Catalyzing Implementation of Evidence-Based Interventions in Safety Net Settings: A Clinical–Community Partnership in South Los Angeles

This study is a process evaluation of a clinical–community partnership that implemented evidence-based interventions in clinical safety net settings. Adoption and implementation of evidence-based interventions in these settings can help reduce health disparities by improving the quality of clinical preventive services in health care settings with underserved populations. A clinical–community partnership model is a possible avenue to catalyze adoption and implementation of interventions amid organizational barriers to change. Three Federally Qualified Health Centers in South Los Angeles participated in a partnership led by a local community-based organization (CBO) to implement hypertension interventions. Qualitative research methods were used to evaluate intervention selection and implementation processes between January 2014 and June 2015. Data collection tools included a key participant interview guide, health care provider interview guide, and protocol for taking meeting minutes. This case study demonstrates how a CBO acted as an external facilitator and employed a collaborative partnership model to catalyze implementation of evidence-based interventions in safety net settings. The study phases observed included initiation, planning, and implementation. Three emergent categories of organizational facilitators and barriers were identified (personnel capacity, professional development capacity, and technological capacity). Key participants and health care providers expressed a high level of satisfaction with the collaborative and the interventions, respectively. The CBO’s role as a facilitator and catalyst is a replicable model to promote intervention adoption and implementation in safety net settings. Key lessons learned are provided for researchers and practitioners interested in partnering with Federally Qualified Health Centers to implement health promotion interventions.

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Helping Optimize Language Acquisition (HOLA) Online Parent Training Modules for Latinx Parents of Toddlers at Risk for ASD: Protocol for a Pilot Funded by the Organization for Autism Research (Preprint)

10.2196/preprints.18004 ◽

2020 ◽

Author(s):

Robin Lynn Dodds

Keyword(s):

At Risk ◽

Los Angeles ◽

Young Children ◽

Parent Training ◽

Autism Spectrum ◽

Professional Services ◽

Evidence Based ◽

Culturally Competent ◽

South Los Angeles ◽

The Impact

BACKGROUND Culturally competent parent training in evidence-based intervention for autism spectrum disorder (ASD) can provide young Latinx children from underserved communities with early interventional support while they wait for professional services, thus reducing the impact of intervention delays. Providing parents with brief bilingual training in Pivotal Response Treatment (PRT) is a strategy that can overcome these barriers and is inexpensive to disseminate. Brief PRT training has been shown to significantly improve joint attention, expressive language, responsivity, and adaptive skills in young children with ASD. However, it is unknown whether an interactive, culturally competent online parent training in PRT is effective in a Latinx population. OBJECTIVE To this end, we will recruit 24 children (16-36 months old) at risk for ASD and their parent(s) from East and South Los Angeles and provide them with a series of 6 online learning modules in their choice of Spanish or English. METHODS This pilot study will utilize a single-group, pilot, pre-post design with follow-up assessments 6 weeks later. Linear mixed-effects model analysis will be used to explore most parent-reported and coded outcomes. RESULTS Brief online parent training in evidence-based treatments has the capacity to increase access to culturally competent early communication interventions for young children at risk for ASD. CONCLUSIONS The results of this trial may have particular salience in additional underresourced communities where children have limited access to interventions prior to entering school. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/18004

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Making sense of evidence in management decisions: the role of research-based knowledge on innovation adoption and implementation in health care

Health Services and Delivery Research ◽

10.3310/hsdr02060 ◽

2014 ◽

Vol 2 (6) ◽

pp. 1-192 ◽

Cited By ~ 9

Author(s):

Yiannis Kyratsis ◽

Raheelah Ahmad ◽

Kyriakos Hatzaras ◽

Michiyo Iwami ◽

Alison Holmes

Keyword(s):

