Universal Service Research Articles

Public Awareness and Perception of the Swasthya Sathi Scheme: Insights from Beneficiaries and Non-Beneficiaries in the Uttar Dinajpur District, West Bengal

The Swasthya Sathi Public Health Program in West Bengal aims to deliver universal medical services to underprivileged groups. This ambitious initiative offers monetary aid and a simple admission to medical care. This analysis explores how computerization optimizes Sathi’s performance and reach. Owing to progress in digitization, the scheme has benefited from streamlined operations, enhanced patient documentation, and better treatment availability. Innovations, such as online registration, digital health cards, and telehealth, have significantly decreased administrative costs and delays, allowing beneficiaries to access care more conveniently. Digitalization has also facilitated real-time data aggregation and tracking, allowing better policy formation and a more efficient allocation of funds. This study examines how digital tools impact various aspects of a scheme’s performance by analyzing case studies and real data from multiple districts in West Bengal. The findings underscore how computerization contributes to the success of the scheme by addressing issues such as fraud prevention, timely reimbursement, and expanded access to healthcare. In the end, this study calls for digital remedies to be fully integrated into Swasthya Sathi's framework to make it stronger and use it as a model for other Indian government-funded health programs.

Analysis of Incentive Compatibility Mechanism for Content Services of Gas Companies under the Background of Universal Service

In recent years, the issue of gas billing has attracted widespread attention from the public, leading to a crisis of trust in gas public goods and services. From the perspective of universal service, based on the characteristics of the gas supply industry under monopoly conditions, this paper analyzes the reasons for the lack of motivation of gas companies to provide perfect content services, and uses incentive theory to explore the incentive compatibility mechanism of gas companies' content services, in order to promote gas companies to use the Internet, big data, cloud computing technology to provide consumers with perfect content services, so as to enhance social harmony and stability.

Government Accountability in Universal Services in Collaborative Regulation: A Perspective on the General Principles of Good Governance (AUPB)

Universal telecommunication services are one of the government's efforts to ensure equitable accessibility of telecommunication services for all levels of society. However, at this time, telecommunications regulation is entering a collaborative generation, which is characterized by the cooperation of various entities to deal with the impact of the widespread digital economy. The purpose of this study is to analyze the extent to which the government has fulfilled its obligations and responsibilities in providing equitable access to telecommunications in the era of the collaborative generation. The research method used is normative juridical with a qualitative approach. The results of this study indicate that while there has been progress in implementing the General Principles of Good Governance in universal telecommunications services, challenges remain in the areas of transparency and accountability, particularly in the allocation of funds and resources. Additionally, disparities in access between urban and rural areas persist, despite collaborative regulatory efforts. The study found that government initiatives, though well-intentioned, require stronger oversight and more inclusive policies to ensure fair and equitable access to telecommunications for all segments of society.

LGBTQ+ Families, Welfare, and Same-sex Marriage Legalisation in Taiwan: A Social Policy Perspective

This article examines whether and to what extent legalised same-sex marriage can assist lesbian, gay, bisexual, trans, and queer (LGBTQ+) people to develop family life and protect them from defamilisation and familisation risks. It focuses on the provision of and gaps in welfare for LGBTQ+ people since Taiwan’s same-sex marriage legalisation in 2019. A content analysis of online community discussions since marriage equality shows that local LGBTQ+ community discussions were filled with concerns about the lack of familial status for cross-border couples, lack of legal parental status and rights for same-sex parents, and questions about heteronormative values and kinship ties. This article reveals how heteronormative assumptions embedded in the policy system and in the wider society adversely influence LGBTQ+ people’s welfare, and identifies supplementary and alternative measures. It highlights the importance of providing universal basic services free from heteronormative biases and prioritising the well-being and rights of all citizens.

New Challenges in Times of Crisis

In the decades since the European Union’s energy policy was established, we have witnessed a process of development which has resulted in the field being regulated by the Treaty in its own legal framework and has continued to evolve to the present day. Governance at the EU level has become more important in the field of energy policy, but the crises have led to an increasing role for Member States. The EU’s single rule aims to ensure a level playing field for market players in the competitive sector, while preventing unfair competitive advantages for companies created by or benefiting from public or state resources. The EU state aid rules have undergone significant changes in the last few years. State subsidies are part of competition policy, which aims to ensure an efficient economy and consumer welfare. Among the market failures in the energy sector, the most significant disadvantage is the presence of externalities and natural monopolies. These need to be addressed through government assistance and its direct and indirect regulatory instruments. Competition law also covers economic services of general interest, which are closely linked to the issue of state subsidies. Member States have discretion to define services of general economic interest, subject only to the limits set by EU law, and to avoid manifest error of assessment. The energy packages include the term “universal service” for electricity, but not for gas, leaving it to the discretion of the Member State to decide on the latter. The crises have brought with them a breakdown of neoliberal ideas and, as a consequence, a strengthening of the tendencies in favour of state regulation. In most Member States, we are witnessing a closure, voices critical of the EU in many respects (e.g. Hungary and Poland in the context of the Art. 7 procedure) and Brexit has had a negative impact on communitarisation policies.

