Aim: To identify key factors associated with varying levels of Medicare's Chronic Care Management (CCM) programme implementation in rural primary care practices in the United States.Background: Despite demonstrated benefits for both patients and providers, CCM implementation remains low nationwide. While previous studies have examined payment-related challenges, limited research exists on other implementation factors such as leadership engagement, organizational culture, and provider training, particularly in rural settings.Methods: This mixed-methods study examined CCM implementation across six rural primary care practices in Wyoming. Thirteen healthcare professionals participated in semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR). Practice performance data collected over three consecutive months were used to categorize sites as high or low implementers based on care coordinator productivity, percentage of care coordinated, and programme sustainability. Interview transcripts were analysed using CFIR constructs to identify factors that distinguished high from low-implementing sites, with each factor rated based on its impact (positive, negative, or neutral) and strength of influence.Findings: Three CFIR constructs strongly distinguished between high and low implementation sites: networks and communication, leadership engagement, and reflecting and evaluating. High-implementing sites demonstrated effective team communication, supportive leadership, and regular programme evaluation practices. In contrast, low-performing sites faced poor communication, minimal leadership support, and weak feedback mechanisms. Further research is needed to examine the effectiveness of targeted interventions designed to strengthen these organizational factors in rural primary care settings, particularly focusing on developing scalable strategies that account for resource limitations and geographic isolation.

Kin caregivers provide support to millions of children in the United States when their biological parents are unable. Despite their critical role, kin caregivers often lack financial, medical, legal, housing, and support resources. These inequities are exacerbated in rural areas. The Wyoming/Montana Kinship Navigator Program was designed to improve outcomes for caregivers and children with a rural, solution-focused, enhanced case-management model. This evaluation protocol includes a quasi-experimental design and propensity score matching for baseline equivalence. Outcomes include caregiver well-being, service access, and child permanency obtained through surveys and administrative records. Findings from this novel two-state evaluation partnership will support an evidence-base regarding rural kinship navigator models and will inform the Title IV-E Prevention Services Clearinghouse program review.

BACKGROUND:Use of the Project ECHO® (Extension for Community Healthcare Outcomes) model in geriatrics has increased dramatically largely because of the Health Resources and Services Administration-funded Geriatrics Workforce Enhancement Programs (GWEP) utilizing it as a key tool for age-friendly, interprofessional workforce development. This manuscript describes the scope and impact of geriatrics ECHOs under the GWEP. METHODS:A survey of GWEPs was conducted to measure the reach, foci, evaluation methods, and other characteristics of ECHO networks. RESULTS:All 48 (100%) GWEPs responded to the survey, and 30 (63%) reported using ECHO. GWEP ECHOs have both rural and urban-underserved reach across the United States, and their hub teams include many health professions. Age-friendly care is incorporated through multiple methods and is taught across foci including primary care, dementia, long term care, and novel topics. GWEP ECHOs have many academic and community partners including Area Agencies on Aging, and reach varied health professions, trainees, and caregivers. Geriatrics ECHOs collect outcomes across the evidence continuum including the community-level outcome of Age-Friendly Health System designation. CONCLUSIONS:The ECHO model has been widely adopted by GWEPs as a key approach for workforce training in age-friendly care. Project ECHO is a valuable tool to expand interprofessional training for the geriatrics workforce, particularly for interprofessional teams in rural and underserved areas.

Youth with mental health disorders (MHD), particularly those who take psychotropic medications, are at increased risk of being overweight or obese (OW/OB) when compared to typical youth. Parents are important resources for interventions addressing OW/OB. However, parents of youth with MHD may face challenges that require interventions designed to address their needs. Prior to investing research funding in the development of interventions for this group, research is needed to understand factors associated with parents’ decisions to enroll in these programs. The theory of planned behavior (TPB) provided a framework for examining parents’ salient beliefs, direct attitudes, and intention to enroll in a hypothetical online healthy lifestyle intervention for their youth (ages 11–17) with OW/OB and treated with psychotropic medication. Parents who were enrolled in the study (n = 84) completed demographic questionnaires and a TPB questionnaire which was constructed for this study. A confirmatory factor analysis (CFA) of the direct attitude (i.e., attitude toward the behavior, subjective norm, perceived behavioral control) questions generally supported the three-factor model (i.e., RMSEA = .07, 90% CI .03–.11, p = .18; CFI = .96, SRMR = .06). Results from a multiple regression analysis demonstrated that direct attitudes predicted parent intention to participate in an online healthy lifestyle intervention for this sample of youth accounting for 84% of variance. In this preliminary study, the TPB appears to be a promising framework for understanding direct attitudes associated with parent intentions toward intervention participation in this population of youth. Interventions for parents of youth with OW/OB who are prescribed psychotropic medication should consider addressing these direct attitudes to improve intention.

