Partnership Development Among Mental Health Organizations

Mental health organizations can play a key role in enhancing youths\u27 access to care by working together to bridge gaps in service delivery systems. This dissertation study examines partnerships among a network of children\u27s behavioral health organizations. The specific aims are to (1) describe and understand the network of partnerships among members of the Children\u27s Services Coalition, (2) assess the capacity of the system to provide coordinated service delivery, and (3) test how patterns of organizational characteristics influence conditions that facilitate and inhibit partnerships among the Children\u27s Service Coalition organizations. This dissertation is a predominantly quantitative cross-sectional network study of 36 children\u27s mental health organizations in St. Louis County that are members of the newly formed Children\u27s Services Coalition. Network data on relationships and archival data from IRS 990 forms were collected and used to explain how organizational characteristics might lead certain organizations to partner, but create conditions that simultaneously facilitate and hinder the degree to which organizations partner. Overall, the key findings describe partnership behavior at the network, small-group, and dyadic-level. First, children\u27s behavioral health organizations in the CSC maintain a complex set of partnerships, which are expected to grow as new opportunities emerge. Second, although partnerships are very common, the larger network may not be well coordinated as evidenced by the few systematic partnership patterns uncovered using descriptive network analysis techniques including sub-group analysis and blockmodeling. However there is potential for coordination at the sub-group level among small groups of similar organizations. Finally, at the dyadic-level, results of a path analysis demonstrate how similar competing organizations depend on one another for resources and benefit from their collaboration, which drives partnerships. Results suggest that organizational interests drive partnership development in this network, and bring together competing organizations that provide similar resources potentially as a strategy for managing competition, or creating efficiencies. This trend runs counter to system reform goals for bridging organizations with complementary services to facilitate access to quality care

Defining Service Coordination: A Social Work Perspective

To address fragmentation, social workers are encouraged to “coordinate.” This pilot study explores the meaning of, and factors that facilitate or prevent “coordination” and is intended as a first step toward future conceptual refinement, theory development, and system interventions. Using data from treatment guidelines archived by the National Guideline Clearinghouse (n=9) and semi-structured interviews with social workers (n=4), themes related to the definition, indicators, and perceptions of coordination were explored using a grounded theory approach. Data suggest the need for coordination is driven by complex client needs, but the quality of providers’ personal relationships influence coordination. Future research might examine the impact of standardization of roles, referral procedures, and treatment philosophies

Clustered alignments of gene-expression time series data

Motivation: Characterizing and comparing temporal gene-expression responses is an important computational task for answering a variety of questions in biological studies. Algorithms for aligning time series represent a valuable approach for such analyses. However, previous approaches to aligning gene-expression time series have assumed that all genes should share the same alignment. Our work is motivated by the need for methods that identify sets of genes that differ in similar ways between two time series, even when their expression profiles are quite different

Impact of health education on knowledge and practices about menstruation among adolescent school girls of rural part of district Ambala, Haryana

Background: This study was undertaken to assess the impact of health education on knowledge regarding menstruation, misconceptions related to it as the prevalence of RTI is still very high in India.  Aims: To study the existing level of status of hygiene, knowledge and practices regarding menstruation among adolescent school girls and to assess the change in their knowledge level and practices after health education. Materials A community-based pre and post interventional study was conducted among 200 adolescents’ girls of class IX and X of rural part of district Ambala. Multistage random sampling technique was used to draw the representative sample. A pre-tested questionnaire was administered and later health education regarding menstruation and healthy menstrual practices was imparted to the girls. Post-test was done after 3 months to assess the impact of health education. Pre- and post-intervention, data were compared using the paired t test, z test for proportions, chi-squared test for paired proportions. Difference between Proportions of the pre-post data and its 95% confidence interval has been calculated of the findings. SPSS for Windows software version 20 (IBM, Chicago, USA) have been used for data analysis. The level of significance has been considered at p value < 0.05. Results: In the pre-test, menstrual perceptions amongst them were found to be poor and practices incorrect while in the post-test, there was a significant difference in the level of knowledge (P<0.05). There was no significant difference in pre and post-test with regard to restrictions followed during menses (P>0.05) while in the post-test preceding health education, significant improvements were observed in their practices. Conclusion: Overall significant improvement was found in knowledge and practices regarding menstruation among adolescent school girls