4.N. Scientific session: Equity in Child Health: Leveraging Universal Health Promotion Services for Families Amid Uncertainty

Abstract This workshop addresses the urgent need to foster resilience and equity in child health within the context of an increasingly uncertain Europe. Rapid societal changes, exacerbated by events such as the COVID-19 pandemic and heightened risks of conflict, climate change and economic instability, underscore the importance of nurturing environments where children can thrive despite challenging circumstances. The workshop aims to explore strategies for promoting well-being and addressing social inequalities in child health within the context of universal health promotion services, such as school health services and child health clinics. Objectives are to 1) Elucidate the importance and impact of universal health promotion services in addressing social inequalities and promoting equitable opportunities for all children, regardless of background or circumstance; 2) Identify actionable steps for interventions mitigating social inequalities and promoting equitable opportunities focusing on health literacy among parents with immigrant backgrounds; 3) Showcase successful models and initiatives in universal healthcare and health promotion services for children and families, emphasizing early intervention and standardized evaluation tools; and 4) Facilitate dialogue and knowledge exchange among professionals, policymakers, and stakeholders involved in child and adolescent health promotion. This workshop’s added value lies in its multidisciplinary approach, fostering collaboration for innovative solutions in child health resilience and equity. The coherence between presentations lies in their joint focus on addressing social inequalities in the context of universal health promotion services for children and families. Each presentation offers a unique perspective on these themes, contributing to a comprehensive understanding of the challenges and opportunities in child health promotion. • Hanne Nissen Bjørnsen’s presentation on the role of universal services in public health and addressing social inequality sets the stage by examining the structural factors contributing to disparities in child health outcomes. • Kirsti Riiseŕs presentation conveys the importance of user, stakeholder, and community involvement in creating culturally sensitive strategies for effective health promotion services in the context of health literacy among parents with immigrant backgrounds • Kristin Haraldstad’s presentation on Starting Right, an evidence-based assessment of children in municipalities healthcare centers, highlights the importance of early intervention and targeted support in mitigating health inequalities and promoting well-being. Format of the workshop: Three 10-minute presentations followed by a 20-minute moderated discussion to delve into empowerment and equity in child health, encouraging rich idea exchanges. Key messages • Leveraging universal health promotion services effectively empowers children and families while addressing social inequalities amidst periods of uncertainty. • Collaborative, user-centered approaches and evidence-based working strategies are key to promoting equity and building resilience in child health.

Healthy city development: Indonesian government plans to build a new capital city

The urgency of urban health in Indonesia is very worrying because most of Indonesia’s population now lives in urban areas with minimal supporting infrastructure. That prompted this study to analyze the government’s response to the healthy city development plan in the new capital city. This study uses a qualitative approach that focuses on thematic analysis. It helps check official government documents related to healthy city development plans. The relevant documents that were found were in the form of regulations. This regulation is Law of the Republic of Indonesia Number 3 of 2022 concerning the National Capital (Ibu Kota Negara, IKN). This official document was coded by maximizing the analysis tool, namely NVivo 12 Plus. This study succeeded in mapping several bare references in the healthy city development plan for the new capital city by the Indonesian government. Some of these primary references include the healthy city model (World Health Organization, WHO), the healthy city strategy (Cardiff), and (Vancouver). All of these primary references aim to improve the quality of life of residents in cities through city development that focuses on health. However, there are several challenges that the Indonesian government may face in the future, including problems with air pollution, environmentally friendly transportation, and the provision of green public spaces, health facilities, universal health services, and other infrastructure. This all requires adequate capacity and budget plans, including ensuring transparency in budget management. This study also encourages collaboration between the government, the private sector, and civil society to support the development of healthy cities that run well and sustainably.

