County Department Research Articles

Understanding Trauma-Informed Care in the PALTC Setting

Understanding Trauma-Informed Care in the PALTC Setting

Minimizing the Impact of COVID-19 in a County Jail Environment to Protect a Vulnerable Population

At the start of the COVID-19 pandemic, there was conflicting information about the spread of the virus. Despite this, early and aggressive protective measures were implemented by a multidisciplinary team within the Riverside County Department of Corrections to mitigate the potential impact of the pandemic on its five county jails. We believe this helped result in a low incidence of severe COVID-19 infections, low rate of spread, and low mortality in these jails, even while local community spread was much higher. With continued pandemic potential of COVID-19 and the possibility of future pandemics, we outline the measures implemented and advocate for an aggressive approach to protect our correctional environment.

Prehospital Testing and Surveillance for SARS-CoV-2: A Special Report from the Sacramento (California USA) Mobile Integrated Health Unit.

Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has killed nearly 800,000 Americans since early 2020. The disease has disproportionately affected older Americans, men, persons of color, and those living in congregate living facilities. Sacramento County (California USA) has used a novel Mobile Integrated Health Unit (MIH) to test hundreds of patients who dwell in congregate living facilities, including skilled nursing facilities (SNF), residential care facilities (ie, assisted living facilities [ALF] and board and care facilities [BCF]), and inpatient psychiatric facilities (PSY), for SARS-CoV-2. The MIH was authorized and rapidly created at the beginning of the COVID-19 pandemic as a joint venture between the Sacramento County Department of Public Health (SCDPH) and several fire-based Emergency Medical Services (EMS) agencies within the county to perform SARS-CoV-2 testing and surveillance in a prehospital setting at a number of congregate living facilities. All adult patients (≥18 years) who were tested for SARS-CoV-2 infection by the MIH from March 31, 2020 through April 30, 2020 and lived in congregate living facilities were included in this retrospective descriptive cohort. Demographic and laboratory data were collected to describe the cohort of patients tested by the MIH. During the study period, the MIH tested a total of 323 patients from 15 facilities in Sacramento County. The median age of patients tested was 66 years and the majority were female (72%). Overall, 72 patients (22%) tested positive for SARS-CoV-2 in congregate living settings, a higher rate of positivity than was measured across the county during the same time period. The MIH was a novel method of epidemic surveillance that succeeded in delivering effective and efficient testing to patients who reside in congregate living facilities and was able to accurately identify pockets of infection within otherwise low prevalence areas. Cooperative prehospital models are an effective model to deliver out-of-hospital testing and disease surveillance that may serve as a blueprint for community-based care delivery for a number of disease states and future epidemics or pandemics.

Editorial Commentary.

No AccessUrology PracticeBusiness1 May 2022Editorial CommentaryThis article comments on the following:Preoperative Optimization of Promotility in Robotic Prostatectomy and Minimally Invasive Kidney Surgery Neil Mendhiratta, and Jonathan Bergman Neil MendhirattaNeil Mendhiratta David Geffen School of Medicine at UCLA, Los Angeles, California More articles by this author , and Jonathan BergmanJonathan Bergman David Geffen School of Medicine at UCLA, Los Angeles, California Los Angeles County Department of Health Services, Los Angeles, California Veterans Health Affairs Greater Los Angeles, Los Angeles, California More articles by this author View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000295.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Commentary." Urology Practice, 9(3), pp. 227–228

SARS-CoV-2 Infection and Hospitalization Among Adults Aged ≥18 Years, by Vaccination Status, Before and During SARS-CoV-2 B.1.1.529 (Omicron) Variant Predominance - Los Angeles County, California, November 7, 2021-January 8, 2022.

