Implementation Of Evidence-based Programs Research Articles

Cancer situation in Latin America and its public policies

Introduction: Cancer in Latin America and the Caribbean presents a worrisome growth, with forecasts of increased incidence and mortality. Factors such as population aging, changes in lifestyles, and inequalities in access to medical care complicate its management. Prevention, early detection and adequate treatment are essential, requiring effective public policies and concerted action among various social and health actors.Methodology: A literature review focused on the situation of cancer in Latin America, examining the implementation of public policies in the region. Documents published since 2019, in three languages, were reviewed, identifying practices and lessons learned in the prevention and early detection of cancer, mainly breast cancer.Results: Latin America faces an increasing cancer burden due to demographic, epidemiological and lifestyle factors. Prevention and early detection efforts vary significantly across the region, with some countries implementing national cancer plans. However, significant challenges exist in financing, equitable access to health services, and comprehensive care.Conclusions: It is crucial to develop comprehensive public policies that address the social determinants of health, promote healthy lifestyles, and ensure equitable access to prevention, diagnosis, and treatment services. The participation of all sectors of society, including citizens, is fundamental for effective cancer management in the region. The implementation of evidence-based programs and the strengthening of health systems are essential to address this public health challenge.

Dissemination and implementation of evidence-based programs for people with chronic disease: the impact of the COVID-19 pandemic.

Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, we describe the implementation of evidence-based chronic disease self-management education (CDSME) programs by the Administration for Community Living CDSME Grantees during 2016-2022 and we also explore the impact of the COVID-19 pandemic on implementation. Grantees collected data before and after the implementation of the CDSME programs and contributed to the national data repository. Data components included workshop information, participant information, and organizational data. The cohort consisted of 175,973 individuals who participated in 34 CDSME programs across 45 states. Participants had a mean ± SD age of 66.1 ± 14.8 years, were primarily female (65.9%) and had a mean ± SD of 2.6 ± 2.3 chronic conditions. Compared to the pre-COVID-19 strata, those who participated during COVID-19 were on average 1.5 years younger and had slightly less comorbidities. For individuals who had pre and post program self-reported health, 65.3% stayed the same, 24.4% improved, and 10.3% worsened (p < 0.001) after participating in CDSME programs. CDSME offers a variety of programs across a broad geographic area to a diverse set of older adults in the US, underscoring the expansive reach of this public health initiative. COVID-19 appears to have shifted participant reach toward a slightly younger and healthier population. Finally, these programs appear to be effective in improving participants' self-rated health. However, these results should be interpreted with caution, given limitations due to missing data and the observational nature of this study design.

Clinical Nurse Specialists Using Evidence-Based Practice to Prevent Falls

Abstract Purpose/Objectives The purpose of this quality improvement project was to reduce inpatient falls and falls with injury by implementing the Hester Davis Fall Program, a comprehensive, evidence-based prevention program, with the leadership of clinical nurse specialists. Description of the Project/Program The Plan-Do-Study-Act model was utilized to implement the program at 2 adult acute care facilities. Clinical nurse specialists collaborated with nurse managers to guide planning, implementation, and evaluation of patient outcomes. Routine meetings with Hester Davis sustainability coaches and access to data analytic dashboards provided visibility of audit data, allowing for the intentional selection of targeted strategies to improve risk assessment scoring and implementation of appropriate interventions. Outcome Although both facilities demonstrated overall favorable trends in fall rates, one facility demonstrated rates less than the National Database of Nursing Quality Indicators mean. In the 9 months following implementation, total falls for both facilities decreased from 744 to 692 for the same period in the previous year, resulting in estimated cost-savings of $202 176 to $491 400. Conclusion Clinical nurse specialists play a key role in the successful implementation of evidence-based programs. As organizations look to improve quality measures, it is vital that senior nurse leaders ensure the availability of appropriate resources including the identification of individuals with the appropriate skill set to lead quality improvement.

Science for behavioral health systems change: evolving research-policy-public partnerships.