Facilitating mental health service use for caregivers: Referral strategies among child welfare caseworkers

Unmet needs for mental health care are common among caregivers involved in the child welfare system. Although child welfare caseworkers are well positioned to identify service needs and refer caregivers to treatment, little is known about the types of referral strategies used in practice, or their effectiveness for promoting mental health service use. The current study examined child welfare caseworkers’ use of different referral strategies and the extent to which these strategies are associated with caregivers’ receipt of mental health services within a national sample of child welfare cases. Analyses of the second cohort of families from the National Survey of Child and Adolescent Well-Being suggest that child welfare workers more often use informational strategies for referring caregivers, including suggesting treatment or providing information about treatment options. However, social referral strategies such as providing caregivers with direct assistance in completing applications and making and attending appointments were associated with a greater likelihood of caregivers receiving mental health services. Findings support evidence from other service contexts that service use is facilitated by caseworkers’ direct support for arranging services. Implications for research and for child welfare managers and administrators are discussed

Context matters: measuring implementation climate among individuals and groups

Abstract Background It has been noted that implementation climate is positively associated with implementation effectiveness. However, issues surrounding the measurement of implementation climate, or the extent to which organizational members perceive that innovation use is expected, supported and rewarded by their organization remain. Specifically, it is unclear whether implementation climate can be measured as a global construct, whether individual or group-referenced items should be used, and whether implementation climate can be assessed at the group or organizational level. Methods This research includes two cross-sectional studies with data collected via surveys at the individual level. The first study assessed the implementation climate perceptions of physicians participating in the National Cancer Institute’s (NCI) Community Clinical Oncology Program (CCOP), and the second study assessed the perceptions of children’s behavioral health clinicians implementing a treatment innovation. To address if implementation climate is a global construct, we used confirmatory factor analysis. To address how implementation climate should be measured and at what level, we followed a five-step framework outlined by van Mierlo and colleagues. This framework includes exploratory factor analysis and correlations to assess differences between individual and group-referenced items and intraclass correlations, interrater agreements, and exploratory factor analysis to determine if implementation climate can be assessed at the organizational level. Results The confirmatory factor analysis demonstrated that implementation climate is a global construct consisting of items related to expectations, support and rewards. There are mixed results, however, as to whether implementation climate should be measured using individual or group-referenced items. In our first study, where physicians were geographically dispersed and practice independently, there were no differences based on the type of items used, and implementation climate was an individual level construct. However, in the second study, in which clinicians practice in a central location and interact more frequently, group-referenced items may be appropriate. In addition, implementation climate could be considered an organizational level construct. Conclusions The results are context-specific. Researchers should carefully consider the study setting when measuring implementation climate. In addition, more opportunities are needed to validate this measure and understand how well it predicts and explains implementation effectiveness

