scholarly journals What will it take? Using an Implementation Research Framework to Identify Facilitators and Barriers in Implementing a School-Based Referral System for Sexual Health Services

2019 ◽  
Author(s):  
Emily Leung ◽  
Kathryn J. Wanner ◽  
Lindsay Senter ◽  
Amanda Brown ◽  
Dawn Middleton
Keyword(s):  
Health Services ◽  
Sexual Health ◽  
Implementation Research ◽  
Critical Role ◽  
The United States ◽  
Successful Implementation ◽  
Community Based ◽  
School Based ◽  
Student Access

Abstract Background:Across the United States (U.S.), sexually-transmitted infections and unintended pregnancy rates are alarmingly high among youth. Schools play a critical role in improving access to sexual health services (SHS) due to their proximity and access to youth. Schools can increase student access to services by creating referral systems (RS) to link students to school- and community-based SHS. From 2013-2018, the Centers for Disease Control and Prevention’s Division of Adolescent and School Health funded 17 Local Education Agencies (LEA) to partner with priority schools, and other stakeholders, to develop and implement RS to increase student access to SHS. CAI served as the Technical Assistance Center, providing capacity building to the LEA. CAI conducted a case study at two large urban LEA to elucidate factors that influence RS implementation in 2016-2017. Methods:This mixed-methods case study included interviewing and surveying 19 LEA and community-based healthcare (CBH) staff in the Southeastern (n=9) and Western U.S. (n=10). Key constructs from the Consolidated Framework for Implementation Research (CFIR) framework guided the methodology and analysis. Consensus qualitative research coding methods were applied to the interviews. We also distributed a quantitative survey to collect participants’ perceived difficulty in implementing and sustaining RS; data was analyzed using descriptive statistics. Results:Interviewees reported strong beliefs that school-based RS can help students achieve better academic outcomes. We identified several contextual key factors across the five CFIR domains that influenced successful implementation and integration of an RS including: enforcing state and district policies, strong LEA and CBH collaboration, positive school culture towards adolescent health, knowledgeable and supportive staff, leveraging of existing resources and staffing structures, and influential district and school building-level leadership and champions. Notably, this case study challenged our initial assumptions that RS are easily implemented in states with comprehensive SHS policies. Rather, our conversations revealed how districts and local-level policies have significant influence to either impede or promote those policies. Conclusions:Using an implementation science lens, this study describes key contextual factors and lessons learned to implementing an RS. Other schools may wish to consider these influencing factors to optimize integration of RS-related evidence-based practices, systems, and policies in their districts.

scholarly journals What will it take? Using an Implementation Research Framework to Identify Facilitators and Barriers in Implementing a School-Based Referral System for Sexual Health Services

2020 ◽  
Author(s):  
Emily Leung ◽  
Kathryn J. Wanner ◽  
Lindsay Senter ◽  
Amanda Brown ◽  
Dawn Middleton
Keyword(s):  
Health Services ◽  
Sexual Health ◽  
Unintended Pregnancy ◽  
Implementation Research ◽  
Contextual Factors ◽  
The United States ◽  
Successful Implementation ◽  
Community Based ◽  
School Based ◽  
Student Access

Abstract Background Across the United States, sexually transmitted infections and unintended pregnancy rates are alarmingly high among youth. Schools, due to their proximity and access to youth, can increase student access to sexual health services (SHS) by creating referral systems (RS) to link students to school- and community-based SHS. From 2013-2018, the Centers for Disease Control and Prevention’s Division of Adolescent and School Health funded 17 Local Education Agencies (LEA) to partner with priority schools and stakeholders to develop and implement RS to increase student access to SHS. Cicatelli Associates Inc. (CAI) was funded to provide capacity-building to LEA. In 2016-2017, CAI conducted case studies at two LEA, both large and urban sites, but representing different geographical and political contexts, to elucidate factors that influence RS implementation. Methods Nineteen LEA and community-based healthcare (CBH) staff were interviewed in the Southeastern (n=9) and Western U.S. (n=10). Key constructs (e.g., leadership engagement, resources, state and district policies) across the five domains of the Consolidated Framework for Implementation Research (CFIR) framework guided the methodology and analysis. Qualitative data was analyzed using the Framework Method and contextual factors and themes that led to RS implementation were identified. Results Interviewees strongly believed that school-based RS can decrease STI, HIV and unintended pregnancy and increase students’ educational attainment. We identified the following contextual key factors that facilitate successful implementation and integration of an RS: enforcing state and district policies, strong LEA and CBH collaboration, positive school culture towards adolescent health, knowledgeable and supportive staff, leveraging of existing resources and staffing structures, and influential district and school building-level leadership and champions. Notably, this case study challenged our initial assumptions that RS are easily implemented in states with comprehensive SHS policies. Rather, our conversations revealed how districts and local-level policies can have significant impact and influence to impede or promote those policies. Conclusions Through the use of the CFIR framework, the interviews identified important contextual factors and themes associated with LEAs’ implementation barriers and facilitators. The study’s results present key recommendations that other LEA can consider to optimize integration of RS-related evidence-based practices, systems, and policies in their districts.

