Community Health Care Workers Research Articles

Blood pressure screening in Mata Sector, a rural area of Rwanda.

In rural sub-Saharan Africa, knowledge of non-communicable diseases such as high blood pressure (BP) is rather limited. This report provides information about a BP screening in Mata Sector, a rural region in Southern Province of Rwanda. Community-based, house-to-house screening was performed between February and July 2020 on more than 7000 inhabitants. The screening was conducted by a local team composed by 20 community health care workers, five community health care supervisors, and one nurse with hypertension surveillance training. BP and heart rate were recorded after 5 min of resting, using a validated automated oscillometric OMRON M6 IT-HEM-7322-E monitor with Intelli Wrap Cuff (HEM-FL31-E) technology. The mean of the second and third value was retained. BP was normal (<140/90 mm Hg) in 6340 (88%) and elevated in 863 (12%) participants with 95% of unawareness. Grade 1 (140-159/90-99 mm Hg) hypertensive BP readings were detected in 697 (81%), grade 2 (160-179/100-109 mm Hg) in 134 (16%), and grade 3 (≥180/≥110 mm Hg) in 32 (3.7%) individuals. The prevalence of hypertensive readings was significantly age-dependent. Additionally, a slightly greater proportion of participants with high BP (14% versus 11%) had a body mass index (BMI) ≥ 25.0 kg/m2. Also resting heart rate was higher in individuals with high BP (82 versus 77 beats/min). Although individuals identified with occasionally elevated BP values need further confirmatory measurements to establish the diagnosis of hypertension, these data suggest that high BP represents a noteworthy and preventable reason of concern within sub-Saharan Africa.

Designing a Community Health Worker (CHW) Certificate Training that Centers Marginalized Youth’s Health and Wellness

The genesis of the youth Community Health Worker (CHW) and Citizen/Community Science (CS) training is rooted in interdisciplinary research and the lived experiences of families in Chicago and Urbana-Champaign. Dr. Mendenhall and colleagues’ (Drs. Robinson, Roberts and Rodriquez-Zas) South Chicago’s Black Mothers’ Resiliency Project provide dinsights into Black women’s experiences with genomics, trauma, and community science. Black women’s testimonies highlighted the health impacts of living in neighborhoods with high levels of gun violence and the resilience strategies they employ. This led to the development of a youth-centered CHW and CS training program, aimed at addressing health disparities. The program trained high school students and young adults (up to age 24) as CHWs and CSs, focusing on the objectives of (1) embedding culturally competent health workers in marginalized communities; (2) amplifying community voices; (3) collecting, analyzing, and quantifying observational data to inform policy decision-making; (4) amplifying community voices in healthcare discussions and (5) creating community health care worker training certification for youth. Over three years, the program trained over 50 participants, incorporating elements of wellness, art, and entrepreneurship.Based on ethnographic notes participants reported increases in wellness such as reduced anxiety and increased empowerment. The program’s long-term goals include creating employment opportunities for graduates and contributing to improved community health outcomes. This initiative represents a step towards addressing racial trauma and promoting community healing through youth-led innovation and empowerment.

Outcome of early detection approach in control of breast, cervical, and oral cancer: Experience from a rural cancer center in India.

In low- and middle-income countries most of the cancer patients attend the hospital at a late stage and treatment completion of these cases is challenging. The early detection program (EDP), in rural areas of Punjab state, India was initiated to identify breast, cervical, and oral cancer at an early stage by raising awareness and providing easy access to diagnosis and treatment. A total of 361 health education programs and 99 early detection clinics were organized. The symptomatic and self-interested (non-symptomatic individuals who opted for screening) cases visited the detection clinic. They were screened for breast, cervical, and/or oral cancer. Further diagnosis and treatment of screen-positive cases were carried out at Homi Bhabha Cancer Hospital (HBCH), Sangrur. Community leaders and healthcare workers were involved in all the activities. The EDP, Sangrur removed barriers between cancer diagnosis and treatment with the help of project staff. From 2019 to 2023, a total of 221,317 populations were covered. Symptomatic and self-interested individuals attended the breast (1627), cervical (1601), and oral (1111) examinations. 46 breast (in situ-4.3%; localized-52.2%), 9 cervical (localized-77.8%), and 12 oral (localized-66.7%) cancer cases were detected, and treatment completion was 82.6%, 77.8%, and 50.0%, respectively. We compared cancer staging and treatment completion of cases detected through EDP with the cases attended HBCH from Sangrur district in 2018; the difference between two groups is statistically significant. Due to the early detection approach, there is disease down-staging and improvement in treatment completion. This approach is feasible and can be implemented to control these cancers in low- and middle-income countries.

