Assessment Interview Research Articles

Introducing an interview-based cognitive assessment tool for people with Schizophrenia in Ethiopia

Assessment of cognitive impairment in people with schizophrenia (PWS) is limited in low and middle-income countries due to lack of context-appropriate measures. This study aimed to select, adapt, and evaluate an interview-based cognitive tool for PWS in Ethiopia. The study was carried out in three phases. In the first phase, we followed a rigorous instrument selection procedure to select a tool for adaptation. We then applied a rigorous instrument adaption procedure, including interviews with 24 participants. Finally, we evaluated the psychometric properties of the adapted tool with 208 PWS and 208 matched controls. The Cognitive Assessment Interview was selected as the appropriate tool for adaptation. This tool is practical and tolerable, with short time of administration. We reported high inter-rater reliability and test-retest reliability for the adapted scale. One-factor structure better represented the data with excellent internal consistency. Weak but significant correlation with a performance-based battery was reported. At a cut-off value of > 13, the tool significantly differentiated PWS from controls (62 % sensitivity and 82 % specificity). Item Response Theory-based analysis showed that the tool gives much information among severely impaired participants. The findings show that the tool is reliable, valid, and practical in resource-scarce settings.

Prevalence of Cognitive Impairment among Elderly in Primary Health Care Centers in Cairo, Egypt

Abstract Background Cognitive impairment (CI) in the elderly is a growing worldwide public health problem. Symptomatic CI is under-diagnosed, even though early detection in dementia care is of great significance and allowing the person to be involved in future care planning. Objectives To measure the prevalence of CI among elderly patients attending primary health care centers in Elsharabya, Egypt and to identify different risk factors associated with CI. Methods A cross-sectional study was performed among 154 elderly using an interview questionnaire including socio-demographic data, Saint – Louis – University – Mental – Status (SLUMS), Test your memory (TYM)) and General practitioner Assessment of Cognition (GPCOG) questionnaires. Results 51.3% of the studied elderly suffered from mild CI compared to 32.5% suffered from marked CI by SLUM. 68.8% suffered from CI by TYM. 83.3% and 13.0% of them were classified as CI by patient assessment and caregiver interview of GPCOG respectively. The most significant factors associated with CI were being older, non-married, and low educational levels. Conclusions and Recommendations The prevalence of CI is high among the studied elderly. Early identification of CI is important to delay the progression to Alzheimer’s disease and achieve a better quality of life.

Resting-state perfusion in motor and fronto-limbic areas is linked to diminished expression of emotion and speech in schizophrenia

Negative symptoms (NS) are a core component of schizophrenia affecting community functioning and quality of life. We tested neural correlates of NS considering NS factors and consensus subdomains. We assessed NS using the Clinical Assessment Interview for Negative Symptoms and the Scale for Assessment of Negative Symptoms. Arterial spin labeling was applied to measure resting-state cerebral blood flow (rCBF) in 47 schizophrenia patients and 44 healthy controls. Multiple regression analyses calculated the relationship between rCBF and NS severity. We found an association between diminished expression (DE) and brain perfusion within the cerebellar anterior lobe and vermis, and the pre-, and supplementary motor area. Blunted affect was linked to fusiform gyrus and alogia to fronto-striatal rCBF. In contrast, motivation and pleasure was not associated with rCBF. These results highlight the key role of motor areas for DE. Considering NS factors and consensus subdomains may help identifying specific pathophysiological pathways of NS.

Biological rhythms are correlated with Na+, K+-ATPase and oxidative stress biomarkers: A translational study on bipolar disorder

