Involving Community Stakeholders Research Articles

Human-centered participatory co-design with children and adults for a prototype lifestyle intervention and implementation strategy in a rural middle school

PurposeThe significance of regular physical activity (PA) in reducing cardiovascular disease (CVD) risk is widely acknowledged. However, children in rural areas encounter specific barriers to PA compared to their urban counterparts. This study employs human-centered participatory co-design, involving community stakeholders in developing a multi-level PA intervention named Hoosier Sport. The primary hypothesis is the co-design sessions leading to the development of a testable intervention protocol.MethodsTwo co-design teams, each consisting of six children and six adults, were formed using human-centered participatory co-design facilitated by research faculty and graduate students. The process involved five co-design sessions addressing problem identification, solution generation, solution evaluation, operationalization, and prototype evaluation. Thematic analysis was employed to identify key themes and intervention components.ResultsChild co-designers (n = 6) ranged from 6th to 8th grade, averaging 12.6 years (SD = 1.8), while adult co-designers (n = 6) averaged 43.3 years (SD = 8.08). Thematic analysis revealed children emphasizing autonomy, the freedom to choose physical and non-physical activities, and the importance of building peer relationships during PA. Adult interviews echoed the importance of autonomy and choice in activities, with a focus on relatedness through positive role modeling.ConclusionThe prototype intervention and implementation strategies developed constitute a testable intervention aligned with Phase 1 of the ORBIT model. This testable prototype lays the groundwork for a collaborative campus-community partnership between the university and the local community, ensuring mutual benefits and sustainable impact.

Equity considerations in mental health diversion in California

Mental health diversion under California Assembly Bill (AB) 1810 created a pretrial pathway for individuals to enroll in community-based treatment as an alternative to incarceration if they have a mental illness that played a significant role in the crime for which they were charged. Mental health diversion may be a promising approach to addressing racial disparities in incarceration. This qualitative, community-partnered study examines how racial equity was considered in the design and implementation of mental health diversion under AB 1810 in nine counties across California. We explored five main themes: involvement of community stakeholders; cultural competence of providers; availability of diversion across counties; efforts to monitor demographics; and diversion as an opportunity to address racial disparities in the criminal legal system. We found that, although many legal professionals are optimistic about the capacity of mental health diversion to address racial disparities in incarceration, there have been limited efforts to monitor the demographics of diversion participants, differing understandings of cultural competency, limited community involvement in the design of mental health diversion, and limitations to the availability of services for individuals enrolled in diversion programs.

Tande nou gwonde! (Hear us roar!)- Youth perspectives of maternal near-misses: Protocol for a photovoice study of young childbearing people's perspectives of maternal near-misses in northwest Haiti.

Globally, a shift is occurring to recognize the importance of young peoples' health and well-being, their unique health challenges, and the potential they hold as key drivers of change in their communities. In Haiti, one of the four leading causes of death for those 20-24 years old is pregnancy, childbirth, and the weeks after birth or at the end of a pregnancy. Important gaps remain in existing knowledge about youth perspectives of maternal health and well-being within their communities. Youth with lived experiences of maternal near-misses are well-positioned to contribute to the understanding of maternal health in their communities and their potential role in bringing about change. To explore and understand youth perspectives of maternal near-miss experiences that occurred in a local healthcare facility or at home in rural Haiti. We will conduct a qualitative, community-based participatory research study regarding maternal near-miss experiences to understand current challenges and identify solutions to improve community maternal health, specifically focused on youth maternal health. We will use Photovoice to seek an understanding of the lived experiences of youth maternal near-miss survivors. Participants will be from La Pointe, a Haitian community served by their local healthcare facility. We will undertake purposeful sampling to recruit approximately 20 female youth, aged 15-24 years. Data will be generated through photos, individual interviews and small group discussions (grouped by setting of near-miss experience). Data generation and analysis are expected to occur over a three-month period. Ethics approval will be sought from Centre Médical Béraca in La Pointe, Haiti, and from the Hamilton Integrated Research Ethics Board in Hamilton ON, Canada. We will involve community stakeholders, especially youth, in developing dissemination and knowledge mobilisation strategies. Our findings will be disseminated as an open access publication, be presented publicly, at conferences, and defended as part of a doctoral thesis.

