Impacts of COVID-19 on Young Children and Families: A Qualitative Study Using Best Starts for Kids Health Survey Data in King County, WA.

OBJECTIVES: To evaluate the impacts of the COVID-19 pandemic on parents and caregivers with young children in King County, Washington using data from a local population-based survey, the Best Starts for Kids Health Survey (BSKHS). METHODS: 7033 parents and caregivers in King County, Washington with children 5th grade and younger participated in the BSKHS in 2021. Three evaluators adopted a framework method approach to thematic analysis for open-ended survey responses regarding the impacts of COVID-19 on families. RESULTS: Children aged 0-5 years missed important social development opportunities, while elementary-school children missed social interactions and felt isolated during remote schooling. Parents were exhausted by the competing demands of work and schooling/childcare, with mothers bearing the brunt of additional responsibilities. Many families faced financial uncertainty and were unable to meet basic needs. Yet, families were grateful for more quality time with family members. CONCLUSIONS FOR PRACTICE: Parents expressed that children aged 0-5 years missed out on social development opportunities with both adults and children their own age and elementary-school children and felt isolated while schools were closed to in-person schooling.

Food and Housing Insecurity in Nevada During the COVID-19 Pandemic.

The COVID-19 pandemic intensified concerns regarding food and housing insecurity in the United States, particularly among vulnerable populations. After the pandemic prompted a shutdown of nonessential businesses in Nevada, unemployment rose dramatically as the gaming, tourism, and hospitality industries struggled. This study analyzed the results of two telephone surveys of Nevada adults' experiences in 2020 (n = 1000) and 2021 (n = 1002). The results demonstrate between 2020 and 2021 an 8.24 percentage point decline in food insecurity (FI) from 30.2% to 21.96% and a 12.58 percentage point increase in housing insecurity (HI) from 12.27% to 24.85%. Age, disability status, and certain categories of race/ethnicity and income were associated with both HI and FI in 2020, but disability was no longer significant in 2021. Instead, spouse/partner-status, living with children ≤ 18-years-old and receipt of SNAP benefits were significantly associated with FI in 2021. In particular, health status became a significant factor of both HI and FI. People of color experienced FI disparities compared to Whites. Asians/Hawaiians/Pacific Islanders were 3.22 times (95% CI 1.51, 6.86) more likely to experience FI in 2021 than Whites. A matched, longitudinal analysis also revealed that Whites experienced a significant 9.1 percentage point estimated decline in the probability of FI between 2020 and 2021. However, the reduction among non-White participants was statistically insignificant at 2.5 percentage points. Results indicate the importance of supporting the food and housing needs of people of color and individuals with disabilities. Further research should especially investigate the comparative FI rate among Asians/Hawaiians/Pacific Islanders in 2021 and offer solutions to the soaring prevalence of housing insecurity.

Years of good life is a well-being indicator designed to serve research on sustainability.

Sustainable development (SD) as popularized by the Brundtland Commission and politically enshrined in the Sustainable Development Goals has been the explicit focus of sustainability science. While there is broad agreement that the trend of human well-being (W) over time should serve as a sustainability criterion, the literature so far has mostly addressed this in terms of its determinants rather than focusing on W itself. There is broad agreement that an indicator for W should have multiple constituents, clearly going beyond gross domestic product. Here, we propose a tailor-made indicator to serve precisely this purpose following a set of specified desiderata, including its applicability to flexibly defined subnational populations by gender, place of residence, ethnicity, and other relevant characteristics. The indicator, years of good life (YoGL), reflects the evident fact that in order to be able to enjoy any quality of life, one has to be alive and thus is primarily based on life expectancy. However, since mere survival is not considered good enough, life years are counted conditional on meeting minimum standards in two dimensions: the objective dimension of capable longevity (consisting of being out of absolute poverty and enjoying minimal levels of physical and cognitive health) and the subjective dimension of overall life satisfaction. We illustrate the calculation of this indicator for countries and subpopulations at different stages of development and with different degrees of data availability.

Broad, subjective, relative: the surprising folk concept of basic needs.