Socio-Behavioural Barriers to Viral Suppression in the Older Adult Population in Rural South Africa.

South Africa has the largest share of people living with HIV in the world and this population is ageing. The social context in which people seek HIV care is often ignored. Apart from clinical interventions, socio-behavioural factors impact successful HIV care outcomes for older adults living with HIV. We use cross-sectional data linked with demographic household surveillance data, consisting of HIV positive adults aged above 40, to identify socio-behavioural predictors of a detectable viral load. Older adults were more likely to have a detectable viral load if they did not disclose their HIV positive status to close family members (aOR 2.56, 95% CI 1.89-3.46), resided in the poorest households (aOR 1.98, 95% CI 1.23-3.18), or were not taking medications other than ART (aOR 1.83, 95% CI 1.02-1.99) likely to have a detectable. Clinical interventions in HIV care must be supported by understanding the socio-behavioural barriers that occur outside the health facility. The importance of community health care workers in bridging this gap may offer more optimum outcomes for older adults ageing with HIV.

Gaps in treatment of epileptic seizures in a Zambian rural area.

Epilepsy is a multifactorial neurological disorder, including parasitic infections of the brain such as neurocysticercosis (NCC). People with epileptic seizures (PWES) in low and middle-income countries often do not receive appropriate treatment, which besides epileptic seizures, may also lead to reduced quality of life and possibly death. The objective of this study was to describe gaps in treatment of epileptic seizures in a Zambian rural area. A cross-sectional study was conducted in Sinda district of Zambia between August and October 2018. PWES identified from clinic records and with the help of community healthcare workers were recruited. Two questionnaires, one to PWES and the other to local healthcare workers, were administered to describe the treatment gap. A total of 146 PWES and 43 healthcare workers were interviewed. Of the 146 PWES, 131 had taken anti-seizure medication (ASM) at some point since their seizure onset, of which 49.6% were on current treatment. Only 18.3% were on continuous ASM, an overall treatment gap of 83.6%. Over 55% of healthcare workers did not know the relationship between epilepsy and NCC. The risk factors associated with lack of appropriate treatment were stock-outs of ASMs, lack of diagnostic equipment, poor patient follow-up, and PWES opting for traditional medicine. The treatment gap is substantial in Sinda district. The causes are multifactorial, involving shortcomings at the level of healthcare facilities, communities, and individuals. Directed training of healthcare workers and significant improvements in the supply and dispensing of ASMs will be key in substantially reducing the gap.

A Qualitative Analysis of Urbanization and Menstrual Health Among Young Women.

This qualitative study, grounded in theory, employed inductive coding for analysis, focusing on menstrual health among urban women aged 10-25. The research aims to explore the menstrual health status, practices, and beliefs of participants. The research delves into the impact of recent government initiatives on menstrual health and assesses the role of urbanization in shaping evolving menstrual health practices among young girls. Employing in-depth qualitative methods such as interviews and focus group discussions, the study seeks a comprehensive understanding of participants' experiences and perceptions related to menstrual health. The dynamics of women's menstrual experiences are significantly influenced by urbanization, heightened exposure to social media, evolving lifestyles, and government initiatives like the distribution of menstrual products in schools and the enhancement of water, sanitation, and hygiene (WASH) facilities in government institutions. Positive shifts have been observed, including reduced restrictions on menstruating individuals, enhanced access to affordable hygiene products, and improved disposal facilitated by municipal garbage collection services. However, notable gaps persist in basic knowledge about menstruation, hygienic practices, effective interpersonal communication with schoolteachers or community health care workers, and compliance with government programs promoting weekly iron-folic acid supplementation and biannual Albendazole intake, calling for substantial improvement.

