Virtual Support Research Articles

A multi-component tailored intervention in family childcare homes improves diet quality and sedentary behavior of preschool children compared to an attention control: results from the Healthy Start-Comienzos Sanos cluster randomized trial

BackgroundChildcare settings are important environments for influencing child eating and physical activity (PA). Family childcare homes (FCCH) care for many children of low-income and diverse racial/ethnic backgrounds who are at greater risk for poor diet quality, low PA, and obesity, but few interventions have targeted this setting. The aim of this study was to assess the efficacy of a multicomponent intervention conducted in FCCH on the diet quality and PA of 2–5 year old children in their care.Trial designCluster randomized trial.MethodsThe cluster-randomized trial, Healthy Start/Comienzos Sanos (2015–2019) evaluated an 8-month nutrition and PA intervention that included four components: (1) monthly telephone calls from a support coach using brief motivational interviewing, (2) tailored reports, newsletters and videos, (3) group support meetings, and (4) active play toys. After completing baseline measurement, FCCH were randomized into intervention or comparison groups in matched pairs. Both groups received the same intervention components but on different topics (intervention: nutrition/PA vs. comparison: reading readiness/literacy). Evaluation staff were blinded to group assignment. Child primary outcome measures collected at baseline and 8-months included: 1) Healthy Eating Index (HEI-2015) scores calculated from diet observation, and 2) accelerometer measurement of PA. Process measures were collected from field data and provider surveys. Generalized Estimating Equation Models assessed changes in HEI-2015 scores and PA over time by experimental condition.ResultsEthnically diverse FCCH providers (n = 119) and 2-to-5-year-old children in their care (n = 377) were included in the final analysis. Process evaluation showed high participation in all intervention components except for group meetings. Compared to children in comparison group FCCH, children in intervention FCCH increased total HEI-2015 scores by 7.2 points (p < .001) including improvement in component scores for vegetables (0.84 points, p = .025) and added sugar (0.94 points, p = .025). For PA, compared to children in the comparison group, children in intervention FCCH decreased sedentary time by 5.7% (p = .021).ConclusionsThe multicomponent Healthy Start intervention was effective in improving diet quality and sedentary behavior of children in FCCH, which demonstrates the promise of obesity prevention interventions in this setting. Future research could include enhancing the Healthy Start intervention to strengthen the PA component, considering virtual peer support, and determining how to best translate and disseminate the intervention into FCCH nationally.Trial registrationNational Institutes of Health, NCT02452645. Registered 5 May 2015.

SmartFVM: A Fast, Flexible, and Scalable Hardware-based Virtualization for Commodity Storage Devices

A computational storage device incorporating a computation unit inside or near its storage unit is a highly promising technology to maximize a storage server’s performance. However, to apply such computational storage devices and take their full potential in virtualized environments, server architects must resolve a fundamental challenge: cost-effective virtualization . This critical challenge can be directly addressed by the following questions: (1) how to virtualize two different hardware units (i.e., computation and storage), and (2) how to integrate them to construct virtual computational storage devices, and (3) how to provide them to users. However, the existing methods for computational storage virtualization severely suffer from their low performance and high costs due to the lack of hardware-assisted virtualization support. In this work, we propose SmartFVM-Engine , an FPGA card designed to maximize the performance and cost-effectiveness of computational storage virtualization. SmartFVM-Engine introduces three key ideas to achieve the design goals. First, it achieves high virtualization performance by applying hardware-assisted virtualization to both computation and storage units. Second, it further improves the performance by applying hardware-assisted resource orchestration for the virtualized units. Third, it achieves high cost-effectiveness by dynamically constructing and scheduling virtual computational storage devices. To the best of our knowledge, this is the first work to implement a hardware-assisted virtualization mechanism for modern computational storage devices.

