Community-based Service Organizations Research Articles

How informal financial service institutes facilitate the financial inclusion of low-income, unbanked consumers

PurposeThe present study aimed to provide an understanding of the roles of community-based financial service organizations (i.e. rotating savings and credit associations [ROSCAs] as institutional pillars in facilitating low-income, unbanked consumers’ access to informal financial services).Design/methodology/approachSemi-structured interviews were conducted with 39 low-income, unbanked consumers participating in ROSCAs in Pakistan, where only 21% of adults have a bank account and almost four out of five individuals live on a low income. The obtained data were analyzed using the thematic analysis technique.FindingsROSCAs’ regulatory, sociocultural and cognitive aspects facilitate low-income, unbanked consumers’ utilization of informal financial services owing to their approachability by, suitability for, and fairness to such consumers. Thus, they promote such consumers’ financial inclusion.Practical implicationsLow-income consumers are mostly unable to access formal financial services due to the existing supply- and demand-side impediments. Understanding ROSCAs’ institutional functioning can help formal financial service providers create more transformative financial services based on the positive institutional aspects of ROSCAs to enhance poor consumers’ financial inclusion and well-being.Social implicationsThe inclusion of low-income, unbanked consumers in formal banking services will help them better control their finances.Originality/valueMany low-income, unbanked consumers in developing countries utilize informal financial services to meet their basic financial needs, but service researchers have rarely investigated how informal financial institutions function. The present study showed that ROSCAs, as informal institutions, meet low-income, unbanked consumers’ personal, social and financial needs in a befitting manner, which encourages such consumers to use the financial services offered by ROSCAs.

MAINTENANCE OF HEALTH BEHAVIOR CHANGE: RECOMMENDATIONS FOR FUTURE RESEARCH

Abstract Modifying poor health behaviors can enhance function, improve quality-of-life, and reduce morbidity and mortality among older adults. However, achieving and sustaining behavior change can be difficult. A growing body of research suggest that initiation and maintenance are unique constructs within health behavior change; each requiring unique skills and each associated with unique outcomes. Although some leading health behavior change models (e.g., Transtheoretical Model of Change) include maintenance as a construct, maintenance is often overlooked in the scientific literature. As part of a NIA Research Centers Collaborative Network (RCCN) pilot award, this project utilized a series of qualitative activities to explore the concept of maintenance and identify future recommendations for advancing the field. Three unique listening sessions were conducted with clinician-researchers (1 group) and community-based service organizations (2 groups). An interdisciplinary expert think tank was then convened to reflect on key findings. All sessions were conducted virtually; transcripts were reviewed using a priori themes with additional themes generated by an open coding approach. Major themes included the following: (1) To date, there is no consensus definition of maintenance nor is there agreement on maintenance across behaviors. (2) Few behavior change models consider how health behaviors must shift to accommodate for age-related changes in cognition and/or physical function. (3) Existing funding mechanisms and timelines may not allow sufficient follow-up periods to examine maintenance over time. (4) Although the terms maintenance and sustainment are used interchangeably, community leaders emphasized the importance of sustaining health promotion programs in order to enable maintenance to occur.

Exploring the Barriers and Potential Opportunities of Technology Integration in Community-Based Social Service Organizations

Community-based social service organizations often face multifaceted challenges, including limited resources, inadequate staffing, funding constraints, and high demand for their services. These challenges are often exacerbated when serving vulnerable communities with complex social needs. Despite these difficulties, technology holds the potential to help bridge the service gap, enabling these organizations to respond more effectively to the diverse needs of their communities. In our work, we conducted 21 semi-structured interviews with representatives from different community-based social service organizations in a mid-sized city in Northern Indiana. This city struggles with high rates of poverty and homelessness in several of its neighborhoods. Our findings revealed that although these organizations faced numerous technological challenges, data and knowledge management was a particularly significant issue. Based on our findings, we offer design recommendations for empowering community-based social service organizations and the people they serve through technology. By leveraging the capabilities of technology, our study aims to promote social justice by assisting community-based organizations in better serving their communities.

