Workforce Capacity Research Articles

Emotional Exhaustion Among US Health Care Workers Before and During the COVID-19 Pandemic, 2019-2021

Extraordinary strain from COVID-19 has negatively impacted health care worker (HCW) well-being. To determine whether HCW emotional exhaustion has increased during the pandemic, for which roles, and at what point. This survey study was conducted in 3 waves, with an electronic survey administered in September 2019, September 2020, and September 2021 through January 2022. Participants included hospital-based HCWs in clinical and nonclinical (eg, administrative support) roles at 76 community hospitals within 2 large health care systems in the US. Safety, Communication, Organizational Reliability, Physician, and Employee Burnout and Engagement (SCORE) survey domains of emotional exhaustion and emotional exhaustion climate. The percentage of respondents reporting emotional exhaustion (%EE) in themselves and a climate of emotional exhaustion (%EEclim) in their colleagues. Survey items were answered on a 5-point scale from 1 (strongly disagree) to 5 (strongly agree); neutral or higher scores were counted as "percent concerning" for exhaustion. Electronic surveys were returned by 37 187 (of 49 936) HCWs in 2019, 38 460 (of 45 268) in 2020, and 31 475 (of 41 224) in 2021 to 2022 for overall response rates of 74.5%, 85.0%, and 76.4%, respectively. The overall sample comprised 107 122 completed surveys. Nursing was the most frequently reported role (n = 43 918 [40.9%]). A total of 17 786 respondents (16.9%) reported less than 1 year at their facility, 59 226 (56.2%) reported 1 to 10 years, and 28 337 (26.9%) reported 11 years or more. From September 2019 to September 2021 through January 2022, overall %EE increased from 31.8% (95% CI, 30.0%-33.7%) to 40.4% (95% CI, 38.1%-42.8%), with a proportional increase in %EE of 26.9% (95% CI, 22.2%-31.8%). Physicians had a decrease in %EE from 31.8% (95% CI, 29.3%-34.5%) in 2019 to 28.3% (95% CI, 25.9%-31.0%) in 2020 but an increase during the second year of the pandemic to 37.8% (95% CI, 34.7%-41.3%). Nurses had an increase in %EE during the pandemic's first year, from 40.6% (95% CI, 38.4%-42.9%) in 2019 to 46.5% (95% CI, 44.0%-49.1%) in 2020 and increasing again during the second year of the pandemic to 49.2% (95% CI, 46.5%-51.9%). All other roles showed a similar pattern to nurses but at lower levels. Intraclass correlation coefficients revealed clustering of exhaustion within work settings across the 3 years, with coefficients of 0.15 to 0.17 for emotional exhaustion and 0.22 to 0.24 for emotional exhaustion climate, higher than the .10 coefficient typical of organizational climate (a medium effect for shared variance), suggestive of a social contagion effect of HCW exhaustion. This large-scale survey study of HCWs spanning 3 years offers substantial evidence that emotional exhaustion trajectories varied by role but have increased overall and among most HCW roles since the onset of the pandemic. These results suggest that current HCW well-being resources and programs may be inadequate and even more difficult to use owing to lower workforce capacity and motivation to initiate and complete well-being interventions.

