Expanding PrEP Services for Men Who Have Sex With Men and Transgender Persons Through Health Department Programs: Key Processes and Outcomes From Project PrIDE, 2015-2019

Objective: Pre-exposure prophylaxis (PrEP) Implementation, Data to Care, and Evaluation (PrIDE) was a demonstration project implemented by 12 state and local health departments during 2015-2019 to expand PrEP services for men who have sex with men (MSM) and transgender persons at risk for HIV infection. We describe findings from the cross-jurisdictional evaluation of the project. Methods: We analyzed work plans, annual progress reports, and aggregate quantitative program data submitted by funded health departments (n = 12) to identify key activities implemented and summarize key project outcomes. Results: PrIDE jurisdictions implemented multiple health equity–focused activities to expand PrEP services to priority populations, including building program capacity, conducting knowledge and awareness campaigns, providing PrEP support services, and addressing barriers to PrEP use. Overall, PrIDE jurisdictions identified 44 813 persons with PrEP indications. Of these, 74.8% (n = 33 500) were referred and 33.1% (n = 14 821) were linked to PrEP providers, and 25.3% (n = 11 356) were prescribed PrEP. Most persons prescribed PrEP were MSM or transgender persons (87.9%) and persons from racial and ethnic minority groups (65.6%). However, among persons with PrEP indications, non-Hispanic Black/African American persons (14.9% of 18 782) were less likely than non-Hispanic White persons (31.0% of 11 633) to be prescribed PrEP ( z = −33.57; P < .001). Conclusions: PrIDE jurisdictions successfully expanded PrEP services for MSM, transgender persons, and racial and ethnic minority groups by implementing health equity–focused activities that addressed barriers to PrEP services. However, PrEP prescription was generally low, with significant disparities by demographic characteristics. Additional targeted interventions are needed to expand PrEP services, achieve equity in PrEP use, and contribute to ending the HIV epidemic in the United States.

Is a Forensic Cohabitation Program Recovery-Oriented? A Logic Model Analysis

Background. Recovery orientation is a movement in mental health practice. Although general mental health services have taken the lead in promoting recovery, forensic psychiatric systems have lagged behind because of the need to reconcile recovery principles with the complexities of legal mandates. Advocating recovery and making systemic changes can be challenging because they require seeking a balance between the competing duties to the patient and the public. This paper used a logic model framework to demonstrate a cohabitation program that placed a woman and her newborn infant in a secure forensic rehabilitation unit, and analyzed the key assumptions of recovery upon which it was based. Methods. This was a qualitative program evaluation. Data collection involved individual interviews with the woman, the infant’s father, five primary healthcare providers, and five system administrators, and 11 focus groups with unit staff and other patients. Content analysis was used to guide the data analysis and develop the critical components of the program logic model. Results. A logic model that consists of input (team building, program planning, staff and patient preparation, resource management), output (logistic activities, risk management, mental healthcare, staff/other patient support, discharge preparation), and outcome (individual, provider, system, and society) components was developed. Conclusions. This study demonstrates a recovery-oriented program for a woman cohabitating with her baby in a secure forensic psychiatric rehabilitation unit. The logic model provided a comprehensive understanding of the way the recovery principles, such as shared decision-making, positive risk-taking, informed choices, and relational security, were implemented.

China’s Belt and Road Initiative with ASEAN Countries: Examining the Trade Cooperation and Impact of Coronavirus

The rising US–China tension in the global trade war increased the trade cooperation between China and the ASEAN. Consequently, China’s total import and export volume with ASEAN increased tremendously to 684.60 billion USD in 2020, up by 6.7% year on year. This trend is part of the Belt and Road Initiative (BRI) which promotes China’s infrastructure building program in the neighboring ASEAN countries and exports China’s technical know-how and engineering standards. However, the recent coronavirus outbreak that stormed China and the rest of the world caused delays to many BRI projects. Subsequently, this outbreak also hit the ASEAN countries and halted many of their mega-projects under the BRI framework. Thus, this study attempts to highlight the trade cooperation and project developments of BRI in the ASEAN countries. In addition, the study features the landscape of BRI projects that were affected by the coronavirus amongst the ASEAN countries.

