Community-based Services Research Articles

Development of an evaluation list for older adult community-based rehabilitation needs through a Delphi method

Older adults’ functional and intrinsic abilities may decline with increasing age. The positive effects of comprehensive community-based rehabilitation services to maintain physical, mental, and social function are essential. Nevertheless, few tools are available to assess the community-based rehabilitation needs of older adults. Therefore, we aimed to construct a list for the comprehensive evaluation of community-based rehabilitation needs of older adults. The International Classification of Functioning, Disability, and Health (ICF) was used to construct a first draft of the assessment list. From September to November 2023, 18 experts from five provinces and nine tertiary hospitals and institutions of higher education in China participated in this Delphi study. The older adult community-based rehabilitation needs evaluation list included six dimensions and 29 items. The weights of the six dimensions, from high to low, included mental function rehabilitation need (0.30), body function rehabilitation need (0.24), social participation need (0.18), individual activity rehabilitation need (0.14), environmental rehabilitation need (0.09) and rehabilitation information need (0.05). Using the Delphi method, an assessment list of older adult community-based rehabilitation needs based on ICF was developed. Future work should evaluate the list’s reliability and validity and its application in managing community-based rehabilitation for older adults.

Understanding Barriers to Access and Opportunities for Telemedicine in Underserved Urban Communities.

Introduction: Loss to follow-up and decreased access to timely care have health consequences that often lead to increased emergency service utilization for benign, treatable, and preventable conditions. As such, significant medical intervention is necessary. Specifically in the District of Columbia (DC), the health of Medicaid beneficiaries of Wards 7 and 8, overwhelmingly underserved communities, necessitates alternative means for more accessible, convenient, and consistent care, which can be achieved by integrating telemedicine services into current care modalities. Methods: Utilizing survey responses from the pre-COVID-19 pandemic, we identified a need for a community-based telemedicine service centered at the Pennsylvania Avenue Baptist Church, designing a threefold project to build knowledge, capacity, and to test feasibility. To build knowledge, we assessed demographics, telemedicine knowledge, current and past telemedicine use, health care utilization, access and improvement issues, telemedicine layperson utilization, and opinions and desire for telemedicine services. Results: A total of 223 responses were gathered from residents residing in Wards 7 and 8 as well as in the neighboring DC communities. An array of data results demonstrates that integrating telemedicine services into community care centers ultimately satisfies identifiable needs in DC's low-income communities for mental health resources, better coordination of care, more convenient and culturally attuned care, and greater health literacy. Discussion: Integrating telemedicine services into community care centers satisfies the need to decrease costs of care and improve the access and quality of care. Effective evaluation strategies and outcome measures that indicate benefits beyond cost savings could provide useful information on how to integrate sustainable telehealth systems in health care delivery models.

교육바우처 정책 사상의 원류와 그 원리에 대한 소고

This study explores the ideological foundation of education vouchers, focusing on educational support programs for commoners during the French Revolution and the educational philosophies of Thomas Paine and John Stuart Mill. Thomas Paine emphasized the expansion of educational choice through government support and assistance for the poor, while John Stuart Mill advocated for educational improvement through free choice and competition. Their philosophies have become core ideas in the modern school choice movement and were institutionalized in the education voucher policy by Milton Friedman. This study analyzes the outcomes of education vouchers from the perspective of public choice theory and examines models such as the Tiebout hypothesis, Demand Side Financing, and Home and Community-Based Services (HCBS). Additionally, it explores the relationship between Hirschman's Exit-Voice-Loyalty model and the principle of voucher choice. In conclusion, this paper emphasizes how these concepts are related to choice and competition in public services. Furthermore, it highlights that the principles inherent in education vouchers serve as an important ideological foundation for democracy and economic development.