Rehabilitation workforce descriptors: a scoping review

BackgroundA comprehensive, accurate description of workforce capacity is important for health service planning, to ensure that health services meet local needs. In many low- to middle-income countries, the government’s service planning ability is barred by the lack of accurate and/or comprehensively-described workforce data. In these low-resource settings, lack of appropriate planning leads to limited or no access to rehabilitation services. Variability in the definitions and scope of rehabilitation professionals further complicates the understanding of rehabilitation services and how it should be planned and delivered. Another challenge to describing the primary rehabilitation workforce capacity, is the lack of standardised and agreed-upon global metrics. These inconsistencies highlight the need for a comprehensive understanding of current practices, which can offer guidance to countries wishing to describe their rehabilitation workforce. This study aimed to scope the range of descriptors and metrics used to describe the rehabilitation workforce and to compare the workforce across countries that used similar descriptors in published reports.MethodsA scoping review was conducted according to the five-step framework first developed by Arksey and O’Malley. The review included a broad search of literature regarding the rehabilitation workforce and how countries quantify and describe the rehabilitation workforce.ResultsNineteen studies on rehabilitation workforce capacity were identified. All but one (a cross-sectional study) were database reviews. The main descriptors and indicators used to describe the rehabilitation workforce capacity were profession type, age, gender, distributions between urban/rural, level of care, and private/public sectors, absolute count totals, and population-adjusted ratios.ConclusionThis scoping review provided an overview of descriptors and indicators used to describe the rehabilitation workforce capacity internationally. The study is a first step towards developing standardised descriptors and metrics to quantify the rehabilitation workforce capacity, that will allow for comparison between different settings.Trial registrationThis scoping review protocol has been registered with the Open Science Framework (http://osf.10/7h6xz).

Master of Public Health Education in the United States Today: Building Leaders of the Future.

For decades, there have been calls to action to change the status quo of public health education in the United States to respond to workforce needs and help reinforce capacity. During the last 10 years, schools and programs of public health have planned and implemented programmatic and curricular changes. This study explored the focus of master of public health (MPH) education in the United States today. We used a 3-phase mixed-methods study to compile data to describe the current state and focus of MPH education in the United States via survey data collection (November-December 2019), semistructured interviews (January-February 2020), and document reviews. Survey responses represented at least 43% (93/215) of eligible MPH programs in the United States. Most respondents (86%, 99/115) reported that the primary focus of MPH education in the United States is to prepare graduates for public health practice and employment linked to public health, and 54% (59/109) reported that their MPH programs adopted this focus in the last 5 years. MPH programs invested in student learning, competence development, and supporting workforce readiness, including a focus on leadership abilities. Programs noted that they seek to develop strategic thinkers and engaged leaders with abilities to understand and address emergent public health needs. Public health education in the United States is in a period of change. MPH programs reported responding to workforce needs by closing gaps in workforce capacity and developing compassionate and professional leaders who can understand needs, collaborating with communities, and facilitating action that will ameliorate health disparities and promote social injustice by practicing public health in new ways.

ATTITUDES, WORK ROLES AND BARRIERS TO NUTRITION CARE - INTERVIEWS WITH AUSTRALIAN AND UK-BASED MEDICAL DOCTORS.

Poor diet is implicated in multiple chronic diseases. Although doctors may be well placed to facilitate nutrition care, nutrition remains a low priority in medical education internationally. Consensus is required on nutrition competencies as a benchmark for education with a regulatory framework to ensure implementation. The aim of this qualitative study was to explore work roles, attitudes, barriers and enablers in the delivery of nutrition care among a cohort of Australian and UK doctors. Semi-structured interviews were conducted with primary care doctors/general practitioners (n = 14) and medical specialists (n = 8) based in Australia and the United Kingdom to explore work roles, attitudes, barriers and enablers in the delivery of nutrition care. Framework analysis identified five key themes: (1) knowledge and skills in nutrition to support medical nutrition care, (2) the delivery of nutrition education, (3) multidisciplinary and interdisciplinary care, (4) systemic barriers and facilitators to care and (5) the need for a paradigm shift. Participants acknowledged nutrition as an important component of medical care but recognised they are currently ill-equipped to support such care, identifying limitations to the systems supporting integrated care. Participants identified that nutrition sits within both a health promotion and medical/treatment model, but they currently work only within the latter. Participants highlighted a lack of knowledge and training regarding nutrition, without which change is not possible. Efforts to improve the nutrition capacity of the medical workforce must be matched by increased investments in primary prevention, including nutrition - a paradigm shift from the medical model.