scholarly journals What will it take? Using an Implementation Research Framework to Identify Facilitators and Barriers in Implementing a School-Based Referral System for Sexual Health Services

2020 ◽  
Author(s):  
Emily Leung ◽  
Kathryn J. Wanner ◽  
Lindsay Senter ◽  
Amanda Brown ◽  
Dawn Middleton
Keyword(s):  
Health Services ◽  
Sexual Health ◽  
Unintended Pregnancy ◽  
Implementation Research ◽  
Contextual Factors ◽  
The United States ◽  
Successful Implementation ◽  
Community Based ◽  
School Based ◽  
Student Access

Abstract Background Across the United States, sexually transmitted infections and unintended pregnancy rates are alarmingly high among youth. Schools, due to their proximity and access to youth, can increase student access to sexual health services (SHS) by creating referral systems (RS) to link students to school- and community-based SHS. From 2013-2018, the Centers for Disease Control and Prevention’s Division of Adolescent and School Health funded 17 Local Education Agencies (LEA) to partner with priority schools and stakeholders to develop and implement RS to increase student access to SHS. Cicatelli Associates Inc. (CAI) was funded to provide capacity-building to LEA. In 2016-2017, CAI conducted case studies at two LEA, both large and urban sites, but representing different geographical and political contexts, to elucidate factors that influence RS implementation. Methods Nineteen LEA and community-based healthcare (CBH) staff were interviewed in the Southeastern (n=9) and Western U.S. (n=10). Key constructs (e.g., leadership engagement, resources, state and district policies) across the five domains of the Consolidated Framework for Implementation Research (CFIR) framework guided the methodology and analysis. Qualitative data was analyzed using the Framework Method and contextual factors and themes that led to RS implementation were identified. Results Interviewees strongly believed that school-based RS can decrease STI, HIV and unintended pregnancy and increase students’ educational attainment. We identified the following contextual key factors that facilitate successful implementation and integration of an RS: enforcing state and district policies, strong LEA and CBH collaboration, positive school culture towards adolescent health, knowledgeable and supportive staff, leveraging of existing resources and staffing structures, and influential district and school building-level leadership and champions. Notably, this case study challenged our initial assumptions that RS are easily implemented in states with comprehensive SHS policies. Rather, our conversations revealed how districts and local-level policies can have significant impact and influence to impede or promote those policies. Conclusions Through the use of the CFIR framework, the interviews identified important contextual factors and themes associated with LEAs’ implementation barriers and facilitators. The study’s results present key recommendations that other LEA can consider to optimize integration of RS-related evidence-based practices, systems, and policies in their districts.

Case Study of an Ethnic Community-Based Organization in the United States

2016 ◽  
Vol 46 (1) ◽  
pp. 199-217 ◽  
Author(s):  
Catherine M. Vu ◽  
Duy Nguyen ◽  
Daniel B. Tanh ◽  
Jessica Chun
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Service Use ◽  
The United States ◽  
Mental Health Service Use ◽  
Community Based ◽  
Study Approach ◽  
Korean Adults

Ethnic nonprofit community-based organizations (CBOs) have played a crucial role in the social fabric of ethnic communities. Despite the importance of ethnic CBOs, limited empirical knowledge exists about these types of organizations. This study seeks to fill this gap by exploring how ethnic CBOs engage their target populations in stigma-associated services using a multidimensional cultural competence framework. A case study approach is used to explore how a Korean ethnic organization engages older adults in mental health services. The study provides an in-depth examination of the organization’s responses to the increasing need for mental health services for older Korean adults by providing culturally grounded services in a nonstigmatized environment. The study contributes to current literature by (a) using a multidimensional approach to examine community, organizational, and individual factors that influence mental health service use and (b) exploring how ethnic organizations consider these domains to serve older Korean adults.

Integrated community-based sexual health services for young people in urban areas: are we meeting the needs of the local community?