Assessing the Feasibility of Integrating the Lethality Assessment Program into the Los Angeles Domestic Abuse Response Team

Abstract Purpose The Lethality Assessment Program (LAP) Maryland Model is an evidence-based intervention designed to prevent intimate partner homicide. It includes the lethality assessment screen, a tool used by field practitioners to assess a victim-survivor’s risk of being killed by their partner, and a referral process linking victim-survivors to community-based domestic violence services. This study aimed to evaluate the LAP's alignment with the needs of Los Angeles and its potential integration into the Los Angeles Domestic Abuse Response Team (DART) Program, which operates in all 21 divisions of the Los Angeles Police Department (LAPD). Methods Between January and May 2021, we conducted qualitative interviews with 15 law enforcement officers, domestic violence service providers, and other stakeholders involved with DART to gather information for tailoring the LAP intervention for pilot implementation in three LAPD divisions. Results Participants were positive about the LAP and its integration into the DART program but identified several gaps, such as limited staff, resources, and training. Despite these concerns, there was widespread agreement that the LAP aligned with existing DART operations, with an emphasis on the importance of obtaining buy-in from non-DART LAPD personnel. Conclusions Results suggest that it will be feasible to pilot test the LAP in Los Angeles. These efforts should include fact-based education for officers on the rationale and factors behind the screening procedures to improve acceptance and implementation of evidence-based practices.

A qualitative exploration of the COVID-19 pandemic on health and nutrition behaviours during the first 1000 days in Sri Lanka.

This study sought to understand reported impacts of the COVID-19 pandemic on maternal and child health and nutrition behaviours during the first 1000 days of life. This qualitative and participatory substudy was embedded within mixed methods formative research conducted during 2020-2022 across two urban, three rural and one estate sector site in Sri Lanka. Semi-structured interviews among caregivers of children aged 6-23 months (n = 34), influencers of caregivers, such as health workers (n = 37), leaders (n = 10) and pregnant women (n = 20) were conducted. Participatory workshops (n = 14) triangulated interview findings. Interview data were analyzed to identify salient themes using Dedoose. Numerical data from voting conducted in workshops were summed and triangulated with interview data. Findings suggest that the COVID-19 pandemic and imposed restrictions shaped maternal and child health and nutrition behaviours through a complex interplay of factors. Imposed restrictions and changes to the food system contributed to temporary unemployment for wage workers and reduced purchasing power to maintain food security for vulnerable households. While deciding whether to seek care, fears of infection prevented usual care-seeking decisions. Also, reduced incomes and disrupted public transportation made transport to health care facilities for antenatal care services difficult. Once women reached facilities, medical services and quality of care were negatively impacted. Implementing expanded community-based services during home visits focused on the first 1000 days and beyond was one effective strategy to maintain maternal and child health and nutrition during the early pandemic in Sri Lanka.

Provision of Home & Community Based Services to Veterans by Race, Rurality, and Neighborhood Deprivation Index.

Home and community-based services (HCBS) enable frail patients to remain at home. We examined whether there were neighborhood-deprivation, racial, or rural disparities in HCBS utilization provided to Veterans by the Department of Veterans Affairs (VA) or Medicare by comparing the adjusted utilization rate of a historically disadvantaged group with the predicted utilization rate had it been treated as the historically dominant group. Among the 2.7 million VA patients over 66 years old in 2019, 11.0% were Black, 39.2% lived in rural settings, 15.3%/29.2%/30.9%/24.7% lived in least/mild/moderate/most-deprived neighborhoods. On average, 11.2% received VA or Medicare HCBS. Veterans residing in more deprived neighborhoods had 0.11-0.95% higher adjusted probability of receiving HCBS than expected had they resided in the least deprived neighborhoods. Veterans residing in rural areas had 0-0.7% lower HCBS rates than expected had they been treated like urban Veterans. Black Veterans were 0.8-1.2% more likely to receive HCBS than expected had they been treated like White Veterans. Findings indicate that VA resources were equitably employed, aligning with probable HCBS needs, suggesting that VA's substantial and long-standing investment in HCBS for care of frail Veterans could serve as a model for other payers and providers in the U.S.

Evaluation of a Counselling Service for the Elderly

An evaluation of WellElder, a counselling service for the elderly, was conducted using four years of accumulated client information and counselling outcome data. This information was collated, analysed, and compared with the New Zealand literature and with information from other countries on counselling the elderly. Findings showed that there was considerable similarity between clients using the WellElder service and clients of all ages at other community-based services in New Zealand and abroad. In addition, outcome data demonstrated that the large majority of clients were receiving brief counselling, fewer than six sessions, and that the counselling being offered to clients was effective in meeting their needs. The implications of these findings are discussed in relation to agency policy and development.