BackgroundBipolar disorder (BD) is a chronic, severe, and multifactorial psychiatric disorder. Although biological rhythms alterations, sodium potassium pump (Na+, K+-ATPase) changes, and oxidative stress appear to play a critical role in the etiology and pathophysiology of BD, the inter-connection between them has not been described. Therefore this study evaluated the association between biological rhythms, Na+, K+-ATPase, and oxidative stress parameters in BD patients and the preclinical paradoxical sleep deprivation model (PSD). MethodsA translational study was conducted, including a case-control protocol with 36 BD and 46 healthy controls (HC). Subjects completed the Biological Rhythm Interview of Assessment in Neuropsychiatry (BRIAN). In addition, Erythrocyte Na+, K+-ATPase activity, and oxidative and nitrosative stress markers were assessed (4-hydroxynonenal [4-HNE], 8-isoprostane [8-ISO], thiobarbituric acid reactive substances [TBARS], carbonyl, 3-nitrotyrosine [3-nitro]). In the preclinical protocol, the same biomarkers were evaluated in the frontal cortex, hippocampus, and striatum from mice submitted to the PSD. ResultsBD patients had a significantly higher total score of BRIAN versus HCs. Additionally, individuals with BD showed decreased Na+, K+-ATPase activity and increased oxidative stress parameters compared to HC without psychiatric disorders. This difference was driven by actively depressed BD subjects. The mice submitted to the PSD also demonstrated decreased Na+, K+-ATPase activity and increased oxidative stress parameters. LimitationsBRIAN biological underpinning is less well characterized; We did not control for medication status; Sample size is limited; PSD it is not a true model of BD. ConclusionsThe present study found a significant correlation between Na+, K+-ATPase and oxidative stress with changes in biological rhythms, reinforcing the importance of these parameters to BD.

"The library is so much more than books": considerations for the design and implementation of teen digital mental health services in public libraries.

Adolescence is a vulnerable developmental period, characterized by high rates of mental health concerns, yet few adolescents receive treatment. Public libraries support adolescents by providing them with access to teen programming, technological resources, and have recently been providing mental health services. Digital mental health (DMH) services may help libraries provide scalable mental health solutions for their adolescent patrons and could be well positioned to address the mental health needs of historically underrepresented racial and ethnic (HURE) adolescents; however, little research has been conducted on the compatibility of DMH services with adolescent patron mental health needs or resource needs of library workers supporting them. The research team formed a partnership with a public library, which serves a large HURE adolescent population. We conducted needs assessment and implementation readiness interviews with 17 library workers, including leadership, librarians, and workers with specialized areas of practice. Interview questions focused on library infrastructure, as well as library needs and preferences around the design and implementation of DMH services for adolescents. We used the Consolidated Framework for Implementation Research as guiding implementation determinant framework to code and analyze the interview transcripts. Our findings revealed library workers play an important role in guiding patrons to desired resources and share a goal of implementing adolescent DMH resources into the library and elevating marginalized adolescents' voices. Existing library resources, such as the library's role as a safe space for adolescents in the community, close relationships with external and community organizations, and availability of no-cost technological resources, could help facilitate the implementation of DMH services. Barriers related to community buy-in, mental health stigma, and library worker confidence in supporting adolescent mental health could affect service implementation. Our findings suggest public libraries are highly promising settings to deploy DMH services for adolescents. We identified important determinants that may impact the implementation of DMH services in public library settings. Special considerations are needed to design services to meet the mental health needs of HURE adolescent populations and those adolescents' most experiencing health inequities.

Person-Centred, Culturally Appropriate Music Intervention to Improve Psychological Wellbeing of Residents with Advanced Dementia Living in Australian Rural Residential Aged Care Homes.

This quasi-experimental, nonrandomized intervention study reports the effect of person-centred, culturally appropriate music on psychological wellbeing of residents with advanced dementia in five rural residential aged care homes in Australia. Seventy-four residents attended in person-centred music sessions and culturally appropriate group sessions. Interest, response, initiation, involvement, enjoyment, and general reactions of the residents were assessed using the Music in Dementia Assessment Scale (MiDAS), and interviews and focus groups were conducted with aged care staff and musicians. The overall effect of person-centred sessions at two-time points were: during the intervention-351.2 (SD 93.5); and two-hours post intervention-315.1 (SD 98.5). The residents presented a moderate to high level of interest, response, initiation, involvement, and enjoyment during the session and at post-intervention. However, the MiDAS sub-categories' mean scores differed between the time-points: interest (t59 = 2.8, p = 0.001); response (t59 = 2.9, p = 0.005); initiation (t59 = 2.4, p = 0.019); and involvement (t59 = 2.8, p = 0.007), indicating a significant decline in the effect of person-centred music over time. Interestingly, during the period of time, most of the residents were observed with no exhibitions of agitation (87.5%), low in mood (87.5%), and anxiousness (70.3%), and with a presentation of relaxation (75.5%), attentiveness (56.5%), and smiling (56.9%). Themes from qualitative data collected regarding culturally appropriate group music sessions were behavioural change, meaningful interaction, being initiative, increased participation, and contentment. The findings suggest that the integration of music into care plans may reduce the residents' agitation and improve their emotional wellbeing in rural aged care homes.