2008 ◽  
Vol 19 (10) ◽  
pp. 713-714 ◽  
Author(s):  
K M Forbes ◽  
N Rahman ◽  
S Mccrae ◽  
I Reeves
Keyword(s):  
Health Services ◽  
Sexual Health ◽  
Urban Areas ◽  
Local Community ◽  
Local Population ◽  
Nucleic Acid Amplification ◽  
Community Based ◽  
Transmitted Infection ◽  
Sti Testing ◽  
Hiv Test

Community-based sexual health services (SHS) are intended to improve access for people who may have difficulty attending traditional genitourinary medicine clinics. The objective of this study was to review uptake of sexually transmitted infection (STI) testing in an outreach clinic for those under 25 in an area where Black and minority ethnic groups comprise the majority of the local population. A retrospective case-notes review was undertaken of those attending. Standards were that Fraser guidelines should be completed in all under 16-year-old and all clients should be offered STI testing, HIV testing and contraception (if applicable) in accordance with local standards. One hundred and seventeen clients attended. Ten percent self-reported ethnicity was Asian. Thirty-six (31%) clients tested for chlamydia. Thirty (26%) had an HIV test. Five (14% of those tested) had a positive nucleic acid amplification test for chlamydia. Five (13%) of those requesting long term contraception had STI testing. This service has successfully improved access to STI screening. However, there may have been missed opportunities to offer tests in those requesting contraception. Under-representation of those of non-white ethnicity suggests access to SHS may be a particular problem and further work is required to improve the sexual health of the local community.

scholarly journals School-Based Health Clinics: Improving Adolescent Sexual and Reproductive Health in British Columbia – An Integrative Literature Review

2020 ◽  
Author(s):  
◽  
Carmen Schalles
Keyword(s):  
British Columbia ◽  
Reproductive Health ◽  
Health Services ◽  
Literature Review ◽  
Sexual Health ◽  
Sexual And Reproductive Health ◽  
Societal Implications ◽  
Health Clinics ◽  
School Based ◽  
Reproductive And Sexual Health

This integrative literature review strives to determine if the delivery of reproductive and sexual health services provided through high school-based primary care clinics can improve BC adolescent sexual and reproductive health. Adolescent sexual and reproductive health not only impacts life-long health; it also has significant societal implications. Although BC has begun to focus on adolescent health, innovative health service solutions are needed to improve adolescents’ health. Systematic search through the University of Northern British Columbia online library databases and Google scholar and the evaluation of the literature using CASP analysis tools resulted in the inclusion of 10 articles. Findings suggest school-based health clinics (SBHCs) decrease barriers that adolescents experience when accessing health services as well as public health system costs. Moreover, SBHCs are an effective mechanism to support adolescent reproductive and sexual health needs, especially in those populations with elevated levels of sexual and reproductive risk factors. However, for SBHCs to be effective, sustainable funding needs to be sourced, and barriers adolescents experience when accessing services need to be evaluated and addressed. SBHCs can complement current adolescent-friendly services to meet this unique population’s needs; however, further research is needed. More robust research on various demographics, health outcomes, and Canadian-based examination is required to strengthen SBHC implementation recommendations.

scholarly journals Complexity, Evaluation and the Effectiveness of Community-based Interventions to Reduce Health Inequalities

2020 ◽  
Author(s):  
Anna Matheson ◽  
Kevin Dew ◽  
Jacqueline Cumming
Keyword(s):  
New Zealand ◽  
Health Inequalities ◽  
Comparative Case Study ◽  
Successful Implementation ◽  
Intervention Effectiveness ◽  
Community Based Interventions ◽  
Community Based ◽  
Theoretical Understanding ◽  
System Perspective

Reducing health inequalities has been part of the New Zealand government's agenda since the early 1990s. As a result, interventions have been implemented nationally with the explicit goal of reducing health inequalities. This paper describes findings from a comparative case study of two community-based interventions - carried out in different New Zealand communities. Complexity theory was used as an analytic tool to examine the case data, and provided a systematic way in which to explore 'local' issues by taking a 'whole system' perspective. The findings showed that two important influences on the successful implementation of the interventions were the existence and capacity of local organisations and their relationships with government agencies. The analysis provided a dynamic picture of shared influences on the interventions in different communities and in doing so offered insight into intervention effectiveness. It is argued in this article that, for examining intervention effectiveness, it is essential to have a theoretical understanding of the behaviour of the complex system in which they are implemented. This theoretical understanding has implications for the appropriate design of interventions to reduce health inequalities, and in turn should lead to more meaningful ways to evaluate them.

