Community-based Service Providers Research Articles

626. Tackling the HIV Epidemic in South Florida: Patient Insights on Approaches for HIV Counseling, Testing, and Access to Prevention or Treatment

BackgroundThe South Florida Metropolitan Statistical Area has for several years recorded the highest HIV incidence in the nation, and prevalence in the top three of all counties. To address the alarming disparity in HIV impact, we developed a survey study to learn about the beliefs, attitudes, and perspectives of persons who accessed services at an HIV community-based organization in South Florida.MethodsSurveys were administered in English and Spanish to 109 persons who visited a community-based HIV service provider (Latinos Salud) at any of its three South Florida sites in April 2019. The survey evaluated the participants’ perspectives on different avenues for HIV counseling, screening, and accessing HIV medications for prevention or treatment.ResultsThe majority of survey participants were male (90%), homosexual/gay/queer (75%), and Hispanic/Latino (56%; Table 1). Participants’ self-reported their HIV status as negative (64%), positive (30%), or unknown (6%; Table 1). Of those not currently living with HIV, 77% reported having been tested within the past 6 months, and 81% reported recent engagement in high-risk activities (Table 1).Most participants considered using social media to promote awareness of HIV and related services a good idea (Table 2). Large proportions of participants endorsed receiving HIV counseling through in-person conversations with clinicians (91%), staff at community-based organizations (83%), friends (83%), telehealth visits (69%), conversations with teachers (63%), or church members (56%; Table 2). Most participants endorsed a range of both clinical (e.g. local health clinic) and non-clinical (e.g. mobile van) locations as acceptable settings for HIV testing (Table 2). Large proportions of participants endorsed receiving medications to prevent or treat HIV immediately after testing (82%), by home delivery (78%), or through telehealth (60%; Table 2). Meaningful associations were found between certain patient demographics (race/ethnicity, testing history, or insurance status) and the participants’ perspectives on specific strategies (Table 3).Table 1. Participant Characteristics Table 2. Participants’ Views on Strategies for HIV Counseling, Testing, and Access to Medications Table 3. Participants’ Views on Strategies for HIV Counseling, Testing, and Access to Medications Stratified by Patient Characteristics ConclusionThese real-world findings can be used to inform clinic- and community-based interventions tailored to individual patient characteristics.Disclosures Tamar Sapir, PhD, Gilead Sciences, Inc. (Other Financial or Material Support, Independent medical education grant)

Facilitators and Barriers to Engaging Stakeholders in Use-Inspired Aging Research

The Cell2Society Aging Research Network at Drexel University is a university-wide, novel ecosystem for the pursuit of use-inspired aging research focused on topics from cellular to societal level. Our goals include: 1) Engaging stakeholders to jointly participate in age-related research; 2) Collaborating to build an infrastructure for age-related research through team science; 3) Develop and implement person-centered research that matters to older adults. We apply interdisciplinary, use-inspired approaches in three areas of relevance to older individuals, their families, healthcare and payment systems, communities and policy makers: (a) preventing and managing chronic conditions, (b) enhancing active and purposeful living, and (c) enabling aging in place in home and communities. Our initial qualitative study described facilitators and barriers experienced by community-based service providers (N=9) and payers/providers (N=5) in the greater Philadelphia area when engaging with academic investigators. We conducted three focus groups. Participants were mostly female (64%), white (64%) and were at their organization between 1-10 years (79%).Conventional content analysis revealed that successful research partnerships were facilitated by: 1) trusted investigators and academic institutions and 2) demonstrated collaborative qualities of investigators (e.g., good communication; provides staff education). Negative experiences engaging with academic-led research were related to: 1) research leaving the community (e.g., results never being shared) and 2) organizational limitations (e.g., lack of internal resources to complete projects). These findings will inform the development of stakeholder-academic partnerships from 2020 onward to design use-inspired aging research initiatives.

Community-Based Service Providers' Experiences With Activities for Persons With Dementia.

Persons with dementia (PWD) benefit from participating in meaningful activities. This study's objective was to learn the characteristics of successful meaningful activities from community-based service providers who work with PWD. Six group interviews were performed with 15 unique professionals from an adult day service or community-based coordinated care program. These were supplemented by 100 hr of researcher immersion through weekly volunteering. Data were analyzed by a team, using qualitative content analysis. Participants reported successful activity content incorporated personalization; continuity and incremental challenges; and social engagement. Successful delivery of activities required managing necessary resources; involving informal (family/friend) caregivers; having a backup plan; monitoring time of day and energy levels; facilitating a domino effect; and ensuring safety. Outcomes of successful activities were experiencing fulfillment and purpose; overcoming challenges; and unexpected triggers. Research and practice recommendations include testing innovative, dynamic, and technology-enabled approaches to providing such activities.

