Scale-up efforts of parenting programs have not served diverse communities well due to inadequate curricular adaptations and the lack of a culturally and linguistically competent workforce. We compared delivery of the parent–child interaction module of SafeCare© (SC-PCI) in a refugee community using two implementation approaches: standard delivery via community-based agencies and a task-shifted delivery via community members trained as community health workers (CHWs). Two hundred and six mothers received SC-PCI from trained SafeCare providers. Implementation metrics included the number enrolled and completed, service satisfaction, and in-session skill uptake. Family outcomes were collected via surveys at baseline, post-intervention, and 4-month follow-up and included parenting skill, stress, and child social-emotional development. Analyses compared differences between implementation approaches. CHWs recruited (Ns = 136 vs. 70) and completed more families (98 to 90

Same-day pre-exposure prophylaxis (PrEP) for HIV prevention is a novel tool to increase biomedical prevention access and uptake. Although prior research has identified same-day PrEP as feasible and acceptable, improved understanding of key barriers and facilitators to implementation is needed to optimize impact. The Network for Implementation Science in HIV (NISH) examined the implementation of same-day PrEP across 42 Ryan White Part A-D-funded organizations in seven Ending the U.S. HIV Epidemic Initiative priority jurisdictions. We used crisp-set coincidence analysis with six conditions to identify key barriers explaining delayed implementation of same-day PrEP among 38 clinical organizations representing 137 individual clinics where same-day PrEP services were available currently or in the future. Our final model explained 67

As the number of forcibly displaced persons worldwide increases, the number of children either forcibly displaced or born as refugees also multiplies. In addition to struggling with basic needs upon resettlement, disruption of daily life can lead to numerous stressors for forcibly displaced parents that may cause friction in the relationship between parent and child. Evidence-based parenting programs may help forcibly displaced parents reconceptualize parenting upon resettlement, strengthen the parent–child bond, and promote positive biopsychological outcomes for children. This study aims to understand refugee parents’ experience with a culturally adapted, evidence-based positive parenting program called SafeCare. We conducted semi-structured interviews with 18 refugee parents of Afghan, Burmese, or Congolese descent who completed SafeCare. Open-ended questions focused on understanding parents’ experiences, likes, and dislikes of the adapted curriculum. We applied thematic analysis to analyze the data. The authors identified six themes related to the experiences of refugee parents: expectations and reasons for engaging with SafeCare, guidance for program implementation, learning active parenting, physical learning materials that help parents acquire new skills, the utility of in-person and virtual learning methods, and provision of tailored support for navigating cultural differences. These findings demonstrate success in adapting parenting programs to a refugee context and suggest that delivering such educational programs for forcibly displaced parents may result in better outcomes for both parent and child.

Background:LGBTQ + youth are at elevated risk for numerous negative health and behavioral health outcomes, which largely stem from minority stress and maladaptive coping. Schools are an important environment where these youth may be exposed to both stressors, like experiences of stigma, bias, discrimination, and violence, and health promotive factors that moderate the impact of minority stress. Collaboration between schools and the broader community plays a crucial role in initiatives designed to improve school climate and culture. In the context of a cluster randomized controlled trial implementing a suite of six LGBTQ + supportive practices in high schools, we used the "Collaborating with Community Scale" adapted specifically to address linkages between schools and communities focused on the needs of LGBTQ + students (CCS-LGTBQ+). Methods:We conducted annual surveys over five years with an administrator and an implementation leader in each of the 42 high schools randomly assigned to either an implementation condition or a delayed implementation condition. The survey included questions on organizational leadership, implementation climate, and the CCS-LGBTQ+. We analyzed inter-rater reliability between respondent types, internal consistency, and change over time in scale items and means. Results:Scale scores between administrators and implementation leaders were strongly correlated. However, administrators rated items higher than implementation leaders, as was expected given their relative positions within school communities. The scale demonstrated a high level of internal consistency, with Cronbach's alphas ranging from .777 to .930 and was sensitive to changes in the implementation of scale items, indicated by increases in the scale means of implementation condition schools from 1.59 in year 1 to 2.08 in year 4 (p < .035). Conclusions:Testing of the CCS-LGBTQ + resulted in a scale with high internal consistency to measure the extent to which schools collaborate with community resources to support and enhance school environments for LGBTQ + students. When used in the context of the parent trial, findings from the CCS-LGBTQ + show that schools' collaboration with their communities increased over time. However, the impact of the COVID-19 pandemic likely reversed some of the gains made within the first years of implementation. The CCS-LGBTQ + is a reliable and useful tool for assessing school-community collaboration for supporting LGBTQ + populations.

