A novel model for curriculum design: Preparation, planning, prototyping, and piloting.

Dental education continuously strives to provide students with positive and meaningful learning experiences. Developing or improving a curriculum usually encompasses three main phases: design, implementation, and evaluation. Most research on curriculum development in dental education has focused on the last two phases. Our commentary addresses this gap by describing a new model for curriculum design that effectively guided the design phase of the complete overhaul of the four-year Doctor of Dental Surgery curriculum at the School of Dentistry, University of Alberta. Built on the strengths of pre-existing curriculum design models, the new model provided enough structure and rigour to support the complexity required during a complete curriculum redesign whilst still allowing sufficient consultation and flexibility to encourage stakeholder engagement. The steps of the new 4P's model (preparation, planning, prototyping, and piloting) and main actions within each step are described. Challenges observed in each step and strategies to address them are reported. Other institutions embarking on renewing or redesigning a curriculum at a program level may benefit from using a curriculum design process similar to the 4P's model. Recommendations are discussed including the inclusion of educational consultants in the curriculum renewal committee, the importance of a leadership that effectively supports curriculum reform, purposeful engagement of stakeholders during each step of the design phase and ensuring that project and change management occur concurrently.

Active learning in undergraduate classroom dental education- a scoping review.

INTRODUCTION: Previous reviews on active learning in dental education have not comprehensibly summarized the research activity on this topic as they have largely focused on specific active learning strategies. This scoping review aimed to map the breadth and depth of the research activity on active learning strategies in undergraduate classroom dental education. METHODS: The review was guided by Arksey & O'Malley's multi-step framework and followed the PRISMA Extension Scoping Reviews guidelines. MEDLINE, ERIC, EMBASE, and Scopus databases were searched from January 2005 to October 2022. Peer-reviewed, primary research articles published in English were selected. Reference lists of relevant studies were verified to improve the search. Two trained researchers independently screened titles, abstracts, and full-texts articles for eligibility and extracted the relevant data. RESULTS: In total, 93 studies were included in the review. All studies performed outcome evaluations, including reaction evaluation alone (n = 32; 34.4%), learning evaluation alone (n = 19; 20.4%), and reaction and learning evaluations combined (n = 42; 45.1%). Most studies used quantitative approaches (n = 85; 91.3%), performed post-intervention evaluations (n = 70; 75.3%), and measured student satisfaction (n = 73; 78.5%) and knowledge acquisition (n = 61; 65.6%) using direct and indirect (self-report) measures. Only 4 studies (4.3%) reported faculty data in addition to student data. Flipped learning, group discussion, problem-based learning, and team-based learning were the active learning strategies most frequently evaluated (≥6 studies). Overall, most studies found that active learning improved satisfaction and knowledge acquisition and was superior to traditional lectures based on direct and indirect outcome measures. CONCLUSION: Active learning has the potential to enhance student learning in undergraduate classroom dental education; however, robust process and outcome evaluation designs are needed to demonstrate its effectiveness in this educational context. Further research is warranted to evaluate the impact of active learning strategies on skill development and behavioral change in order to support the competency-based approach in dental education.

Multiple cases in case-based learning: A qualitative description study.

INTRODUCTION: Case-based learning is widely used in health professions education to improve clinical learning, but little is known about how best to approach multiple cases in this active learning strategy. Our study explored dental student views of multiple case-based learning in oral pathology. MATERIALS AND METHODS: Qualitative description informed the study design. Data were collected through semi-structured, individual interviews with twenty-one third- and fourth-year dental students who participated in multiple case-based learning seminars. Data were analysed using inductive, manifest thematic analysis. RESULTS: Themes were identified at approach and case levels. Approach-level themes included preparing students for clinical practice and board exams and maximising exposure (e.g., to lesions/conditions), knowledge application, and engagement within the time allotted for the learning session. Case-level themes included using challenging but manageable cases, linking cases to lecture content, providing the necessary clinical information to solve the cases, and ensuring that cases were authentic and common with non-typical presentations. Aspects of themes encompassed definitions of case characteristics, benefits, conditions of implementation, and recommendations for improvement. CONCLUSION: Cases should be considered individually, collectively, purposefully, and contextually in multiple case-based learning. Evaluations of learning and behavioural outcome are needed to further establish the effectiveness of approaches and case characteristics in multiple case-based learning.

