Primary Partnerships Research Articles

Assessing a Couples-Based, Digital HIV Serostatus-Neutral Intervention (Para Ti, Para Mí, Para Nosotros) for Adult Cisgender Sexual Minority Male Couples in Lima, Peru: Protocol for a 6-Month Pilot Randomized Controlled Trial.

HIV disproportionately affects sexual minority men (SMM; eg, gay, bisexual, and other men who have sex with men) in Lima, Peru; epidemiological data estimate that 32% to 39% of new HIV infections occur among adult cisgender SMM within primary partnerships (ie, male couples). Most HIV prevention-care research in Lima, Peru, has focused on SMM as individuals and not couples. To help address this critical gap in prevention care, we developed Para Ti, Para Mí, Para Nosotros (P3): a couples-based, digital HIV serostatus-neutral intervention (DHI) for adult cisgender SMM couples in Lima, Peru. The P3 DHI is designed to facilitate couples with skill-building, communication, decision-making, and working together to form and adhere to a detailed prevention care plan that aligns with their explicit sexual agreement. The P3 DHI is theoretically informed, self-guided, directed, sequential, and fully automated. This pilot randomized controlled trial (RCT) aims to examine the preliminary effects of P3 on couples' formation and adherence to a detailed prevention care plan containing evidence-based strategies that also aligns with their explicit sexual agreement over time. In addition, the feasibility of enrollment and retention and couples' acceptability of P3 will be assessed. The research implements a prospective, 6-month pilot RCT with a 3-month delayed control condition. After baseline, 60 enrolled SMM couples will be randomized to 1 of 2 conditions. Couples randomized to the unmatched, delayed control condition will receive access to the P3 DHI to use during the last 3 months of the trial after the 3-month assessment. Couples randomized to the immediate intervention condition will immediately receive access to the P3 DHI for 6 months. Study assessments will occur at baseline and months 3 and 6. Descriptive, comparative, qualitative, and longitudinal analyses using generalized linear mixed-effect, multilevel, and actor-partner interdependence models will be conducted to address the specific aims. The 6-month pilot RCT is ongoing. Recruitment, enrollment, and data collection began in January 2023 and ended in April 2024. A total of 74 adult cisgender SMM couples met all inclusion criteria, provided consent, and were enrolled in the pilot RCT. Retention was 92% (68/74) at month 6. Data are currently being analyzed to address the 3 specific aims regarding feasibility, acceptability, and preliminary efficacy. Findings from this research will reveal whether couples deemed the P3 DHI to be acceptable. Findings will also highlight the preliminary efficacy of the P3 DHI on couples managing their vulnerability to HIV and other sexually transmitted infections (STIs) over time via alignment of their prevention-care plan and sexual agreement. Trial findings will help shape the future direction of the P3 DHI while addressing the existing gap in prevention and care services for couples in the local context. ClinicalTrials.gov NCT05873855; https://clinicaltrials.gov/study/NCT05873855. DERR1-10.2196/63106.

A Qualitative Analysis of a Primary Care Medical-Legal Partnership: Impact, Barriers, and Facilitators.

Certain health-related risk factors require legal interventions. Medical-legal partnerships (MLPs) are collaborations between clinics and lawyers that address these health-harming legal needs (HHLNs) and have been shown to improve health and reduce utilization. The objective of this study is to explore the impact, barriers, and facilitators of MLP implementation in primary care clinics. A qualitative design using a semistructured interview assessed the perceived impact, barriers, and facilitators of an MLP, among clinicians, clinic and MLP staff, and clinic patients. Open AI software (otter.ai) was used to transcribe interviews, and NVivo was used to code the data. Braun & Clarke's framework was used to identify themes and subthemes. Sixteen (n = 16) participants were included in this study. Most respondents were women (81%) and white (56%). Four respondents were clinic staff, and 4 were MLP staff while 8 were clinic patients. Several primary themes emerged including: Patients experienced legal issues that were pernicious, pervasive, and complex; through trusting relationships, the MLP was able to improve health and resolve legal issues, for some; mistrust, communication gaps, and inconsistent staffing limited the impact of the MLP; and, the MLP identified coordination and communication strategies to enhance trust and amplify its impact. HHLNs can have a significant, negative impact on the physical and mental health of patients. Respondents perceived that MLPs improved health and resolved these needs, for some. Despite perceived successes, integration between the clinical and legal organizations was elusive.