COVID-19 vaccines are effective at preventing infection with SARS-CoV-2, the virus that causes COVID-19, as well as severe COVID-19-associated outcomes in real-world conditions (1,2). The risks for SARS-CoV-2 infection and COVID-19-associated hospitalization are lower among fully vaccinated than among unvaccinated persons; this reduction is even more pronounced among those who have received additional or booster doses (boosters) (3,4). Although the B.1.1.529 (Omicron) variant spreads more rapidly than did earlier SARS-CoV-2 variants, recent studies suggest that disease severity is lower for Omicron compared with that associated with the B.1.617.2 (Delta) variant; but the high volume of infections is straining the health care system more than did previous waves (5).*,† The Los Angeles County (LAC) Department of Public Health (LACDPH) used COVID-19 surveillance and California Immunization Registry 2 (CAIR2) data to describe age-adjusted 14-day cumulative incidence and hospitalization rates during November 7, 2021-January 8, 2022, by COVID-19 vaccination status and variant predominance. For the 14-day period ending December 11, 2021, the last week of Delta predominance, the incidence and hospitalization rates among unvaccinated persons were 12.3 and 83.0 times, respectively, those of fully vaccinated persons with a booster and 3.8 and 12.9 times, respectively, those of fully vaccinated persons without a booster. These rate ratios were lower during Omicron predominance (week ending January 8, 2022), with unvaccinated persons having infection and hospitalization rates 3.6 and 23.0 times, respectively, those of fully vaccinated persons with a booster and 2.0 and 5.3 times, respectively, those of fully vaccinated persons without a booster. In addition, during the entire analytic period, admission to intensive care units (ICUs), intubation for mechanical ventilation, and death were more likely to occur among unvaccinated persons than among fully vaccinated persons without or with a booster (p<0.001). Incidence and hospitalization rates were consistently highest for unvaccinated persons and lowest for fully vaccinated persons with a booster. Being up to date with COVID-19 vaccination is critical to protecting against SARS-CoV-2 infection and associated hospitalization.

COVID-19 Outbreaks Associated With Youth Club Sports: Maricopa County, Arizona, September-November 2020.

The Maricopa County Department of Public Health in Arizona investigated three COVID-19 outbreaks associated with club sports, two in tournaments and one in a hockey league. During September through November 2020, 195 team-associated and 69 secondary household contact cases were identified among 2093 athletes, coaches, and staff members; the team attack rate ranged from 6% to 72%. Outbreaks occurred during high community transmission periods in Maricopa County. Identification of contacts and characterization of prevention strategies were challenging because of limited cooperation from athletes, families, and staff. (Am J Public Health. 2022;112(2):216-219. https://doi.org/10.2105/AJPH.2021.306579).

Design and Implementation of a COVID-19 Case Investigation Program: An Academic-Public Health Partnership, Arizona, 2020.

From May through July 2020, Arizona was a global hotspot for new COVID-19 cases. In response to the surge of cases, local public health departments looked for innovative ways to form external partnerships to address their staffing needs. In collaboration with the Maricopa County Department of Public Health, the Arizona State University Student Outbreak Response Team (SORT) created and implemented a virtual call center to conduct public health case investigations for COVID-19. SORT officially launched a dedicated COVID-19 case investigation program after 3 weeks of program design and training. From June 29 through November 8, 2020, SORT recruited and trained 218 case investigators, completed 5000 case patient interviews, and closed 10 000 cases. Our team also developed process improvements to address disparities in case investigation timeliness. A strong infrastructure designed to accommodate remote case investigations, paired with a large workforce, enabled SORT to provide additional surge capacity for the county's high volume of cases. University-driven multidisciplinary case investigator teams working in partnership with state, tribal, and local public health staff members can be an effective tool for supporting a diverse and growing public health workforce. We discuss the essential design factors involved in building a university program to complement local COVID-19 response efforts, including workflows for case management, volunteer case investigator recruitment and training, secure technology platforms for conducting case investigations remotely, and robust data-tracking procedures for maintaining quality control and timely case reporting.

Tackling Persistent and Large Disparities in Birth Outcomes in Allegheny County, Pennsylvania.