The advantages of virtual dogs over virtual people: Using augmented reality to provide social support in stressful situations

Past research highlights the potential for leveraging both humans and animals as social support figures in one’s real life to enhance performance and reduce physiological and psychological stress. Some studies have shown that typically dogs are more effective than people. Various situational and interpersonal circumstances limit the opportunities for receiving support from actual animals in the real world introducing the need for alternative approaches. To that end, advances in augmented reality (AR) technology introduce new opportunities for realizing and investigating virtual dogs as social support figures. In this paper, we report on a within-subjects 3x1 (i.e., no support, virtual human, or virtual dog) experimental design study with 33 participants. We examined the effect on performance, attitude towards the task and the support figure, and stress and anxiety measured through both subjective questionnaires and heart rate data. Our mixed-methods analysis revealed that participants significantly preferred, and more positively evaluated, the virtual dog support figure than the other conditions. Emerged themes from a qualitative analysis of our participants’ post-study interview responses are aligned with these findings as some of our participants mentioned feeling more comfortable with the virtual dog compared to the virtual human although the virtual human was deemed more interactive. We did not find significant differences between our conditions in terms of change in average heart rate; however, average heart rate significantly increased during all conditions. Our research contributes to understanding how AR virtual support dogs can potentially be used to provide social support to people in stressful situations, especially when real support figures cannot be present. We discuss the implications of our findings and share insights for future research.

Lessons learnt from UNAIDS virtual technical support to countries applying for funding from the Global Fund COVID-19 Response Mechanism

In 2020 the Global Fund for AIDS, Tuberculosis and Malaria initiated a new funding modality, the COVID-19 Response Mechanism, to mitigate the pandemic’s effects on HIV, TB and malaria programmes and health systems in implementer countries. In 2021 UNAIDS introduced an innovative technical virtual support mechanism for COVID-19 Response Mechanism proposal development to help countries quickly implement COVID-19 interventions while at the same time adapting HIV and related services to the pandemic’s circumstances and mitigate its impact while maintaining hard-won gains. It also intended to ensure more attention was paid to communities, human rights and gender considerations in proposal development, resulting in successful proposals to mitigate COVID-19’s impact, bring human rights-based and people-centred HIV programmes back on track and even expand their reach through using new delivery platforms. In 2021, applications from 18 sub-Saharan African and Asian countries received in-depth remote peer reviews. We discuss the reviews’ key findings and recommendations to improve proposal quality and identify future opportunities for virtual technical support. The model was successful and contributed to better quality funding applications, but also highlighted challenges in pandemic mitigation, adaptations and innovations of HIV programmes. Countries still fell short on comprehensive community, human rights and gender interventions, as well as innovations in HIV service delivery, especially in prevention and gender-based violence. Several other weaknesses meant that some countries would have to refine their programme design and implementation model in the final version of their funding application. There are implications for future assistance to countries trying to mitigate the impact of COVID-19 on their health programmes and innovative ways to deliver technical support using new technologies and local expertise.

IDF21-0564 The Use of a Digital Self-Care Platform in The Control of Diabetes in People With Diabetes During the COVID-19 Pandemic

Background: People living with diabetes are at a high risk of suffering poor outcomes after being infected with COVID-19. In the early months of the pandemic in Nigeria, there was a dearth of face-to-face opportunities for people with diabetes to receive care and education on managing their condition. mDoc is a digital health social enterprise which provides virtual self-care support to people living with regular and chronic health conditions including diabetes through our CompleteHealth™ platform. This is a digital health platform where members, once registered, can monitor and track their health. This presentation describes how virtual self-care support was provided to members with diabetes during the pandemic. Aim: To examine how providing virtual self-care support during the COVID-19 pandemic to people living with diabetes is a viable method of helping them manage their condition. Method: A retrospective study was conducted with 88 members with diabetes registered onto the mDoc CompleteHealth™ platform between March 2020 and June 2021. Members were provided with self-care support through the mDoc’s virtual omni-channel support system: weekly messages were sent via WhatsApp and the CompleteHealth™ chat to members and the coach-led multidisciplinary care teams (including a nutritionist and fitness coach) called members to provide lifestyle modifications on diet and exercise as well as self-care education on diabetes management. The members were also encouraged to check their blood glucose levels regularly and adhere to their prescribed medications. The blood glucose levels of the members were collected through the CompleteHealth™ platform where members log in health metrics either by themselves or through their health coach. Members also received information on the COVID-19 prevention protocols and where to get vaccinated when COVID-19 vaccine rollout began in Nigeria. Results: The average age of members with diabetes registered on the CompleteHealth™ platform over the study period was 58 years old with 35.3% being men and 64.7% being women. Of the 88 members who received this virtual support, with multiple FBG values, 78 (88.6%) showed an improvement in their control of their blood sugar levels, with the average value for their FBG falling from 163.2 mg/dL at baseline to 133.6 mg/dL by June 2021. These members also saw their average weekly exercise duration increase from 59.3 minutes per week to 72.7 minutes per week. Discussion: We saw a decrease in blood sugar levels in a majority of members that received weekly virtual support from a health coach-led multidisciplinary care team over the 15 months that the self-care support was provided. This intervention helps people manage diabetes from afar, which is important as self-care has become an increasingly essential part of the global healthcare system, especially due to the limited access to face-to-face doctor consultations during the COVID-19 pandemic. We believe that empowering people with the self-efficacy they need to take care of themselves can lead to better control of their chronic disease which will eventually lead to better health outcomes.