Incorporating research evidence within child welfare systems can improve services and health equity for vulnerable youth. Bidirectional collaboration between researchers and system-level actors may foster evidence-informed policies and programs through cultural exchange. This anthropological analysis of longitudinal qualitative data from the Community-Academic Partnership for Translational Use of Research Evidence (CAPTURE) illuminates the complexities of cultural exchange involving a child welfare system, including capacity for research use, trust, communication, and power dynamics. Successful cultural exchange for catalyzing the use of research evidence requires a multilevel approach attentive to power structures, institutions, and community perspectives. Anthropology must play a central role in critiquing power within partnerships while exploring pragmatic and ethical ways to collaborate with influential entities to implement data-driven policies and programs to enhance health equity.

BackgroundIn the United States Department of Veterans Affairs (VA), veterans who are lesbian, gay, bisexual, transgender, queer, and similar gender and sexual minoritized people (LGBTQ+) experience health disparities compared to cisgender, heterosexual veterans. VA’s LGBTQ+ Health Program created two healthcare policies on providing LGBTQ+ affirming care (healthcare that is inclusive, validating, and understanding of the LGBTQ+ population). The current project examines providers’ barriers and facilitators to providing LGBTQ+ affirming care and LGBTQ+ veterans’ barriers and facilitators to receiving LGBTQ+ affirming care.MethodsData collection and analysis were informed by the Consolidated Framework for Implementation Research, which was adapted to include three health equity domains. Data collection involved telephone interviews conducted with 11 VA providers and 12 LGBTQ+ veterans at one rural and one urban VA medical center, and one rural VA community clinic. Qualitative data were rapidly analyzed using template analysis, a data reduction technique.ResultsProviders described limited education, limited time, lack of experience with the population, and a lack of awareness of resources as barriers. Providers discussed comfort with consulting trusted peers, interest in learning more about providing LGBTQ+ affirming care, and openness and acceptance of the LGBTQ+ community as facilitators. LGBTQ+ veterans described a lack of provider awareness of their needs, concerns related to safety and discrimination, and structural discrimination as barriers. LGBTQ+ veterans described positive relationships with providers, knowledge of their own healthcare needs, and ability to advocate for their healthcare needs as facilitators. Although VA’s LGBTQ+ affirming care policies are in place, providers and veterans noted a lack of awareness regarding specific healthcare processes.ConclusionAllowing more time and capacity for education and engaging LGBTQ+ veterans in determining how to improve their healthcare may be the path forward to increase adherence to LGBTQ+ affirming care policies. Engaging patients, especially those from marginalized backgrounds, in strategies focused on the uptake of policy may be a path to improve policy implementation. It is possible that creating truly collaborative structures in which patients, staff, providers, leadership, and policymakers can work together towards policy implementation may be a useful strategy. In turn, improved policy implementation would result in increased physical and mental health for LGBTQ+ veterans.

High rates of negative behavioral health outcomes among sexually diverse (SD) youth are consistently documented, but population-level trends obscure within-group differences. Social dynamics intersect in youths' lives in ways that cannot be accounted for by summing their independent effects. An intersectional perspective is essential to understanding the behavioral health outcomes of SD youth. We performed multigroup structural equation modeling using an SD subset of New Mexico Youth Risk and Resiliency Survey (N = 10,037) respondents to examine the moderating role of supportive adult relationships for lesbian, gay, and bisexual youth across 12 intersecting (sexual orientation by race/ethnicity by sex) identity categories. Standardized estimates show that supportive relationships are associated with moderate reductions in psychological distress among lesbians (beta = -0.459 for Native, beta = -0.303 for Hispanic, and beta = -0.421 for white) and female bisexual youth (beta = -0.352 for Native, beta = -0.376 for Hispanic, and beta = -0.393 for white). Among male youth, supportive relationships are associated with reduced likelihood of substance use for gay (beta = -0.330 for Native, beta = -0.464 for Latinx and beta = -0.591 for white) and bisexual youth (beta = -0.442 for Native, beta = -0.306 for Latinx and beta = -0.290 for white). This study challenges monolithic characterizations of SD youth, illustrating that the health-promotive benefits of support differ based on sexual orientation, race/ethnicity, and sex.