Effectiveness of Project ECHO Programs in Improving Clinician Knowledge and Confidence in Managing Complex Psychiatric Patients: a Waitlist-Controlled Study

ObjectiveThe authors aimed to determine if Project Extension for Community Healthcare Outcomes (ECHO), a health-education model utilising teleconferencing technology, improves the capacity of clinicians in assessing and managing complex psychiatric patients.MethodsThree pilot Project ECHO programs were evaluated as a prospective waitlist-controlled trial, focusing on Adult Eating Disorders, Adult Intellectual Disability Mental Health, and General Mental Health. Each program comprised 9–10 weekly teleconferencing group sessions. Participants and waitlist-controls completed pre- and post-program surveys. The primary outcomes were self-reported knowledge and confidence in assessing and managing complex patients relevant to each group. Linear mixed models were used to assess the group-by-time interaction, or change over time, as appropriate.ResultsBetween July 2020 and June 2021, three series of the Adult Intellectual Disability Mental Health program, two series of the Adult Eating Disorders program, and two series of the General Mental Health program were delivered. Compared to waitlist-controls (n = 21), there were statistically significant improvements in self-reported knowledge and confidence for all topics amongst participants of the Adult Eating Disorders program (n = 44). In the Adult Intellectual Disability Mental Health program, there were significant improvements in self-reported knowledge and confidence amongst participants (n = 67) for most topics compared to controls (n = 21). There were no waitlist-controls for the General Mental Health program, but within-group analysis (n = 28) showed significant improvements in participants’ knowledge and confidence following program completion, compared to baseline.ConclusionProject ECHO is a feasible and effective model to develop workforce capacity in managing complex psychiatric conditions.

What are the “Disaster medicine” curriculum topics for public health medicine specialty training in Türkiye? A Delphi Study

ObjectivePublic health medicine specialists have unique roles in disaster risk management through prevention, preparedness, response and recovery for all kinds of disasters. A well structured and designed “disaster medicine training curriculum” would improve the efficacy and quality of playing these forementioned roles. In this study, it was aimed to determine the disaster medicine curriculum topics which should be addressed in public health medicine specialty education and training in Türkiye. MethodsAll faculty members from public health departments of medical faculties in Türkiye (238 experts) were invited to a three round Delphi study aiming to evaluate disaster medicine topics of the curriculum prepared by the International Society of Disaster Medicine (ISDM) as it is the most comprehensive curriculum ever developed. All items were rated by using a seven-point Likert scale in consecutive online questionnaires. The final consensus was determined at the end of the third round according to the consensus criteria. FindingsThe response rate for the first round was 37.8% (90 experts), with a dropout of 34.4% (59 experts) and 35.5% (38 experts) for the following rounds. For the “Medical Care” division, 35.3% of items were agreed to be included in the curriculum, while this rate was 93.2% for “Disaster Management” division, 100.0% for “Public Health” and “Education and Training in Disaster Medicine” divisions. Among all, 62.5% of items reached consensus to be included in the curriculum. ConclusionIn the end of three rounds, disaster medicine topics were evaluated with a public health perspective and the curriculum was enriched with original contributions from the experts. This agreed national curriculum for the major workforce of public health services in the country will strengthen the health workforce capacity for building disaster resilient communities and health services.

Bridging the gap: A library-based collaboration to enhance data skills for clinical researchers.