Impact of the COVID-19 pandemic on gender disparities in acute coronary syndrome patterns.

Background: Global evidence has emerged showing fewer Acute Coronary Syndrome (ACS) cases than expected during the COVID-19 pandemic. Our study aims to evaluate the incidence of ACS before and after the onset of the COVID-19 pandemic and analyze differences in gender distribution, and type of presentation. Methods: This is a retrospective study of 997 patients who presented to Huntsville Hospital's catheterization lab for elective and emergency catheterization for ACS and non-ACS during a four-week period from February 26, 2020, to March 10, 2020, and from March 25, 2020, to April 8, 2020, and compared with the equivalent weeks in 2019. Results: We report a 45.5% decrease in ACS cases presenting during the COVID-19 pandemic between March 25, 2020, to April 8, 2020 compared to equivalent weeks in 2019, with a significant drop in percentage of female patients presenting by 30.6%. Upsurge in STEMI cases and a drop in NSTEMI cases was observed during the COVID pandemic compared to 2019. Conclusions: Patients presenting after the onset of the pandemic had elevated cardiac markers, representing higher severity and potentially presenting later in the disease course. The number of total ACS cases and percentage of females presenting to the catheterization lab before the COVID surge (February/March 2019 and 2020) almost remained stable. This comparison data provides validity that the drop in ACS case volume and females in March/April 2020 is more likely due to the pandemic and not due to improvements in overall cardiovascular health metrics. Reasons for this disparity are likely multifaceted and deserve further investigation.

Dental Students' Knowledge, Confidence, Ability, and Self-Reported Difficulties in Periodontal Education: A Mixed Method Pilot Study.

Evidence on periodontal education areas in which students have difficulties and their factors are limited. In this study, third- and fourth-year dental students' knowledge was assessed as well as their confidence and ability in five periodontal educational areas using a mixed-method approach. A survey was used to collect data related to history-taking, medical examination, diagnosis, treatment planning, and follow-up. Student answers were compared to the consensual answers of an expert panel using the cosine-similarity index (CSI). Descriptive statistics assessed confidence and ability for diagnosis. Semi-structured individual interviews were used to collect data on reported reasons for difficulties in periodontal education. A content analysis was employed to analyze the interview data. Eighteen third- and fourth-year dental students completed the survey and eleven were interviewed. Students' knowledge was adequate regarding diagnosis and treatment planning. Third-year students' median CSI were 0.93 and 0.89, respectively. Fourth-year students' median CSI were 0.9 and 0.93, respectively. Students felt confident in history-taking and examination but lacked confidence and ability in diagnosis and treatment planning. Reported reasons for difficulties in periodontal education were linked to both preclinical and clinical pedagogical issues. Further improvements in preclinical and clinical periodontal education are needed to address students' lack of knowledge, confidence, and skills in key periodontal areas.

Behavioural change as a theme that integrates behavioural sciences in dental education.

The behavioural sciences curriculum in dental education is often fragmented and its clinical relevance is not always apparent to learners. Curriculum integration is vital to understand behavioural subjects that are interrelated but frequently delivered as separate issues in dental programmes. In this commentary, we discuss behavioural change as a curricular theme that can integrate behavioural sciences in dental programmes. Specifically, we discuss behavioural change in the context of dental education guidelines and describe four general phases of behavioural change (defining the target behaviour, identifying the behavioural determinants, applying appropriate behavioural change techniques and evaluating the behavioural intervention) to make the case for content that can be covered within this curricular theme, including its sequencing. This commentary is part of ongoing efforts to improve the behavioural sciences curriculum in dental education in order to ensure that dental students develop the behavioural competencies required for entry-level general dentists.

Effects of cardiac toxicity of combination therapy with hydroxychloroquine and azithromycin in COVID-19 patients.

Coronavirus disease 2019 (COVID-19), which began in China, caused a global pandemic. Few studies have shown the benefit of hydroxychloroquine (HY) ± azithromycin (AZ) for treating COVID-19. Concerns of QT prolongation and increased risks of torsade's de pointes (TdP) with this combination have been raised since each agent can individually prolong the QT interval. This retrospective, observational study included hospitalized patients treated with HY and AZ from March 2020 to May 2020 at a large community hospital. Serial assessments of the QT interval were performed. Our aim is to evaluate the safety and characterize the change in QTc interval and arrhythmic events in COVID-19 patients treated with HY/AZ. A total of 21 COVID patients who received at least four days of HY and AZ were included in this study. Mean baseline was QTc 403 ms, mean maximum QTc was 440 ms, mean change in QTc was 36 ms. Only one patient (4.8%) developed prolonged QTc > 500 ms. No patient had a change in QTc of 60 ms or more. No patient developed TdP. Fifteen patients (71.4%) had hypoxia on admission, with only two patients (9.5%) required oxygen of 1-2 L at discharge. 80.9% of patients have been discharged home or inpatient rehabilitation.