Development and feasibility of the peer and nurse-led HIV Self-Testing Education and Promotion (STEP) intervention among social networks of men in Dar es Salaam, Tanzania: application of the ADAPT-ITT model

BackgroundAccording to the 2016–2017 Tanzania HIV Impact Survey, only 45% of men living with HIV (MLWH) were aware of their HIV status. In an effort to increase HIV testing in Tanzania, including among men, the Government of Tanzania passed a law in December 2019 allowing HIV self-testing (HIVST) to be included in the national testing strategies. The objective of this paper is to describe the development and pilot feasibility assessment of the Self-Testing Education and Promotion (STEP) intervention, which includes male peer education and demand creation for HIVST, and nurse-led distribution of HIVST kits in a community setting.MethodsThe development and piloting processes were guided by the ADAPT-ITT model and informed by a national PEPFAR/USAID-funded HIV implementation science project called Sauti.The adapted STEP intervention included the following two components: 1) peer-based HIVST promotion; and 2) nurse-led HIVST distribution. For the feasibility assessment, 25 men were selected and trained as peer educators in 2019 to promote HIVST among their peers before recruiting 253 men who received instructions and an HIVST kit from a nurse at a community-based study tent site.ResultsOf the 236 participants who completed the 1-month follow-up survey, 98.3% reported using the kit. The majority (92.4%) of participants reported a negative HIVST result while 4.2% (n = 10) received a positive result. Most (70%, n = 7) of the participants with a positive result sought follow-up services at a healthcare facility while 40.3% (n = 95) of the participants with a negative self-test result visited the community-based project site. Most of the men (53%, n = 129) did not visit a healthcare facility or the study site.ConclusionThe findings demonstrate that the combined peer-based promotion and nurse-led distribution of HIVST intervention was acceptable and feasible, though seeking follow-up services at healthcare facilities remained low. Future research should evaluate the effectiveness of offering nurse-led community-based clinical follow-up services in addition to HIVST rather than referral to facilities.

A state-of-the-art review of community-based palliative care services in rural areas of Southern Minnesota and the United States.

This state-of-the-art (SOTA) review aimed to understand the historical, current and future of rural community palliative care services (PCS) with a primary focus in rural southern Minnesota communities and the United States. This review followed the six step SOTA systematic review process described by Barry et al (2022) and examined articles from 2010-2023 regarding rural PCS. Historical and current research consistently supported the benefits of PCS and reported the top facilitators as a clear definition of palliative care and PCS. The top barriers included a lack service provision, funding/resources, national policies/regulation, and shortages of trained providers in rural communities. Barriers to the provision of PCS have not improved based on this review in rural areas and must be addressed to reduce healthcare disparities for rural populations.

Oncology care model cost data for breast, lung, and multiple myeloma: Influence of outpatient rehabilitation therapy services.