Health Care ◽

Scientific Practice ◽

National Level ◽

Decision Makers ◽

Infection Prevention And Control ◽

Management Approach ◽

Evidence Based ◽

Research Knowledge ◽

Making Sense ◽

Adoption And Implementation

BackgroundAlthough innovation can improve patient care, implementing new ideas is often challenging. Previous research found that professional attitudes, shaped in part by health policies and organisational cultures, contribute to differing perceptions of innovation ‘evidence’. However, we still know little about how evidence is empirically accessed and used by organisational decision-makers when innovations are introduced.Aims and objectivesWe aimed to investigate the use of different sources and types of evidence in innovation decisions to answer the following questions: how do managers make sense of evidence? What role does evidence play in management decision-making when adopting and implementing innovations in health care? How do wider contextual conditions and intraorganisational capacity influence research use and application by health-care managers?MethodsOur research design comprised multiple case studies with mixed methods. We investigated technology adoption and implementation in nine acute-care organisations across England. We employed structured survey questionnaires, in-depth interviews and documentary analysis. The empirical setting was infection prevention and control. Phase 1 focused on the espoused use of evidence by 126 non-clinical and clinical hybrid managers. Phase 2 explored the use of evidence by managers in specific technology examples: (1) considered for adoption; (2) successfully adopted and implemented; and (3) rejected or discontinued.Findings(1) Access to, and use of, evidence types and sources varied greatly by profession. Clinicians reported a strong preference for science-based, peer-reviewed, published evidence. All groups called upon experiential knowledge and expert opinion. Nurses overall drew upon a wider range of evidence sources and types. Non-clinical managers tended to sequentially prioritise evidence on cost from national-level sources, and local implementation trials. (2) A sizeable proportion of professionals from all groups, including experienced staff, reported difficulty in making sense of evidence. Lack of awareness of existing implementation literature, lack of knowledge on how to translate information into current practice, and lack of time and relevant skills were reported as key reasons for this. (3) Infection outbreaks, financial pressures, performance targets and trusted relationships with suppliers seemed to emphasise a pragmatic and less rigorous approach in sourcing for evidence. Trust infrastructure redevelopment projects, and a strong emphasis on patient safety and collaboration, appeared to widen scope for evidence use. (4) Evidence was continuously interpreted and (re)constructed by professional identity, organisational role, team membership, audience and organisational goals. (5) Doctors and non-clinical managers sourced evidence plausible to self. Nursing staff also sought acceptance of evidence from other groups. (6) We found diverse ‘evidence templates’ in use: ‘biomedical-scientific’, ‘practice-based’, ‘rational-policy’. These represented shared cognitive models which defined what constituted acceptable and credible evidence in decisions. Nurses drew on all diverse ‘templates’ to make sense of evidence and problems; non-clinical managers drew mainly on the practice-based and rational-policy templates; and doctors drew primarily on the biomedical-scientific template.ConclusionsAn evidence-based management approach that inflexibly applies the principles of evidence-based medicine, our findings suggest, neglects how evidence is actioned in practice and how codified research knowledge inter-relates with other ‘evidence’ also valued by decision-makers. Local processes and professional and microsystem considerations played a significant role in adoption and implementation. This has substantial implications for the effectiveness of large-scale projects and systems-wide policy.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Increasing the Delivery of Health Care Services to Migrant Farm Worker Families Through a Community Partnership Model

Public Health Nursing ◽

10.1111/j.1525-1446.2007.00644.x ◽

2007 ◽

Vol 24 (4) ◽

pp. 355-360 ◽

Cited By ~ 18

Author(s):

Ann Connor ◽

Laura P. Rainer ◽

Jordan B. Simcox ◽

Karen Thomisee

Keyword(s):

Health Care ◽

Delivery Of Health Care ◽

Health Care Services ◽

Community Partnership ◽

Farm Worker ◽

Care Services ◽

Partnership Model ◽

Migrant Farm

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Community partnership model for health professions education

Journal of the American Podiatric Medical Association ◽

10.7547/87507315-83-6-328 ◽

1993 ◽

Vol 83 (6) ◽

pp. 328-331 ◽

Cited By ~ 1

Author(s):

RC Henry

Keyword(s):

Health Care ◽

Care Center ◽

Health Professions ◽

Academic Community ◽

Public Health Care ◽

Community Partnership ◽

Health Care Needs ◽

Care Needs ◽

Health Care Center ◽

Partnership Model

Many health professions schools have neglected the US population's health by emphasizing acutely ill patients in hospitals, biomedical research of disease, and high technology. Because most students will eventually fill practitioner roles in primary and secondary care, it is logical that the health professions must shift their curricula's focus to prepare practitioners for the health care needs of the community. The Community Partnership Model is one approach that focuses on public health care needs by educating students in multiprofessional teams in a new organizational structure known as the academic, community-based, primary health care center. This partnership between academic institutions and communities is designed to shift the educational and socializing activities of health professions training outside hospitals to the community setting where research, teaching, and service take place in one structure.