Prevalence and Late-Infancy Predictors of Persistent Externalizing Problems During Early Childhood: Child and Family Factors to Consider for Early Screening

This study determined prevalence and late-infancy predictors of persistent externalizing problems during early-childhood for screening in clinical practice. 1353 primary-caregivers with 8-month infants were recruited systematically from universal well-child centers and followed to 4–5 years (‘Families in Mind’ population-based randomized trial). Externalizing problems were measured by Child Behavior Checklist at 2, 3 and 4–5 years; child/family predictors at 8–12 months. Four percent of toddlers developed persistent externalizing problems of clinical concern (≥2 time-points). Key late-infancy predictors were primary-caregiver distress, harsh discipline and low nurturing. Findings suggest benefits of screening these family factors in late-infancy via universal services to identify early-starters’.

Universal Service Regulation and Network Effects in Services of General Economic Interest in the European Union

The process of the liberalisation of services of general economic interest (SGEI) in the EU adopted the universal service (US) regulatory model. The objectives of the process were to strengthen free competition and improve social welfare. SGEIs have the characteristic of networked services and, as such, generate network externalities, as considered by the theory of market failures. This paper analyses the potential of the US in its role as a remedy for network externalities. In the SGEI context, the large number of participants reinforces network externalities, while limiting coordination mechanisms between users. Based on the relevant literature, a theoretical debate arises around the contribution of universal service obligations (USOs) to social welfare. A microeconomic analysis shows that USOs modify consumers’ utility functions by shifting from inefficient market equilibria to efficient equilibria, thereby improving social welfare.

OPTIMUM DESIGN OF INTENSIVE CARE UNIT- AN EVIDENCE- BASED HEALING ENVIRONMENT

Successfully designing a new ICU requires clarity of vision and purpose and the recognition that the patient room is the core of the ICU experience for patients, staff, and visitors. The ICU canbe conceptualised into three components: the patient room, central areas, and universal support services. Each patient room should be designed for single patient use and be similarly configured and equipped. The design of the room should focus upon functionality, ease of use, healing, safety, infection control, communications, and connectivity. All aspects of the room, including itsinfrastructure; zones for work, care, and visiting; environment, medical devices, and approaches to privacy; logistics; and waste management, are important elements in the design process. Since most medical devices used at the ICU bedside are really sophisticated equipments, the ICU needs to be capable of supporting the full scope of medical informatics. The patient rooms, the central ICU areas (central stations, corridors, supply rooms, pharmacy, laboratory, staff lounge, visitor waiting room,) and the universal support services (infection prevention, finishings & and flooring, staff communications, signage & wayfinding, security and fire & safety) work best when fully interwoven. This coordination helps establish efficient and safe patient throughput and care and fosters physical and social cohesiveness within the ICU. Synchronisation of the universal support services in the ICU with the hospital’s existing systems maintains unity of purpose and continuity across the enterprise and avoids unnecessary duplication of efforts.

Health and wellbeing of survivors of sexual violence and abuse attending sexual assault referral centres in England: the MESARCH mixed-methods evaluation.

One million people in England and Wales experience sexual violence and abuse each year, with nearly half experiencing serious sexual offences; around 30,000 survivors access sexual assault referral centres. This research was commissioned by National Institute for Health and Care Research to evaluate access, interventions and care pathways for survivors, especially those provided through sexual assault referral centres. The sexual assault referral centres care pathway was investigated through six sub-studies. There were two Cochrane Reviews (4274 participants). Seventy-two providers and 5 survivors were interviewed at eight sites; the children and young people study involved 12 participants from two sexual assault referral centres. A cohort study involving three-wave data collection over 1 year (21 sites; 2602 service users screened, 337 recruited) used a multilevel modelling framework to explore risk factors for burden of post-traumatic stress disorder symptoms at baseline and change at 1 year. We analysed costs and outcomes and conducted a narrative analysis (41 survivors). We worked closely with survivors and prioritised the safety/welfare of participants and researchers. Cochrane Reviews identified large effects from psychosocial interventions for post-traumatic stress disorder and depression. Sexual assault referral centres delivered a high-quality frontline service for survivors but groups experiencing domestic abuse and some ethnic and cultural minorities were under-represented. The qualitative research emphasised inter-agency collaboration for survivor benefit. The cohort study identified a risk 'triad' of adverse childhood experiences, poor mental health and economic deprivation, which was associated with baseline trauma burden. There were important improvements in trauma symptoms a year later. These improvements were unrelated to different sexual assault referral centre models. Costs and other outcomes were also similar across models. Harmful policing and justice practices/procedures were identified by 25% of participants. In this context, trauma-competent interviewing techniques, regular/timely updates and conveying case decisions with care signalled good practice. The cohort study lacked a comparison group, reducing confidence in the finding that access to sexual assault referral centres explained the reduction observed in post-traumatic stress disorder. Barriers to access call for concerted efforts to implement trauma-informed universal health services. The risk 'triad' underscores the value of holistic approaches to care at sexual assault referral centres and timely follow-on care. Poor mental health was the main barrier to service access beyond sexual assault referral centres. The persistence of trauma symptoms a year after accessing sexual assault referral centres signals urgent need for tackling counselling wait-lists, expanding support options and commitment to lifelong care. Multidisciplinary evaluation of sexual assault referral centres for better health provides a foundation for advancing trauma-informed practices in the context of sexual violence and abuse. This study is registered as ISRCTN30846825 https://doi.org/10.1186/ISRCTN30846825. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 16/117/04) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 35. See the NIHR Funding and Awards website for further award information.

