30 years of youth system of care lessons learned - a qualitative study of Hawai'i's partnership with the Substance Abuse and Mental Health Services Administration.

BACKGROUND: The Hawai'i State Department of Health, Child and Adolescent Mental Health Division (CAMHD) has maintained a longstanding partnership with Substance Abuse and Mental Health Services Administration (SAMHSA) to enhance capacity and quality of community-based mental health services. The current study explored CAMHD's history of SAMHSA system of care (SOC) awards and identified common themes, lessons learned, and recommendations for future funding. METHODS: Employing a two-phase qualitative approach, the study first conducted content analysis on seven final project reports, identifying themes and lessons learned based on SOC values and principles. Subsequently, interviews were conducted with 11 system leaders in grant projects and SOC award projects within the state. All data from project reports and interview transcripts were independently coded and analyzed using rapid qualitative analysis techniques. RESULTS: Content validation and interview coding unveiled two content themes, interagency collaboration and youth and family voice, as areas that required long-term and consistent efforts across multiple projects. In addition, two general process themes, connection and continuity, emerged as essential approaches to system improvement work. The first emphasizes the importance of fostering connections in family, community, and culture, as well as within workforce members and child-serving agencies. The second highlights the importance of nurturing continuity throughout the system, from interagency collaboration to individual treatment. CONCLUSIONS: The study provides deeper understanding of system of care evaluations, offering guidance to enhance and innovate youth mental health systems. The findings suggest that aligning state policies with federal guidelines and implementing longer funding mechanisms may alleviate administrative burdens.

Scale-up of Global Child and Youth Mental Health Services: A Scoping Review.

Numerous influential policy and scientific bodies are calling for more rapid advances in the scale-up of child and youth mental health services (CYMHS). A number of CYMHS innovations hold promise for advancing scale-up but little is known about how real-world efforts are progressing. We conducted a scoping review to identify promising approaches to CYMHS scale-up across the globe. Searches were completed in six databases (Academic Search Complete, CINAHL, MEDLINE, PsychInfo, PubMed, and Web of Science). Article selection and synthesis were conducted in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist. A second search focused on low-and-middle-income countries (LMIC) was conducted based on the Cochrane Library recommended search filters of the World Bank listed LMIC countries. Authors used a double coding strategy during the title/abstract and full-text review. Twenty-eight articles meeting the eligibility criteria were identified that described 22 initiatives (in 11 different countries). Our review found the majority of published scale-up studies in CYMHS were not informed by scale-up frameworks in design or reporting. The methods and outcomes used in the identified articles were highly variable and limited our ability to draw conclusions about comparative effectiveness although promising approaches emerged. Successes and failures identified in our review largely reflect consensus in the broader literature regarding the need for strategies to better navigate the complexities of system and policy implementation while ensuring CYMHS interventions fit local contexts.

Child and adolescent mental health services in a devolved healthcare system: a qualitative exploration of sustainable practices.

BACKGROUND: The transference of research evidence into routine healthcare practice remains poorly understood. This includes understanding the prerequisites of longer-term viability. The present study investigated the sustainable practices of GM i-THRIVE, a programme which reconceptualizes mental health services for children and young people (CYP) in Greater Manchester, United Kingdom. We aimed to establish whether a sustainable future was likely, and to identify areas of focus to improve that likelihood. METHODS: The NHS Sustainability Model, typically completed as a questionnaire measure, was converted into interview questions. The responses of nine professionals, from a variety of roles across the CYP mental health workforce, were explored using inductive thematic framework analysis. Selected participants completed the original questionnaire. RESULTS: Five themes (communication; support; barriers to implementation; past, present, and future: the implementation journey; and the nuances of GM i-THRIVE) and 21 subthemes formed the final thematic framework. Relationships with senior leaders and with colleagues across the workforce were seen as important. Leaders' roles in providing meaning and fit were emphasized. Whilst training delivered the programme's aims well, monitoring its dissemination was challenging. Widespread issues with dedicating sufficient time to implementation were raised. The flexibility of the programme, which can be applied in multiple ways, was discussed positively. This flexibility links to the idea of GM i-THRIVE as a mindset change, and the uniqueness of this style of intervention was discussed. To varying degrees, themes were supported by responses to the quantitative measure, although several limitations to the use of the questionnaire were discovered. Consequently, they were used to infer conclusions to a lesser degree than originally intended. CONCLUSIONS: Professionals involved with GM i-THRIVE reported many elements that indicate a positive future for the programme. However, they suggested that more attention should be given to embedding the core concepts of the model at the current stage of implementation. Limitations relating to its use within our study are discussed, but we conclude that the NHS Sustainability Model is a suitable way of guiding qualitative implementation research. It is especially valuable for localized interventions. The constraints of our small sample size on transferability are considered.