Opioids and Chronic Pain: Impact of the NIH Pathways to Prevention Evidence-Based Workshop Program.

The National Institutes of Health (NIH) Office of Disease Prevention (ODP) sponsors Pathways to Prevention (P2P), an evidence-based scientific workshop program that helps advance prevention research. Each P2P workshop is presided over by an independent expert panel and informed by a systematic evidence review, scientific presentations, and public input. Post-workshop activities include collaborating with federal agency partners to develop an action plan for addressing key research gaps. Primary outcomes of P2P workshops include developing a research agenda and creating or enhancing initiatives to implement the agenda. In 2014, ODP partnered with the NIH Pain Consortium and two NIH institutes to convene "The Role of Opioids in the Treatment of Chronic Pain." This workshop assessed the state-of-the-science on the long-term effectiveness, safety, and harms of opioid use for managing chronic pain. In 2021, ODP initiated an assessment of the outcomes and impact of the Opioids P2P workshop. We applied an evaluation framework and a mixed methods approach encompassing web analytics, bibliometric assessment, grant portfolio analysis, policy assessment, and key informant interviews. Our data showed that the workshop attracted a broad audience, and its published reports had high impact. The workshop also helped inform over 100 new research projects through grants funded by three federal agencies, as well as national legislation and practice guidelines from influential organizations. In sum, the Opioids P2P workshop and follow-up activities have identified gaps in scientific knowledge, informed clinical practice, and catalyzed change on a national level for addressing the prescription opioid crisis.

Implementing a revised online screening tool in a routine care online clinic treating anxiety and depression.

The ItFits implementation toolkit was developed as part of the ImpleMentAll EU Project, to help guide implementation processes. The ItFits toolkit was tested in the online clinic, Internetpsykiatrien, in the Region of Southern Denmark, where it was employed to optimize screening and intake procedures. We hypothesized that a larger proportion of assessed patients would be referred to treatment. Further, we hypothesized the completion rate and effectiveness would increase, as a result of including a more relevant sample. Using the ItFits-toolkit, Internetpsykiatrien developed a revised online screening tool. Data on patient flow and symptom questionnaires was extracted from Internetpsykiatrien six months prior to- and six months after implementation of the revised online screening tool. A total of 1,830 applicants self-referred for treatment during the study period. A significantly lower proportion of patients were referred to treatment after implementation of the revised screening tool (pre-implementation, n = 1,009; post-implementation, n = 821; odds ratio 0.67, 95% CI: 0.51; 0.87). The number of patients that completed treatment increased significantly (pre-implementation: 136/275 [49.45%], post-implementation, n = 102/162 [62.96%]; odds ratio 1.79, 95% CI 1.20; 2.70). The treatment effect was unchanged (B = 0.01, p = .996). Worth noting, the number of patients that canceled their appointment for the video assessment interview decreased drastically. By using the ItFits toolkit for a focused and structured implementation effort, the clinic was able to improve the completion rate, which is an important effect in iCBT. However, contrary to our hypotheses, we did not find an increase in clinical effect, nor a larger ratio being referred to treatment after assessment. The decreased number of referrals for treatment could be a result of increased awareness of inclusion criteria among the clinicians.

Insight in cognitive impairment assessed with the Cognitive Assessment Interview in a large sample of patients with schizophrenia

The Cognitive Assessment Interview (CAI) is an interview-based scale measuring cognitive impairment and its impact on functioning in subjects with schizophrenia (SCZ). The present study aimed at assessing, in a large sample of SCZ (n = 601), the agreement between patients and their informants on CAI ratings, to explore patients’ insight in their cognitive deficits and its relationships with clinical and functional indices. Agreement between patient- and informant-based ratings was assessed by the Gwet’s agreement coefficient. Predictors of insight in cognitive deficits were explored by stepwise multiple regression analyses. Patients reported lower severity of cognitive impairment vs. informants. A substantial to almost perfect agreement was observed between patients’ and informants’ ratings. Lower insight in cognitive deficits was associated to greater severity of neurocognitive impairment and positive symptoms, lower severity of depressive symptoms, and older age. Worse real-life functioning was associated to lower insight in cognitive deficit, worse neurocognitive performance, and worse functional capacity. Our findings indicate that the CAI is a valid co-primary measure with the interview to patients providing a reliable assessment of their cognitive deficits. In the absence of informants with good knowledge of the subject, the interview to the patient may represent a valid alternative.

