Care Navigation Increases Initiation of Hepatitis C Treatment After Release From Prison in a Prospective Randomized Controlled Trial: The C-LINK Study.

Background: Prison-based hepatitis C treatment is safe and effective; however, many individuals are released untreated due to time or resource constraints. On community re-entry, individuals face a number of immediate competing priorities, and in this context, linkage to hepatitis C care is low. Interventions targeted at improving healthcare continuity after prison release have yielded positive outcomes for other health diagnoses; however, data regarding hepatitis C transitional care are limited. Methods: We conducted a prospective randomized controlled trial comparing a hepatitis C care navigator intervention with standard of care for individuals released from prison with untreated hepatitis C infection. The primary outcome was prescription of hepatitis C direct-acting antivirals (DAA) within 6 months of release. Results: Forty-six participants were randomized. The median age was 36 years and 59% were male. Ninety percent (n = 36 of 40) had injected drugs within 6 months before incarceration. Twenty-two were randomized to care navigation and 24 were randomized to standard of care. Individuals randomized to the intervention were more likely to commence hepatitis C DAAs within 6 months of release (73%, n = 16 of 22 vs 33% n = 8 of 24, P < .01), and the median time between re-entry and DAA prescription was significantly shorter (21 days [interquartile range {IQR}, 11-42] vs 82 days [IQR, 44-99], P = .049). Conclusions: Care navigation increased hepatitis C treatment uptake among untreated individuals released from prison. Public policy should support similar models of care to promote treatment in this high-risk population. Such an approach will help achieve hepatitis C elimination as a public health threat.

Learning social and emotional skills in Head Start: Influence of familial risk factors and teacher perceptions

Social-emotional competence has a profound impact on healthy child development and is associated with numerous outcomes that persist across the lifespan (Bettencourt et al., 2017;Jones et al., 2015). Children enrolled in Head Start are at an increased risk for deficits in social and emotional skills (Yoshikawa et al., 2012) due to numerous familial risk factors across a bioecological framework (Bronfenbrenner & Morris, 2006). Thus, it is critically important to support social-emotional learning (SEL) in early childhood, particularly in Head Start where children have an increased risk for deficits. Despite substantial literature on teachers and social-emotional learning, previous research has overlooked teachers' perceptions on SEL for children exposed to adversity. The current study aimed to: (a) identify the relation of familial risk factors and adverse events with child social and emotional skills;(b) explore teachers' perceptions of SEL;(c) explore teachers' perceptions of supporting children exposed to familial risk;and (d) explore teacher perceptions of the impact of COVID-19 in the classroom. Data collected included clinical records, juvenile court records, and teacher-reports on child social-emotional functioning for 103 enrolled Head Start children. Qualitative interviews exploring perceptions on SEL and the impact of familial risk were also conducted with Head Start teachers. Results demonstrate high rates of familial risk and adversity with over half of children experiencing 7 or more familial risk factors and 14.6% of enrolled children having a court-substantiated record of maltreatment. While total familial risk and adverse events were associated with several child social-emotional skills, court-substantiated maltreatment was not. Teachers identified several facilitators and barriers to SEL including time constraints, parent-teacher partnerships, language, staff support, and familiarity. Teachers also identified facilitators and barriers to supporting children exposed to familial risk including consistent routines, parent relationships, and training. Findings provide rich information about the role of teachers in facilitating SEL, particularly for children exposed to familial risk. Policy and practice implications for Head Start and other early childhood education programs are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved)