Community Support Services Research Articles

Development of Communication Support Services for People with Aphasia : Training and Activities of Supporters in Hiroshima Prefecture

Development of Communication Support Services for People with Aphasia : Training and Activities of Supporters in Hiroshima Prefecture

STRATEGIES FOR ADVANCING REGIONAL ORIGINAL INCOME DURING THE COVID-19 PANDEMIC IN THE OFFICE OF COOPERATIVES, MSMES, INDUSTRY AND TRADE IN BOALEMO REGENCY

The study aimed to develop a strategy for increasing regional original income during the Covid-19 pandemic at the Boalemo Regency's Office of Cooperatives, Small and Medium-Sized Enterprises, Industry, and Trade (Diskumperindag). The descriptive research method is combined with a qualitative approach in this study.
 The sample size for this study was 43 individuals. The study's findings indicated that; (1) The Office of Cooperatives, Small and Medium Enterprises, Industry and Trade of Boalemo Regency possesses several strengths, including the potential for significant regional retributions in the form of Regional Original Income, regional retribution rates that support Regional Original Income (PAD), local government and community support for Cooperatives, Small and Medium Enterprises, Industry and Trade, and the existence of a regional regulation that promotes regional original income. 2) Weaknesses that must be addressed include the absence of regional taxes, ineffective market management, and failure to attain the regional original income target. (3) Possibilities These include growing economic activity, government commitment and support, and the involvement and cooperation of multiple agencies in collecting Regional Original Revenue. 4) The threats include the following: Regional Original Income during the Covid-19 Pandemic, the installation of Large-Scale Social Restrictions during the Pandemic era I community awareness and support services, and community knowledge.

Experiences of Carers and People with Dementia from Ethnic Minority Groups Managing Eating and Drinking at Home in the United Kingdom.

Eating and drinking difficulties, such as loss of appetite and swallowing problems, are common in dementia, but little is known about the experiences of ethnic minority groups who are managing these difficulties at home. The purpose of our study was to explore the meaning of food, the impact of dementia on eating and drinking, and carers’ experiences of support. We undertook semi-structured interviews with 17 carers and people with dementia from ethnic minority backgrounds living in England, using thematic analysis to analyse the data. Food/drink had strong links to identity, culture and emotions. Providing culturally familiar foods, celebrating traditional festivals and supporting previous food-related roles promoted reminiscence, which encouraged the people living with dementia to eat and drink, as did social interactions, although these could lead to distress in those with more advanced dementia. Food choices were also influenced by carer strain, generational differences and the impact of health conditions. Despite a strong sense of duty to care for relatives at home, there was low awareness of community support services. The carers expressed a need for culturally tailored support for managing dementia-related eating and drinking difficulties at home. Healthcare professionals must provide contextually relevant advice to carers, being mindful of how cultural backgrounds can affect dietary choices.

Mood Disturbances Across the Continuum of Care Based on Self-Report and Clinician Rated Measures in the interRAI Suite of Assessment Instruments

BackgroundMood disturbance is a pervasive problem affecting persons of all ages in the general population and the subset of those receiving services from different health care providers. interRAI assessment instruments comprise an integrated health information system providing a common approach to comprehensive assessment of the strengths, preferences and needs of persons with complex needs across the continuum of care.ObjectiveOur objective was to create new mood scales for use with the full suite of interRAI assessments including a composite version with both clinician-rated and self-reported items as well as a self-report only version.MethodsWe completed a cross-sectional analysis of 511,641 interRAI assessments of Canadian adults aged 18+ in community mental health, home care, community support services, nursing homes, palliative care, acute hospital, and general population surveys to develop, test, and refine new measures of mood disturbance that combined clinician and self-rated items. We examined validity and internal consistency across diverse care settings and populations.ResultsThe composite scale combining both clinician and self-report ratings and the self-report only variant showed different distributions across populations and settings with most severe signs of disturbed mood in community mental health settings and lowest severity in the general population prior to the COVID-19 pandemic. The self-report and composite measures were strongly correlated with each other but differed most in populations with high rates of missing values for self-report due to cognitive impairment (e.g., nursing homes). Evidence of reliability was strong across care settings, as was convergent validity with respect to depression/mood disorder diagnoses, sleep disturbance, and self-harm indicators. In a general population survey, the correlation of the self-reported mood scale with Kessler-10 was 0.73.ConclusionsThe new interRAI mood scales provide reliable and valid mental health measures that can be applied across diverse populations and care settings. Incorporating a person-centered approach to assessment, the composite scale considers the person's perspective and clinician views to provide a sensitive and robust measure that considers mood disturbances related to dysphoria, anxiety, and anhedonia.

