Evidence-based Model Research Articles

What Supports Do Incarcerated Mothers and Their Families Need? The Views of Incarcerated Mothers and Service Providers

Maternal incarceration causes complex and diverse outcomes, affecting the mother, her family, and her community. Despite this, there are few evidence-based models of support. This paper aims to identify participant’s perspectives in developing a model of support by identifying needs, preferred services, and current barriers. Incarcerated mothers (n = 75) and service providers (n = 24) in Queensland, Australia contributed through workshops. Participants identified three support areas: (i) children’s wellbeing and mother-child relationships; (ii) while mothers are incarcerated; and (iii) when mothers return to the community. Mothers prioritized relational and self-development goals whereas service providers prioritized material needs and service delivery methods. Barriers reflected mothers’ multifaceted needs and the complex service delivery area. Preferred programs incorporated individualized, multi-modal, long-term, culturally-informed, and trauma-informed care, while system-level barriers included administrative burdens and navigating complex systems. Overall, models of support must incorporate optimal program-level and system-level characteristics to improve the outcomes of mothers and their children.

Australian community and inpatient general public sector mental health services between 2017-18 and 2021-22: Relative stasis in bed capacity, increasing outpatient demand, and stunted expenditure.

To descriptively analyse Australian public sector General Mental Health Services (GMHS) expenditure, ambulatory, and inpatient services, including key performance indicators (KPIs) in comparison with other subspeciality mental health services (MHS). We descriptively analysed data published by the Australian Institute of Health and Welfare (AIHW), including inpatient, ambulatory services, expenditure, and KPIs. From 2017-18 to 2021-22, per capita expenditure for Australian GMHS (18-64) rose by an average annual inflation-adjusted change of 2%. Overall bed numbers remained static, with non-acute beds declining, and commensurate expansion of acute beds. Community GMHS had high outpatient utilisation, with high rates of schizophrenia, schizoaffective disorder, and bipolar affective disorders as primary diagnoses in mid-life. From 2017-18 to 2021-22, GMHS inpatient and ambulatory episodes had decreasing rates of significant improvement and increasing rates of significant deterioration. Although GMHS has the highest overall population and service utilisation, there has been static bed availability and relatively small increases in expenditure which are occurring concurrently with worsening clinical outcomes. Evidence-based modelling of GMHS and outcomes is required to inform future service improvement.

Commentary: Strengthening System Readiness for Health Interventions: Lessons for Implementing Interventions and Implementation Support in Low-And Middle-Income Countries.

In low- and middle-income countries (LMICs), barriers such as low system readiness, contextual mismatches, and resource limitations impede effective implementation of evidence-based interventions. This commentary offers insights into overcoming these challenges with a case study of the PRISM project, designed to reduce behavioral and psychological symptoms of dementia in older adults living in Thailand. The case highlights how combining two evidence-based models - the Reducing Disability in Alzheimer's Disease clinical intervention and the Getting To Outcomes implementation science process enhances program success. Using interviews with stakeholders across various health system levels, we identify factors critical to successful program implementation: (1) integrating interventions into policy frameworks, (2) empowering local implementers, (3) fostering collaborative learning, and (4) adapting interventions to local contexts. The case demonstrates that building system readiness through local engagement and ownership is central to scaling up health programs in LMICs. This commentary's contribution lies in its emphasis on the role of implementation science as a vehicle for translating research into practice. It presents a practical, adaptive model for embedding interventions into routine health systems, thereby offering a pathway for successfully scaling up evidence-based programs in LMICs. Such findings provide lessons for overcoming barriers to implementation in resource-limited environments.

Establishment of Evidence-Based Nursing Indices for Dysphagia After Anterior Cervical Spine Surgery.