Perceived Effectiveness and Applicability of Think-Pair-Share Including Storytelling (TPS-S) to Enhance Clinical Learning.

Problem: Think-pair-share (TPS) is a teaching strategy that promotes active and collaborative learning; however, the effectiveness and applicability of this strategy in its original or altered form remain to be established, especially in health professions education. As a first step in this direction, the objective of our study was to examine the perceived effectiveness and applicability of TPS including storytelling (TPS-S) in an oral pathology seminar from the perspectives of students, seminar instructors, and peer instructors (experienced instructors who observed the seminar). Intervention: Prompts for individual thinking (T), pair discussion (P), and class sharing (S) included clinical case-based questions related to diagnosis and management and wildcards with additional information about the cases. In addition to the traditional TPS phases, the experiences of the leading instructor in dealing with the cases discussed in the seminar were shared through storytelling to model good practices in clinical diagnosis and management. Context: Our study was conducted in the School of Dentistry at the University of Alberta. Participants in this mixed-method study included third (Y3) and fourth (Y4) year dental students (n = 55) in their clinical training, seminar instructors (n = 2), and peer instructors (n = 3). Data from students, seminar instructors, and peer instructors were obtained through the Student Evaluation of Educational Quality (SEEQ) questionnaire, journaling, and interview, respectively. Descriptive statistics were performed to analyze SEEQ dimensions and statements (factors). MANOVA was used to determine significant differences between Y3 and Y4 students for SEEQ dimensions and ANOVA to identify the factors that accounted for significant differences. Qualitative data were analyzed using inductive content analysis. Impact: Participants positively valued the TPS-S seminar. Students rated all SEEQ dimensions between good and very good and regarded the seminar as superior to traditional lectures. Perceived conditions that facilitated the implementation of TPS-S included the use of real-life clinical cases, instructor facilitation skills, and the scaffolded structure of the seminar. Perceived conditions that hindered the implementation of TPS-S included unequal participation of Y3 and Y4 students, time constraints, and issues related to student pairing. Lessons learned: TPS-S was perceived as effective to improve clinical learning and applicable to dental clinical education as long as its implementation matches the characteristics of the learning context. Further evidence is needed to empirically demonstrate the effectiveness and applicability of TPS-S.

A Blueprint for Productive Maintenance of Certification, But Is the American Board of Internal Medicine up to the Challenge?

The future of the American Board of Internal Medicine Maintenance of Certification (MOC) program is at a crossroads. The current MOC program lacks a clear visible mission, adds to modern health care's onerous bureaucracy, and thus pulls physicians from the most important humanistic aspects of their profession. The aim of the MOC program should be to promote the best patient care by ensuring certified physicians maintain core skills through continuous education and evaluation. The program should focus on education and be designed with the rigorous obligations of practicing physicians in mind. Moving forward, the American Board of Internal Medicine should cocreate MOC with the physician community and apply innovative adult education techniques. Over time, data-driven methods and member feedback should be used to provide continuous program improvement. This review describes the origins of the current state of MOC, explores its evidence base, provides examples of model programs for the maintenance of complex professional skills, and outlines guiding principles for the future of MOC.

Recommendations for approaching the introduction section of manuscripts and grant applications.

Research on dental and dental hygiene education is key to improving learning, teaching, and oral health care in academic dental institutions. Faculty should be able to write research proposals and reports properly to secure funding for research and share the findings of studies with stakeholders. Specifically, they should demonstrate why the study matters in the introduction section of their text. Our experience in mentoring dental and dental hygiene faculty shows that some have difficulty justifying the importance of their studies due to the way they approach the introduction section. This short communication provides 3 recommendations to help faculty approach and write this section adequately, which can be useful for writing other sections of manuscripts and grant applications.