Enterprise data warehouses (EDWs) serve as foundational infrastructure in a modern learning health system, housing clinical and other system-wide data and making it available for research, strategic, and quality improvement purposes. Building on a longstanding partnership between Northwestern University's Galter Health Sciences Library and the Northwestern Medicine Enterprise Data Warehouse (NMEDW), an end-to-end clinical research data management (cRDM) program was created to enhance clinical data workforce capacity and further expand related library-based services for the campus. The training program covers topics such as clinical database architecture, clinical coding standards, and translation of research questions into queries for proper data extraction. Here we describe this program, including partners and motivations, technical and social components, integration of FAIR principles into clinical data research workflows, and the long-term implications for this work to serve as a blueprint of best practice workflows for clinical research to support library and EDW partnerships at other institutions. This training program has enhanced the partnership between our institution's health sciences library and clinical data warehouse to provide support services for researchers, resulting in more efficient training workflows. Through instruction on best practices for preserving and sharing outputs, researchers are given the tools to improve the reproducibility and reusability of their work, which has positive effects for the researchers as well as for the university. All training resources have been made publicly available so that those who support this critical need at other institutions can build on our efforts. Library-based partnerships to support training and consultation offer an important vehicle for clinical data science capacity building in learning health systems. The cRDM program launched by Galter Library and the NMEDW is an example of this type of partnership and builds on a strong foundation of past collaboration, expanding the scope of clinical data support services and training on campus.

Academic health science centre models across the developing countries and lessons for implementation in Indonesia: a scoping review

ObjectiveTo describe models of academic health science centres (AHSCs) across developing countries, in order to inform AHSC development in Indonesia.DesignScoping review with systematic methods.Data sourcesOvid MEDLINE, ProQuest Central, Wiley online...

505P The impact of COVID-19 on the wellness and resilience of the Canadian medical oncology workforce: A Canadian Association of Medical Oncologists survey

The COVID-19 (C19) pandemic has presented professional and personal challenges. The Canadian Association of Medical Oncologists (CAMO) has been examining the effects of C19 on the workforce to understand the impact that the pandemic has had on the medical oncology (MO) community. This survey examines how C19 has impacted the wellness and resilience of the MOs and will assess the impact that C19 may have on MO workforce capacity going forward.

Strengthening assessment and response to mental health needs for Aboriginal and Torres Strait Islander children and adolescents in primary care settings: study protocol for the Ngalaiya Boorai Gabara Budbut implementation project

IntroductionOpportunities for improved mental health and wellbeing of Aboriginal and Torres Strait Islander children and young people lie in improving the capability of primary healthcare services to identify mental healthcare...

"I Have to Ask": A Mixed-Methods Study on the Collection of Sexual Orientation and Gender Identity Data Within the San Francisco County COVID-19 Case Investigation and Contact Tracing Program.

To understand how the San Francisco (SF) COVID-19 case investigation and contact tracing (CICT) workforce documented sexual orientation and gender identity (SOGI) data, as well as a qualitative assessment of the workforce's capacity to successfully collect that data. This mixed-methods project analyzed data from 2 sources: SOGI item completeness among adult completed/partially completed interviews in the SF digital CICT COVID-19 database, and a secondary data analysis of qualitative data from 16 semistructured 90-minute virtual interviews with the SF CICT workforce, between November 14, 2020, and April 14, 2021. Among 15 416 COVID-19 cases and 7836 close contacts, sexual orientation data are missing from 20% of cases and 17% of contacts. The proportion of transgender/nonbinary individuals was 0.32% and 0.5%, respectively. The SF CICTs participants discussed challenges in collecting SOGI data, not understanding SOGI measure rationale, and feeling uncomfortable asking the questions. Qualitative interviews with the COVID-19 CICT workforce and quantitative data on SOGI parameters in COVID-19 surveillance suggest that these data may have been underreported. Our results strongly suggest that comprehensive training is crucial in the collection of SOGI data among COVID-19 cases and their close contacts. If SOGI data are not collected accurately, the true impact of COVID-19 among lesbian, gay, bisexual, transgender, and queer populations remains unknown, preventing data-driven allocation of COVID-19 funds to lesbian, gay, bisexual, transgender, and queer communities.

Early Impacts of the COVID-19 Pandemic on Public Health Systems and Practice in 3 Canadian Provinces From the Perspective of Public Health Leaders: A Qualitative Study.