Potent partnerships among researchers, policymakers, and community members have potential to produce positive changes in communities on a range of topics, including behavioral health. The paper provides a brief illustrative review of such partnerships and then describes the development and evolution of one partnership in particular in Virginia. The origin of the partnership is traced, along with its founding vision, mission, and values. Some of its several projects are described, including (a) needs assessment for implementation of evidence-based programs (EBPs) pursuant to the Family First Prevention Services Act; (b) statewide fidelity monitoring of key EBPs; and (c) projects to synergize state investments in specific EBPs, like multisystemic therapy, functional family therapy, and high fidelity wraparound. The paper concludes with some themes around which the center has evolved to serve the state and its citizens more effectively.

STRATEGIES FOR MAINTAINING FIDELITY AND SUSTAINABILITY IN EVIDENCE-BASED PROGRAM DELIVERY

Abstract Federal agencies and advisory councils emphasize the need to expand delivery of evidence-based programs (EBPs) to meet the needs of the increasing millions of family members and friends providing long-term, complex care to persons living with dementias in the U.S. (Alzheimer’s Association, 2022). Achieving lasting value and impact of such implementations requires systematic and replicable programmatic fidelity and sustainability to ensure caregivers’ broad access and positive outcomes, and the significant investments of providers, stakeholders, and funders are maintained. Unfortunately, a paucity of reported evidence on such strategies continues to limit the full benefit of most intervention efforts. (Hailemariam, M., Bustos, T., Montgomery, B. et al. 2019). To inform the larger RO1 effort described in the previous two papers, we recruited nine organizations from diverse regions that deliver Savvy Caregiver® to discern the key strategies employed to ensure program fidelity and sustainability. Semi-structured interviews were conducted with organization directors (n=9) and Savvy coordinators and group leaders (n=23). Thematic content analyses of transcribed transcripts yielded salient findings on fidelity best practices, including: Assuring EBP coherence with an organization’s mission; proactively integrating fidelity into interventionists’ training; and integration of fidelity monitoring strategies. Regarding structural practices supporting sustainability, findings included: Engaging leadership buy-in of Savvy as an anchor program; establishing succession plans for seamless program delivery; creation of local collaborative partnerships for long-term recruitment or in-kind contributions; establishment of infrastructure to secure ongoing state and federal financial support. Findings highlight effective, accessible, and achievable strategies for ensuring long-term benefits for all EBP implementation efforts.

CREATING STRUCTURES FOR SUSTAINABILITY OF EVIDENCE-BASED DEMENTIA CAREGIVER PROGRAMS

Abstract Ensuring sustainable impact for broad-based evidence-based programs (EBPs) serving caregivers for persons living with dementia in the U.S. requires systemic maintenance of programmatic fidelity. This symposium aims to assist decision makers, aging and public health networks, and intervention developers to anticipate and deploy effective strategies and resources required to implement EBP interventions and sustain them. A series of four papers describes precursor studies and activities leading to the development of a structure aimed at ensuring that one such EBP, the Savvy Caregiver® (Savvy), can be faithfully sustained by sponsoring organizations. The first paper presents results from in-depth qualitative interviews of key staff (n=25) in nine organizations delivering Savvy. Findings highlight organizational, structural, and regional collaborations that contributed to sustained EBP implementation with fidelity. The second paper describes an online program to train Savvy interventionists. Informed by the first paper’s findings a fully asynchronous multi-media professional continuing educational interventionist training program was developed in collaboration with the educational design team at Emory’s School of Nursing. The third paper presents results of the online trainer program evaluation conducted among 76 interventionists from 32 organizations in eight states. High scores on content comprehension (95-99%) and participant feedback document benefits of self-paced learning, interactive materials and quizzes, and self-reflective exercises. The final paper describes a platform (Savvy Systems, LLC) created to ensure Savvy’s long-term dissemination, programmatic integrity and sustained use. The single platform provides for authorized content dissemination, leader training, enhanced referrals, and copyright compliance through licensing. Discussant will offer policy and practice implications. This is a collaborative symposium between the Alzheimer’s Disease and Related Dementias and Family Caregiving Interest Groups.

A Mixed-Method Evaluation of a Rural Elementary School Implementing the Coordinated Approach to Child Health (CATCH) Program.