Developing the Types of Exercise to Improve the Agility of Wheelchair Badminton Athletes

This study aims to produce a developing product of exercise types to improve the agility of disabled badminton athletes. This research and development is conducted by adapting development research steps as follows: (1) preliminary studies, (2) initial draft design, (3) initial draft validation and revision, (4) small-scale trials and revisions, (5) large-scale trials and revisions, (6) final products, and (7) effectiveness tests. Small-scale trials were conducted at NPC of Bantul, and large-scale trials were conducted in the NPC of Yogyakarta Special Region. The effectiveness test was conducted in NPC of Yogyakarta Special Region. The data collection instruments used were: (1) interview guideline, (2) questionnaires, (3) and effectiveness test instruments in the form of performance tests. The effectiveness test used a zig-zag run modification instrument. Data were analyzed quantitative descriptive on the assessment scale, t-test on effectiveness test and qualitative descriptive on product assessment input and interview results. The results showed that: (1) Types of exercise to improve the agility of wheelchair badminton athletes with development stages starting from: (a) preliminary studies, (b) developing initial products; expert validation (materials and media) and revisions, (c) product trials; small-scale trials/ revisions and large-scale trials/ revisions, and, (d) product effectiveness tests. The final product in this study is a book entitled “Types of Agility Exercises for Wheelchair Badminton Athletes”. The product produces ten types of agility exercises for wheelchair badminton athletes. (2) The types of exercise to improve agility for wheelchair badminton athletes based on a material expert assessment of 81% is in the very good/ very feasible category and a media expert assessment of 80%, is in the good/ feasible category. (3) Types of exercise to improve agility for wheelchair badminton athletes is effective with a p value < 0.05 and an increase of 8.73%.

Is book reading always best? Children learn and transfer complex scientific explanations from books or animations

BackgroundStorybooks are an effective tool for teaching complex scientific mechanisms to young children when presented in child-friendly, joint-attentional contexts like read-aloud sessions. However, static storybooks are limited in their ability to convey change across time and, relative to animated storybooks, are harder to disseminate to a wide audience. This study examined second graders’ abilities to learn the deeply counterintuitive concepts of adaptation and speciation from multi-day interventions centered around two storybooks about natural selection that were either read-aloud (static) or watched on a screen (animated). The storybook sequence was progressive and first explained—in counter-essentialist and non-teleological terms—how the relative distribution of a terrestrial mammal’s trait changed over time due to behavioral shifts in their primary food resource (adaptation, book 1). It then explained how–after a sub-population of this species became geographically isolated–they evolved into an entirely different aquatic species over many generations via selection on multiple foraging-relevant traits (speciation, book 2). The animated and static versions of the storybooks used the same text and illustrations, but while the animations lacked joint-attentional context, they more dynamically depicted successive reproductive generations. Storybook and animation presentations were interspersed with five parallel talk-aloud assessment interviews over three days.ResultsFindings revealed substantial learning from the read-aloud static storybook sequence. They also revealed substantial learning from the animation condition with patterns suggesting that the dynamic representations of change over time particularly scaffolded acquisition of the deeply counterintuitive idea that a species can evolve into an entirely different category of species by natural selection.ConclusionsThe results provide much-needed optimism in a context of increasing demands for scalable solutions to promote effective learning: animated storybooks are just as good (and may even be better) than static storybooks.