Reproductive health interventions for Inuit youth in the north: a scoping review.

BACKGROUND: Inuit have thrived in the northern regions of Canada and Alaska for thousands of years. Recent evidence suggests that Inuit in this region have experienced systemic barriers to reproductive health with resulting disparities in reproductive health-related outcomes including those among youth. Northern youth-focused reproductive health intervention research or evaluations have not to date been well summarized. The objective of this scoping review was to summarize the literature over the past twenty years focusing on reproductive health interventions for adolescents in northern Inuit communities. METHODS: English-language articles from 2000 to 2020 were identified from seven scientific databases, a general internet search and a review of relevant websites. Two reviewers screened titles, abstracts and full texts and included articles if they mentioned a reproductive health intervention and pertained, directly or indirectly, to reproductive health for Inuit aged 10-19 in northern communities. RESULTS: Seventeen articles met the inclusion criteria, across six themes: (1) Barriers to reproductive health interventions in the north; (2) Northern midwifery; (3) Northern birthing centres; (4) Fetal fibronectin tests for identifying high-risk pregnancies; (5) Prenatal education classes; and (6) Interventions to improve access to and quality of reproductive health supports. CONCLUSION: Overall there is relatively limited evidence base specific to reproductive health interventions and northern Inuit youth. What does exist largely focuses on maternal health interventions and is inclusive of but not specific to youth. There is some evidence that youth specific educational programs, participatory action research approaches and the promotion of northern birthing centres and midwifery can improve reproductive health for adolescents and young mothers in northern Inuit communities. Future initiatives should focus on the creation and evaluation of culturally relevant and youth specific interventions and increasing community and youth participation in intervention research for better reproductive health.

Recommendations from an expert panel of health professionals regarding a gestational diabetes risk reduction intervention for American Indian/Alaska Native Teens.

BACKGROUND: American Indian/Alaska Native (AI/AN) adolescents are at higher risk for gestational diabetes (GDM), type 2 diabetes, and pregnancy complications than the general population. OBJECTIVE: To inform cultural adaptation of a validated evidence-based intervention (VEBI) originally designed to deliver preconception counseling and diabetes education to non-AI/AN teens with diabetes. DESIGN: Qualitative data were collected using focus group and individual interview methods with health care professionals and experts (n = 16) in AI/AN health, GDM, adolescent health, and/or mother-daughter communication. A semistructured discussion guide elicited responses about provision of care for AI/AN girls at risk for GDM, experience with successful programs for AI/AN teens, comfort of mother/daughter dyads in talking about diabetes and reproductive health and reactions to video clips and booklet selections from the VEBI. All interviews were recorded and transcribed verbatim, and data analysis included inductive coding and identification of emergent themes. RESULTS: Providers felt teens and their moms would be comfortable talking about the VEBI topics and that teens who did not feel comfortable talking to their mom would likely rely on another adult female. Participants suggested including: AI/AN images/motifs, education with a community focus, and avoiding directive language. Concerns included: socioeconomic issues that affect AI/AN people such as: food and housing insecurity, abuse, and historical trauma. CONCLUSIONS: Perspectives from these participants have been used to guide the development of a culturally tailored GDM risk reduction program for AI/AN girls. This program will be available to health care providers who serve the AI/AN population.

Introducing a single point of access (SPA) to child and adolescent mental health services in England: a mixed-methods observational study.