Despite children living in rural US areas having 26% greater odds of being affected by obesity compared to those living in urban areas, the implementation of evidence-based programs in rural schools is rare. We collected quantitative data (weight and height) from 272 racially and ethnically diverse students at baseline, and qualitative data from students (4 focus groups), parents, and school staff (16 semi-structured interviews and 29 surveys) to evaluate program outcomes and perceptions. At the 2-year follow-up, paired data from 157 students, represented by racial/ethnic groups of 59% non-Hispanic White, 31% non-Hispanic Black, and 10% Hispanic, showed an overall mean change (SD) in BMI z-score of -0.04 (0.59), a decrease of -0.08 (0.69) in boys, and a significant -0.18 (0.33) decrease among Hispanic students. Boys had a mean decrease in obesity prevalence of 3 percentage points (from 17% to 14%), and Hispanic students had the largest mean decrease in BMI percentile. Qualitative data showed positive perceptions of the CATCH program and its implementation. This community-engaged research, with collaboration from an academic institution, a health department, a local wellness coalition, and a rural elementary school, demonstrated successful CATCH program implementation and showed promising outcomes in mean BMI changes.

Growing stronger together: Implementing the Strengthening Families Program with Indigenous communities

BackgroundChild welfare agencies commonly seek to use evidence-based programs (EBPs) for their demonstrated results. Challenges remain in adapting programs to fit for Indigenous populations. We suggest that relationality holds promise as a guide in the implementation of EBPs with Indigenous families and children. ObjectiveWe provide the story of a culturally integrated implementation of the EBP, Strengthening Families Program (SFP), with Indigenous families. Participants and settingInsights from the staff who implemented SFP, project leadership and a community steering committee were brought together to create the collective implementation story. MethodsA relational approach was used in thematic analysis with a focus on the three Rs - responsibility, respect, and reciprocity- that support Indigenous knowledge organization. ResultsFindings offer insight into cultural integrations in the implementation of SFP. The program centered Indigenous and community identities through meals, gifts, parenting practice examples and discussions tailored by each group of families and staff. Practices related to responsibility, respect and reciprocity each proved to be essential concepts in the relationship building among caregivers, children, SFP staff, project leadership, and community supporters that led to program success. ConclusionCultural integration created a space that reflected Indigenous knowledge relationality. It respected the uniqueness among groups of families who participated in the evidence-based SFP. Our story supports the importance of having Indigenous staff and group leaders to guide cultural integration in relationship with tribal communities.

A conceptual model for building program sustainability in public health settings: Learning from the implementation of the program sustainability action planning model and training curricula.

The emergence of implementation science has driven an increase in research examining the implementation of evidence-based programs and policies. However, there has been less attention through program sustainability. To achieve the full benefit of investment in program development and implementation, there must be an understanding of the factors that relate to sustainability; additionally, there is a need for a robust set of tools and trainings to support strategic long-term program sustainability. This paper presents results of our sustainability training intervention and a new conceptual model of sustainability. The proposed conceptual model builds upon the intervention design, further specifying the implementation strategy, strategy-mechanism linkages, and effect modifiers. This research is part of the larger randomized control trial evaluating the effectiveness of the Program Sustainability Action Planning Model and Training Curricula. Specifically, this multimethod study establishes a conceptual model for program sustainability and related capacity-building interventions. The training intervention was delivered through workshops and technical assistance to 11 state tobacco control programs, principally entailing the development and implementation of a sustainability action plan. We utilize descriptive statistics and participant perspectives to evaluate the training intervention and propose an empirically-grounded conceptual model for sustainability capacity-building interventions in public health settings. Participants found intervention components (workshop, workbook, instructor and resources) to be effective. Overall, participants found the intervention improved their ability to develop sustainability action plans and assess their program and partners. Throughout the study, program managers emphasized the importance of the workshop in providing direction for their sustainability work and the value of robust, ongoing technical assistance. Program managers identified several factors that interfered with intervention reception including staff turnover, competing priorities, partnership challenges, and the COVID-19 pandemic. The present study documents the development and implementation of a novel Program Sustainability Action Planning Model and Training Curricula, one of the first interventions designed to improve program sustainability. In addition, we present an empirically-grounded conceptual model for program sustainability. Considering the paucity of research in this understudied and undefined topic area, this is an important contribution that can serve as a framework for similar intervention designs and implementation efforts. Clinical Trail Registration: ClinicalTrails.gov identification number is NCT03598114.