Some normative theorists appeal to the concept of basic needs. They argue that when it comes to issues such as global justice, intergenerational justice, human rights or sustainable development our first priority should be that everybody is able to meet these needs. But what are basic needs? We attempt to inform discussions about this question by gathering evidence of ordinary English speakers' intuitions on the concept of basic needs. First, we defend our empirical approach to analyzing this concept and identify a number of its potential features. Then we present three preregistered empirical studies that were conducted to investigate the extent to which ordinary speakers endorse these features. The studies yield convergent evidence for the following three claims: (1) ordinary speakers sometimes apply the concept of basic needs to necessities for a flourishing (not just a minimally decent) life, (2) most ordinary speakers attribute at least some degree of subjectivity to the concept, and (3) most ordinary speakers attribute at least some degree of relativity to the concept. We discuss the implications of these findings for philosophical analyses of basic needs.

Bidirectional processes linking social determinants of health and pediatric sickle cell anemia management: A qualitative study.

BACKGROUND: Children with sickle cell anemia (SCA) have substantial medical needs and more unmet basic needs than children with other medical conditions. Despite a recent focus on social determinants of health (SDoH), there remains an incomplete understanding of the processes linking SDoH and disease management, particularly for youth with SCA. This study elucidated these processes and identified ways to mitigate deleterious effects of adverse SDoH on SCA management. METHODS: Parents/primary caregivers (N = 27) of children with SCA (≤12 years old) participated in semi-structured interviews regarding SCA management and SDoH and completed quantitative measures of basic needs. Qualitative data were systematically coded and analyzed using applied thematic analysis. Quantitative data were presented descriptively. RESULTS: Three qualitative themes were identified. First, SCA management is bidirectionally linked with the social environment, whereby challenges of SCA management can hinder basic needs from being met, and unmet basic needs and financial hardship hinder SCA management. Second, due to limited resources, parents/caregivers are faced with difficult choices between prioritizing basic needs versus SCA management. Third, addressing material, emotional, and informational needs may improve SCA management. Quantitatively, 73% of families endorsed ≥1 basic need, including food insecurity (42%), housing instability (62%), and/or energy insecurity 19% (vs. 20%). CONCLUSION: Despite documented associations, there remains a poor understanding of the processes linking SDoH and health. Findings underscore how day-to-day conditions undermine the management of SCA treatments, symptoms, and complications, limiting treatment effectiveness. Understanding these processes may inform family-centered, health equity interventions and policies to improve living conditions, disease management, and health outcomes.

A systematic review of measures of ability to meet basic needs in older persons.

BACKGROUND: The ability of older persons to meet their basic needs (i.e. personal, financial and housing security), as well as to perform Activities of Daily Living (ADL), is crucial. It is unclear, however, whether such measures exist. This systematic review aimed to review English-language measures of the ability of older persons to meet their basic needs, and to critically review the comprehensiveness of these measures and their psychometric properties. METHODS: Fifteen electronic databases including PubMed, EBSCOhost and CINAHL were systematically searched for studies of measures that assessed the ability of older persons to meet their basic needs, as defined by the World Health Organization. Two review authors independently assessed the studies for inclusion in the review and evaluated their comprehensiveness and psychometrics. RESULTS: We found seven instruments from 62 studies that assessed multi-domain function including ADL and some elements of basic needs. The instruments varied in breadth and in reporting of key psychometric criteria. Further, no single instrument provided a comprehensive assessment of the ability of older persons to meet their basic needs. CONCLUSION: No single instrument that measures the ability to meet basic needs was identified by this review. Further research is needed to develop an instrument that assesses the ability of older persons to meet their basic needs. This measure should include an evaluation of ADL.

Targeting Cash Transfers on the "Poorest of the Poor" in the Slums: How Well Did the Kenya's Older Persons Cash Transfer Programme Perform?