Purpose Parent–child relationships formed in early childhood have profound implications for a child’s development and serve as a determinant for bio-social outcomes in adulthood. Positive parenting behaviors play a strong role in this development and are especially impactful during times of crisis because they buffer stressors that may lead to externalizing and internalizing behaviors. Children of forced migrants experience numerous extreme stressors and their parents may struggle with parenting due to their own adjustment and trauma histories. The purpose of this study is to understand how these parents conceptualize their struggles with parenting upon resettlement. Design/methodology/approach The authors conducted semi-structured interviews with 27 migrant parents from three communities (Afghan, Burmese and Congolese) to understand their parenting experiences. The authors applied thematic text analysis to analyze the data. Findings The authors identified four interrelated themes on parenting challenges across responses: adjustment to a new culture, acculturation differences, fear for children and balancing multiple responsibilities. The findings demonstrate that parents of different cultural backgrounds share certain experiences when negotiating a new cultural identity after resettlement. Providing educational programs that focus on these concerns may result in better outcomes for both parent and child. Originality/value These findings extend and reinforce the existing literature on parenting in a new context. While the parents in this research come from different cultures, they share certain experiences that are important to consider when developing parenting programs, social services and other interventions, such as what may be negotiable and nonnegotiable practices for parents of different cultures.

School-based health centers (SBHCs) provide vital behavioral, sexual, and reproductive healthcare services to school-aged youth across the United States. Adolescents who are sexual and gender diverse (SGD) are far more likely to suffer from adverse health outcomes than their cisgender and heterosexual peers. Emerging structural competency frameworks call for cultivating capacities in SBHCs to modify organizational service delivery environments, including provider and staff knowledge and behaviors, to influence SGD adolescent well-being. Nationally recognized guidelines for nurturing structural competency include (1) adopting, disseminating, and adhering to SGD supportive policies and procedures; (2) creating welcoming physical environments; (3) systematically documenting and using sexual orientation and gender identity information in clinical care; (4) training all employees in best practices for interacting with SGD patients; and (5) developing the clinical workforce to deliver high-quality services to SGD patients. This community-engaged study will test the effectiveness of the Dynamic Adaptation Process (DAP) in implementing these guidelines in SBHCs in culturally and geographically diverse areas of New Mexico. We will conduct mixed-method readiness assessments to identify inner- and outer-context determinants affecting the implementation of structurally competent changes in SBHCs; employ a stepped-wedge trial to examine how the DAP-enabled implementation impacts adoption and changes in SBHC, student (patient), and implementation outcomes; and investigate inner- and outer-context determinants, bridging factors, and associated mediators and moderators influencing implementation processes and outcomes related to guideline adoption and SGD student care (e.g., reduced barriers, greater satisfaction and engagement). This study addresses the long-term goal of high-quality care and decreased health disparities for SGD youth. As investments in SBHCs rise nationwide, opportunities to enhance services for SGD youth will also grow. This study will demonstrate the usefulness of a multifaceted implementation strategy, the DAP, in helping SBHCs build structural competency to serve a sizeable population of students affected by stigmatization, discrimination, and other social forces that create inequities in health. Accordingly, we will advance a model featuring a set of implementation strategies to reduce knowledge and practice gaps, create welcoming environments, and improve the quality of care for SGD youth. ISRCTN13844475; 20 September 2024.

In 2021, the National Association of School Nurses published an updated position statement affirming the unique position of school nurses to support the health and well-being of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) students who are faced with a variety of health disparities rooted in experiences of stigma, discrimination, and bias. The 5-year cluster randomized controlled trial “Reducing LGBTQ+ Adolescent Suicide” leveraged school nurses as leaders to facilitate the uptake of six evidence-informed, LGBTQ-supportive practices in New Mexico high schools. We analyzed 5 years of interview data from 24 school nurses in 13 intervention schools to examine what factors impacted their ability to serve as an effective leader for this initiative. Several factors including job characteristics, leadership and organizational skills, relationships and reputation, and personal commitments emerged from analysis. Contextual factors, such as working in urban or rural school, and the size of the school also influenced nurses’ leadership.