BACKGROUND: In many high-income countries, primary care practitioners are the main point of referral for specialist mental health services. In England, Child and Adolescent Mental Health Services (CAMHS) are increasingly adopting a Single Point of Access (SPA) to streamline referrals and introduce self and parent/carer-referrals. This involves a significant shift of responsibility from primary care towards CAMHS who adopt a more active role as gatekeeper for their service. This study evaluates the adoption of a SPA in CAMHS across a large region in England. METHODS: We conducted an observational mixed methods study in two CAMHS from January 2018 to March 2019 to evaluate the adoption of a SPA. We collected quantitative data from electronic patient records and qualitative data through ethnographic observation and in-depth interviews of staff and stakeholders with experience of using CAMHS. Additional data on volumes was shared directly from the SPAs and a further snapshot of 1 week's users was collected. RESULTS: A similar SPA model emerged across the two services. Staff were positive about what the model could achieve and access rates grew quickly following awareness-raising activities. Despite the initial focus being on a telephone line, online referrals became the more regularly used referral method. Increased access brought challenges in terms of resourcing, including identifying the right staff for the role of call handlers. A further challenge was to impose consistency on triage decisions, which required structured information collection during the assessment process. Similar to GP referrals, those self-referring via the SPA were mainly from the least deprived areas. CONCLUSIONS: The introduction of a SPA has the potential to improve young people's access to mental health services. By addressing some of the barriers to access, simplifying where to go to get help and making it easier to contact the service directly, a SPA can help more individuals and families access timely support. However, the introduction of a SPA does not in itself expand the capacity of CAMHS, and therefore expectations within services and across sectors need to be tempered accordingly. SPA services providing different referral approaches can further improve access for the harder to reach populations.

Roadmap for Effective School-Based Practices to Support Expectant and Parenting Youth: Lessons from the New Heights Program in Washington, DC.

INTRODUCTION: New Heights is a voluntary school-based program that provides a well-defined system of supports for expectant and parenting students in Washington, DC, and was found to be effective at improving educational outcomes. This study explores the program elements and practices that, when used together, improved academic outcomes for New Heights participants and define a possible roadmap for service providers interested in replicating the program's success. METHODS: The study team collected data through site visits, key informant interviews, staff surveys, program observations, case files, and program materials. RESULTS: The core design and implementation elements of the New Heights program are (1) placing a trained staff member in the school to provide advocacy, case management, education, and in-kind incentives; (2) bringing community-based service providers into the school; (3) giving trained staff autonomy and a strong grounding in local context; and (4) using a highly collaborative process to hire and support school-based coordinators. DISCUSSION: Staff and funders interested in improving outcomes for young parents in school could use the experience of New Heights and the key practices that were critical to its success as a guide: (1) ensure that the program is well defined but can be tailored to the needs of schools and students, (2) engage community partners to bring services to participants, (3) hire and train the right staff who are committed to "do whatever it takes," (4) actively cultivate a culture of collaboration among program staff, and (5) develop buy-in with school staff and illustrate program value.

Creating Systems-Level Change to Better Support Expectant and Parenting Young People: A Case Study.

INTRODUCTION: Expectant and parenting young people (young parents) require diverse services to support their health, educational success, and family functioning. Rarely can the needs of young parents be met by a single school or service provider. This case study examines how one large school district funded through the pathways to success initiative was able to facilitate systems change to increase young parents' access to and use of supportive services. METHODS: Data sources include a needs and resources assessment, quarterly reports documenting grantee effort, sustainability plans, social network analysis, and capstone interviews. All data sources were systematically reviewed to identify the existing context prior to the start of the initiative, the changes that resulted from the initiative, and efforts that could potentially be maintained beyond the grant period. RESULTS: The community context prior to Pathways implementation was one of disconnected services and missed opportunities. The full-time program coordinator hired by the district focused on systems-level change and facilitated connections between organizations. This greater connectivity contributed to increased collaboration with the goal of producing lasting benefits for young parents. DISCUSSION: Promoting sustainable connections and collaboration at the systems level can help dismantle barriers to service access and benefit young parents.

Examining partnerships within an international knowledge translation network focused on youth mental health promotion.