In resource poor environments, identifying those most in need of limited available resources is challenging. Kenya's older persons cash transfer programme (OPCT) targeted at the most poor used a 2-stage targeting process to identify beneficiaries, combining community-based selection with a proxy means-test. This paper investigates whether the process "correctly" identified targeted vulnerable older people in Nairobi's informal settlements and whether receipt of the OPCT resulted in an improvement in perceived financial wellbeing. Regression results show that individuals with greater need were covered under the OPCT. Using propensity score matching, the paper evidences that the OPCT improved subjective financial wellbeing among beneficiaries.

Impact of Basic Needs Fulfillment on the Health, Well-being, and Academic Engagement of Occupational Therapy Students.

The basic needs of students may serve as unknown factors in academic engagement and well-being. Challenges in meeting these needs disproportionately impact underrepresented minority and first-generation students. The purpose of this pilot study was to explore the perceived presence and impact of basic needs on health, well-being, and academic engagement in occupational therapy students. A 43-item survey was distributed to 231 students and focused on questions addressing basic needs in physiology, safety, and belonging. Respondents reported worry over or the need to work to pay bills, no support from family/friends, and limited access to food in the past 30 days and related this to feeling stressed, not being able to do homework, not participating in class, and loss of leisure time. Ninety-four percent used student health services frequently. Recommendations to address gaps in basic needs include flexible policies, inclusive learning environments, supportive and intentional actions, and providing resources.

Approach to the basic needs in patients on invasive ventilation using eye-tracking devices for non-verbal communication.

PURPOSE: To analyze the feasibility of eye-tracking (ET) devices as a communicative approach to the basic needs (BN) of intensive care unit (ICU) and invasively ventilated nonverbal patients. METHODS: Prospective, monocentric, and observational study including all patients without delirium, with an endotracheal tube or tracheostomy tube, with a history of invasive ventilation for more than 48 h, and inadequate nonverbal communication skills. The investigation was performed with commercially available ET devices (Tobii Dynavox I-15+) to express BN of ICU patients following a standardized 30-item yes-or-no questionnaire. RESULTS: A total of 64 patients with a mean age of 58.6 years were included. The main diagnoses for ICU admission were major trauma (43.6%), sepsis (21.8%), and acute abdomen (15.6%). Pain during repositioning (69%), thirst (69%), sleep disorders (66%), fatigue (64%), and anxiety regarding the lifelong need for assistance (64%) were the main problems reported by the patients. However, most of the patients described expectations of health improvement (78%), good family support (66%), and an improvement in quality of life due to the use of ET devices (67%). CONCLUSION: The use of ET in selected ICU patients with impaired communication is feasible, allowing them to express their BN. Apart from knowing the patients' individual BN, the results of our BN questionnaire may provide guidance for improvement measures in the care of patients in the ICU who are unable to speak. We believe that ET is useful for inquiring about and expressing BN and, therefore, may be capable of improving patient-medical team interactions and patient satisfaction.

A cross sectional assessment of basic needs insecurity prevalence and associated factors among college students enrolled at a large, public university in the Southeastern U.S.

BACKGROUND: There is increasing evidence of problematic rates of food insecurity among college students, yet few studies have gone beyond this to examine housing insecurity rates or rates of basic need insecurity (BNI), which is defined as having both food and housing insecurity, among the postsecondary population. BNI may have significant impacts on the mental and social health, and academic outcomes of college students, yet remains understudied. The researchers of this study are among the first to assess the prevalence of food insecurity, housing insecurity, and basic needs insecurity among college students enrolled at a large, public university in the Southeast and to identify factors associated with experiencing food, housing, and basic needs insecurity. METHODS: A cross-sectional online survey was conducted at a large, public university in the Southeast United States. All eligible, enrolled students (n = 23,444) were asked to complete an online survey, 2634 responded (11.2% response rate). Multivariate logistic regression models were used to assess relationships between demographic and financial factors and the outcomes of interest (food, housing, and basic needs insecurity). RESULTS: High rates of food insecurity (48.5%), housing insecurity (66.1%), and basic needs insecurity (37.1%) were identified. After controlling for confounders, factors that were significantly associated with increased odds of students having basic needs insecurity included previous food insecurity (p < 0.001; Odds Ratio (OR) = 3.36; Confidence Interval (CI) = 2.64-4.28), being employed (p < 0.001, OR = 1.70; CI = 1.34-2.17), not receiving family financial support (p < 0.001, OR = 1.61; CI = 1.30-2.00), and living off-campus (p < 0.001, OR = 1.67; CI = 1.25-2.22). Juniors (p < 0.001, OR = 1.78; CI = 1.31-2.42), seniors (p < 0.001, OR = 2.06; CI = 1.52-2.78), Masters (p = 0.004, OR = 1.68; CI = 1.18-2.40), and PhD or EdD (p = 0.029, OR = 1.55; CI = 1.05-2.31) students were significantly more likely to experience basic needs insecurity than sophomore students. CONCLUSIONS: This research identifies high rates of food, housing, and basic needs insecurity among college students enrolled at a large, public university. Financial factors such as being food insecure prior to attending college, working during college, and not having familial financial support were all related to BNI in this sample. Students who were more advanced in their education experienced more BNI than less advanced students. Innovative interventions with enhanced BNI measures, for example, partnering with financial aid offices to screen and refer students to food resources, are likely needed to address this multi-faceted problem.