scholarly journals Complexity, Evaluation and the Effectiveness of Community-based Interventions to Reduce Health Inequalities

2020 ◽  
Author(s):  
Anna Matheson ◽  
Kevin Dew ◽  
Jacqueline Cumming
Keyword(s):  
New Zealand ◽  
Health Inequalities ◽  
Comparative Case Study ◽  
Successful Implementation ◽  
Intervention Effectiveness ◽  
Community Based Interventions ◽  
Community Based ◽  
Theoretical Understanding ◽  
System Perspective

Reducing health inequalities has been part of the New Zealand government's agenda since the early 1990s. As a result, interventions have been implemented nationally with the explicit goal of reducing health inequalities. This paper describes findings from a comparative case study of two community-based interventions - carried out in different New Zealand communities. Complexity theory was used as an analytic tool to examine the case data, and provided a systematic way in which to explore 'local' issues by taking a 'whole system' perspective. The findings showed that two important influences on the successful implementation of the interventions were the existence and capacity of local organisations and their relationships with government agencies. The analysis provided a dynamic picture of shared influences on the interventions in different communities and in doing so offered insight into intervention effectiveness. It is argued in this article that, for examining intervention effectiveness, it is essential to have a theoretical understanding of the behaviour of the complex system in which they are implemented. This theoretical understanding has implications for the appropriate design of interventions to reduce health inequalities, and in turn should lead to more meaningful ways to evaluate them.

scholarly journals Trilha Verde da Maria Fumaça: patrimônio ferroviário e turismo no Vale do Jequitinhonha

2016 ◽  
Vol 9 (6) ◽  
Author(s):  
Rosalia Aparecida Moreira ◽  
Hugo Rodrigues Araujo
Keyword(s):  
United States ◽  
Literature Review ◽  
Qualitative Analysis ◽  
The United States ◽  
Local Economy ◽  
Community Based ◽  
Descriptive Case Study ◽  
Practical Applications ◽  
Structured Questionnaire

Em 1986, foi criado nos Estados Unidos a Rails-to-Trails Conservancy, entidade sem fins lucrativos com a missão de contribuir para conservação do patrimônio ferroviário, transformando os ramais abandonados em trilhas ferroviárias destinadas, exclusivamente, para caminhantes, ciclistas e cavaleiros. Com essa perspectiva, há 15 anos iniciou-se uma mobilização comunitária para transformar o antigo Ramal Ferroviário Corinto-Diamantina, localizado no Vale do Jequitinhonha/MG, na primeira trilha ferroviária do Brasil, denominada Trilha Verde da Maria Fumaça - TVMF. Além da conservação dos bens ferroviários, a TVMF busca a dinamização da economia local através do Turismo de Base Comunitária. Este artigo corresponde a um estudo de caso da TVMF, de caráter exploratório-descritivo. A pesquisa envolveu revisão bibliográfica e entrevista do gestor da ONG Caminhos da Serra, utilizando questionário semiestruturado. A análise qualitativa dos dados permitiu obter resultados que proporcionam o entendimento sobre a TVMF, contribuem para a abertura da discussão sobre trilhas ferroviárias no Brasil e fornecem informações para subsidiar aplicações práticas em outras ferrovias que se encontram abandonadas. Trilha Verde da Maria Fumaça: railroad heritage and tourism in the Vale do Jequitinhonha (Brazil). In 1986, the Rails-to-Trails Conservancy was created in the United States, a nonprofit organization with a mission to contribute to conservation of the railway heritage, turning extensions abandoned on rails trails, designed exclusively for walkers, cyclists and riders. With this perspective, 15 years ago a community began a mobilization to transform the old Railway Corinto-Diamantina, located in Vale do Jequitinhonha / MG, into the first rail trails in Brazil, called Trilha Verde da Maria Fumaça - TVMF. In addition to the conservation of rail assets, TVMF seeks to stimulate the local economy through the Community Based Tourism. This article is an exploratory and descriptive case study of TVMF. The research involved literature review and interview questions for the manager of the NGO Caminhos da Serra, by using semi-structured questionnaire. Through qualitative analysis of data it was possible to get results that provide an understanding of the TVMF, contribute to opening the discussion about rails trails in Brazil, and provide information to support practical applications in other railways that are abandoned. KEYWORDS: Railway Tourism; Sustainable Tourism; Rails Trails.

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