Age-friendliness of city, loneliness and depression moderated by internet use during the COVID-19 pandemic.

SummaryThe purpose of this study was to examine the association between age-friendliness of a city, loneliness and depression moderated by internet use among older people during the coronavirus disease 2019 (COVID-19) pandemic. The survey was from ‘The 2020 Survey of Needs Assessment for a Safe Community and Age-Friendly City’ in Xinyi District, Taipei, which was conducted by face-to-face interviews with community-based older adults who were aged 65 and above from one district of Taipei City from May to June 2020 (n = 335). Partial least square structural equation modeling and the SPSS PROCESS macro were used for data analysis. Two domains of an age-friendly city (housing and community support and health services) were found to be associated with reduced loneliness, while one (respect and social inclusion) was associated with decreased depression. The age-friendliness of cities mitigates depression through moderator (internet use) and mediation (loneliness) mechanisms. Although some age-friendly domains of the city reduced loneliness and depression directly, the age-friendliness–loneliness-depression mechanism held true only for older adults who used the internet and not for nonusers. Maintaining the age-friendliness of an environment is beneficial to mental health, and internet use is a necessary condition to gain optimum benefits from age-friendly initiatives. Policy suggestions are discussed.

Barriers and facilitators of using dementia community support services provided by an Alzheimers organisation: Perceptions of informal caregivers receiving services.

Known barriers prevent informal caregivers of a person with dementia using community services; however, there is a dearth of knowledge on how organisations can overcome these barriers. This study examined caregivers' perceptions of the barriers and facilitators of service use with regards to their membership to one Alzheimers organisation and their recommendations for improvements. In-depth interviews were conducted with 19 informal caregivers. Thematic analysis revealed personal and organisational barriers to service use, and associated recommendations. Six recommendations were made for dementia service organisations: (a) be proactive and arrange regular scheduled meetings with clients; (b) utilise consistent, trusting, empathic support personnel who can build strong relationships with clients; (c) provide support groups; (d) tailor support; (e) ensure expert knowledge and numerous channels of information delivery to clients, the general public and health professionals and (f) actively promote the organisation and services offered. This study provides novel insights into how a community organisation can overcome client barriers to service use. In addition, the study reveals caregivers perceived value of an Alzheimers organisation, argued to be an essential service, but until now clients' perceptions of the value received have not been explored.

Dental Service and Resource Needs during COVID-19 among Underserved Populations.

Introduction:In response to the coronavirus disease 2019 (COVID-19) outbreak, dental services in British Columbia, Canada, were restricted to urgent and emergency cases between March 16 and May 18, 2020. It is unclear how the curtailment of oral health services has affected underserved populations who already often have limited access to dental care due to cost, fear, stigma, and discrimination.Objectives:To explore the experiences of underserved populations and their community organizations when accessing oral health services and information in British Columbia and identify their coping mechanisms employed during the curtailment of oral health care services.Methods:Semistructured, remote interviews were conducted with 13 staff and 18 members from 6 community-based organizations. These organizations serve men and women with a history of incarceration and/or experiencing poverty and homelessness, persons living with human immunodeficiency virus/AIDS, adults living with mental illness, and older adults in long-term care facilities. The interviews were audio-recorded, transcribed verbatim, and coded for emerging themes using NVivo 12 software. Thematic analysis was performed.Results:The pandemic raised concerns and hesitancy among underserved populations and further reduced access to care. In turn, those with unmet dental needs resorted to coping mechanisms, including turning to community support or medical services, self-management of dental issues, and not dealing with dental issues altogether. Community organizers and members outlined needed resources such as assistance navigating the dental care system, having a contact for dental-related questions, and member preparation for dental service changes, while emphasizing the importance of positive relationships with dental providers.Conclusion:Underserved populations who already face barriers to oral health care services experienced increased difficulty in addressing their oral health needs and concerns during the beginning of the COVID-19 pandemic. Strategies aimed at reaching out to this population and those who support them are needed to help mitigate negative coping strategies and increased oral health disparities.Knowledge Transfer Statement:This study depicts ways of addressing unmet oral health–related issues during the COVID-19 pandemic for underserved populations and their community organizations with policy implications as well as practical strategies.