IDF21-0566 Adherence to Foot and Eye exams Among People Living with Diabetes in Nigeria

Background: Adverse outcomes of diabetes such as diabetic foot gangrene and diabetic retinopathy are often as a result of poorly controlled glycemia and late detection of early signs of complications. But even where people are informed about these complications of diabetes, there is sparse data in Nigeria on whether patients with diabetes undergo routine foot and eye exams. mDoc is a digital health social enterprise which provides virtual self-care support to people living with regular and chronic health conditions including diabetes through our CompleteHealth™ platform. In our service provision, we see many members with diabetes and noticed that only a few of them reported having eye or foot exams. This presentation describes how we surveyed members to get a clear picture of their adherence to foot and eye exams in Nigeria. Aim: To examine adherence to foot and eye exams among people living with diabetes in Nigeria, using a digital self-care platform. Method: This was a survey conducted on members with diabetes registered on the mDoc CompleteHealth™ platform between September 2020 and August 2021. After onboarding, members were provided with self-care support through the mDoc’s virtual omni-channel support system: weekly messages were sent via CompleteHealth™ to members and the coach-led multidisciplinary care teams (including a nutritionist and fitness coach). They were provided with lifestyle modifications on diet and exercise as well as self-care education on diabetes management and the importance of foot and eye care. Also, they received advice on regular blood glucose levels checks and medication adherence. Members could also enter and track their health metrics via the CompleteHealth™ platform. The survey was administered by the health coach who called members to offer self-care guidance and advice on diabetes management. The members were asked if they had undergone a foot and/or an eye exam in the 12 months preceding the survey. Afterwards, data was collected via CompleteHealth™ for the analysis. Results: 103 members were contacted as part of the survey. Of these, 77 members responded at the time of calling. All 77 members responded to the first question regarding adherence to foot care. Of these, only 8 (10.5%) had undergone a foot exam in the preceding year. 71 members responded to the second question regarding adherence to eye care, and of these 16 (22.5%) answered “yes” indicating they had done one. Discussion: Our study showed that despite educating people with diabetes on the importance of foot and eye care and providing them with self-care support, there was low adherence to foot and eye exams. Although there was a general decrease in the average fasting blood glucose among members with diabetes of the platform (there was a reduction of 19 mg/dL among members over the same period), it is alarming to see such low adherence figures. While education on the control of diabetes is an important tool in reducing the incidence of retinopathy and foot complications, there is also a need to increase access to foot and eye care which is low across Africa.

IDF21-0182 Evaluating diabetes related distress in people with Type 2 DM – Insights from Diabefly Digital Therapeutics Platform

Background: Diabetes management is a lifelong process. This can add significant stress to an individual’s life. Stress raises blood sugar levels, impairs glucose tolerance, increases insulin resistance and impacts blood pressure. In India, there are no previous studies related to how digital therapeutics can help in dealing with several emotional and stress related concerns among people with Type 2 DM. In order to design an effective lifestyle modification program for management of issues like depression, anxiety and diabetes related distress, it is important to understand to what extent the disease has impacted people physically as well as emotionally. Hence, it becomes imperative to assess an individual’s stress levels so that a highly customized diabetes management program can be designed. Aim: The purpose of this study was to evaluate the level of distress among Indians who were diagnosed with Type 2 DM through Diabefly Digital Therapeutics platform. Method: 130 participants diagnosed with Type 2 DM were randomly included in the sample (57 females and 73 males with mean age = 46.8 years and SD = 12.16) from different parts of India who were a part of the Diabefly Digital Therapeutics program. This program provides virtual support to people with a multidisciplinary approach, having virtual support extended by psychologists, nutritionists and physiotherapists through mobile application. Digital logging of meals, app based psychometric assessments as well as access to motivational content are some of the key features of the program. Initial assessment of participants was done using Diabetes Distress Scale to investigate the prevalence and factors associated with diabetes related distress. The Spearman method was used for correlation analysis. P<0.05 was considered as statistically significant. Results: 55% of participants had high diabetes distress, 60% had high emotional burden of diabetes, 58% had high regimen distress, 23% had high interpersonal distress and 31% had high physician distress. HbA1c at baseline was found to be significantly correlated with physician distress (r = 0.176, P = 0.046). Discussion: The study demonstrates the assessment of diabetes related distress among participants using digital therapeutics program. Diabetes distress has been found to be significantly high. This indicates that emotional distress resulting from living with diabetes or the relentless burden of daily self-management of diabetes is definitely a core area of concern which needs attention. Harmony in relationships and adequate family support is also important in order to manage the increasing demands of the disease. Specialized psychotherapeutic intervention needs to be designed for managing diabetes for individuals who have high diabetes related distress, in order to help them manage their sugar levels effectively. On the basis of the results, it must be concluded that focussing on emotional and mental health is equally important as it is to pay attention to the physical health of people with diabetes, in order to manage the disease effectively.