Missing link: a qualitative analysis of community-based organisations’ contributions to partnered collaborative care to treat late-life depression

ObjectiveExtending collaborative care, a model integrating mental health services into primary care, to include community-based organisations (CBOs) may improve older patient health outcomes by increasing access to care and addressing...

Preparedness, impacts, and responses of public health emergencies towards health security: qualitative synthesis of evidence

BackgroundNatural and human-made public health emergencies (PHEs), such as armed conflicts, floods, and disease outbreaks, influence health systems including interruption of delivery and utilization of health services, and increased health service needs. However, the intensity and types of impacts of these PHEs vary across countries due to several associated factors. This scoping review aimed to synthesise available evidence on PHEs, their preparedness, impacts, and responses.MethodsWe conducted a scoping review of published evidence. Studies were identified using search terms related to two concepts: health security and primary health care. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines to select studies. We adapted the review framework of Arksey and O’Malley. Data were analyzed using a thematic analysis approach and explained under three stages of PHEs: preparedness, impacts, and responses.ResultsA total of 64 studies were included in this review. Health systems of many low- and middle-income countries had inadequate preparedness to absorb the shocks of PHEs, limited surveillance, and monitoring of risks. Health systems have been overburdened with interrupted health services, increased need for health services, poor health resilience, and health inequities. Strategies of response to the impact of PHEs included integrated services such as public health and primary care, communication and partnership across sectors, use of digital tools, multisectoral coordination and actions, system approach to responses, multidisciplinary providers, and planning for resilient health systems.ConclusionsPublic health emergencies have high impacts in countries with weak health systems, inadequate preparedness, and inadequate surveillance mechanisms. Better health system preparedness is required to absorb the impact, respond to the consequences, and adapt for future PHEs. Some potential response strategies could be ensuring need-based health services, monitoring and surveillance of post-emergency outbreaks, and multisectoral actions to engage sectors to address the collateral impacts of PHEs. Mitigation strategies for future PHEs could include risk assessment, disaster preparedness, and setting digital alarm systems for monitoring and surveillance.

Understanding Dynamics Dating Infidelity: Behaviors, Motivations, and Implications for Relationship Well-being

This research delves into the intricate dynamics of dating infidelity within the context of modern romantic relationships. By examining behaviors, motivations, consequences, challenges, and treatment interventions related to dating infidelity, this study offers a comprehensive exploration of this complex phenomenon. The findings reveal a spectrum of behaviors, ranging from emotional connections facilitated by technology to seeking sexual novelty and exploring relationships outside of primary partnerships. Motivational factors, including emotional fulfillment, sexual exploration, and dissatisfaction within the current relationship, emerge as key drivers of dating infidelity. The implications of infidelity extend beyond individuals, impacting relationship well-being and household welfare. Challenges such as communication breakdowns and unrealistic expectations hinder effective relationship dynamics. Treatment interventions, such as couples therapy, communication training, and strategies for rebuilding trust, provide a roadmap for addressing infidelity and promoting healing. This research enriches relationship science by offering insights into the evolving landscape of modern romantic connections and underscores the importance of open dialogue and communication to foster healthier and more resilient relationships.