Social Determinants of Health Screening: Primary Care PRAPARE Tool Implementation

Social determinants of health (SDOH) substantially impact health. Evidence-based SDOH screening was implemented in a small urban primary care practice. This quality improvement project aimed to increase SDOH screening from 0% to 50%. The Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (PRAPARE) tool is a validated SDOH screener administered by a community health care worker during annual physical examinations over 12 weeks. PRAPARE was administered to 81 of 85 patients (95.3%), and 8 (9.9%) screened positive. Benchmarks were surpassed for SDOH screening and resulted in referrals to community resources. Research should use community health care workers as care extenders and test SDOH screening to identify needs toward improved health.

Knowledge of Pregnant Women Regarding Premature Birth at the Intermediate Hospital Antenatal Care Clinic in Namibia: A Quantitative Study

Background: The knowledge and information awareness among expectant mothers on the conditions that have adverse outcomes on the pregnancy is crucial. A body of knowledge exist on the knowledge about preterm births among obstetricians, patients, couples, midwives, clinical officers and community health care workers. However, no study exists that assess pregnant women knowledge on the premature births. Methods: The study adopted a quantitative descriptive design. A probability simple random sampling method was used to select the participants. Data collection took place at the study antenatal care clinic. Fifty-five participated in the study and completed the questionnaire in front of the researcher. Competence was based on 50% because, data was collected on the participants of whom some may not have any educational or medical background. Descriptive statistics was used to analyse the data. Results: The study found n= 49 (89%) participants knowledge competent about pre-term births by obtaining a knowledge score of above 50%. Conclusion: Therefore this, study can conclude that the expectant mother attending antenatal care at Katutura Intermediate hospital have good knowledge about the causes, risks factors, prevention and management of preterm births.

Importance of Utilizing Non-Communicable Disease Screening Tools; Ward-Based Community Health Care Workers of South Africa Explain.

The screening of patients in the community is important and is a commonly used indicator to detect, prevent, and treat abnormal health changes. As such, the South African Department of Health following the initiative of the World Health Organization has appointed ward-based community health care workers through a primary health care reengineering program. The main objective of their appointment was to screen household members to reduce the burden of diseases such as diabetes mellitus and hypertension. As such, the study investigated the importance of using non-communicable disease screening tools by ward-based community health care workers in South Africa. A qualitative, exploratory, and descriptive design was used. A non-probability purposive sampling method was used to select forty participants from primary health care facilities. Four focus group discussions were held with ten participants in each group. Semi-structured focus group discussions were held with participants in their workplaces. Content data analysis was applied to come up with one theme and six subthemes. The study findings revealed that the use of screening tools facilitated comprehensive household assessments, helped identify risk factors and symptoms, and facilitated health education and patient referrals. The continuous supply of screening tools and updates on their use was recommended to reduce the rate and burden caused by non-communicable diseases to society at large.

Visit to the Dentist for Oral Health Prevention at "Age One": A proposed policy report from the Indian perspective.

Early childhood caries is a major public health issue in India. The primary reason for poor oral health in children is a lack of awareness about the role of primary teeth and the importance of an early dental visit for infants and toddlers. The primary objectives of an early dental visit are to analyze the child's risk level, provide guidance to parents regarding proper oral hygiene measures, review dietary and eating habits, provide information regarding the infectivity of dental caries, review the risks of traumatic injuries and discuss factors which affect the development of occlusion. Through this paper, we are proposing an "Age One" policy that recognizes dentists, physicians, allied health professionals, community health-care workers, and nongovernmental organizations to work toward a child's overall health as partners to achieve this goal. The expectation is that this policy will provide guidance to childcare centers, pediatric dentists, other health-care professionals, and legislators regarding oral health activities and the promotion of oral health in infants. The purpose of the policy is to lay the foundation for a lifetime of preventive education and dental care, to help ensure optimal oral health beginning in childhood and continuing through the life course.