Perspectives From Community-Based HIV Service Organization Leaders on Priorities in Serving Sexual and Gender Minority Populations.

Sexual and gender minority (SGM) populations experience discrimination and care-related barriers when seeking appropriate sexual health services. Using rapid assessment procedures we conducted site visits with 11 community-based HIV service agencies to identify priorities, assets, and needs related to serving SGM clients and assessed the alignment of these services with the city's local Ending the HIV Epidemic plan. We identified and mapped themes across agencies into the Consolidated Framework for Implementation Research domains of inner and outer settings: client-facing materials; priorities in serving SGM communities; SGM policies and protocols; collecting sexual orientation and gender identity data; training and education; and funding and scope of programs. Rapid assessment procedures can accelerate the collection and interpretation of data to help public health institutions and community partners make timely adaptations when implementing comprehensive and culturally humble sexual health services for SGM communities.

Engaging Sexual and Gender Minority Older Adults to Elicit Concerns and Recommendations for Communicating Care Preferences in Long-Term Care: Focus Group Findings

ABSTRACT Objectives 1) Describe sexual and gender minority (SGM) older adults’ current practices and concerns for communicating end-of-life (EOL) and daily care preferences in long-term care (LTC); 2) Elicit ideas about adapting a video-based intervention to facilitate communication. Methods After consulting a community advisory board, we conducted two focus groups with SGM older adults ≥55 years of age recruited from a community-based service organization (n = 4) and a continuing care retirement community (n = 9). We audio-recorded, transcribed, and coded data using directed content analysis methods and summarized results descriptively. Results Most participants were cisgender (n = 12), female (n = 11), lesbian (n = 10), White and non-Hispanic (n = 13); mean age was 70.62. Participants’ concerns included discrimination, autonomy, chosen family, and community; they linked daily care preferences with personhood and quality of life. They advocated for building intentional community-based support networks to help peers discuss preferences and produce videos before LTC transition and ensure compliance after. Conclusions For SGM older adults, asserting and protecting their full personhood, through daily care preferences, is essential to quality of life in LTC. Clinical Implications Video-recorded statements of daily preferences, facilitated and supported by a peer network, could promote culturally competent, person- and community-centered care for SGM older adults in LTC settings.

Proposed Social Drivers Of Health Bonds Offer Promising Improvements But Face Many Challenges To Implementation.

Social drivers of health (SDH) bonds have been proposed as a way of incentivizing investment in SDH interventions by Medicaid managed care organizations. The success of SDH bonds is predicated on the acceptance of shared responsibilities and resources for corporate and public-sector stakeholders. Underwritten against a Medicaid managed care organization's financial strength and promise to pay, SDH bond proceeds would support social services and investments in interventions that may mitigate social drivers that lead to poor health outcomes, which would in turn lower health care costs for low-to-moderate-income populations in communities of need. This systematic public health approach would tie together community-level benefits with the shared cost of care of participating managed care organizations. The Community Reinvestment Act model allows for innovation to meet business needs of health organizations, and cooperative competition can facilitate needed technology improvements for community-based social service organizations.

Factors affecting collaboration between clinical and community service organizations.