BACKGROUND: Systems transformation for health promotion, involving engagement from multiple disciplines and levels of influence, requires an investment in partnership development. Integrated youth service is a collaborative model that brings organisations together to provide holistic care for youth. Frayme is an international knowledge translation network designed to support the uptake and scaling of integrated youth service. Social network analysis (SNA) is the study of relationships among social units and is useful to better understand how partners collaborate within a network to achieve major objectives. The purpose of this paper is to apply SNA to the Frayme network in order to (1) examine the level and strength of partnerships, (2) identify the strategies being employed to promote the main objectives and (3) apply the findings to current research in youth mental health and system transformation. METHODS: The PARTNER tool includes a validated survey and analysis software designed to examine partner interconnections. This tool was used to perform the SNA and 51 of the 75 partners completed the survey (14 researchers, 2 advisory groups and 35 organisations). A network map was created and descriptive frequencies were calculated. RESULTS: The overall network scores for the Frayme network were 20.6% for density, 81.5% for centralisation and 71.7% for overall trust. The Frayme secretariat received a 3.84 out of a possible 4 for value. In addition, the youth and family advisories each received a value score of 4 and all Leadership Team organisations received a score of 2.97 or above. CONCLUSIONS: The Frayme secretariat links many partners who would otherwise be disconnected and acts as a significant conduit for novel information. Frayme may have the opportunity to enhance value perceptions among broader network members by profiling individual organisations and the potential leveraging opportunities that might exist through their work. These findings increase understanding with respect to the mechanisms of network development and will be helpful to inform partnership development in the future. In addition, they contribute to the literature with respect to knowledge translation practice as well as the scaling of collaborative interventions within youth mental health.

Supportive Community Resources Are Associated with Lower Risk of Substance Use among Lesbian, Gay, Bisexual, and Questioning Adolescents in Minnesota.

Research has indicated that lesbian, gay, bisexual, and queer/questioning (LGBQ) adolescents have disproportionately high rates of substance use compared to heterosexual peers; yet certain features of schools and communities have been associated with lower substance use rates in this population. To advance this field, research examining multiple levels of influence using measures developed with youth input is needed. With community, school, and student data, this study tested hypotheses that LGBQ students attending high schools and living in communities with more LGBQ-supportive environments (assessed with a novel inventory tool) have lower odds of substance use behaviors (cigarette smoking, alcohol use, marijuana use, prescription drug misuse, and other drug use) than their peers in less supportive LGBQ environments. Multilevel models using data from 2454 LGBQ students (54.0% female, 63.9% non-Hispanic white) in 81 communities and adjusting for student and school covariates found that LGBQ adolescents who lived in areas with more community support had lower odds of frequent substance use, particularly among females. Expanding and strengthening community resources (e.g., LGBQ youth-serving organizations, LGBQ events such as a Pride parade, and LGBQ-friendly services) is recommended to further support LGBQ adolescents and reduce substance use disparities.

Building capacity for child and adolescent mental health and psychiatry in Papua New Guinea.

OBJECTIVE: To describe the recent work of child psychiatrists in Australia, New Zealand (ANZ) and Papua New Guinea (PNG) adding to mental health capacity building across the life-span, starting with children and adolescents. METHOD: Concerns about treatment access and clinical training needs, combined with academic leadership and National Department of Health commitment, supported the collaborative involvement of the Royal Australian and New Zealand College of Psychiatry (RANZCP) in workforce development. This has been initially established under the auspices of the Faculty of Child and Adolescent Psychiatry (FCAP). RESULTS: Workforce development in child and adolescent mental health is underway, with sustainability, consolidation and scaling up of initiatives required to meet need. CONCLUSIONS: Expanding mental health workforce capacity in partnership with the National Department of Health and the University of Papua New Guinea (UPNG) seems feasible. Ongoing cooperation is required to realize the potential of such collaborative initiatives.

CAMH in Primary Care Fiji: developing child and adolescent mental health in primary care.

OBJECTIVE: To describe the CAMH in Primary Care Fiji Project. METHODS: The context; process of development and planning; aims and goals; delivery and outcome are described. RESULTS: Two CAMH in Primary Care Fiji training workshops were delivered in 2017 and 2018 with positive structured and unstructured feedback. CONCLUSION: A successful, collaboratively developed, culturally appropriate and replicable training for primary care in CAMH is possible.

Asiasiga i A'oga ma Nu'u: a child and adolescent post-tsunami intervention based on Indigenous Samoan values.

OBJECTIVE: To describe a community-based single-session group intervention designed to address psychosocial needs of Samoan young people following a tsunami. METHOD: This programme resulted from collaboration between Samoan therapists, Samoan Catholic pastoral care workers and non-Samoan mental health clinicians. Informed by Samoan concepts of self and wellbeing, it incorporated cultural and spiritual practices familiar to Samoan young people and their families as well as body-centred therapeutic techniques, the 'Tree of life' exercise and provision of a cooked meal. RESULTS: Following household visits to affected families in villages throughout southern and eastern Upolu and the island of Manono, the programme was devised and carried out in 11 villages with 1295 children participating. There was a high degree of acceptance of the programme by Pulenu'u (village governance leaders), young people, their families and community members. CONCLUSIONS: Interventions to address the psychological needs of Indigenous Pacific children and adolescents following a major disaster need to be embedded in the values of their communities. This paper describes an innovative programme based on Samoan values that was consistent with evidence-informed principles used to guide post-disaster responses.