To select and obtain relevant evidence for the management of dysphagia after anterior cervical spine surgery both domestically and internationally, clinical quality evaluation indicators were developed based on evidence-based nursing practices, and obstacles and promoting factors in evidence-based nursing practices were analysed. This research was aimed to provide a basis for evidence-based nursing practices to promote standardized management of dysphagia after anterior cervical surgery. Dysphagia is the most common complication following anterior cervical surgery, but there is a lack of standard protocols and guidelines to direct clinical practice. Mixed methods were employed for the translational research to support evidence-based practice. This study was based on the JBI evidence-based health care model. According to the '6S Evidence Resource Pyramid Model', we searched from top to bottom. This study is guided by the knowledge to action (KTA) evidence-based practice model. Utilizing a comprehensive evidence-based approach and following the 6S evidence resource pyramid model, relevant evidence on the management of swallowing disorders after cervical anterior surgery was selected from both domestic and international sources. Based on the best available evidence, the Delphi expert consultation method was used to establish a management plan for swallowing disorders post-cervical anterior surgery. Semi-structured interviews were then conducted to identify barriers to clinical implementation, and clinical quality evaluation indicators, as well as promoting factors, were subsequently developed. Based on the 31 best evidence points, 12 evaluation indicators were developed. The baseline results of these indicators reveal that, apart from evaluation indicator 8, which has a compliance rate of 72.2%, the compliance rates for most of the other indicators are relatively low. Based on the results of the clinical quality review, the following main obstacles were analysed: negative behaviours and attributes, lack of professional knowledge, and lack of standardized management. Effective management of swallowing disorders after cervical spine surgery is crucial for enhancing treatment outcomes, reducing complications, shortening hospital stays and improving patient quality of life. This study identified the best evidence for managing dysphagia post-anterior cervical surgery and developed corresponding solutions. The next step involves applying these measures in clinical practice to improve patient prognosis and elevate the quality of care.

Evidence-Based Implementation Support: Considering Motivation and Capacity Within the Ecosystem of Training and Technical Assistance.

This invited commentary reflects on Wandersman and Scheier's (2024) call for a more evidence-based model of training and technical assistance (i.e. TTA or implementation support). Their clarion call prompts us to consider what steps need to be taken to refine and scale a solution that genuinely enhances the effectiveness of TTA through a re-imagined model of implementation support. We highlight eight priorities to re-imagine a more effective and efficient model of TTA that reflects best practice and simultaneously contributes to continuous, collective evidence-building. The eight priorities include: (1) an ecosystem of TTA connecting TTA research and practice; (2) TTA capacity building; (3) health equity, and equitable partnerships; (4) trust and relationships; (5) TTA evaluation; (6) continuous quality improvement; (7) implementation support mechanisms; and (8) cost-effective solutions. We advocate for an international, cross-disciplinary, applied agenda aimed at establishing a robust empirical foundation for TTA to foster a culture of continuous quality improvement and knowledge generation across government agencies and philanthropies that fund TTA Centers. We describe a potential scenario for how funders can initiate and support evidence-based TTA.

Development of a Sexological Ontology.

This study aimed to show what role biomedical engineering can play in sexual health. A new concept of sexological ontology, an essential tool for building evidence-based models of sexual health, is proposed. This ontology should be based on properly validated mathematical models of sexual reactions identified using reliable measurements of physiological signals. This paper presents a review of the recommended measurement methods. Moreover, a general human sexual reaction model based on dynamic systems built at different levels of time × space × detail is presented, and the actual used modeling approaches are reviewed, referring to the introduced model. Lastly, examples of devices and computer programs designed for sexual therapy are described, indicating the need for legal regulation of their manufacturing, similar to that for other medical devices.