Planning with a gender lens: A gender analysis of pandemic preparedness plans from eight countries in Africa

BackgroundHealth planning and priority setting with a gender lens can help to anticipate and mitigate vulnerabilities that women and girls may experience in health systems, which is especially relevant during health emergencies. This study examined how gender considerations were accounted for in COVID-19 pandemic response planning in a subset of countries in Africa. MethodsMulti-country document review of national pandemic response plans (published before July 2020 and as of March 2022) from Ethiopia, Ghana, Kenya, Nigeria, Rwanda, South Africa, Uganda, and Zambia, supplemented with secondary data on gender representation on planning committees. A gender analysis framework informed the study design and the Morgan et al. matrix guided data extraction and analysis. ResultsAll plans reflected implicit and explicit considerations of the impacts of the pandemic responses on women and girls. Through a gender lens, the implicit considerations focused on ensuring safety and protections (e.g., training, access to personal protective equipment) for community and facility-based health care workers and broad engagement of the community in risk communication. The explicit gender considerations, reflected in a minority of plans, focused on addressing gender-based violence and providing access to essential services (e.g., sexual and reproductive health care, psychosocial supports), products (e.g., menstrual hygiene products) and social protection measures. Women were underrepresented on the COVID-19 planning committees in all countries. ConclusionsThe plans reflected varying national efforts to develop pandemic responses that anticipated and reflected unique vulnerabilities faced by women, though subsequent plans reflected further consideration of gender-relevant impacts compared to initial plans. Embedding a gender lens in emergency preparedness planning furthers equity and could support anticipation and timely mitigation of negative outcomes for women and girls who are often further marginalized during health emergencies.

Community health surveillance via digital collection of syndromic and behavior data by community healthcare workers in rural Kenya: a pilot study

Disease surveillance is essential to enable adequate detection and response to disease outbreaks. Syndromic surveillance is used to augment traditional approaches, especially in community-based surveillance. Here we demonstrate that Community Healthcare Workers (CHWs) supported by a mobile phone application can provide community-based syndromic disease surveillance in low-resource settings, and that they are able to generate relevant symptom-based and behavior data such as cough symptoms, use of mosquito nets and availability of household handwashing facilities. We analyzed 1.6 million data points collected by CHWs during home visits in rural Kenya as a proof of principle that the symptoms and behavior they observe can be used as a community-based health surveillance tool. To demonstrate the relevance of the data, we show that national covid-19 case numbers did not align with reported cough symptoms in remote populations, which implies that rural populations did not experience covid-19 outbreaks in tandem with urban populations. We also found that the behavior of using long-lasting insecticidal nets could be tracked by the CHWs, and it followed the seasonality of the mosquito burden. Strengthening community-based syndromic and behavior surveillance through CHWs is therefore a great opportunity to strengthen national public health surveillance and response in Africa and should be included in the Integrated Disease Surveillance and Response (IDSR) strategy.

Digital health solutions and integrated COVID-19 and TB services to help recover TB care and prevention services in the COVID-19 pandemic: A descriptive study in four high TB burden countries.