Critical health literacy: conceptualization and settings-based development

Abstract Background Health literacy is conceptualized as a continuum of social practices spanning functional, interactive and critical domains. Critical health literacy enables individuals and communities to reflect on the wider health determinants and engage in social and political processes towards health equity. This project introduces the Oxford Bibliographies (OB) entry and illustrates through an empirical case study of critical health literacy in a community-based setting. Methods The OB entry provides a literature review of critical health literacy conceptualization, measurement and interventions. An institutional ethnography of critical health literacy in libraries, models a settings-based approach to critical health literacy development in children. Results Barriers to critical health literacy development include the lack of validated instruments and evaluation of interventions. Common settings for development with children are schools, but institutional settings face challenges in developing the political action element of critical health literacy. There is a need to move beyond single settings to consider multiple settings working in partnership where children can learn, live, and play. A coordinated supersetting approach leverages the strengths of different settings to promote critical health literacy. A model proposes four antecedents to a supersetting in which sub-settings collectively support (1) a determinants-based perspective, (2) open access to information and resources, (3) involvement of community stakeholders and (4) informed action on health. Conclusions Although conceptualized over two decades ago, it is only recently that research on critical health literacy has normalized the consolidation of both its cognitive and social dimensions into a joint strategy of critical thinking and empowerment. A supersetting approach can combine community-based and school-based support to embed critical health literacy development opportunities early in the life course.

Research and scholarly methods: Community‐engaged research

AbstractCommunity‐engaged research (CER) is a collaborative approach used by health services researchers to integrate the voice of community stakeholders in research design to increase the relevance and impact of research in advancing health outcomes. CER is guided by principles such as leveraging strengths and resources of a community, ensuring research is mutually beneficial for all partners, facilitating co‐learning among all partners, disseminating findings to all partners, and committing long term to a community. The level of community engagement can range on a continuum from outreach, consultations, and community‐academic partnerships to community‐based participatory research depending on the type and extent of community stakeholder involvement. Given pharmacists' accessibility to the public and role as the medication expert across the health care continuum, pharmacist researchers can use CER to authentically engage communities to better understand medication‐related needs and design community‐informed interventions to optimize medication outcomes. The purpose of this paper is to provide a practical overview of CER for pharmacist researchers by: (1) introducing the CER continuum and describing how CER principles can be used before, during, and after a study, (2) describing practical considerations for conducting CER, and (3) discussing two examples of CER in improving medication‐related outcomes in health services research.

Toward Community-Based Natural Language Processing (CBNLP): Cocreating With Communities.

Rapid development and adoption of natural language processing (NLP) techniques has led to a multitude of exciting and innovative societal and health care applications. These advancements have also generated concerns around perpetuation of historical injustices and that these tools lack cultural considerations. While traditional health care NLP techniques typically include clinical subject matter experts to extract health information or aid in interpretation, few NLP tools involve community stakeholders with lived experiences. In this perspective paper, we draw upon the field of community-based participatory research, which gathers input from community members for development of public health interventions, to identify and examine ways to equitably involve communities in developing health care NLP tools. To realize the potential of community-based NLP (CBNLP), research and development teams must thoughtfully consider mechanisms and resources needed to effectively collaborate with community members for maximal societal and ethical impact of NLP-based tools.

The role of community-based approaches in achieving universal health coverage: addressing the Nigerian narrative.

