Technical Assistance Resources Research Articles

Moving upstream: healthcare partnerships addressing social determinants of health through community wealth building

BackgroundHealthcare-based interventions addressing social needs such as food and housing generally fail to impact the upstream wealth and power inequities underlying those needs. However, a small number of US healthcare organizations have begun addressing these upstream inequities by partnering with community wealth building initiatives. These initiatives include community land trusts, resident-owned communities, and worker cooperatives, which provide local residents ownership and control over their housing and workplaces. While these partnerships represent a novel, upstream approach to the social determinants of health, no research has yet evaluated them.MethodsTo assess the current state and key aspects of healthcare-community wealth building partnerships, we conducted a multiple case study analysis using semi-structured interviews with thirty-eight key informants across ten partnerships identified through the Healthcare Anchor Network. To analyze the interviews, we used a two-stage coding process. First, we coded responses based on the phase of the intervention to which they corresponded: motivation, initiation, implementation, or evaluation. Then we assessed responses within each aspect for common themes and variation on salient topics.ResultsPartnerships were generally motivated by a combination of community needs, such as affordable housing and living wage jobs, and health system interests, such as workforce housing and supply chain resilience. Initiating projects required identifying external partners, educating leadership, and utilizing risk mitigation strategies to obtain health system buy-in. Implementation took various forms, with healthcare organizations providing financial capital in the form of grants and loans, social capital in the form of convening funders and other stakeholders, and/or capacity building support in the form of strategic planning or technical assistance resources. To evaluate projects, healthcare organizations used more process and community-level metrics rather than metrics based on individual health outcomes or returns on investment. Based on best practices from each partnership phase, we provide a roadmap for healthcare organizations to develop effective community wealth building partnerships.ConclusionsAssessing healthcare partnerships with community wealth building organizations yields key strategies healthcare organizations can use to develop more effective partnerships to address the upstream causes of poor health.

Integrity and credibility issues in strategic information on MSM and transgenders in Eastern Europe and Central Asia countries

The article describes the results of an expert survey of activists from two HIV-vulnerable communities (men who have sex with men (MSM) and transgender people), as well as public health professionals from seven countries in the Eastern Europe and Central Asia region regarding the state of strategic information (SI) regarding MSM and trans people in the context of HIV at the national level (quality, integrity, relevance and use of data). An analysis of scientific literature on studies of these communities was also used. According to the level of completeness and quality of SI, the studied countries can be ranked in descending order as follows: Ukraine, Kyrgyzstan, Georgia, Armenia, North Macedonia, Belarus, Estonia. At the same time, information about transgender people is available only in Armenia, Georgia, Kyrgyzstan and Ukraine. The integrity, relevance and use of strategic information in countries mostly depend on the availability of international financial and technical assistance resources, as well as the institutional capacity of organizations of vulnerable communities, in particular in the area of advocacy of the interests of the communities they represent in state authorities. The quality of the available information is also determined by other factors: differences in the definitions of the studied communities (in particular, the inclusion of trans women in the group of men who have sex with men), failure to take into account migration processes, the size and structure of general populations (mostly unknown), the impossibility of constructing non-random samples of sufficient size or insufficient quality of construction of pseudo-random samples, lack of coverage of the entire territory of the respective countries (only the capital and sometimes large cities), etc. In general, with few exceptions, the strategic information available in the Eastern Europe and Central Asia region on MSM and trans people in the context of HIV is incomplete, underutilized and of limited validity.

Advancing Patient-Centered Cancer Survivorship Care: Evaluation of a Dissemination Project.