The measures undertaken to control COVID-19 have disrupted many platforms including tuberculosis (TB) healthcare services. Consequently, declines in TB notifications have been observed in various countries. We visualized changes over time in TB and SARS-CoV-2 infection notifications and reported on country-specific strategies to retain TB care and prevention services in Kyrgyzstan, Nigeria, Tanzania, and Vietnam. We collected and visualized quarterly, retrospective, and country-specific data (Quarter (Q) 1 2018- Q1 2021) on SARS-CoV-2 infection and TB notifications. Additionally, we conducted a country-specific landscape assessment on COVID-19 measures, including lockdowns, operational level strategy of TB care and prevention services, and strategies employed to recover and retain those services. We used negative binomial regression models to assess the association between the installation of COVID-19 measures and changes in TB notifications. TB notifications declined in Kyrgyzstan and Vietnam, and (slightly) increased in Nigeria and Tanzania. The changes in TB notifications were associated with the installation of various COVID-19 prevention measures for Kyrgyzstan and Vietnam (declines) and Nigeria (increases). All countries reported reduced TB screening and testing activities. Countries reported the following strategies to retain TB prevention and care services: digital solutions for treatment adherence support, capacity building, and monitor & evaluation activities; adjustment in medication supply/delivery & quantity, including home delivery, pick up points, and month supply; integrated TB/COVID-19 screening & diagnostic platform; and the use of community health care workers. Following the COVID-19 pandemic, we did not observe consistent changes in TB notifications across countries. However, all countries reported lower operating levels of TB prevention and care services. Digital health solutions, community-based interventions, and the integration of COVID-19 and TB testing services were employed to recover and retain those services.

Help us help you using technology to maximize resource response to patient reported SDoH and depression screening.

576 Background: Social determinants of health (SDoH) are associated with inferior health outcomes, morbidity, life expectancy, and healthcare expenses. Screening for SDoH is increasingly incorporated into routine clinical practice, however clinical decision support and resources addressing positive SDoH screening are less robust. As part of the ASCO PC4, we developed an electronic workflow that utilizes SDoH and depression screening tools with prepopulated referrals to assist the clinician in directing the referral to the most appropriate supportive service. Methods: Smilow Cancer Hospital ASCO Patient Centered Care Certification Implementation Team collaborated with our social work, psycho oncology, and Community Health Worker (CHW) to optimally screen and respond to patients who screened positive for SDoH or depression. A workflow was established using Welcome Web software in combination with Epic to transfer patient results collected in the waiting room via iPad to the patient’s medical record. Positive screening results trigger a best practice advisory when clinician opens chart. The alert links to a Smartset prepopulating an order to the appropriate resource for the reported need. Patients with transportation, food insecurity, or housing concerns were referred to Community Healthcare Worker. Social workers received referrals for patients with social connection concerns and PHQ-9 scores between 9-14. Patients with a PHQ-9 score of 15 and above were referred to the psycho-oncology team. A specialized workflow was created for any patient who responded positively to thoughts of self-harm. These patients received an immediate intervention and were screened using the Columbia Suicide Severity Screening Tool. Results: See table. Conclusions: Incorporating SDoH screening alongside clinical decision support and automated referrals was feasible. Technology enabled screening enhances efficiency and assists clinicians with direct referrals to the appropriate resource, while allowing resources to operate at the top of their licensure and enhance efficiency. Future Directions for Research: 1. Monitor emergency room utilization, admissions, and unplanned visits for patients receiving services from CHW, Social Work, and Psycho-oncology services. 2. Monitor work queue volumes to assess if directed referrals expedite response.[Table: see text]

The effect of armed conflict on public health and strengthening of healthcare system during and post -armed conflict in Sudan

Background: Armed conflict has catastrophic effect on public health and overall wellbeing including causalities during war, long lasting physical and psychological effects, the reduction in human and financial resources which available to meet social needs and creation of setting in which violence is primary domain this issues clearly appeared in Sudan since conflict between Sudan army force and Rapid response force in 15th of April 2023. Methodology: This review aimed to reflect the effect of armed conflict on public health especially vulnerable groups and create plan for reform of collapsed health system during and after war in Sudan. Comprehensive review for previous related article using Pub –med, Google scholar Lancet and records from Federal and Local Ministry of Health in Sudan was done. Also SWOT analysis for current complexes was done to detect problems and achieve solutions. Results: The study reflects the effect of armed conflict on public health in countries suffered from war. The vulnerable populations those sufferings during war are elderly, children, neonates and women. SWOT analysis for current situation in Sudan reflects devastating effect of war in healthcare system. The study also offering a plan for strengthening of healthcare system which build on decentralization policy, Innovation related to community healthcare workers (CHWs) adoption and health-financing system strengthens. Conclusion: Strengthening of healthcare systems after disasters is an urgent concern, especially in countries that have experienced armed conflict due to great impact on public health. However, since few studies have been conducted concerning this topic in Sudan, further research is recommended.