Based in Allegheny County, a coalition of local stakeholders took note of the region's infant mortality rates, particularly the stark disparities observed by race, and established a vision to reduce infant mortality in the region. The group undertook a multi-faceted effort to (1) develop predictive models of infant mortality risk; (2) evaluate the effectiveness of available interventions; and (3) combine these tools in order to tailor intervention referrals based on maternal risk profiles. With this effort, the coalition sought to address the apparent disconnect between the region's robust maternal and child health care system and relatively poor birth and infant outcomes and racial disparities. The effort started with the integration of data from a variety of sources into an integrated database built specifically for this research effort covering the period 2003 to 2013. With the database, researchers linked each individual's data across multiple data sources, including the Allegheny County Health Department, the University of Pittsburgh Medical Center, the Allegheny County Department of Human Services Data Warehouse, and individual programs. With these data, we used a standard method for comparing outcomes and measuring the racial disparity between Black and white infants that involved calculating a ratio by dividing the rate or percentage for Black infants by the rate or percentage for white infants. Overall, the results showed that between 2003 and 2013 in Allegheny County disparities were more pronounced for infant mortality (3.25) than low birthweight (1.88) or preterm birth (1.49). Among the different potential causes of infant mortality, the most pronounced disparity was for SIDS (1.78). Among maternal health factors, pre-pregnancy obesity and gestational diabetes had the highest infant mortality disparity. The low birthweight disparity was similar and lower than the infant mortality disparity across all of the maternal health factors, while the preterm birth disparity was even lower. For the maternal behavioral and contextual factors, the infant mortality disparity ranged from 1.5 to 2.3. The 11-year span of data reported in the IMPreSIv database and the breadth of intervention data included allowed us to report granular information on birth outcomes within Allegheny County over this time period. The database also allowed us to summarize the various factors associated with the range of birth outcomes and describe the participation rates in the medical and community setting interventions. Against this backdrop of pronounced disparities in birth outcomes across a range of factors, we examined the effectiveness of interventions for women with different risk factors (e.g. substance use disorders) in order to develop a tool to facilitate individualized referrals to the interventions that will help the most for a specific risk profile.

Organizational, Technical and Behavioral Factors Associated with Malaria Routine Data Reporting among Health Workers in Selected Health Facilities in Trans-Nzoia County, Kenya

Purpose: Malaria remains to be among the primary causes of sickness, infirmity and cases of deaths and has continued to negatively affect health and socio-economic progress in the country. Rapid reporting of malaria cases could avert prospective epidemics which would lead to a high proportion of sickness and deaths. The study, therefore, sought to assess the determinants of malaria routine data reporting among health workers in selected health facilities in Trans-Nzoia County.&#x0D; Methodology: A descriptive cross-sectional study was conducted to evaluate the organizational, technical, and behavioral aspects that influence the reporting of malaria routine data among health workers. The sample size was 123 health facilities that were selected randomly based on their strata. Research tools that were utilized were structured questionnaires, focused group discussion, and key informant interview guide. Chi-square (χ2) was used to test the hypothesis with a p ≤ 0.05 being considered significant.&#x0D; Findings: The findings on socio-demographic characteristics indicated that majority of the research participants were females 76(62.6%), had college education 85(69.1%) and 81 (65.9%) had worked in the health facility for 5 to 10 years. Most 76(61.8%) of the health facilities were Level 3 (Health Centres). There was significant relationship between level of health facility and malaria routine data reporting at (χ2 =9.999, df=3, p-value = 0.019). Other organizational factors that had significant association with malaria routine data reporting (p&lt; 0.001) include inadequate budget, low staffing, poor ICT infrastructure and complex data management procedures. In terms of technical aspects, limited training on technologies had significant relationship with malaria routine data reporting (p&lt; 0.001). Regarding behavioral aspects, identified factors include lack of incentives and inadequate resources.&#x0D; Unique contribution to theory, practice and policy: The outcomes of the study provide proof for support, tactical organization, and collaboration in the health sector in Trans-Nzoia County as well as to the other developmental agencies working in the field of malaria control. The study recommends that the county government of Trans-Nzoia should provide adequate funds and ICT infrastructure to boost malaria routine data reporting. The county department of health with support from the national government through Division of National Malaria Program (DNMP )should consistently conduct in-service training, support supervision and data quality audits.