Care coordination among primary care providers and oncologists continues to be a challenge in cancer survivorship care. The Advancing Patient-Centered Cancer Survivorship Care Toolkit ("Toolkit") was developed to provide a "workshop in a box" for comprehensive cancer control (CCC) stakeholders to advance patient-centered cancer survivorship care in their region. The Toolkit was disseminated through an e-learning module, established webpages, an online forum, and social media. Toolkit dissemination was evaluated using the RE-AIM framework. For effectiveness, e-learning module and workshop participants were surveyed to assess changes in confidence in learning objectives. The Toolkit Web page received over 10,000 impressions. E-learning module participants (n = 212) reported statistically significant improvement (p < 0.001) between the pre- (M = 3.42, SD = 0.85) and post-test (M = 4.18, SD = 0.60) mean scores on self-confidence to describe patient-reported priorities for cancer survivorship care. Among virtual workshop trainees (n = 121), 28 participants completed paired pre- and post-workshop surveys. Among those with matched responses, there were statistically significant improvements from pre- to post-workshop self-reported knowledge on what patients want in cancer survivorship care (M = 2.5, SD = 1.0, vs. M = 3.3, SD = 1.0; p = 0.001); confidence in describing critical components of patient-centered cancer survivorship care (M = 3.1, SD = 1.2, vs. M = 4.2, SD = 0.5; p < 0.001); and confidence in describing patient priorities for cancer survivorship care (M = 3.0, SD = 1.1, vs. M = 4.1, SD = 0.6; p < 0.001). Provision of technical assistance resources in a variety of formats can successfully build capacity of healthcare providers and comprehensive cancer coalition stakeholders to feel more prepared to deliver patient-centered, coordinated cancer survivorship care.

More and better investment now! How unlocking sustainable and digital investment flows can help achieve the SDGs

The global community can address the collapse of investment following COVID-19, drive digital transformation, and help achieve the SDGs through five actions: (1) establish a Facility and Fund to provide resources for technical assistance and facilitate private–public collaboration, including through a new EASI Alliance, (2) endorse a Sustainable Investment Framework to advance such collaboration, through aligning and coordinating efforts, (3) adopt specific investment policies and measures to support sustainable FDI for sustainable development, prioritizing linkages, (4) adopt specific policies and measures to facilitate investment in the digital economy, accelerating productive transformation while building resilience, and (5) develop partnerships and industry-based coalitions to operationalize these efforts.

More and Better Investment Now! How Unlocking Sustainable and Digital Investment Flows Can Help Achieve the SDGs

The global community can address the collapse of investment following COVID-19, drive digital transformation, and help achieve the SDGs through five actions: (1) establish a Facility and Fund to provide resources for technical assistance and facilitate private–public collaboration, including through a new EASI Alliance, (2) endorse a Sustainable Investment Framework to advance such collaboration, through aligning and coordinating efforts, (3) adopt specific investment policies and measures to support sustainable FDI for sustainable development, prioritizing linkages, (4) adopt specific policies and measures to facilitate investment in the digital economy, accelerating productive transformation while building resilience, and (5) develop partnerships and industry-based coalitions to operationalize these efforts.

A LOGIC MODEL TO DESCRIBE ADULT PROTECTIVE SERVICES IN THE U.S

The adult protective services (APS) system in the U.S. serves as an investigative and service delivery system, targeting cases of reported abuse, neglect, and exploitation of older adults and adults with disabilities. APS developed from a piecemeal investigatory system, driven by state and local processes. This system has persisted, with little federal oversight or uniformity. In turn, little systematic information exists about the structure and process of the APS system nationwide. This poster presents an effort to construct a logic model for APS in the U.S., compiled jointly by researchers and practitioners under the auspices of the National APS Technical Assistance Resource Center. The process included initial drafting by six experts from various backgrounds and was reviewed by diverse stakeholders in three iterative rounds of review. Because of the unique nature of APS, the product has a partially non-traditional structure for a logic model, plotting context, inputs/resources, activities, activity metrics, and results. Inputs/resources are plotted across various sources: APS staff, consultative experts, community partners, operational supports, funding for services, and legal and ethical processes. Activities, activity metrics, and results are mapped across three stages of service provision—intake, investigation, and post-investigation services—and at the quality assurance level. The resultant logic model can be used at the national level to drive system change and evaluation; alternatively, it can be customized to specific state/local contexts to enable quality improvement and evaluation efforts. The pursuit of these efforts, coupled with existing national strategies, can contribute to continued system change and evolution within APS.