A real-world comparison of in-person vs. virtual contraceptive care trainings for clinicians and support staff

ObjectivesTo conduct an exploratory analysis comparing in-person vs. virtual training programs about contraceptive care among clinicians and staff at 14 healthcare agencies in Washington state. MethodsSurvey data from in-person trainings were collected between July 2019 and March 2020 and from virtual trainings between June 2020 and January 2021. Primary outcomes: changes in contraceptive knowledge, understanding of contraceptive counseling and care, and participant engagement and experience with the training. ResultsPost-survey response rates for in-person trainings were 82% for clinicians and 72% for support staff while post-survey response rates for virtual trainings were 48% for clinicians and 43% for staff. Average knowledge scores for in-person clinician trainings increased from 63% prior to training to 80% post-training (p < 0.05), knowledge scores for virtual clinician trainings increased from 72% to 86% (p < 0.05), and the pre-to-post change in scores between training modalities was similar (p > 0.05 for the score difference). Average knowledge scores among in-person support staff trainings increased from 63% to 84% (p < 0.05), scores among virtual support staff trainings increased from 68% to 87% (p < 0.05) and, again, the pre-to-post change in scores between training modalities was similar (p > 0.05 for the score difference). Only minimal differences in survey scores between modalities were observed on most measures of participant engagement and experience with the trainings (p > 0.05 for most score differences). ConclusionsThese exploratory results suggest that in-person and virtual contraceptive care trainings yielded comparable results among both clinicians and support staff. ImplicationsResults from this post-hoc analysis of survey data suggest a general equivalency of effectiveness between in-person trainings and virtual trainings, although in-person trainings may be more satisfying or engaging for participants. Further work and research is needed to inform strategies for making virtual trainings more engaging and satisfying for participants.

Features of building virtual PBX

The article considers the features of organizing highly efficient telephone communication using cloud-based PBXs.&#x0D; The advantages of solutions based on IP-telephony compared to classical automatic telephone exchanges are treated. It is shown that the use of a virtual PBX as a separate configuration of a dedicated server will provide a flexible system of settings.&#x0D; The virtualization model is considered. The analysis of virtualization methods is carried out and it is noted that the result of their development is the emergence of multi-core processors, an increase in the throughput of computer interfaces, an increase in the capacity and speed of data storage systems. It is shown that each of these methods differs in hardware emulation methods and finds its place depending on the application.&#x0D; A solution using the Asterisk software product is considered for organizing the IP-telephony. The configuration of the virtualization environment setting is discussed. It is proposed to use a reliable PROXMOX VE infrastructure, which is an open source virtualization system and support for live migration.&#x0D; Studies have been carried out to determine the performance parameters of virtualization technologies, namely, hypervisor and container ones. It is noted that the main peak of the load on the OP is the assembly of the system from binary files, which requires significantly more resources (the load increases by about 2 times) than the preparation of these files. During the CPU load analysis, the virtual machine was found to be very demanding. It has been proven that virtual machines with hypervisor virtualization technology consume more server hardware resources than virtual machines with container virtualization technology.