[Family Care Centres for health protection and promotion of individuals and communities: a reflection at the time of the Coronavirus]. / Il consultorio familiare per la tutela e promozione della salute dei singoli e delle comunità: una riflessione ai tempi del Coronavirus.

THE CONTEXT: among the community health services representing a resource to face the COVID-19 emergency, there are the Family Care Centres (FCCs). A national study coordinated by the Italian National Institute of Health (ISS) and funded by the Italian Ministry of Health, recently described their activities and needs, highlighting a large interregional variability in the number of centres and staff availability. Ante and post-natal care, cervical cancer screening and actions addressed at teenagers are the FCCs strategic activities. THE CF IN FRONT OF COVID-19: despite the need to limit the offer of care to the services that cannot be postponed during the lockdown, many FCCs have been exemplary in promptly reorganizing activities in the new context. The paper presents a selection of experiences carried out from March to June 2020 by some FCCs in different Italian Regions concerning FCCs strategic activities. CONCLUSIONS: the combined reading of some of the results of the ISS study and of the activities implemented during the COVID-19 pandemic offers a measure of the ability of the FCCs to respond to the needs of the community and to adapt to change. These services based on an innovative health model deserve enhancement and support.

Wellbeing Wednesdays: nurse-led clinic for improving physical health care in a general adolescent inpatient unit.

BACKGROUND: Young people with mental illness are at high risk of physical health complications. Physical healthcare on a general adolescent inpatient unit is complex. AIM: To establish a wellbeing clinic to improve efficiency and quality of the physical healthcare offered and increase health promotion. METHODS: Plan, Do, Study, Act (PDSA) cycles were used to drive this quality-improvement project. The authors audited 12 records before establishing the clinic and 12 at three further time points (6, 18 and 30 months post-intervention) to guide changes. RESULTS: Results progressively improved over PDSA cycles. Time taken for initial investigations dropped. Compliance with medication monitoring and management of important physical health domains rose from zero in some cases to 100% in all but one area. CONCLUSIONS: Establishing a dedicated physical health clinic in this setting is feasible and leads to improved performance against local and national standards. Mental health teams need to ensure physical health is prioritised.

Planning for child and adolescent mental health interventions in a rural district of South Africa: a situational analysis.

Objective: The aim of this study was to conduct a situational analysis as part of formative work to inform the development of community-based mental health services for children and adolescents at a district level. The purpose of the situational analysis was to determine the current state of child and adolescent mental health (CAMH), the available resources for CAMH, the range of services provided, and the existing pathways to CAMH care in a low-resource district with a view to developing a district mental health plan to improve access to CAMH services. Methods: Data for this situational analysis was collected from a rural district in the KwaZulu-Natal province using mixed methods. The qualitative component explored various stakeholders' (n = 26) perspectives using semi-structured interviews. The quantitative data for the study was collected using an adaptation of the situation analysis tool developed by the PRIME consortium. Results: The findings revealed the need to strengthen all the basic building blocks of the health system due to the weaknesses identified in the current CAMH care system in the district. The result of the situational analysis revealed that the provision of CAMH services in the district is sparse, uncoordinated, and not prioritised. Discussion: The findings of the study highlighted a severe shortage of specialised CAMH services in the district, poor integration of CAMH services into primary health care, and at the community platform there are deficits in the integrated school health programme. Further, the lack of a coordinated intersectoral collaborative system and well-defined referral pathways were revealed. Conclusion: The study highlights various challenges facing CAMH services at the Amajuba district. While these are not new, the study contributes to our understanding of the district level factors that may hinder the development of a district CAMH plan.

Empowering Chicago's Youths as the Next Generation of Health Advocates.

The CHAMPIONS NETWork summer program trains high school students to become health advocates in underserved Chicago, Illinois, communities. It provides a more innovative approach to traditional pipeline programs through the added responsibility of active health promotion. To determine whether student empowerment changed during the program, participants completed pre- and postassessments on health knowledge and self-efficacy. We found significant increases in student empowerment after the program compared with before, especially regarding the students' abilities and experiences.

Adolescent vaccinations: updates for the general practitioner.

