Impact of veteran-led peer mentorship on posttraumatic stress disorder.

Peer mentorship shows promise as a strategy to support veteran mental health. A community-academic partnership involving a veteran-led nonprofit organization and institutions of higher education evaluated a collaboratively developed peer mentor intervention. We assessed posttraumatic stress disorder (PTSD), postdeployment experiences, social functioning, and psychological strengths at baseline, midpoint, and 12-week discharge using the PTSD Checklist for DSM-5 (PCL-5), Deployment Risk and Resilience Inventory-2, Social Adaptation Self-evaluation Scale, and Values in Action Survey. Brief weekly check-in surveys reinforced mentor contact and assessed retention. The sample included 307 veterans who were served by 17 veteran peer mentors. Mixed-effects linear models found a modest effect for PTSD symptom change, with a mean PCL-5 score reduction of 4.04 points, 95% CI [-6.44, -1.64], d = 0.44. More symptomatic veterans showed a larger effect, with average reductions of 9.03 points, 95% CI [-12.11, -5.95], d = 0.77. There were no significant findings for other outcome variables. Compared to younger veterans, those aged 32-57 years were less likely to drop out by 6 weeks, aORs = 0.32-0.26. Week-by-week hazard of drop-out was lower with mentors ≥ 35 years old, aHR = 0.62, 95% CI [0.37, 1.05]. Unadjusted survival differed by mentor military branch, p = .028, but the small mentor sample reduced interpretability. Like many community research efforts, this study lacked a control group, limiting the inferences that can be drawn. Continued study of veteran peer mentorship is important as this modality is often viewed as more tolerable than therapy.

How telehealth can work best for our patients.

A hybrid model of care embracing office visits and remote consultations may provide the benefits and curtail the disadvantages of both.

Science Cafés: Transforming citizens to scientific citizens-What influences participants' perceived change in health and scientific literacy?

INTRODUCTION: Science Cafés facilitated by the Clinical and Translational Science Institute of Southeast Wisconsin seek to increase health and scientific literacy through informal conversation between researchers and community members. The goal was to understand what factors have the greatest influence on attendees' perceived changes in health and science literacy levels (PCHSL) to increase impact. METHODS: Previous research established the evaluation used in the Science Cafés to measure PCHSL. In this study, comparisons were made between (1) 2 different approaches to Science Cafés (Genomics Science Cafés or Health Science Cafés) and (2) regression models to show which factors best predicted PCHSL. RESULTS: The approach of the Genomics Science Cafés series to Science Cafés showed a larger impact on PCHSL. Regression models suggest SES and education significantly contributes to PCHSL. CONCLUSIONS: Insights for program development to have greater impact on PCHSL were identified. Continuing to optimize dissemination of research findings to the public is essential for improving community health and well-being.

Towards a practical model for community engagement: Advancing the art and science in academic health centers.

INTRODUCTION: Community engagement (CE) has become more prevalent among academic health centers (AHCs), with significant diversity in practices and language. The array of approaches to CE contributes to confusion among practitioners. METHODS: We have reviewed multiple models of CE utilized by AHCs, Clinical and Translational Science Awards, and higher education institutions overall. Taking these models into consideration, we propose a comprehensive model of CE that encompasses a broader spectrum of activities and programs. RESULTS: The CE Components Practical Model includes 5 components: Community Outreach and Service, Education, Clinical Care, Research, and Policy and Advocacy. The components are supported by the foundational elements within administrative functions and infrastructure. CONCLUSIONS: This model will accomplish the following: (1) reduce confusion about CE; (2) provide a broader understanding of CE; and (3) increase the ability of CE practitioners to interact with each other through this common reference and engage in advancing CE scholarship.

Community Veterans' Decision to Use VA Services: A Multimethod Veteran Health Partnership Study.

BACKGROUND: Ensuring veterans' access to healthcare is a national priority. Prior studies of veterans' use of Veterans Health Administration (VA) healthcare have had limited success in evaluating barriers to access for certain vulnerable veteran subpopulations. OBJECTIVES: Our coalition of researchers and veteran community members sought to understand factors affecting use of VA, particularly for those less likely to participate in traditional survey studies. METHODS: We recruited 858 veterans to complete a collaboratively designed survey at community events or via social media. We compared our results regarding VA use with the 2010 National Survey of Veterans (NSV) using chi-square tests, multiple logistic regression to identify predictors of VA use, and content analysis for open-ended descriptions of barriers to VA use. RESULTS: Veterans in our study were more likely than NSV respondents to report using VA healthcare ever (76% vs. 28%; p<0.0001). Within this group, more veterans in our sample were current VA users (83% vs. 68%; p<0.0001). In multivariable analysis, VA use was predicted by self-reported physical problems (comparing "a lot" vs. "none" for each variable, adjusted odds ratio [OR], 8.35), thinking problems (OR, 1.14), need for smoking cessation (OR, 1.54), need for pain management (OR, 1.65), and need for other mental health services (OR, 3.04). We identified 15 themes summarizing veterans' perceived barriers to VA use. CONCLUSION: Persistent actual and perceived barriers prevent some veterans from using VA services. The VA can better understand and address these issues through community-academic partnerships with veterans' organizations.