Letter to Readers

New SpaceVol. 10, No. 3 EditorialFree AccessLetter to ReadersKen DavidianKen DavidianEditorially yours, Ken Davidian, PhD, Editor-in-Chief, New Space E-mail Address: newspace.eic@gmail.comSearch for more papers by this authorPublished Online:13 Sep 2022https://doi.org/10.1089/space.2022.29044.kdAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Dear New Space Readers,New Space is dynamic, and I want to tell you about two important dimensions of change I am very excited about: size (of publication) and organizational partnerships.Regarding publication size, New Space is currently bursting at the seams with publishable content and our original allotment of printed pages per volume became constraining. The past two issues of New Space were phenomenal special issues focusing on the new space movement in India and In Situ Research Utilization (guest edited by Dr Narayan Prasad and Dr Kevin Cannon, respectively). Both issues were larger than average so our remaining issues for 2022 will be smaller than average (thereby respecting the economic constraint of page limits set by our publisher).While putting together these two special issues, New Space accumulated a backlog of article to publish in print. All submissions are published online as soon as they pass their reviews and are accepted. We appreciate the patience shown by the authors with the amount of time required to get them in hardcopy. The bright side of this backlog is that it factored into the publisher's decision to increase the number of printed pages per year allotted to our publication. New Space is growing in pages of printed material in the following way: From 4 issues at 64 pages each for a total of 256 pages in Volumes 1–9 (2013–2021),now currently at 4 issues at 84 pages each for a total of 336 pages for Volume 10 (2022),to 6 issues at 56 pages each for a total of 336 pages starting with Volume 11 (2023).Even as our physical growth is obvious and exciting, even more exciting (and dynamic) the second dimension of change I would like to highlight, the push to increase the number of organizational partnerships. Unfortunately, our primary partnership with the FAA Center of Excellence for Commercial Space Transportation (COE CST) ended, not for any nefarious or interesting reason, but simply because the center came to the natural conclusion of its existence. COE CST officially ceased to exist on August 19, 2022 and all its members, sponsors, beneficiaries, and partners are sad to see it go (including New Space). I will keep you posted regarding the status of future partnerships and hopefully you will see new logos appearing on the front covers of future issues. If any reader represents an organization interested in developing a relationship with New Space and Mary Ann Liebert, Inc., publishers, please do not hesitate to contact me.Finally, as of August 31, 2022, I retired from my career as a civil servant in the U.S. government, thereby providing me more opportunity to continue my New Space and other commercial space-related activities.FiguresReferencesRelatedDetails Volume 10Issue 3Sep 2022 InformationCopyright 2022, Mary Ann Liebert, Inc., publishersTo cite this article:Ken Davidian.Letter to Readers.New Space.Sep 2022.239-239.http://doi.org/10.1089/space.2022.29044.kdPublished in Volume: 10 Issue 3: September 13, 2022Online Ahead of Print:August 3, 2022PDF download

Protocol for an attention-matched randomized controlled trial of 2GETHER: a relationship education and HIV prevention program for young male couples

BackgroundYoung men who have sex with men (YMSM) are disproportionately impacted by the HIV epidemic in the USA, and a large number of new infections among YMSM occur in the context of main or primary partnerships. At the same time, healthy romantic relationships promote health and wellbeing by improving social support and encouraging healthy behaviors. Thus, we created 2GETHER: a relationship education and HIV prevention program for young male couples. 2GETHER is delivered face-to-face in a university setting and is composed of two group sessions and two individualized skills coaching sessions. We observed strong support of the feasibility, acceptability, and preliminary efficacy of 2GETHER in a pilot trial.MethodsWe are conducting an attention-matched randomized controlled trial (RCT) to test the efficacy of 2GETHER relative to a control condition based on a well-validated positive affect enhancement program. Enrollment occurred between August 2017 and March 2021 in Chicago and surrounding areas, and we enrolled and randomized 128 dyads (N = 256 individuals). Follow-up is ongoing and we will examine primary and secondary behavioral outcomes at 12 months post-intervention, with interim follow-up at 3, 6, and 9 months post-intervention. The primary biomedical outcome is sexually transmitted infection incidence at a 12-month follow-up.Discussion2GETHER is innovative in that it places an equal emphasis on relationship skill building and HIV prevention. Thus, the program has the potential to impact numerous health-related outcomes. Despite challenges related to the recruitment of couples and the COVID-19 pandemic, we were able to enroll a robust sample of young male couples with sufficient power to detect effects on study outcomes.Trial registrationClinicalTrials.gov NCT03186534.