Burkholderia cepacia complex outbreak linked to a no-rinse cleansing foam product, United States - 2017-2018.

In March 2018, the US Food and Drug Administration (FDA), US Centers for Disease Control and Prevention, California Department of Public Health, Los Angeles County Department of Public Health and Pennsylvania Department of Health initiated an investigation of an outbreak of Burkholderia cepacia complex (Bcc) infections. Sixty infections were identified in California, New Jersey, Pennsylvania, Maine, Nevada and Ohio. The infections were linked to a no-rinse cleansing foam product (NRCFP), produced by Manufacturer A, used for skin care of patients in healthcare settings. FDA inspected Manufacturer A's production facility (manufacturing site of over-the-counter drugs and cosmetics), reviewed production records and collected product and environmental samples for analysis. FDA's inspection found poor manufacturing practices. Analysis by pulsed-field gel electrophoresis confirmed a match between NRCFP samples and clinical isolates. Manufacturer A conducted extensive recalls, FDA issued a warning letter citing the manufacturer's inadequate manufacturing practices, and federal, state and local partners issued public communications to advise patients, pharmacies, other healthcare providers and healthcare facilities to stop using the recalled NRCFP. This investigation highlighted the importance of following appropriate manufacturing practices to minimize microbial contamination of cosmetic products, especially if intended for use in healthcare settings.

After Action Report: Lessons Learned From Simulating Unified Command In Response to an Active Shooter Incident Using a Command Competency Laboratory.

On October 10, 2019, the Loudoun County Sheriff's Office (LCSO) and Loudoun County Fire and Rescue (LCFR) led one of the largest act of violence (AVI) exercises ever conducted in Loudoun County, Virginia. Over 300 participants and 50 role-players participated across 15 county departments and agencies within Loudoun County. The exercise identified an important recommendation: "future joint unified command trainings are needed throughout the fire and law enforcement command structures." Effective, unified command is an essential NFPA 3000 principle of responding to an AVI. "The success or failure of the response will hinge on the quality of unified command." After-action reports from AVIs across the United States emphasized the importance of unified command. A second exercise recommendation proposed "a joint AVI unified command competency scenario between LCFR and LCSO should be developed and delivered across all levels of supervision... this scenario should demonstrate 'best practices' for establishing and operating unified command between LCFR and LCSO." The authors developed two active shooter command competency simulations that require LCSO and LCFR to form unified command and manage the initial response. The simulations reinforced accepted response practices, such as identification of cold/warm/hot zones, early unified command, rescue task force team deployment, and protected corridor establishment. The simulations were packaged into a unified command competency training and simulation program. Through the facilitated debriefings with participants and facilitator debriefs, three types of lessons learned were identified: 1) high threat incident response lessons, 2) lessons for conducting AVIs in the command competency lab, and 3) active threat operational considerations for command officers.

Community Options to Fund Aging Services: A National Study to Track Local Initiatives

The majority of federal support for older people needing in-home services and supports comes from the Medicaid program. However, less than 10% of older people are eligible for Medicaid and to receive long-term services, a person must have a severe disability. Many older people with moderate levels of disability or those who are not impoverished are not eligible. In response to these system limitations, some counties across the nation have developed alternative funding strategies, such as property tax levies, to better serve older members of their communities. After identifying 15 states with such initiatives, a survey was distributed to 414 contacts within these states, with a response rate of 55%. Respondents included organizations such as area agencies on aging, councils on aging, and county departments on aging. Local funding varied within and across states, with annual funding ranging from $8,000-$47 million. Most commonly provided services with local funds include home-delivered (81%) and congregate (73%) meals, transportation (61%), and homemaker services (49%). A majority of programs (63%) indicated that local funds are used to provide at least one family or friend caregiver service. This study is the first compilation and description of locally-funded elder service initiatives in the U.S. Locally-funded initiatives can help older people with long-term services needs continue to live in their own homes and communities. On the other hand, some have raised questions about whether this is a good approach to funding aging services, raising concerns that this will lead to further inequities across states and communities.