Mobile Health to Support Community-Integration of Individuals With Disabilities Using iMHere 2.0: Focus Group Study.

BackgroundMobile health (mHealth) systems that support self-management can improve medical, functional, and psychosocial outcomes for individuals with disabilities and chronic conditions. The mHealth systems can potentially be expanded to support community integration.ObjectiveThe purposes of this study were to (1) partner with a community-based organization that supports community integration of individuals with disabilities; (2) identify software requirements needed to support community participation; and (3) iteratively refine an existing mHealth application to include new requirements.MethodsCommunity Living and Support Services (CLASS), a nonprofit organization that serves individuals with disabilities in Pittsburgh, Pennsylvania, was identified as the focus group for this study. Key stakeholders within the Community Partners Program at CLASS proposed design requirements for an existing mHealth application, Interactive Mobile Health and Rehabilitation (iMHere) 2.0, that has been used to support self-management.ResultsWe gathered qualitative data from a focus group composed of CLASS members to develop and iteratively revise iMHere 2.0 to include new modules and features to support community integration. A caregiver app was also developed. The new system contains features to support finance, transportation, client and caregiver communication, calendar and checklist management, upcoming medical and nonmedical appointments, social engagement, pain management, and access to a personal profile. Modifications were made to the following existing modules: education, mood, personal health record, goals, medications, and nutrition.ConclusionsA successful partnership with a community-based organization that supports individuals with disabilities resulted in a newly designed mHealth system with features to support community integration.

Emergency department presentations in the first weeks following release from prison among men with a history of injecting drug use in Victoria, Australia: A prospective cohort study.

Rates of emergency department (ED) use are higher among people released from prison than in the general population. However, little is known about ED presentations specifically among people with a history of injecting drug use (IDU) leaving prison. We measured the incidence of ED presentation in the three months following release from prison, among a cohort of men with histories of IDU, and determined pre-release characteristics associated with presenting to an ED during this period. We analysed linked survey and administrative data from the Prison and Transition Health (PATH) study (N=400) using multiple-failure survival analysis. Twenty-one percent (n=81/393) of the cohort presented to an ED at least once within the three months after release from prison. The incidence of ED presentation was highest in the first six days after release. Cox proportional hazards modelling showed that a history of in-patient psychiatric admission and housing instability were associated with increased hazard of an ED presentation, and identifying as Aboriginal and Torres Strait Islander was associated with decreased hazard. In our study, ED presentations following release from prison among people with a history of IDU was linked to acute health risks related to known mental health and social vulnerabilities in this population. Greater collaboration and systems integration between prison and community health and support services is needed to reduce presentations to ED and associated morbidities among people with a history of IDU after release from prison.

Abstract P3-14-07: Breast cancer screening disparities among insured women in the Washington DC-Baltimore area