Universal health coverage (UHC) is aimed at ensuring that individuals and communities have affordable access to essential health care services without facing financial hardship. Achieving UHC and the third sustainable development goal of the United Nations requires that health systems transition from a vertical, top-down, curative approach toward one that puts people at the core of health care services, such as community-centered health interventions. Nigeria operates a decentralized health care system with the least focus on primary health care, making access to quality, and affordable health care for several citizens a challenge as the major percentage of the Nigerian population relies on primary health care services. The limited number of health care workers, the poor economic state, the inadequate health financing structures and high illiteracy rates have led to challenges such as low health service availability, hesitancy to utilize health interventions, high out-of-pocket expenditure rates, and health misinformation. These can be effectively tackled at the community level by revamping primary health care services, adequate and sustainable health financing, establishing Ward Development Committees, and the involvement of community stakeholders in health policy implementation. Employing such community-based approaches will ensure continuous progress of the Nigerian health care system toward UHC.

Abstract 714: Using empathy-driven instructional design to reimagine cancer research

Abstract Following the advent of groups like PCORI, patient engagement in clinical research is no longer a novel concept. However, involvement of lay stakeholders in areas such as artificial intelligence or biomedical informatics can pose challenges. Community stakeholder involvement in cancer research can prove especially challenging as cancer has personally impacted nearly everyone. The purpose of this study was to assess whether addressing needs outlined in the Self-Determination Theory (SDT) helped community stakeholders feel prepared for this role. The University of Florida (UF) health science center employs Citizen Scientists (CSs) as partners in the research process to offer insight otherwise unavailable to researchers. To prepare for this role, CSs complete an online curriculum, co-created by their peers and UF researchers, to educate them about clinical research. The UF Health Cancer Center created the CS Cancer Curriculum (CSCC) as a companion piece to the clinical research course. To create the CSCC, researchers, administrators, and CSs and participated in a needs assessment to identify common interests. Through this needs assessment, the research team found that each CS had personal connections to cancer and the team felt an empathic approach to the course design was necessary to respect these experiences. The SDT and reflective questions were applied throughout the course. Storytelling was used to present a multipart case study series with a patient, family members, and physician. Those videos were accompanied by a note that the story may cause the viewer to recall their own painful experiences. The note then prompted viewers to review resources from the National Cancer Institute support services page if needed. All but two of the nine CSs scored a 95% or higher across all questions in the CSCC. Overall course assessments included a pre/posttest and a case study assessment based on the SDT. Relatedness (100%) and autonomy (83%) were the highest construct scores of the case study assessment, indicating that CSs felt most empowered in their role once they had more of an emotional connection to the subject matter. For the pre/posttests, confidence in their ability to learn and apply the content to their work grew slightly (79% to 80%). However, scores for the “Capable” construct rose by several percentage points. At the pretest, 81% felt they were capable of learning the content and, at the posttest, 86% felt that they were capable of applying the content. Taking the time to ensure that the psychological needs of learners are met can result in committed, engaged research partners who can provide pragmatic feedback and have long-lasting effects on cancer research. The CSs in this study were passionate about this work, despite the intimidating jargon and dense concepts used in this field. They are an excellent example of how impactful community stakeholders can be if researchers can meet them where they are. Citation Format: Janet Brishke, Zachary Jones, Elizabeth A. Shenkman. Using empathy-driven instructional design to reimagine cancer research [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 714.

Gender and leadership positions: understanding women's experiences and challenges in patriarchal societies in Northern Ghana