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Improving Health Care for the Future Uninsured in Los Angeles County: A Community Partnered Dialogue

Ethnicity & Disease ◽

10.18865/ed.25.4.487 ◽

2015 ◽

Vol 25 (4) ◽

pp. 487 ◽

Cited By ~ 2

Author(s):

Sharat Parameswaran Iyer ◽

Andrea Jones ◽

Efrain Talamantes ◽

Elizabeth S. Barnert ◽

Hemal K. Kanzaria ◽

...

Keyword(s):

Health Care ◽

Los Angeles ◽

Health Care Access ◽

Local Community ◽

Safety Net ◽

Care Access ◽

Pile Sort ◽

Community Forum ◽

Improving Health Care

Objectives: To understand the health care access issues faced by Los Angeles (LA) County’s uninsured and residually uninsured after implementation of the Affordable Care Act (ACA) and to identify potential solutions using a community-partnered dialogue.Design: Qualitative study using a community-partnered participatory research framework.Setting: Community forum breakout discussion.Discussants: Representatives from LA County health care agencies, community health care provider organizations, local community advocacy and service organizations including uninsured individuals, and the county school district.Main Outcome Measures: Key structural and overarching value themes identified through community-partnered pile sort, c-coefficients measuring overlap between themes.Results: Five overarching value themes were identified – knowledge, trust, quality, partnership, and solutions. Lack of knowledge and misinformation were identified as barriers to successful enrollment of the eligible uninsured and providing health care to undocumented individuals. Discussants noted dissatisfaction with the quality of traditional sources of health care and a broken cycle of trust and disengagement. They also described inherent trust by the uninsured in “outsider” community-based providers not related to quality.Conclusions: Improving health care for the residually uninsured after ACA implementation will require addressing dissatisfaction in safety-net providers, disseminating knowledge and providing health care through trusted nontraditional sources, and using effective and trusted partnerships between community and health care agencies with mutual respect. Community-academic partnerships can be a trusted conduit to discuss issues related to the health care of vulnerable populations. Ethn Dis. 2015; 25(4)487- 494; doi:10.18865/ed.25.4.487

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Between Tolerant Containment and Concerted Constraint: Managing Madness for the City and the Privileged Family

American Sociological Review ◽

10.1177/0003122419859533 ◽

2019 ◽

Vol 84 (4) ◽

pp. 664-689 ◽

Cited By ~ 3

Author(s):

Neil Gong

Keyword(s):

Mental Health ◽

Health Care ◽

Los Angeles ◽

Mental Health Care ◽

Public Space ◽

Urban Poverty ◽

Safety Net ◽

Health Providers ◽

Liberal Societies ◽

The Right

How do public safety net and elite private mental health providers cope with a key dilemma since psychiatric deinstitutionalization—managing madness when people have the right to refuse care? I observed two approaches to voluntary community-based services, one that tolerates “non-compliance” and deviant choices, and another that attempts to therapeutically discipline clientele. The puzzle, given theories of the paternalistic governance of poverty, is that select poor patients are given autonomy while the privileged are micro-managed. Drawing on comparative fieldwork in Los Angeles, I show how contrasting ecological pressures and resource bases shape divergent practices. In the context of urban poverty governance, mental health care and low-barrier housing offer a way to remove problem people from public space. This “tolerant containment” is linked to limited therapeutic capacity and the construction of clients as beyond transformation. In the context of family systems governance, elite private mental health care is a project to reform wayward relatives and equip them with respectable futures. A “concerted constraint” of deviance, akin to Lareau’s theory of privileged childrearing, is reserved for those who can afford rehabilitation and conceivably recover. Using these cases, I contribute to theories of social control and inequality in advanced liberal societies.

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Peace of Mind Program (PMP): Impact of the Dissemination and Implementation of an Evidence-based Intervention (EBI) to Improve Mammography Appointment Adherence in Safety Net Clinics

10.21203/rs.3.rs-493474/v1 ◽

2021 ◽

Author(s):

Jennifer Holcomb ◽

Suja S Rajan ◽

Gayla M Ferguson ◽

Jiali Sun ◽

Gretchen H Walton ◽

...