Modelo de Estrategia de Dogan Aplicado a Los Prestadores de Servicios de Turismo Com Base Comunitaria, En Las Provincias de Imbabura y Pichincha [Ecuador

Modelo de Estrategia de Dogan Aplicado a Los Prestadores de Servicios de Turismo Com Base Comunitaria, En Las Provincias de Imbabura y Pichincha [Ecuador

Social Interactions between Family and Community-Based Service Providers in Dementia Caregiving

ABSTRACT Objectives: This study aimed to evaluate the psychosocial experiences in community-based dementia caregiving by assessing the characteristics of social interactions between family caregivers and community-based service providers and associated psychological responses. Methods: Two independent groups of participants (family caregivers and community-based service providers) completed a one-time survey to report their social interactions and psychological states. A linear regression model was fit for each outcome (satisfaction, 10-item CES-D) while controlling for significant relevant covariates. Results: Higher perceived levels of collaboration were associated with higher job satisfaction and lower depression score among service providers, and higher satisfaction with providers among family caregivers. Higher perceived social support from the provider was associated with higher satisfaction among family caregivers. Conclusions: Participants reported varying levels of provider-family collaboration. The extent of collaborations and support exchange may have implications on the psychological well-being of those providing care to individuals with dementia including families and providers. Clinical implications: It may be beneficial to identify providers and families who perceive low levels of collaboration and implement intervention to facilitate positive social interactions. Developing organizational culture and payment systems that value high-quality social interactions may help enhance the psychological well-being of service providers and satisfaction among families who receive their services.

Building a Collaborative Understanding of Pathways to Adolescent Alcohol Misuse in a Mi’kmaq Community: A Process Paper

In April of 2006, a team of researchers consisting of both university and community partners from a Mi’kmaq reserve in Nova Scotia began the data-collection phase of a high school-based research study that had been two years in planning. The study examines the possible relationships between youth-reported childhood maltreatment, posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, alcohol misuse, and resiliency factors. The aim of the research study is to provide information about adolescent alcohol misuse that is of practical benefit to community-based service providers, and capable of making a scholarly contribution to the scientific study of the relations of anxiety/mood symptoms and addictive behaviours. The primary aim of this paper is to present both the context from which the project grew, and the steps involved in conducting research with our school partners and the community service providers. A secondary aim is to present some of the preliminary data from the study, with a specific focus on resiliency.

Cairns Mental Health Co-Responder Project: Essential elements and challenges to programme implementation.

In Australia and internationally, co-responder models are becoming an increasingly common intervention to respond to police callouts where there is an assumed mental health-related component or crisis. This type of model involves a collaborative approach where trained police officers team with mental health clinicians to provide specialized responses in order to improve outcomes for persons with mental illness. However, there is limited understanding as to major elements required for implementation of the model. This study aims to identify the essential elements and challenges in implementation of the Mental Health Co-Responder Project in Cairns, Australia, where the team consists of a mental health nurse with demonstrated competencies in crisis intervention and a specially trained police officer. In 2016, 39 participants completed semi-structured interviews regarding knowledge and experience of the Cairns co-responder model. The participants represented first responders and community-based service providers who work with and support persons living with mental illness. Using a thematic analysis approach, key elements identified as essential to successful project implementation were as follows: co-responder team characteristics, senior and project executive level support, collaborative project governance, and co-location of the team within a mental health setting. The main perceived challenges to project implementation included the following: initial concerns regarding client confidentiality, lack of an evaluation plan, and adequate project resourcing. Governance through a vigorous joint agency operation committee and adequate resourcing is imperative to the sustainability of this model.