Context:The COVID-19 pandemic has impacted health systems worldwide. Studies to date have largely focused on the health care system with less attention to the impact on public health systems and practice.Objective:To describe the early impacts of COVID-19 on public health systems and practice in 3 Canadian provinces from the perspective of public health system leaders and synthesize lessons learned.Design:A qualitative study using semistructured virtual interviews with public health leaders between October 2020 and April 2021. The World Health Organization's essential public health operations framework guided data collection and analysis.Setting:This study involved the Canadian provinces of Alberta, Ontario, and Québec. These provinces were chosen for their large populations, relatively high COVID-19 burden, and variation in public health systems.Participants:Public health leaders from Alberta (n = 21), Ontario (n = 18), and Québec (n = 19) in organizations with a primary mandate of stewardship and/or administration of essential public health operations (total n = 58).Results:We found that the COVID-19 pandemic led to intensified collaboration in public health systems and a change in workforce capacity to respond to the pandemic. This came with opportunities but also challenges of burnout and disruption of non-COVID-19 services. Information systems and digital technologies were increasingly used and there was greater proximity between public health leaders and other health system leaders. A renewed recognition for public health work was also highlighted.Conclusions:The COVID-19 pandemic impacted several aspects of public health systems in the provinces studied. Our findings can help public health leaders and policy makers identify areas for further investment (eg, intersectoral collaboration, information systems) and develop plans to address challenges (eg, disrupted services, workforce burnout) that have surfaced.

Validation of a Measure of District Systems Implementation of Positive Behavioral Interventions and Supports

District leadership teams perform key roles in building the systems to support schools in the implementation of Positive Behavioral Interventions and Supports (PBIS). However, there is a lack of measures for assessment and progress monitoring specific to district PBIS systems. To address this gap, we evaluated the validity of a measure of implementation of district PBIS systems, the District Systems Fidelity Inventory (DSFI). Using 183 school districts and 760 schools implementing PBIS, we found the DSFI to have good evidence of structural validity for measuring nine aspects of district systems (Leadership Teaming, Stakeholder Engagement, Funding and Alignment, Policy, Workforce Capacity, Training, Coaching, Evaluation, and Local Implementation Demonstrations). We also found DSFI subscales to be moderately related to school-level PBIS implementation fidelity, providing evidence of convergent validity. We describe how leadership teams can use the DSFI to improve PBIS implementation and student outcomes.

Analysis of cyber security knowledge gaps based on cyber security body of knowledge.

Due to the increasing number of cyber incidents and overwhelming skills shortage, it is required to evaluate the knowledge gap between cyber security education and industrial needs. As such, the objective of this study is to identify the knowledge gaps in cyber security graduates who join the cyber security workforce. We designed and performed an opinion survey by using the Cyber Security Knowledge Areas (KAs) specified in the Cyber Security Body of Knowledge (CyBOK) that comprises 19 KAs. Our data was gathered from practitioners who work in cyber security organizations. The knowledge gap was measured and evaluated by acknowledging the assumption for employing sequent data as nominal data and improved it by deploying chi-squared test. Analyses demonstrate that there is a gap that can be utilized to enhance the quality of education. According to acquired final results, three key KAs with the highest knowledge gap are Web and Mobile Security, Security Operations and Incident Management. Also, Cyber-Physical Systems (CPS), Software Lifecycles, and Vulnerabilities are the knowledge areas with largest difference in perception of importance between less and more experienced personnel. We discuss several suggestions to improve the cyber security curriculum in order to minimize the knowledge gaps. There is an expanding demand for executive cyber security personnel in industry. High-quality university education is required to improve the qualification of upcoming workforce. The capability and capacity of the national cyber security workforce is crucial for nations and security organizations. A wide range of skills, namely technical skills, implementation skills, management skills, and soft skills are required in new cyber security graduates. The use of each CyBOK KA in the industry was measured in response to the extent of learning in university environments. This is the first study conducted in this field, it is considered that this research can inspire the way for further researches.

Consumer Perspectives on the Use of Artificial Intelligence Technology and Automation in Crisis Support Services: Mixed Methods Study.