A Social Network Analysis of 140 Community-Academic Partnerships for Health: Examining the Healthier Wisconsin Partnership Program.

INTRODUCTION: Social Network Analysis (SNA) provides an important, underutilized approach to evaluating Community Academic Partnerships for Health (CAPHs). This study examines administrative data from 140 CAPHs funded by the Healthier Wisconsin Partnership Program (HWPP). METHODS: Funder data was normalized to maximize number of interconnections between funded projects and 318 non-redundant community partner organizations in a dual mode analysis, examining the period from 2003-2013.Two strategic planning periods, 2003-2008 vs. 2009-2014, allowed temporal comparison. RESULTS: Connectivity of the network was largely unchanged over time, with most projects and partner organizations connected to a single large component in both time periods. Inter-partner ties formed in HWPP projects were transient. Most community partners were only involved in projects during one strategic time period. Community organizations participating in both time periods were involved in significantly more projects during the first time period than partners participating in the first time period only (Cohen's d = 0.93). DISCUSSION: This approach represents a significant step toward using objective (non-survey) data for large clusters of health partnerships and has implications for translational science in community settings. Considerations for government, funders, and communities are offered. Examining partnerships within health priority areas, orphaned projects, and faculty ties to these networks are areas for future research.

Towards Building a Bridge between Community Engagement in Research (CEnR) and Comparative Effectiveness Research (CER).

A major national priority is establishing an effective infrastructure for translation of scientific discoveries into the community. Knowledge and practice continue to accelerate in health research yet healthcare recommendation adoption remains slow for practitioners, patients, and communities. Two areas of research placed in the later stages of the translational research spectrum, Community Engagement in Research and Comparative Effectiveness Research, are ideal for approaching this challenge collaboratively. The Clinical and Translational Science Institute of Southeastern Wisconsin convened academics and community-based organizations familiar with these fields of research in a 1-day workshop to establish an initial dialogue on similarities and differences with a goal of exploring ways to operationalize a collective effort. Participants represented four academic institutions and twelve other healthcare and community-based service organizations. Primary fields of study included community engaged research, comparative effectiveness research, psychology, clinical research, administration, nursing, public health, education, and other professionals. This initial report outlines the results of this diverse discussion and provides insights into the priorities, diverging issues, and areas for future examination and practice. Key discoveries reveal clear crosscutting issues, value in philosophical and provocative discussions among investigators, a need for practice and lessons learned, and bidirectional exchange with community representation.

Piloting a nationally disseminated, interactive human subjects protection program for community partners: unexpected lessons learned from the field.

Funders, institutions, and research organizations are increasingly recognizing the need for human subjects protections training programs for those engaged in academic research. Current programs tend to be online and directed toward an audience of academic researchers. Research teams now include many nonacademic members, such as community partners, who are less likely to respond to either the method or the content of current online trainings. A team at the CTSA-supported Michigan Institute for Clinical and Health Research at the University of Michigan developed a pilot human subjects protection training program for community partners that is both locally implemented and adaptable to local contexts, yet nationally consistent and deliverable from a central administrative source. Here, the developers of the program and the collaborators who participated in the pilot across the United States describe 10 important lessons learned that align with four major themes: The distribution of the program, the implementation of the program, the involvement of community engagement in the program, and finally lessons regarding the content of the program. These lessons are relevant to anyone who anticipates developing or improving a training program that is developed in a central location and intended for local implementation.

Science cafés: engaging scientists and community through health and science dialogue.

Engagement of the community through informal dialogue with researchers and physicians around health and science topics is an important avenue to build understanding and affect health and science literacy. Science Cafés are one model for this casual interchange; however the impact of this approach remains under researched. The Community Engagement Key Function of the Clinical and Translational Science Institute of Southeast Wisconsin hosted a series of Science Cafés in which topics were collaboratively decided upon by input from the community. Topics ranged from Personalized Medicine to Alzheimer's and Dementia to BioMedical Innovation. A systematic evaluation of the impact of Science Cafés on attendees' self-confidence related to five health and scientific literacy concepts showed statistically significant increases across all items (Mean differences between mean retrospective pre-scores and post-scores, one tailed, paired samples t-test, n=141, p<.0001 for all items). The internal consistency of the five health and scientific literacy items was excellent (n=126, α=0.87). Thematic analysis of attendees' comments provides more nuance about positive experience and suggestions for possible improvements. The evaluation provides important evidence supporting the effectiveness of brief, casual dialogue as a way to increase the public's self-rated confidence in health and science topics.