Collaboration between clinical and community-based social service organizations is increasingly seen as vital for preventing and managing chronic diseases but has been challenging to establish and sustain. The aim of this study was to identify organizational barriers and facilitators for clinic-community collaboration. We employed multiple methods to study a national sample of nonprofit community-based organizations that each collaborated with local clinical organizations for diabetes prevention in the United States. We used qualitative data collected longitudinally through 65 semistructured interviews from 2016 to 2017 at seven of these organizations and their clinical collaborators to understand their relationships. We employed survey data ( N = 247 with 73% response rate) to measure and explore relationships among qualitatively identified themes and collaboration performance. We documented three levels of organizational challenges to community-clinic collaboration. Interorganizational challenges pertain to facing only weakly aligned interests across organizations. Interpersonal challenges pertain to misperceptions and miscommunications that occur as frontline employees from differing organizations seek to work together. Task-related challenges pertain to the inadequacy of current processes to effectively link services across clinical and community settings. We found that bridging leadership , provisional teamwork, and learning processes helped to overcome these challenges by enabling iterative progress. Follow-up national survey results indicated that these facilitators were significantly associated with collaboration performance. Because community-clinic collaboration presents substantial interorganizational, interpersonal, and task-related challenges, financial incentives alone are likely insufficient for success. Resources that help develop capacity to work across community and clinical settings may be vital and warrant dedicated funding.

Economic and environmental benefits of performance management controls in human service transportation planning

Sustainability strategies are being implemented in organizations as best practices demonstrate that these initiatives not only provide environmental and social benefits but also financial benefits (Nawaz & Koç, 2019). The problem addressed is that community-based human service organizations often rely upon their own vehicles or the personal vehicles of their employees to transport clients, but the skills and resources to apply and implement sustainable transportation best practices are lacking (Busko & Saltzman, 2021). The purpose is to demonstrate how the application of process mapping and systems approach can reduce fuel usage and greenhouse gas emissions, and save time and financial costs which can, in turn, be used to improve the quality of life of those served by these organizations. The methodology is a qualitative grounded theory approach applied by conducting a textual analysis of conceptual approaches that could be applied to transportation in this industry. The results demonstrate that if human service organizations adopt process mapping and systems approach for their transportation, economic and environmental benefits can be achieved. The conclusion reviews the findings and recommendations. This research is relevant because small businesses and nonprofit organizations need to be lean to stay competitive and to provide the best services to their clients.

RECRUITMENT FOR A MULTISITE PRAGMATIC TRIAL OF DEMENTIA CARE STRATEGIES: BARRIERS AND SUCCESS DURING COVID-19

Abstract With 2176 participants recruited, D-CARE is the largest pragmatic clinical trial of dementia care strategies, to date. At four clinical trial sites (CTS), D-CARE will compare the effectiveness of three dementia care strategies over 18 months: 1) by nurse practitioners or physician assistants within a health care system, 2) by social workers or nurses at community-based service organizations (CBO), or 3) usual care. Primary outcomes include person with dementia (PWD) behavioral symptoms and caregiver strain. Other outcomes include the PWD quality of life and ability to reach personal goals, and caregiver self-efficacy, distress, and depressive symptoms. Recruitment began in June 2019 with a basic protocol in which participating providers reviewed lists generated from the electronic health records (EHR) of patients who had a diagnosis of dementia, allowing the removal of patients who should not be contacted and giving an opportunity to provide information about the family caregiver. Some practices gave “blanket” referral allowing research staff to recruit participants directly. Other practices provided direct referrals via EHR communications to the research team. Self-referrals triggered by public postings in clinics and CBOs, social media, and media coverage were also accepted if a dementia diagnosis was confirmed in the EHR. By March 16, 2020, all in-person recruitment visits were suspended due to COVID-19. In response, informed consent was switched to telephone with verbal consent as permitted by State and Institutional regulations. This symposium describes the creative approaches employed by CTS’ to respond to these challenges and reach the recruitment goal in January 2022.

Recruitment Challenges of a Colorectal Cancer Screening Dissemination Study.