Keyword(s):

Implementation Research ◽

Safety Net ◽

Baseline Period ◽

Evidence Based ◽

Intervention Period ◽

Peace Of Mind ◽

Appointment Adherence ◽

Adoption And Implementation ◽

Safety Net Clinics ◽

Inner Setting

Abstract Backgroundhe Peace of Mind Program – an adapted evidence-based intervention to improve mammography appointment adherence in underserved women – was expanded to safety net clinics. This study assessed effectiveness of the intervention in improving mammography appointment adherence and implementation of the intervention. MethodsThe intervention was implemented through a non-randomized stepped wedge cluster design with 19 Federally Qualified Health Centers and charity care clinics in the Greater Houston area. Clinics were their own control during the baseline period and conducted at least three mammography drives during the baseline and intervention period. A multivariable generalized estimating equation logistic regression was conducted to examine mammography appointment adherence. To examine adoption and implementation of the intervention, two surveys assessing Consolidated Framework for Implementation Research constructs were conducted with clinic leadership and staff. One-sided t-tests were conducted to analyze mean score changes between the adoption and implementation survey. Results total of 4402 women (baseline period = 2078; intervention period = 2324) were included in the final analysis. Women in the intervention period were more likely to attend or reschedule their mammography appointment (OR = 1.30; p < 0.01). Similarly, for those in the intervention period, women who completed the intervention were more likely to attend or reschedule their mammography appointment than those who did not complete the intervention (OR = 1.62; p < 0.01). The mammography appointment no-show rates for those in the baseline period, in the intervention period, and who completed the intervention were, respectively, 22%, 19%, and 15%. In terms of the adoption and implementation survey, a statistically significant mean score decrease was observed in Inner Setting overall and in two Inner Setting constructs, Culture – Effort and Implementation Climate. ConclusionsThis study provided a pragmatic approach to translating an evidence-based mammography intervention into practice in safety net clinics. While the intervention improved mammography appointment adherence, there our opportunities to further integrate Consolidated Framework for Implementation Research constructs in future implementation of the intervention. Future research on the effects of implementation moderators particularly Inner Setting constructs would be of value to implementation practitioners.

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A Micropractice/Community Partnership Model for Lifestyle Medicine

American Journal of Lifestyle Medicine ◽

10.1177/1559827617726524 ◽

2017 ◽

Vol 12 (2) ◽

pp. 124-127 ◽

Cited By ~ 2

Author(s):

Kerry Graff

Keyword(s):

Health Care ◽

Family Medicine ◽

Community Partnership ◽

Local Health ◽

Lifestyle Medicine ◽

Medical Expenses ◽

Current Health ◽

Partnership Model ◽

Current Health Care System ◽

Local Health System

Lifestyle medicine (LM) has been shown to be effective at preventing and reversing disease, while simultaneously reducing overall medical expenses. However, the current health care system is not designed to reimburse LM clinicians for the value that they provide. The micropractice model is an innovative approach to deliver LM in a financially viable manner. Costs are minimized by automating much of the practice through a website, limiting physical clinic space, and employing only essential staff. Described in this article is a unique micropractice family medicine/lifestyle medicine hybrid office that has partnered with a local health system and a culinary center to offer additional services.

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Helping Optimize Language Acquisition (HOLA) Online Parent Training Modules for Latinx Parents of Toddlers at Risk for ASD: Protocol for a Pilot Funded by the Organization for Autism Research

JMIR Research Protocols ◽

10.2196/18004 ◽

2020 ◽

Vol 9 (12) ◽

pp. e18004

Author(s):

Robin Lynn Dodds

Keyword(s):

At Risk ◽

Los Angeles ◽

Young Children ◽

Parent Training ◽

Autism Spectrum ◽

Professional Services ◽

Evidence Based ◽

Culturally Competent ◽

South Los Angeles ◽

The Impact

Background Culturally competent parent training in evidence-based intervention for autism spectrum disorder (ASD) can provide young Latinx children from underserved communities with early interventional support while they wait for professional services, thus reducing the impact of intervention delays. Providing parents with brief bilingual training in Pivotal Response Treatment (PRT) is a strategy that can overcome these barriers and is inexpensive to disseminate. Brief PRT training has been shown to significantly improve joint attention, expressive language, responsivity, and adaptive skills in young children with ASD. However, it is unknown whether an interactive, culturally competent online parent training in PRT is effective in a Latinx population. Objective To this end, we will recruit 24 children (16-36 months old) at risk for ASD and their parent(s) from East and South Los Angeles and provide them with a series of 6 online learning modules in their choice of Spanish or English. Methods This pilot study will utilize a single-group, pilot, pre-post design with follow-up assessments 6 weeks later. Linear mixed-effects model analysis will be used to explore most parent-reported and coded outcomes. Results Brief online parent training in evidence-based treatments has the capacity to increase access to culturally competent early communication interventions for young children at risk for ASD. Conclusions The results of this trial may have particular salience in additional underresourced communities where children have limited access to interventions prior to entering school. International Registered Report Identifier (IRRID) PRR1-10.2196/18004

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