Predicting implementation of the PAX Good Behavior Game + MyTeachingPartner interventions.

Effective classroom management is critical to creating a classroom environment in which social, emotional, and academic learning can take place. The present study investigated the association between early career, early elementary teachers' occupational health (job stress, burnout, and perceived teaching ability) and perceptions of program feasibility in relation to their implementation dosage and quality of two evidence-based classroom management programs implemented together: the PAX Good Behavior Game (GBG) and MyTeachingPartner (MTP) intervention. Teachers provided information on their occupational health at the start of the school year and were then randomized to the PAX GBG + MTP condition or control condition. Teachers' perceptions of the feasibility of the program, implementation dosage, and implementation quality of the intervention were measured at the end of the school year for the 94 intervention teachers. Teachers participated in more MTP coaching cycles when they reported that the combined PAX GBG + MTP program was feasible. Although there were no main effects of occupational health on implementation, the associations between job stress and implementation quality were moderated by perceptions of feasibility. Findings highlight the complexity of factors influencing the implementation of evidence-based programs in school settings.

Evaluating a transitional care program for the oldest adults: results from the quantitative phase of a mixed-methods study

PurposeThis quantitative phase of a mixed-methods study aims to describe the effect of the Transitional Care Bridge (TCB) programme on functional decline, mortality, health-care utilisation and health outcomes compared to usual care in a regional hospital in the Netherlands.Design/methodology/approachIn a pre- and post-cohort study, patients aged ≥70 years, admitted to the hospital for ≥48 h and discharged home with an Identification of Seniors at Risk score of ≥2, were included. The TCB programme, started before discharge, encompassed six visits by the community nurse (CN). Data were obtained from the hospital registry and by three questionnaires over a three months period, addressing activities of daily living (ADL), self-rated health, self-rated quality of life and health-care utilisation.FindingsIn total, 100 patients were enrolled in this study, 50 patients in the TCB group and 50 patients in the usual care group. After three months, 36.7% was dependent on ADL in the TCB group compared to 47.1% in the usual care group. Mean number of visits by the CN in the TCB group was 3.8. Although the TCB group had a lower mortality, this study did not find any statistically significant differences in health outcomes and health-care utilisation.Research limitations/implicationsChallenges in the delivery of the programme may have influenced patient outcomes. More research is needed on implementation of evidence-based programmes in smaller research settings. A qualitative phase of the study needs to address these outcomes and explore the perspectives of health professionals and patients on the delivery of the programme.Originality/valueThis study provides valuable information on the transitional care programme in a smaller setting.

The person within: Parents and professionals’ views about the practitioner’s role in a parenting program

Practitioners’ characteristics and actions influence the implementation of evidence-based programs, but little is known about the practitioner’s role in the implementation of parent-based programs. The present qualitative study is the first to explore the perceptions of parents and professionals regarding the practitioners’ characteristics and actions which influence the implementation of a parent program directed at children’s behavior problems. Using thematic analysis, data were examined from eight focus groups comprising 24 parents and 19 practitioners who have participated in the Incredible Years parent group program (IYPP). The analysis identified three groups of practitioners’ characteristics perceived to impact the implementation of the IYPP: inferred interpersonal characteristics (genuine interest; empathy and warmth; positive regard; humbleness); inferred intrapersonal characteristics (objectivity; flexibility; well-being; reflexiveness) and objective characteristics (similar age; being a parent; clinical professional background; professional experience with children and the IYPP). These personal characteristics are perceived as serving to underpin practitioners’ actions, and an integrated framework model is proposed where specific practitioners’ actions are understood in relation to personal characteristics. Inferred characteristics are perceived as determinants in the intervention process while objective characteristics are seen as facilitators of parent engagement in the earliest stages of intervention. Finally, most of the characteristics and actions perceived as relevant in this study are contemplated in the IYPP model; however, the practitioners’ intrapersonal well-being, self-reflexiveness and genuineness emerged as characteristics which may merit further consideration. The results from this study suggest that in the IYPP the person of the practitioner may indeed be worthy of more critical examination.