EXAMINING COMMUNITY-BASED SERVICES DISCONNECTS IN LATE OLD AGE: PATHS FOR REACH THROUGH THE COMMUNICATION ECOLOGY

As potentially eligible recipients continue to increase in number, understanding service system utilization and barriers can help ensure very old adults can access support from their communities when needed. A communication disjuncture between seniors and community-based service providers was revealed through a multi-year, county-wide older adult needs assessment utilizing data from 1,870 individuals. In response, officials convened a post assessment team that formed the three-person Community Advisory Group (CAG, all ≥69 years) who participated in this community-based participatory research (CBPR) study. This applied, qualitative study, guided by an ecological health communication research framework, conducted multilevel examinations of interactions among older adults and their social environment. Twenty in-depth, face-to-face, semi-structured interviews (mean = 82.5 years) were conducted based on a critical threshold of understanding achieved via researcher immersion in the community preceding this study, data collected, and CAG insight revealed through collaborative analysis. Communication Infrastructure Theory helped to reveal how participants’ diminishing social network interrelated with the communication environment acted to impede connections to services. In addition to utilization impediments, enabling elements of the communication infrastructure were identified so those resources might be leveraged to bridge the senior-provider divide. Findings from this study suggest new outreach approaches for connecting to older adults through their communication ecology. The findings add to the growing convergence of evidence that calls for improved communication with older adults to minimize poor interactions that hinder accessing resources that may enhance their social, emotional, and physical well-being.

Assessing the palliative care needs and service use of diverse older adults in an urban medically-underserved community.

Although palliative care (PC) has become increasingly familiar, considerable gaps persist in access to and use of services. Community-based programs remain rare, and low-income, minority communities significantly under-utilize hospice and palliative services. We used community-based participatory research (CBPR) methods to conduct a mixed-methods community needs assessment of seriously-ill older adults (n=100) and providers from community-based programs and churches (n=41) in an urban medically-underserved community in the U.S. to explore: (I) the prevalence and severity of illness-related symptoms and psychosocial-spiritual concerns; (II) the scope and quality of community supports helping older adults manage their symptoms; and (III) the perceptions and utilization of palliative and supportive care services among older adults and community-based service providers. Participants reported high rates of chronic illness-related symptoms (i.e., pain, fatigue, sleeping difficulties, depression, and anxiety), and many described unmet needs around symptom management. Few had ever utilized PC or pain management services, and most relied primarily on family, friends, and faith communities to help them manage burdensome symptoms. Barriers included lack of familiarity with PC, limited access and financial concerns. Older adults were largely unfamiliar with PC, and many described unmet needs and desire for help with symptom burden. Findings support the need to further explore community-level and cultural barriers to PC among diverse, underserved older adults. Development of innovative community partnerships may help raise awareness of PC and address the physical and psychosocial-spiritual challenges facing chronically-ill minority older adults and their families.

"Being Married Doesn't Mean You Have to Reach the End of the World": Safety Planning With Intimate Partner Violence Survivors and Service Providers in Three Urban Informal Settlements in Nairobi, Kenya.

Intimate partner violence (IPV) harms women physically, sexually, and psychologically. Safety strategies, or harm reduction techniques implemented by women undergoing recurrent violence, may help mitigate the negative health, economic, and social consequences of IPV. This study aimed to understand recommended and utilized safety strategies among three urban informal settlements in Nairobi, Kenya. Semi-structured key informant discussions (KIDs; n = 18) with community-based service providers and focus group discussions (FGDs; n = 49) with IPV survivors were conducted. All interviews were audio-recorded, transcribed, and translated verbatim from Swahili to English. Inductive thematic analysis was used to structure codes. Convergence matrices were used to analyze emergent strategies by data source (service providers vs. IPV survivors). Women preferred safety strategies that they could implement unassisted as first line of harm reduction. Strategies included removing stressors, proactive communication, avoidance behaviors, sexual and reproductive health (SRH), economic, leaving partner for safety, child safety, and securing personal property. Strategies recommended by service providers and utilized by IPV survivors differed, with clear divergence indicated for leaving the abusive relationship, SRH, and personal property strategies. Innovative strategies emerged from IPV survivors for safeguarding property. Similar to upper-income and other low and middle-income contexts, women experiencing IPV in urban informal settlements of Nairobi actively engage in behaviors to maximize safety and reduce harm to themselves and their families. Integration of strategies known to be helpful to women in these communities into community-based prevention and response is strongly encouraged. Increased synergy between recommended and implemented safety strategies can enhance programming and response efforts.