A prediction model of PTSD in the Israeli population in the aftermath of october 7th, 2023, terrorist attack and the Israel–Hamas war

BackgroundOn October 7th, 2023, a mass terror attack was launched by Hamas militants, which was followed by the Israel-Hamas war. These events constitute a nationwide trauma with major ramifications for public mental health. This article presents an evidence-based model for the prediction of the prevalence of posttraumatic stress disorder (PTSD) related to the terrorist attack and the war.Main body: The creation of the model consisted of several steps. Firstly, the Israeli population was divided into six groups based on the intensity, context, and type of traumatic exposure (direct exposure to terror, close proximity to terror, soldiers in combat and support units, intense exposure to rocket attacks, moderate exposure to rocket attacks, and indirectly affected communities), and the population size of each group was assessed using official national databases. Secondly, an estimation of the expected prevalence of PTSD in each of the exposure groups was based on a review of the relevant literature. A random-effects meta-analysis of the prevalence rates was conducted separately per each exposure group. Finally, the predicted number of PTSD causalities in the population was calculated by multiplying the group size and the PTSD prevalence estimation. Based on population size and estimated PTSD prevalence within each exposure category, the model predicts that approximately 5.3% (N = 519,923) of the Israeli population (95% confidence interval, 1.64–9%), may develop PTSD as a result of the terrorist attack and the war.ConclusionsThe predicted number of individuals with PTSD following mass trauma is expected to be considerable. The presented model can assist policymakers, clinicians, and researchers in preparing and devising adequate interventions for the mental health needs of large populations. Moreover, this model can be applied in other instances of mass-trauma exposure.

How do industry and other actors undermine tobacco control policies post-adoption? A scoping review

Abstract Background Over recent decades, many countries have strengthened their tobacco control policies. To be effective, full implementation is needed. Tobacco industry interference is widely recognised as a key barrier to tobacco control progress and evidence-based models like the policy dystopia model (PDM) list industry strategies, focusing on those avoiding and undermining policy adoption. While prior research highlighted industry activities post-adoption, these have not been captured systematically. This review aimed to map the efforts of industry, front groups and other actors to undermine the implementation of policies, including marketing, packaging, smokefree and flavour measures. Methods We searched six literature databases, relevant bibliographies and grey literature, and consulted experts. We included articles describing one or more attempts to undermine adopted policies, including marketing, packaging, smokefree and flavour. The PDM served as starting point for coding; additional strategies were identified inductively. Strategies were charted against aims and policies. Results Several aims and strategies were identified which were similar across policies. Following policy adoption efforts to 1) overturn and 2) weaken measures, and 3) delay implementation continued. Legal strategies were utilised and there were attempts to influence stakeholders. In addition, tobacco industry and other actors sought to 4) undermine policy effectiveness by creating confusion, circumventing policies, and noncompliance, and 5) use implementation as an opportunity to enhance industry reputation. Conclusions Interference from tobacco industry and other actors threatens effective tobacco control policy implementation. The public health community must continue to monitor, expose and counter industry conduct after policy adoption. More research is needed to enhance our understanding of how industry interferes in policy implementation, and how this can be pre-empted and countered. Key messages • The interference from tobacco industry and other actors following policy adoption threatens effective tobacco control, and needs to be monitored, exposed and countered by the public health community. • Policymakers and civil servants need to be wary of efforts to undermine tobacco control policies and act to ensure effective policy implementation.

Development of a systematic referral model to primary care health interventions for patients with atrial fibrillation. a delphi study