Health Behavior Changes Among Adults in the Supplemental Nutrition Assistance Program Education, Los Angeles County, California.

Purpose and ObjectivesThe Supplemental Nutrition Assistance Program Education (SNAP-Ed), the educational branch of SNAP, can play an important role in improving dietary outcomes, eliminating food insecurity, and preventing chronic disease among low-income populations. This study examined the effects of local SNAP-Ed efforts on self-reported health behaviors and body mass index (BMI) over a 1-year period, using data collected from intercept surveys of program-eligible adults.Intervention ApproachFrom 2016 to 2020, the Los Angeles County Department of Public Health partnered with 24 community-based organizations to provide nutrition education and to implement policy, systems, and environmental changes in the community.Evaluation MethodsA cross-sectional survey was conducted in 2018 and repeated in 2019 to measure 6 outcomes describing population-level changes in health behaviors and BMI. The study recruited 4 samples: 2 samples from outside selected supermarkets (2018, n = 2,098; 2019, n = 2,323) and 2 samples from participants at SNAP-Ed class sites (2018, n = 651; 2019, n = 569).ResultsWhile study results showed an increase in consumption of fruits and vegetables and in vigorous physical activity, they also showed an increase in BMI and high consumption of unhealthy foods. Participating in SNAP-Ed classes was positively associated with several health behaviors but no change in BMI. Participants who experienced food insecurity had worse health behavior outcomes than those who did not experience this condition.Implications for Public HealthSNAP-Ed interventions appear to have a favorable effect on fruit and vegetable consumption, but increases in BMI suggest that unhealthy food consumption is abundant and may be counteracting the benefits gained from eating more fruits and vegetables. Future efforts should take these results into consideration and optimize enrollment in nutrition assistance programs. These efforts should include coordinating with local programs to increase healthy food access for at-risk low-income populations in Los Angeles County.

Bringing inside-out online: coming together in a virtual environment

Inside-Out courses bring together traditional campus-based students and incarcerated students to learn alongside one another in a correctional setting. This novel approach to the delivery of educational programming has recognized benefits for both inside and outside students. This past year, the COVID pandemic prevented non-essential staff, such as college instructors, from physically entering correctional institutions. While most colleges and universities continued to provide educational services to its campus-based students virtually, they were prohibited from doing the same with their incarcerated students. The majority of correctional institutions have been resistant to using this technology because of security concerns, even though with proper planning, such programming can be provided successfully and safely. Although most Inside-Out programs were canceled during the Coronavirus pandemic, this article profiles one program that was able to continue virtually through the use of internet-based services at the Westchester County Department of Correction. Data from this feasibility study suggest that a virtual pedagogical approach has the ability to create positive learning experiences for inside and outside students. Results imply that increased programmatic opportunities could be available to more correctional institutions, even post-COVID, if correctional staff are open to the implementation of internet-based technology and willing to work collaboratively with outside program providers.

A Tale of Two Institutions: COVID-19 Positive Rates in Asymptomatic Patients Pre-Screened for Spine Procedures and Surgeries in Los Angeles, California.