Basic needs satisfaction in a military learning environment: An exploratory study.

Military academies request initiatives for better pedagogy to keep their cadets motivated and successful. Following the self-determination theory, one could promote autonomous motivation by fulfilling the three basic psychological needs of students: the need for autonomy, relatedness and competence. In this qualitative research, we investigated which motivational critical events go together with a perception of high or low autonomy, relatedness and competence. To this end, we organized four focus groups with participants from the two faculties of the Royal Military Academy of Belgium (RMA): Social and Military Sciences (SMS) and Engineering (ENG). Using the critical incident method, we searched for the facilitating and inhibiting events with regard to motivation within the learning environment. Thereafter, we used the constant comparison method as an analysis technique to link the critical events to one of the three basic needs. We found that a perception of high relatedness was the most effective in motivating SMS cadets, while the perception of high competence was the most effective in motivating ENG cadets. For both the SMS and ENG cadets, a lack of autonomy was demotivating. This study provides a model that suggests in which way context characteristics within a (military) learning environment meets students' basic psychological needs and how it is facilitating or inhibiting motivation in turn.

The typicality effect in basic needs.

According to the so-called Classical Theory, concepts are mentally represented by individually necessary and jointly sufficient application conditions. One of the principal empirical objections against this view stems from evidence that people judge some instances of a concept to be more typical than others. In this paper we present and discuss four empirical studies that investigate the extent to which this 'typicality effect' holds for the concept of basic needs. Through multiple operationalizations of typicality, our studies yielded evidence for a strong effect of this kind: (1) Participants tended to recall the same core examples of the concept in a free-listing task. (2) They judged some basic needs to be more typical than others. (3) The items that were judged to be more typical were listed more frequently in the free-listing task. (4) These items were listed earlier on in the free-listing task. (5) Typical basic needs, as well as non needs, were classified faster than atypical basic needs in a reaction time study. These findings suggest that the concept of basic needs may have a non-classical (e.g., exemplar or prototype) structure. If so, the quest for a simple and robust intensional analysis of the concept may be futile. Supplementary Information: The online version contains supplementary material available at 10.1007/s11229-022-03859-9.

Cervical cancer risk and screening among women seeking assistance with basic needs.

