A Community Partnered Approach for Defining Child and Youth Thriving.

OBJECTIVE: To develop a community-informed definition of child and youth thriving and identify community priorities for child/youth thriving. METHODS: Through concept mapping, a mixed-methods community-based participatory research method, this study examined community and health professionals' conceptualizations of child and youth thriving. We conducted brainstorming, sorting and rating, and interpretation sessions in 3 geographically distinct neighborhoods with concentrated disadvantage; simultaneously, researchers and health professionals participated in online sessions. RESULTS: Participants included 91 community members, health care and social service professionals, and researchers who identified 104 items related to child and youth thriving and grouped these items into 7 distinct clusters. Two clusters focused on child-level factors (Strong Minds and Bodies; Positive Identity and Self-Worth), 2 focused on place-based factors (Healthy Environments; Vibrant Communities), and 3 focused on relationships and interactions between children and their environments (Caring Families and Relationships; Safety; and Fun and Happiness). The community-informed conceptualization of child thriving builds on previous models, adding dimensions of physical health and safety. Participants ranked having "someone to talk to," being "comfortable in their own skin," having "pride in themselves," and having a "strong sense of self and self-worth" as most important to child and youth thriving. CONCLUSIONS: By integrating perspectives of community members from diverse neighborhoods with those of researchers and health professionals, this study captures novel domains to inform a conceptual model of thriving that focuses on stakeholder priorities. Findings will guide development, implementation, and evaluation of community-based interventions and their impact on child and adolescent health and thriving.

THRIVE Conceptual Framework and Study Protocol: A Community-Partnered Longitudinal Multi-Cohort Study to Promote Child and Youth Thriving, Health Equity, and Community Strength.

BACKGROUND: Given the profound inequities in maternal and child health along racial, ethnic, and socioeconomic lines, strength-based, community-partnered research is required to foster thriving children, families, and communities, where thriving is defined as optimal development across physical, mental, cognitive, and social domains. The Pittsburgh Study (TPS) is a community-partnered, multi-cohort study designed to understand and promote child and youth thriving, build health equity, and strengthen communities by integrating community partners in study design, implementation, and dissemination. TPS launched the Tracking Health, Relationships, Identity, EnVironment, and Equity (THRIVE) Study to evaluate children's developmental stages and contexts from birth through completion of high school and to inform a child health data hub accessible to advocates, community members, educators, health professionals, and policymakers. METHODS AND ANALYSIS: TPS is rooted in community-partnered participatory research (CPPR), health equity, antiracism, and developmental science. Using our community-informed conceptual framework of child thriving, the THRIVE Study will assess cross-cutting measures of place, environment, health service use, and other social determinants of health to provide longitudinal associations with developmentally appropriate child and youth thriving outcomes across participants in six cohorts spanning from pregnancy through adolescence (child ages 0-18 years). Data from electronic health records, school records, and health and human services use are integrated to assess biological and social influences of thriving. We will examine changes over time using paired t-tests and adjusted linear regression models for continuous thriving scores and McNemar tests and adjusted logistic regression models for categorical outcomes (thriving/not thriving). Data analyses will include mixed models with a random intercept (in combination with the previously-specified types of regression models) to account for within-subject correlation. DISCUSSION: By enhancing assessment of child and youth well-being, TPS will fill critical gaps in our understanding of the development of child and youth thriving over time and test strategies to support thriving in diverse communities and populations. Through CPPR and co-design, the study aims to improve child health inequities across multiple socioecological levels and developmental domains.

Federally funded comprehensive women's health centers: leading innovation in women's healthcare delivery.

AIMS: Women's healthcare has historically been fragmented, given the artificial separation of reproductive care from general medical care. Aiming to advance new care models for delivery of comprehensive, integrated clinical care for women, two federal agencies-the U.S. Department of Health and Human Services (DHHS) and Department of Veterans Affairs (VA)-launched specialized women's health centers (WHCs). Exemplars of comprehensive service delivery, these originally federally funded centers have served as foundations for innovations in delivering comprehensive care to women in diverse practice settings. Little is known, however, about details of their organization, staffing, practice arrangements, and service availability that might inform adoption of similar models in the community. METHODS: Using comparable key informant surveys, we collected organizational data from the DHHS National Centers of Excellence (CoE) (n = 13) and the original VA comprehensive WHC's (n = 8). We abstracted supplemental data (e.g., academic affiliation) from the 2001 American Hospital Association (AHA) survey. RESULTS: All DHHS and VA women's health programs served urban areas, and nearly all had academic partnerships. DHHS centers had three times the average caseload as did VA centers. Preventive cancer screening and general reproductive services were uniformly available at all centers, although DHHS centers offered extensive reproductive services on-site more frequently, and VA centers more often had on-site mental healthcare. CONCLUSIONS: The DHHS and VA comprehensive WHCs share similar missions and comparable organization, education, and clinical services, demonstrating their commitment to reducing fragmented service delivery. Their common structural components present opportunities for further advancing women's quality of care across other systems of care.