Promotoras as Mental Health Practitioners in Primary Care: A Multi-Method Study of an Intervention to Address Contextual Sources of Depression

We assessed the role of promotoras—briefly trained community health workers—in depression care at community health centers. The intervention focused on four contextual sources of depression in underserved, low-income communities: underemployment, inadequate housing, food insecurity, and violence. A multi-method design included quantitative and ethnographic techniques to study predictors of depression and the intervention’s impact. After a structured training program, primary care practitioners (PCPs) and promotoras collaboratively followed a clinical algorithm in which PCPs prescribed medications and/or arranged consultations by mental health professionals and promotoras addressed the contextual sources of depression. Based on an intake interview with 464 randomly recruited patients, 120 patients with depression were randomized to enhanced care plus the promotora contextual intervention, or to enhanced care alone. All four contextual problems emerged as strong predictors of depression (chi square, p < .05); logistic regression revealed housing and food insecurity as the most important predictors (odds ratios both 2.40, p < .05). Unexpected challenges arose in the intervention’s implementation, involving infrastructure at the health centers, boundaries of the promotoras’ roles, and “turf” issues with medical assistants. In the quantitative assessment, the intervention did not lead to statistically significant improvements in depression (odds ratio 4.33, confidence interval overlapping 1). Ethnographic research demonstrated a predominantly positive response to the intervention among stakeholders, including patients, promotoras, PCPs, non-professional staff workers, administrators, and community advisory board members. Due to continuing unmet mental health needs, we favor further assessment of innovative roles for community health workers

Teacher education, motivation, compensation, workplace support, and links to quality of center-based child care and teachers’ intention to stay in the early childhood profession

The purposes of this study were to present a conceptual model for selection into the early childhood profession and to test the model using contemporaneous assessments. A stratified random sample of center-based child care providers in 4 Midwestern states (n = 964) participated in a telephone interview, and 223 were also assessed with the Early Childhood Environment Rating Scale—Revised or the Infant–Toddler Environment Rating Scale to rate global observed quality, and the Caregiver Interaction Scale to rate interactional quality. When the model was tested with infant–toddler and preschool teachers combined, having a Child Development Associate (CDA) predicted global observed quality, education years and child development coursework predicted compensation, and compensation predicted observed quality. When the model was tested separately for infant–toddler teachers, years of education and child development coursework predicted compensation, but none of the education variables predicted observed quality and compensation did not predict observed quality. For preschool teachers, years of education predicted compensation and having a CDA predicted observed quality, but compensation did not predict observed quality. For all of the models, only motivations for child care work predicted intention to stay in the profession. No variables in the structural equation models predicted interactional quality

Family income, parent education, and perceived constraints as predictors of observed program quality and parent rated program quality

Observed child care quality and parent perceptions of child care quality received by children in poor (below Federal Poverty Line, FPL), low-income (between FPL and 200% of FPL), and non-low-income families were examined. Observations were completed in 359 center- and home-based child care programs in four Midwestern states and surveys were received from 1313 parents whose children were enrolled in these programs. Multilevel structural equation modeling revealed that programs with higher proportions of low-income families tend to have lower observed quality than programs with a higher proportion of non-low-income families. Programs with more educated parents tended to have better observed quality, however, more educated parents tended to have lower perceptions of quality

Food insecurity: is it an issue among tertiary students?

Insufficient access to food is known to compromise tertiary studies. Students often belong to groups known to have poor food security such as those renting or relying on government payments. The present study administered a cross-sectional survey incorporating the USDA food security survey module (FSSM) to 810 students at a metropolitan university in Brisbane, Australia. One in four students indicated they were food insecure, this being double that previously reported for tertiary students and five times that previously reported for the general population. Factors associated with food insecurity included low income, reliance on government support and renting. Students from food insecure households were twice as likely to report only fair or poor general health and three times as likely to have deferred their studies due to financial difficulties. Further, at least 80 % of these students reported that their studies were compromised. Strategies to alleviate food insecurity among students could improve retention rates and educational outcomes