PurposeWomen are rarely seen in positions of leadership in patriarchal societies, which is unsurprising. Following gender equity policies, few women have been able to break through the gender equity barrier and assume leadership positions in schools. Few research investigations have delved into the experiences and challenges that women encounter in positions of leadership in patriarchal societies in government schools in Northern Ghana. The study seeks to comprehend the experiences and challenges that women confront in positions of leadership in patriarchal societies in Northern Ghana.Design/methodology/approachThe study aimed to gain a better understanding of the experiences and challenges that women encounter in educational leadership roles in patriarchal societies in Northern Ghana. To achieve the study's objectives, a quantitative research approach and a social survey design were used, as well as descriptive and inferential statistics.FindingsThe findings of the study revealed that in patriarchal societies in Northern Ghana, women experience conventional gender roles that conflict with roles, cultural values, gender stereotyping, family responsibilities and cultural beliefs and perceptions of women and attitudes and low expectations of women's managerial skills discourage women from taking on leadership positions in men-dominated societies.Research limitations/implicationsThere is a need to shift the gender position and question the negative cultural convictions of cultural and patriarchal societies. Equal opportunities for men and women necessitate equal access to leadership positions. It proposes that in patriarchal societies, education and community stakeholder involvement in leadership training programmes for women be considered, as policy documents alone would not be sufficient to eradicate deeply embedded cultural social practices and dispel negative notions about women in leadership positions in men-dominated societies.Originality/valueThe study established that in patriarchal societies, women experienced conventional gender roles that conflict with roles, cultural values, gender stereotyping, family responsibilities, cultural vulnerability of women and the interplay between cultural expected roles and management goals influence women from taking on leadership positions.

How Zambia reduced inequalities in under-five mortality rates over the last two decades: a mixed-methods study

BackgroundZambia experienced a major decline in under-five mortality rates (U5MR), with one of the fastest declines in socio-economic disparities in sub-Saharan Africa in the last two decades. We aimed to understand the extent to which, and how, Zambia has reduced socio-economic inequalities in U5MR since 2000.MethodsUsing nationally-representative data from Zambia Demographic Health Surveys (2001/2, 2007, 2013/14 and 2018), we examined trends and levels of inequalities in under-five mortality, intervention coverage, household water and sanitation, and fertility. This analysis was integrated with an in-depth review of key policy and program documents relevant to improving child survival in Zambia between 1990 and 2020.ResultsThe under-five mortality rate (U5MR) declined from 168 to 64 deaths per 1000 live births between 2001/2 and 2018 ZDHS rounds, particularly in the post-neonatal period. There were major reductions in U5MR inequalities between wealth, education and urban–rural residence groups. Yet reduced gaps between wealth groups in estimated absolute income or education levels did not simultaneously occur. Inequalities reduced markedly for coverage of reproductive, maternal, newborn and child health (RMNCH), malaria and human immunodeficiency virus interventions, but less so for water or sanitation and fertility levels.Several policy and health systems drivers were identified for reducing RMNCH inequalities: policy commitment to equity in RMNCH; financing with a focus on disadvantaged groups; multisectoral partnerships and horizontal programming; expansion of infrastructure and human resources for health; and involvement of community stakeholders and service providers.ConclusionZambia’s major progress in reducing inequalities in child survival between the poorest and richest people appeared to be notably driven by government policies and programs that centrally valued equity, despite ongoing gaps in absolute income and education levels. Future work should focus on sustaining these gains, while targeting families that have been left behind to achieve the sustainable development goal targets.

Cost and community acceptability of enhanced antibiotic distribution approaches for trachoma in the Republic of South Sudan: enhancing the A in SAFE (ETAS) study protocol

BackgroundThe World Health Organization targeted trachoma for global elimination as a public health problem by 2030. Reaching elimination thresholds by the year 2030 in the Republic of South Sudan will be a considerable challenge, as the country currently has many counties considered hyper-endemic (> 30% trachomatous inflammation-follicular [TF]) that have yet to receive interventions. Evidence from randomized trials, modeling, and population-based surveys suggests that enhancements may be needed to the standard-of-care annual mass drug administration (MDA) to reach elimination thresholds in a timely manner within highly endemic areas. We describe a protocol for a study to determine the cost and community acceptability of enhanced antibiotic strategies for trachoma in South Sudan.MethodsThe Enhancing the A in SAFE (ETAS) study is a community randomized intervention costing and community acceptability study. Following a population-based trachoma prevalence survey in 1 county, 30 communities will be randomized 1:1 to receive 1 of 2 enhanced MDA interventions, with the remaining communities receiving standard-of-care annual MDA. The first intervention strategy will consist of a community-wide MDA followed by 2 rounds of targeted treatment to children ages 6 months to 9 years, 2 weeks and 4 weeks after the community MDA. The second strategy will consist of a community-wide biannual MDA approximately 6 to 8 months apart. The costing analysis will use a payer perspective and identify the total cost of the enhanced interventions and annual MDA. Community acceptability will be assessed through MDA coverage monitoring and mixed-methods research involving community stakeholders. A second trachoma-specific survey will be conducted 12 months following the original survey.DiscussionETAS has received ethical clearance and is expected to be conducted between 2022 and 2023. Results will be shared through subsequent manuscripts. The study’s results will provide information to trachoma programs on whether enhanced interventions are affordable and acceptable to communities. These results will further help in the design of future trachoma-specific antibiotic efficacy trials. Enhanced MDA approaches could help countries recover from delays caused by conflict or humanitarian emergencies and could also assist countries such as South Sudan in reaching trachoma elimination as a public health problem by 2030.Trial registrationThis trial was registered on December 1st, 2022 (clinicaltrails.org: NCT05634759).

