Barriers to Community Service Use Among Persons With Dementia and Their Care Partners: A Focus on Consumers of a Novel Statewide Dementia Care Program.

Although the importance of access to, and utilization of, home and community-based services (HCBS) is a well-documented aspect of informal care and the ability to age in place among people living with dementia, these resources are underutilized, especially in the initial stages of the disease. In 2017, the Georgia Memory Net was established as a novel private-public partnership to extend dementia screening, diagnosis, care planning, and direct HCBS connections for people with memory concerns throughout the State of Georgia. We aimed to identify barriers and facilitators to HCBS utilization following a dementia diagnosis and subsequent referral for services. Data were collected through in-depth interviews with 7 Georgia Memory Net patients and 19 care partners (unconnected dyads) and analyzed using thematic analysis. We found that even with a direct handoff, many people do not use HCBS and face barriers to accessing services. We offer several recommendations based on these findings.

The role of consultative alliance in infant and early childhood mental health consultation: Child, teacher, and classroom outcomes.

Young children's social-emotional development is powerfully shaped by their early environments, which for many includes early childhood education (ECE). Infant and Early Childhood Mental Health Consultation (IECMHC) pairs teachers and infant and early childhood mental health (IECMH) consultants to promote teachers' capacity to foster positive social-emotional development in ECE. Although the outcomes of IECMHC have been well studied, little research has investigated how this model leads to changes for teachers and children. According to theory, the quality of the relationship between teachers and IECMH consultants, termed consultative alliance (CA), is a key mechanism of change. This study analyzed the role of CA on 6-month outcomes of IECMHC in a sample of 316 children, 289 teachers, and 62 IECMH consultants. Results from multilevel models suggested that stronger CA predicted greater improvements in teacher-child closeness and teacher-rated child attachment behaviors. In addition, a strong CA was related to greater improvement in classroom climate, teachers' self-efficacy, and teachers' perceptions of their jobs. This study upholds the centrality of relationship-building and parallel process in mental health consultation, and by advancing understanding of the mechanisms of change for IECMHC may provide salient implications for policy and practice.

El desarrollo socio-emocional de los niños pequeños es formado de manera poderosa por sus tempranos ambientes, los cuales, para muchos incluyen la educación en la temprana niñez (ECE). La Asesoría de Salud Mental del Infante y la Temprana Niñez (IECMHC) empareja maestros y Asesores de la Salud Mental del Infante y la Temprana Niñez (IECMH) para promover la capacidad de los educadores de crear un positivo desarrollo socio-emocional en ECE. A pesar de que los resultados de IECMHC han sido bien estudiados, poca investigación se ha enfocado en cómo este modelo conduce a cambios para educadores y niños. De acuerdo con la teoría, la calidad de la relación entre educadores y Asesores de IECMH, llamada Alianza Consultiva (CA), es un mecanismo clave para el cambio. Este estudio analizó el papel de la Alianza Consultiva en resultados de seis meses de IECMHC en un grupo muestra de 316 niños, 289 educadores y 62 Asesores de IECMH. Los resultados de modelos de multiniveles sugieren que una más fuerte CA predijo mayores mejoras en la cercanía entre educador y niño y las conductas de afectividad del niño evaluadas por el educador. Adicionalmente, una más fuerte CA se relacionó con una mayor mejora en el ambiente del aula de clases, la auto-efectividad de los educadores y las percepciones que los educadores tenían de su trabajo. Este estudio apoya la centralidad de establecer una relación y un proceso paralelo en la asesoría de salud mental, y por medio del avance en la comprensión de los mecanismos de cambio para IECMHC, pudiera proveer implicaciones destacadas para la política y la práctica.

Le développement socio-émotionnel des jeunes enfants est fortement formé par leurs premiers environnements, ce qui pour bien d'entre eux inclut l'enseignement préscolaire. L'approche IECMHC (Infant and Early Childhood Mental Health Consultation soit Consultation en Santé Mentale du Nourrisson et de la Petite Enfance) jumelle des enseignants et des consultants IECHM (Santé Mentale du Nourrisson et de la Petite Enfance) afin de promouvoir la capacité des enseignements à cultiver et à favoriser un développement socio-émotionnel positif dans l'enseignement préscolaire. Bien que les résultats de l'approche IECMHC aient été bien étudiés il existe peu de recherches sur la manière dont ce modèle mène à des changements pour les enseignants et les enfants. Selon la théorie, la qualité de la relation entre les enseignants et les Consultants IECMH, appelée Alliance Consultative (AC), est un mécanisme clé de changement. Cette étude a analysé le rôle de l'Alliance Consultative sur les résultats à six mois de la IECMHC chez un échantillon de 316 enfants, 289 enseignants, et 62 Consultants IECMH. Les résultats de modèles multi-niveaux ont suggéré qu'une AC plus forte prédisait des améliorations plus importantes dans le rapprochement enseignant-enfant et dans les comportements d'attachement de l'enfant évalués par l'enseignant. De plus une AC plus forte était liée à une amélioration plus importante du climat de la salle de classe, de l'auto-efficacité des enseignements et des perceptions que les enseignants se faisaient de leur travail. Cette étude maintient la centralité de la construction de la relation et du processus parallèle dans la consultation de santé mentale. En faisant progresser la compréhension des mécanismes de changement pour la IECMHC elle présente aussi des implications importantes pour les décisions stratégiques et la pratique.

Expulsion prevention: Framework for the role of infant and early childhood mental health consultation in addressing implicit biases.