Perceived impacts as narrated by service users and providers on practice, policy and mental health system following the implementation of the mhGAP-IG using the TEAM model in a rural setting in Makueni County, Kenya: a qualitative approach

BackgroundA team approach is key to reduction of the mental health treatment gap. It requires collaborative effort of all formal and informal community based service providers and the consumers of the services. Qualitative evaluations of such an approach add value to the quantitative evaluations.MethodsA qualitative study was conducted among 205 participants. These were grouped into a total of 19 focus group discussions for community health workers (CHW), traditional healers (TH), faith healers (FH) and patients. For nurses and clinical officers we held 10 key informant interviews and three key informant discussions. We aimed to document personal perceptions as expressed in narratives on mental health following a community based application of the WHO mental health treatment Gap-intervention guideline (mhGAP-IG) using the TEAM model. We also aimed to document how the narratives corroborated key findings on the quantitative wing of the TEAM model.ResultsThere were three categories of perceptions: (i) patient-related, (ii) health provider-related and, (iii) health system related. The patient related narratives were linked to improvement in their mental and physical health, increased mental health awareness, change in lifestyle and behavior, enhanced social functioning and an increase in family productivity. Health provider perceptions were related to job satisfaction, capacity building and increased interest in mental health training. Mental health system related narratives included effectiveness and efficiency in service delivery and increase in number of referrals at the primary health care facilities.ConclusionThe TEAM is a feasible model for the implementation of the mhGAP-IG. It led to positive perceptions and narratives by service provides and service consumers. The qualitative findings corroborated the quantitative findings of TEAM.

The Runaround: Punishment, Welfare, and Poverty Survival after Prison

AbstractBased on 17 months of ethnographic fieldwork and 45 in-depth interviews with formerly-incarcerated men, this article explores how former prisoners navigate criminal justice and welfare bureaucracies in their daily lives. Formerly-incarcerated men must repeatedly engage with parole, public assistance agencies, transitional housing facilities, and community-based service providers to maintain freedom and access food, shelter, and rehabilitative services. Accessing resources requires the men simultaneously to manage multiple, overlapping entanglements across a fragmented network of bureaucracies. This runaround exacerbates the stress of poverty, breeds distrust of state authorities, and, in some cases, precipitates recidivism. Former prisoners learned how to cope with the runaround by treating systems navigation as a full-time occupation, but these skills did not translate into long-term economic security. Most study participants recurrently cycled between low-wage jobs, transitional housing facilities, and public assistance programs for years after release. This article illustrates the need to theorize prisoner reentry as a process that unfolds across a network of criminal justice and welfare bureaucracies and demonstrates how formerly-incarcerated men experience citizenship not only through coercive encounters with the criminal justice system but also through their simultaneous entanglements with safety-net bureaucracies.

Advancing emergency preparedness for people with disabilities and chronic health conditions in the community: a scoping review

Background: Community-based service providers are optimally positioned to contribute to the inclusion of people with disability and chronic health conditions in community-level disaster risk reduction. However, little is known about how to enable emergency preparedness within existing community health care, disability, and rehabilitation service delivery.Purpose: This study synthesised findings from a scoping review of the literature on how community-based service providers can enable emergency preparedness for clients in the community. Emphasis was placed on the practice scope of service providers undertaking this emerging role, the knowledge, skills and attitudes required to enable preparedness in others, and the current tools and training available to support service providers.Method: Six electronic databases, hand and cited searches were undertaken to identify studies for inclusion. In total, 24 publications were included.Results: Providers have competencies in conducting functional assessments that make them well-suited to enabling emergency preparedness with clients. Findings revealed seven provider responsibilities associated with this role and eight tools and training resources to support providers.Conclusion: Whilst community-based service providers are willing and optimally placed to enact these roles, they require additional support to do so in a manner that espouses values of inclusion and enablement.Implications for RehabilitationA wide range of community-based service providers are willing to leverage their role to enable emergency preparedness with clients in the community.Research is needed to understand how to optimise the expertise of diverse health care, disability and rehabilitation providers in facilitating emergency preparedness with clients.Strengths-based tools are needed to increase client self-sufficiency in preparing for and responding to emergencies.Enablement processes should guide the development of emergency preparedness as a critically important and emerging role for community-based service providers.Disability and rehabilitation professionals can use this scoping review to self-assess their capacity and develop opportunities to embed emergency preparedness into routine practice with clients.

Five-year Changes in Methamphetamine Use, Dependence, and Remission in a Community-recruited Cohort.