Purpose: Lesbian, gay, bisexual, and questioning (LGBQ) high schoolers experience high prevalence of poor behavioral health, but little is known about LGBQ middle schoolers. We sought to quantify behavioral health disparities of LGBQ middle school students.Methods: Using 2021 New Mexico Middle School Youth Risk and Resiliency Survey data (N = 12,400), we estimated the size of the LGBQ middle school population and calculated adjusted risk ratios to investigate behavioral health disparities between LGBQ and heterosexual youth.Results: A quarter of the sample identified as LGBQ. These youth reported significantly more suicidal behaviors and poorer mental health than heterosexual youth. LGBQ youth were more likely to use most substances compared with heterosexual youth.Conclusion: LGBQ middle school students demonstrated high prevalence of poor behavioral health. These findings show that disparities begin earlier than previously assumed and underscore that sociocultural landscapes for sexually diverse youth remain challenging.

Background One practice in healthcare implementation is patient engagement in quality improvement and systems redesign. Implementers in healthcare systems include clinical leadership, middle managers, quality improvement personnel, and others facilitating changes or adoption of new interventions. Patients provide input into different aspects of health research . However, there is little attention to involve patients in implementing interventions, especially in the United States (U.S.), and this might be essential to reduce inequities. Implementers need clear strategies to overcome challenges, and might be able to learn from countries outside the U.S. Methods We wanted to understand existing work about how patients are being included in implementation activities in real world U.S. healthcare settings. We conducted an environmental scan of three data sources: webinars, published articles, and interviews with implementers who engaged patients in implementation activities in U.S. healthcare settings. We extracted, categorized, and triangulated from data sources the key activities, recurring challenges, and promising solutions using a coding template. Results We found 27 examples of patient engagement in U.S. healthcare implementation across four webinars, 11 published articles, and seven interviews, mostly arranging patient engagement through groups and arranging processes for patients that changed how engaged they were able to be. Participants rarely specified if they were engaging a population experiencing healthcare inequities. Participants described eight recurring challenges; the two most frequently identified were: (1) recruiting patients representative of those served in the healthcare system; and (2) ensuring processes for equitable communication among all. We matched recurring challenges to promising solutions, such as logistic solutions on how to arrange meetings to enhance engagement or training in inclusivity and power-sharing. Conclusion We clarified how some U.S. implementers are engaging patients in healthcare implementation activities using less and more intensive engagement. It was unclear whether reducing inequities was a goal. Patient engagement in redesigning U.S. healthcare service delivery appears similar to or less intense than in countries with more robust infrastructure for this, such as Canada and the United Kingdom. Challenges were common across jurisdictions, including retaining patients in the design/delivery of implementation activities. Implementers in any region can learn from those in other places.

INTRODUCTION:Cocreation, a collaborative process of key interested partners working alongside researchers, is fundamental to community-engaged research. However, the field of community-engaged research is currently grappling with a significant gap: the lack of a pragmatic and validated measure to assess the quality of this process. This protocol addresses this significant gap by developing and testing a pragmatic cocreation measure with diverse community and research partners involved in participatory health-related research. A valid measure for evaluating the quality of the cocreation process can significantly promote inclusive research practices and outcomes. METHODS AND ANALYSIS:The measure consists of two components: (1) an iterative group assessment to prioritise cocreation principles and identify specific activities for achieving those principles and (2) a survey assessing individual partner experience. An expert panel of 16-20 patients, community, healthcare providers and research partners, will participate in a modified Delphi process to assist in construct delineation and assess content validity using group discussions and rating exercises. We will compute survey items using an Item-Level Content Validity Index and a modified kappa statistic to adjust for chance agreement with panel members' ratings. We will then conduct cognitive interviews with a new group of 40 participants to assess survey item comprehension and interpretation, applying an iterative coding process to analyse the data. Finally, we will assess the measure's psychometric and pragmatic characteristics with a convenience sample of 300 participants and use the Psychometric and Pragmatic Evidence Rating Scale. Construct validity will be assessed by examining survey data using confirmatory and exploratory factor analysis. ETHICS AND DISSEMINATION:This funded study (years 2024-2025) has been approved by the Institutional Review Board at the University of Colorado, Denver. The team will share the study findings online, with key partners, and by publishing results in a peer-reviewed journal.