Graduate Medical Education Training and the Health of Indigenous Peoples.

Graduate Medical Education Training and the Health of Indigenous Peoples.

Community-engaged learning to broaden the impact of applied ecology: A case study.

Ecological changes are creating disruptions that often disproportionately impact communities of color and economically disadvantaged areas. Scientists who study the consequences experienced by these communities are uniquely suited to bring the public into their work as a way of setting conditions that enable impacted residents to empower themselves to advance environmental and community change. In addition to involving community stakeholders in the process of science, community science can be used to motivate learning and increase engagement of students. Here we highlight a case study of one way a historically Black college involved local communities and students in water quality monitoring efforts to examine the role of the environment in human health. Students in an introductory-level environmental toxicology course collaborated with community members to track pollution and monitor conditions in an urban, impaired stream. Students participated in bi-monthly water quality monitoring alongside community watershed researchers and an annual day-long multisite sampling event with community residents and organizations. Through this engagement, students and community members contributed to the collection of data, learned about the significance of their results, and translated findings into strategies to advance watershed restoration, health, quality of life, and environmental justice goals.

Provincial government agency public services: An analysis of their internal competency, internal and external environment factors

Public services (PS) in modern societies have become increasingly difficult to keep up with, creating a strain on governments with limited budgets. As a result, new ways of delivering public value must be sought. In order to better understand the factors that influence public services of the Thai provincial government agency public services (PGAPS), the authors conducted a stratified random sample survey of 400 individuals in a rural province of Northern Thailand in 2021. The latent variable path analysis used LISREL 9.10, with the results showing that internal competency factors (ICF) were ranked as very strong, external environment factors (EEF) as strong, and internal environment factors (IEF) as weak. All four hypotheses were also supported, with an individual’s personal and educational factors having a significant effect on PGAPS. The authors suggest that gender could be used to limit corruption’s influence and should be explored in greater detail in further studies. Effective PS delivery requires good governance, community stakeholder involvement, and cross-organizational collective leadership. Good governance should also enhance economic, social, and political development values. Additionally, this study provides valuable insights for municipalities to improve their implementation processes, increase transparency, and ensure fiscal responsibility (OECD & ADB, 2019).