HIV Testing Patterns Among Recently Self-Tested Russian Men Who Have Sex With Men: A Qualitative Study.

Most qualitative research to date on HIV self-testing (HIVST) has been devoted to questions related to perceptions of HIVST among various groups of men who have sex with men (MSM) in different countries. However, little is known about HIV testing patterns of HIVST testers. Thrity-two Russian MSM, 10 with HIV and 22 without, from five cities were interviewed about their HIV testing and risk behaviors. Five types of testers "maintenance testers," "risk-based testers," "convenience testers," "test avoiders," and "HIVST-only testers" were identified in the study. Three dimensions of HIV testing patterns-testing motive, frequency, and mode-were proposed to improve existing typifications. Almost all informants practiced condomless sex with their primary partners; HIV testing or condom negotiation in primary partnerships before proceeding to condomless sex was rare. Increase in HIVST availability at no cost for MSM and targeted prevention efforts for MSM on both individual and dyadic level are urgently needed.

Exploring Contextual Differences for Sexual Role Strain Among Transgender Women and Men Who Have Sex with Men in Lima, Peru.

Sexual and gender politics inform relational expectations surrounding sexual experiences of Peruvian transgender women (TW) and men who have sex with men (MSM). We used the framework of sexual role strain, or incongruence between preferred sexual role and actual sexual practices, to explore potential conflicts between personally articulated identities and externally defined norms of gender and sexuality and its potential to increase HIV/STI risk. Cross-sectional individual- and dyad-level data from 766 TW and MSM in Lima, Peru were used to assess the partnership contexts within which insertive anal intercourse was practiced despite receptive role preference (receptive role strain), and receptive anal intercourse practiced despite insertive role preference (insertive role strain). Sexual role strain for TW was more common with non-primary partners, while for MSM it occurred more frequently in the context of a primary partnership. Receptive role strain was more prevalent for TW with unknown HIV status (reference: without HIV) or pre-sex drug use (reference: no pre-sex drug use). For homosexual MSM, receptive role strain was more prevalent during condomless anal intercourse (reference: condom-protected) and with receptive or versatile partners (reference: insertive). Among heterosexual or bisexual MSM, insertive role strain was more prevalent with insertive or versatile partners (reference: receptive), and less prevalent with casual partners (reference: primary). Our findings suggest TW and MSM experience different vulnerabilities during sexual role negotiation with different partner-types. Future studies should explore the impact of sexual role strain on condom use agency, HIV/STI risk, and discordances between public and private presentations of gender and sexual orientation.

Reductions In Hospitalizations Among Children Referred To A Primary Care-Based Medical-Legal Partnership.

Medical-legal partnerships integrate legal advocates into health care settings to address health-related social needs. However, their effect on health outcomes is unclear. This retrospective cohort study examined the effect of referral to a medical-legal partnership on hospitalization rates among urban, low-income children in Greater Cincinnati, Ohio, between 2012 and 2017. We compared 2,203 children referred to a pediatric primary care-based medical-legal partnership with 100 randomly selected control cohorts drawn from 34,235 children seen concurrently but not referred. We found that the median predicted hospitalization rate for children in the year after referral was 37.9percent lower if children received the legal intervention than if they did not. We suspect that this decrease in hospitalizations was driven by the ability of legal advocates to address acute legal needs (for example, threat of eviction and public benefit denial) and, when possible, to confront root causes of ill health (for example, unhealthy housing conditions). Interventions such as those provided through a medical-legal partnership may be important components of integrated, value-based service delivery models.