Identifying strategies to advance equitable implementation of co-occurring mental health and substance use disorder treatment in drug treatment courts: A study protocol.

Behavioral health treatment disparities by race and ethnicity are well documented across the criminal legal system. Despite criminal legal settings such as drug treatment courts (DTCs) increasingly adopting evidence-based programs (EBPs) to improve care, there is a dearth of research identifying strategies to advance equitable implementation of EBPs and reduce racial/ethnic treatment disparities. This paper describes an innovative approach to identify community- and provider-generated strategies to support equitable implementation of an evidence-based co-occurring mental health and substance use disorder intervention, called Maintaining Independence and Sobriety through Systems Integration, Outreach and Networking-Criminal Justice (MISSION-CJ), in DTCs. Guided by the Health Equity Implementation Framework, qualitative interviews and surveys will assess factors facilitating and hindering equitable implementation of MISSION-CJ in DTCs among 30 Black/African American and/or Hispanic/Latino persons served and providers. Concept mapping with sixty Black/African American and/or Hispanic/Latino persons served and providers will gather community- and provider-generated strategies to address identified barriers. Finally, an advisory board will offer iterative feedback on the data to guide toolkit development and inform equitable implementation of MISSION-CJ within DTCs. The paper illustrates a protocol of a study based in community-engaged research and implementation science to understand multilevel drivers of racial/ethnic disparities in co-occurring disorder treatment and identify opportunities for intervention and improvements within criminal legal settings.

CAPABLE IMPLEMENTATION: PROGRESS AND BARRIERS

Abstract CAPABLE is an evidence-based 4-to-6-month program that improves daily function and the home environment based on the older adult’s goals. Study aims were to: (1) understand context and readiness factors in implementation, (2) identify barriers and facilitators, and (3) examine the utility of two frameworks. The unit of analysis was the organization. We employed the CFIR and RE-AIM frameworks for this qualitative study, using multiple data sources and traced the implementation of 40 organizations over 3 years. Leadership support, perceived value of the program, initial funding, strategic importance, and program champion were common supportive factors. Common challenges included difficulty with recruitment, staffing and infrastructure readiness and sustainability of funding. This study indicates readiness, technical support, and resources needed for implementation and sustainability of CAPABLE and suggests external environmental supports needed. It offers a practical way to monitor, evaluate, and report on ongoing implementation of evidence-based programs.

Healthier Lives Implementation Research Network for Māori and Pacific community health providers in Aotearoa New Zealand: a study protocol with an observational mixed methods design

BackgroundDespite incremental gains in the Aotearoa New Zealand health sector, Māori and Pacific peoples still experience poorer health outcomes than non-Māori and non-Pacific. Access to the latest research and innovation is critical to improving and addressing health outcomes and health inequities in particular. However, there are numerous challenges to translating research into practice including that there is currently no known a specific infrastructure in Aotearoa New Zealand to facilitate this process. The aim of the project is to develop a network of community providers, researchers and health systems representatives that can help facilitate the implementation of novel and innovative programmes and products that help to meet the health needs of Māori and Pacific communities.MethodsThis project has three stages, one of which has been completed. In Stage 1, we engaged with key leaders of organisations from various components in the health system through a co-design process to identify parameters and infrastructure of the network. In Stage 2, we propose to construct the network involving approximately 20–30 community providers (and other affiliated researchers and health system representatives) and refine its parameters through an additional co-design process. Additionally, we will use a mixed methods research design using survey and interviews to identify perceived implementation needs, facilitators and barriers to help inform the work in the third stage. In Stage 3, we will support the active implementation of evidence-based programmes with a smaller number of providers (approximately four to eight community providers depending on the complexity of the implementation). Mixed methods research will be conducted to understand facilitators and barriers to implementation processes and outcomes.DiscussionThe proposed network infrastructure is an equity-oriented strategy focused on building capacity through a strength-based approach that can help address inequities over time. Our “proof-of-concept” study will not be able to change inequities in that time period given its relatively small scale and time period, but it should set the foundation for continued equity-oriented work.