Abstract Background The European Society of Cardiology (ESC) guidelines for the management of atrial fibrillation (AF) recommend integrated care in AF, combining medical treatment with lifestyle modifications and psychosocial management in a multi-disciplinary set-up. Research show that patients with AF can benefit from lifestyle interventions and psychosocial management, like patient education. According to World Health Organization recommendations, these health interventions are moving from hospitals to primary healthcare settings. Therefore, patients with AF should be systematically referred to these interventions. Yet, an evidence-based referral model that can support this transition is lacking. Purpose The purpose is to develop a systematic referral model for primary care health interventions for patients with AF. Methods We used the Delphi-technique with three rounds of questionnaires (figure 1). International and national clinical experts in AF across disciplines and health sectors were invited to participate. In the first round, the expert panel evaluated items that could be part of a referral model on relevance, improvability and self-reporting. In the second round, the expert panel evaluated each item as either an inclusion or exclusion criteria, important knowledge to have, or not relevant. In the third round, the expert panel evaluated the items according to data source and outcome status. A final model was drawn based on items reaching consensus. The study was reported according to the guidance on conducting and reporting Delphi studies (CREDES). Results In total, 69 of 139 invited experts accepted to participate (50%). These were mostly academics or clinicians (90%), stemming from primary sector (16%), secondary sector (35%) and research (32%). Most were medical doctors (36%) and nurses (35%). However physiotherapist, psychologists, dieticians, and other disciplines along with six patients with AF were also represented. The expert panel (60% females) had a mean age of 50 years, and 65% were from Denmark. For the final referral model (figure 2), AF symptom burden and impaired health-related quality of life, anxiety and poor medicine compliance combined with a risk factor profile were the main inclusion criteria. Furthermore, it was important to know about the patients’ mental well-being, self-management abilities and comorbidities. Conclusion Consensus was reached for a generic referral model, which can be further adjusted in the appropriate clinical context. The model includes inclusion criteria which closely correlate with guidelines for AF management focusing on reducing the patients’ symptom and risk factor burden. The referral model is expected to increase the number of patients with AF referred to primary care health interventions, which could lead to better quality of life, fewer hospital admissions and lowered health care costs in AF.

Achievements and Challenges in the Development of a Nurse-Led Respectful Delivery Care Model Provided by Partners in Health in Rural Mexico.

The model of obstetric care predominant in Mexico in most public and private healthcare institutions is particularly focused on a physiological perspective of the female body that does not respond to women's need for emotional comfort and satisfaction. In the last decade, however, various initiatives that provide obstetric care centered on women's rights have emerged. To analyze the implementation of a model of humanized/respectful delivery care supervised by nursing and midwifery undergraduate interns in a birthing center in the state of Chiapas, in order to identify achievements and future challenges. We used information from secondary sources and carried out a descriptive analysis. Births attended at the birthing center increased in relation to all the births registered in the Angel Albino Corzo municipality between 2017 and 2022. Positive indicators of respectful care increased with the implemented model, while negative indicators decreased. Between 2016 and 2022, obstetric nurses attended more than 1500 births without maternal deaths and managed some emergency cases referred to specialized care. This case illustrates the potential of alternative models of obstetric care. Evidence-based, midwife- and nurse-led models of clinical obstetric care should be expanded in the Mexican healthcare system.

The knowledge and skills needed for forensic social work in Australia: A Delphi study

Summary Forensic social work is the application of social work knowledge, skills, values and ethics within a legal and criminal justice context. Globally, social workers play an integral role in the criminal justice system but in many countries, including Australia, there is limited conception of the competencies needed for this specialist practice. Australia serves as an example of forensic social work regulated through a generalist social work competency framework, where specialist skills and knowledge are not distinctly outlined or assessed. The purpose of this study was to identify the knowledge and skills used by forensic social work practitioners in Australia. This study used a 3-round Delphi method with an expert panel of social workers working in forensic practice across Australia. It consisted of a 1-hour semi-structured individual interview followed by 2 rounds of online surveys. Findings Consensus was obtained for 30 skill and knowledge items for Australian forensic social work. The panel identified these competencies as specialist, meaning requiring further training beyond generalist proficiency. Of these, eight of the skill and knowledge items were seen as essential for graduates entering forensic social work. Applications The findings from this study contribute to an evidence-based model of forensic social work competency. In Australia, they can be used to consider potential gaps between current generalist mechanisms and specialist practice expectations. With further research, these findings can be used to inform professional standards for forensic social work in Australia and potentially internationally.

