Sustained home visiting for vulnerable families and children: a review of effective processes and strategies

Parenting young children has become a more complex and stressful business, especially for those families in our community with the least resources (Grose, 2006; Hayes et al, 2010; Poole, 2004; Richardson & Prior, 2005; Trask, 2010). A widening gap exists between families that function well and those that are vulnerable. The paradox of service delivery for children and families is that vulnerable families – that is, those families with the greatest needs – are also the least likely to be able to access those services (Ghate & Hazel, 2002; Fram, 2003). A range of barriers exist for vulnerable and at risk families in making use of services (Carbone et al, 2004). One of the key barriers to vulnerable families accessing services is that many find it difficult to relate to the formal service system and are easily alienated by practices others find acceptable. Research regarding parents’ experiences of support services suggests that parents want services where they are simultaneously cared for and enabled in their role as parents, and to receive services characterised by empathy, competence, functionality, respect, flexibility and honesty (Attride-Stirling et al, 2001; Winkworth et al, 2009). Vulnerable parents fear a loss of autonomy in their interactions with support services and want services that are non-judgemental and that provide continuity of care (Ghate & Hazel, 2002; von Bultzingslowen, 2006). In addition to the barriers faced by vulnerable and marginalised families in accessing services, the system does not work in an integrated or coherent fashion to ensure that all children and families needing support receive it. Furthermore, the vast majority of services for children and families in Australia do not have an outreach function, that is, a means of engaging these vulnerable and at risk families who are in need of support but use services inconsistently or not at all. In short, the service system was not designed to meet the needs of vulnerable families within the context of a rapidly changing social and economic climate. Therefore, many families requiring support are not receiving it. Related identifier: ISSN 2204-340

The science of intervention development for type 1 diabetes in childhood: a systematic review

This paper is a report of a review of the science of intervention development for type 1 diabetes in childhood and its implications for improving health outcomes in children, adolescents, and/or their families

Building Effective Responses: An Independent Review of Violence against Women, Domestic Abuse and Sexual Violence Services in Wales

Independent researchers from the Connect Centre for International Research on Interpersonal Violence based in the School of Social Work at the University of Central Lancashire were commissioned by the Welsh Government in 2013 to conduct research into violence against women, domestic abuse and sexual violence services in Wales. The research aimed to inform the forthcoming Ending Violence Against Women and Domestic Abuse (Wales) Bill, implementation of the legislation and future policy more generally, as well as informing future funding decisions. The remit of the review covers: Domestic abuse, including that experienced in Lesbian, Gay, Bisexual and Transgender (LGBT) relationships and elder abuse. Violence against women, including female genital mutilation (FGM), forced marriage and honour-based violence. Sexual violence including rape, sexual assault and harassment Sexual exploitation including prostitution and trafficking1 for sexual purposes. Services for women and men who are victims or perpetrators of violence against women, domestic abuse or sexual violence. The review does not encompass criminal justice services or housing services and, with the exception of prevention work, services for children and young people in Wales were also excluded from this study

Development and Usability Testing of an Internet Intervention to Increase Physical Activity in Overweight Adolescents

Background: Internet interventions may provide opportunities for low threshold counseling using feedback to guide and support health behavior, including increased physical activity. Research shows that overweight and obese adolescents are less physically active than their peers of normal weight. There are good reasons to believe that Internet-based interventions may be particularly suitable for motivating adolescents to increase physical activity, but we need to gain further knowledge of what features are effective and how to design such interventions. Objective: To describe the process of development and evaluation of usability of a Web-based program for increasing physical activity in overweight adolescents. Methods: Informed by the self-determination theory, motivational interviewing, and perspectives on self-regulation, this intervention was developed in a stepwise process by an interdisciplinary team of researchers, designers, developers, and representatives from the target group. An iterative qualitative usability testing approach (observation, survey, and interview) was applied in 2 sequences, first in the lab and second in the field, to assess how adolescents (aged 12-16 years) used and experienced the program and to make adjustments to the program based on evaluation of their response. Results: The following components were included in the program: self-monitoring through planning and registration of physical activity and graphical response on progress, autonomy supportive individual Web-based counseling, forum for social support, and relevant age-adjusted information about physical activity. The first usability test resulted in adjustments related mainly to making the content and aim of the different features more visible and explicit. The second test evaluated the program with adjustments from the first test, revealing that the program was well accepted by the participants and only small aesthetic adjustments had to be made to complete the final version of the Internet program, Young & Active. Conclusions: Thorough preparation, with clear theory foundation and close monitoring in the developmental phase, as well as contribution and iterative evaluation from the target group, is essential to create a user-friendly and engaging program. The efficacy of the program will be evaluated in a controlled trial

Interventions to improve treatment, retention and survival outcomes for adolescents with perinatal HIV-1 transitioning to adult care: moving on up

