Quality of Life Enhancement Research Program: Lessons Learned.

The attempted Quality of Life Enhancement program appeared to be a novel method for creating a symbiotic and sustainable relationship between a large Southeastern university and local nursing home and assisted living facilities (ALF), through which ALF residents would attend university arts and sporting events. During implementation, it was discovered that this project was unsustainable, undesired, unneeded by many care centers, difficult to implement, and required a dedicated and specialized staff. After attempting to enroll 14 local care facilities, only 2 were interested in becoming involved and produced 5 eligible participants. During the program itself, coordination with facilities and residents was difficult to maintain and unique transportation and accommodation needs were challenging to overcome. Finally, data collection was time consuming and generally unfruitful. Ultimately the project was discontinued after a year of attempted recruitment and implementation of inclusive changes to protocol. While creating an ongoing relationship with local care facilities and local universities may enhance opportunities for residents and research into important areas, such relationships take time, effort, and specialized staff to maintain.

The in's and out's of science outreach: assessment of an engaging new program.

Many professors are interested in providing science outreach to local K-12 students, but may not have the time or resources needed to create an engaging presentation. The American Physiological Society supports outreach initiatives through programs such as the Physiology Understanding (PhUn) Week. Building on these activities, it was desired to create and assess an immersive and engaging Outreach Program in a disadvantaged K-12 student population. Three distinct modules were created on cardiovascular physiology, respiratory physiology, and oral health. All resources for these modules underwent peer review and publication, allowing other professors to easily execute their own outreach programming. The outreach modules were presented to 288 students in 3rd, 5th, 6th, and 7th grade classes. Implementation of the modules resulted in significant increases in student content knowledge, ranging from 32 to 57% improvement ( P < 0.001, dependent t-test), with an average increase of 46%. K-12 science teachers reported that the program was at an appropriate educational level, increased students' enthusiasm for science, and increased students' exposure to science careers. Additionally, the presenters of the Outreach Program were perceived to be enthusiastic, knowledgeable, and proficient at interacting with the students. On open-response survey items, the science teachers indicated a high level of satisfaction with the program and an enthusiasm for continued collaborations. These results indicate the importance of organized and interactive science activities for the success of a new Outreach Program.

Evaluation of a community immunization outreach program--Philadelphia, Pennsylvania.

CONTEXT: Every year the Philadelphia Department of Public Health selects roughly 5000 10-month olds not up-to-date (UTD) for their 6-month vaccinations for a community-based outreach program. OBJECTIVE: To evaluate the outreach program's effectiveness from 2008 to 2012. DESIGN: Outreach children from 2008 to 2012 were compared with children not selected for outreach on UTD rates and median UTD age in a retrospective cohort study. SETTING: Philadelphia, Pennsylvania PARTICIPANTS: : 10- to 15-month olds from targeted Philadelphia ZIP codes. INTERVENTION: Outreach workers investigated immunization status, educated families on the importance of timely immunizations, and assisted patients in securing health care services to bring children UTD on their 6-month vaccinations. MAIN OUTCOME MEASURES: Outcomes included UTD status for recommended vaccinations due by 6, 15, and 18 months and median age at which 15- and 18-month vaccinations were completed for outreach versus nonoutreach children. RESULTS: Outreach children had significantly higher UTD rates for 6-month vaccinations than nonoutreach children. Outreach children also had significantly higher UTD rates for 15- and 18-month vaccinations, and therefore the effect of outreach is lasting. From 2008 to 2012, median UTD ages for 15- and 18-month vaccinations were significantly lower for outreach than for nonoutreach children. CONCLUSIONS: Outreach was effective in increasing immunization UTD rates and is a useful tool for improving childhood immunization rates in urban settings.

Group model building: a framework for organizing healthy community program and policy initiatives in Columbia, Missouri.