A Study on Information Classification and Storage in Cloud Computing Data Centers Based on Group Collaborative Intelligent Clustering

Internet of things (IoT) and cloud computing are combined to form a cloud computing data center, and cloud computing provides virtualization, storage, computing, and other support services for IoT applications. Data is the foundation and core of cloud IoT platform applications, and massive multisource heterogeneous IoT data aggregation and storage have basic requirements such as real-time, security, and scalability. This paper focuses on the aggregation and storage methods of massive heterogeneous cloud IoT data, solving the multisource data aggregation problem caused by inconsistent protocols and the heterogeneous data storage problem caused by inconsistent data types. A heterogeneous network protocol adaptation and data aggregation method is proposed for the multisource data aggregation problem caused by protocol inconsistency. A protocol adaptation layer is set up in the IoT virtual gateway to achieve compatibility with multiple types of data aggregation protocols, ensuring adaptive access to different types of IoT nodes, and on this basis, data is transmitted to the cloud IoT platform through a unified interface, shielding the variability of IoT sensing devices. Given the problems of device forgery and malicious tampering in the data aggregation process, we propose a fast authentication and data storage method for IoT devices based on “API key” and implant the device authentication API key into the protocol adaptation layer of the virtual gateway to realize the source authentication of IoT nodes and ensure the authenticity of data.

505 The Successful Development of a Digital Peer Supporter Training Program - How It is Done

IntroductionThe global pandemic of 2020 and 2021 has had an unforgettable impact on our lives and community well-being. Burn survivors are a particularly vulnerable population for social isolation and loneliness and, therefore, an amplified need for social connection. This abstract outlines the strategic structure, curriculum, and training required to move an in-person course to an innovative digital model.MethodsA group of burn subject matter experts (SMEs), including burn survivors, peer supporters, and course instructors, virtually met to brainstorm program redesign, considering the needs of the burn survivors. Research of topics guided manual and course revisions. Experts recommended a website and digital resource review to streamline organizational data collection and participants’ experiences. A scheduled pilot course and evaluation would provide feedback for changes. SMEs created a short turnaround timeline.ResultsAfter research, the revised digital manual was condensed from 200 to 50 pages, allowing for hyperlinks, abbreviated resources, and replicated content removal. Five major content areas previously taught in-person were converted to recorded PowerPoint learning modules (April – June 2020). The asynchronous modules totaled 4 hours of self-paced learning assigned to the candidates before a set virtual course. A survey monkey assessment after each module evaluates the learner's base knowledge. SMEs developed a 4-hour virtual class incorporating the modules, manual, and group exercises. A designed pre-course worksheet prepares the candidates for group exercises. Based on their burn injury type or situation (parent to parent, survivors with amputations, death of loved one), candidates practice virtual peer support visits. After the first pilot course, a comprehensive evaluation tool assessed participant satisfaction and confidence, curriculum, instructor expertise, and comfort level navigating the virtual model (August 2020). A website landing page centralized course resources and content location, streamlining participant experience and organizational data collection (March 2021). A 2-hour instructor course (n=10) provided an update on the new structure. The instructors also observe a virtual peer supporter course, participate as an instructor in-training, then co-teach with another instructor before independent course instruction (June 2021).ConclusionsThe digital model has trained burn survivors (n=41) in 6 courses over eight months during a pandemic. Burn survivors have trained together from around the globe to one of the calendared courses improving efficiencies. There are monetary and resource cost savings for burn centers and the organization. The digital manual is easily updated, saving in resource allocation. Peer supporters navigate additional online resources for ongoing self-growth through the embedded website landing page.