Retrospective cohort study. The coronavirus disease (COVID-19), caused by the severe respiratory syndrome coronavirus 2 (SARS-CoV-2), has created an unprecedented global public health emergency. The aim of the current study was to report on COVID-19 rates in an asymptomatic population prior to undergoing spine procedures or surgeries at two large Los Angeles healthcare systems. Elective spine procedures and surgeries from May 1, 2020 to January 31, 2021 were included. Results from SARS-CoV-2 virus RT-PCR nasopharyngeal testing within 72 hours prior to elective spine procedures were recorded. Los Angeles County COVID-19 rates were calculated using data sets from Los Angeles County Department of Public Health. Chi-squared test and Stata/IC were used for statistical analysis. A total of 4,062 spine procedures and surgeries were scheduled during this time period. Of these, 4,043 procedures and surgeries were performed, with a total of 19 patients testing positive. Nine positive patients were from UCLA, and 10 from USC. The overall rate of positive tests was low at .47% and reflected similarities with Los Angeles County COVID-19 rates over time. The current study shows that pre-procedure COVID-19 testing rates remains very low, and follows similar patterns of community rates. While pre-procedure testing increases the safety of elective procedures, universal COVID-19 pre-screening adds an additional barrier to receiving care for patients and increases cost of delivering care. A combination of pre-screening, pre-procedure self-quarantine, and consideration of overall community COVID-19 positivity rates should be further studied.

575. Local Experience of Breakthrough SARS-CoV-2 Infections After Full Vaccination

BackgroundSARS-CoV-2 the etiology of COVID-19 has caused more than 33 million cases and almost 600,000 deaths in the United States alone. Vaccination is a vital tool in controlling the pandemic. With accelerated infection rates in various parts of the world, the incidence of variants has risen and threatens to set back the long sought after immunity, provided by available vaccines. The objective of this study was to evaluate the breakthrough infection rate after complete vaccination, in Sangamon County, with a rural and urban population of 195,000 in Central Illinois.MethodsData regarding breakthrough infections collected from the Sangamon County Department of Public Health, included the total number of infections, time after vaccination, age range of those infected and the type of vaccine used. Complete vaccination was defined as 14 days after the single dose of Johnson & Johnson/Janssen or the second dose of Pfizer-BioNTech or Moderna Inc. vaccine.ResultsVaccineInfections% of BreakthroughPfizer-BioNTech1443.75Moderna, Inc.1031.25Johnson & Johnson/Janssen825Total32100The number of fully vaccinated individuals at the time of writing of this study was 87,086 which corresponded to 44.58 % of the total population. The breakthrough infection percentage was calculated as 0.036%. The mean time after vaccination to infection was 49.13 days with a standard deviation of 23.28.ConclusionBreakthrough infections among fully vaccinated individuals in our county, have been quite rare, which points to the high efficacy of the vaccines. A complex number of factors likely contribute to this including virus-related factors i.e. variant forms and specific patient-related factors which are not a part of this study. The afore-mentioned high efficacy rate of the vaccines provides further justification, to continue to pursue a persistent vaccination strategy to mitigate the effects of the SARS-CoV-2 virus.Disclosures All Authors: No reported disclosures

389. Demographic and Clinical Characteristics of Suspect SARS-CoV-2 Reinfection Cases in Los Angeles County from March 10 to June 1, 2021: A Cross-sectional Study of Case Interview Data

