Suchergebnisse

Ethn Dis. 2018;28(Suppl 2): 287-290; doi:10.18865/ed.28.S2.287.

Background: Given national concern over rising mortality from opioid use disorders (OUD) and challenges to increasing OUD treatment access, a coalition approach may hold promise to improve access and out­comes for diverse populations. We present considerations of a community-partnered working group on adapting the Community Partners in Care (CPIC) study and coalition approach to OUD.Method: During January 2016 through Jan­uary 2017, academic, provider, consumer and policy stakeholders reviewed options to adapt CPIC's Resources for Services (RS) for individual program technical assistance and Community Engagement and Planning (CEP) for coalition support to OUD treatments, integrating stakeholder input into design op­tions with estimated sample sizes.Findings: The working group recommend­ed Community Reinforcement and Family Treatment (CRAFT) as a stakeholder-support intervention to facilitate uptake and adher­ence to Medications for Addiction Treat­ment (MAT). Recommended implementa­tion interventions for MAT/CRAFT were expert technical assistance supplemented by organizational readiness, and CEP for coali­tion support with a Learning Collaborative. Power estimation suggests that to compare implementation intervention effects on abstinence would require a somewhat larger enrolled sample and 3-4 times the screening sample as CPIC, and for mortality, at least 5-10 times the enrolled sample as CPIC.Discussion: Stakeholders viewed the CPIC design and interventions as feasible and acceptable as community-wide approaches for addressing the opioid epidemic, but comparing impacts on mortality would require large, multi-site trials. Ethn Dis. 2018;28(Suppl 2):381-388; doi:10.18865/ed.28.S2.381.

Community resilience (CR)—ability to withstand and recover from a disaster—is a national policy expectation that challenges health departments to merge disaster preparedness and community health promotion and to build stronger partnerships with organizations outside government, yet guidance is limited.

Objective: Depressed individuals may require help from different agencies to ad­dress health and social needs, but how such coordination occurs in under-resourced communities is poorly understood. This study sought to identify priorities of Latino and African American depressed clients, ex­plore whether service providers understand client priorities, and describe how providers address them.Methods: Between October 2014 and February 2015, we interviewed 104 clients stratified by depression history and 50 representatives of different programs in health and social community agencies who participated in Community Partners in Care, a cluster-randomized trial of coalition-building approaches to delivering depres­sion quality improvement programs. Clients were queried about their most pressing needs; program representatives identified their clients' needs and explained how they addressed them.Results: Physical and mental health were clients' top priorities, followed by housing, caring for and building relationships with others, and employment. While persistently depressed clients prioritized mental health, those with improved depression prioritized relationships with others. Program repre­sentatives identified housing, employment, mental health, and improving relationships with others as clients' top priorities. Needs assessment, client-centered services, and linkages to other agencies were main strate­gies used to address client needs.Conclusion: Depressed clients have mul­tiple health and social needs, and program representatives in under-resourced commu­nities understand the complexity of clients' needs. Agencies rely on needs assessment and referrals to meet their clients' needs, which enhances the importance of agency partnership in "whole person" initiatives. Our results illustrate agency capacity to adopt integrated care models that will ad­dress clients' multiple needs through multi-sector collaboration and describe potential strategies to help reach the goal of whole person care.Ethn Dis. 2018;(Suppl 2): 371- 380; doi:10.18865/ed.28.S2.371.

Objective: Although evidence supports the potential for community coalitions to posi­tively address social determinants of mental health, little is known about the views of stakeholders involved in such efforts. This study sought to understand county leaders' perspectives about social determinants related to the Health Neighborhood Initia­tive (HNI), a new county effort to support community coalitions.Design: Descriptive, qualitative study, 2014.Setting: Community coalitions, located in a large urban city, across eight service planning areas, that serve under-resourced, ethnic minority populations.Procedures: We conducted key informant interviews with 49 health care and commu­nity leaders to understand their perspectives about the HNI. As part of a larger project, this study focused on leaders' views about social determinants of health related to the HNI. All interviews were audio-recorded and transcribed. An inductive approach to coding was used, with text segments grouped by social determinant categories.Results: County leaders described multiple social determinants of mental health that were relevant to the HNI community coalitions: housing and safety, community violence, and employment and education. Leaders discussed how social determinants were interconnected with each other and the need for efforts to address multiple social determinants simultaneously to ef­fectively improve mental health.Conclusions: Community coalitions have an opportunity to address multiple social determinants of health to meet social and mental health needs of low-resourced com­munities. Future research should examine how community coalitions, like those in the HNI, can actively engage with com­munity members to identify needs and then deliver evidence-based care.Ethn Dis. 2018;28(Suppl 2):389-396; doi:10.18865/ed.28.S2.389.