14 Background: High value cancer care is defined by access to coordinated, appropriate healthcare services that achieve optimal outcomes at a reasonable cost. Evidence supports outpatient cancer rehabilitation (physical, occupational or speech therapy) as a mechanism to improve outcomes such as health-related quality of life, suggesting that integration of these services is beneficial for cancer survivors. However, the impact of outpatient rehabilitation services on healthcare costs is unknown. We aimed to compare cost segments between those who attended community-based outpatient rehabilitation therapy services (Rehab) versus those who did not (Non-rehab). We hypothesized that healthcare costs would be lower for the Rehab group in the following cost segments: emergency department (ED), part D drugs, home health services, skilled nursing facility services (SNF), inpatient rehabilitation facilities (IRF), and hospice. Methods: This is a retrospective cohort study of Medicare beneficiaries who received chemotherapy at a large community oncology practice that participated in the oncology care model (OCM) program from 2018 to 2021. Two data sources were linked, OCM cost data and the rehabilitation medical record. This yielded sufficient sample sizes for analysis of breast, lung, or multiple myeloma (MM) cancer types. Rehab cases were then matched to Non-rehab cases 3:1 based on cancer type, stage, and sex. Cost variables included total cost of care (TCOC) and cost segments using OCM methodology. Mann-Whitney-Wilcoxon statistic (p<.05) was used for analysis. Results: Cases (N=3,033) primarily had early-stage cancer (0 to 2, 74.8%) and were 70.4±7.3 (Rehab) or 71.6±8.5 years old at diagnosis (Non-rehab). Most had breast cancer (81.2%), followed by lung cancer (11.7%) and MM (7.2%). TCOC was $32,387 and $26,257 for the Rehab and Non-rehab groups, respectively. Costs were significantly lower for the Rehab group in five of the six segments analyzed; IRF costs were lower, but not statistically significant (Table). Conclusions: To our knowledge, this is the first study to explore the influence of real-world, outpatient cancer rehabilitation therapy services on the cost of cancer care. Community-based therapy services were associated with significantly lower costs in ED, part D drugs, home health, SNF, and hospice segments. Future studies examining rehabilitation services as a relatively low-cost supportive care option to meet patient needs and enhance high-value care are warranted. Healthcare segment costs for rehab vs. non-rehab cases. Rehab Non-rehab Between-group Difference Mean, (SD) Mean (SD) p-value ED $85 (260) $104 (372) .019 Part D drugs $4,813 (18,221) $5,675 (18,797) <.001 Home health $433 (1,600) $705 (2,118) <.001 SNF $160 (1,988) $386 (3,943) .046 Hospice $75 (770) $198 (1,529) <.001 IRF $245 (2,275) $384 (3,277) .434

The impact of the first phase of the COVID-19 pandemic on referral patterns and therapeutic service provision for children and young people's psychosocial distress in a Low-or Middle-Income Country: A service evaluation of routinely collected data from a non-government organisation operating in schools in the Western Cape, South Africa.

In low- and middle-income countries (LMICs), including South Africa, there is a paucity of psychosocial support services. Therefore, services are often provided in schools by non-government organisations like Community Keepers (CK). The COVID-19 pandemic and resultant restrictions meant that children and young people's (CYP) lives changed, negatively affecting their mental health. Further, organisations like CK had to change their working processes. This project compared routinely collected data from CK from 2019 (pre-pandemic) to 2020 (pandemic) to describe the changes that occurred in referral patterns to, and service provision by, CK. Both pre-pandemic and during the pandemic, most referrals of CYP were for emotional/psychological support and behavioural difficulties. In 2020, referrals for general guidance increased, whilst referrals for peer group issues and sexuality decreased. Further, CK completed more brief check-ins, provided wellbeing workshops to increased numbers of teachers, parents and CYP, and had more consultation sessions with other service providers during the pandemic. Routinely collected data from this community-based service in a LMIC context shows differences in the way that support was provided, and to whom, during the COVID-19 pandemic. Clinical implications, including the importance of increasing access to psychosocial support via technology, are included.

Effectiveness of a package of community-based mental healthcare services to address perinatal mental disorders in Bangladesh: A cluster-randomized controlled trial

BackgroundPerinatal mental disorders of women have an impact on their pregnancy and their child’s brain development across low and middle-income countries. However, to address this issue, there are no specific guidelines for community-level service providers in Bangladesh. Therefore, we aimed to develop a community-based mental healthcare (CBMHC) service package and test its effectiveness in reducing depression, anxiety, and stress among mothers during the perinatal period. MethodsA cluster-randomized controlled trial (cRCT) was applied to test the CBMHC package in 2017 and 2018. It was provided to one group of mothers along with routine maternal care while another group received only routine maternal care. Paired sample t-test was applied to assess mean changes at baseline and endline in the Depression, Anxiety, and Stress Scales-21 (DASS-21) and EuroQol-5 Dimension and 3 Level (EQ5D3L) scales. A linear mixed-effects model was used to assess the relationship between the DASS-21 score and EQ5D3L. Results1,215 participants were enrolled, including 605 in the intervention group and 610 in the control group. Measures of depression, anxiety, and stress were significantly decreased in both groups. Reduction in the levels of stress, as measured by changes in the stress score, were significantly greater in the intervention than in the control group (diff: 1.2, 95% CI: 0.1, 2.2). The EQ5D3L index improved significantly, 0.02 units more at endline in the intervention group than in the control group (diff: 0.02, 95% CI: 0.007, 0.03). The levels of mobility, usual activities, pain or discomfort, depression, and anxiety improved by 1.4%, 7.6%, 4.4%, 2.6%, and 0.4% more, respectively, in the intervention group compared to the control groups. These improvements were statistically significant. The DASS-21 score was negatively and significantly correlated with both the EQ-5D3L index and the Visual Analogue Scale (VAS) score for the intervention group as well as for the usual care group, indicating that EQ5D3L improved when common mental disorders decreased. ConclusionAlthough the improvements were modest, a CBMHC service package was effective in reducing perinatal levels of stress among Bangladeshi rural women. Trial registrationClinicalTrials.gov ID: NCT03678415