PURPOSE OF REVIEW: There is an increasing number of deaths among adult survivors of perinatal HIV. Multiple and complex factors drive this mortality, including problems with retention in care and adherence during adolescence, coupled with the critical period of transition from paediatric to adult care, increasing their risk of treatment failure and severe immunosuppression. We reviewed studies that evaluated the impact of service delivery interventions to improve the health of perinatally infected adolescents living with HIV (P-ALHIV) to gain insight into what might help them survive the vulnerable period of adolescence. RECENT FINDINGS: Youth-focused health services and individual-level interventions may improve P-ALHIV adherence and retention in care. However, there have been few studies, many with small sample sizes and with short durations of follow-up that end before the transition period. Studies from other childhood-onset chronic diseases are similarly limited. SUMMARY: Further studies are urgently needed to identify optimal intervention strategies to reduce mortality and poor outcomes as the adolescent population expands and ages into adult care. Until we have a more robust evidence base, programmes can develop transition plans based on best practice recommendations to optimize the health and longevity of ALHIV in adulthood

Addressing Childhood Obesity in a Rural Community Using Motivational Interviewing

Abstract Purpose: Childhood obesity is a significant health problem associated with increased adult morbidity and mortality. Rural areas like Central Valley California demonstrate disproportionate rates of obesity. Children in rural and underserved populations are at a higher risk of developing obesity. Data suggest that obesity is often under-addressed during routine health care visits. Primary care practitioners are the first point of health care contact and have a unique opportunity to prevent and address obesity through health monitoring and education. In response to escalating rates of obesity, clinical recommendations have been established for primary care providers including the use of patient-centered approaches to motivate families on behavior change. The use of Motivational Interviewing (MI) encourages the patient to recognize their readiness for change, assess the benefits of embracing healthy behavior, and evaluate their confidence and perceived ability to make the change. Recommended behavioral changes to address childhood obesity include encouraging consumption of nourishing foods rich in whole grains, low fat or fat-free foods, fruits and vegetables, lean meat and other protein sources, and daily physical activity of 60 minutes or more for ages 6 to 18 with emphasis on aerobic, muscle, and bone strengthening. This DNP student developed a health promotion project that focused on educating Family Nurse Practitioner (FNP) students from the University of San Francisco (USF) and San Jose State University (SJSU) on best practices for addressing childhood obesity in the primary care setting. A prevention strategy was designed to use MI to address childhood obesity within the context of a routine pediatric health screening. Method: An in-service was conducted for the FNP students including (a) MI techniques and Change Talk interactive scenario to elicit change in behavior, physical activity, and diet; (b) BMI screening guidelines; (c) 5-2-1-0 rule educational tool; (d) the Choose My Plate educational tools; and (e) the Healthy Eating and Activity Together (HEAT) educational tool. Interventions were implemented at Reedley and Orange Cove High Schools in Kings Canyon Unified School District in Fresno County during the sports physical assessment program. Measures: Evaluation metrics included a pre/post-test questionnaire to measure student FNP (n=15) knowledge and confidence after delivery of the MI education to students from Reedley and Orange Cove High Schools. The survey evaluated the knowledge of MI techniques, childhood obesity prevention readiness, confidence in the use of MI, and potential barriers to participating in the prevention strategies. Results: Project outcomes showed an increased mean of 4.13 (SD 1.06) in knowledge, while confidence increased from mean of 2.6 (SD .06) to 4.13 (SD 0.64) in MI techniques, childhood obesity screening guidelines, and BMI screening. Conclusions: Outcomes indicate that an education program can increase student FNP’s knowledge and confidence in using the MI techniques to address childhood obesity in the primary care setting. Keywords: Motivational Interviewing, Childhood Obesity, Central Californi

Can-Do-Tude: an Online Intervention Using Principles of Motivational Interviewing and Tailored Diabetes Self-Management Education for Adolescents with Type 1 Diabetes

abstract: Type 1 diabetes (T1D) is one of the most common chronic diseases in youth and it has been shown that adolescents have the worst glycemic control of any age group. The objective of this study was to develop, test and evaluate the feasibility of an online intervention (Can-Do-Tude) that uses the principles of motivational interviewing (MI) to deliver tailored diabetes self-management education to adolescents with T1D. Bandura’s efficacy belief system was used to guide the design of this study. The study used a multi-phase, multi-method approach. The first phase (alpha) of this study was a qualitative descriptive design to examine the intervention’s fidelity. Evaluation of performance was conducted by experts in the fields of MI, T1D, adolescence and/or online education. The second phase (beta) was a quantitative descriptive design conducted in order to evaluate feasibility by examining the acceptability (recruitment, retention and satisfaction) and implementation (diabetes self-management self-efficacy) to determine whether the intervention was appropriate for further testing. First phase findings showed that the intervention passed all measures with the content experts (n = 6): it was functional, accurate, usable and secure. Improvements to the intervention were made based on reviewer recommendations. For the second phase 5 adolescents between 14 and 17 were enrolled. Three adolescents completed all 4 weeks of the intervention while 2 completed only 3 weeks. Participants (n = 3) rated satisfaction on a 5-point Likert-type scale ranging from “not at all” satisfied (1) to “very much” satisfied (5). There was a positive response to the intervention (M = 4.28, SD = 0.55). Implementation was measured by a pre- and post-test for diabetes self-management self-efficacy. Participants (n = 3) demonstrated overall improvements in diabetes self-management self-efficacy (Z = -2.952, p = .007). Implications for further Can-Do-Tude research are planned at a metropolitan diabetes center using updated technology including an application platform. Although the sample was small, findings indicate that the intervention can be conducted using a web-based format and there is initial evidence of improvement in self-efficacy for diabetes self-management.Dissertation/ThesisDoctoral Dissertation Nursing and Healthcare Innovation 201