Towards a unified taxonomy of health indicators: academic health centers and communities working together to improve population health.

The Clinical and Translational Science Awards (CTSA) program represents a significant public investment. To realize its major goal of improving the public's health and reducing health disparities, the CTSA Consortium's Community Engagement Key Function Committee has undertaken the challenge of developing a taxonomy of community health indicators. The objective is to initiate a unified approach for monitoring progress in improving population health outcomes. Such outcomes include, importantly, the interests and priorities of community stakeholders, plus the multiple, overlapping interests of universities and of the public health and health care professions involved in the development and use of local health care indicators.The emerging taxonomy of community health indicators that the authors propose supports alignment of CTSA activities and facilitates comparative effectiveness research across CTSAs, thereby improving the health of communities and reducing health disparities. The proposed taxonomy starts at the broadest level, determinants of health; subsequently moves to more finite categories of community health indicators; and, finally, addresses specific quantifiable measures. To illustrate the taxonomy's application, the authors have synthesized 21 health indicator projects from the literature and categorized them into international, national, or local/special jurisdictions. They furthered categorized the projects within the taxonomy by ranking indicators with the greatest representation among projects and by ranking the frequency of specific measures. They intend for the taxonomy to provide common metrics for measuring changes to population health and, thus, extend the utility of the CTSA Community Engagement Logic Model. The input of community partners will ultimately improve population health.

The EnRiCH Community Resilience Framework for High-Risk Populations.

INTRODUCTION: Resilience has been described in many ways and is inherently complex. In essence, it refers to the capacity to face and do well when adversity is encountered. There is a need for empirical research on community level initiatives designed to enhance resilience for high-risk groups as part of an upstream approach to disaster management. In this study, we address this issue, presenting the EnRiCH Community Resilience Framework for High-Risk Populations. METHODS: The framework presented in this paper is empirically-based, using qualitative data from focus groups conducted as part of an asset-mapping intervention in five communities in Canada, and builds on extant literature in the fields of disaster and emergency management, health promotion, and community development. RESULTS: Adaptive capacity is placed at the centre of the framework as a focal point, surrounded by four strategic areas for intervention (awareness/communication, asset/resource management, upstream-oriented leadership, and connectedness/engagement). Three drivers of adaptive capacity (empowerment, innovation, and collaboration) cross-cut the strategic areas and represent levers for action which can influence systems, people and institutions through expansion of asset literacy. Each component of the framework is embedded within the complexity and culture of a community. DISCUSSION: We present recommendations for how this framework can be used to guide the design of future resilience-oriented initiatives with particular emphasis on inclusive engagement across a range of functional capabilities.

Development of a pilot family medicine hand-carried ultrasound course.

BACKGROUND AND OBJECTIVES: A hand-carried ultrasound training session was organized as an initial step in developing a long-term ultrasound education program for family medicine residents and faculty. Comparative effectiveness studies examining the potential benefits, risks, and any possible cost savings associated with this technology will be predicated on having a sufficient number of primary care physicians trained and able to use hand-carried ultrasounds as part of routine care. The proposed training described here is a first step toward this broader conversation and empirical study of hand-carried ultrasound use in family medicine. METHODS: An 8-hour training consisting of didactic lectures, case review, and hands-on experience imaging standardized patients with ultrasound machines and an ultrasound simulator. The objective of the course was to introduce focused ultrasound acquisition and interpretation of the gall bladder, kidney, heart, and abdominal aorta to family medicine physicians. Participating physicians were evaluated for changes in self-perceived comfort and proficiency with the hand-carried ultrasound before and after the training. RESULTS: Statistically significant changes for most comfort and proficiency items were demonstrated. Importantly, the only item that did not show significant change dealt with basing clinical decisions on information obtained from the device. CONCLUSION: The subjective improvement suggests this approach is one potentially useful hand-carried ultrasound training framework. Future work should attempt to further develop curricula and address issues such as longitudinal training assessments and certification and the development of competency in the necessary skill sets.

The dirty dozen: twelve failures of the hurricane katrina response and how psychology can help.

This comprehensive analysis addresses the United States' alarming lack of preparedness to respond effectively to a massive disaster as evidenced by Hurricane Katrina. First, a timeline of problematic response events during and after Hurricane Katrina orients readers to some of the specific problems encountered at different levels of government. Second, a list of the "Dirty Dozen"--12 major failures that have occurred in prior disasters, which also contributed to inadequate response during and after Hurricane Katrina--is presented. Third, this article encourages expanding psychology's role beyond the treatment of trauma to encompass disaster planning and mitigation efforts from a broader public health perspective. Finally, areas for important interdisciplinary research in human behavior that will influence our nation's overall preparedness for future catastrophes are identified, and ways psychologists can become personally involved beyond treating casualties are discussed.