Index selection in terminal sires improves lamb performance at finishing

Lamb meat is often perceived by consumers as fatty, and consumption has decreased in recent decades. A lean growth index was developed in the UK for terminal sire breeds to increase carcass lean content and constrain fat content at a constant age end point. The purposes of this study were 1) to evaluate the effects of index selection of terminal sires on their crossbred offspring at finishing and 2) to evaluate its effectiveness within terminal sire breeds. Approximately 70% of lambs marketed in the UK have been sired by rams of breeds typically thought of as specialized terminal sires. The most widely used are Charollais, Suffolk, and Texel. These breeds participated in sire referencing schemes from the early 1990s by sharing rams among flocks selected on the lean growth index. From 1999 to 2002 approximately 15 “high” and 15 “low” lean growth index score rams were selected from within their sire referencing schemes and mated to Welsh and Scottish Mule ewes. Their crossbred offspring were commercially reared on 3 farms in the UK. Lambs were finished to an estimated 11% subcutaneous fat by visual evaluation. At finishing, lambs were weighed, ultrasonically scanned, and assessed for condition score and conformation. Records were obtained for 6,356 lambs on finishing BW (FWT), ultrasonic muscle depth (UMD), ultrasonic fat depth, overall condition score (OCS), and conformation of gigot, loin, and shoulder. Ultrasonic fat depth was log transformed (logUFD) to approach normality. High-index-sired lambs were heavier at finishing (1.2 ± 0.2 kg) with thicker UMD (0.7 ± 0.2 mm) and less logUFD (0.08 ± 0.01 mm; P \u3c 0.05). There were no differences in OCS or conformation based on the sire index or breed (P \u3e 0.08). Suffolk-sired lambs were heavier than Charollais (1.0 ± 0.3 kg), which were heavier than Texel (0.9 ± 0.3 kg; P \u3c 0.001). Texel-sired lambs had thicker UMD than Charollais (0.7 ± 0.2 mm; P \u3c 0.001) but were not different than Suffolk. Charollais-sired lambs had greater logUFD than both Texel (0.098 ± 0.016 mm) and Suffolk (0.061 ± 0.017 mm) sired lambs (P \u3c 0.001). Within a breed, high- and low-index-sired lambs differed in performance with the exceptions of FWT and UMD in Suffolks. Index selection produced heavier and leaner lambs at finishing. Producers have flexibility in choosing the terminal sire that best fits their production system

Index selection in terminal sires improves early lamb growth

The use of terminal sires (TS) for crossbreeding is integral to the UK sheep industry where approximately 71% of market lambs are sired by TS rams. Early growth of these crossbred lambs affects profitability. The objectives of this study were i) to evaluate the effectiveness of index selection among TS on BW and ADG of their crossbred offspring; and ii) to compare the efficacy of that selection within TS breeds. The most widely used TS breeds in the United Kingdom are Charollais, Suffolk, and Texel. These participated in sire referencing schemes in which they were evaluated on a lean growth index designed to increase carcass lean weight at a given age. From 1999 to 2002, approximately 15 high and 15 low lean growth index rams per breed (93 in total, differing in index on average by 4.6 SD) were selected from within their sire referencing schemes and mated to Welsh and Scottish Mule ewes. Their crossbred offspring were reared commercially on 3 experimental farms in England, Scotland, and Wales. A total of 6,515 lambs were born between 2000 and 2003. Lambs were weighed at birth (BWT), 5 wk (5WT), and 10 wk (10WT), and their ADG from birth to 10 wk was calculated. Lambs sired by high index rams were on average, across breeds, heavier at all ages (P \u3c 0.01) with 0.07 ± 0.03, 0.3 ± 0.1, and 0.4 ± 0.1 kg greater BWT, 5WT, and 10WT, respectively. Their ADG was 5.1 ± 1.9 g/d greater than low-index-sired lambs (P \u3c 0.01). Suffolk-sired lambs were on average heavier at all ages, with greater ADG, whereas Charollais-sired lambs were lightest with smallest ADG. Overall, there was no significant interaction between sire index and sire breed (P \u3e 0.10). Within Suffolk-sired lambs, there was little difference between high and low index sires for the traits studied (P \u3e 0.3). High and low index Charollais-sired lambs differed in BWT (0.09 ± 0.04 kg) and 5WT (0.3 ± 0.1 kg), and Texel-sired lambs differed in 5WT (0.5 ± 0.1 kg), 10WT (0.9 ± 0.2 kg), and ADG (10.2 ± 3.3 g/d; P \u3c 0.01). Lambs from Scottish Mule dams were heavier, with greater ADG, than lambs born to Welsh Mules (P \u3c 0.01). Lambs reared in Scotland were heavier at all ages (P \u3c 0.01). The results suggest that using index selection in TS can improve the growth of their commercial offspring reared on grass