0884 User Needs and Preferences for a Smartphone App to Treat Insomnia in Cancer Survivors

Abstract Introduction Cancer patients with insomnia have unique needs and require tailored healthcare interventions. iCANSleep is a mobile health intervention aimed at providing evidence-based insomnia treatment via a smartphone app. As part of a user-centered development process, virtual needs assessment interviews were conducted with cancer survivors who report insomnia to determine the needs and preferences of this patient group for insomnia treatment. Methods 22 cancer survivors from 5 Canadian provinces completed an online survey and participated in a needs assessment interview. Surveys were analyzed using descriptive statistics, while interviews were transcribed and analyzed using thematic analysis. Results 81.8% (18/22) of cancer survivors report that their insomnia started or was exacerbated during the time of their cancer diagnosis and treatment. Of the participants who discussed insomnia with a medical provider, hypnotic medications were prescribed in 64.3% (9/14) of cases. With some exceptions, participants reported strong familiarity with smartphone technology, had experience using apps for health management, and found an insomnia treatment app highly acceptable. Participant-identified facilitators of app use included ease of access, lack of cost, anonymity, empirical basis, and recommendation by local care teams. Smartphone ownership, cumbersome user interface, and limited access to internet were raised as potential challenges of implementation. Additional functionality identified by participants included options to link consumer wearable devices, additional modules to address comorbid conditions such as pain and anxiety, and an anonymous peer support forum. Conclusion Mobile apps hold promise as an avenue for the effective delivery of insomnia treatment; however, treatments must be evidence-based, and apps must be designed for maximum ease of use. Findings provide novel insight into how to best promote uptake and sustained use of mobile health interventions in cancer survivors and will be used to develop functional guidelines. Support (if any) Samlau Kutana is a trainee in the Cancer Research Training Program of the Beatrice Hunter Cancer Research Institute, with funds provided by the Canadian Cancer Society’s JD Irving, Limited – Excellence in Cancer Research Fund. Dr. Sheila Garland is supported by a Canadian Cancer Society Emerging Scholar Award (Survivorship) (grant #707146).

Development and Validation of the Questionnaire for Adaptive Hyperactivity and Goal Achievement (AHGA).

This paper illustrates the preliminary psychometric properties of the Questionnaire for Adaptive Hyperactivity and Goal Achievement (AHGA), aimed at measuring adaptive characteristics of hyperactivity and goal pursuit in older adults. The 12-item scale was administered to a sample of 120 subjects (older adults) between February 2022 and June 2022. The reliability of AHGA was measured using Cronbach's alpha, and factor structure was established using parallel analysis (PA) and principal component analysis (PCA). Convergent validity was tested against the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN). All included subjects have an average age of 74.1±5.1 years. AHGA reliability was good (Cronbach's alpha: 0.713 [95%CI: 0.630 to 0.783]). Factor analysis suggested two main components: goal achievement and hyperactivity, which explained 41% of the variance in the data. The results support the convergent validity of the scale: AHGA measures adaptive characteristics of hyperactivity and goal pursuit, in contrast to BRIAN, which measures pathological characteristics. The reported findings represent an innovative approach to hyperthymic features by embracing a broader spectrum concept that conceptualizes the potential transition between pathological and adaptive aspects as a continuum.

“Keep up the messages, sometimes it was a lifesaver”: Effects of cultural adaptation on a suicide prevention clinical trial in American Indian/Alaska Native communities

Suicide disproportionately affects many American Indian/Alaska Native (AI/AN) communities. Caring Contacts is one of the few suicide prevention interventions with demonstrated success in diverse populations, but its acceptability and effectiveness have not been evaluated in AI/AN communities. Using community-based participatory research (Phase 1), we conducted focus groups and semi-structured interviews with AI/AN adults, healthcare providers, and leaders in four communities to improve study design and maximize intervention acceptability and effectiveness for implementation in a randomized controlled trial (Phase 2). This paper describes how adaptations made during Phase 1 affected the acceptability, fit, and responsiveness of the study features to the communities’ needs. Acceptability of the study procedures and materials in this community appears to be high, with 92% of participants indicating the initial assessment interview was a positive experience. Broadening eligibility criteria with regard to age and possession of a cellular device resulted in the recruitment of an additional 48% and 46% of participants, respectively. Inclusion of locally-informed methods of self-harm allowed us to capture a wider range of suicidal behavior than would have otherwise been identified. Clinical trials would benefit from community-engaged, cultural adaptation studies with populations in which the interventions would eventually be applied.

Policy and Systems Change in Intimate Partner Violence and Human Trafficking: Evaluation of a Federal Cross-Sector Initiative.