Abstract Background: Breast cancer screening (BCS) gaps have closed between non-Hispanic Black (NHB) and non-Hispanic White women when adjusted for covariates including insurance. However, gaps in breast cancer (BC) mortality persist. Washington DC and Baltimore (DC-Balt) are two high-resource cities with diverse populations, low BCS uptake, and high BC mortality. This analysis investigates the association between residence in a high NHB area and BCS uptake. Methods: This retrospective analysis used de-identified administrative data (2017–2019) from a large national US health insurer and publicly available demographic data. Included were adult (birth year 1957 to 1967) female members with a qualifying DC-Balt zip code, continuous coverage in a commercial fully insured plan, and 1+ evaluation and management (E&M) claims. Qualifying zip codes were Core Based Statistical Areas (CBSA) 47900 or 12580 per Housing and Urban Development Q1 2021 ZIP-CBSA data and zip code area type per 2019 Uniform Data System (UDS) Zip to zip code tabulation area (ZCTA) mapping. Study cohorts were created based on residence in an area of ≥40% NHB or <40% NHB. Members with a BC diagnosis were excluded. A BCS outcome was identified by presence of digital mammography or digital breast tomosynthesis claims. Population data (NHB and total) by ZCTA was from American Community Survey (ACS) Table B03002 2019 5 Yr Estimates. Multiple regression analysis included the following covariates: a specific large regional employer (SLRE), member preventive care seeking beyond an E&M visit via the proxy of lipid panel claims, and healthcare systems (HCS) variation via one-shot encoded E&M visit claim from 12 top regional HCSs. Post-hoc sensitivity analysis examined correlation of high NHB to low household income (LHI <$40k) per ACS Table B19001 and impact of LHI to regression. Results: After excluding 698 (5.0%) members with evidence of BC, 13,128 members met study criteria (22% ≥40% NHB, 78% <40% NHB). Of those, 9,161 (70%)had BCS (61% ≥40% NHB, 72% <40% NHB), 4,539 (35%) SLRE enrollment (48% ≥40% NHB, 30% <40% NHB), 11,179 lipid claims (88% ≥40% NHB, 85% <40% NHB), and 7,087 (57%) 1+ E&M visit at an identified HCS (65% ≥40% NHB, 51% <40% NHB). OR for BCS given ≥40% NHB was 0.55 (CI 0.50-0.61). Covariate OR were 0.77 (CI 0.71-0.84) for SLRE plan enrollees and 3.92 CI (CI 3.54-4.34) for lipid screening. HCS E&M exposure OR were significant (p<0.05) at 9 of 12 HCS. 7 HCS had higher OR and 2 lower OR. HCS OR ranged from 1.98 (CI 1.61-2.45) to 0.56 (CI 0.45-0.71). LHI was correlated with NHB ≥40% (r=0.29), but not significant in regression. LHI did not change significance or magnitude of NHB ≥40% or other covariates. Conclusion: Despite the Affordable Care Act’s mandate that most insured patients pay nothing out of pocket for BCS, insured women living in areas of Washington DC and Baltimore having higher minority populations are less likely to be screened than insured women living in lower minority population areas. This analysis suggests community-based outreach needs to target all women living in high minority population areas as disparities exist even among women with insurance. Multiple stakeholders (e.g. government, employers, healthcare providers, insurers, community support services) need to collaborate to reduce remaining barriers to BCS and actively facilitate this high value preventive care. Table 1.Cohort CharacteristicsNot Screened (N=3967) (30.2%)Screened (N=9161) (69.8%)Overall (N=13128)ZCTA NHB Pct0-20%2247 (56.6%)5983 (65.3%)8230 (62.7%)>20-40%622 (15.7%)1501 (16.4%)2123 (16.2%)>40-60%314 (7.9%)577 (6.3%)891 (6.8%)>60-80%400 (10.1%)528 (5.8%)928 (7.1%)>80-100%384 (9.7%)572 (6.2%)956 (7.3%)ZCTA LHI<$40k Pct0-20%2684 (67.7%)6490 (70.8%)9174 (69.9%)>20-40%1153 (29.1%)2399 (26.2%)3552 (27.1%)>40-80%130 (3.3%)272 (3.0%)402 (3.1%)Lipid ClaimNo1098 (27.7%)851 (9.3%)1949 (14.8%)Yes2869 (72.3%)8310 (90.7%)11179 (85.2%)SLRENo2432 (61.3%)6157 (67.2%)8589 (65.4%)Yes1535 (38.7%)3004 (32.8%)4539 (34.6%)Any 12 HCSsNo1972 (49.7%)4069 (44.4%)6041 (46.0%)Yes1995 (50.3%)5092 (55.6%)7087 (54.0%) Citation Format: James Staib, Kierstin Catlett, Stacey Dacosta Byfield. Breast cancer screening disparities among insured women in the Washington DC-Baltimore area [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-14-07.

How older people experience the age-friendliness of The Hague: A quantitative study

The municipality of The Hague has been a member of the WHO's Global Network for Age-Friendly Cities and Communities since 2015. The municipality commissioned a survey to investigate how older citizens view the age-friendliness of their city. A cross-sectional survey was conducted among a diverse sample of 393 community-dwelling older citizens. The survey made use of the Age Friendly Cities and Communities Questionnaire (AFCCQ), and multilevel regression techniques to investigate how social groups differ on the domains of the AFCCQ. The Hague scored a satisfied as an overall score (16.9 ± 8.87), and a satisfied on social participation (2.6 ± 2.46), civic participation and employment (1.4 ± 1.34), communication and information (1.4 ± 1.32), respect and social inclusion (1.6 ± 1.59), community support and health services (2.7 ± 2.79), transportation (1.7 ± 1.26) and financial situation (1.9 ± 1.26). The Hague has an above-average score in the field of housing (2.4 ± 1.06). For Outdoor spaces and buildings, the municipality scores a moderate positive score (0.9 ± 1.41). Significant differences were found for sex, age, socio-economic position, receiving care support, and use of mobility aids. The findings show that older people have different perceptions regarding their city's age-friendliness. Policy makers must acknowledge this heterogeneity among their older citizens and adapt city policies accordingly.

