Suchergebnisse

This study describes the progress made and challenges faced by Welcome Back Veterans, an initiative that supports organizations that, in turn, provide programs and services to support veterans and their families.

This study sought to understand if shared decision making and/or receipt of mental health care was associated with patient satisfaction for patients with depression and to determine whether gender modified this relationship. The data are from the Quality Improvement for Depression study, a national collaborative study of 1,481 patients diagnosed with major depression in managed care settings. The cross-sectional analyses were performed using multiple logistic regression on a sample of 1,317 patients who answered both the baseline and month six questionnaires. Shared decision making and receipt of mental health care were both positively associated with patient satisfaction. Gender was not a moderator of this relationship. Health plans may be able to improve patient satisfaction levels by teaching physicians the importance of shared decision making. Contrary to expectations, patient gender made no difference in the effects of quality of care on patient satisfaction.

As U.S. service members deploy for extended periods on a repeated basis, their ability to cope with the stress of deployment may be challenged. Many programs are available to encourage and support psychological resilience among service members and families. However, little is known about these programs' effectiveness. This report reviews resilience literature and programs to identify evidence-informed factors for promoting resilience.

As U.S. service members deploy for extended periods on a repeated basis, their ability to cope with the stress of deployment may be challenged. A growing number of programs and strategies provided by the military and civilian sectors are available to encourage and support psychological resilience to stress for service members and families. Though previous research from the field of psychology delineating the factors that foster psychological resilience is available, there has been no assessment of whether and how well the current military resilience programs are addressing these factors in their activities. Further, little is known about the effectiveness of these programs on developing resilience. To assist the Department of Defense in understanding methodologies that could be useful in promoting resilience among service members and their families, the research team conducted a focused literature review to identify evidence-informed factors for promoting psychological resilience. The team also reviewed a subset of military resilience programs to determine the extent to which they included those evidence-informed factors. This article describes the context, approach, and findings from these research activities.

Military life presents a variety of challenges to military families, including frequent separations and relocations as well as the risks that service members face during deployment; however, many families successfully navigate these challenges. Despite a recent emphasis on family resilience, the U.S. Department of Defense (DoD) does not have a standard and universally accepted definition of family resilience. A standard definition is a necessary for DoD to more effectively assess its efforts to sustain and improve family resilience. RAND authors reviewed the literature on family resilience and, in this study, recommend a definition that could be used DoD-wide. The authors also reviewed DoD policies related to family resilience, reviewed models that describe family resilience and identified key family resilience factors, and developed several recommendations for how family-resilience programs and policies could be managed across DoD.

Background:Implementing evidence-based practices (EBPs) within service systems is critical to population-level health improvements, but also challenging, especially for complex behavioural health interventions in low-resource settings. 'Mis-implementation' refers to poor outcomes from an EBP implementation effort; mis-implementation outcomes are an important, but largely untapped, source of information about how to improve knowledge exchange.

Aims and objectives:We present mis-implementation cases from three pragmatic trials of behavioural health EBPs in US Federally Qualified Health Centers (FQHCs).

Methods:We adapted the Consolidated Framework for Implementation Research and its Outcomes Addendum into a framework for mis-implementation and used it to structure the case summaries with information about the EBP and trial, mis-implementation outcomes, and associated determinants (barriers and facilitators). We compared the three cases to identify shared and unique mis-implementation factors.

Findings:Across cases, there was limited adoption and fidelity to the interventions, which led to eventual discontinuation. Barriers contributing to mis-implementation included intervention complexity, low buy-in from overburdened providers, lack of alignment between providers and leadership, and COVID-19-related stressors. Mis-implementation occurred earlier in cases that experienced both patient- and provider-level barriers, and that were conducted during the COVID-19 pandemic.

Discussion and conclusion:
Multilevel determinants contributed to EBP mis-implementation in FQHCs, limiting the ability of these health systems to benefit from knowledge exchange. To minimise mis-implementation, knowledge exchange strategies should be designed around common, core barriers but also flexible enough to address a variety of site-specific contextual factors, and should be tailored to relevant audiences such as providers, patients, and/or leadership.

Introduction -- Puerto Rico Before the Storms -- An Overview of Hurricane Irma and Hurricane Maria -- Methods Used for the Damage and Needs Assessment -- Puerto Rico's Economy -- Puerto Rico's People and Communities -- Puerto Rico's Energy Systems -- Puerto Rico's Communications and Information Technology -- Puerto Rico's Water -- Puerto Rico's Transportation -- Puerto Rico's Housing -- Puerto Rico's Public Buildings -- Puerto Rico's Cultural Resources -- Puerto Rico's Natural Resources -- Puerto Rico's Education, Health, and Social Services -- Puerto Rico's Recovery and Resilience Needs -- Appendix: Summary Tables.