Out of Pocket Expenditure Associated with COVID 19 Pandemic in India

Corona virus 2019, popularly known as COVID-19 is a viral illness which has caused a threat in the minds of people across the world in recent times. Even developed countries are facing major challenges in preventing and treating this dreadful disease. In view of unavailability of effective vaccine and healthcare facilities, the burden of this disease is growing day by day. An important concern among the people living in these countries is the Out of Pocket Expenditure, which is ‘an expenditures borne directly by a patient, where insurance does not cover the full cost of the health goods or service’. As of 2014 data, Public expenditure on health in India has remained at 1% of GDP, very low compared to emerging BRICS (Brazil, the Russian Federation, India, China and South Africa) economies and even below neighbouring countries like Nepal and Sri Lanka. Hence it is high time that Government of India focuses on strengthening the primary healthcare system, community participation and Public private partnership so that disparity in healthcare needs is addressed and OOPE is reduced.

Viral suppression among middle-aged and aging MSM living with HIV: Partnership type and quality.

Functional support—the availability of material aid, emotional support, or companionship—promotes general well-being. For men who have sex with men (MSM) living with HIV, having a person who supports you associates with viral suppression. This study examines the association between supportive partnerships and HIV viral suppression among middle-aged and aging MSM living with HIV. A total of 423 middle-aged and aging MSM (mean age, 58.2 years) from the Multicenter AIDS Cohort Study provided self-reported data about their partnerships. Separate Poisson regression models assessed how partnership type, support, strain, and duration from April 2017 were associated with repeated viral load measurements up to April 2019. Of the follow-up visits (N = 1289), 90.0% of participants were virally suppressed. Most participants reported being non-Hispanic White (61.0%) and college-educated (83.4%). Participants were asked about their primary partnerships (i.e., “someone they are committed to above anyone else”) and secondary partnerships (i.e., those who can also be intimate or supportive but not necessarily romantic or sexual). The participants reported: no partnerships (45.2%), only primary partnerships (31.0%), only secondary partnerships (11.1%), or both primary and secondary partnerships (12.8%). Primary and secondary partnerships had mean (SD) durations of 15.9 (11.3) and 25.2 (16.5) years, respectively. Participants reporting both primary and secondary partnerships (compared with no partnership) showed significantly higher odds of being virally suppressed (adjusted prevalence ratio [aPR], 1.04; 95% CI, 1.00–1.08; p = 0.043). Albeit not statistically significant, primary-only (aPR, 1.01; 95% CI, 0.97–1.06; p = 0.547) or secondary-only (aPR, 1.03; 95% CI, 0.98–1.08; p = 0.224) partnership types were positively associated with viral suppression. Partner support and strain were not associated with viral suppression in any partnership group. Being older and non-Hispanic Black were positively and negatively associated with viral suppression, respectively. Encouraging partnerships should be considered one of clinicians’ many tools to help middle-aged and aging MSM achieve long-term viral suppression.

Intersecting Communities and PrEP Uptake among US-based Latinx Sexual Minority Men.

The Latinx community in the USA continues to be disproportionately burdened by the HIV epidemic, especially among Latinx sexual minority men (LSMM). Research indicates that up to two-thirds of new HIV infections occur among men who have sex with men (MSM) within primary partnerships. One promising biomedical approach for HIV prevention includes community scale-up of pre-exposure prophylaxis (PrEP) among LSMM. We examine the relationship between community connectedness (with the Latinx and gay communities) and PrEP uptake among 307 partnered LSMM who reported casual partner sex (i.e., non-monogamous relationships). Within the sample, approximately thirty percent (29.7%) of participants were on PrEP, and 43.3% reported partner approval for PrEP(i.e., my partner is in favor of PrEP generally), while only 7.2% were opposed to PrEP. Insurance status and income levels were significantly associated with PrEP uptake. There was a significant interaction term (gay community connectedness and Latinxgroup membership), which was positively associated with PrEP uptake (OR = 2.18; p = .007). Findings suggest that there may be structural barriers preventing this population from seeking and initiating PrEP care. Results point to the utility of integratingculturally relevant content related to intersecting identities and their corresponding communities when conceptualizing community-based and culturally informed interventions to improve the PrEP care cascade among LSMM.