Investigate patterns of methamphetamine use over time, specifically factors associated with remission from dependent and harmful patterns of use; and examine drug treatment and health/support service utilization pathways among people who use methamphetamine. People who regularly use methamphetamine were recruited from nontreatment settings in Melbourne, Australia, in 2010, and followed up twice over 5 years. Trajectories of past-month methamphetamine use and methamphetamine dependence were mapped. Random-effects logistic regression modeling identified factors associated with these outcomes. Overall, past-month methamphetamine use and methamphetamine dependence decreased among the cohort over the study period. Variability in methamphetamine use and dependence trajectories was observed; 56% of participants achieved past-month abstinence; however, 14% subsequently relapsed and 44% reported past-month use at every time-point. During the study period, 27% of participants were never classified methamphetamine-dependent, 30% remitted from dependence, and 23% were consistently classified dependent. Factors independently associated with past-month methamphetamine use included male sex and poor physical health. Factors independently associated with methamphetamine dependence included poor physical health, low self-perceived social support, current mental health medication prescription, and current engagement with drug treatment services for methamphetamine use. Engagement with treatment and health/support services remained low (12%-22%) over the study period. Our findings indicate people who remit from methamphetamine dependence, reduce their frequency of use or cease entirely can maintain this over long periods. Initiatives addressing social determinants of health could be optimal for combating methamphetamine dependence. Community-based frontline service providers should be educated in relation to appropriately addressing methamphetamine use.

Strategies Employed by Community-Based Service Providers to Address HIV-Associated Neurocognitive Challenges: A Qualitative Study

Background:HIV-associated neurocognitive disorders and other causes of neurocognitive challenges experienced by people living with HIV (PLWH) persist as public health concerns in developed countries. Consequently, PLWH who experience neurocognitive challenges increasingly require social support and mental health services from community-based providers in the HIV sector.Methods:Thirty-three providers from 22 AIDS service organizations across Ontario, Canada, were interviewed to determine the strategies they used to support PLWH experiencing neurocognitive difficulties. Thematic analysis was conducted to determine key themes from the interview data.Results:Three types of strategies were identified: (a) intrapersonal, (b) interpersonal, and (c) organizational. Intrapersonal strategies involved learning and staying informed about causes of neurocognitive challenges. Interpersonal strategies included providing practical assistance, information, counseling, and/or referrals to PLWH. Organizational strategies included creating dedicated support groups for PLWH experiencing neurocognitive challenges, partnering with other organizations with services not available within their own organization, and advocating for greater access to services with expertise and experience working with PLWH.Conclusion:Through concerted efforts in the future, it is likely that empirically investigating, developing, and customizing these strategies specifically to address HIV-associated neurocognitive challenges will yield improved social support and mental health outcomes for PLWH.

Enhancing individual placement and support (IPS) - Supported employment: A Type 1 hybrid design randomized controlled trial to evaluate virtual reality job interview training among adults with severe mental illness

Individual Placement and Support (IPS) is the evidence-based model of supported employment that increases employment rates in adults with severe mental illness (SMI). Although IPS is largely successful, over 80% of adults with SMI remain unemployed. An enhancement to high fidelity IPS could be an evidence-based job interview training component. To meet this training need, our group recently completed a series of randomized controlled efficacy trials funded by the National Institute of Mental Health to develop and test virtual reality job interview training (VR-JIT) in a lab setting. The results demonstrated that the intervention was efficacious at helping trainees improve their job interview skills and receive job offers within six months of completing VR-JIT compared to non-trainees. The overarching goal of this study is to evaluate the effectiveness of VR-JIT as an enhancement to IPS when delivered in a large community-based mental health service provider via a randomized controlled trial and initial process evaluation. Our aims are to: evaluate whether IPS services-as-usual in combination with VR-JIT, compared to IPS services-as-usual alone, enhances IPS outcomes for adults with SMI; evaluate mechanisms of employment outcomes and psychological distress; and conduct a multilevel, multidisciplinary, and mixed-method process evaluation of VR-JIT adoption and implementation to assess the acceptability, scalability, generalizability, and affordability of VR-JIT.

Managing the hope and worry of housing renewal-supporting well-being in the emerging community.