BackgroundEmerging technologies, such as artificial intelligence (AI), have the potential to enhance service responsiveness and quality, improve reach to underserved groups, and help address the lack of workforce capacity in health and mental health care. However, little research has been conducted on the acceptability of AI, particularly in mental health and crisis support, and how this may inform the development of responsible and responsive innovation in the area.ObjectiveThis study aims to explore the level of support for the use of technology and automation, such as AI, in Lifeline’s crisis support services in Australia; the likelihood of service use if technology and automation were implemented; the impact of demographic characteristics on the level of support and likelihood of service use; and reasons for not using Lifeline’s crisis support services if technology and automation were implemented in the future.MethodsA mixed methods study involving a computer-assisted telephone interview and a web-based survey was undertaken from 2019 to 2020 to explore expectations and anticipated outcomes of Lifeline’s crisis support services in a nationally representative community sample (n=1300) and a Lifeline help-seeker sample (n=553). Participants were aged between 18 and 93 years. Quantitative descriptive analysis, binary logistic regression models, and qualitative thematic analysis were conducted to address the research objectives.ResultsOne-third of the community and help-seeker participants did not support the collection of information about service users through technology and automation (ie, via AI), and approximately half of the participants reported that they would be less likely to use the service if automation was introduced. Significant demographic differences were observed between the community and help-seeker samples. Of the demographics, only older age predicted being less likely to endorse technology and automation to tailor Lifeline’s crisis support service and use such services (odds ratio 1.48-1.66, 99% CI 1.03-2.38; P<.001 to P=.005). The most common reason for reluctance, reported by both samples, was that respondents wanted to speak to a real person, assuming that human counselors would be replaced by automated robots or machine services.ConclusionsAlthough Lifeline plans to always have a real person providing crisis support, help-seekers automatically fear this will not be the case if new technology and automation such as AI are introduced. Consequently, incorporating innovative use of technology to improve help-seeker outcomes in such services will require careful messaging and assurance that the human connection will continue.

Key Learning Statements for Persistent Pain Education: An Iterative Analysis of Consumer, Clinician and Researcher Perspectives and Development of Public Messaging

Over the last decade, the content, delivery and media of pain education have been adjusted in line with scientific discovery in pain and educational sciences, and in line with consumer perspectives. This paper describes a decade-long process of exploring consumer perspectives on pain science education concepts to inform clinician-derived educational updates (undertaken by the authors). Data were collected as part of a quality audit via a series of online surveys in which consent (non-specific) was obtained from consumers for their data to be used in published research. Consumers who presented for care for a persistent pain condition and were treated with a pain science education informed approach were invited to provide anonymous feedback about their current health status and pain journey experience 6, 12 or 18 months after initial assessment. Two-hundred eighteen consumers reported improvement in health status at follow-up. Results of the surveys from 3 cohorts of consumers that reported improvement were used to generate iterative versions of ‘Key Learning Statements’. Early iteration of these Key Learning Statements was used to inform the development of Target Concepts and associated community-targeted pain education resources for use in public health and health professional workforce capacity building initiatives. PerspectiveThis paper reflects an explicit interest in the insights of people who have been challenged by persistent pain and then recovered, to improve pain care. Identifying pain science concepts that consumers valued learning provided valuable information to inform resources for clinical interactions and community-targeted pain education campaigns.

Regulating in the public interest: Lessons learned during the COVID-19 pandemic.

This article has three aims. First, to reflect on how conceptualizations of the public interest may have shifted due to COVID-19. Second, to focus on the implications of regulatory responses for the health workforce and corresponding lessons as health leaders and systems transition from pandemic response to pandemic recovery. Third, to identify how these lessons lead to potential directions for future research, connecting regulation in a whole-of-systems approach to health system safety and health workforce capacity and sustainability. Pandemic regulatory responses highlighted both strengths and limitations of regulatory structures and frameworks. The COVID-19 pandemic may have introduced new considerations around regulating in the public interest, particularly as the impact of regulatory responses on the health workforce continues to be examined. Clearly articulating practitioner practice parameters, reducing barriers to practice, and working collaboratively with stakeholders were primary aspects of regulators' pandemic responses that impacted the health workforce.

