Mónica Pérez Jolles

Cultural and Linguistic Adaptation of a Multimedia Colorectal Cancer Screening Decision Aid for Spanish Speaking Latinos

As the United States becomes more linguistically and culturally diverse, there is a need for effective health communication interventions that target diverse, vulnerable populations, including Latinos. To address such disparities, health communication interventionists often face the challenge to adapt existing interventions from English into Spanish in a way that retains essential elements of the original intervention while also addressing the linguistic needs and cultural perspectives of the target population. The authors describe the conceptual framework, context, rationale, methods, and findings of a formative research process used in creating a Spanish-language version of an evidence-based (English language) multimedia colorectal cancer screening decision aid. The multistep process included identification of essential elements of the existing intervention, literature review, assessment of the regional context and engagement of key stakeholders, and solicitation of direct input from target population. The authors integrated these findings in the creation of the new adapted intervention. They describe how they used this process to identify and integrate sociocultural themes such as personalism (personalismo), familism (familismo), fear (miedo), embarrassment (verguenza), power distance (respeto), machismo, and trust (confianza) into the Spanish-language decision aid.

Fostering Activation Among Latino Parents of Children With Mental Health Needs: An RCT

OBJECTIVE Latino families raising children with mental health and other special health care needs report greater dissatisfaction with care compared with other families. Activation is a promising strategy to eliminate disparities. This study examined the comparative effectiveness of MePrEPA, an activation intervention for Latino parents whose children receive mental health services. METHODS A randomized controlled trial (N=172) was conducted in a Spanish-language mental health clinic to assess the effectiveness of MePrEPA, a four-week group psychoeducational intervention to enhance parent activation among Latino parents, compared with a parent-support control group. Inclusion criteria were raising a child who receives services for mental health needs and ability to attend weekly sessions. Outcomes were parent activation, education activation, quality of school interaction, and parent mental health. Effectiveness of the intervention was tested with a difference-in-difference approach estimating linear mixed models. Heterogeneity of treatment effect was examined. RESULTS MePrEPA enhanced parent activation (β=5.98, 95% confidence interval [CI]=1.42-10.53), education activation (β=7.98, CI=3.01-12.94), and quality of school interaction (β=1.83, CI=.14-3.52) to a greater degree than did a parent-support control group. The interventions impact on parent activation and education outcomes was greater for participants whose children were covered by Medicaid and were novices to therapy and those with low activation at baseline. No statistically significant effects were observed in parent mental health. CONCLUSIONS Activation among Latino parents was improved with MePrEPA, which can be readily incorporated in current practices by mental health clinics. Future work should replicate findings in a large number of sites, adding behavioral measures and distal impacts while examining MePrEPAs effects across settings and populations.

Organizational and Individual Determinants of Evidence Use by Managers in Public Human Service Organizations

Promoting the use of evidence by managers is a strategy for enhancing effectiveness in human service organizations, and for responding to the demands of performance management. This study addresses two multipart questions. First, what levels of managerial evidence use exist in public human service organizations and for what purposes is this evidence used? Second, what organizational factors and individual attitudinal characteristics are associated with different levels of evidence use? Based on survey data from a sample of administrators, middle managers, and supervisors in 11 county public human service organizations located in the San Francisco Bay Area, we find that managers are engaged in evidence use at moderate levels. They are most engaged in reviewing agency reports, searching for research literature and other evidence, and using online resources to identify promising practices. Evidence use is found to be positively associated with having access to performance measurement systems, being an administrator, and being innovation minded and responsive to organizational change. Our findings suggest that evidence use by human service managers may be contingent on organizational resources, organizational role, and individual attitudes. These results underscore the importance of training human service managers in evidence-informed practice in order to promote agencywide knowledge utilization and organizational effectiveness.

Involving Latina/o parents in patient-centered outcomes research: Contributions to research study design, implementation and outcomes

Comparative effectiveness research (CER) is supported by policymakers as a way to provide service providers and patients with evidence‐based information to make better health‐care decisions and ultimately improve services for patients. However, Latina/o patients are rarely involved as study advisors, and there is a lack of documentation on how their voices contribute to the research process when they are included as collaborators.

Factors Associated With Managerial Innovation in Public Human Service Organizations

ABSTRACT Contextual changes affecting human service organizations have challenged human service managers to adapt through innovation. Yet no research has examined innovation along the spectrum of lower- to upper-level managers in public human service organizations. This study analyzed survey data of 466 public human service managers to examine the relationship between individual characteristics and managerial innovation. Results showed that 38% of managers took an innovative approach to their work, and characteristics of perceived responsiveness to change and evidence-informed practice network involvement were significantly associated with managerial innovation. Managerial innovation could be promoted through the development of evidence-based networks and communities of learning.

Child Welfare Caseworker Education and Caregiver Behavioral Service Use and Satisfaction With the Caseworker

Social work has long been identified with child welfare, and research has generally found that child welfare caseworkers with a social work degree are better prepared than caseworkers with other degrees. Little knowledge exists though about the relationship between caseworker professional background and caregiver behavioral health service use or their satisfaction with the caseworker. Using data from the National Survey of Child and Adolescent Well-Being, we found no significant relationships between having a social work degree and caregiver use of services or satisfaction with the caseworker. More research is needed to clarify how caseworker characteristics, including professional preparation, influence child welfare outcomes.

Managerial Strategies to Influence Frontline Worker Understanding of Performance Measures in Nonprofit Child Welfare Agencies

In response to demands of funders and interorganizational competition, nonprofit human service organizations have invested in performance measurement to demonstrate the effectiveness and efficiency of internal operations. Literature suggests that frontline workers’ involvement in performance measurement is critical in supporting organizational efforts to improve performance. Yet, we lack information on how nonprofit managers convey performance standards to frontline workers and promote their engagement in performance measurement. This study draws on data from the 2011 National Survey of Private Child and Family Serving Agencies to identify strategies nonprofit managers used to engage frontline workers in performance measurement. Findings indicate that less than half of managers reported that their workers had a strong or very strong understanding of the agency’s performance measures. Managerial communication and board involvement in performance measurement were associated with greater worker understanding of performance measures. These managerial approaches may be key factors in frontline understanding of performance measures.

Mental health service use for adult patients with co-occurring depression and physical chronic health care needs, 2007-2010.

Background:Individuals with mental illness experience poor health and may die prematurely from chronic illness. Understanding whether the presence of co-occurring chronic physical health conditions complicates mental health treatment is important, particularly among patients seeking treatment in primary care settings. Objectives:Examine (1) whether the presence of chronic physical conditions is associated with mental health service use for individuals with depression who visit a primary care physician, and (2) whether race modifies this relationship. Research Design:Secondary analysis of the National Ambulatory Medical Care Survey, a survey of patient-visits collected annually from a random sample of 3000 physicians in office-based settings. Subjects:Office visits from 2007 to 2010 were pooled for adults aged 35–85 with a depression diagnosis at the time of visit (N=3659 visits). Measures:Mental health services were measured using a dichotomous variable indicating whether mental health services were provided during the office visit or a referral made for: (1) counseling, including psychotherapy and other mental health counseling and/or (2) prescribing of psychotropic medications. Results:Most patient office visits (70%) where a depression diagnosis was recorded also had co-occurring chronic physical conditions recorded. The presence of at least 1 physical chronic condition was associated with a 6% decrease in the probability of receiving any mental health services (P<0.05). There were no differences in service use by race/ethnicity after controlling for other factors. Conclusions:Additional research is needed on medical care delivery among patients with co-occurring health conditions, particularly as the health care system moves toward an integrated care model.