Dissemination strategies to reach underserved and minority populations to promote screening for colorectal cancer (CRC) are key to reducing disparities. We conducted a study to examine a tailored messaging approach to navigate individuals from communities (i.e., lower income, less access to care, and underscreened) to clinics to receive CRC screening. We encountered several political, demographic, and secular trend issues that required reconsideration and redesign of implementation strategies. Through study implementation from 2012 to 2017, changes in medical reimbursement and immigration policies-at the state level and later at the national level-affected healthcare delivery systems that had initially committed to supporting the study and our recruitment methods. Although our selected zip codes and sites had previously yielded high rates of CRC screening nonadherence, within a few years, these sites showed substantially higher screening adherence rates-yielding limited numbers of eligible participants. In addition, state immigration policy trends created mistrust and fear, leading to lower participation rates than anticipated. This report documents and provides valuable insights on how we and the community network developed creative strategies to overcome these challenges. New relationships with community partners were extended to tap advisory board input to meet the challenges. Criteria for clinic participation widened from originally selected Federally Qualified Health Centers (FQHCs) to various nonprofit, hybrid, and privately insured reimbursement types. Recruitment site options were creatively redefined to reach community participants where they live, work, and receive services. Strategies that engage community members in identifying alternative healthcare delivery structures and that link recruitment efforts to community-based service organizations were found to be critical to recapturing community trust in the face of unfavorable political environments. Widening the type of clinic partners from FQHCs to stand-alone nonprofits and private clinics and identifying unusual types of recruitment sites provided alternative solutions for successful study implementation. In prevention-based studies that face unplanned system and political barriers to recruitment, embedding the study in the community may aid in reestablishing trust levels to improve engagement and recruitment of clinic partners and eligible participants.

The landscape of trauma informed care in community-based HIV service organizations in the United States south

ABSTRACT Among people living with HIV, trauma is associated with increased viral loads and obstructed access to HIV care. Trauma-Informed Care (TIC), a SAMHSA Evidence Based Practice, responds to the impact of trauma for service users by focusing on all aspects of service delivery systems and structures. TIC could be potentially lifesaving in regions where HIV rates continue to rise, like the U.S. South. Thus, the purpose of this study is to (1) understand the extent to which HIV service organizations in the U.S. South provide mental health and substance use services and referrals; (2) the extent to which they employ trauma informed care and (3) the barriers of employing trauma informed care. Analyzing quantitative data of 207 organizations, we found that less than a third of organizations provided a trauma informed intervention. Only 44% of organizations had participated in TIC training but 84% expressed interest in TIC training. Organizations who completed TIC training were 10 times more likely than those who did not to report that they implemented at least one trauma informed care strategies. Barriers to TIC implementation included lack of training, capacity, and resources. Building the capacity of organizations to implement TIC will be a key to ending the HIV epidemic.

Unmet health needs and barriers to health care among people experiencing homelessness in San Francisco’s Mission District: a qualitative study

BackgroundPeople experiencing homelessness have unique health needs and barriers to medical and behavioral health care (mental health, substance use disorder, and overall well-being) compared to housed people. It remains unclear why many people experiencing homelessness do not access care when community-based homeless health care resources are available at low or no cost. This qualitative study examined perspectives of people experiencing homelessness and staff members at community-based homeless health and service organizations in San Francisco’s Mission District on unmet medical and behavioral health needs and barriers to accessing care.MethodsWe conducted 34 interviews between September and November 2020: 23 with people experiencing homelessness and 11 with staff at community-based homeless health and service organizations in the Mission District. Qualitative interviews were transcribed, coded, and analyzed using the Framework Method on NVivo Qualitative Data Analysis Software.ResultsBoth staff and homeless participants reported unmet and common health needs of mental illness, physical injury and disability, food and nutrition insecurity, and substance use disorder. Barriers to care included negative prior health care experiences, competing priorities, and provider turnover. Recommendations for improving services included building more trust with people experiencing homelessness by training clinic staff to treat patients with respect and patience and expanding clinical outreach and health education programs.ConclusionsPeople experiencing homelessness face many different health needs and barriers to care, some of which community-based organizations have the ability to address. These findings can help inform future strategies for homeless health care programs to identify and target the specific unmet health needs and barriers to care of people experiencing homelessness in their communities.