The Healthy Native Youth Implementation Toolbox: Using Implementation Mapping to adapt an online decision support system to promote culturally-relevant sexual health education for American Indian and Alaska Native youth.

American Indian and Alaska Native (AI/AN) youth experience serious disparities in sexual and reproductive health, including the highest teen birth rate among racial/ethnic groups, and disproportionate rates of sexually transmitted infections (STI), including HIV. A growing number of evidence-based programs (EBPs) that integrate the strengths and cultural teachings of Native communities exist. Yet, multiple factors, including lack of trained personnel, limited resources, and geographic isolation, may hinder their adoption and implementation. Innovative implementation strategies that facilitate the adoption and implementation of sexual health EBPs in Native communities may help reduce these disparities. We applied Implementation Mapping, a systematic planning framework that utilizes theory, empirical evidence, and community input, to adapt a theory-based, online decision support system, iCHAMPSS (CHoosing And Maintaining Effective Programs for Sex Education in Schools), to support underlying dissemination and implementation processes unique to Native communities. We used an iterative design process, incorporating input from Native practitioners and academicians, to ensure that the adapted decision support system reflects cultural identification, community values, and experiences. Grounded in diffusion of innovations, organizational stage theory, and social cognitive theory, the Healthy Native Youth Implementation Toolbox supports Native practitioners through five phases (Gather, Choose, Prepare, Implement, and Grow) to adopt, implement, and maintain a culturally-relevant, age-appropriate sexual health EBP. The Toolbox provides tools, ready-to-use templates, and guidance to plan, implement, and grow a culturally-relevant adolescent health program with their Tribe or community. Hosted within the Healthy Native Youth website (www.healthynativeyouth.org), the Toolbox comprises: (1) a curriculum portal with access to 15 culturally-relevant, age-appropriate evidence-based health promotion programs for AI/AN youth; (2) a "resource library" comprising 20+ support tools, templates, and links to external resources, and (3) "stories from the field" comprising testimonials from experienced Native educators, who have implemented sexual health programs. There is a continued need to design, test, and evaluate D&I strategies that are relevant to Native communities. The Healthy Native Youth Implementation Toolbox contributes to the dissemination and implementation of evidence-based, culturally-relevant sexual health education programs in diverse Native communities. Implementation Mapping provided a systematic approach to guide the adaptation process and integrate community voice with the ultimate goal of enhancing sexual health equity among AI/AN youth.

Adapting the self-assessment of contextual fit scale for implementation of evidence-based practices in adolescent HIV settings

BackgroundContextual fit is an important variable in the implementation of evidence-based programs (EBPs). The objectives of the current study were to examine the psychometric properties of the adapted Self-Assessment of Contextual Fit (SACF) measure for HIV clinical care settings (calling it SACF-HIV) and explore how perceptions of contextual fit varied across two different interventions (an intervention to scale up tailored motivational interviewing and an individually focused HIV prevention intervention) and 12 clinical sites.MethodsWe collected SACF-HIV data as part of a larger cross-project implementation science study (ATN 153). The study sample includes 128 clinicians, community health workers, interventionists, adherence counselors, and other members of the prevention and care team who engage in the implementation of EBPs at 12 HIV prevention and clinical care sites in the USA. We assessed the internal consistency of the SACF-HIV using Cronbach’s alpha and examined the sub-dimensionality of the scale with an exploratory factor analysis. To explore concurrent validity, we examined Pearson’s correlation coefficients between the adapted scale and fit-related sub-scale scores from the Evidence-Based Practice Attitudes Scale-50 (EBPAS-50). Variation in perceptions of fit by intervention was examined using descriptive statistics.ResultsInternal consistency of the adapted scale was strong (α=0.895). Factor analyses revealed two sub-scales—one capturing general insights regarding contextual fit, such as perceptions of skill, experience, and alignment with client needs (loadings ranging from .5 to .84), and a second centering perceptions regarding implementation support, such as resources and administrative support (loadings ranging from .89 to .97). Concurrent validity was supported by statistically significant correlations in the expected direction with EBPAS-50 fit-related sub-scales (r=.33–.35, p ≤ 0.05). SACF-HIV mean fit scores varied by intervention and the difference was statistically significant (2.78 vs. 2.53, p < 0.05).ConclusionsThere are relatively few tools assessing perceptions of contextual fit in HIV clinical settings. These results suggest the 12-item adapted SACF is a reliable, valid global assessment of perceptions of contextual fit and implementation support. The SACF-HIV can be used by practitioners and researchers interested in understanding an implementation context when planning to prepare and support EBP implementation.Trial registrationTMI ClinicalTrials.gov NCT03681912; YMPH ClinicalTrials.gov NCT03488914