BackgroundProbable and suspect SARS-CoV-2 reinfection has been reported globally, with implications for risk assessment and pandemic control. Genomic sequencing and supporting data are frequently unavailable to confirm SARS-CoV-2 reinfection. MethodsIn March 2021, Los Angeles County Department of Public Health began interviewing suspect reinfection cases, defined as individuals with SARS-CoV-2 RNA detected ≥ 90 days after the first detection of SARS-CoV-2 RNA via molecular testing. We conducted a cross-sectional study of case interview data from March 10 to June 1, 2021 to estimate the prevalence of suspect reinfection cases; describe the interval between repeat positives ≥ 90 days; and, estimate bivariate prevalence odds ratios (OR) with 95% confidence intervals (95% CI) for suspect reinfections and age, sex, race/ethnicity, reason for testing, symptomology, and comorbidities. ResultsFrom March 10 to June 1, 2021, we attempted 29,983 case interviews, including 1,901 (6.3%) suspect reinfection cases and 28,082 (93.7%) initial cases. Among suspect reinfection cases, the median interval between repeat positive tests was 117 days (interquartile range: 102, 141). Suspect reinfection cases had decreased odds of completing case interviews (n=738; 38.8%) compared to initial cases (n=13,263; 47.2%) (OR: 0.71; 95% CI: 0.65, 0.78). Among completed case interviews, suspect reinfection cases had increased odds of being older (50-64 years OR: 1.63 [95% CI: 1.32, 2.01]; ≥ 65 years OR: 3.77 [95% CI: 3.00, 4.74]; ref. 30-49 years); Hispanic/Latino (OR: 2.64 [95% CI: 2.10, 3.33]; ref. White); female (OR: 1.21 [95% CI: 1.04, 1.41]); reporting screening as their testing reason (OR: 10.39; [95% CI: 7.45, 14.48]; ref. known exposure); and reporting underlying health conditions (OR: 2.64; 95%CI: 2.24, 3.10). Suspect reinfection cases had decreased odds of being symptomatic (OR 0.15; 95% CI: 0.13, 0.18). ConclusionThis analysis of case interview data indicates individuals who are older, Hispanic, female, and have underlying health conditions may be vulnerable populations for suspect reinfection. Limitations include unconfirmed reinfection and alternative explanations such as persistent positivity with decreased symptoms and infectivity over time.Disclosures All Authors: No reported disclosures

Integrating PrEP delivery in public health family planning clinics: a protocol for a pragmatic stepped wedge cluster randomized trial in Kenya

BackgroundAdolescent girls and young women account for a disproportionate fraction of new HIV infections in Africa and are a priority population for HIV prevention, including provision of pre-exposure prophylaxis (PrEP). Anchoring PrEP delivery to care settings like family planning (FP) services that women already access routinely may offer an efficient platform to reach HIV at-risk women. However, context-specific implementation science evaluation is needed.MethodsThe Family Planning Plus Project is a prospective, pragmatic implementation evaluation, designed as a stepped wedge, cluster randomized trial, at 12 clinics in Kenya. In collaboration with the Kenya Ministry of Health and Kisumu County Department of Health, we will introduce integration of HIV risk screening and PrEP delivery in public health FP clinics. The core multifaceted implementation strategies to integrate PrEP in FP clinics will include: (1) PrEP delivery by existing FP clinic staff, (2) health provider training, (3) PrEP technical assistance to coach and mentor providers, (4) joint supervision with Kisumu County health officials, and (5) stakeholder engagement. All core components of PrEP delivery—including screening for HIV risk, HIV testing, dispensing, adherence and risk reduction counseling, assessment of side effects, and provision of refills, or safety assessment—will be conducted by existing FP clinic staff as part of a standard care service package. The goal is to catalyze sustainable scale-up within existing infrastructures beyond the project. We will rigorously evaluate implementation outcomes and impact, using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, and we will use Organizational Readiness for Implementing Change (ORIC) and the Consolidated Framework for Implementation Science Research (CFIR) to assess readiness to implement and contextual enablers and barriers of implementation, including how clinics innovate efficient delivery systems.DiscussionAnchoring PrEP delivery to existing FP systems and staffing has tremendous potential to address barriers that women face in accessing HIV prevention and PrEP care, including lack of time, cost, and stigma of visiting a facility solely for HIV prevention. The FP Plus Project will initiate preparation for full-scale and sustainable model of integration of comprehensive HIV prevention services, including PrEP implementation, in public health FP clinics in low-income settings.Trial registrationRegistered with ClinicalTrials.gov on December 14, 2020: NCT04666792

Patterns of Child Mental Health Service Utilization Within a Multiple EBP System of Care