Targeting Community-Based Palliative and Serious Illness Care Resources: Challenges of More Stringent Diagnostic Criteria for Prospective Enrollment.

Background: For patients with serious illnesses, one aim of palliative care services is to reduce the frequency and severity of hospital-based episodes of care. Since hospital-alternative palliative care may consume costly resources, providers need to efficiently target high-intensity services toward those most at risk for such adverse episodes of care. Objective: Our objective was to investigate progressively more restrictive diagnosis-based indications of serious illness as used to prospectively identify patients with higher average rates of hospitalization. Design/Setting: We designed an observational cohort quality improvement study using historical Medicare claims records to evaluate diagnostic inclusion criteria for targeting palliative and serious illness care resources. We first isolated a Seriously Ill Population (SIP) and then defined More SIP and Most SIP subgroups. Measurements: Our primary outcome measure was the 2019 acute-care count of hospitalizations for patients in the SIP, More SIP, and Most SIP subgroups, respectively. Results: The More SIP and Most SIP subgroups exhibited higher hospitalization rates. However, they also excluded progressively more seriously ill patients who did experience hospitalizations. In addition, almost half of the Most SIP subgroup were not hospitalized at all, despite having an average hospitalization rate greater than one. Conclusion:Allocating resources (personnel and services) toward reducing hospitalizations when almost half of the targeted population never goes to the hospital could result in unnecessary expenditures and exclude patients that could potentially benefit. Engaging community-based services to detect changes in status could provide supplemental indications of when and for whom to target palliative care resources.

How Long Is Long COVID? Evaluation of Long-Term Health Status in Individuals Discharged from a Specialist Community Long COVID Service.

Background: Post COVID-19 syndrome or long COVID (LC) is a novel fluctuating condition with a protracted course in some patients. Specialist LC services have been operational in the UK since 2020 and deal with a high caseload of patients. Aims: To evaluate long-term outcomes in patients discharged from a community-based LC specialist service. Methods: A service evaluation study that included patients who were well engaged in the services [completed the standard Patient Reported Outcome Measures (PROMs) and received intervention from clinician(s)] and had been discharged for at least 3 months from the service. They consented to the study and completed standard PROMs: COVID-19 Yorkshire Rehabilitation Scale (C19-YRS), EQ-5D-5L and National Institute for Health and Care Excellence (NICE) criteria for myalgia encephalomyelitis/chronic fatigue syndrome (ME/CFS). Results: Out of 460 patients contacted, 112 (average of 37.6 months since infection and 9.8 months post-discharge) completed the PROMs. Of these, 90.2% patients continued to experience LC symptoms and disability and had not returned to their pre-COVID-19 health status. The average EQ-5D-5L index score was 0.53 (SD 0.29), highlighting a significant disability and that LC had become a long-term condition (LTC) in the majority of patients who responded to the survey. Of these patients, 43% met the criteria for suspected ME/CFS. Conclusions: A proportion of LC patients develop persistent long COVID (PLC) consistent with a LTC and had a significant overlap with ME/CFS.