Evidence-based flood resilience models for bridges

Bridges are critical infrastructural components that can be significantly impacted by flooding. Despite substantial research on the risk of bridges to floods, there is a knowledge gap regarding the restoration modelling, which this research aims to fill. This paper analyses the restoration of a portfolio of bridges damaged or collapsed, during the 2015 Cumbrian floods in the UK. The purpose of this exercise is to develop a methodology that can be replicated to other case studies for facilitating resilience modelling for bridges affected by floods. The paper deploys published restoration and recovery modelling techniques to establish a repeatable way of analysing a large portfolio of bridges in one model, offering valuable insights into the specific challenges and strategic considerations essential for effective post-flood recovery. This approach evaluates the serviceability levels during the restoration process, and identifies key factors influencing restoration outcomes, underscoring the need for evidence-based restoration models to enhance infrastructure resilience against future flood events

A Joanna Briggs Institute Framework Approach to Shared Decision Making in End-of-Life.

To implement shared decision-making (SDM) through a patient decision aid (PtDA) for the initiation of palliative care (PC) in end-of-life (EOL) cancer patients. A comprehensive Scoping Review was conducted on SDM in PubMed, CINAHL and PsycInfo. An evidence-based implementation of PtDAs was created using the Joanna Briggs Institute framework, which followed rigorous pillars: (1) context, (2) facilitation and (3) evaluation. Fifteen studies were identified and categorised into (1) Implementation characteristics and (2) Strategies for implementing SDM in terminally ill cancer patients. SDM should consider the decision-making location, optimal timing, participants and decision type. Strategies include professional training, PtDAs and implementation programmes. A PtDA implementation protocol in video format for deciding to initiate PC is proposed, following International Patient Decision Aid Standards (IPDAS) and Clinical Practice Guidelines (CPG). SDM implementation should be guided by evidence-based methodological models justifying and structuring its execution, especially in complex and interdisciplinary contexts. National or international frameworks facilitate the adoption of health innovations, such as PtDAs, benefiting patients and improving their usage. SDM is not just a concept but an important approach to the Care of cancer patients at EOL, enhancing patient satisfaction and improving care quality. The success and sustainability of SDM hinge on the fundamental aspects of staff training, interdisciplinary collaboration and ongoing evaluation. The lack of specific aid in Spanish underscores the immediate need for local development. Further research is needed in this area, as most reviewed studies did not measure SDM effectiveness in diverse hospital settings. This proposal was developed based on the experience and input of the nursing staff from the healthcare service where it is intended to be implemented.

Exploring the determinants of oral health care uptake among women with gestational diabetes mellitus: A qualitative study to develop a logic model and framework for an oral health intervention.

Gestational diabetes mellitus (GDM) is a condition of glucose intolerance in pregnancy. Oral health has been shown to mediate blood glucose management and pregnancy outcomes. There is also a greater prevalence of poor oral health in GDM pregnancies when compared to normoglycemic pregnancies. While current guidelines recommend an oral health review as part of diabetes and pregnancy management, it is under-considered in GDM care. Hence, it is important to understand how to improve oral health care in this context. To explore the determinants of oral health care uptake among women with GDM to develop a logic model for an intervention to improve awareness and activation of oral health behaviours in this population. Semi-structured interviews were used to collect the data and the Theoretical Domains Framework inspired the interview guide. The study population consisted of UK-based women with GDM over 18 years of age. The data were analysed with Framework Analysis and the COM-B Model was used to orientate the data. Seventeen women participated in the study. Five themes including knowledge about oral health; the health of the baby; the impact of the GDM diagnosis; social support and barriers and facilitators were found to influence the uptake of oral health care. This study developed an evidence-based logic model of the determinants of oral health care uptake among women with GDM. This will serve as a framework for developing an oral health intervention. This study may be the starting point for initiating conversations about implementing oral health care in GDM management.

Nurse-led telehealth and mobile health care models for type 2 diabetes and hypertension in low-income US populations: A scoping review.