506 Hidradenitis Suppurativa Reddit Support Group: Finding New Meaning in Social Media during the COVID-19 Pandemic

IntroductionHidradenitis suppurativa (HS) is a chronic inflammation of sweat glands that can result in abscesses and scarring, significantly impacting quality of life. Online support groups provide a platform to connect with other HS patients – increasingly important with pandemic-related social isolation. The popular social media site Reddit allows users with common interests, like HS, to form a community and share information. This study characterizes HS patients’ use of Reddit and social media more broadly before and during the COVID-19 pandemic.MethodsThis study consisted of a cross-sectional survey of HS patients treated at our institution between May 2021 and July 2021, collecting data on patient demographics, HS status, and social media support group usage/interest. A longitudinal analysis of use of a popular HS support page on Reddit from January 2019 to August 2021 was also conducted, analyzing the number of subscribers over time.ResultsThe number of subscribers to the subreddit r/Hidradenitis increased exponentially from January 2019 to August 2021 (R2= 0.9978 for exponential model fit to data); this suggests that the onset of the COVID-19 pandemic was associated with a greater increase in the number of subreddit subscribers. Further, 20 patients (90% female, mean age of 32.4 years) completed the survey that was administered. Participants were stratified into two groups: online support group users (n=8) and non-users (n=12). There were no significant differences in sex, age, education level, HS activity, antidepressant usage, and overall social media usage between these groups. However, there was a significant difference in Hurley staging between the two groups; 75% (n=6) of online support group users reported a Hurley III staging, while only 16.7% (n=2) of non-users self-reported as Hurley III (p=0.003). In terms of features patients desired to see in online support groups, non-users ranked the following categories of advice/information as important more frequently than current users: bandaging/dressing boils, living with HS, medical advice from professionals, causes of HS, and diet (p=0.047, p=0.043, p=0.043, p=0.047, and p=0.013, respectively).ConclusionsThis study demonstrates that online support group use is associated with patients with HS of higher clinical severity. Since virtual support groups have an unprecedented importance due to increased social isolation and limited access to in-person support groups and health resources, healthcare providers may encourage non-users to partake in these online support communities during these trying times. Based on the needs and expectations of these patients as identified in this study, recommendations can be made to moderators of online communities to help fill any existing lacunae.

770 Increasing SOAR Participation in a Burn Center through a Social Work Team Approach

IntroductionPeer support has long been used in Burn Centers through organized support groups and programs like Phoenix Society for Burn Survivor’s SOAR (Survivors Offering Assistance in Recovery) individual peer support, often led by Social Workers (SW). The addition of an ambulatory SW in partnership with an inpatient SW allowed our Burn Center to continue participation in the group and individual peer support offerings despite the simultaneous COVID-19 pandemic. We sought to examine participation in support services using our dual SW model.MethodsPrior to 2020, our ABA verified Burn Center only had an inpatient SW who was able to engage our admitted patient population to support services. With the addition of an ambulatory SW, we have been able to target support group participation in the larger ambulatory population. Our dual SW model allows for continued recruitment to our support services; meeting the patient’s needs at each stage of recovery. This tag team approach, coupled with increased use of technology driven by the pandemic, has shown to increase the average number of participants. We reviewed our support group participation and attendance over the past 2 years.ResultsIn calendar year 2020 with one SW facilitator, only 14 virtual support groups were held with an attendance average of 4-5 participants and 22 individual peer support visits. In only the first 9 months of calendar year 2021 with the addition of a second SOAR trained SW, 18 support groups were completed virtually with new inpatient, in-person participation. The participation rate of now bi-monthly support groups has increased to 9 participants per support group average. At this continued rate, we expect to serve 216 attendees per year through support group. In this same 9-month span 51 SOAR individual peer support visits (12 in-person and 39 virtual), were conducted. Which is an increase from the 22 total peer support visits facilitated in 2020.ConclusionsAn additional SOAR trained SW to our Burn Center has increased participation and availability of support groups and individual peer support visits. Peer support promotes socialization and can provide healing for the burn patients and their families in a meaningful and profound way. Burn centers must continue to prioritize the role of the clinical SW to ensure programs such as SOAR support group and individual peer support can be facilitated to ensure an environment that fosters psychological and emotional healing.

Increasing support group attendance for metabolic and bariatric surgery patients with online groups.

Support group attendance for patients undergoing metabolic and bariatric surgery has been shown to improve outcomes. Finding meaningful ways to engage as many patients as possible with these group sessions is important. Attendance records of 120 in-person and 48 virtual support groups that took place over 6-years were reviewed and compared from a metabolic and bariatric surgery (MBS) program in the USA. No significant difference in attendance for in-person groups or the first year of virtual support groups was found. The second consecutive year of virtual support groups were found to have a significant increase in patient attendance when compared to in-person groups and also the first year of virtual groups. Support groups for MBS patients are valuable experiences. Offering these virtually can help increase the number of patients that attend groups after the first year.