BACKGROUND: Between 2008 and 2012, the multidisciplinary Healthy Community Partnership of Columbia, Missouri, participated in a national program to address child obesity. This article describes a systems-level evaluation of their work to implement healthy eating and active living policy, system, and environmental changes to support healthier communities for children. METHODS: In 2011, the partnership participated in a Group Model Building session, consisting of 2 primary activities. First, participants sketched behavior-over-time graphs, illustrating the evolution of community variables related to child obesity, such as prevalence of walking to school or the marketing of high-sugar drinks. Later, the graphs were arranged on a large area of wall space and connections were drawn between those variables that were believed to influence each other--either positively (reinforcing connections) or negatively (opposing connections). The resulting causal loop diagram is a visual representation of the interacting systems, as perceived by the partnership. RESULTS: In reviewing the diagram, the group identified areas where they felt the diagram "made sense" and other areas where there were inconsistencies between the diagram and their own mental model of the processes at work. To address the inconsistencies, participants were surveyed to determine which specific modifications should be made to the diagram so it would become an accurate representation of the group's shared concept of the relevant relationships. DISCUSSION: The group felt that the final Modified causal loop diagram achieved this goal and that it provides useful insight into how their work addresses child obesity. They believe the diagram also has the potential to improve community engagement by serving as a visual model, improve planning through better resource allocation, improve implementation by identifying policy leverage points, and increase resources when used in grant applications.

Establishing a community of practice for Occupational Therapy curriculum development: the value of a two-way process.

INTRODUCTION: A novel application of the concept of a community of practice was adopted in the development of a revised curriculum for undergraduate occupational therapy education in July 2012. University Academic staff and invited practice scholars met together, half yearly for day long meetings to develop and review a new curriculum. The formation of this community of practice allowed for open discourse and feedback to integrate theory and practice. METHOD: A qualitative study utilised two focus groups, one for academic staff and one for practice scholars, at the end of the third meeting. The focus groups were facilitated by an external researcher, recorded and transcribed verbatim. Thematic analysis elicited five major themes. FINDINGS: Participants reported a sense of community and commitment to the curriculum process. Five themes emerged from the focus groups: (i) a sense of community; (ii) a two-way process with mutual benefits; (iii) benefits to the curriculum and to student learning; (iv) future opportunities including resilience of graduates, and potential research collaborations; and (v) the structure and process of engaging in the community of practice. CONCLUSION: The commitment of time, planning and resources required to establish and participate in collaborative curriculum development with practice scholars is shown to be a valuable investment for occupational therapy academics, expert practice scholars and ultimately for student learning. Further studies of student and graduate outcomes from the curriculum are warranted. Potential future outcomes of this process include resilience in graduates and collaborative research with practice scholars.

All things to all people? The provision of outreach by community mental health teams for older people in England: findings from a national survey.

OBJECTIVE: The objective of this study is to identify the extent of outreach activity community mental health teams (CMHTs) for older people provide to mainstream services in light of the recommendations of the National Dementia Strategy. In particular, to determine the range of settings in receipt of support; to specify the form of this activity; to identify the professionals involved; and to explore the factors associated with the provision of such support. METHODS: A self-administered postal questionnaire was sent to all CMHTs in England. The reported arrangements were categorised and reviewed according to a taxonomy of outreach developed from the literature. RESULTS: Three hundred and seventy six (88%) of the CMHTs responded. Although nearly all teams undertook some outreach work, much of this was informal in nature. Nevertheless, the vast majority of teams had some formal outreach arrangements in at least one mainstream setting. Just less than three-quarters provided support (most typically education) to care homes, approaching half centres to day centres, and over a third to primary care practices, social services teams, home care providers and general hospitals, respectively. Link workers were the favoured means of supporting general hospital staff. Community mental health nurses were most commonly involved in providing outreach, and larger teams were more likely than smaller teams to have formalised arrangements. A significant minority of teams expressed concerns about their capacity to provide effective services. CONCLUSIONS: The findings suggest that both more resources and more evidence will be needed to meet the National Dementia Strategy's aim of improving care for older people with mental health problems in mainstream settings.

Measuring the processes of change for increasing blood donation in black adults.

BACKGROUND: Blacks have significantly lower blood donation rates than whites. Many views, experiences, and behaviors associated with blood donation are unique to black culture. Evidence suggests that culturally tailored health promotion programs help with increasing black blood donation. To be effective, tailored interventions should be based on valid and reliable measures. The Transtheoretical Model's (TTM) Processes of Change (POC) construct provides an assessment of participants' covert and overt activities and experiences in blood donation. This study describes development and validation of POC for increasing blood donation tailored to blacks. STUDY DESIGN AND METHODS: Cross-sectional measure development with online survey dissemination was used in 566 blacks in the Northeastern United States. Factor analytic structural modeling procedures were used to examine validity of the POC measure. Blood donation POC were examined in participants representing a range of blood donation history and intentions (nondonors, sometimes donors, regular donors) based on an established algorithm. RESULTS: Confirmatory analyses replicated the theoretically expected structure of POC scales which is a 10-factor, fully correlated best-fit model. Expected POC patterns by Stages of Change based on theoretical and empirical predictions were confirmed. The range of effect sizes for 10 POC were η(2) = 0.04 to 0.25, indicating that TTM POC are strong strategies in blood donation decision making for blacks and can be applied to interventions to increase blood donation for a minority population. CONCLUSION: POC measure was internally and externally valid in a sample of blacks. Interventions can utilize the POC measure to guide stage-matched interventions to encourage use of relevant experiential and behavioral strategies to increase blood donation.