Social Influence and Uptake of Couples HIV Testing and Counselling in KwaZulu-Natal, South Africa

Social influences may create a barrier to couples HIV testing and counselling (CHTC) uptake in sub-Saharan Africa. This secondary analysis of data collected in the ‘Uthando Lwethu’ randomised controlled trial used discrete-time survival models to evaluate the association between within-couple average ‘peer support’ score and uptake of CHTC by the end of nine months’ follow-up. Peer support was conceptualised by self-rated strength of agreement with two statements describing friendships outside of the primary partnership. Eighty-eight couples (26.9%) took up CHTC. Results tended towards a dichotomous trend in models adjusted only for trial arm, with uptake significantly less likely amongst couples in the higher of four peer support score categories (OR 0.34, 95% CI 0.18, 0.68 [7–10 points]; OR 0.53, 95% CI 0.28, 0.99 [≥ 11 points]). A similar trend remained in the final multivariable model, but was no longer significant (AOR 0.59, 95% CI 0.25, 1.42 [7–10 points]; AOR 0.88, 95% CI 0.36, 2.10 [≥ 11 points]). Accounting for social influences in the design of couples-focused interventions may increase their success.

Academic Womxn and Their Partners: Managing Scholarly Expectations During the Coronavirus Pandemic With the Support of Intimate Relationships in Quarantine

ObjectiveThe purpose of this study was to explore how academic womxn experience their partnerships during quarantine and to determine the impact of those relational dynamics on scholarly productivity.BackgroundPast literature indicates traumatic events and extended quarantine is associated with negative mental health outcomes. While primary partnerships serve as one protective factor, extended quarantine with one's partner introduces novel stress to a relationship, which may have unintended outcomes, including those that affect productivity.MethodAn online survey was provided to academic womxn invested in scholarship. Responses from participants who identified as in a relationship (n = 67) were coded using thematic analysis through a feminist lens.FindingsParticipants highlighted three major themes across their responses: time and space, communication, and needs. These findings reflected stressors typical within couple relationships but highlighted important considerations for partners of academic womxn in support of their scholarly activity during quarantine.ConclusionThough the flexibility available during the pandemic for academic womxn provided time and space for some to nurture their relationship as well as focus on scholar activity, this was not consistent across partners.ImplicationsFindings show the mixed experiences of partners and confirm the importance of communication, especially about time and space and professional needs. Recommendations can be extrapolated to other processional and career partnerships.

HIV Treatment Cascade and PrEP Care Continuum Among Serodiscordant Male Couples in the United States.

A large proportion of HIV infections among men who have sex with men occur within primary partnerships, however, there is a lack of research focused on serodiscordant male couples. We used baseline data collected as part of Project Stronger Together-a randomized controlled trial to improve treatment outcomes among 155 serodiscordant male couples. We described engagement in HIV care/prevention using the HIV treatment cascade and PrEP care continuum. Among partners living with HIV, 86.5% were linked to care, 77.4% retained in care, 81.3% prescribed ART, 60.7% adherent, and 67.7%virally suppressed. Among HIV-negative partners, 62.6% were willing to take PrEP, 48.4% had ever taken PrEP, and 26.5% were adherent to PrEP. Black partners living with HIV had lower odds of being virally suppressed compared to White partners. Our findings provide evidence to suggest designing programs to address the racial disparities in viral suppression, addressing barriers to HIV prevention/treatment, and improving PrEP education.

Couples-focused intervention to improve engagement in HIV care: protocol for a randomised controlled trial

IntroductionAdvances in HIV treatment have proven to be effective in increasing virological suppression, thereby decreasing morbidity, and increasing survival. Medication adherence is an important factor in reducing viral load among...