Housing renewal is a common urban housing and development strategy internationally. An intended result is increased social inclusion and well-being of residents through public housing de-concentration. In this study, we examined challenges encountered during the process of housing renewal from the perspectives of community-based staff and volunteers. We conducted semi-structured qualitative interviews with housing and community workers, service managers and community volunteers who were working with residents experiencing housing renewal in an outer metropolitan estate in New South Wales. We analysed the data thematically. Seventeen participants were interviewed in a mix of individual and group interviews. Housing workers uncovered substantial resident health and social support needs during housing assessments. Promoting access to services and supporting the mental health and social connectedness of residents into the future were seen as key goals and challenges. However, lack of clarity on which services and community resources would exist in the new neighbourhood at the completion of the renewal project made this more difficult, particularly when supporting the social housing residents who were remaining in the changing community. Supporting the mental health and well-being of residents experiencing housing renewal is an important role of community-based workers, volunteers and service providers. This includes facilitating access to health care and other services and promoting social connectedness in the emerging community. Increased clarity on what community resources and services will be available subsequent to redevelopment will assist in these aims. SO WHAT?: Early knowledge of what community resources and services will be in place long term in communities undergoing housing renewal will allow staff and volunteers to better support the health and well-being of residents.

Newcomer Central American Immigrants' Access to Legal Services

Increased Central American child and family migration is impacting local communities across the U.S. Between late 2013 and mid 2018, over 193,000 unaccompanied children (UACs) and 300,000 adults and children traveling as family units from Central America were apprehended at the U.S.-Mexico border. As their cases overburden the immigration courts, federal engagement in the provision of immigration legal services remains virtually non-existent. Local governments and community-based organizations (CBOs) have been forced to improvise how best to provide legal services for this growing newcomer population as they navigate the immigration process. Varying levels of capacity and response across diverse community contexts, however, are contributing to disparities in newcomers’ ability to secure an attorney. Without legal representation, many newcomers face nearly certain deportation regardless of whether they may qualify for immigration relief. To better understand local variations in the provision of legal assistance and barriers faced by Central American migrants in accessing existing services, researchers from the Center for Latin American & Latino Studies (CLALS) at American University and the Graduate College of Social Work at the University of Houston conducted interviews with service providers, local government officials, and other stakeholders across three major immigrant receiving communities: the Washington, DC and Houston metropolitan areas, and North and South Carolina. Drawing on project interviews and publicly available data, this report documents legal service gaps, catalogues the principal challenges confronting community-based legal service providers, and highlights strategies for enhancing service provider capacity and overcoming access barriers. While both public and private partners across a number of U.S communities are engaged in innovative, scaled-up approaches to providing legal services, demand continues to outstrip available resources. The need is particularly acute in localities outside of the major metropolitan areas that are home to large Central American immigrant communities. Significant barriers to access remain and—in the current context of immigration enforcement policy—are accumulating. The forecast of continued strain on an already over-taxed ecology of service providers and on the immigration adjudication system threatens the well-being of tens of thousands of newcomers whose futures hinge on improved capabilities.

Hispanic Caregiver Experiences Supporting Positive Postschool Outcomes for Young Adults With Disabilities

The rate of competitive employment, or employment in community settings for minimum wage or higher, of working-age individuals with disabilities trails behind individuals without disabilities in the United States. These statistics are even more alarming among Hispanic individuals who have disabilities. The purpose of this study was to explore the negative and positive experiences of Hispanic caregivers from a Midwestern state as they support their family members with disabilities to achieve positive postschool outcomes, including competitive employment. We conducted semistructured interviews with 13 caregivers of family members with disabilities aged 14-25 years. Three key themes emerged from our analysis: (a) negative experiences with school educators, (b) negative experiences with community-based service providers, and (c) positive experiences and strategies for overcoming barriers. Implications for practice and future research are discussed.

Home and Community-Based Service Organizations’ Capacity for and Experiences With Quality Improvement Initiatives

Few studies have examined quality improvement (QI) initiatives among home and community-based service (HCBS) providers. Study objectives were to (1) examine HCBS organizations’ QI capacity, (2) explore organizational differences in providers’ QI experiences, and (3) explore the impact of a state’s QI initiatives on providers’ efforts. A survey assessing HCBS providers’ experiences and QI capacity was administered. Overall, respondents reported a moderate amount of previous QI experience. In terms of QI capacity, smaller and rural organizations were more likely to report inadequate support for project implementation ( p < .05). Larger organizations were more likely to report challenges with staffing. Smaller organizations reported less of a perceived impact of the state’s initiative ( p < .05). Smaller and rural providers need individualized support to overcome lack of QI experience and resources.