Community-oriented medical education: bringing perspectives to curriculum planners in Damascus University.

The varying health needs in Syria because of the trend of increasing communicable and noncommunicable diseases necessitate new curricula for all health professions schools in which community health needs, socio-cultural aspects of health and disease can be emphasized. There is a need to produce more primary level healthcare professionals who are trained to apply the principles, policies and strategies of the World Health Organization and achieve better health for all. A new perspective in the Faculty of Dentistry in Damascus University has been suggested and is presented here. Graduates generally are not well prepared to provide primary level healthcare in the community. Community-oriented medical education (COME) can produce health-oriented professionals who are equipped with broad skills and able to work for health promotion, disease prevention, and cure. Health orientation is one of the most radical features of COME, wherein the curriculum is appropriate to learners' future practice in the community. Community orientation enables students to become more people focused so that they can work towards people's self-empowerment, change people's attitudes and behaviors, and improve their self-awareness and esteem. This viewpoint addresses the importance of redesigning the dental curriculum and the need to implement COME in Damascus University. It is proposed as an example of changes needed in all health professions schools in Syria. The call to redesign the curricula to serve the health needs of the Syrian population will be difficult to achieve but is vital. Improving our understanding of the concept of COME and having all sectors of government and society commit to it will make the transition possible and will make the COME a reality.

Patient Protection and Affordable Care Act; Exchange functions: standards for Navigators and non-Navigator assistance personnel; consumer assistance tools and programs of an Exchange and certified application counselors. Final rule.

This final rule addresses various requirements applicable to Navigators and non-Navigator assistance personnel in Federally-facilitated Exchanges, including State Partnership Exchanges, and to non-Navigator assistance personnel in State Exchanges that are funded through federal Exchange Establishment grants. It finalizes the requirement that Exchanges must have a certified application counselor program. It creates conflict-of-interest, training and certification, and meaningful access standards; clarifies that any licensing, certification, or other standards prescribed by a state or Exchange must not prevent application of the provisions of title I of the Affordable Care Act; adds entities with relationships to issuers of stop loss insurance to the list of entities that are ineligible to become Navigators; and clarifies that the same ineligibility criteria that apply to Navigators apply to certain non-Navigator assistance personnel. The final rule also directs that each Exchange designate organizations which will then certify their staff members and volunteers to be application counselors that assist consumers and facilitate enrollment in qualified health plans and insurance affordability programs, and provides standards for that designation.

The illusions and juxtapositions of commercial sexual exploitation among youth: identifying effective street-outreach strategies.

To explore sexually exploited youths' perspectives of how street outreach workers can effectively provide outreach and connections to services, we conducted qualitative interviews with 13 female participants, ages 14 to 22, in a Midwest U.S. city. Participants reported multiple types of exploitation, most first exploited by age 13, plus substance use and recurrent homelessness. Nearly all had a pimp, and all used the internet as a venue for sexual exploitation. Participants wanted outreach workers to use "soft words" to refer to exploitation. They expressed contradictory images of their "boyfriend" pimps and their exploitation. They wanted outreach workers to "provide resources," "be nonjudgmental," "listen," and "care." Street outreach can be one way to support sexually exploited youth but should occur in multiple settings.

Integrating tobacco cessation quitlines into health care: Massachusetts, 2002-2011.

QuitWorks is a Massachusetts referral program that links health care organizations, providers, and patients to the state's tobacco cessation quitline and provides feedback reporting. Designed collaboratively with all major Massachusetts health plans, QuitWorks was launched in April 2002. In 2010, approximately 340 institutions and practices used QuitWorks. Between April 2002 and March 2011, approximately 3,000 unique providers referred patients and 32,967 tobacco users received referrals. An analysis of QuitWorks data showed 3 phases in referrals between April 2002 and March 2011: referrals increased from April 2002 through November 2005, plateaued during December 2005 through January 2009, then substantially increased during February 2009 through March 2011. Factors responsible include partnerships with stakeholders, periodic program promotions, hospital activities in response to Joint Commission tobacco use measures, service evolutions, provision of nicotine replacement therapy for referred patients, and electronic referral options. QuitWorks' history demonstrates that tobacco cessation referral programs can be successfully sustained over time; reach substantial numbers of tobacco users, benefit providers and health care organizations; and contribute to sustainable systems-level changes in health care.