Primary and secondary supportive partnerships among HIV-positive and HIV-negative middle-aged and older gay men.

This study describes the primary and secondary partnerships of aging gay men participating in the Understanding Patterns of Healthy Aging Among Men Who Have Sex with Men substudy of the Multicenter AIDS Cohort Study and examines differences in the prevalence of these relationship structures by HIV status while adjusting for age, education, and race/ethnicity. Relationships were compared within the following structural categories: “only a primary partnership”, “only a secondary partnership”, “both a primary and secondary relationship”, or “neither a primary nor secondary relationship”. There were 1,054 participants (51.9% HIV negative/48.1% HIV positive) included in the study. Participants had a median age of 62.0 years (interquartile range: 56.0–67.0) and most reported being non-Hispanic white (74.6%) and college educated (88.0%). Of the 1,004 participants with available partnership status data, 384 (38.2%) reported no primary or secondary partnerships, 108 (10.8%) reported secondary-only partnership, 385 (38.3%) reported primary-only partnership, and 127 (12.6%) reported both primary and secondary partnerships. Of participants who reported primary partnerships only, the prevalence rates (PRs) were lower among those 62 years and older, HIV positive, black non-Hispanic and Hispanics. Of participants who reported only having a secondary partnership, the PRs were higher among those 62 years and older and HIV positive. Of participants who did not report having either a primary or secondary partnership, the PRs were higher among those 62 years and older, HIV positive, and black non-Hispanic compared with their respective referent groups. There was no significant difference in PRs of having both primary and secondary partnerships by age category, HIV status, race/ethnicity, and education. This study aimed to fill a knowledge gap in the literature regarding both primary and secondary supportive partnerships among aging HIV-positive and HIV-negative gay men.

The experience of intergroup contact in primary-school ‘Shared Education’ classrooms: evidence from Northern Ireland

ABSTRACT The purpose of this paper is to explore the experiences of pupils and teachers within two primary school Shared Education partnerships in Northern Ireland; in particular, how intergroup contact is experienced within such contexts. A comparative, instrumental case study design was employed, which included document review, observation of Shared Education activities, interviews with school principals and teachers, and arts-based group interviews with children. While the paper supports existing research from secondary schools which suggests the potential of Shared Education to create spaces for building positive relations between pupils, the findings also highlighted several key issues which further extend understanding of Shared Education. Firstly, it emphasised the importance of planning, time and structure in Shared Education activity in order to dispel negativity and social awkwardness; secondly, it suggested the need for teachers to ‘model’ positive cross-group relations in their relationships between each other; and thirdly, it revealed a lack of clarity around how to deal with controversial issues as part of Shared Education activity. The paper concludes by suggesting that there is a need for additional guidance for schools around the intended aims and outcomes of Shared Education in relation to its potential to promote positive intergroup contact.

Child and Adolescent Mental Health Access in the U.S.: A Multifactorial Challenge with Dynamic Policy

On March 11, 2021, The American Rescue Plan Act allocated 80 million dollars in grants to increase mental health access for children and adolescents. This provision lent needed attention and validation to the tremendous treatment gaps in child and adolescent mental health care, an issue with high costs to the health system, and short and long-ranging impacts. Most child mental illnesses go untreated and hurdles to access, including social factors and geography, play prominent roles. This paper will give a brief background of the epidemiology of child mental illness in the US and then discuss some of the challenges in mental health access among children and adolescents in the US. Further, proposed and ongoing solutions will be discussed to address the challenge of unequal distribution of care and the sheer lack of capacity. These approaches include expanding the training landscape, using a WHO resource conservation model, tele-mental health, and primary care-specialist partnerships. These approaches lend policymakers and stakeholders a preliminary analysis of how these funds could be allocated and thereby have tremendous importance for the current moment.