Connecting the Digital Dots: Engaging Diverse Older Adults Through Virtual Outreach

According to the Administration on Aging in 2018, 34% of older adults are racial and ethnic minorities. The median income of older adults was ∼$25K, with 18.9% of older Non-Hispanic (NH) Blacks, 11.7% of older Asians, and 19.5% of older Hispanics living below the poverty level (compared to 7.3% NH Whites). With a growing cohort of older adults ≥75 years old, 50% report difficulty in physical functioning. At the intersection of race/ethnicity, income inequality, age and frailty; many older adults face challenges to receiving high quality mental health care and access to clinical trials. 40% of homebound older adults have a psychiatric or cognitive disorder but have limited access to mental health services. Despite increased illness burden, both racial/ethnically diverse and homebound older adults are underrepresented in clinical trials.The Montefiore Home Care Geriatric Psychiatry Program (MHC-GPP) and the Montefiore Hudson Valley Center of Excellence for Alzheimer's Disease (CEAD) have extensive experience serving a culturally and economically diverse patient population since 2004 and 2014, respectively. Both programs have collaborated to provide older adults with comprehensive assessments of psychological symptoms, cognitive and psychosocial needs across varied cultural and socioeconomic backgrounds. These assessments have connected patient/caregiver dyads with community supports and clinical trials. In 2016, the MHC-GPP and the CEAD secured two funding opportunities to provide problem based psychosocial interventions in the home. Over ¾ of the patients served by these programs are NH Black or Hispanic older adults, most of which have less than 12 years of education.However, in March 2020, the COVID-19 pandemic presented new barriers to reaching frail and cognitively impaired patients in this diverse community. In order to address these complex needs, the MHC-GPP social work team began proactively calling patients admitted to a Certified Home Health Agency (CHHA) during the first quarter of the pandemic. This provided a unique opportunity to address the concrete and mental health needs of those most vulnerable to COVID-19. In addition, the MHC-GPP psychiatric team pivoted to telehealth evaluations that would still provide comprehensive assessment and management of psychological and cognitive symptoms. The MHC-GPP team also conducted virtual support groups for the CHHA staff. At the same time, the CEAD team converted the community engagement studio framework to a virtual format to engage a cohort of older predominately NH Black woman to discuss recruitment and retention of participants to a future clinical trial.During this session, the presenters will describe how telehealth interventions were implemented throughout the pandemic to engage diverse older adults in community. Presenters will describe how the MHC-GPP social work team developed a telephone assessment to proactively identify both concrete and mental health needs during the first quarter of the pandemic. Presenters will describe how the MHC-GPP in home psychiatric assessment was adapted to telehealth, while still continuing to provide behavioral and cognitive assessment in English and Spanish, to initiate treatment, to refer to clinical studies, and to provide a training site for fellows and residents. Finally, presenters will share results from a virtual community engagement studio, which was conducted to improve the recruitment and retention of under-resourced populations in a future clinical trial. The chair will also facilitate discussion of case examples and lessons learned.

A Qualitative Study Exploring Access to Mental Health and Substance Use Support among Individuals Experiencing Homelessness during COVID-19.

People experiencing homelessness have higher rates of mental ill-health and substance use and lower access to health services compared to the general population. The COVID-19 pandemic led to changes in service delivery across health and social care services, with many adopting virtual or telephone support for service users. This paper explores the experiences of access to community-based mental health and substance use support for people experiencing homelessness during the COVID-19 pandemic. Qualitative telephone interviews were conducted with 10 women and 16 men (ages 25 to 71) who self-identified as experiencing homelessness in North East England between February and May 2021. With five individuals with lived experience, results were analysed using inductive reflexive thematic analysis. Reactive changes to support provision often led to inadvertent exclusion. Barriers to access included: physical locations, repetition of recovery stories, individual readiness, and limited availability. Participants suggested creating services reflective of need and opportunities for choice and empowerment. Community mental health and substance use support for people experiencing homelessness should ensure the support is personalised, responsive to need, inclusive, and trauma-informed. The findings of this research have important implications for mental health and substance use policy and practice for individuals who experience homelessness during a public health crisis.