A Randomized Controlled Trial of the City Year Whole School Whole Child Model's Tier 2 Services in Five Urban School Districts

The paper reports results from an evaluation of City Year's Whole School Whole Child (WSWC) model's Tier 2 services in 22 middle schools in five urban school districts before the COVID-19 pandemic. Student Success Coaches provide universal holistic services and Tier 2 services to students based on assignment to one or more “focus lists” of students recommended based on one or more early indicators that are associated with whether students will stay in school and graduate from high school. The effects of Tier 2 services on student math and ELA achievement, attendance, social-emotional skills, and suspensions were evaluated using a two-year, individual randomized controlled trial (RCT). The sample included 1,755 Grade 6 students randomly assigned to receive Tier 2 services or to the control group. There were no significant effects of Tier 2 services on student outcomes. Limitations of the study, including disruptions due to COVID-19 and the challenges of implementing an RCT as a method for studying a complex intervention, are discussed.

"Like an umbrella, protecting me from the rain until I get to my destination": Evaluating the implementation of a tailored primary care model for urban marginalized populations.

Improving health equity and access to the highest possible standard of health care is a key issue of social accountability. Centretown Community Health Centre in Ottawa, Canada has iteratively developed a program to target and serve marginalized and complex populations since 1999. The program implementation was evaluated using a validated implementation framework. Quantitative and qualitative data were collected through a health records extraction (n = 570), a client complexity assessment tool (n = 74), semi-structured interviews with clients and key stakeholders (n = 41), and a structured client satisfaction survey (n = 30). Data were analyzed using descriptive statistics and inductive thematic analysis. Five hundred and seventy unique clients were seen between November 1-30, 2021. A third of clients (34%) did not have a provincial health card for access to universal health care services, and most (68%) were homeless or a resident of rooming houses. Most clients who reported their income (92%) were at or below Canada's official poverty line. The total mean complexity score for clients seen over a one-month period (n = 74) was 16.68 (SD 6.75) where a total score of at least 13 of 33 is perceived to be a threshold for client biopsychosocial complexity. Clients gained the majority of their total score from the Social support assessment component of the tool. Clients (n = 31) and key informants (n = 10) highlighted the importance of building relationships with this population, providing wrap-around care, and providing low-barrier care as major strength to the Urban Health program (UH). Key areas for improvement included the need to: i) increase staff diversity, ii) expand program hours and availability, and iii) improve access to harm reduction services. Clients appeared to be highly satisfied with the program, rating the program an average total score of 18.50 out of 20. The program appears to serve marginalized and complex clients and seems well-received by the community. Our findings have relevance for other health care organizations seeking to better serve marginalized and medically and socially complex individuals and families in their communities.

How does health visiting in the first year of life vary by family characteristics? A longitudinal analysis of administrative data.

The health visiting service in UK promotes the health and wellbeing of families with young children and comprises a universal offer (three mandated contacts between birth and 12months) and additional contacts based on need. We aimed to understand how the level of health visiting support received varies by family characteristics. Using the Community Services Data Set linked to Hospital Episode Statistics, we identified 52 555 children in 10 local authorities with complete health visiting data for 12months between April 2016 and March 2020. We analysed variation in health visiting contacts by deprivation, child ethnicity, maternal age, adversity and previous live births. 41 340/52 555 children (79%) received the universal service; 63% received ≥1 additional contact and 25% received ≥3 additional contacts. The likelihood of receiving ≥3 additional contacts was greatest for children whose mothers had a history of hospital admissions relating to mental health, violence, self-harm or substance misuse (adjusted relative risk=1.55, 95% confidence interval 1.26-1.92). Most families received health visiting support in addition to the universal service. Policymakers and commissioners should consider how health visiting services can be expanded or targeted more effectively to ensure all families receive the support they need.