Increasing numbers of underserved people with chronic diseases and decreasing providers in rural areas have contributed to the care shortage in the United States. Nurse-led telehealth/mobile care models have potential benefits for this population. However, there is a substantial gap in the literature regarding this topic. To examine the available literature on nurse-led telehealth/mobile health care models with a particular focus on care model settings, nursing roles, care components, achieved outcomes, and the identification of both facilitative factors and encountered challenges. The ultimate goal is to offer recommendations based on these findings, thereby aiding the development or refinement of evidence-based care models that meet to the unique needs of low-income populations. Literature published from 2010 to 2023 was searched in six electronic databases (Cumulative Index to Nursing and Allied Health Literature, Communication and Mass Media Complete, Medline, APA PsycINFO, Social Sciences Index, and Web of Science databases). Commonalities identified among included studies with significant improvements were the provision of home monitors and education to participants, multiple engagements, and extensive community and/or family involvement. Nurse-led telehealth/mobile health care models for chronic diseases are an emerging approach. Nurse educators must ensure that future nurses are adept in diverse telehealth modes, collaborating across disciplines. Leveraging advanced practice registered nurses and interdisciplinary teams provides holistic care. Our review outlined recent research findings that suggest enhanced patient outcomes through technology, communication, and community support. In addition, we offered suggestions for future research and practice, emphasizing the importance of exploring the requirements of diverse and underserved communities.

The Dynamic Adaptation of the Journey of Hope: A School-Based Intervention to Support Pandemic and Disaster-Affected Children and Youth.

The Journey of Hope (JoH) is an evidence-based behavioral health prevention intervention model designed for disaster-affected children and youth. While the in-person JoH model has been extensively delivered and studied, the virtual implementation of this intervention, specifically tailored for the unique needs of children and youth during the COVID-19 pandemic, has not been previously explored. In this context, authors of this article adapted the JoH to a virtual delivery model, aiming to provide access to behavioral health preventive services for children and youth during the COVID-19 pandemic when in-person services were not feasible. This adaptation, utilizing the dynamic adaptation process (DAP) and community-based participatory research (CBPR) principles, was carefully designed to meet pandemic-related challenges while maintaining the core components of the original intervention. The primary objectives of this article are twofold: (1) to provide an overview of the theoretical and conceptual underpinnings of the JoH-C19, including the framework that guided the adaptation, and (2) to describe the virtually adapted curriculum and initial pilot of the JoH-C19. This adaptation represents a crucial step in ensuring the accessibility of virtual behavioral health interventions for young populations facing various collective traumas and challenges in a rapidly evolving world.

Climate Anxiety: Current Evidence and Future Directions.

Challenging cognitive, somatic, and behavioral responses to climate change are often conceptualized as climate anxiety (CA). Due to the increased recognition of the impacts of climate change on mental health, a growing body of scientific literature is developing. The purpose of this manuscript is to review the current evidence base for CA and propose future research needs for this emerging construct. Early evidence supports underlying psychological mechanisms in the development and maintenance of CA, which are similar to other anxiety-related conditions. However, the study of CA poses unique challenges to researchers. The psychological impacts that occur in the context of climate change may be adaptive depending on the imminent threat of natural disasters, forced migration, or other climate-related challenges. Due to the potentially adaptive nature of CA and limited current evidence, a coordinated research program of climate-related distress is necessary. A review of the extant literature identified current gaps in understanding the epidemiology and individual differences that promote CA. Current evidence supports the prominent role of neuroticism, intolerance of uncertainty, and rumination. The development of evidence-based models of climate-related distress may provide a more valid and comprehensive depiction of the impacts of climate change on mental health. Transdiagnostic treatment methods are likely the most appropriate intervention for climate-related distress. As models, measures, and treatments of climate-related distress are developed, it is crucial to incorporate studies of populations most at risk for climate change-related mental health effects.

Telehealth in Home Visiting for New Mothers: Are Outcomes Different if the First Visits Are in Person?