Pandemic-related experiences, mental health symptoms, substance use, and relationship conflict among older adolescents and young adults from Manitoba, Canada

There is growing awareness of the negative impact of the COVID-19 pandemic on young people. The purpose of this study was to examine older adolescents’ and young adults’ pandemic-related experiences, including financial difficulties, emotional support, social connections, mental health symptoms, substance use, and relationship conflict. Data from the Well-being and Experiences Study (The WE Study) were gathered from November to December 2020 in Manitoba, Canada, among a community sample (n = 664; ages 16–21 years). Over half of the sample self-reported increased stress/anxiety (57.6%) and depression (54.2%) attributed to the pandemic. Increased alcohol consumption was reported by 18.2% of alcohol-users. Among cannabis-users, 35.1% reported increased use. Conflict with parents, siblings, and an intimate partner increased for 19.9%, 15.2%, and 24.0% of respondents, respectively. Females reported greater financial burden, mental health burden, and conflict with parents than males. Young adults reported greater financial and mental health burden than older adolescents. Higher household income was protective of some experiences. The current study adds to growing evidence that young people were adversely impacted by the COVID-19 pandemic. Increased access to virtual support resources is needed and should continue following the pandemic. Evidence-based interventions may need to be tailored to females and young adults.

The Evolving Role of Triage and Appointment-Based Admission to Improve Service, Care and Outcomes in Animal Shelters.

The historical norm for many animal shelters has been to admit animals on an unscheduled basis, without prior assessment of animal or client need or regard to the shelter's ability to deliver humane care or ensure appropriate outcomes. This approach allows little opportunity to provide finders or owners with alternatives to keep pets safe in their homes or community rather than being impounded. In addition to needlessly impounding animals and separating pets from families, unmanaged/unscheduled admission frequently results in animal influx exceeding shelter capacity, leading to crowding, stress, disease, and euthanasia of animals, as well as poor customer experience, compromised staffing efficiency and decreased organizational effectiveness. Many of these harmful consequences disproportionately impact vulnerable community members and their pets. Triage and appointment-based services have been well developed in healthcare and other service sectors allowing organizations to prioritize the most urgent cases, align services with organizational resources and provide situation-specific solutions that may include virtual support or referral as appropriate. This article discusses the trend in animal sheltering toward triage and appointment-based services that parallels the use of these practices in human healthcare. Reported positive results of this approach are detailed including improved staff morale, reduced disease rates and substantially reduced euthanasia. These positive outcomes support the endorsement of triage and appointment-based services by multiple North American animal welfare professional and academic organizations, recognizing that it better realizes the goals of shelters to serve the common good of animals and people in the most humane, equitable and effective possible way.

THE CHALLENGE OF PORTUGUESE LANGUAGE TEACHING IN TIMES OF LIQUID TEXTUALITY

Currently, one of the biggest challenges of teaching Portuguese in basic education is the dynamics contained in linguistic processes through digital information and communication technologies (TDIC). The National Curricular Common Base - BNCC, promotes a mitigating discourse in this scenario, pointing out that its demands are in complete harmony with modern guidelines for reading, writing and textual production, considering, including the development of new textual genres from virtual supports in literacy records, symbols and other interpretive signs of language. In this sense, the present work, characterized by a bibliographical rereading, aims to visit and analyze the main discussions about the existence or not of new textual genres in the face of the speed and diversity present in social communication. In addition, from these indicators, it was possible to register the confrontation of specific works regarding new textual genres with the normative proposal established by the BNCC in the current teaching process in the country.

PODRŠKA NA DALJINU OBITELJIMA DJECE S TEŠKOĆAMA U RAZVOJU TIJEKOM PANDEMIJE COVID-19

VIRTUAL SUPPORT TO FAMILIES OF CHILDREN WITH DISABILITIES DURING THE COVID-19 PANDEMIC ABSTRACT The COVID-19 pandemic has brought many changes in our lives. Parents of children with disabilities were unable to go to therapy, due to strict physical distancing measures and other necessary epidemiological measures to prevent disease transmission. Numerous challenges have emerged that need to be addressed, a global crisis has been created, which has and will continue to have a profound impact on all areas of life. The aim of this study was to examine the satisfaction of parents of children with disabilities, included in the Early Intervention Program within the Rehabilitation Center Zagreb, who obtained on-line professional support. The study was conducted with a sample of 24 parents of children with disabilities, who participated in individual or group online work during a COVID-19 pandemic. An online survey questionnaire and descriptive statistic were applied. Research has shown that most parents, although satisfied with the online services and support, prefer to choose face-to-face therapy. This paper presents evidence of online work through communication technologies, highlights the challenges and risks associated with online methods, and raises questions about the ways to provide intervention and support to parents with the aim to develop their skills and competencies guided by professionals to improve the quality of life of children and families. Key words: COVID-19 pandemic; early intervention; face-to-face therapy; parental satisfaction; virtual support