Acquired brain injury nurse-led clinic: roll out, review and referral

Aim: This paper documents the introduction of a nurse-led outpatient clinic for patients post acquired brain injury (ABI). Nurse-led clinics in primary care settings have been widely acclaimed as a positive step towards improving access to investigations and specialist services, and offering a solution towards limited clinician resources. Method: A retrospective analysis was undertaken to review the ABI nurse-led clinic service over a 12-month period. This analysis reviewed how the clinic has impacted the hospital in terms of hours saved by the neurosurgical consultant clinic by the patient attending the nurse-led clinic. This paper also looks at how the clinic benefits the patient by timely access to the ABI clinical nurse specialist along with referrals and review by community-based rehab services, Headway Ireland and ABI Ireland. Findings: Through the review of the ABI clinic over a 12-month period, 47 hours were saved from the consultant led clinics. It was also found that 30% of patients reviewed in the ABI clinic were now in an appropriate ABI community support service. Conclusion: The audit shows that the ABI nurse-led clinic benefits the patient is terms of timely review and follow-up after traumatic brain injury (TBI). The patient also has early access to specialist TBI follow-on services, which enhances recovery and overall quality of care. The nurse-led clinic also benefits the organisation by reviewing and following up on patients who would have previously have been reviewed at the consultant-led clinics, therefore, reducing waiting times.

Domains Influencing Malaysia in Achieving Age-Friendly Nation Status

An "age-friendly environment," defined by the WHO as one that is open to all people regardless of their physical or mental abilities or limitations, that promotes health, engagement, and safety, has been recommended in order to keep older people active and engaged in society. According to WHO guidelines, active aging is linked to eight domains of the age-friendly environment: urban spaces and built environment, housing, transportation, social participation, civic participation and employment, respect and social inclusion, access to community support and health services, and communication and information. By the year 2035, Malaysia is expected to be an aging nation. Urban areas are expected to be home to a large proportion of the elderly in the future, making preparations for the aging population crucial for municipal and relevant government organizations. There is a paradigm shift from the individual to the community, focusing on the dynamic interactions between individuals and the environment in which they live. In Kuala Lumpur, Malaysia, we gathered data from 300 participants. Structural Equation Modeling (SEM) was employed to perform the analysis. The findings indicated that supportive social environments such as a community with respect and social inclusion; improved transportation services, parking facilities, health care, and economic security by prolonging employment for the senior population are contributing factors towards achieving age-friendly nation status.

Perspectives of community processes in establishing community-based mental health services in Hong Kong: a case study

BackgroundIntegrated Community Centres for Mental Wellness (ICCMWs) provide district-based community support services for patients discharged from mental health facilities and other residents in Hong Kong. However, selecting locations for these community centres is challenging primarily because of community opposition, which has introduced barriers to responses to service users’ interests and the operations of individual centres. This study examines public preferences for conflict resolution options, evaluates the feasibility of different consultation approaches, identifies effective methods for reducing public opposition and recommends possible approaches to public consultation and location selection.MethodsA total of 74 individual interviews were conducted with key informants, including government personnel, service operators, politicians, resident representatives, community activists and service users. These interviewees were asked about their knowledge, experiences and perspectives of centre location selection processes.ResultsInterviews revealed that neighbourhood consultations for establishing community centres for mental wellness are time-consuming and did not yield a consensus of support from residents. In some instances, the government may decide to delay or withdraw location selection plans because of strong public opposition mainly because of bias and misunderstanding towards service users. However, the role of local politicians in mediating neighbourhood opinions and the government’s determination in planning location selection are essential for successfully selecting ICCMW locations.ConclusionGovernment departments should develop stronger collaboration to study target neighbourhoods and lobby stakeholders at earlier stages. Such investigations should involve identifying key stakeholders, the political and social dynamics of controversies and community demographics. A protocol specifying a time frame should be implemented to facilitate smooth and effective public consultation and community mental health service location selection processes.