IntroductionSocial isolation and loneliness are global public health concerns experienced among older adults which are commonly associated with negative physical, psychological, and social outcomes. The healthcare system has an opportunity to identify and address social isolation and loneliness in older adults. The Program of All-Inclusive Care for the Elderly (PACE) was developed to serve comprehensive social needs along with medical and behavioral needs of older adults who qualify for long-term care while still living in the community. In 2021, due to state budget reductions, Wyoming’s only PACE program (WY PACE) closed, resulting in the discharge of all participants and loss of social engagement opportunities provided by this program. The objectives of this evaluation were to (1) examine the impact of the WY PACE closure on isolation and loneliness, (2) identify how older adults adapted to the loss of services addressing isolation and loneliness, and (3) identify needs for future interventions to address isolation among clients who experienced loss of supportive programs.MethodsA mixed-methods design was used to facilitate understanding of qualitative findings while also conducting quantitative analyses to provide context for qualitative responses. Participants included 17 individuals who were either former PACE participants or their caregivers. Participants (n = 12; M = 74 years old) were predominantly non-Hispanic White (n = 8, 66%) and cisgender female (n = 7, 58%). Caregivers of participants (n = 5; M = 63 years old) were predominantly Hispanic, Latino, or of Spanish origin (n = 3, 60%) and cisgender female (n = 4, 80%).ResultsA mixed-methods design was used to facilitate understanding of qualitative findings while also conducting quantitative analyses to provide context for qualitative responses. Participants included 17 individuals who were either former PACE participants or their caregivers. Participants (n = 12; M = 74 years old) were predominantly non-Hispanic White (n = 8, 66%) and cisgender female (n = 7, 58%). Caregivers of participants (n = 5; M = 63 years old) were predominantly Hispanic, Latino, or of Spanish origin (n = 3, 60%) and cisgender female (n = 4, 80%).DiscussionThis evaluation provided preliminary insight into the impacts of the loss of programs like WY PACE on social isolation and loneliness. Creative solutions to maintain social engagement of this vulnerable population are needed.

While kinship care is prevalent and preferred over out-of-family care, there are relatively few measurement tools validated for use with this audience. The Title IV-E Clearinghouse, used to rate Families First Prevention Services such as Kinship Navigator Programs, requires valid tools. Such families face a myriad of needs in supporting children in their care. Previous research has established the significant challenges faced by rural families. Accurate assessment of these needs, particularly for rural families, is an essential component of kinship navigation services. In this study, we examined the face validity of the Family Needs Scale for use with kinship caregivers in rural programs. Methods: The evaluation teams with each respective kinship program conducted four virtual focus groups comprising kinship caregivers (n = 18) in three rural states. Participants were recruited from outside an ongoing Kinship Navigator Program Evaluation sample but had previously received program support as kinship caregivers. All states received IRB approval from their respective universities. Verbal consent was obtained at the time of the focus group. Focus groups lasted approximately 60–90 min and participants received a gift card incentive. Data were transcribed and qualitatively coded by question set and individual questions to identify phenomenological trends. Findings: Across four focus groups, we found four themes: (1) Broad agreement regarding the face validity of most assessment items; (2) Lack of clarity and shared understanding of several terms used within the tool, (3) Responses change with Ages and Stages of kinship family, and (4) Perspective considerations varying when completing the assessment. Discussion: Findings indicate that most assessment items had strong face validity, where there are a few opportunities to clarify key concepts relevant to rural kinship families and assess additional needs to understand the situational scope of the kinship experience. Overall, the needs assessment tool appears to have validity in assessing current kinship needs and outcomes within Kinship Navigator program evaluation.