The implementation & sustainment facilitation (ISF) strategy: Cost and cost-effectiveness results from a 39-site cluster randomized trial integrating substance use services in community-based HIV service organizations.

Background: As part of the Substance Abuse Treatment to HIV Care Project, the Implementation & Sustainment Facilitation (ISF) strategy was found to be an effective adjunct to the Addiction Technology Transfer Center (ATTC) strategy for integrating a motivational interviewing-based brief intervention (MIBI) for substance use disorders. This study presents the cost and cost-effectiveness results. Methods: Thirty-nine HIV service organizations were randomized to receive the ATTC-only condition or the ATTC + ISF condition. Two staff from each organization received the ATTC-training. In ATTC + ISF organizations, the same two staff and additional support staff participated in facilitation sessions to support MIBI implementation. We estimated costs using primary data on the time spent in each strategy and the time spent delivering 409 MIBIs to clients. We estimated staff-level cost-effectiveness for the number of MIBIs delivered, average MIBI quality scores, and total client days abstinent per staff. We used sensitivity analyses to test how changes to key variables affect the results. Results: Adjusted per-staff costs were $2,915 for the ATTC strategy and $5,371 for ATTC + ISF, resulting in an incremental cost of $2,457. ATTC + ISF significantly increased the number of MIBIs delivered (3.73) and the average MIBI quality score (61.45), yielding incremental cost effectiveness ratios (ICERs) of $659 and $40. Client days abstinent increased by 59 days per staff with a quality-adjusted life-year ICER of $40,578 (95% confidence interval $29,795-$61,031). Conclusions: From the perspective of federal policymakers, ISF as an adjunct to the ATTC strategy may be cost-effective for improving the integration of MIBIs within HIV service organizations, especially if scaled up to reach more clients. Travel accounted for nearly half of costs, and virtual implementation may further increase value. We also highlight two considerations for cost-effectiveness analysis with hybrid trials: study protocols kept recruitment low and modeling choices affect how we interpret the effects on client-level outcomes.

Deploying Implementation Strategies to Facilitate Professionals’ Use of the Home Care Frailty Scale

Home- and community-based service (HCBS) organizations play an instrumental role in maximizing the independence of older adults, ages 60 and over. HCBS clients typically have multiple health complications, placing them at great risk of frailty—a complex condition associated with health decline and institutionalization. However, despite their frequent contact with older adults, HCBS professionals are not required to assess the frailty levels of their clients, creating a missed opportunity to monitor the needs of this at-risk population. The purpose of this quality improvement study was to test a package of five implementation strategies designed to support HCBS professionals’ use of the evidence-based Home Care Frailty Scale (i.e., Frailty Scale) with all new clients at one large HCBS organization. Implementation strategies included (a) selecting one professional to serve as the organization’s Frailty Scale “champion,” (b) holding three training sessions with 25 HCBS professionals, (c) modifying client charts to allow professionals to document Frailty Scale results, (d) pilot testing the Frailty Scale with a small group of clients, and (e) completing monthly chart audits to monitor rates of Frailty Scale implementation. During the first three months of Frailty Scale use, HCBS professionals administered the Frailty Scale to 414 out of 467 eligible clients (88.6%). For Month 1, 87.4% of eligible clients were administered the Frailty Scale, followed by 90.8% in Month 2, and 85.6% in Month 3. This quality improvement study suggests that a multifaceted package of implementation strategies can support professionals’ use of an evidence-based frailty instrument in the HCBS setting.

Urban Neighborhood Characteristics and the Spatial Distribution of Home and Community-Based Service Organizations in Michigan Metropolitan Statistical Areas.