Barriers and Drivers to Accessing and Using Workforce and Technical Assistance Resources for Small and Medium Manufacturers (SMMs) in Rural Regions

Workforce shortages and market shifts have left many small and medium manufacturers (SMMs) struggling to maintain their operations. Still some SMMs tend not to utilize the workforce development and technical assistance resources available to them. This is particularly true of those in more rural regions where manufacturing is even more essential to the sustained vitality of these economies. This study explores the factors preventing these firms from pursuing and accessing these services. The authors used surveys and interviews to engage manufacturers with fewer than 500 employees in rural Southwestern Virginia and identify factors limiting their participation in these services. Findings indicate constant and consistent outreach to SMMs, regular engagement in social and economic networks, and a diverse array of services tailored to rural SMMs’ needs to play key roles in developing productive partnerships between SMMs and resource providers.

Factors influencing ‘Sea to School’ purchases of local seafood products

Local seafood marketing is intended to improve livelihoods in coastal communities and the sustainability of fisheries practices. While local seafood procurement aligns with the objectives of “farm to school” (F2S) programming in the United States (U.S.), local seafood purchases by schools are infrequent. Understanding the impediments to local seafood procurement can inform strategies to support such practices. This research employs Farm to School Census data to identify attributes that influence school purchases of local seafood at both the school-level and regional-level in the U.S. At the school-level, outreach strategies and promotional efforts employed by schools are important in influencing local seafood sourcing decisions, while the percentage of students on free/reduced-price lunch and school size are not. These findings suggest that technical assistance to practitioners is impactful in supporting the development of local seafood markets. Schools that are close to commercial fishing ports are also more likely to procure seafood locally. At the regional-level, North Pacific and New England schools had a greater propensity to procure local seafood than elsewhere. In the North Pacific this could be occurring because the commercial fishery is economically prominent. In New England this phenomenon may be occurring to develop new markets for alternative seafood species, since historically-important groundfish stocks are depleted. Local agricultural marketing is also relatively important in New England. Thus, there could be spillover benefits to local fishers from technical assistance resources developed to support the local marketing of agricultural products.

Building and Scaling-up California Quits: Supporting Health Systems Change for Tobacco Treatment

The California Tobacco Control Program is the longest standing, publicly funded tobacco control program in the U.S. California's adult smoking rate declined from 23.7% (1989) to 11% (2016) but California still has more than 3 million smokers dispersed over 58 counties, requiring a coordinated approach to further tobacco control. Early California Tobacco Control Program success is rooted in public health policy strategies and a statewide media campaign that shifted social norms. In 2009, concepts for a coordinated approach were introduced by the California Tobacco Control Program in the state's first tobacco quit plan. The state quit plan called for public health's tobacco control programs to engage healthcare systems and insurers to work more directly with the California Smoker's Helpline (Helpline). With California's Medicaid (Medi-Cal) program expansion and the implementation of electronic medical record systems, health care plans and providers received additional support for system changes. Simultaneous with these changes, coordinated tobacco control efforts began, including California's Medi-Cal Incentives to Quit Smoking project (2012-2015). In the Medi-Cal Incentives to Quit Smoking project, safety-net providers and Medi-Cal plans were outreached and engaged to promote incentives for Medi-Cal members to utilize Helpline services. In another effort, UC Quits (2013-2015), the five University of California health systems used electronic medical record tools to promote tobacco treatments and electronic referrals to the Helpline. Now, as tobacco prevention is increasingly prioritized for quality improvement, California Tobacco Control Program is funding CA Quits, a statewide tobacco-cessation learning collaborative and technical assistance resource to promote integration of tobacco treatment services and quality improvement activities into safety-net health systems. CA Quits, in coordination with the Helpline, will connect public health departments, Medi-Cal plans, and safety-net providers to accelerate health systems change for tobacco-cessation treatment throughout the state. SUPPLEMENT INFORMATION: This article is part of a supplement entitled Advancing Smoking Cessation in California's Medicaid Population, which is sponsored by the California Department of Public Health.