Abstract Approximately 59% of older adult Medicare beneficiaries experience two or more chronic conditions. This rate is even higher among those dually-enrolled in Medicare and Medicaid (i.e., 77%; Boersma et al. 2021). In 2015, the Centers for Medicare and Medicaid Services introduced Chronic Care Management (CCM), a value-based care program, to provide reimbursement to practices for care coordination services that support the management of patients with multimorbidity. Importantly, physical and mental health conditions are often interrelated; however, providers often struggle to adequately treat mental health needs in the context of physical illness (Lattie et al., 2020). The purpose of this study was to examine healthcare providers’ perspectives on serving individuals with mental health diagnoses enrolled in CCM within primary care practices. Investigators developed an interview for this qualitative study. Employees of six practices that have implemented CCM participated. Participants completed sociodemographic, professional, and practice history measures, and a qualitative interview. Participants (n = 13) were predominantly White, cisgender females (n = 12; 92%) and represented care coordinators, primary care providers, allied health professionals, and administrators. All participants completed a 60-minute interview, which was audio recorded, transcribed verbatim, and subjected to thematic analysis. Four themes were identified: Types of Chronic Health Conditions Treated, Access to Mental Health Services, Provider Experience and Comfort, and Educational Needs. Participants expressed a willingness to complete mental health training but faced challenges identifying particular training needs. Future training efforts should address foundational knowledge in mental health disorders and strategies to serve people with common mental health comorbidities.

Abstract Approximately 60% of Americans live with one or more chronic conditions (CDC, 2023). Chronic disease self-management programs empower individuals to take an active role in their health management. Self-efficacy is an important construct determining self-management behaviors. Recently, low self-reported ratings of self-efficacy for managing chronic disease have been associated with high loneliness ratings (Lee et al., 2023); however, other variables that may be important regarding the relationship between loneliness and self-efficacy are less known. Depressive symptoms are associated with both loneliness and management of chronic disease. This study examined the mediating role of depressive symptoms in the relationship between loneliness and self-efficacy among individuals with chronic disease participating in the Self-Management Resource Centers, Chronic Disease Self-Management Program (CDSMP). The sample (n = 48, M = 63.0 years old, SD = 18.0) comprised primarily White females (n = 37; 77%) who presented with chronic conditions and completed a CDSMP workshop. Regression analyses revealed that baseline loneliness predicted baseline depressive symptoms (β =.49, p <.001). Both baseline loneliness (β = -.46, p <.006) and depressive symptoms (β = -.75, p <.001) predicted baseline self-efficacy. The relationship between loneliness and self-efficacy became non-significant (β = -.12, p =.301) after controlling for depressive symptoms. Examination of loneliness and depression to changes in self-efficacy pre- to post-intervention showed similar results. Depressive symptoms are important in the relationship between loneliness and self-efficacy among participants in the CDSMP. Addressing depressive symptoms may support improvement in self-efficacy among CDSMP participants experiencing loneliness.

Abstract Social isolation and loneliness are public health problems seen in late adulthood that are associated with health risks (e.g., premature mortality, depression, and suicidality) and these issues are even more common among older adults with chronic illnesses (Nicholson, 2012). The Program of All-Inclusive Care for the Elderly (PACE) was developed to serve medical and behavioral needs and provide opportunities for social engagement for older adults with chronic illnesses. Budget cuts shut down Wyoming’s PACE program. This study aimed to (1) examine the impact of this closure on social isolation and loneliness, (2) identify how individuals have adapted to the loss of services that address social isolation, and (3) identify needs and preferences for future intervention to address social isolation. A concurrent mixed-methods design was used to examine these aims. Participants (n = 12; M = 74 years old, SD = 9.5) were predominantly White (n = 8, 66%), female (n = 6, 50%), and lived alone (n = 6, 50%). Caregivers of participants (n = 5; M = 63 years old, SD = 11) were predominantly Hispanic, Latino, or of Spanish origin (n = 3, 60%), female (n = 4, 80%), and lived with a partner (n = 4, 80%). Four central themes emerged: social isolation, emotional concerns, transportation loss, and care loss. Data showed decreases in social support and increases in loneliness. Results suggest programs like PACE greatly benefit older adults. Future directions may include developing community-based interventions to address service needs and social isolation concerns in Wyoming.

Abstract In 2015, the Centers for Medicare and Medicaid Services introduced Chronic Care Management (CCM) to provide reimbursement to practices for care coordination services necessary to manage chronic conditions among older adults. However, uptake of this program among primary care practices is low, and few Medicare beneficiaries actually receive this service. Implementation of CCM may be even more challenging in rural, low-resourced areas. The purpose of this study was to examine factors associated with more and less successful implementation of CCM within primary care practices located in a rural state. A qualitative study was conducted, which was guided by the Consolidated Framework for Implementation Research (CFIR). Employees of practices (n = 8) that have implemented CCM were approached for study participation. Members (n = 17) of various healthcare teams were included in the study. Participants completed sociodemographic, professional, and practice history measures and completed a qualitative interview. Participants (n = 17) were predominantly White (n = 16; 94%), female (n = 16; 94%), and represented care coordinators, primary care providers, allied health professionals, and administrators. CrossTX records were analyzed to categorize practices by high and low implementation success. Content analysis, guided by CFIR, identified domains associated with implementation success, including Intervention Characteristics (I.e., Relative Advantage), Outer Setting (e.g., Patient Needs and Resources), Inner Setting (e.g., Implementation Climate, Leadership Engagement), and Process (e.g., Champions). Strategies to address barriers include addressing characteristics of the Inner Setting (e.g., Available Resources). Developing training mechanisms to address staff turnover is critical to address barriers.