An Overview of Health Care Support of Intimate Partner Violence Survivors

Intimate Partner Violence (IPV) has severe physical and psychological effects on survivors. Despite growing awareness, accessing comprehensive health care remains a challenge for many survivors. This review aims to assess the impact of IPV on the survivors, health care needs, and interventions for IPV survivors, evaluate their effectiveness, and identify areas for improvement. This paper reviewed literature and guidelines from reputable journals with a focus on studies about health care support, including interventions and outcomes for IPV survivors. The paper found there is a need for routine IPV screening in health settings, effective multidisciplinary care, and better training for healthcare providers. Barriers such as stigma, resource limitations, and inadequate referral systems were common. Survivors also face difficulties accessing the healthcare system due to fear and confidentiality issues. Quality and effective support requires universal screening, trauma-informed care, and accessible services. While some practices are beneficial, there is a need for standard and improved provider training. Policymakers should focus on overcoming systemic barriers and enhancing support services. The support system for IPV survivors is improving but still faces significant challenges. Addressing these issues through better policies, resources, and training is crucial for providing effective care and reducing the long-term impact of IPV. Keywords: Intimate Partner Violence, Health Care Support, Survivor support, Multidisciplinary Approaches, Trauma-Informed Care

Enhancing Agriculture through AloT and Data Analytics Middleware

Middleware in Agriculture delves into the data analytics role of systematic Artificial Intelligence of Things (AIoT) in convergence agriculture with smart farming. AIoT devices, remote diagnostic data analytics platforms, data analytics, formal recognition, and vision learning have generated both the amount and nature of work in rural areas. The reason for the developing changes in the global population by age is the bias in the distribution of food resources, as well as changes in climate change and the soil condition of compost. Data scientists are soon attempting to dive convergence Internet of Things (IoT) advances in savvy cultivating to support ranchers in producing better seeds, crop assurance, and manures utilizing AIoT convergence technology[1]. This distinguishes consumer-provider-administrator as a service subscriber roleon the platform, which goes for earning the nation's economy and the profitability of ranchers. The central regions where AIoT begins to emerge are agricultural robots, scrutiny, and soil and yield observation. While middleware technology for data analysis is applied, there is a great advantage of analyzing regional observation data at a real-time level. Based on this analysis method, it will spread to high-tech industries connected to production, processing, and consumption, which are subdivided areas of each precision agriculture. In this sense, ranchers are utilizing sensors for data analysis and soil information in a detailed way to gather a model that the executives dynamic platforms might use for further examination. Through an outline of real-time data analytics AIoT applications in the farming convergence industry, this paper tries a trust data basement forecast to the farming protocols[2]. It starts with a roadmap to the AIoT and an investigation of real-time data strategies utilized in the horticultural industry data analytics using Universal Middleware, service platforms, vision learning, and dynamic statistics. This study advances a dynamic platform examination of the literature on data resources and how AIoT is utilized in farming convergence. This study looked at the unstructured systems of modern agriculture, divided these processes into devices and services, and presented a systematic formalization model. It should contribute to the integration of segmented data connectivity in the AIoT field. The enhanced research model contributes to the discovery of numerous untapped additional services between devices and services.

Acceptance of IoT-based E-coin Track-and-trace: A Case of the Digital Euro Project in Italy

As the world becomes increasingly digitalised, there are growing concerns about the use of big data and machine learning techniquesto monitor and control citizens’ spending habits. This is particularly the case regarding Central Bank Digital Currencies (CBDC), whichare being trialled by an increasing number of countries. There is a perception that such currencies could violate privacy due to thecentralisation of money liability. The aim of this research is to assess whether a universal e-coin level tracking service of money and public expenditures, available to everyone and inspired by Internet of Things (IoT) architectures and standards, could instil trust ininstitutions while increasing the acceptance of CDBCs. The research methodology comprises three key elements: (i) the conceptualisation and implementation of an IoT-based CBDC, (ii) a qualitative, technical and compliance assessment with regard to the specific reference to the Digital Euro (D€) project, and (iii) a survey we conducted among 351 respondents to ascertain the potential for CBDC acceptance within Italy. The results demonstrate that the prototype is a viable concept despite storage limitations. Furthermore, 73.83 percent of respondents who initially expressed scepticism indicated that they would be more inclined to adopt the CDBC instrument if a universal track-and-trace tool of money were made available.