BACKGROUND: In the United States, more than half of cervical cancers occur in women who are inadequately screened. Interventions to improve access to cervical cancer preventive care is critical to reduce health inequities. OBJECTIVE: This study aimed to evaluate the need for cervical cancer screening among women seeking assistance with basic needs and to assess best approaches to facilitate Papanicolaou test referral. STUDY DESIGN: This study is a secondary analysis of a randomized controlled trial of low-income female callers to 2-1-1 Missouri, a helpline for local health and social services. The need for cervical cancer screening was assessed. Callers were randomized to 1 of 3 arms, each providing a Papanicolaou test referral: verbal referral only, verbal referral and tailored print reminder, or verbal referral and navigator. The primary outcome was contacting a Papanicolaou test referral 1 month following intervention. Student t tests or Mann-Whitney U tests were used to analyze significant differences in continuous variables, whereas Fisher exact or χ2 tests were used for categorical variables. We stratified by number of unmet basic needs (0-1 vs ≥2) and compared success of contacting a Papanicolaou test referral among study groups (verbal referral vs tailored reminder vs navigator) using the Fisher exact test and χ2 test, respectively. Multivariate logistic regression was used to assess risk factors for nonadherence for Papanicolaou test at baseline and at 1 month follow-up, adjusting for race and ethnicity, age, insurance status, self-rated health, smoking, and study group. RESULTS: Among 932 female callers, 250 (26.8%) needed cervical cancer screening. The frequency of unmet basic needs was high, the most common being lack of money for unexpected expenses (91.2%) and necessities, such as food, shelter, and clothing (73.2%). Among those needing a Papanicolaou test, 211 women received screening referrals. Women in the navigator group (21 of 71, 29.6%) reported higher rates of contacting a Papanicolaou test referral than those exposed to verbal referral only (11/73, 15.1%) or verbal referral and tailored print reminder (9/67, 13.4%) (P=.03). Among 176 women with ≥2 unmet needs who received a Papanicolaou test referral, the provision of a navigator remained associated with contacting the referral (navigator [33.9%] vs verbal referral [17.2%] vs tailored reminder [10.2%]; P=.005). Assignment to the navigator group (adjusted odds ratio, 3.4; 95% confidence interval, 1.4-8.5) and nonwhite race (adjusted odds ratio, 2.0; 95% confidence interval, 1.5-2.8) were independent predictors of contacting a Papanicolaou test referral. CONCLUSION: Low-income women seeking assistance with basic needs often lack cervical cancer screening. Health navigators triple the likelihood that women will make contact with Papanicolaou test services, but most 2-1-1 callers still fail to schedule Papanicolaou testing despite assistance from navigators. Interventions beyond health navigators are needed to reduce cervical cancer disparities.

Trainer-exerciser relationship: The congruency effect on exerciser psychological needs using response surface analysis.

Perceptions of fitness trainers' need-supportive and need-thwarting behaviors have been shown to impact exercisers' psychological need satisfaction and frustration. Currently, it is unknown whether an agreement or disagreement between exercisers' and fitness trainers' reported perceptions of these behaviors leads to the satisfaction and/or frustration of psychological needs. Based on self-determination theory, the present study examined the effect of congruency between fitness trainers' and exercisers' perceptions of need-supportive and need-thwarting interpersonal behaviors on basic psychological need satisfaction and frustration. A sample of 130 fitness trainers (43 females; Mage  = 31.58 ± 7.65) and a total of 640 gym exercisers (350 females; Mage  = 34.23 ± 11.59) participated in this study. Findings suggested that the majority of fitness trainers tended to over-report their use of need-supportive behavior and under-report their need-thwarting behaviors. Results showed that when there was congruency between fitness trainers' reported use and exercisers' perception of interpersonal behaviors, basic need satisfaction tended to increase. This effect was greater for exercisers that rated their respective fitness trainer high on relatedness support. Fitness trainers should be self-aware of their interpersonal behaviors when engaging with exercisers and interventions based on self-determination theory could serve as a promising avenue to improve the quality of exercisers' experience.

Addressing unmet basic needs for children with sickle cell disease in the United States: clinic and staff perspectives.

BACKGROUND: The purpose of this study was to assess pediatric hematology clinic staff's perspectives regarding barriers and facilitators in addressing unmet basic needs for children with sickle cell disease (SCD). METHODOLOGY: Six focus groups were held at four urban pediatric hematology clinics in the Northeastern region of the United States from November to December 2019. Discussion questions were developed to align with the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) implementation science framework, focusing on the domains of context and recipient and how clinics address adverse social determinants of health (SDoH) in their patient populations. A summative content analytical approach was taken to identify major themes in the data. RESULTS: We discerned the following themes: (1) families of children with SCD experience numerous unmet basic needs; (2) clinic staff believed they had a role to play in addressing these unmet basic needs; (3) staff felt their ability to address families' unmet basic needs depended upon caregivers' capacity to act on staff's recommendations; and (4) clinic staff's ability to address these needs was limited by organizational and systemic factors beyond their control. CONCLUSIONS: These findings have important implications for how best to address adverse SDoH for this vulnerable pediatric population so that urban-based pediatric hematology clinics can more equitably support families.

