Kaston D. Anderson-Carpenter

Using Communities of Practice to Support Implementation of Evidence-Based Prevention Strategies

Communities of practice are important for supporting multisectoral engagement to address community problems. In this study, communities of practice were used to support implementation of the Strategic Prevention Framework in Kansas. The findings reveal that communities of practice were used at local and state levels, and communities used integrated technology to facilitate collaboration. Additionally, the findings indicate that communities of practice facilitated practice changes across communities. These findings support previous research related to communities of practice, while demonstrating the need for increased exploration in how communities of practice can support the implementation of evidence-based prevention strategies within and across communities.

Multiple Behavior Change Intervention to Improve Detection of Unmet Social Needs and Resulting Resource Referrals.

OBJECTIVE It is critical that pediatric residents learn to effectively screen families for active and addressable social needs (ie, negative social determinants of health). We sought to determine 1) whether a brief intervention teaching residents about IHELP, a social needs screening tool, could improve resident screening, and 2) how accurately IHELP could detect needs in the inpatient setting. METHODS During an 18-month period, interns rotating on 1 of 2 otherwise identical inpatient general pediatrics teams were trained in IHELP. Interns on the other team served as the comparison group. Every admission history and physical examination (H&P) was reviewed for IHELP screening. Social work evaluations were used to establish the sensitivity and specificity of IHELP and document resources provided to families with active needs. During a 21-month postintervention period, every third H&P was reviewed to determine median duration of continued IHELP use. RESULTS A total of 619 admissions met inclusion criteria. Over 80% of intervention team H&Ps documented use of IHELP. The percentage of social work consults was nearly 3 times greater on the intervention team than on the comparison team (P < .001). Among H&Ps with documented use of IHELP, specificity was 0.96 (95% confidence interval 0.87-0.99) and sensitivity was 0.63 (95% confidence interval 0.50-0.73). Social work provided resources for 78% of positively screened families. The median duration of screening use by residents after the intervention was 8.1 months (interquartile range 1-10 months). CONCLUSIONS A brief intervention increased resident screening and detection of social needs, leading to important referrals to address those needs.

Associations Between Methamphetamine Use, Housing Status, and Incarceration Rates Among Men Who Have Sex With Men and Transgender Women

The present study examined associations between methamphetamine use and social factors among men who have sex with men (MSM) and transgender women. Over a 4-year period, 7,419 HIV outreach encounters were conducted with MSM (n = 6,243) and transgender women (n = 1,176). Logistic and negative binomial regressions estimated associations between sociodemographics, incarceration history, housing status, and methamphetamine use. Incarceration history was associated with marginal housing or homelessness (adjusted odds ratio [AOR] = 3.4) and with increased likelihood (AOR = 6.00) and adjusted incidence rate ratio (AIRR = 3.57) of methamphetamine use. African American/Black MSM and transgender women were more likely to report a recent incarceration history compared with non-African American/Black participants (AOR = 2.18). Incarceration history was associated with a HIV-positive status (AOR = 1.69), and transgender women were 5.2 times more likely to report recent incarceration relative to MSM. Understanding these associations may provide a basis for developing interventions that account for the social factors influencing health outcomes among these two high-risk populations.

Improving community readiness for change through coalition capacity building: Evidence from a multisite intervention

Often, community coalitions are facilitators of community-level changes when addressing underage drinking. Although studies have shown that enhancing coalition capacity is related to improved internal functioning, the relationship between enhanced capacity and community readiness for change is not well established. The present study used a pretest-posttest design to examine whether enhancing coalition capacity through training and technical assistance was associated with improved community readiness and coalition-facilitated community-level changes. Seven Kansas communities engaged in an intensive capacity building intervention through implementation of the Strategic Prevention Framework. The results indicated strong correlations between increased coalition capacity, changes in community readiness stages, and the number of community changes facilitated. The results suggest that strengthening coalition capacity through training and technical assistance may improve community readiness for change and enable the implementation of community-wide program and environmental changes.

The role of advocacy in occasioning community and organizational change in a medical-legal partnership

Health disparities among low-income individuals remain a significant problem. A number of social determinants are associated with adverse health outcomes. Medical–legal partnerships address legal concerns of low-income individuals to improve health and wellness in adults and children. The Medical-Legal Partnership at Legal Aid of Western Missouri provides free direct legal services for patients with legal concerns affecting health. There is limited evidence regarding the association between advocacy-related efforts and changes within both the medical–legal partnership structure and in health-care facilities. Three health-care organizations in Kansas City, MO participated in implementing the medical–legal partnership model between 2007 and 2010. Advocacy efforts conducted by key medical–legal partnership personnel were strongly associated with changes in health-care organizations and within the medical–legal partnership structure. This study extends the current evidence base by examining the types of advocacy efforts required to bring about community and organizational changes.