Minnesota’s energy paradox: Household energy insecurity in the face of racial and economic disparities

The “Minnesota Paradox” points to the nation-leading socioeconomic indicators enjoyed in Minnesota that belie some of the largest racial disparities between the state’s majority White and minority Black populations. The Minnesota Paradox has been identified in indicators with complex, structural social determinants: income, employment, educational outcomes, incarceration rates, home ownership, and even drowning. In this paper, we ask if similar disparities exist in access to shared infrastructure systems, focusing on the electric system, an essential service delivered by heavily regulated public utilities. We examine disparities in access to electricity service across three dimensions: utility disconnection, service reliability, and availability of the grid to host distributed energy resources. We quantify disparities across Census block groups by leveraging unique, high-resolution datasets that have only recently been made publicly available. We find significant and pervasive evidence of the Minnesota Paradox across utility disconnection and service reliability. Across a battery of regression models, we find that living in neighborhoods with a greater concentration of people of color is associated with a statistically and practically significant difference in the likelihood of disconnection from service due to non-payment and the experience of extended power outages. We also find a positive association between communities with larger populations of people of color and hosting capacity, suggesting a potential opportunity to affirmatively address disparities in energy insecurity in the energy transition. These findings shed light on the pervasive nature of the Minnesota Paradox in the electric system, which underscores the pressing need for policy initiatives to rectify deep-seated inequalities and ensure all communities have equitable access to universal basic utility service and reliable, clean energy.

Unequal geographies of gender-affirming care: A comparative typology of trans-specific healthcare systems across Europe

RationaleGender-affirming healthcare can carry significant benefits for trans people. However, there are substantial geographical inequalities in the provision of and access to trans-specific healthcare across Europe. Comparative healthcare systems research has typically focused on universal services, neglecting provision which serves specific groups within populations (e.g., trans people). ObjectiveThis study aimed to develop a comparative typology of trans-specific healthcare systems across 28 European countries (the EU 27 plus the UK), and to examine country-level correlates which may influence or be influenced by these systems. MethodsUsing hierarchical and k-means cluster analysis, countries were classified into four types based on measures of trans-specific healthcare provision, regulation and access. Possible country-level correlates (including socio-political climate, medical outcomes, and the general healthcare system) were investigated. Results and discussionThe cluster analysis identified four clusters of trans-specific healthcare systems in Europe, characterized as: 1) Centralized conservative (highly centralized, extensive range of treatments, few trans-specific government policies); 2) Centralized reformist (highly centralized, extensive range of treatments, multiple trans-specific government policies); 3) Decentralized marketized (highly decentralized, moderate range of treatments, few trans-specific government policies); 4) Underdeveloped (highly decentralized, limited range of treatments, few or no trans-specific government policies). We found statistically significant differences between the clusters in rates of: public support for trans people; gender identity concealment; treatment access; overall health expenditure; gender inequality. ConclusionsThe study develops a novel typology of trans-specific healthcare systems in Europe. It also identifies a range of potential drivers and outcomes of geographical divergences and inequalities in trans-specific healthcare provision. Building on this typology, future comparative research should aim to link the structure of healthcare systems to outcomes for trans people. Comparative healthcare systems research must account for the distinctive forms taken by services and systems that provide healthcare to specific groups within populations.

Guidelines for Adapting Mindfulness-Based School Interventions with Youth Who Are Racially and Ethnically Marginalized

ABSTRACT Youth who are racially and ethnically marginalized in the United States are placed at risk for mental health disparities and inequities. We propose that promoting social-emotional competencies through universal school-based service delivery is one potential solution for improving the accessibility and quality of support for these youth. We further propose that mindfulness-based school interventions may be especially useful as universal supports for promoting social-emotional competencies, as they are broadly effective, low-cost, scalable, and flexible. This work unpacks the empirical and logical proposition driving this proposal, and then provides guidelines to help school-based consultants (e.g., school psychologists, counselors, social workers, and other mental health professionals in schools) translate this proposition into practice. Our guidelines have two emphases: first, we offer recommendations for consultants to support implementers in tailoring mindfulness-based school interventions to engage the student population; second, we discuss strategies for consultants to support implementers themselves as they engage with the process of implementing mindfulness-based interventions in schools.