Collaboration between mental health and vocational rehabilitation programs for transition-age youth vocational outcomes.

Transition-age youth (TAY) with serious mental health conditions (SMHC) face many challenges as they establish adult employment. Mental health (MH) programs and vocational rehabilitation (VR) programs each provide key supports toward this goal, but collaboration is required. OBJECTIVE: The present study's objective was to assess the extent of collaboration between VR programs and MH programs that serve this age group and to identify interorganizational factors associated with collaboration levels. METHOD: Participants were 100 key informants from VR, and child mental health (CMH), transition-age youth MH (TAYMH), and adult mental health (AMH) programs in communities that received federal funding to improve services for TAY with or at risk of SMHC. Participants completed web surveys that queried four interorganizational factors and employed a modified social network analysis methodology to assess collaboration levels. RESULTS: The interorganizational factor, depth of knowledge, had a strong and consistent association with collaboration levels. There was little difference in MH-VR collaboration levels between MH programs serving different age groups. However, VR programs and CMH programs had both lower depth of knowledge of each other and lower collaboration levels, compared to TAY and AMH programs. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Collaboration between VR and MH programs is instrumental to making sure that TAY with SMHC receive appropriate career development and employment services. Increasing the depth of knowledge that programs have about each other may enhance collaboration and appears particularly needed between VR and CMH programs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Strategies to improve the recruitment and retention of underserved children and families in clinical trials: A case example of a school-supervised asthma therapy pilot.

BACKGROUND: Due to underrepresentation of racial/ethnic minority and low-income groups in clinical studies, there is a call to improve the recruitment and retention of these populations in research. Pilot studies can test recruitment and retention practices for better inclusion of medically underserved children and families in subsequent clinical trials. We examined this using a school-based asthma intervention, in preparation for a larger clinical trial in which our goal is to include an underserved study population. METHODS: We recruited children with poorly controlled asthma in a two-site pilot cluster randomized controlled trial of school-supervised asthma therapy versus enhanced usual care (receipt of an educational asthma workbook). We sought a study population with a high percentage of children and families from racial/ethnic minority and low-income groups. The primary outcome of the pilot trial was recruitment/retention over 12 months. Strategies used to facilitate recruitment/retention of this study population included engaging pre-trial multi-level stakeholders, selecting trial sites with high percentages of underserved children and families, training diverse medical providers to recruit participants, conducting remote trial assessments, and providing multi-lingual study materials. RESULTS: Twenty-six children [42.3% female, 11.5% Black, 30.8% Multiracial (Black & other), 76.9% Hispanic, and 92.3% with family income below $40,000] and their caregivers were enrolled in the study, which represents 55.3% of those initially referred by their provider, with 96.2%, 92.3%, and 96.2% retention at 3-, 6-, and 12-month follow-up, respectively. CONCLUSION: Targeted strategies facilitated the inclusion of a medically underserved population of children and families in our pilot study, prior to expanding to a larger trial.

School Nurse Perspectives on School-Supervised Asthma Therapy: A Qualitative Study.

Background: School-supervised asthma therapy improves asthma outcomes for children, yet this strategy is not widely utilized. School nurses play a vital role in this intervention, yet their perspectives on school-supervised asthma therapy have not been thoroughly examined. Objectives: To examine the perspectives of school nurses participating in school-supervised asthma therapy and identify key facilitators, barriers, and proposed solutions that will facilitate the uptake of this strategy. Methods: We used purposeful sampling to recruit 12 school nurses participating in Asthma Link, a real-world application of school-supervised asthma therapy, between 2017 and 2019. We performed semistructured interviews with school nurses to elicit their perspectives on the facilitators, barriers, and proposed solutions to barriers to Asthma Link implementation. Interview transcripts were analyzed using qualitative descriptive methodology to identify major themes. Results: School nurses identified facilitators for Asthma Link adoption, including the ease of integrating supervised therapy into school nurse routines, recognition of benefits for families with limited resources, and satisfaction participating in preventive care. School nurses identified barriers, including communication challenges with families and providers, families not reliably bringing medication to school, limited nursing staff in schools, and increased school nurse turnover. School nurses proposed specific solutions to these barriers, including appointing Asthma Link liaisons within pediatric practices, incentivizing families to bring medicine to school, and partnering new school nurses with those experienced in delivering Asthma Link to overcome staffing issues and promote program fidelity. Conclusions: School nurse perspectives on the facilitators, barriers, and solutions to barriers are important for understanding how to promote real-world implementation of school-supervised asthma therapy. The themes identified in this study will be utilized to refine our protocol for Asthma Link to facilitate real-world adoption of this evidence-based strategy.

Alignment of stakeholder agendas to facilitate the adoption of school-supervised asthma therapy.

BACKGROUND: School-supervised inhaled corticosteroid (ICS) therapy improves pediatric asthma medication adherence, outcomes, and morbidity. However, school-supervised ICS therapy has not been widely adopted into practice. We developed Asthma Link™ as a sustainable, low-cost model of school-supervised asthma therapy, designed for real-world adoption. Initial outcomes of Asthma Link™ demonstrated a significant improvement in health outcomes. OBJECTIVE: In this study, we examined the perspectives of Asthma Link™ participants to identify systems-level barriers and facilitators to refine the Asthma Link™ protocol and facilitate real-world uptake of school-supervised asthma therapy. METHODS: Using qualitative research methods, we interviewed 29 participants in Asthma Link™ from 2016 to 2018. Semi-structured interviews were conducted over the phone. Interviews were transcribed and the transcripts were coded to identify major themes within and across stakeholder groups. RESULTS: Stakeholders agreed on many facilitators for successful Asthma Link™ execution including the brief and easy to follow procedures and the perceived beneficial health impacts for children involved. Some of the barriers identified were deviations from the protocol and insurance companies denying coverage for two inhalers. However, the participants did propose solutions to address these barriers. CONCLUSION: Asthma Link™ is a low-cost, sustainable model of school-supervised asthma therapy that leverages the established infrastructure and collaboration of medical providers, school staff, and families. In this study, we elicited the perspectives from these stakeholder groups and identified an agreement in several facilitators, barriers, and proposed solutions that will ultimately inform refinement of the program protocol and support real-world adoption of Asthma Link™ and other similar models.

Postsecondary students with psychiatric disabilities identify core services and key ingredients to supporting education goals.

OBJECTIVE: Accessing and successfully completing postsecondary educational opportunities may be challenging for those living with psychiatric disabilities. This exploratory study highlights the experiences of individuals with psychiatric disabilities participating in postsecondary educational support initiatives. METHOD: Investigators conducted case studies with 3 education support initiatives across the United States. Focus groups revealed what concrete supported education services were helpful and key ingredients in delivering education supports. RESULTS: Access to specialists, mindfulness techniques, help with time management and procrastination, and facilitating classroom accommodations were identified as critical. Developing authentic relationships with supported education staff, flexibility in service delivery and access to student peers living with psychiatric disabilities were noted as key ingredients in service delivery. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Incorporating the voice of students with psychiatric disabilities into supported education services can increase access, involvement, and retention, therein providing more supports to students with psychiatric disabilities achieving their postsecondary education goals. (PsycINFO Database Record (c) 2018 APA, all rights reserved).