Age-friendly neighbourhoods and physical activity of older Surinamese individuals in Rotterdam, the Netherlands.

BackgroundAge-friendly neighbourhoods seem to promote physical activity among older individuals. Physical activity is especially important for chronically ill individuals. In the Netherlands, older Surinamese individuals are more likely to have chronic diseases than are their native Dutch counterparts. This study examined relationships of neighbourhood characteristics with physical activity among older Surinamese individuals in Rotterdam, the Netherlands.MethodsOf 2749 potential participants, 697 (25%) community-dwelling older (age ≥ 70 years) Surinamese individuals living in Rotterdam, the Netherlands, completed a questionnaire on personal and neighbourhood characteristics between March and June 2020. Correlation and multilevel regression analyses were performed to identify associations between missing neighbourhood characteristics for ageing in place and physical activity.ResultsScores for the neighbourhood domains communication and information (r = -0.099, p ≤ 0.05), community support and health services (r = -0.139, p ≤ 0.001), and respect and social inclusion (r = -0.141, p ≤ 0.001), correlated negatively with participants’ PA. In the multilevel analysis, overall missing neighbourhood characteristics to age in place scores were associated negatively with physical activity (p ≤ 0.05).ConclusionThis study showed the importance of age-friendly neighbourhoods for physical activity among older Surinamese individuals in Rotterdam, the Netherlands. Our findings suggest that the neighbourhood plays an important role in supporting older individuals’ leading of physically active lifestyles. Further research is needed to support the development of interventions to create age-friendly neighbourhoods.

The short-term effects of COVID-19 on HIV and AIDS control efforts among female sex workers in Indonesia

BackgroundThe COVID-19 pandemic has raised concerns as to its impact on other health programs. One program that appears particularly vulnerable is HIV and AIDS. We undertook an assessment of COVID-19 impact on HIV control efforts in Indonesia for a sub-population that has received little attention in the global literature—female sex workers (FSW).MethodsThe study was undertaken in 23 National AIDS program priority districts. Four sources of monthly data during January–July 2020 were considered. COVID-19 infection data were extracted from national and district surveillance systems. Combination prevention program outputs were reported by civil society organizations (CSOs) providing community support services to FSW. These organizations also undertook monthly scans of levels of commercial sex activity and HIV testing availability. We also considered data from an ongoing HIV community screening trial. The primary mode of analysis entailed comparisons of levels and trends of indicators from the four data series.ResultsCommercial sex activity was severely curtailed in April–May in many districts. While recovering to pre-COVID-19 levels in “Localization” areas, the number of active FSW in July was one-third below that in February. HIV testing service availability declined by 50% at health facilities before recovering slowly, while mobile clinic services largely ceased during April–June. Numbers of FSW reached, condoms distributed, FSW tested for HIV, HIV cases detected, and FSW starting treatment all declined precipitously in April/May but had largely recovered to pre-COVID-19 levels by July. We found only a temporary dip in treatment initiation rates among HIV positive FSW and no discernible impact on treatment retention. The HIV community screening trial data revealed significant demand for HIV testing among FSW that was not being met even before the onset of COVID-19.ConclusionsCOVID-19 has had at least short-run economic effects on FSW and the national response to HIV and AIDS targeting FSW. However, the effects appear to have been cushioned by community-based services and support in study districts. The findings make a compelling case for the expansion of community-based services irrespective of the future trajectory of COVID-19. As COVID-19 has not yet been contained, the trajectory of economic activity and service delivery is uncertain.

Evaluation of State-Led Surveillance of Neonatal Abstinence Syndrome - Six U.S. States, 2018-2021.

Opioid use disorder (OUD) is a significant public health problem in the United States, which affects children as well as adults. During 2010-2017, maternal opioid-related diagnoses increased approximately 130%, from 3.5 to 8.2 per 1,000 hospital deliveries, and neonatal abstinence syndrome (NAS) increased 83%, from 4.0 to 7.3 per 1,000 hospital deliveries (1). NAS, a withdrawal syndrome, can occur among infants following in utero exposure to opioids and other psychotropic substances (2). In 2018, a study of six states with mandated NAS case reporting for public health surveillance (2013-2017) found that mandated reporting helped quantify NAS incidence and guide programs and services (3). To review surveillance features and programmatic development in the same six states, a questionnaire and interview with state health department officials on postimplementation efforts were developed and implemented in 2021. All states reported ongoing challenges with initial case reporting, limited capacity to track social and developmental outcomes, and no requirement for long-term follow-up in state-mandated case reporting; only one state instituted health-related outcomes monitoring. The primary surveillance barrier beyond initial case reporting was lack of infrastructure. To serve identified needs of opioid- or other substance-exposed mother-infant dyads, state health departments reported programmatic successes expanding education and access to maternal medication for opioid use disorder (MOUD), community and provider education or support services, and partnerships with perinatal quality collaboratives. Development of additional infrastructure is needed for states aiming to advance NAS surveillance beyond initial case reporting.