Implementation of a Treatment Program for Individuals Imprisoned for Sex Offenses in Uruguay: Achievements, Problems and Challenges.

Treatment for individuals convicted of sex offenses has substantially improved in developed countries in recent decades, providing practitioners with an extensive literature to guide the implementation of effective programs to reduce sexual reoffending. Nevertheless, sexual offending rehabilitation is still in its infancy in Latin American countries such as Uruguay, so little is known about the transference and implementation of evidence-based programs. The current study examines the strengths, barriers, and challenges of implementing a sex offenses treatment program in Uruguay. The findings suggest some achievements of the program, but also several problems with implementation. Some problems are universal among different countries (e.g., scarce resources and facilities, insufficiently trained staff, and unexpected changes in the organization), but others were particularly relevant in the Uruguayan context (e.g., government policy alien to a rehabilitation approach, lack of appropriate prison facilities, lack of training for therapists from a cognitive-behavioral perspective). All these difficulties must be anticipated and solved for successful generalizability of rehabilitation programs to different correctional systems.

United for health to improve urban food environments across five underserved communities: a cross-sector coalition approach

BackgroundCross-sector coalitions can be a powerful vehicle to promote adoption and implementation of evidence-based programs and policies across diverse racial/ethnic communities with a high chronic disease burden. Few studies have examined coalition composition, function, or capacity to promote learning among members.MethodsWe used a mixed methods approach to examine the United for Health coalition’s implementation of multiple food environment interventions across five low-income communities of color in Los Angeles, California (USA). At the coalition-level, key measures included the collaborative environment, membership characteristics, process and structure, communication, resources, strengths, challenges/barriers, and community impact. At the organizational- and individual-levels, we collected data on participation, leadership development, intraorganizational change, perceived benefits, and learning outcomes.FindingsOverall, the United for Health coalition produced five community gardens, three pop-up produce markets, and one farmers’ market; members also expanded Electronic Benefits Transfer (EBT) access at three existing farmers’ markets. Findings indicate early coalition strengths included having a mutual purpose, which was maintained throughout the study period. Coalition participation and engagement was consistently high, while coalition and inter-organizational communication improved over time. Strengths were membership diversity and the availability of learning opportunities. Benefits included leadership development and strategic alignment across organizations. Members demonstrated an increased awareness of the importance of culturally adapted interventions and knowledge of community health planning topics. Key implementation challenges were a lack of resources and social context barriers.ConclusionsExamining coalition function and maturation in a real-world context reveals important lessons for scholars and practitioners committed to addressing nutrition-related health disparities in marginalized and historically underserved communities. Future work should investigate the sustainability of externally funded cross-sector coalitions after funding ceases.

Mental Health Promotion in Adolescents

The number of adolescents with mental disorders is becoming a worldwide problem, since it has an influence not only on the health of this generation while they are still in this age group but also on their health as adults. The objective of this review aimed to focus on mental health problem and health promotion program among adolescents. The significance of mental health promotion and intervention programs in enhancing adolescents’ well-being and reducing mental health problems is highlighted in this study. There is an opportunity to apply a whole-school strategy with online curriculums. In the digital era, smartphone applications, social networking sites, and the Internet play an important role in daily life, there is an opportunity to develop a mental health promotion program. In addition, through the implementation of evidence-based programs, schools have been placed at the frontline of promoting positive mental health and well-being. The recommended intervention programs can be implemented in a variety of settings, including schools and communities, as well as through digital platforms. Therefore, adolescents’ mental health problems can be mitigated by using effective mental health promotion programs.