PURPOSE OF REVIEW: Adolescent providers have a unique opportunity to interface with adolescents during a transformative time period. Optimizing vaccinations may protect teens against preventable but potentially deadly diseases. Healthcare providers must be aware of the evolving vaccination data and up-to-date recommendations for vaccinations. RECENT FINDINGS: In spite of the Center for Disease Control recommendations, there is a gap between the actual and desired vaccination rates of adolescents. Tetanus, diphtheria, and acellular pertussis, meningococcal against ACWY serotypes, and human papillomavirus (HPV) are vaccinations unique to the adolescent period. There has been a marked increase in pertussis cases over the last 2 decades. Either of the meningitis B vaccines may be given to 16-18 year olds and are effective in controlling college outbreaks. Increasing evidence continues to demonstrate the safety and efficacy of the HPV vaccination, although a substantial number of adolescents remain unvaccinated. Fortunately, there are proven strategies to remedy this. SUMMARY: Adolescent providers should be aware of the increase in pertussis cases over the past 2 decades and the Category B recommendation for meningococcal B vaccine at 16-18 years, and they should work towards closing the gap between the actual and desired HPV vaccination rates.

Pilot evaluation of a standardized patient actor training intervention to improve HIV care for adolescents and young adults in Kenya.

Poor retention in HIV care remains a major problem for Adolescents and Young Adults (AYA). A Standardized Patient (SP) clinical training intervention was developed to improve healthcare worker (HCW) "adolescent-friendly" competencies in Kenya. Professional actors were trained to portray HIV-infected AYA according to standardized scripts. HCWs completed a 2-day SP training that included didactic sessions, 7 video-recorded SP encounters, and group debriefing. AYA health experts rated HCWs by reviewing the video recordings. All HCWs (10/10) reported high satisfaction with the intervention and overall improvement in self-rated competency in caring for HIV-infected AYA. Cases were reported to be realistic and relevant by between 7 and 10 of 10 HCWs. The case on disclosure and adherence was rated as most challenging in communication and making medical decisions by HCWs. Areas identified by SPs for improvement by HCWs included allowing patients time to ask questions, and enabling SP to share sensitive information. The overall ICC by experts was low 0.27 (95% CI: -0.79 to 0.95), however, ICCs in assessment of HIV disclosure 0.78 (95% CI: 0.17-0.98), and sexual behavior 0.97 (95% CI: 0.89-0.99) were high. This intervention was acceptable for Kenyan HCWs and improved self-rated competency in caring for HIV-infected AYA.

Nutritional service needs of pregnant and lactating adolescent girls in Trans-Mara East Sub-County, Narok County: focus on access and utilization of nutritional advice and services.

BACKGROUND: An understanding of the association between adolescent nutrition, adolescent pregnancy and their quest for healthcare services may elucidate a basis for intervention and formulation of programs that enhance post-partum and increase the lifespan of the newborn, improve the quality of life and bridge morbidity, mortality and healthcare-associated cost. However, the nutritional needs of pregnant and lactating adolescent girls aged below 10 years resident in Trans Mara East Sub-County, Kenya remained unestablished. The objective of this study was to assess the nutritional needs of pregnant and lactating adolescent girls (under 19) when accessing and utilizing nutritional advice and services in Trans-Mara East Sub-County, Narok County. METHODS: The study adopted a cross-sectional approach that employed mixed methods with both quantitative and qualitative research approaches. Cochran formula was applied to arrive at a minimum of 291 households. Probability proportionate to size sampling techniques using cluster and simple random methods were used to practically access adolescents who are pregnant or lactating. Data was collected using questionnaires, in-depth interview and Focus Group Discussion. Quantitative data was analyzed descriptively using frequencies and inferentially using odds ratio and z-test. Framework analysis was employed to analyze qualitative data. p ≤ 0.05 was considered statistically significant. RESULTS: The study revealed that access of pieces of nutritional-related advice represented by 67.8% was significantly higher than expected frequency of 50%. Nutrition supplementation, food fortification or blending and complementary feeding were significantly below the expectant frequency (p < 0.01) of 50%. Nutrition service areas such as provision and collection of vitamin A and IFAS were significantly lower than expected frequency (p < 0.01). CONCLUSIONS: The most widely utilized were nutrition services that falls within the preventive-focused services followed by curative-focused services. Nutritionist and nurse more likely to increase overall utilization of nutrition services.