Needs satisfaction and motivation among adolescent boys and girls during self-directed learning intervention.

INTRODUCTION: Self-directed learning (SDL) fosters adolescents' needs satisfaction. According to self-determination theory, meeting adolescents' needs for autonomy, competence and relatedness is essential for their motivation. However, students' needs satisfaction and motivation tend to decrease during adolescence and the rate of decrease varies by gender. Prior research within the self-determination theory literature has described adolescents in traditional teacher-directed learning (TDL) contexts, but little research has examined decreases in adolescents' needs satisfaction and motivation or gender-based differences among adolescents in SDL interventions. METHODS: The present two-wave study compared questionnaire data from German adolescent boys and girls (N = 754; Mage = 13.56; SD = 1.2; 49.4% girls) who attended an SDL intervention. To investigate possible gender-based differences in the interplay and extend of the variables, two multi-group structural equation model (multigroup SEM) and latent mean comparison (LMC) were programmed. RESULTS & CONCLUSIONS: Boys reported higher values only for introjected and extrinsic regulation. With two different restricted multigroup SEMs, the present study detected additional gender-based differences. For example, the paths between autonomy and intrinsic and identified motivation were stronger for boys than for girls, and competence was only associated with intrinsic motivation among girls. Overall, these findings suggest that fewer gender-based differences exist in needs satisfaction and academic self-regulation in an SDL intervention than have been observed in previous research in TDL contexts. Further, adolescents' needs satisfaction was explicitly associated with higher forms of academic motivation (i.e., intrinsic and identified).

Self-worth and bonding emotions are related to well-being in health-care providers: a cross-sectional study.

BACKGROUND: Interacting with patients can elicit a myriad of emotions in health-care providers. This may result in satisfaction or put providers at risk for stress-related conditions such as burnout. The present study attempted to identify emotions that promote provider well-being. Following eudaimonic models of well-being, we tested whether certain types of emotions that reflect fulfilment of basic needs (self-worth, bonding with patients) rather than positive emotions in general (as suggested by hedonic models) are linked to well-being. Specifically, we hypothesized that well-being is associated with positive emotions directed at the self, which reflect self-worth, and positive as well as negative emotions (e.g., worry) directed at the patient, which reflect bonding. However, we expected positive emotions directed at an object/situation (e.g., curiosity for a treatment) to be unrelated to well-being, because they do not reflect fulfilment of basic needs. METHODS: Fifty eight physicians, nurses, and psychotherapists participated in the study. First, in qualitative interviews, they reported their emotions directed at the self, the patient, or an object/situation during distressing interactions with patients. These emotions were categorised into positive emotions directed towards the self, the patient, and an object/situation, and negative emotions directed towards the patient that reflect bonding. Second, providers completed questionnaires to assess their hedonic and eudaimonic well-being. The well-being scores of providers who did and did not experience these emotions were compared. RESULTS: Providers who experienced positive emotions directed towards the self or the patient had higher well-being than those who did not. Moreover, for the first time, we found evidence for higher well-being in providers reporting negative patient-directed emotions during distressing interactions. There was no difference between providers who did and did not experience positive object/situation-directed emotions. CONCLUSIONS: These findings may point towards the importance of "eudaimonic" emotions rather than just positive emotions in interactions with patients. Emotions such as contentment with oneself, joy for the patient's improvement, and, notably, grief or worry for the patient may build a sense of self-worth and strengthen bonding with the patient. This may explain their association with provider well-being.

What should adult children do for their parents?