Home visiting programs for new parents have a broad range of goals, including improvements in maternal and child health, reductions in child maltreatment, and improvements in child development. Before 2020, few home visits were conducted through phone or video encounters, i.e., telehealth home visiting (teleHV). However, rapid adoption of teleHV was required by the coronavirus disease 2019 (COVID-19) pandemic. To understand how conducting initial visits via teleHV was associated with outcomes, we performed a secondary data analysis to make use of the natural experiment created by COVID-19. Utilizing data from the Nurse-Family Partnership, a US national evidence-based model, we compared outcomes for families whose initial home visits were in person (enrolled 10/2019 to 1/2020; n = 7066) to those whose first visits were through teleHV (enrolled 4/2020 to 12/2020; n = 14,587). TeleHV at intake was associated with a higher likelihood of elevated depressive symptoms at 12 months (OR = 1.37; 95% CI 1.07, 1.76), a lower likelihood of retention to child’s age 12 months (OR = 0.67; 95% CI 0.58, 0.78), a higher likelihood of early drop from the program (OR = 1.77; 95% CI 1.48, 2.12), and fewer screening assessments completed (b = − 0.06; 95% CI − 0.07, − 0.04). No differences were detected between groups for the likelihood of breastfeeding at child’s age 6 months, elevated intimate partner violence (IPV) risk, 90% of attempted visits completed, or time to attrition. COVID-19 may have led families in different groups to have different experiences during key points of child development; however, as both groups’ involvement in the program occurred primarily during the pandemic, they were both subject to comparable influences. These findings suggest that in-person visits have some advantages in the first months of program involvement.

Literacy Promotion: An Essential Component of Primary Care Pediatric Practice: Technical Report.

Early literacy promotion in pediatric primary care supports parents and caregivers reading with their children from birth, offering counseling in interactive, developmentally appropriate strategies and providing developmentally and culturally appropriate and appealing children's books. This technical report reviews the evidence that reading with young children supports language, cognitive, and social-emotional development. Promoting early literacy in pediatric primary care offers a strengths-based strategy to support families in creating positive childhood experiences, which strengthen early relational health. An increasing body of evidence, reviewed in this report, shows that clinic-based literacy promotion, provided with fidelity to an evidence-based model, has benefits for children, for parents and caregivers, and for pediatric physicians and advanced care providers as well. Reading with young children supports early brain development and the neural "reading network," and improves school readiness. High-quality literacy promotion is especially essential for children who face disparities and inequities because of social factors, systemic racism, and socioeconomic risk. All families benefit from high-quality and diverse books and from developmentally appropriate guidance supporting interactions around books and stories. Thus, literacy promotion can be a universal primary prevention strategy to strengthen families and support healthy development. Partnerships at community, local, and state levels offer opportunities for integration with other programs, services, and platforms. Literacy promotion in primary care pediatric practice, recognized by the AAP as an essential component since 2014, has become increasingly common. There are successful models for public funding at federal, state, county, and municipal levels, but sustainable funding, including payment to pediatric physicians and advanced care providers, remains a need so that the benefits of pediatric early literacy promotion and the joys of books and shared reading can truly be offered on a population level.

Father Engagement in Home Visiting: Findings From a Continuous Quality Improvement Learning Collaborative.

The present study describes the efforts of a home visiting (HV) continuous quality improvement learning collaborative aimed at increasing father engagement in HV and parenting. Local implementing agencies (n=11) delivering 3 evidence-based HV models participated in the collaborative. Each agency developed and implemented 3 rapid-cycle Plan-Do-Study-Act (PDSA) projects to increase father engagement. Specific, Measurable, Achievable, Realistic, Time-bound (SMART) aims were used to guide development of change strategies and meaningful measurement goals. HV providers collected data from enrolled families (n=714) about fathers' level of parenting and HV involvement. Mean father engagement scores increased 39% from the first to the second assessment and over 60% of the PDSAs met or exceeded their SMART aim goal. Data suggest that fathers are open to participating in HV and are responsive to parenting guidance. In the current paper, we share engagement strategies and lessons learned during the collaborative.