Objectives: This study evaluates Project Catalyst's impact on policies related to Intimate Partner Violence (IV) and Human Trafficking (HT), which contribute to negative health outcomes for survivors. Methods: We utilized continuous evaluation using data from policy assessment tools and interviews with participating state leadership team (SLT) members. Results: Five SLTs reported integration of IPV into state-level initiatives. All implemented clinical practice and organizational policy recommendations. SLTs reported that Project Catalyst increased awareness of IPV/HT and health impacts and established ongoing partnerships between the three organizations. Conclusions: Funding, training, and technical assistance to encourage cross-sector collaboration at the state level can promote policy changes that support comprehensive health center responses to IPV/HT.

Assessing students’ understanding of time concepts in Years 3 and 4: insights from the development and use of a one-to-one task-based interview

AbstractTime is an important but complex area of learning for students in the primary years. This study sought to develop a tool which would provide a clear picture of students’ understanding of what constitutes time and how time is related to clock and calendar use. Four major components of time, Awareness of time, Succession, Duration, and Measurement of time, with related key ideas, formed the basis for a Framework for the Learning and Teaching of Time. This Framework underpinned the development of a 69-item, one-to-one task-based interview to assess students’ understanding of time. Data from interviews of Year 3 and 4 students gave a clear picture of how they experienced the mathematics of time. The range of scores across all assessed areas of the Framework revealed a considerable spread of students’ understandings of time concepts. This paper focuses on the development of the Framework and interview, the interview data, and the general benefits of the use of the task-based assessment interview in assessing the mathematical understanding and thinking of children regarding time.

Initial evidence of vowel space reduction in a subset of individuals with schizophrenia.

Acoustic phonetic measures have been found to correlate with negative symptoms of schizophrenia, thus offering a path toward quantitative measurement of such symptoms. These acoustic properties include F1 and F2 measurements (affected by tongue height and tongue forward/back position, respectively), which determine a general "vowel space." Among patients and controls, we consider two phonetic measures of vowel space: average Euclidean distance from a participant's mean F1 and mean F2, and density of vowels around one standard deviation of mean F1 and of F2. Structured and spontaneous speech of 148 participants (70 patients and 78 controls) was recorded and measured acoustically. We examined correlations between the phonetic measures of vowel space and ratings of aprosody obtained using two clinical research measures, the Scale for the Assessment of Negative Symptoms (SANS) and the Clinical Assessment Interview for Negative Symptoms (CAINS). Vowel space measurements were significantly associated with patient/control status, attributed to a cluster of 13 patients whose phonetic values correspond to reduced vowel space as assessed by both phoenetic measures. No correlation was found between phonetic measures and relevant items and averages of ratings on the SANS and CAINS. Reduced vowel space appears to affect only a subset of patients with schizophrenia, potentially those on higher antipsychotic dosages. Acoustic phonetic measures may be more sensitive measures of constricted vowel space than clinical research rating scales of aprosody or monotone speech. Replications are needed before further interpretation of this novel finding, including potential medication effects.

From design to action: participatory approach to capacity building needs for local overdose response plans

BackgroundIn response to the rise in opioid-related deaths, communities across Ontario have developed opioid or overdose response plans to address issues at the local level. Public Health Ontario (PHO) leads the Community Opioid / Overdose Capacity Building (COM-CAP) project, which aims to reduce overdose-related harms at the community level by working with communities to identify, develop, and evaluate capacity building supports for local needs around overdose planning. The ‘From Design to Action’ co-design workshop used a participatory design approach to engage communities in identifying the requirements for capacity building support.MethodsA participatory approach (co-design) provided opportunity for collaborative discussion around capacity building needs at the community level. The co-design workshop included three structured collaborative activities to 1) prioritize scenarios that illustrated various challenges associated with community overdose response planning, 2) prioritize the challenges within each scenario and 3) prioritize the supports to address each of these challenges. It was conducted with fifty-two participants involved in opioid/overdose-related response plans in Ontario. Participatory materials were informed by the results of a situational assessment (SA) data gathering process, including survey, interview, and focus group data. A voting system, including dot stickers and discussion notes, was applied to identify priority supports and delivery mechanisms.ResultsAt the workshop, key challenges and top-priority supports were identified, for development and implementation. The prioritized challenges were organized into five categories of capacity building supports addressing: 1) stigma & equity; 2) trust-based relationships, consensus building & on-going communication; 3) knowledge development & on-going access to information and data; 4) tailored strategies and plan adaptation to changing structures and local context; and 5) structural enablers and responsive governance.ConclusionUsing a participatory approach, the workshop provided an opportunity for sharing, generating, and mobilizing knowledge to address research-practice gaps at the community level for opioid response planning. The application of health design methods such as the ‘From Design to Action’ co-design workshop supports teams to gain a deeper understanding of needs for capacity building as well as illustrating the application of participatory approaches in identifying capacity building needs for complex public health issues such as the overdose crisis.