Adult children's particular obligations to their parents are filial obligations. The gratitude of filial obligations that treats one's filial obligations as duties of gratitude to one's parents is a mainstream view. However, in terms of the requirements of such obligations, the gratitude account fails to provide practical guidance. The general requirement seems that children should benefit their parents as the beneficiary should benefit the benefactor. The question is what kinds of benefits adult children should provide to their parents? In some cases, adult children feel obligated to provide particular benefits to their parents like paying their medical bills or spending time with them. While in some other cases, it seems that they can use their own discretion to decide how to satisfy the filial obligations so long as what they do benefits their parents. In this article, I am trying to argue that although the general requirement of the filial obligations is to benefit the parents, there are two kinds of benefits that adult children are strongly obligated to provide. These are special goods that parents can only get from their children and things that meet their parents' basic needs. In addition, although adult children have filial obligations to benefit their parents, there should be some limitations on the requirements of filial obligation. Namely, adult children do not have a filial obligation to meet their parents' desires that could only be satisfied at the cost of adult children's liberty related to significant aspects of their lives, or to meet their parents' desires that could only be satisfied at the cost of infringing their capacity to fulfil other important duties.

School Social Worker Voice during COVID-19 School Disruptions: A National Qualitative Analysis.

The novel coronavirus (COVID-19) pandemic has created unprecedented impacts on our schools and society, requiring school social workers (SSWs) to attend to layered and cascading effects for students and their families. This study presents rich qualitative data from a national survey of SSWs about their personal and professional roles supporting students, families, and staff members as schools shifted to remote instruction. Findings indicate that SSWs are highly concerned about a lack of basic needs resources, including food, housing, and mental health support for students and families. SSWs highlighted the unequal effects of school closures for families without technology and Internet access as well as the difficulties providing services during the pandemic. Recovery policies should target resources to schools with the highest needs while prioritizing food, housing, mental health, and access to tools for online learning. SSWs also need additional and refined professional support to overcome their isolated roles in schools and bolster their ability to deliver online services effectively.

Intensive psychotherapy and case management for Karen refugees with major depression in primary care: a pragmatic randomized control trial.

BACKGROUND: Despite an unparalleled global refugee crisis, there are almost no studies in primary care addressing real-world conditions and longer courses of treatment that are typical when resettled refugees present to their physician with critical psychosocial needs and complex symptoms. We studied the effects of a year of psychotherapy and case management in a primary care setting on common symptoms and functioning for Karen refugees (a newly arrived population in St Paul, Minnesota) with depression. METHODS: A pragmatic parallel-group randomized control trial was conducted at two primary care clinics with large resettled Karen refugee patient populations, with simple random allocation to 1 year of either: (1) intensive psychotherapy and case management (IPCM), or (2) care-as-usual (CAU). Eligibility criteria included Major Depression diagnosis determined by structured diagnostic clinical interview, Karen refugee, ages 18-65. IPCM (n = 112) received a year of psychotherapy and case management coordinated onsite between the case manager, psychotherapist, and primary care providers; CAU (n = 102) received care-as-usual from their primary care clinic, including behavioral health referrals and/or brief onsite interventions. Blinded assessors collected outcomes of mean changes in depression and anxiety symptoms (measured by Hopkins Symptom Checklist-25), PTSD symptoms (Posttraumatic Diagnostic Scale), pain (internally developed 5-item Pain Scale), and social functioning (internally developed 37-item instrument standardized on refugees) at baseline, 3, 6 and 12 months. After propensity score matching, data were analyzed with the intention-to-treat principle using repeated measures ANOVA with partial eta-squared estimates of effect size. RESULTS: Of 214 participants, 193 completed a baseline and follow up assessment (90.2%). IPCM patients showed significant improvements in depression, PTSD, anxiety, and pain symptoms and in social functioning at all time points, with magnitude of improvement increasing over time. CAU patients did not show significant improvements. The largest mean differences observed between groups were in depression (difference, 5.5, 95% CI, 3.9 to 7.1, P < .001) and basic needs/safety (difference, 5.4, 95% CI, 3.8 to 7.0, P < .001). CONCLUSIONS: Adult Karen refugees with depression benefited from intensive psychotherapy and case management coordinated and delivered under usual conditions in primary care. Intervention effects strengthened at each interval, suggesting robust recovery is possible. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT03788408. Registered 20 Dec 2018. Retrospectively registered.