La recherche sur l'éducation en matière d'art dentaire et d'hygiène dentaire joue un rôle clé dans l'amélioration de l'apprentissage, de l'enseignement et des soins de santé buccodentaire dans les établissements universitaires dentaires. Le corps professoral devrait pouvoir rédiger des offres de service et des rapports de recherche de façon adéquate en vue d'obtenir du financement pour la recherche et de partager les résultats des études avec les parties intéressées. Plus précisément, il devrait démontrer l'importance de l'étude dans l'introduction de ses textes. Notre expérience en matière de mentorat du corps professoral de l'art dentaire et de l'hygiène dentaire montre que beaucoup de personnes ont de la difficulté à justifier l'importance de leurs études en raison de la façon dont ils abordent la section d'introduction. Ce bref article fournit 3 recommandations qui aideront au corps professoral à aborder cette section et à la rédiger de manière adéquate, ce qui peut être utile lors de la rédaction d'autres sections de manuscrits et de demandes de subventions.

Dental faculty and student views of didactic and clinical assessment: A qualitative description study.

OBJECTIVE: Although assessment is essential to accurately represent student learning, little is currently known about student and faculty perceptions of assessment in dental schools. Our study aimed to explore faculty and student views of didactic and clinical assessments in the School of Dentistry at the University of Alberta. METHOD: Qualitative description informed the study design. Data were collected through focus groups and analysed inductively using manifest content analysis. RESULTS: Five focus groups were conducted with faculty (n = 34) and three with students (n = 19). Faculty and student views of assessment were related to improvements made (perceived positive changes), improvements needed (perceived limitations) and improvements recommended (recommendations to improve perceived limitations). Faculty and students reported that improvements made (eg adequacy of assessment to students' levels of training) varied across instructors, courses and learning environments. Both faculty and students perceived clinical assessments as less appropriate than didactic assessments. Faculty perceived limitations were mostly related to assessment appropriateness, especially assessment accuracy and comprehensiveness, whilst student perceived limitations included other issues related to appropriateness (eg misalignment with course objectives) as well as issues related to assessment volume, pace and scheduling. Similarly, faculty recommendations focused on enhancing the assessment of clinical competencies, whilst students' recommendations aimed to also improve assessment scheduling, volume and usage (eg for learning purposes). CONCLUSIONS: Faculty and student views of assessment complemented one another. Our data show that assessment in dental education is multidimensional, so that multilevel strategies may be needed to improve this component of dental curricula.

Intersection of Migration and Access to Health Care: Experiences and Perceptions of Female Economic Migrants in Canada.

More people are migrating than ever before. There are an estimated 1 billion migrants globally-of whom, 258 million are international migrants and 763 million are internal migrants. Almost half of these migrants are women, and most are of reproductive age. Female migration has increased. The socioeconomic contexts of women migrants need investigation to better understand how migration intersects with accessing health care. We employed a focused ethnography design. We recruited 29 women from three African countries: Ghana, Nigeria, and South Africa. We used purposive and convenient sampling techniques and collected data using face-to-face interviews. Interviews were audio-recorded and transcribed verbatim. Data were analyzed with the support of ATLAS.ti 8 Windows (ATLAS.ti Scientific Software Development GmbH), a computer-based qualitative software for data management. We interviewed 10 women from both South Africa and Ghana and nine women from Nigeria. Their ages ranged between 24 and 64 years. The four themes that developed included social connectedness to navigate access to care, the influence of place of origin on access to care, experiences of financial accessibility, and historical and cultural orientation to accessing health care. It was clear that theses factors affected economic migrant women's access to health care after migration. Canada has a universal health care system but multiple research studies have documented that migrants have significant barriers to accessing health care. Most migrants indeed arrive in Canada from a health care system that is very different than their country of origin. Access to health care is one of the most important social determinants of health.

Thinking ecologically about clinical education in dentistry.

Traditional approaches to clinical education (CE) in dentistry have primarily focused on the needs and interests of students (student-centred), patients (patient-centred) or individuals receiving care (person-centred). Research has shown that giving priority to the interests of one stakeholder (eg students) may negatively affect the interests of others (eg patients, instructors and administrators). In this commentary, we discuss some limitations of traditional approaches to CE and suggest an eco-centred approach that assumes that the interests of all stakeholders must be considered when planning CE due to the interdependent relationships between stakeholders. A description of this new approach is provided, whilst research and innovation are encouraged to develop an ecologically informed system of CE.