Young children of color-especially boys-are at disproportionate risk for suspension and expulsion from early care and education settings. Infant and Early Childhood Mental Health Consultation (IECMHC) is an approach associated with lower than expected expulsion rates, but the mechanisms through which it may influence preschool expulsion are unknown. This paper reflects on the parallels between IECMHC and interventions created to reduce implicit bias. Based on interviews with leaders in IECMHC practice, implementation, and evaluation, a theoretical framework was created to articulate how IECMHC is hypothesized to affect expulsion by first reducing the influence of implicit bias on disciplinary decisions. Implications for practice and research are provided.

Los pequeños niños de raza negra -especialmente los varones- están bajo un riesgo desproporcionado en cuanto a la suspensión y expulsión de lugares donde se les presta cuidado y educación tempranos. La Consulta de Salud Mental en la Infancia y la Temprana Niñez (IECMHC) es un acercamiento asociado con niveles más bajos de expulsión que los que se esperan, pero se desconocen los mecanismos a través de los cuales la misma pudiera influir en la expulsión prescolar. Este artículo reflexiona sobre los paralelos entre IECMHC y las intervenciones creadas para reducir los prejuicios implícitos. Con base en entrevistas con los líderes en la práctica, implementación y evaluación de IECMHC, se creó un marco de trabajo para articular cómo IECMHC se plantea como hipótesis para afectar la expulsión por medio de reducir primero la influencia de los implícitos prejuicios sobre las decisiones disciplinarias. Se aportan las implicaciones para la práctica y la investigación.

Les jeunes enfants de couleur - surtout les garçons - sont à risque disproportionné de suspension et d'expulsion d'établissements d'éducation et de crèches. La Consultation de Santé Mentale du Nourrisson et de la Petite Enfance (abrégé en anglais ECMHC) est une approche liée à des taux d'expulsion moins élevés que les taux d'expulsion auxquels on s'attend, mais les mécanismes au travers desquels elle pourrait influencer l'expulsion des crèches sont méconnus. Cet article porte sur les parallèles entre la IECHMH et les interventions créées afin de réduire les préjugés implicites. Basé sur des entretiens avec des praticiens de la pratique de l'IECMHC, sa mise en place et son évaluation, une structure théorique a été créée afin d'articuler la manière dont on suppose que l'IECHHC affecte l'expulsion en réduisant d'abord l'influence des préjugés implicites sur les décisions disciplinaires. Des implications pour la pratique et la recherche sont présentées.

Exopolysaccharide microchannels direct bacterial motility and organize multicellular behavior.

The myxobacteria are a family of soil bacteria that form biofilms of complex architecture, aligned multilayered swarms or fruiting body structures that are simple or branched aggregates containing myxospores. Here, we examined the structural role of matrix exopolysaccharide (EPS) in the organization of these surface-dwelling bacterial cells. Using time-lapse light and fluorescence microscopy, as well as transmission electron microscopy and focused ion beam/scanning electron microscopy (FIB/SEM) electron microscopy, we found that Myxococcus xanthus cell organization in biofilms is dependent on the formation of EPS microchannels. Cells are highly organized within the three-dimensional structure of EPS microchannels that are required for cell alignment and advancement on surfaces. Mutants lacking EPS showed a lack of cell orientation and poor colony migration. Purified, cell-free EPS retains a channel-like structure, and can complement EPS- mutant motility defects. In addition, EPS provides the cooperative structure for fruiting body formation in both the simple mounds of M. xanthus and the complex, tree-like structures of Chondromyces crocatus. We furthermore investigated the possibility that EPS impacts community structure as a shared resource facilitating cooperative migration among closely related isolates of M. xanthus.

Dual biochemical oscillators may control cellular reversals in Myxococcus xanthus.

Myxococcus xanthus is a Gram-negative, soil-dwelling bacterium that glides on surfaces, reversing direction approximately once every 6 min. Motility in M. xanthus is governed by the Che-like Frz pathway and the Ras-like Mgl pathway, which together cause the cell to oscillate back and forth. Previously, Igoshin et al. (2004) suggested that the cellular oscillations are caused by cyclic changes in concentration of active Frz proteins that govern motility. In this study, we present a computational model that integrates both the Frz and Mgl pathways, and whose downstream components can be read as motor activity governing cellular reversals. This model faithfully reproduces wildtype and mutant behaviors by simulating individual protein knockouts. In addition, the model can be used to examine the impact of contact stimuli on cellular reversals. The basic model construction relies on the presence of two nested feedback circuits, which prompted us to reexamine the behavior of M. xanthus cells. We performed experiments to test the model, and this cell analysis challenges previous assumptions of 30 to 60 min reversal periods in frzCD, frzF, frzE, and frzZ mutants. We demonstrate that this average reversal period is an artifact of the method employed to record reversal data, and that in the absence of signal from the Frz pathway, Mgl components can occasionally reverse the cell near wildtype periodicity, but frz- cells are otherwise in a long nonoscillating state.

FrzS regulates social motility in Myxococcus xanthus by controlling exopolysaccharide production.

Myxococcus xanthus Social (S) motility occurs at high cell densities and is powered by the extension and retraction of Type IV pili which bind ligands normally found in matrix exopolysaccharides (EPS). Previous studies showed that FrzS, a protein required for S-motility, is organized in polar clusters that show pole-to-pole translocation as cells reverse their direction of movement. Since the leading cell pole is the site of both the major FrzS cluster and type IV pilus extension/retraction, it was suggested that FrzS might regulate S-motility by activating pili at the leading cell pole. Here, we show that FrzS regulates EPS production, rather than type IV pilus function. We found that the frzS phenotype is distinct from that of Type IV pilus mutants such as pilA and pilT, but indistinguishable from EPS mutants, such as epsZ. Indeed, frzS mutants can be rescued by the addition of purified EPS, 1% methylcellulose, or co-culturing with wildtype cells. Our data also indicate that the cell density requirement in S-motility is likely a function of the ability of cells to construct functional multicellular clusters surrounding an EPS core.