Cost-efficient child vaccination project results from hard-to-reach rural communities in Kenya

Abstract Child immunization is a cost-effective public health measure for reducing child morbidity and mortality. Child immunization coverage in Kenya has improved in recent years, with coverage rates for most vaccines exceeding 80%. However, there are still pockets of low coverage, particularly in remote or hard-to-reach areas. We implemented a community-based project to improve access and equity in child immunization services in three Kenyan counties (Nairobi, Wajir and Mandera). We trained health workers, promoted community acceptance, and provided logistical support to Ministry of Health (MoH) for child immunization services through community outreach centers. During the project period (January 2020 to February 2023), our project facilitated full immunization coverage for 93,879 children and we reached 200,554 community members whom we communicated relevant messages for recommended practice about health, nutrition and child vaccination. Our project achieved a 26 percentage-point increase (increased from 62% at baseline in 2020 to 88% at endline in 2022) in age-appropriate child vaccinations by end of the project. We also conducted a cost-efficiency analysis by taking the actual costs incurred and project achievements into account. The key results from the cost-efficiency analysis revealed approximate cost for a fully immunized child as 21 US dollar, while per capita cost for communicating health messages to community members and health care worker training was 10 US dollar. UNICEF estimated approximately 32 US$ as vaccine delivery cost (=total cost - cost of vaccine and supply) per fully vaccinated child with standard schedule for children &amp;lt; 24 months which is higher than the cost for ensuring a fully immunized child in our project. These data clearly indicate the efficiency and success of community-based approach for strengthening MoH child immunization services in Kenyan rural and hard-to-reach communities. Key messages • Strong collaboration with Ministry of Health and community participation are critical key aspects for implementing child vaccination program successfully and cost-efficiently in rural communities. • Facilitating Ministry of Health for health system strengthening focus yields sustainable impact as footprint after end of a short-term of a community based project in developing country settings.

Facilitators and barriers to COVID-19 testing in community and clinical settings: Lessons learned from Lesotho and Zambia.

The sudden emergence of the coronavirus disease 2019 (COVID-19) had a devastating impact on health systems and population health globally. To combat the spread of COVID-19, countries enacted guidelines and safety measures, including testing, contact tracing, and quarantine. It was unclear the extent to which uptake of COVID-19 testing and other health initiatives would be accepted in countries with a history of dealing with widespread communicable disease transmission such as HIV or Tuberculosis. The objective of this study was to understand and compare the facilitators and barriers to COVID-19 testing at hospital sites in two rural communities in Lesotho and community spaces (referred to as hubs) in one urban community in Zambia during active phases of COVID-19 pandemic. Individual interviews and focus group discussions (FGDs) were held during March-October 2021 to explore facilitators and barriers to COVID-19 testing. FGDs with 105 community members and health care workers, and 16 individual interviews with key informants and four mystery shoppers were conducted across the two countries. In Zambia, four mystery shopper observations, and eight hub observations were also conducted. Individual country codebooks were developed and combined; thematic analyses were then conducted using the combined codebook. Findings were compared across the two countries, and most were consistent across the two countries. Two primary themes emerged that related to both barriers and facilitators: (1) structural conditions; (2) social implications and attitudes. The structural conditions that operated as barriers in both countries included public health isolation measures and misinformation. In Lesotho, the cost of tests was an additional barrier. The only structural facilitators were in Zambia where the community hubs were found to be accessible and convenient. The social implication barriers related to fear of isolation, stigma, and mental health implications because of quarantine, perceived pain of the test, and compromised privacy. Social facilitators that led to people testing included experiencing COVID-19 firsthand and knowing people who had died because of COVID-19. Across both countries, primary barriers and facilitators to COVID-19 related to structural conditions and social implications and attitudes. Public health measures can be at odds with social and economic realities; pandemic response should balance public health control and the socio-economic needs. Data from Zambia revealed that community-based settings have the potential to increase uptake of testing services. Community-based campaigns to normalize and reduce stigma for COVID-19 testing services are needed.