Abstract The challenges of supporting the health and social needs of older adults and caregivers in rural and frontier areas are well-documented. It is common for rural older adults to experience barriers in accessing geriatric specialists, care coordination services, and caregiver support and education programs. The Wyoming Geriatric Workforce Enhancement Program (WyGWEP) is an innovative partnership comprising an academic geriatrics program, primary care delivery sites, single-unit on aging representing community-based organizations, and a tribal health program. This partnership, funded by the Health Resources and Services Administration, provides the infrastructure to assess needs, provide education and training, create programs to address gaps in care, implement practice innovation, and advocate for needs of rural older adults. This symposium includes five presentations detailing the unique projects of the WyGWEP partnership and the impact of this collaborative work on a variety of stakeholders. The results of a mixed-methods evaluation of the WyGWEP partnership will describe the benefits to the partners and areas for growth. A collaborative effort to assess the needs of older adults informs recommendations to support rural aging in place. Schenck et al. will describe the adaptation of the widespread ECHO model for use with dementia caregivers in rural and remote locations. Representatives from Wyoming’s only Program for All-Inclusive Care of the Elderly (PACE) will explain the cost of a recent decision to de-fund and close this important program. Finally, the impact of a novel Chronic Care Management implementation program will be discussed, including sustainable billing revenue produced by rural primary care clinics.

Abstract The goal of the Wyoming Geriatrics Workforce Enhancement Program (WyGWEP) is to utilize partnerships to improve health outcomes for older adults by developing a healthcare workforce trained to address unmet health and social determinant needs of Wyoming’s older residents. The purpose of this presentation is to report results from the novel mixed-methods evaluation of the WyGWEP partnership. Data were gathered from WyGWEP stakeholders through the Partnership’s Self-Assessment Tool (n=17; Center for the Advancement of Collaborative Strategies in Health, 2002), which assesses domains of Synergy, Leadership, Resource Sharing — Non-financial and Financial, Benefits and Drawbacks, Decision Making, and Administration/Management and Satisfaction. Semi-structured interviews (n=12) with partnership participants provided additional information and context. Evaluation results indicate that WyGWEP partners are highly satisfied across all domains of the Partnership’s Self-Assessment Tool. WyGWEP partners from Eastern Shoshone Tribal Health will share what has contributed to a successful collaborative. Additional results related to how this type of partnership has influenced participants’ ability to complete objectives and activities will be reviewed.

Youth who are prescribed psychotropic medication are disproportionally affected by overweight/obesity (OW/OB), yet few interventions have been tailored to their needs. To develop new interventions, it is important to address the needs, preferences, and intentions of target users. Qualitative methods within the theory of planned behavior (TPB) framework were used in this study to identify salient beliefs which may influence attitudes associated with parents' intentions to participate in a future online intervention designed to develop behavioral health coaching skills among parents and guardians. Twenty parents and guardians of youth with OW/OB who were taking psychotropic medications, and were eligible for the study, were recruited through TurkPrime. Parents and guardians identified key salient beliefs consistent with the theory of planned behavior including behavioral beliefs (e.g., access and convenience), normative beliefs (e.g., family), and control beliefs (e.g., cost) that may influence their decision to enroll in a future, parent-oriented intervention. The results of this study suggest important salient beliefs which may be included in future research, as well as specific preferences which may be used to guide the development of a future intervention. Future work should focus on the creation of a salient belief quantitative measure and assess the relationships of these beliefs to attitudinal constructs and behaviors.