PLATFORM COOPS NOW!: A team entrepreneurship capacity building program to create platform coops

Traditional labour relationships have been disrupted due to the digital platforms based businesses. This article aims on the one hand to share the consequences the sharing economy has generated for workers, and how MONDRAGON’s principles as one of the best examples of worker owned business group in the world, can be applied within the new digital era. On the other hand, this paper provides a literature review on how digital platforms can operate with fairer principles based on the framework that platform coops consist of. Last but not least, Mondragon University and The New School have set up a capacity building program on team entrepreneurship and an online incubation program that aims to support the creation of platform coops, whose results after two editions and future opportunities for research are shared.

Developing fluency with multi-word expressions

<p>This three-part study was motivated by the need for empirically tested methods for teaching and learning multi-word expressions to develop fluency in language learning classrooms. Using an action research paradigm in an EFL university learning context in rural Japan, the study draws on earlier work by Boers, Eyckmans, Kappel, Stengers, & Demecheleer (2006) who linked speaking fluency with the use of multi-word expressions, and Wood (2009) who found increases in fluency after multi-word expression focussed teaching and practice with one learner in an ESL context. This study also draws on Nation's (2007) Four Strands framework for fluency building. In the first of the three studies, a conceptual replication of the fluency workshop (including phrase instruction, shadowing, dictogloss, and role-play for example) by Wood (2009) was carried out. In contrast to Wood’s approach, this study contained more than one participant (n = 52) and a control group (n = 35). The control group also followed a fluency building program but without a focus on learning target expressions. Learning effects were tested using pre- and post-test measures, including a cloze test of 30 target multi-word expressions to measure form and meaning knowledge, a dialogue role-play recording between participants to measure speaking fluency and use of multi-word expressions, and the first three levels of the Listening Vocabulary Levels Test (McLean et al., 2015) to measure general vocabulary knowledge. Feedback was collected from participants and teacher/researcher observations were recorded to evaluate the contextual appropriateness of experimental classroom activities. Results showed development of meaning and form knowledge of target expressions, but no discernible development in spoken use of the expressions or fluency for the experimental group when compared with the control group. There was also no difference in general vocabulary knowledge between the groups. The second study (n = 25) incorporated improvements to the class activities, such as adding time limits to activities, and data collection methods, including expanding the role-play scenario, based on feedback from the first study. A qualitative analysis of two speakers’ use of a target expression in conversation suggested that fluent use of target expressions could be achieved within nine class hours if participants had some prior knowledge of the expressions. However, a replication was necessary with more participants and a control group to be able to generalise target expression use results to a wider population. Therefore, the third study replicated the second with more participants (n = 65) and a control group (n = 51). Results confirmed that the adapted experimental teaching activities were effective for developing form and meaning knowledge as well as the use of the target expressions in conversation. However, while fluency improved within the experimental group, the improvement was not statistically significant when compared with the control group. The results from these studies suggest that a focus on multi-word expressions with speaking practice is helpful for developing knowledge of meaning, form and use. Therefore, language teachers are encouraged to layer up opportunities through a range of activities such as shadowing and role-play for learners to encounter and re-use frequent and useful multi-word expressions. Teachers are also encouraged to engage in action research so that they can discover learner preferences applicable to their contexts and adapt their activities to be more effective for learning and more enjoyable for learners. Developing fluency in an EFL context may indeed require more than nine intervention hours, therefore a conceptual replication of the third study with a longer intervention period would help to expand our understanding for how long it takes to attain fluency benefits from multi-word expression focused interventions in an EFL context.</p>