Living in a neighborhood with dense HCBS organizations can promote older adults' health and well-being and may mitigate health disparities generated by living in materially deprived urban neighborhoods. Using 2016 US County Business Patterns and the American Community Survey (2013-2017), focused on 516 ZIP Codes in Michigan Metropolitan Statistical Areas, this study examines the association between neighborhood characteristics and the relative density of businesses offering services for older adults and persons with disabilities (e.g., senior centers, adult day service centers, personal care) and businesses offering home health care. Results from a series of spatial econometric models show that social care organization density tends to be high in neighborhoods with a greater number of residents who have a bachelor's degree, who are older, and who are in poverty. Home health care density was not explained by neighborhood factors. Multiple neighborhood socio-demographic indicators explain the spatial distribution of social care organizations.

Theorizing Organizational Learning to Enhance Youth-Adult Partnerships in Community-Based Youth Serving Organizations.

Youth-adult partnerships are intentionally cultivated intergenerational relationships characterized by shared power among youth and adults. Although youth-adult partnerships (Y-APs) are widely adopted as a strategy to promote key positive development outcomes in youth service organizations, research documents various challenges that affect their quality implementation. This critical literature review presents a theoretical framework for how community-based youth service organizations may enhance youth-adult partnership quality through organizational learning. The main premise is that Y-AP implementation challenges are best understood as challenges of collective learning within an organization. As such, the review integrates theory and research in organizational learning with present scholarship on Y-APs to delineate how two learning processes-intra-group and inter-group knowledge transfer-influence Y-AP quality. These learning pathways exist in dynamic interaction at different levels of the organizational hierarchy, at the point of service and beyond. The theoretical framework provides a road map for effective functioning of Y-APs in practice and an interpretive lens for descriptive and intervention research to understand and address Y-AP challenges.

Survivors' Input on Health Care-Connected Services for Intimate Partner Violence.

Background: Intimate partner violence (IPV) is increasingly recognized as a social factor impacting health, and health care providers are encouraged to routinely screen and refer patients for needs related to IPV. Health care settings are often challenged, however, in their ability to connect patients with community-based IPV services. Some organizations have invested in on-site programs to facilitate identification and connection. Methods: The goal of this study was to understand IPV survivors' experiences with and perspectives on health care-connected IPV services. Semistructured in-depth interviews were conducted in-person by a trained and experienced interviewer and were audio-recorded and transcribed verbatim. Interview transcripts were analyzed using team-based qualitative thematic content analysis. Participants included 68 individuals who had experienced IPV, recruited through one of two settings: (1) a health care organization with embedded IPV services or (2) a community-based IPV service organization that partners with health care settings. Results: Interviews revealed benefits of having health care-connected IPV services, including that the health care setting can be critical for providing information about IPV programs and that survivors may need assistance with navigation of community services. Survivors further highlighted recommendations for trauma-sensitive care that includes providing clarification about the role and scope of IPV services, following-up with but not forcing intervention, and ensuring privacy, confidentiality, and trust in interactions. Conclusions: Findings support health care settings having in-house or close partnership with IPV advocates to adequately support patients' needs in connecting with and navigating community based IPV-related services.

A hybrid effectiveness/implementation trial of an evidence-based intervention for HIV-serodiscordant African American couples.

Couples-based behavioral HIV prevention interventions have demonstrated efficacy, but few are routinely available in community-based settings in the United States. The Eban intervention, designed for heterosexual African American serodiscordant couples and proven efficacious in a cluster randomized trial, was implemented in community-based HIV service organizations in two cities disproportionately affected by the HIV epidemic. This article reports primarily on the effectiveness results related to condom use and results related to retention challenges within a Hybrid Type 2 implementation/effectiveness trial. Ninety-one individuals enrolled at baseline; 39 completed the posttest, and 30 completed the 3-month follow-up. Although condom use did not monotonically increase from baseline to posttest and 3-month follow-up, it did increase from baseline (44%) to posttest (73%), and from baseline to 3-month follow-up with an overall positive slope of Time 0.13 to 0.14 (p < .001). There was a significant increase in the number of people who used condoms 100% of the time from baseline (36.3%) to posttest (56.4%; p = .04) but not from baseline to 3-month follow-up (46.7%; p = .2907). Challenges with resources as basic as housing, food, and transportation complicated participation (and therefore implementation) and may have impeded couples' maintenance of risk reduction strategies beyond the intervention. In light of couples' numerous observed vulnerabilities, we constructed a composite score of "critical vulnerability" and found that depression was persistently related to critical vulnerability and that retention was higher among those with less vulnerability. These findings highlight the important yet underaddressed role of patient-level factors in the process and outcomes of hybrid implementation/effectiveness research. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Increasing Social Connectedness for Underserved Older Adults Living With Depression: A Pre-Post Evaluation of PEARLS