Elementary Grade Intervention Approaches to Treat Specific Learning Disabilities, Including Dyslexia.

The purpose of this narrative review of the literature is to provide a description of intensive interventions for elementary grade students with dyslexia, students with learning disabilities, and students with intensive reading and writing needs. First, we provide a brief overview of response to intervention. Second, we explain our theoretical framework for the review. Third, we describe evidence-based interventions, which are divided into predominantly reading or writing interventions. Fourth, we explain data-based individualization for these programs based on a taxonomy of intensity, and we provide an illustrative case study. We conclude by describing a set of links to websites and technical assistance resources that may be helpful for speech-language pathologists, teachers, and other interventionists to stay current with this research base and to lead professional learning communities.

NewSTEPs: The Establishment of a National Newborn Screening Technical Assistance Resource Center.

As newborn screening (NBS) programs in the US implement expanded screening panels, utilize emerging technologies and identify areas for improvement, the need to establish and maintain a community engagement based national technical assistance center becomes apparent. The Newborn Screening Technical assistance and Evaluation Program (NewSTEPs)—a program of the Association of Public Health Laboratories (APHL) in partnership with the Colorado School of Public Health (ColoradoSPH), offers expertise in newborn screening program development, member connection, data analysis, and program evaluation. NewSTEPs provides a secure online data repository designed to collect comprehensive data on newborn screening programs in three strata: state profiles (description of each state program including program hours, fees, and disorders screened), quality indicators (metrics of program performance encompassing screening accuracy and timeliness) and NBS public health surveillance case definitions. NewSTEPs was created in 2012 under a cooperative agreement with the United States Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). Successful activities of NewSTEPs have resulted in the establishment of a technical assistance resource center and the organization of a network of newborn screening experts. In addition, NewSTEPs coordinates efforts with other federally funded programs in order to maximize resources and to ensure a unified approach to data collection and information sharing.

Summer Meal Programs Provide an Opportunity for Nutrition Education and Physical Activity

Summer Meal Programs Provide an Opportunity for Nutrition Education and Physical Activity

Improving Lives through Evidence-Based Health Promotion Programs: A National Priority.

Improving Lives through Evidence-Based Health Promotion Programs: A National Priority.

Qualitative mid-term evaluation of a maternal, newborn and child health training and research capacity building program in Kenya

was selected as the VH-ATTC hub, as it is the country’s leading institution in coordinating curriculum development in many fields of medicine and public health. UCLA provides consultation to HMU in developing a plan to become a self-sustaining training and technical assistance resource. Outcomes & Evaluation: The VH-ATTC has succeeded in building the capacity to develop a skilled and knowledgeable local workforce by establishing: master trainers with considerable technical knowledge and capabilities, an abundance of Vietnamese language materials, resources and curricula, and a website, newsletter and listserv. The VH-ATTC has been designated as a national training institution, and its staff members have provided technical assistance to clinics in more than 10 provinces. Evaluation activities are designed to determine whether the VH-ATTC is effectively providing ongoing workforce development and training resources, andmeetingU.S.Government (GPRA) reporting requirements. Since its inception, the VH-ATTC team has carried out more than 60 trainings, 15 lectures on addiction science, and two large conferences; far exceeding projected GPRA targets (380+% of goal). Going Forward: During Phase II, a second high-functioning VHATTC will be created in southern Vietnam at the Ho Chi Minh City University of Medicine and Pharmacy. The priority of this project is to expand training and technical assistance resources throughout Vietnam and strengthen the capacity of the addiction services system. The VH-ATTC at HMU will play a substantial role in mentoring the South VH-ATTC in the foundation components of a newly established VH-ATTC. By the end of the current work plan, each university will “own” their VH-ATTC, and will have developed a plan to generate revenue for sustainability beyond the project period. Funding: Substance Abuse and Mental Health Services Administration (SAMHSA) Abstract #: 02ETC017