Implementation Of A Novel And Integrated Community Flexible Endoscopic Evaluation Of Swallowing (FEES) Service Model For Older Persons

Abstract Background FEES is a gold standard Speech & Language Therapy (SLT) led diagnostic instrument that facilitates evidence-based dysphagia care. A novel community-based FEES service for older persons’ services was recently established in Ireland's Mid-West. New pathways, integrated across divisions, were designed and implemented to complement existing dysphagia pathways within Integrated Care Programme for Older Persons (ICPOP), inpatient rehabilitation for older persons and primary care. An integrated pathway was also established with acute services (Otolaryngology). The aim of this abstract is to describe the implementation process for this novel community FEES service. Methods An SLT-led FEES team engaged with a range of community- and acute-based stakeholders across policy and practice: SLTs, Otolaryngologists, management teams, ICPOP teams, Gerontology Consultants, General Practitioners, Infection Prevention and Control (IPC) teams. Normalisation Process Theory (NPT), an empirically tested and theoretically-sound implementation science framework, scaffolded discussion across a range of implementation and consultation activities including co-design workshops and educational presentations and training, using Health Service Executive (HSE) Change Management tools. Results Stakeholders co-developed a shared understanding of current and new pathways to identify and enact implementation strategies at individual, discipline and system-levels. The project involved stakeholder mapping, communication/engagement planning, risk management, resource planning, and large-scale targeted education/training across settings and disciplines. A FEES working group was formed to coordinate, sustain, monitor, and futureproof implementation activities. Conclusion This collaborative project generated interdisciplinary vision and action to enact an innovative dysphagia care pathway for older people in the community. Articulated through an NPT lens, the project provides insights into the collaboration needed to implement truly integrated care and to identify enablers at individual, disciplinary, and organisational levels. Such knowledge is essential for enhancing integrated care and enacting change and innovation in the Irish health service.

Rationing Rights: Administrative Burden in Medicaid Long-term Care Programs.

States use Medicaid waivers to provide supports for disabled people in communities, rather than in institutions. Because waivers are not entitlements, those deemed eligible are not guaranteed these supports. How do states, in practice, use bureaucratic procedures to ration this 'conditional' right? Drawing on primary and secondary data, we analyze waiver programs, and document state administrative procedures to indirectly and directly ration access. Burdens indirectly limit disabled peoples' access to Medicaid home and community-based services, via a complex array of waiver programs that exacerbate costs associated with gaining eligibility, and directly limit access, via waitlists and prioritization among the eligible. There is also evidence that states strategically deploy opaqueness to provide political cover for unpopular waitlists. The overall process is opaque, confusing, and time intensive, with burdens falling hardest on marginalized groups. Administrative burdens impede the right to live in the community afforded to people with disabilities under the American with Disabilities Act. The opaqueness and associated burdens with waiver programs are a way to conceal these costs, thereby demonstrating how burdens "neatly carry out the 'how' in the production of inequality, while concealing ... the why."

Barriers to accessing home and community-based services among family caregivers of Veterans.

The Department of Veterans Affairs (VA) has long recognized the importance of having a rich complement of home and community-based resources for the Veteran population. For Veterans experiencing disability-related impairments, home- and community-based services (HCBS) facilitate aging in place and alleviate family caregivers' burden. However, even in the enriched VA context, HCBS are underutilized. Our objective was to understand unmet needs and barriers to accessing HCBS from the perspectives of Veterans' family caregivers. This multi-method study recruited family caregivers of Veterans seen within a major VA Health Care System. Eligible caregivers provided care for at least 8 h/week in the prior 6 months, to a Veteran with 1+ impairments in instrumental activities of daily living. Recruitment was conducted via flyers, physician referrals, registries, and chart reviews. Participants completed 1-h semi-structured interviews to assess unmet psychosocial needs and barriers to accessing VA and non-VA HCBS. Interviews were analyzed using a thematic analysis approach. A total of 23 caregivers (62.9 + 13.5 years; 74% women; 52.2% White; 26.1% Black; 95.2% pre-9/11) provided 8.4 ± 6.3 h of daily care. Most had provided care for more than 1 year; nine had cared for their Veteran for 5+ years. The following themes were identified: (1) need for clear, accurate, timely information about HCBS; (2) lack of time, amplified by COVID-19 restrictions; (3) need for respite to manage their own health and other caregiving responsibilities; and (4) perceived difference in care needs that can strain caregivers' relationship with the care recipient. In addition to known barriers including lack of timely knowledge, service delays, and caregiver stress, Veteran-caregiver disagreements emerged as a novel barrier to using HCBS. A multi-pronged approach that addresses these barriers may increase timely access to HCBS.