Developing fluency with multi-word expressions

<p>This three-part study was motivated by the need for empirically tested methods for teaching and learning multi-word expressions to develop fluency in language learning classrooms. Using an action research paradigm in an EFL university learning context in rural Japan, the study draws on earlier work by Boers, Eyckmans, Kappel, Stengers, & Demecheleer (2006) who linked speaking fluency with the use of multi-word expressions, and Wood (2009) who found increases in fluency after multi-word expression focussed teaching and practice with one learner in an ESL context. This study also draws on Nation's (2007) Four Strands framework for fluency building. In the first of the three studies, a conceptual replication of the fluency workshop (including phrase instruction, shadowing, dictogloss, and role-play for example) by Wood (2009) was carried out. In contrast to Wood’s approach, this study contained more than one participant (n = 52) and a control group (n = 35). The control group also followed a fluency building program but without a focus on learning target expressions. Learning effects were tested using pre- and post-test measures, including a cloze test of 30 target multi-word expressions to measure form and meaning knowledge, a dialogue role-play recording between participants to measure speaking fluency and use of multi-word expressions, and the first three levels of the Listening Vocabulary Levels Test (McLean et al., 2015) to measure general vocabulary knowledge. Feedback was collected from participants and teacher/researcher observations were recorded to evaluate the contextual appropriateness of experimental classroom activities. Results showed development of meaning and form knowledge of target expressions, but no discernible development in spoken use of the expressions or fluency for the experimental group when compared with the control group. There was also no difference in general vocabulary knowledge between the groups. The second study (n = 25) incorporated improvements to the class activities, such as adding time limits to activities, and data collection methods, including expanding the role-play scenario, based on feedback from the first study. A qualitative analysis of two speakers’ use of a target expression in conversation suggested that fluent use of target expressions could be achieved within nine class hours if participants had some prior knowledge of the expressions. However, a replication was necessary with more participants and a control group to be able to generalise target expression use results to a wider population. Therefore, the third study replicated the second with more participants (n = 65) and a control group (n = 51). Results confirmed that the adapted experimental teaching activities were effective for developing form and meaning knowledge as well as the use of the target expressions in conversation. However, while fluency improved within the experimental group, the improvement was not statistically significant when compared with the control group. The results from these studies suggest that a focus on multi-word expressions with speaking practice is helpful for developing knowledge of meaning, form and use. Therefore, language teachers are encouraged to layer up opportunities through a range of activities such as shadowing and role-play for learners to encounter and re-use frequent and useful multi-word expressions. Teachers are also encouraged to engage in action research so that they can discover learner preferences applicable to their contexts and adapt their activities to be more effective for learning and more enjoyable for learners. Developing fluency in an EFL context may indeed require more than nine intervention hours, therefore a conceptual replication of the third study with a longer intervention period would help to expand our understanding for how long it takes to attain fluency benefits from multi-word expression focused interventions in an EFL context.</p>

Development and Formative Evaluation of a Death Education Program for Community-Dwelling Chinese Older Adults

Planning for end-of-life (EOL) care in advance can enhance one’s quality of life at EOL. Culturally sensitive educational programs are needed in Chinese populations to enlighten the public and encourage advance planning due to a culture of death-denying and avoidance. This study describes the team’s efforts to develop and formatively evaluate a death education program designed for community-dwelling Chinese older adults. The program was designed based on the Knowledge-Attitude-Behavior Model, as a 2-session 3-hour program spreading over two days with 1.5 hours for each day. The content paid attention to discussing the importance of making plans for EOL in Chinese culture and discussing how to have death-related conversations with the family and health care professionals. In 2020, semi-structured interviews were conducted by phone with 12 health care professionals and researchers, and four Chinese older adults in China to obtain their feedback on program content and delivery. The directed content analysis method was used to analyze the data. Although they confirmed multiple challenges in conducting death education in China, such as family avoidance even if an older adult initiates the death-related conversation, health care professionals not feeling comfortable with such discussions, etc., they also felt the urgency and importance of delivering death education among older adults and in society as a whole. Detailed suggestions were categorized into relationship building, program preparation (e.g., setting, materials), multiple ways of recruitment, target population, length, various formats of content delivery, content (e.g., pay attention to spiritual care), and general support from the public.

Creative Arts-Based Approaches to Improve the Well-Being of Older Adults

As older adults age they may face cognitive impairment, disruption in their sleep, and a decrease in mood and overall well-being. Given the negative consequences of the COVID-19 pandemic, they may experience a disruption in their access to health care services. Creative arts-based approaches have shown promise in improving the well-being of older adults and may be helpful in augmenting health care services. In this symposium, we will present research results of creative arts-based interventions aimed at improving the well-being of older adults, including those with dementia. We will also discuss ways to successfully engage with organizations that serve older adults using arts-based interventions. The first presentation will focus on the results from a feasibility randomized controlled trial examining the effects of a tailored music listening intervention on sleep outcomes in older adults living with dementia and their caregivers. The second presentation will report findings from the Mason Music & Memory Initiative aiming to improve mood and behavioral outcomes in persons living with dementia in nursing homes. The third presentation will focus on the preliminary results of a pilot study that integrated the delivery of music therapy telehealth with remote social work support and service linkage for rural older adults from low-income areas. The fourth presentation will report findings from the capacity-building program for teaching artists, health/aging organizations, and arts organizations committed to strengthening Creative Aging efforts through research. Implications for future research and creative arts-based intervention development for older adults will be discussed.