Distinguishing community benefits: tax exemption versus organizational legitimacy.

US policymakers continue to call into question the tax-exempt status of hospitals. As nonprofit tax-exempt entities, hospitals are required by the Internal Revenue Service (IRS) to report the type and cost of community benefits they provide. Institutional theory indicates that organizations derive organizational legitimacy from conforming to the expectations of their environment. Expectations from the state and federal regulators (the IRS, state and local taxing authorities in particular) and the community require hospitals to provide community benefits to achieve legitimacy. This article examines community benefit through an institutional theory framework, which includes regulative (laws and regulation), normative (certification and accreditation), and cultural-cognitive (relationship with the community including the provision of community benefits) pillars. Considering a review of the results of a 2006 IRS study of tax-exempt hospitals, the authors propose a model of hospital community benefit behaviors that distinguishes community benefits between cost-quantifiable activities appropriate for justifying tax exemption and unquantifiable activities that only contribute to hospitals' legitimacy.

[What kinds of skills are needed to develop the outreach services in the context of community-based mental health?].

Outreach services in the context of a policy, "from hospital based to community based", are intended to know more about community living situation of patients, and provide supports so that they can bring their life back as citizens. Therefore, these outreach services are completely different from traditional monitoring based outreach services. These supports require skills which are different from those in psychiatric hospitals. Those differences would be visible in terms of skills because staff will be exposed to "life" of patients. Furthermore, those differences in skills would come up from necessity of facing negative feeling of people who receive outreach services often have toward medical care and support. Based on this standpoint, the author proposed tentative plan which divided necessary skills for outreach into five phases from the viewpoint of the training as follows: Level 1: Shifting perspectives from illness management to community living based, Level 2: Knowing their living situations and strengths. Building trusting relationship as staying present to the person. Level 3: Staying on top of skills in strength model, case management, and psychoeducation. Level 4: Being able to work in a team setting smoothly. Level 5: Even if the paternalism is necessary in the particular situation, staff needs to be able to face that situation without escaping. In addition, the author called the attitude of psychiatric facilities toward community psychiatry as "regionalization" and divided "regionalization" into six stages while showing necessary skills for each stage.

Regular provision of outreach increases acceptance of cataract surgery in South India.

OBJECTIVES: The prevalence of visual loss and blindness from cataract remains high in India. Marginalized communities are frequently reached through outreach clinics. The aim of this study was to explore the hypothesis that regular outreach, held in the same location by the same provider, leads to greater acceptance of cataract surgery than outreach clinics that are irregular in terms of timing and location. METHODS: The study was integrated into outreach clinics run in two districts by Sankara Eye Centre, Coimbatore, Southern India. A semi-structured questionnaire was administered to patients who had attended outreach eye clinics and either accepted or not accepted the offer of cataract surgery. RESULTS: Overall acceptance of surgery was high (91.7%), being higher in the district with regular outreach (94.6%vs. 82.3%, P < 0.001). A total of 398 participants (240, 60% acceptors) were interviewed. Acceptors were more likely to live in smaller households and in supportive families than non-acceptors who lived in larger families which could not provide support and where transport and distance were also barriers (P .001). Attending regular outreach and having had first eye cataract surgery were independent predictors of acceptance in a logistic regression model. CONCLUSION: The findings indicate the importance of providers building trust by organizing regular outreach in the same location. Previous eye surgery was also a strong predictor of accepting cataract surgery. To promote universal access to health care, marginalized rural communities will continue to need outreach for some time to come.

Communicating to Engage: An Improvisational Theater-Based Communication Training Designed to Support Community-Academic Partnership Development.