Assessing students' confidence in interpreting dental radiographs following a blended learning module.

OBJECTIVE: This study assessed senior dental hygiene (DH) students' self-reported confidence in interpreting dental radiographs following the introduction of a blended learning (BL) module for radiology interpretation. The assessment of students was conducted five months prior to graduation. METHODS: A BL oral radiology module was designed. In order to capture the context, descriptions and differences of students' experience and confidence, a qualitative research approach was selected. Data were captured using a semi-structured interview process and analysed using phenomenographic methods. RESULTS: Sixteen students were interviewed. Blinded transcripts were analysed, and the main themes relating to confidence were extracted and arranged into categories. The categories were coded as to how confident (low, medium or high) each of the students felt specific to varying contexts and complexities of radiographic interpretation. CONCLUSION: Predominately, the BL model had a positive impact on DH students' confidence in the interpretation of radiographic findings. However, when asked about their level of overall confidence in interpreting dental radiographs, students still did not describe themselves as confident for all potential findings on radiographs at this point in their education. The students highlighted the importance of having patient history details and clinical assessment findings included in the interpretation exercises and expressed a desire to collaborate with other professionals when interpreting radiographs.

Dental hygiene students and faculty attitudes and utilization of a single source electronic textbook platform.

OBJECTIVE: Transitioning to interactive e-textbooks has been considered revolutionary for enhancing student learning. However, adopting this technology has been met with hesitation. This study investigates student and faculty attitudes and utilization of mandatory e-textbooks in a dental hygiene program. METHODS: In 2017, an online questionnaire was distributed to students and a focus group was conducted with faculty to examine their perspectives about using VitalSource™. Using a 5-point Likert scale with five indicating strongly agree, the questionnaire examined convenience; compatibility with learning style; perceived enjoyment; and usefulness. Open-ended questions captured benefits and challenges. The focus group gathered faculty perspectives. Questionnaire data were analysed using descriptive statistics. Data from the open-ended questionnaire questions and focus group transcript followed a narrative analysis process. RESULTS: Survey response was 48% (n = 105). Students scored all factors below neutral. Results from four categories showed convenience (M = 2.75, SD = 0.92); compatibility (M = 1.93, SD = 0.83); perceived effectiveness (M = 2.15, SD = 0.90); and perceived usefulness (M = 2.36, SD = 1.04). A high correlation between all factors suggests they were uniformly rated by students. Majority of students (71%) did not use a textbook greater than once a month. Narrative analysis revealed few benefits; challenges included technical glitches, eyestrain, cost and inability to choose books as desired. Faculty's perspectives aligned with the students, but they appreciated portability of texts and quality of clinical images. CONCLUSIONS: Students strongly disliked the platform and the online medium and do not frequently access e-textbooks but rely on PowerPoint handouts for studying. Faculty felt e-textbooks do not align with positive learning experiences.

Becoming a dentist: faculty perceptions of student experiences with threshold concepts in a Canadian dental program.

BACKGROUND: In each discipline, there are moments where students "get stuck" in their education and/or training and are often unable to move forward. These moments may be caused by threshold concepts as they represent a portal that students must cross in order to become successful in their chosen profession. This study investigated the threshold concepts from the instructors' perspective that students must navigate as they transform from learners to dentists within a dental program. METHODS: Two focus groups with faculty members within the School of Dentistry, University of Alberta were completed in the fall of 2017. Focus groups explored the faculty's perception of the students' transition from learner to dentist, difficult moments in the program, and the students' ability to navigate the program successfully. RESULTS: A qualitative phenomenographic analysis of the faculty focus group transcripts identified four potential threshold concepts within the dental program: 1) dealing with the whole patient, 2) accountability, 3) that you may not know everything, and 4) problem solving and adapting during practice. CONCLUSION: This study demonstrates that there are concepts within a dental program that faculty believe students must navigate in order to transition from learner to dentist. These concepts may inform curriculum design as well as other disciplines in the health sciences.

Dental Hygiene Students' Clinical Skill Acquisition: Activity theory and the use of videos.