To evaluate PEARLS effectiveness for increasing social connectedness among underserved older adults with depression. Multisite, pre-post single-group evaluation. Community-based social service organizations (N = 16) in five U.S. states, purposively sampled for maximum variation of participants and providers. A total of 320 homebound older adults (mean(SD) age 72.9(9.6), 79% female, 44% people of color, 81% low-income, 61% living alone, average four chronic conditions) with clinically significant depression (PHQ-9 mean(SD) 12.7(4.6)). Four to 6 month home-based depression care management model delivered by trained front-line providers. Brief validated social connectedness scales: Duke Social Support Index 10-item (DSSI-10), PROMIS-Social Isolation (6-item), UCLA-Loneliness (3-item); sociodemographic and health measures. At baseline, PEARLS participants overall and with ≥1 of the following characteristics were less socially connected: younger (50-64), white, LGBTQ+, not partnered, not caregiving, living alone, financial limitations, chronic conditions, and/or recently hospitalized. Six-months post-PEARLS enrollment, participants significantly increased social interactions and satisfaction with social support (DSSI-10 t[312] = 5.2, p <0.001); and reduced perceived isolation (PROMIS t[310] = 6.3, p <0.001); and loneliness (UCLA t[301] = 3.7, p =0.002), with small to moderate effect sizes (Cohen's d DSSI-10: 0.28, PROMIS-SI: 0.35, UCLA: 0.21). Increased social connectedness was associated with reduced depression. Improvements in social connectedness (except social interactions) persisted during early COVID-19. Being Latino and/or having difficulty paying for basic needs was associated with less improvement in post-PEARLS social connectedness. PEARLS has potential to improve social connectedness among underserved older adults, though additional supports may be needed for persons facing multiple social determinants of health. Further research is needed to establish causality.

Pilot Study of the Adaptation of an Alcohol, Tobacco, and Illicit Drug Use Intervention for Vulnerable Urban Young Adults.

Objectives: There is limited information about the applicability and effectiveness of tobacco and illicit drug use interventions in urban and racial/ethnic minority youth, a population with great need for prevention of alcohol and drug use. We pilot-tested the feasibility of a behavioral intervention to reduce alcohol, tobacco, and illicit drug use among urban young adults in New Orleans, Louisiana.Study Design: The 12-week intervention pilot project was developed to be implemented at a community-based social service organization that provides educational, juvenile justice-related case management, and mentoring services to youth with substance use and incarceration histories.Methods: One-hour intervention sessions included interactive discussions and lesson reviews guided by a health educator and peer facilitators. Recruitment was done by case managers. Thirty African American young adults aged 16–21 years participated between January 2016 and July 2017.Results: We were able to adapt the 14-session intervention to a 12-session, weekly curriculum that was well-received by the target population. Average rating for each session was 9.5 ± 0.3 (scale 0–10). Youth were willing to engage in the program, but retention was low. Rates of alcohol and drug use were significantly higher within our pilot population than national estimates. We found no significant decreases in self-reported alcohol, tobacco, or illicit drug use after participation in the intervention.Conclusion: Results emphasize the need to devote additional educational resources to intervention and retention factors for vulnerable youth. Individuals often experiment with drugs during adolescence; thus, this period represents a prime opportunity for education and intervention.