HUMAN CENTERED DESIGN TO DEVELOP A LGBTQ+ COMMUNITY ADVISORY BOARD FOR SKILLED NURSING FACILITIES

Abstract Lesbian, gay, bisexual, transgender, queer (LGBTQ+) adults will require inclusive skilled nursing care as they age, but there is a paucity in LGBTQ+ specific training resources for skilled nursing facility (SNF) healthcare workers. Development of community advisory boards is becoming common in research studies as funders place emphasis on stakeholder engagement, but how advisory boards are created with community member involvement at the onset remains less clear. This presentation describes the creation of a community advisory board of LGBTQ+ community members, community organizations, and SNF administrators that work together to develop LGBTQ+ resources for 25 SNFs. Advisory board members were identified using a design thinking framework and the Field Guide to Human-Centered Design. Potential board members were identified through networking with community-based organizations, existing relationships with SNFs, and by word of mouth. The advisory board consists of 3 LGBTQ+ adults, 4 SNF administrators, 1 AARP community outreach and advocacy associate director, 1 advocacy coordinator for LGBTQ+ older adults, 1 SNF physician liaison, and 1 nurse scientist. To gain buy-in, individual interviews and focus groups with potential advisory board members were conducted. Meetings provided an opportunity to describe project goals and how potential member’s expertise would guide development of resources. LGBTQ+ adult community members received compensation for their participation. The advisory board is meeting monthly and approaching the design phase. Community stakeholder involvement in early stages of development will help ensure that LGBTQ+ resources are relevant and applicable to enhance health and well-being of LGBTQ+ older adults in the future.

OPPORTUNITIES AND OUTCOMES OF CENTERING OLDER ADULTS IN PATIENT-ORIENTED AND COMMUNITY-ENGAGED RESEARCH

Abstract Community engagement is critical for achieving context-sensitive and culturally appropriate communication, implementation and research approaches that can lead to better public and patient health outcomes. Though patient and community-engaged approaches are increasingly utilized in social research, the inclusion of older adults remains limited, as are methodologies that will help inform adult-centric programs and interventions. To advance the science of community engagement and implementation, this symposium brings together methodological innovations to help researchers shift from involving older adults as participants in research, toward collaboratively engaging and partnering with older adults in the design and conduct of research. The first presentation centers on place-based health disparities by starting with a statewide survey to identify communities that researchers could engage. The second highlights how the involvement of older adults led to the development of tactics for connecting with the hardly-reached, people over the age of 75, with health enhancing services and support. The third discusses a model for greater involvement of older adults to draw out lessons for implementation science in long-term care. The final presentation demonstrates an innovative approach to pilot new solutions with multidisciplinary and community partners in clinical settings. This CEnR and PPER interest group collaborative symposium concludes by imagining ways to integrate the diverse perspectives to advance the science of engaged research and implementation in community and clinical settings. This symposium represents diverse perspectives on involving community stakeholders meaningfully and equitably with research, to bend the later life health equity arc toward greater inclusion and justice.

ENGAGING OLDER ADULTS AND STAKEHOLDERS TO DEVELOP A COMMUNITY MASTER AGING PLAN: A CASE EXAMPLE

Abstract As our population ages, communities are creating policies and programs to support older adults. Yet, there is a lack of input from older adults about which policies and programs meet their needs. This case example describes how one community in North Carolina (NC) engaged community stakeholders (older adults and organizational leaders) in all phases of their Master Aging Plan (MAP). Community stakeholders participated in a community assessment through surveys (n=860), focus groups (n=13, 63 participants), key stakeholder interviews (n=34), and two community-wide listening sessions. Organized by the WHO’s age-friendly framework domains, community stakeholders formed workgroups to create, implement, and track the MAP. An evaluation was completed using the tracking documents, ripple effect mapping, and workgroup leader interviews. Orange County, NC’s experience with collaborative community engagement can serve as a guide for other communities seeking to involve community stakeholders in the development and evaluation of their own MA

A systematic review of community stakeholder involvement during application of the ADAPT-ITT model to adapt trauma interventions for new populations.

Adapting evidence-based interventions for new populations and involving community stakeholders in the adaptation process is important for improving the dissemination and efficacy of interventions aimed to prevent trauma or prevent/treat problems among trauma survivors. Yet, little is known about community stakeholders' involvement during the adaptation process. This systematic review aims to do the following: (a) identify studies applying the ADAPT-ITT model to adapt interventions for preventing trauma or preventing/treating problems among trauma survivors, (b) examine both the presence/absence of community stakeholders' involvement, and (c) identify innovative community stakeholder involvement during application of this model. Six databases were searched for related studies. Data was extracted about community stakeholders' involvement during specific phases of the ADAPT-ITT model that allowed for greater community stakeholder involvement. One phase involves stakeholders providing suggested intervention modifications during what is called a "theater test." Thirty-two studies that described the adaptation of 19 interventions were identified. Most studies involved community stakeholders during the needs assessment and theater tests (83%). Few studies described community stakeholders as sharing decision making about which intervention to use for the new population (18%). Approximately half (44-50%) reported community stakeholders either received training on the adapted intervention or facilitated the adapted interventions during testing phase. Innovative strategies included using community stakeholder advisory boards to guide intervention selection and modifications. Findings suggest the need for improving community stakeholder involvement throughout the application of the ADAPT-ITT model to advance trauma science and provide examples of innovative strategies for doing so. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Outcomes of children involved with child protection in Manitoba, Canada: a demonstration project for working in partnership across government, community organizations, and academia.