The Need for Speed: A Qualitative Study on Nurse Recruitment and Management Amidst the COVID-19 Pandemic in Indonesia.

IntroductionNursing workforce is a pivotal element in tackling the COVID-19 pandemic. However, this has not been comprehensively discussed, particularly in Indonesia. This study aimed to explore stakeholders’ perspectives on Indonesian nursing workforce recruitment and management during the COVID-19 pandemic.MethodsThis study employed a qualitative design with an exploratory descriptive approach. Stakeholders who recruited and managed nursing resources in Indonesia were involved. In-depth interviews and focus group discussions with stakeholders representing eight different institutions were undertaken. Data were analysed using thematic analysis. Eight key stakeholders were interviewed.ResultsThree themes emerged, namely uncertain recruitment system, nursing labour market situation, and workforce management dynamics. COVID-19 caused reduced workforce capacity and increased demands for health professionals, especially nurses.ConclusionUncertainty and volatility happened at the recruitment and management of nursing human resources during the pandemic. Stakeholders were not convinced of overall quality of local nurses recruited to care for COVID-19 patients given workforce was dominated by new graduates and nurses without specialistic qualifications. Employers gave new staff more training to ease their deployment to COVID-19 units to make up for the nurses’ lack of expertise and experience.

The contribution of family physicians to African health systems.

BackgroundAfrica is the last region to incorporate family physicians into its health systems. They are still a relatively new concept in many countries, small in numbers and deployed in a variety of ways. There is a need for more evidence on their contribution to African health systems to guide policymakers.AimThe aim of this study was to review the special collection of short reports on the contribution of family physicians to African health systems, published in the African Primary Health Care and Family Medicine Journal in 2021.MethodSeventeen short reports from eight countries were qualitatively and thematically analysed in ATLAS.ti. Codes, which were derived inductively, were organised into categories according to the World Health Organization’s primary health care monitoring framework.ResultsIn the domain of health system determinants, family physicians made little contribution to governance, adjustment to population health needs or financing. They did, however, contribute substantially to the capacity of the health workforce, supply of equipment, functioning of the health information system and use of digital technologies. In the domain of service delivery, they strengthened the model of care and championed systems for improving the quality of care. This translated into improved availability and utilisation of services, core functions of primary care, quality of care and patient safety.ConclusionFamily physicians described their important contribution to service delivery in district hospitals and primary health care. This should lead to improvements in outcomes and impact for the health system. Their contribution to the concept of resilient facilities and health services needs further exploration.

Mental health service availability for autistic youth in New York City: An examination of the developmental disability and mental health service systems.

Autistic children and adolescents experience high rates of co-occurring mental health conditions, including depression and suicidality, which are frequently identified by stakeholders as treatment priorities. Unfortunately, accessing community-based mental health care is often difficult for autistic youth and their families. The first obstacle families confront is finding a provider that offers mental health treatment to autistic youth within the many service systems involved in supporting the autism community. The mental health and developmental disability systems are two of the most commonly accessed, and previous work has shown there is often confusion over which of these systems is responsible for providing mental health care to autistic individuals. In this study, we conducted a telephone survey to determine the availability of outpatient mental health services for autistic youth with depressive symptoms or suicidal thoughts or behaviors in New York City across the state's mental health and developmental disability systems. Results showed that while a greater percentage of clinics in the mental health system compared with in the developmental disability system offered outpatient mental health services to autistic youth (47.1% vs 25.0%), many more did not offer care to autistic youth and there were very few options overall. Therefore, it is important that changes to policy are made to increase the availability of services and that mental health care providers' knowledge and confidence in working with autistic youth are improved.