Background Schools are critical venues for supporting LGBTQ+ youth well-being. Implementing LGBTQ-supportive practices can decrease experiences of stigmatization, discrimination, and victimization that lead to adverse mental health outcomes like anxiety, depression, and suicidality. However, schools are also subject to a wide range of outer-context pressures that may influence their priorities and implementation of LGBTQ-supportive practices. We assessed the role of emergent outer-context determinants in the context of a 5-year cluster randomized controlled trial to study the implementation of LGBTQ-supportive evidence-informed practices (EIPs) in New Mexico high schools. Method Using an iterative coding approach, we analyzed qualitative data from annual interviews with school professionals involved in EIP implementation efforts. Results The analysis yielded three categories of outer-context determinants that created challenges and opportunities for implementation: (a) social barriers related to heterocentrism, cisgenderism, and religious conservatism; (b) local, state, and national policy and political discourse; and (c) crisis events. Conclusions By exploring the implications of outer-context determinants for the uptake of LGBTQ-supportive practices, we demonstrate that these elements are dynamic—not simply reducible to barriers or facilitators—and that assessing outer-context determinants shaping implementation environments is crucial for addressing LGBTQ health equity.

Introduction: Multi -level and cross -context implementation strategies are needed to support health systems, healthcare delivery organizations, and providers to adopt evidence -based practice (EBP) for substance use disorder (SUD) treatment. However, misalignment between state oversight agencies and healthcare organizations about which services to prioritize and which outcomes are reasonable to expect can hinder implementation success and widespread access to high -quality care. This study investigated the utility of the Leadership and Organizational Change for Implementation -System Level (LOCI -SL) strategy for supporting statewide EBP implementation for SUD treatment. Methods: Nine community mental health centers (CMHCs) contracted by a state agency participated in a combined motivational -enhancement therapy and cognitive behavioral therapy (MET/CBT) implementation effort. Five of the CMHCs also received the LOCI -SL strategy to obtain ongoing implementation support. We conducted 21 individual interviews and three small group interviews with 30 participants across CMHCs and state health agencies to investigate the utility of LOCI -SL in supporting their EBP implementation efforts. Deductive thematic analysis was guided by the Exploration, Preparation, Implementation, Sustainment Framework. Results: Five themes described CMHCs' LOCI -SL and broader contextual experiences implementing EBPs: (1) LOCI -SL supported executives in Preparation phase activities that holistically considered organizational needs and capacity to implement and sustain EBPs; (2) LOCI -SL facilitated trust and communication processes across Preparation, Implementation, and Sustainment phases to improve EBP uptake; (3) LOCI -SL increased CMHCs' use of implementation climate strengthening activities throughout the Implementation phase; (4) state contracts did not emphasize quality and thus were not sufficient bridging factors to enforce EBP fidelity during Implementation; and, (5) limited funding and low Medicaid reimbursement rates hindered EBP use throughout the Implementation and Sustainment phases. Conclusions: LOCI -SL was viewed as a favorable and useful implementation strategy for supporting statewide adoption of EBPs. However, outer context barriers, including limited financial investments in the treatment system, impeded implementation and sustainment efforts. While previous research suggests that contracts are viable alignment -promoting bridging factors, this study demonstrates the importance of articulating implementation outcome expectations to aid state -contracted organizations in achieving EBP implementation success. This study also highlights the need for multi -level implementation strategies to effectively align implementation expectations between outer- and inner -context entities.

Navigating health care and insurance systems presents significant challenges for American Indian (AI) Elders. Access to culturally congruent assistance with decision-making, scheduling, transportation, and communication can bridge the gap between AI Elders and health systems. This study uses qualitative interviews with professionals providing navigation services to American Indian Elders in a Southwestern state to understand the skills, experiences, and challenges involved in delivering this support. We conducted semi-structured interviews with 16 professionals providing navigation support to AI Elders between November 2018 and August 2020 and used a constant comparative approach to identify themes. Participants' descriptions of their work centered on the themes of (1) respect for Elders; (2) wide-ranging responsibilities; (3) acting as a trusted communicator; (4) developing trust; and (5) challenges to providing navigation support for AI Elders. Efforts to achieve health equity for AI Elders must include supporting individuals such as these within communities and advocating for a just health care system for American Indian people.

Accreditation is gaining ground in human services as leaders find ways to demonstrate the quality and legitimacy of services. This study examined site-level accreditation for SafeCare®, an evidence-based practice designed to prevent and reduce child maltreatment. We leveraged two waves of qualitative data to explore the perspectives of trainers, organizational and system leaders, and program developers who participated in an initial rollout of a site-level accreditation process for SafeCare. Institutional theory was used to frame accreditation’s potential benefits, burden, and impact. Findings highlight specific considerations for the human service environment, including the inherent resource scarcity, interdependence among organizations, and the impact of cost and slow-moving bureaucratic processes.