ObjectivesSPECTRUM is a unique multi-disciplinary, cross-sector collaborative research partnership between academics, government, and community organizations in Manitoba working together to address complex social problems. In our first research project, partners identified the need for quantitative evidence around outcomes of children involved with Child Protection Services (CPS), using linked administrative data.
 ApproachFrom the SPECTRUM partnership, a research team with CPS expertise was established, including government policy-makers, community organizations representing First Nations families, and academics from multiple disciplines. The research is guided by an Advisory Circle of First Nations Knowledge Keepers. Linking health, education, CPS, and justice data we developed a matched cohort identifying children involved with CPS (2007-2018) for whom there was discretion in the decision to 1) place them in out-of-home care (n=19,718), or 2) keep them in their family home while providing services (n=28,154). Instrumental Variable analysis, with CPS agency as the instrument, will be used to compare outcomes.
 ResultsFollowing the trajectories of these two groups of CPS-involved children over time, we will compare their mental and physical health, educational achievement, and justice system involvement while accounting for individual-level (e.g., age, sex, chronic health conditions) and family-level (e.g., family income, maternal mental health, number of siblings) factors that may contribute to these outcomes. Preliminary findings will be workshopped with the SPECTRUM partnership to facilitate discussions on framing the evidence for policy makers. The SPECTRUM policy team will then prepare policy recommendations for government to consider. The Advisory Circle and a youth advisory squad will facilitate contextualizing and mobilizing findings. Actions taken by government in response to material provided will be monitored and will inform the development of subsequent research projects conducted by SPECTRUM.
 ConclusionGovernment and community stakeholder involvement throughout bolsters the likelihood of evidence translating into program and policy changes. This is not a situation where academics are telling government how to do their jobs – this is government, community organizations, and academics working together with the shared goal of better outcomes for children.

From Procurement to Consumption: A Model to Understand Nutrition Policy Implementation in Permanent Supportive Housing

Background: Food insecurity has become an increasingly complex public health issue across the United States, particularly among various people battling with current or previous homelessness. This project sought to understand the food system in permanent supportive housing sites (PSH) that serve formerly homeless individuals and to explore the use of nutrition standards, specifically the Food Service Guidelines for Federal Facilities (FSGFFs), in this context. Methods: Participants were members of the administrative staff involved in the food procurement process, food preparation, administrative tasks, and daily operations in a small-intensive program managed by a local nonprofit agency that serves 12 adults over the age of 18 who experience chronic homelessness and persistent mental illness, or substance use disorders, and a second PSH site that helps 41 low-income adults with health conditions experiencing homelessness. The PSH Inquiry Tool (PSH-IT) was developed to better understand the business operations at each site, and the PSH Audit (PSH-A) was created to assess the applicability of FSGFF at each site. Results: Findings suggest that funding mechanisms, staff training, staff capacity, and access to nutrition education were critical barriers to the successful development and implementation of nutrition standards in PSH sites. Furthermore, findings suggest that adaptations to FSGFFs are required before implementation at PSH sites. Conclusion: This report advocates for increased involvement of community stakeholders to support nutrition policy development and implementation, a nutrition policy that impacts all levels of the food system from procurement to consumption, and local, state, or federal policy changes to support improved nutrition in PSH.