Development of an Implementation Facilitation Strategy to Link Mental Health Screening and eHealth Intervention for Clients in Ryan White-Funded Clinics in Chicago.

BACKGROUND: To reduce the impact of depression on people living with HIV, we are implementing a clinic-based behavioral health screener and referral to Optimizing Resilience and Coping with HIV through Internet Delivery, an evidenced-based intervention. We used the Consolidated Framework for Implementation Research to identify contextual barriers and facilitators in advance of implementation. SETTING: Sixteen Chicagoland area Ryan White Medical Case Management sites. METHODS: We conducted a sequential mixed-methods study with medical case managers and supervisors. Participants completed an online survey assessing Consolidated Framework for Implementation Research domains, scored on a 1 (strongly disagree) to 5 (strongly agree) scale. Survey results informed a purposive sampling frame and interview protocol. Interviews were analyzed by rapid qualitative analysis. RESULTS: On average, survey respondents (n = 58) slightly agreed with positive views of team culture, learning climate, and implementation readiness (mean = 3.80-3.87). Potential barriers included intervention complexity (mean = 3.47), needed human resources (mean = 2.71-3.33), and only slight agreement with relative advantage over existing screening/referral systems (mean = 3.09-3.71). Qualitative results (n = 15) identified low advantage for clinics with robust behavioral health systems but strong advantage in clinics without these services. Respondents identified system-wide training and monitoring strategies to facilitate implementation. CONCLUSIONS: Ryan White Medical Case Management sites are a generally favorable context for the implementation of the interventions. As illustrated in an implementation research logic model, barriers will be addressed through deploying strategies proposed to impact clinic- and individual-level outcomes, including electronic prompts (reduce complexity), training on Optimizing Resilience and Coping with HIV through Internet Delivery as a complement to other behavioral health services (increase relative advantage), and feedback during implementation (strengthen rewards/incentives).

Fatherhood in Foster Care: A Scoping Review Spanning 30 Years of Research on Expectant and Parenting Fathers in State Care.

Over the past 30 years, there has been a surge of interest in understanding the experiences and outcomes of expectant and parenting foster youth. Despite the importance of understanding this unique population of foster youth, there remains a lack of research on fathers in foster care. Most studies of expectant and parenting foster youth focus on mothers in care, and studies that have examined fathers in care provide little insight compared to what we know about mothers. Furthermore, existing research on fathers in foster care is limited by underreporting, service engagement issues, lack of meaningful engagement data, and very little information on fathers' involvement with their children. There is very little published research on the experience of fatherhood in foster care or on related outcomes for fathers in care such as residency with children, father engagement with children, coparental relationship quality, or the health and well-being of their children. While there have been over 60 studies and three reviews on expectant and parenting foster youth spanning roughly 30 years, the articles have primarily focused on empirical findings relating to mothers in foster care. Information on fathers in foster care has received little attention and is restricted to empirical studies. This scoping review aims to fill this gap by examining the available information on fathers in foster care. To this end, our scoping review explores empirical findings and knowledge from practice-, legal-, and policy-related literature related to fathers in foster care from peer-reviewed journal articles, reports, dissertations, white papers, and grey literature published between 1989 and 2021. Findings from 94 sources of evidence on expectant and parenting foster youth suggest that mothers in foster care are consistently the focus of the literature. If fathers in foster care are included in the literature, findings or guidance are often provided in the aggregate (e.g., parents in care). However, when aggregated, literature still focuses on mothers in care, or female pronouns are used to describe the larger expectant or parenting foster youth population. Many of the studies excluded fathers, and the primary exclusion rationale includes a lack of identified fathers in care, unreliable child welfare data on fathers, or high attrition of fathers in parenting services. In terms of information on fathers in foster care by the source of evidence, research papers often provided quantitative descriptions of fathers, practice papers focused on rights of fathers, legal papers centered on paternity establishment or paternal rights, and policy papers largely discussed the need for improved data tracking and interventions for fathers. More research is needed to support fathers in foster care as they transition out of care into early adulthood and young fatherhood.