A Scoping Review of Home and Community-Based Services and Older Adults’ Health Outcomes

Most older adults aspire to age in their homes and communities; they often face challenges due to functional limitations. The demand for home and community-based services (HCBS) has steadily increased to address these challenges. This scoping review explores the relationship between HCBS and the health outcomes of older adults. A total of 11,317 peer-reviewed articles published between January 1, 2005, and August 1, 2023, were identified from major electronic databases, with 12 articles selected for the final sample. The findings indicate that HCBS are consistently associated with better health outcomes, including improvements in physical and mental health and reduced hospitalizations. However, Black and Asian older adults reported lower accessibility to HCBS and poorer self-rated health compared to their White counterparts. Additionally, low density and lack of HCBS in neighborhoods were linked to poorer health outcomes among older adults. Policymakers should prioritize improving HCBS accessibility in neighborhoods, consider the demographic characteristics of older adults, and address their diverse needs to tailor HCBS effectively.

“Everyone’s brains are different…you can’t just have one therapy plan to suit everyone” – A qualitative investigation of community-based rehabilitation services following traumatic brain injury

Purpose To examine the lived experiences of adults who have received community-based rehabilitation (CBR) services in Australia or New Zealand for cognitive-communication disorders (CCDs) following traumatic brain injury (TBI) and their support people. Participants’ recommendations for future models of care were also explored to enhance rehabilitation services for people with TBI. Method A qualitative descriptive approach grounded in phenomenology was used, whereby semi-structured interviews were conducted with each participant. A total of 28 interviews were completed, four in-person and 24 via video conferencing. Two participant groups were recruited: Adults with TBI; and their support people. Sixteen adults with a self-reported diagnosis of cognitive-communication disorder (CCD) following TBI who had received CBR and 12 support people were included. Interviews were analysed using reflexive thematic analysis. Result Four themes were identified by the participant groups indicating the core pillars of CBR models of care. They included the importance of: (a) accessible and inclusive CBR services; (b) specialised clinical skills and treatment approaches; the acknowledgment that (c) knowledge is power; and the significance of (d) peer networks and support. Conclusion This study further advances the evidence base of how services can be optimised to meet the complex needs of adults with CCDs following a TBI. Clinicians, researchers, and service providers should endeavour to incorporate the four core pillars outlined to enhance future CBR models of care for this clinical population.

Predicting Mental Health Hospitalizations Among First Nations Adults in Residential Treatment

Indigenous peoples in Canada experience disproportionately higher rates of hospitalization for mental health and substance use concerns than non-Indigenous populations. Ambulatory care sensitive conditions are community-level markers of mental illness which can theoretically be managed through community-based health services, and therefore should not require urgent care services. Previous mental health related ambulatory sensitive conditions have included psychotic and mood disorders; however, limited research has explored these relationships of increased hospitalization among specific health disorders with Indigenous populations. This study analyzed predictors of prior mental health hospitalizations among a predominately First Nations population seeking residential treatment for substance use. We hypothesized that increased co-morbid mental health concerns would predict increased hospitalizations for mental health concerns, and this relationship would be moderated by higher Adverse Childhood Experience (ACE) scores. Logistic regression showed that for every increase in each reported mental health concern, the odds of prior hospitalization was 1.6 times higher among this sample, although ACEs did not moderate this relationship. Participants with depressive, anxiety-related, psychotic, and personality-related disorders reported proportionally more hospitalization. Although study results suggest ACEs are not a useful predictor of hospitalization, their presence has previously shown to exacerbate co-morbid concerns, and thus, may influence prior hospitalization history indirectly. Further research can explore relationships between exposure to childhood trauma and hospitalization, particularly in consideration of access to tertiary mental health services.