Public health program capacity for sustainability: A new framework

Abstract Background Public health programs can only deliver benefits if they are able to sustain activities over time. There is a broad literature on program sustainability in public health, but it is fragmented and there is a lack of consensus on core constructs. The purpose of this paper is to present a new conceptual framework for program sustainability in public health. Methods This developmental study uses a comprehensive literature review, input from an expert panel, and the results of concept-mapping to identify the core domains of a conceptual framework for public health program capacity for sustainability. The concept-mapping process included three types of participants (scientists, funders, and practitioners) from several public health areas (e.g., tobacco control, heart disease and stroke, physical activity and nutrition, and injury prevention). Results The literature review identified 85 relevant studies focusing on program sustainability in public health. Most of the papers described empirical studies of prevention-oriented programs aimed at the community level. The concept-mapping process identified nine core domains that affect a program’s capacity for sustainability: Political Support, Funding Stability, Partnerships, Organizational Capacity, Program Evaluation, Program Adaptation, Communications, Public Health Impacts, and Strategic Planning. Concept-mapping participants further identified 93 items across these domains that have strong face validity—89% of the individual items composing the framework had specific support in the sustainability literature. Conclusions The sustainability framework presented here suggests that a number of selected factors may be related to a program’s ability to sustain its activities and benefits over time. These factors have been discussed in the literature, but this framework synthesizes and combines the factors and suggests how they may be interrelated with one another. The framework presents domains for public health decision makers to consider when developing and implementing prevention and intervention programs. The sustainability framework will be useful for public health decision makers, program managers, program evaluators, and dissemination and implementation researchers

Advice-seeking during implementation: a network study of clinicians participating in a learning collaborative

Abstract Background Successful implementation depends on the transfer of knowledge and expertise among clinicians, which can occur when professionals seek advice from one another. This study examines advice-seeking patterns among mental health clinicians participating in learning collaboratives (a multi-component implementation and quality improvement strategy) to implement trauma-focused cognitive behavioral therapy (TF-CBT). We apply transactive memory system theory, which explains how professionals access and retrieve knowledge, to examine factors associated with the evolution of advice-seeking relationships during implementation. Our aim is to unpack learning collaboratives’ mechanisms by investigating how and why advice-seeking networks change, which may help us understand how implementation strategies can best target networks. Methods Using social network analysis and a pretest-post-test design, we examined patterns in general and treatment-specific advice-seeking among 146 participants (including five clinical experts) from 27 agencies participating in a regional scale-up of TF-CBT. Surveys were administered in-person at the first and last of three in-person learning sessions (10 months apart) that comprise a core component of learning collaboratives. Participants nominated up to five individuals from whom they seek general and treatment-specific advice. Exponential random graph models (ERGMs) tested the likelihood of maintaining or forming advice-seeking relationships based on indicators of expertise quality, accessibility, need, and prior advice-seeking relationships. Results Participants formed or maintained advice-seeking relationships with those who possess perceived expertise (e.g., learning collaborative faculty experts, supervisors, and those with greater field experience than themselves). Participants also tended to seek advice from those within the same organization and with similar disciplinary training, highlighting the importance of expertise accessibility. Prior relationships and network structural features were associated with advice-seeking, indicating that participants built on existing social ties. Advice-seeking did not vary based on participants’ role or experience. Conclusions Given the importance of accessible clinical expertise and ongoing supervision for delivering treatment with fidelity, learning collaboratives may support implementation by promoting clinicians’ awareness of and access to others’ expertise, especially those with substantial expertise to share (e.g., faculty experts and supervisors). Future controlled studies are needed to verify the effectiveness of learning collaboratives for building networks that connect clinicians and experts and for improving implementation