Using Behavioral Skills Training to Teach Functional Assessment Interviewing, Cultural Responsiveness, and Empathic and Compassionate Care to Students of Applied Behavior Analysis.

Within the field of applied behavior analysis, there is a recognized need for increased training for practitioners on cultural responsiveness, as well as to improve behavior analysts' demonstration of compassion and empathy towards the families with whom they work. The present study used behavioral skills training via telehealth to teach three skillsets-functional assessment interviewing, empathic and compassionate care, and cultural responsiveness. Participants were seven graduate students who had no previous coursework in behavioral assessment and whose caseload mainly included clients who did not share the participant's cultural, ethnic, or religious backgrounds. The results showed that behavioral skills training was effective in improving performance across all three skillsets. In addition, high levels of responding maintained following the completion of the training for the majority of the participants. Several levels of social validity measures support the utility and impact of this training. The findings have implications for training practitioners on these vital skills.

Application of implementation mapping to develop strategies for integrating the National Diabetes Prevention Program into primary care clinics.

Diabetes is considered one of the most prevalent and preventable chronic health conditions in the United States. Research has shown that evidence-based prevention measures and lifestyle changes can help lower the risk of developing diabetes. The National Diabetes Prevention Program (National DPP) is an evidence-based program recognized by the Centers for Disease Control and Prevention; it is designed to reduce diabetes risk through intensive group counseling in nutrition, physical activity, and behavioral management. Factors known to influence this program's implementation, especially in primary care settings, have included limited awareness of the program, lack of standard clinical processes to facilitate referrals, and limited reimbursement incentives to support program delivery. A framework or approach that can address these and other barriers of practice is needed. We used Implementation Mapping, a systematic planning framework, to plan for the adoption, implementation, and maintenance of the National DPP in primary care clinics in the Greater Houston area. We followed the framework's five iterative tasks to develop strategies that helped to increase awareness and adoption of the National DPP and facilitate program implementation. We conducted a needs assessment survey and interviews with participating clinics. We identified clinic personnel who were responsible for program use, including adopters, implementers, maintainers, and potential facilitators and barriers to program implementation. The performance objectives, or sub-behaviors necessary to achieve each clinic's goals, were identified for each stage of implementation. We used classic behavioral science theory and dissemination and implementation models and frameworks to identify the determinants of program adoption, implementation, and maintenance. Evidence- and theory-based methods were selected and operationalized into tailored strategies that were executed in the four participating clinic sites. Implementation outcomes are being measured by several different approaches. Electronic Health Records (EHR) will measure referral rates to the National DPP. Surveys will be used to assess the level of the clinic providers and staff's acceptability, appropriateness of use, feasibility, and usefulness of the National DPP, and aggregate biometric data will measure the level of the clinic's disease management of prediabetes and diabetes. Participating clinics included a Federally Qualified Health Center, a rural health center, and two private practices. Most personnel, including the leadership at the four clinic sites, were not aware of the National DPP. Steps for planning implementation strategies included the development of performance objectives (implementation actions) and identifying psychosocial and contextual implementation determinants. Implementation strategies included provider-to-provider education, electronic health record optimization, and the development of implementation protocols and materials (e.g., clinic project plan, policies). The National DPP has been shown to help prevent or delay the development of diabetes among at-risk patients. Yet, there remain many challenges to program implementation. The Implementation Mapping framework helped to systematically identify implementation barriers and facilitators and to design strategies to address them. To further advance diabetes prevention, future program, and research efforts should examine and promote other strategies such as increased reimbursement or use of incentives and a better billing infrastructure to assist in the scale and spread of the National DPP across the U.S.