Detroit Needs Assessment Study: A Community Academic Partnership With the Detroit Area Agency on Aging

This presentation discusses a comprehensive needs assessment to inform long-term strategic planning for the Detroit Area Agency on Aging. The goal was to provide in-depth input from the older population (age 60+) and key agency stakeholders, using surveys (413 community participants), listening sessions (132 participants), 23 interviews with homebound older adults, and online surveys (94) targeting medical, church, government, academic, media and HSO stakeholders. Findings indicate that many participants were not aware of available community services. For example, one-third (33.3%) had not heard of Medicaid waivers providing services outside of nursing homes, while nearly one in five (22.0%) had not heard about senior employment services. The most common areas of unmet need were for caregiver workshops (16.3%) and diabetes management classes (15.7%). Community services most often noted as ‘extremely important’ included health and wellness programs (68.8%), services to help access health and supportive services (71%), easy to find service information (67.7%), home care and housekeeping services (66.4%), and caregiver support (63.7%). Stakeholder findings provide insight regarding this lack of awareness. Asked “How familiar do you think the general public is with DAAA?” , 10.8% answered ‘very familiar’ and 33% ‘unfamiliar’. Findings related to an “Age-Friendly City” suggest the importance of access to supportive community services, transportation, safety, housing, and healthcare. Engagement of older adults in needs assessments plays a vital role in Area Agencies on Aging meeting the needs of emerging aging cohorts by developing ‘age friendly’ strategies to address increasing racial, ethnic, socioeconomic, and cultural diversity.

Developing an mHealth Application to Coordinate Nurse-Provided Respite Care Services for Families Coping With Palliative-Stage Cancer: Protocol for a User-Centered Design Study.

BackgroundPatients living with palliative-stage cancer frequently require intensive care from their family caregivers. Without adequate community support services, patients are at risk of receiving inadequate care, and family caregivers are at risk for depression and poor health. For such families, in-home respite care can be invaluable, particularly when the services are flexible and staffed by trusted care providers, such as nurses. Other industries are using mobile apps to make services more flexible. However, few apps have been developed to coordinate nurse-provided respite care services, and to our knowledge, none have been designed in conjunction with families affected by cancer.ObjectiveThe aim of this study is to develop a mobile health (mHealth) app prototype for coordinating flexible and trusted in-home respite care services provided by nurses to families coping with palliative-stage cancer in Québec, Canada.MethodsThis user-centered design research comprises the core component of the iRespite Services iRépit research program. For this study, we are recruiting 20 nurses, 15 adults with palliative-stage cancer, and 20 of their family caregivers, from two palliative oncology hospital departments and one palliative home-care community partner. Overseen by an Expert Council, remote data collection will occur over three research phases guided by the iterative Information Systems Research Framework: Phase 1, brainstorming potential app solutions to challenging respite care scenarios, for better supporting the respite needs of both family caregivers and care recipients; Phase 2, evaluating low-fidelity proofs of concept for potential app designs; and Phase 3, usability testing of a high-fidelity interactive proof of concept that will then be programmed into an app prototype. Qualitative and quantitative data will be descriptively analyzed within each phase and triangulated to refine the app features.ResultsWe anticipate that preliminary results will be available by Spring 2022.ConclusionsAn app prototype will be developed that has sufficient complimentary evidence to support future pilot testing in the community. Such an app could improve the delivery of community respite care services provided to families with palliative-stage cancer in Québec, supporting death at home, which is where most patients and their families wish to be.International Registered Report Identifier (IRRID)PRR1-10.2196/34652

Serious Mental Illness in Post-Acute and Long-Term Care:Building Knowledge, Sharing Care

Serious Mental Illness in Post-Acute and Long-Term Care:Building Knowledge, Sharing Care