2015 Mid-Atlantic Telehealth Resource Center Annual Summit

The Mid-Atlantic Resource Center (MATRC; http://www.matrc.org/) advances the adoption and utilization of telehealth within the MATRC region and works collaboratively with the other federally funded Telehealth Resource Centers to accomplish the same nationally. MATRC offers technical assistance and other resources within the following mid-Atlantic states: Delaware, District of Columbia, Kentucky, Maryland, North Carolina, Pennsylvania, Virginia and West Virginia.The 2015 MATRC Summit “Shaping the Future of Healthcare through Innovation and Technology” will be held March 29-March 31, 2015, at The Greenbrier, White Sulphur Springs, West Virginia. The Summit will explore how the partnership of human innovation and technological advancements is both shaping and transforming the future of healthcare.For further information and registration, visit: http://matrc.org/summit/index.html

A Framework for Inclusive Educational Delivery Systems

Abstract This article introduces a theoretical framework for an inclusive educational delivery system to increase academic, behavioral, and social outcomes for all students with a variety and range of abilities. The framework is a fully braided delivery system that brings together evidence-based practices for individual school systems and structures, district and state education policy, and family and community engagement. We describe (a) systemic and structural challenges to inclusive education, (b) the framework and its evidence-based features, and (c) a technical assistance resource that builds educational agency capacity to independently implement and sustain inclusive educational delivery systems in their communities.

Integrated Data System Person Identification: Accuracy Requirements and Methods

This report responds to a Workforce Data Quality Initiative (WDQI) challenge — the unreported quality of person identification (PI) features in many integrated data systems (IDS) that link confidential workforce, education and social services administrative records.The importance of the PI topic reflects concern that many local K-12 education agencies do not collect student Social Security Numbers. Some conclude from this widespread omission that linkage of secondary student records with workforce data may be impossible. However, others have adopted ad hoc and commercial software solutions to bridge this gap. To date no standard record linkage method has been endorsed.Will performance dashboards and research findings based on IDS information be accepted as trustworthy by individuals making important appropriation of funds, policy and program-level resource allocation decisions? Should IDS public-use releases be believed and acted upon?A standard technical language is used in professional communication about PI topics. Record linkage can be pursued using exact matching or statistical matching. Within the exact matching portfolio are deterministic and probabilistic methods. And within the deterministic portfolio are direct and hierarchical methods.A familiar first step among WDQI award teams is application of exact matching when two or more administrative data files each contains a SSN field. This first step is also the last step in some record linkage actions, which introduces selection bias threats, singly or in various combinations. Confirmation that a SSN has been issued, and is therefore valid, does not mean that the valid nine-digit SSN was issued to the person associated with this SSN in one or more administrative data files.We completed a series of three record linkage steps: (1) determine what candidate identifiers are available in each administrative data set; (2) use Link Plus software to carry out multiple deterministic and probabilistic PI diagnostics; and (3) examine the potential matched pairs identified in step two, assigning each pair to one of three categories — match, non-match, or uncertain match. Our intent has been to illustrate typical PI accuracy challenges that are found in administrative data files. These challenges occur over time within a single administrative data source and among different administrative data files.Our diagnostic findings are not amenable to summary coverage. Sections 5 and 6 describe what steps we undertook and what we found. Given our diagnostic findings to date: So what? If left unresolved, can a PI of unreported and perhaps unknown quality translate into unacceptable deficiencies in information, conclusions and recommendations that are released to stakeholders making important decisions about appropriation of funds, policies and program-level priorities?PI accuracy is a necessary first step for successful integration of multiple administrative data sources. This is a universal requirement that applies to any and all attempts to link unit-record person specific administrative data sources.Avoidance of stakeholder skepticism — rejection at worst — is within our collective control, but we need to take positive steps now to retain this control. Lost confidence is difficult to recover. We need to be out in front of this potential threat to realization of the return on past, current and future IDS investments.We are not aware of an ongoing serious and sustained professional conversation about the criteria that are appropriate to define PI accuracy tolerances for specific applications. This conversation is needed because the community of practitioners does not know whether we are over- or under-investing in PI technologies and applications.We encourage the U.S. Department of Labor, Employment and Training Administration WDQI leadership team to propose an appropriate forum — perhaps through the technical assistance resources of Social Policy Research Associates — to ensure immediate attention to the PI accuracy topic.

