From the Defense Health Board: Military Accessions and the Continuum of Mental Health Research.

The Defense Health Board conducted a year-long examination of mental health accession screening and related issues. In its August 2020 report, Examination of Mental Health Accession Screening: Predictive Value of Current Measures and Processes, the Board recommends a paradigm shift in how mental health impacts on readiness are understood and addressed. This shift can only occur with the development and implementation of a research plan that follows cohorts of military personnel from recruitment through their military career. The following article describes this research plan as an excerpt of the larger report.

Mobilizing the U.S. Military's TRICARE Program for Value-Based Care: A Report From the Defense Health Board.

The U.S. Military Health System spends about $50 billion annually to provide care to 9.6 million active duty service members, retirees, and their families through its TRICARE health plans. TRICARE follows the predominant payment model in the USA-fee-for-service-although the Department of Defense (DoD) and Congress encourage and mandate a move toward alternative payment models-mainly, fee-for-value. For the next TRICARE contracts which will begin in 2023, the DoD asked its health-focused federal advisory committee, the Defense Health Board (DHB), to recommend how best to assess and prioritize leading value-based healthcare initiatives identified from private, public, and employer-based health plans. The November 2020 report, 'Modernization of the TRICARE Benefit', specifies a rubric to evaluate these value-based care initiatives not only in traditional measures of effectiveness but also in terms of the Defense Health Agency's Quadruple Aim with its focus on readiness. The goal of TRICARE's move toward value-based care is to leverage its size and focus on prevention of disease and injury to maintain the readiness of the U.S. Armed Forces in addition to delivering great outcomes and value to the DoD's nearly 10 million beneficiaries. The DHB emphasizes that TRICARE's size and focus on providing quality care at lower cost will incentivize providers to participate in the shift toward value-based care despite the potential challenges in transitioning to this system. This shift also aims to motivate other large government and private payors to accelerate the adoption of value-based care through TRICARE's example.

Validation of the Malawi Developmental Assessment Tool for children in the Dominican Republic: Preliminary results.

BACKGROUND: This study initiated the validation process of a translated and adapted version of the Malawi Developmental Assessment Tool (MDAT) for children in the Dominican Republic (DR). Like Malawi before the development of the MDAT, the DR did not have early childhood development (ECD) tools explicitly designed for low-resource areas that are also valid assessments of child development. We chose MDAT because it underwent a rigorous validation process and retained measurements of test items that were culturally adaptable from the Denver Developmental Screening Test II. We aimed to test the internal consistency and inter-rater reliability of the MDAT in children under the age of two years living in low-income neighborhoods in Santo Domingo in 2017. METHODS AND FINDINGS: Forty-two children from 2 to 24 months of age (mean = 11.26, SD = 6.37, boys = 22, girls = 20) and their corresponding caregiver participated in the study. We conducted a cross-sectional, pre-experimental study. The primary outcome measure was an index of ECD, as assessed by the Dominican adaptation of the MDAT. The tool evaluates children in four domains: social, fine motor, language, and gross motor. To determine internal consistency, we obtained Spearman-Brown split-half reliability for each sub-scale. The results showed a good consistency (>.6) for social, fine motor, and gross motor, and an acceptable consistency (>.5) for language. Second, to test the inter-rater reliability, we conducted a Kendall's Taub test of independence for both the general scale and each sub-scale. Significant rτ scores ranged from .923 to .966, indicating appropriate inter-rater reliability. Third, we correlated the age variable with each subscale to determine if the development scale followed a progression of abilities that are expected to increase with maturation. The age variable correlated positively with all the subscales (social r = .887, p < .001; fine motor r = .799, p < .001; language r = .834, p < .001; gross motor r = .805, p < .001), indicating that the older the child, the better scores in the development measurements, as expected. There were no adverse events. This study, however, has multiple limitations. We did not gather information about socioeconomic position, which is an important variable when assessing child development; however, all participants lived in a low-income neighborhood. Given that this is the first ECD tool specific to the Dominican Republic, norm-referenced scores for the Dominican population do not yet exist. This study sample size is insufficient to make inferences about the national population. CONCLUSIONS: This study represents the first attempt to obtain a valid tool to screen for development milestones in children living in poverty in the DR. More research is needed to refine the instrument. The availability of the tool will enable impact evaluations of ECD intervention programs and the development of evidence-based public policies in the DR.

Can school-based distribution be used to maintain coverage of long-lasting insecticide treated bed nets: evidence from a large scale programme in southern Tanzania?

Many sub-Saharan African countries have achieved substantial gains in insecticide treated bednet coverage since 2005. The Tanzania National Malaria Control Programme identified school-based net distribution as one potential 'keep-up' strategy for the purpose of maintaining long-lasting insecticidal net (LLIN) coverage after a nationwide mass campaign in 2011. The School Net Programme (SNP) was implemented in three regions of southern Tanzania and distributed one LLIN to each enrolled child attending schools in primary grades (standards) 1, 3, 5 and 7, and secondary grades (forms) 2 and 4 in 2013 and again with slightly modified eligibility criteria in 2014 and 2015. Household surveys in the programme area as well as in a control area were conducted after each of the SNP distributions to measure ownership and use of long-lasting insecticide treated nets. Ownership of at least one LLIN after the first distribution was 76.1% (95% CI 70.8-80.7) in the intervention area and 78.6% (95% CI 74.4-82.3) in the control area. After the second distribution, ownership of at least one LLIN had dropped significantly in the control area to 65.4% (95% CI 59.5-71.0) in 2015 (P < 0.001), while coverage in the intervention area was maintained at 79.3% (95% CI 75.4 × 82.6). Ownership of at least one LLIN in intervention area remained stable following the second round of net distribution. During the same period LLIN ownership, especially of enough nets to ensure all household member access, fell significantly in the control area. These results demonstrate that the SNP may be sufficient to maintain stable LLIN coverage following a mass distribution of LLINs.

A Reliable, Feasible Method to Observe Neighborhoods at High Spatial Resolution.

INTRODUCTION: Systematic social observation (SSO) methods traditionally measure neighborhoods at street level and have been performed reliably using virtual applications to increase feasibility. Research indicates that collection at even higher spatial resolution may better elucidate the health impact of neighborhood factors, but whether virtual applications can reliably capture social determinants of health at the smallest geographic resolution (parcel level) remains uncertain. This paper presents a novel, parcel-level SSO methodology and assesses whether this new method can be collected reliably using Google Street View and is feasible. METHODS: Multiple raters (N=5) observed 42 neighborhoods. In 2016, inter-rater reliability (observed agreement and kappa coefficient) was compared for four SSO methods: (1) street-level in person; (2) street-level virtual; (3) parcel-level in person; and (4) parcel-level virtual. Intra-rater reliability (observed agreement and kappa coefficient) was calculated to determine whether parcel-level methods produce results comparable to traditional street-level observation. RESULTS: Substantial levels of inter-rater agreement were documented across all four methods; all methods had >70% of items with at least substantial agreement. Only physical decay showed higher levels of agreement (83% of items with >75% agreement) for direct versus virtual rating source. Intra-rater agreement comparing street- versus parcel-level methods resulted in observed agreement >75% for all but one item (90%). CONCLUSIONS: Results support the use of Google Street View as a reliable, feasible tool for performing SSO at the smallest geographic resolution. Validation of a new parcel-level method collected virtually may improve the assessment of social determinants contributing to disparities in health behaviors and outcomes.