Purpose: Entry-level students in dental hygiene programs have already demonstrated a level of academic success; however they often struggle with the acquisition of psychomotor skills. Recognizing that traditional course materials were not addressing the needs of entry level dental hygiene students, instructional videos were produced to demonstrate clinical skills. The purpose of this study was to investigate students' perception of instructional videos and their impact on the learning environment in regards to students' experiences of skills acquisition.Methods: Online surveys were distributed to all students (n=84) in the fall semesters of 2015 (n=42) and 2016 (n=42). Responses from the surveys were analyzed qualitatively, utilizing an activity theory framework, to identify the impact of instructional videos on the learning environment. The activity theory framework involves the encapsulation of the learning environment that is mediated by tools and situated in a community where a learning activity is carried out to achieve an outcome.Results: Response rates were 76% (n=32) and 69% (n=29), respectively. Student responses concluded that the videos were very or extremely helpful, with 84% (n=27) in 2015 and 79% (n=23) in 2016. Students made comments on the usefulness of the videos and gave suggestions for future improvements. In addition, the comments demonstrated that students found the videos helpful for review purposes and for overall stress reduction associated with the process of psychomotor skill acquisition.Conclusion: Results from this study demonstrate the positive impact instructional videos have on the acquisition of psychomotor skills even within the dynamics of a small class size. Videos can also be utilized as an on-demand review tool that can be accessed before clinical evaluation processes, reducing student stress and providing a level of clarification to support student success.

Taking the Reins on Systems of Care for ST-Segment-Elevation Myocardial Infarction Patients: A Report From the American Heart Association Mission: Lifeline Program.

BACKGROUND: Early success with regionalization of ST-segment-elevation myocardial infarction (STEMI) care has led many states to adopt statewide prehospital STEMI hospital destination policies, allowing emergency medical services to bypass non-percutaneous coronary intervention-capable hospitals. The association between adoption of these policies and patterns of care among STEMI patients is unknown. METHODS AND RESULTS: Using data from January 1, 2013, to December 31, 2014, from the National Cardiovascular Data Registry and Acute Coronary Treatment and Intervention Outcomes Network Registry, 6 states with bypass policies (cases included Delaware, Iowa, Maryland, North Carolina, Pennsylvania, and Massachusetts) were matched to 6 states without bypass policies (controls included South Carolina, Minnesota, Virginia, Texas, New York, and Connecticut) a priori on region, hospital density, and percent state participation in the registry. Using the matched sample, logistic regression models were adjusted for patient- and state-level characteristics. Outcomes were receipt of reperfusion and receipt of timely percutaneous coronary intervention. Our study cohort included 19 287 patients at 379 sites across 12 states. Patients from states with hospital destination policies were similar in age, sex, and comorbidities to patients from states without such policies. After adjustment for patient- and state-level characteristics, 57.9% (95% confidence intervals, 53.2%-62.5%) of patients living in states with hospital destination policies when compared with 47.5% (95% confidence intervals, 43.4%-51.7%) living in states without hospital destination policies received primary percutaneous coronary intervention within their relevant guideline-recommended time from first medical contact. CONCLUSIONS: Statewide adoption of STEMI hospital destination policies allowing emergency medical services to bypass non-percutaneous coronary intervention-capable facilities is associated with significantly faster treatment times for patients with STEMI.

Partners in Parenting: A Multi-Level Web-Based Approach to Support Parents in Prevention and Early Intervention for Adolescent Depression and Anxiety.

Depression and anxiety disorders in young people are a global health concern. Various risk and protective factors for these disorders are potentially modifiable by parents, underscoring the important role parents play in reducing the risk and impact of these disorders in their adolescent children. However, cost-effective, evidence-based interventions for parents that can be widely disseminated are lacking. In this paper, we propose a multi-level public health approach involving a Web-based parenting intervention, Partners in Parenting (PIP). We describe the components of the Web-based intervention and how each component was developed. Development of the intervention was guided by principles of the persuasive systems design model to maximize parental engagement and adherence. A consumer-engagement approach was used, including consultation with parents and adolescents about the content and presentation of the intervention. The PIP intervention can be used at varying levels of intensity to tailor to the different needs of parents across the population. Challenges and opportunities for the use of the intervention are discussed. The PIP Web-based intervention was developed to address the dearth of evidence-based resources to support parents in their important role in their adolescents' mental health. The proposed public health approach utilizes this intervention at varying levels of intensity based on parents' needs. Evaluation of each separate level of the model is ongoing. Further evaluation of the whole approach is required to assess the utility of the intervention as a public health approach, as well as its broader effects on adolescent functioning and socioeconomic outcomes.