Sustainability of community-based workers in multisectoral food security programs: a case study of producer leaders, village vaccinators, mother leaders, and community health workers in Burkina Faso

The community-based worker (CBW) model is commonly used by food security projects as an approach to catalyze community-driven development and to enhance long-term sustainability of project impacts in rural areas of low-income countries. However, there is limited follow-up research exploring how CBWs continue to carry out expected activities in the years that follow project exit. This case study examines how four different CBW roles—producer leaders, village vaccinators, community healthcare workers, mother leaders—all trained to contribute to the food security goals of a multi-year initiative in Kaya, Burkina Faso, sustained their respective activities post-project. Two years after the project ended, we collected qualitative data to examine how well these CBWs continued providing the activities that they had been trained to provide as expected by the project. We employ a conceptual framework of sustainability and exit strategies to assess what factors contributed to sustained activities and, where activities ceased, what caused them to stop. We find that where activities were sustained, all four hypothesized factors—sustained capacities, resources, motivation, and linkages—were present. We conclude by discussing key lessons and considerations for using the CBW model: (1) gradually transition to independent operation during project lifetime; (2) integrate CBWs into permanent and functional systems through gradual project exit; (3) professionalize the CBW role (re-think the volunteer approach); (4) what to do about resources and (5) co-develop endogenous definitions and indicators from the project onset.

H - 15 Leveraging Community Health Care Workers in Rural Communities to Address Brain Health Equity.

To address brain health in rural communities, Telehealth ROCKS developed a service delivery program with local partners. Community healthcare workers (CHWs) assess and provide students with referrals to address social determinants of health (SDoH) and mental health needs. Qualitative and quantitative data were collected. This program serves seven school districts and 6876 students in an area historically reliant on a mining/factory economies with high concerns for environmental exposures. Students were from diverse backgrounds with a range of neurological and neurodevelopmental conditions. To close SDOH gaps, CHWs utilized Community CareLink (CCL), an online platform tailored for rural communities that documents, tracks, and identifies SDOH gaps. Since 2022, 85% of families elected to pursue CHW support. To date, 10 CHWs have worked directly with approximately 10% of the school population with 80% of encounters having an attendance component. Thematic analysis shows building trust has been an important encounter theme: "Building that trust within the families is so important. By being able to help them with housing, utility assistance or getting access to Medicaid can be a huge relief..." The pandemic impacted SDOH domains, further exacerbating rural and other systemic disparities that will have long-lasting impact on brain health in rural communities. For neuropsychologists, adopting this program design may help to foster trusted relationships and community partnerships, improve culturally informed referrals, and provide scaffolding/coaching around referrals so that our expertise can aid patients and families where and when it is needed most.

Analysis of Mental Health Conditions and Coping Strategies for the Elderly

With the arrival of the aging society, the mental health of the elderly population has been a social concern, and the psychological care work of the elderly population has become one of the important tasks of social work in China. This paper, through the questionnaire survey method, combined with the interview method, through the Beijing and Qingdao each 10 communities, 50 community health care workers and 500 elderly people and their families, the results shows that: the overall level of community mental health services is not high; 25.4% of the elderly people's overall happiness experience time is less than half of the time, the elderly people's sleep problems are more prominent, and the elderly people's self-esteem level is not high in general. Based on the analysis of the factors influencing the level of mental health of the elderly, this paper combines the current situation of community mental health services and puts forward suggestions for measures to improve the mental health of the elderly.