interventions to improve health, but it is unclear how health systems collaborate with other sectors that are addressing food insecurity. In this study, we aimed to evaluate existing collaborations and explore opportunities for further cross-sector engagement. METHODS: From December 2020 to March 2021, we conducted semi-structured interviews (N = 34) with informants involved in increasing child food access in North Carolina. Our informants represented different sectors, including community (e.g., food pantry), education (e.g., school lunch program), and government (e.g., Supplemental Nutrition Assistance Program). Rapid qualitative analysis was used to interpret the results and identify themes. RESULTS: Informants rarely mentioned the health care sector as a source of referrals or as a collaborator. Barriers limiting access to food insecurity programs were exacerbated by the COVID-19 pandemic, including lack of transportation, stigma deterring use, limited food choice, and burdensome enrollment processes. Stakeholders recommended mitigating barriers through the expansion of food delivery, colocalization of assistance programs in schools and health care settings, increased food choice, and supporting cross-program enrollment mechanisms. LIMITATIONS: The majority of the stakeholders represented programs from five counties in central North Carolina, with only a few representing statewide initiatives. CONCLUSIONS: The COVID-19 pandemic both highlighted the fragmented system of food insecurity organizations and accelerated development of cross-sector collaborations to reduce access barriers. Health care systems are siloed from school and community efforts but have the opportunity to leverage ongoing innovative policy initiatives to construct novel cross-sector models. Such models can better link food insecurity screening with community-based solutions to address family-level food access barriers.