The current study (1) characterizes patterns of mental health service utilization over 8 years among youth who received psychotherapy in the context of a community implementation of multiple evidence-based practices (EBPs), and (2) examined youth-, provider- and service-level predictors of service use patterns. Latent profile analyses were performed on 5,663,930 administrative claims data furnished by the county department of mental health. Multinomial logistic regression with Vermunt’s method was used to examine predictors of care patterns. Based on frequency, course, cost, and type of services, three distinct patterns of care were identified: (1) Standard EBP Care (86.3%), (2) Less EBP Care (8.5%), and (3) Repeated/Chronic Care (5.2%). Youth age, ethnicity, primary language, primary diagnosis and secondary diagnosis, provider language and provider type, and caregiver involvement and service setting were significant predictors of utilization patterns. Although the majority of youth received care aligned with common child EBP protocols, a significant portion of youth (13.7%) received no evidence-based care or repeated, costly episodes of care. Findings highlight opportunities to improve and optimize services, particularly for youth who are adolescents or transition-aged, Asian-American/Pacific Islander, Spanish-speaking, or presenting with comorbidities.

Phased Return of Students to 77 Transitional Kindergarten-8th Grade Schools With Cohesive Mitigation Strategies Serving as Protective Factors Against the Increase of COVID-19 Cases in Marin County: September 2020-January 2021.

Background and objectiveEarlier uncertain implications of the coronavirus disease 2019 (COVID-19) pandemic on the pediatric population prompted the authorities to close schools worldwide under the premise that school settings would serve as drivers of an increase in the cases of COVID-19. Safe and equitable full-in-person school instruction is a critical factor in the continued educational gains of children and for their general well-being. The objective of this study was to report epidemiological trends related to the increasing percentage of students returning to in-person instruction, the suspected in-school transmission of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), the virus that causes COVID-19, and countywide COVID-19 case rates during the first 21 weeks of school reopening in Marin County, CA, in the fall of 2020.Materials and methodsThe institutional review board (IRB) approval was waived for this study as it did not involve any identifiable human subjects data. Retrospective electronic reviews of countywide COVID-19 daily case count and COVID-19-related reports associated with in-person school participants from 77 schools in Marin County, CA, from September 8, 2020, to January 29, 2021, were conducted. The data were made available in collaboration with the Marin County Office of Education (MCOE) and Marin County Department of Health and Human Services (Marin HHS). Descriptive trends analyses were performed to determine whether the phased increase of students attending in-person learning was a significant contributor to countywide COVID-19 incidence rate, crude rate, and in-school COVID-19 viral transmission. This is the first long retrospective study of COVID-19 data among the reopened school population during the second half of the first pandemic year. It was conducted in a 21-week surveillance period involving an immense collaboration between Marin County’s public health officials and school administrators.ResultsOver the 21-week observational period involving 17,639 students, 4,938 school staff, and 899,175 student days, the countywide COVID-19 crude rate decreased (from 89.9 to 35.89 per 10,000) as more students returned to in-person learning. The schools’ strict adherence to public health guidance and site-specific safety plans against COVID-19 yielded a significantly reduced incidence rate of 0.84% among in-person learning participants; only nine cases were traced to suspected in-school SARS-CoV-2 transmission by way of rigorous contact tracing. The countywide COVID-19 incidence rate was 2.09%.ConclusionsIt is possible to minimize COVID-19 transmissions in in-person learning settings with cohesive mitigation strategies, specifically strict adherence to proper masking by students and staff while on school grounds. There is no clear correlation that the increasing phased return of students to in-person school drove an increase in countywide COVID-19 cases in Marin County, CA. Our findings revealed that schools were capable of safely resuming operations by following public health orders and recommendations. The increasing percentage of students returning to in-person school did not drive an increased COVID-19 case rate in the community. On the contrary, this analysis revealed that there was a drop in countywide COVID-19 cases as the phased student return percentage increased.