Bridge Builders to Health Equity: The High School Community Health Worker Training Program

Background: During the summers of 2016- 2019, Morehouse School of Medicine (MSM) with the support of community partners, developed, piloted and implemented an innovative Community Health Worker Training Program for High School students (HSCHW). Training high school community health workers can impact health and social disparities in underserved populations and demonstrates pipeline of future workers in community health and other health careers. The program has achieved promising outcomes, and access to the program model has been requested many universities and community-based organizations. Method: The HSCHW training consists of summer classroom instruction, field instruction and monthly continuing education during the school year. The students are trained in CHW core competencies through a combination of online curriculum, interactive classroom experiences, and field activities provided by community partners, multidisciplinary MSM clinical instructors, and graduate student interns. Results: 77 high school students from metropolitan Atlanta High Schools and rural Columbus, GA have been trained as CHWs in the HSCHW program. Students are ages 15-18 and are rising sophomores to recent high school graduates. All participants (100%) were from economically disadvantaged communities. Sixteen school-based and community-based health improvement projects have been developed and implemented by teams of trained HSCHWs. Additionally, over 300 individuals (family and community members) received monthly health monitoring by trained HSCHWs. Conclusions: Overall, the HSCHW program models the engagement of community partners in translational educational initatives to support community transformation. It can be a giant leap toward improved population health and achieving health equity in underserved communities. It has had a tremendous impact on the youth themselves, their families, and the communities in which they live. In communities with disparate prevalence of chronic disease and unhealthy behaviors, early exposure may mitigate exacerbation or early onset of disease among the participants and their families. High School Community Health Workers are bridges to health equity

Youth involvement in alcohol and drug prevention: A systematic review

To review and analyse how youth involvement was conceptualised and applied in published alcohol and drug preventive interventions. A systematic review of the scientific literature on alcohol and drug prevention where young people (18–29 years old) participated at any stage of the intervention was conducted. We searched relevant bibliographic databases and online repositories for peer-reviewed studies published between 2001 and 2021. Twenty-seven articles reporting on studies in different countries and settings and using a variety of intervention strategies were eligible for inclusion. The analysis of the stages of youth involvement and the dimension of power sharing in decision-making showed that only a minority of studies could be considered genuinely youth-led whereas many involved young people merely as implementers of highly controlled research-led interventions. However, the few studies that promoted sustained youth involvement struggled with translating results into rigorously evaluated interventions, thus demonstrating a tension between adoption of effective interventions and support to genuinely participatory processes. Knowledge gaps and implications for practice and research are discussed from a participatory research perspective

Respite Partnership Collaborative (RPC) Innovation Project Evaluation: Final Report

The Mental Health Services Act (MHSA)—funded by Proposition 63—supports five unique components: (1) Community Services and Supports, (2) Prevention and Early Intervention, (3) Workforce Education and Training, (4) Capital Facilities and Technology, and (5) Innovative Programs. In September 2010, the Sacramento County Division of Behavioral Health Services (DBHS) initiated a community planning process to develop Sacramento's first Innovation Project. DBHS convened an Innovation Workgroup that developed the Innovation Plan and the Respite Partnership Collaborative (RPC) Innovation Project.Through a competitive selection process, Sacramento County DBHS awarded Sierra Health Foundation: Center for Health Program Management (the Center) a contract to administer the RPC Innovation Project. The RPC Innovation Project is a public-private partnership of the Sacramento County DBHS and the Center. The Center uses MHSA Innovation funding to support the RPC, whose members are from the community at large. RPC members make recommendations for respite service grants to community organizations. The RPC's goal is to increase local mental health respite service options to offer alternatives to hospitalization for community members experiencing a crisis in Sacramento County.American Institutes for Research (AIR) conducted an evaluation of the RPC Innovation Project from April 2013 through March 2016. Evaluation objectives were to assess the extent to which the RPC Innovation Project achieved the following:1. Promoted successful collaboration between public and private organizations (i.e., DBHS and the Center) in Sacramento County2. Demonstrated a community-driven process3. Improved the quality and outcomes of respite services in Sacramento County This report presents findings from evaluation activities, which included stakeholder interviews, RPC member surveys, and document reviews.This report emphasizes data collected in the third year of the evaluation after June 2015. The report begins with a brief history of the RPC Innovation Project. Next we describe evaluation objectives and methods for conducting the evaluation. Finally, we present findings, organized by evaluation objective