PROBLEM: The potential for community-engaged research to address health inequity requires deliberate effort to create trusting and equitable community-academic partnerships. A lack of evidence-based opportunities for cultivating such partnerships remains a barrier. APPROACH: In 2017 and 2018, the authors designed, facilitated, and evaluated a mixed stakeholder training, Communicating to Engage, at 2 urban academic medical centers involved in the All of Us research program, Boston Medical Center and Mass General Brigham. The goal was to bring together researchers and community members to develop communication skills through improvisational theater-based co-learning. The curriculum was inspired by several evidence-based learning frameworks including community-based participatory research principles and improvisational theater techniques. A self-administered survey completed before and after the training session measured participants' communication skills using the Self-Perceived Communication Competence Scale (SPCCS) and comfort with specific communication styles as outlined in the program's training objectives. Paired t tests were used to measure changes in scaled responses among combined participants and separately among self-identified community members and researchers. OUTCOMES: Sixty-nine total participants across 6 workshops completed training evaluations. Overall, pre-post survey analysis demonstrated significant mean score improvement for both the SPCCS and comfort with specific communication styles. In stratified analysis, both community members (n = 26) and researchers (n = 38) reported significant improvement in scores related to comfort with specific communication styles. Only researchers, but not community members, had significant improvement in SPCCS scores. NEXT STEPS: The Communicating to Engage program brought community and researcher stakeholders together and demonstrated improvement in self-perceived communication styles, yet researcher participants benefited more than community participants. Future innovation is necessary to further target community stakeholder communication training needs. Mixed stakeholder improvisational theater-based learning provides deliberate opportunities to build new community-academic partnerships that may enhance health equity initiatives.

Guidance on the use of social media in reproductive medicine practice.

The term "social media" refers to computer-mediated technologies that enable individuals and communities to gather, communicate, network, and share information. These technologies represent useful tools for enabling individual providers and their clinics to broadcast content that educates, informs, advertises, and narrates content to a larger audience. There are multiple benefits to maintaining a presence on social media, either as an individual physician or as a clinic, but several pitfalls deserve consideration as well. This guidance document does not endorse any specific cloud-based platform or service, though some are mentioned for the purposes of illustration.

[Quality assurance of take-over from in-patient to out-patient care: experiences in Lower Austria]. / Zum Schnittstellenmanagement zwischen einem psychiatrischen Krankenhaus und einem gemeindepsychiatrischem Dienst.

OBJECTIVE: Community mental health teams (CMHT) provide support for severely disabled, chronic mentally ill patients. In this study, referrals to CMHT by a psychiatric hospital in Lower Austria were analysed, as were the first few weeks of care for referred patients. METHODS: Referrals to CMHT of a catchment area (pop 250.000) were analysed for 2002- 2006. RESULTS: In the first 6 months of each year, 124 to 189 patients were referred to CMHT. Between 2002 and 2006, the percentage of affective disorders (ICD-10: F3: 40.0 %), and substance use disorders (F1: 38.9 %) within the referrals diminished, as compared to patients suffering from schizophrenia (F2 initially 25.4 % of referrals vs. 49.7 %) and personality disorders (F6 initially 6.4 % of referrals vs. 22.4 %). In 30.7 % vs. 56.6 % of patients, CMHT workers managed to establish contact to patients after discharge from hospital. They actively sought contact with 39.9 to 74.6 % of referred patients (by means of telephone calls, letters, home visits, etc.). In 26.5 to 46.9 % of the referrals, continuous care was planned. CONCLUSIONS: This study emphasizes the advantage of specific referrals to CMHT, if care for severely disabled individuals is needed and should be provided. Furthermore, a description of outreach activities, which are intended to maintain contact with patients characterized by poor compliance, is presented. These activities are not yet part of routine care in German speaking countries.

Medical Civil-Military Relationships: A Feasibility Study of a United Kingdom Deployment in South Sudan.

OBJECTIVES: Civil-military relationships are necessary in humanitarian emergencies but, if poorly managed, may be detrimental to the efforts of humanitarian organizations. Awareness of guidelines and understanding of risks relating to the relationship among deployed military personnel have not been evaluated. METHODS: Fifty-five military and 12 humanitarian healthcare workers in South Sudan completed questionnaires covering experience, training and role, agreement with statements about the deployment, and free text comments. RESULTS: Both cohorts were equally aware of current guidance. Eight themes defined the relationship. There was disagreement about the benefit to the South Sudanese people of the military deployment, and whether military service was compatible with beneficial health impacts. Two key obstacles to the relationship and 3 areas the relationship could be developed were identified. CONCLUSION: This study shows that United Kingdom military personnel are effectively trained and understand the constraints on the civil-military relationship. Seven themes in common between the groups describe the relationship. Current guidance could be adapted to allow a different relationship for healthcare workers.