Objectives Although the majority of older adults wish to "age in place" in their communities, rural contexts pose challenges to maintaining long-term independence. The purpose of this study was to develop an understanding of the experiences of rural older adults who live in Skilled Nursing Facilities (SNFs) and thus have not aged in place. By retrospectively analyzing their pre-institution care situation, we aim to generate foundational knowledge on the barriers to aging in place in rural settings. Methods A series of individual and group interviews was conducted in SNFs across seven rural communities. A grounded, thematic analysis was used to interpret interview findings, and coding was informed by the socio-ecological model (SEM). Results Participants were 32 adults with a mean age of 72 years (SD = 5.7 years) and an average SNF residence of 3.9 years. Two themes emerged as primary barriers to successful aging in place: (1) Caregiver-related support issues and (2) Present focus, or lack of advanced care-planning. Conclusions Findings suggest the importance of specifically supporting caregivers, to ease burden and allow for increased agency for rural older adults. A lack of access to caregiver supports and other services limits the ability of community-dwelling rural older adults to age in place or plan for the future. Clinical Implications Existing networks of rural community resources and innovative solutions should be leveraged to improve access to services for older adults and their informal caregivers.

AbstractBackgroundRates of overweight and obesity are disproportionately high among youth with serious emotional disturbance (SED). Little is known about community mental health providers' delivery of weight loss interventions to this vulnerable population.ObjectiveThis study examined attitudinal predictors of their providers' intentions to deliver weight loss interventions to youth with SED using the theory of planned behaviour.DesignThis study used a cross‐sectional, single‐time‐point design to examine the relationship of the theory of planned behaviour constructs with behavioural intention.Setting and ParticipantsCommunity mental health providers (n = 101) serving youth with SED in the United States completed online clinical practice and theory of planned behaviour surveys.Main Variables StudiedWe examined the relationship of direct attitude constructs (i.e., attitude towards the behaviour, social norms and perceived behavioural control), role beliefs and moral norms with behavioural intention. Analyses included a confirmatory factor analysis and two‐step linear regression.ResultsThe structure of the model and the reliability of the questionnaire were supported. Direct attitude constructs, role beliefs and moral norms predicted behavioural intention to deliver weight loss interventions.DiscussionWhile there is debate about the usefulness of the theory of planned behaviour, our results showed that traditional and newer attitudinal constructs appear to influence provider intentions to deliver weight loss interventions to youth with SED. Findings suggest preliminary strategies to increase provider intentions.Public ContributionThis study was designed and the results were interpreted as part of a larger, community‐based participatory research effort that included input from youth, families, providers, administrators and researchers. Collaborative discussions with community mental health providers and administrators particularly contributed to the study question asked as well as interpretation of results.

Informal caregivers provide valuable care for ill or disabled adults. Nevertheless, many caregivers experience negative consequences from caregiving such as reduced mental health. Balancing personal costs of caregiving with caregivers' desires or obligations to provide care, is necessary to promote the well-being of these individuals and their care recipients. Drawing on a self-determination theory (SDT) perspective, caregivers whose psychological needs for relatedness, autonomy, and competence are satisfied with their care recipient, and their care recipients' healthcare providers, should be more autonomously motivated to care. Greater autonomous motivation should promote better mental health. This study tested mediation models in a sample of 158 caregivers in the United States. Autonomous motivation was examined as a mediator of the (a) associations between caregivers' need satisfaction with their care recipient and caregiver burden and depressive symptoms, and (b) associations between caregivers' autonomy support received from their care recipients' healthcare providers and caregiver burden and depressive symptoms. Next, specific types of motivation that vary in their relative autonomy were examined as unique mediators. Support was found for models using autonomous motivation as the mediator. Additionally, caregivers' autonomy support and female caregivers' need satisfaction were positively associated with intrinsic motivation to care which was negatively associated with burden. Although much research suggests caregivers' outcomes stem from the care recipients' condition, such as their functional dependence on others, the present study focused on the caregivers' relationships and motivations. Results support an SDT perspective of caregiving. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objectives: The provision of information and referral (I&R) and connection to support services is crucial for individuals with Alzheimer's disease and related dementias (ADRD) and their informal caregivers, especially in rural and remote regions where care and support resources may be limited. The purpose of this study was to develop a deeper understanding of needs for I&R from community stakeholders across a rural and remote state. Methods: A series of town hall meetings were conducted across ten communities in a frontier state. Results: Participants were 175 adults with a mean age of approximately 60 years (SD = 15 years); a majority were non-Hispanic white, female, and self-identified as informal caregivers. Three themes emerged as primary areas of need: (1) to address stigma related to ADRD; (2) to improve the availability of dementia-related I & R; and (3) to efficiently disseminate dementia-related I&R. Conclusions: Findings suggest the importance of a single point of access for I&R with presence in local communities as well as initial and ongoing assessment and provision of appropriate I&R throughout the course of ADRDs.