Small Business Financial Health Analysis

The Small Business Financial Health Project is a joint initiative of the Community Development divisions of the Federal Reserve Banks of Chicago and San Francisco, FundWell, Inc and Pepperdine University Private Capital Markets Project. The purpose of the project is to raise awareness about small business financial health, in order to highlight policies, investments, financial and technical assistance resources needed to help small businesses achieve their goals. This report presents the results and findings from a Financial Health Business Survey that was administered in 2013 and initiates a discussion around the factors that drive the sustainability and growth of small enterprises.

Resource needs for a socially just and sustainable urban agriculture system: Lessons from New York City

AbstractMany urban agriculture programs, and the organizations that run them, require substantial resources to remain viable and provide the multifunctional benefits that practitioners and supporters hope to achieve. As urban agriculture activity expands, practitioners and supporters face significant challenges, including how to match resources to the needs of practitioners and expectations of municipalities, and how to distribute those resources effectively and equitably so that communities, and the city as a whole, capture the benefits of these projects. This is particularly important as cities face increasing pressure to reduce costs and maximize the return on public expenditures. A 2-year study called Five Borough Farm documented the goals and objectives of urban agriculture projects in New York City and the resources for their success. The data showed that resource needs go beyond the material and financial needs discussed in the urban agriculture literature (e.g., land, soil, money). Interviews documented that urban agriculture projects have broader goals than merely producing food, and that attaining these goals (e.g., environmental improvements, community development, social justice) requires the support of government and networks of practitioners, non-profit organizations and philanthropies. Moreover, interviewee comments suggested that significant disparities in access to resources make the urban agriculture system in New York unequal and constrain the efforts of some farms and gardens. This paper, based on the Five Borough Farm research, examines the resource needs of urban agriculture operations in terms of farm and garden viability and equity among practitioners. It describes the goals, expectations and resource needs of New York City urban agriculture from the perspectives of farmers and gardeners, and from the views of city officials, funders and supporting non-profits. It discusses the need for attention to the political and social structures that create disparity and precariousness to ensure a sustainable and just urban agricultural system, in addition to the financial and technical assistance resources that enable farmers and gardeners to produce food. The paper concludes with recommended strategies to align resource needs and urban agriculture goals and expectations in New York and other cities.

Implementing a multicomponent school-based obesity prevention intervention: a qualitative study.

To explore barriers and facilitators to implementing and sustaining Healthy Choices, a 3-year multicomponent obesity prevention intervention implemented in middle schools in Massachusetts. Using purposive sampling, 56 in-depth interviews were conducted with middle school employees representing different positions (administrators, teachers, food service personnel, and employees serving as intervention coordinators). Interviews were recorded and transcribed. Emergent themes were identified using thematic analyses. State-mandated testing, budget limitations, and time constraints were viewed as implementation barriers, whereas staff buy-in, external support, and technical assistance were seen as facilitating implementation. Respondents thought that intervention sustainability depended on external funding and expert assistance. Results confirm the importance of gaining faculty and staff support. Schools implementing large-scale interventions should consider developing sustainable partnerships with organizations that can provide resources and ongoing training. Sustainability of complex interventions may depend on state-level strategies that provide resources for implementation and technical assistance.