Applying RE-AIM to evaluate two community-based programs designed to improve access to eye care for those at high-risk for glaucoma

IntroductionGlaucoma is a leading cause of vision loss and blindness in the U.S. Risk factors include African American race, older age, family history of glaucoma, and diabetes. This paper describes the evaluation of a mobile eye health and a telemedicine program designed to improve access to eye care among people at high-risk for glaucoma.MethodsThe RE-AIM (reach, efficacy, adoption, implementation, and maintenance) evaluation framework was used to harmonize indicators. Both programs provided community-based eye health education and eye services related to glaucoma detection and care. Each program reported data on participants and community partners. An external evaluator conducted site visit interviews with program staff and community partners. Quantitative and qualitative data were integrated and analyzed using the RE-AIM dimensions.DiscussionBy targeting high-risk populations and providing comprehensive eye exams, both programs detected a large proportion of new glaucoma-related cases (17–19%) – a much larger proportion than that found in the general population (<2%). The educational intervention increased glaucoma knowledge; evidence that it led people to seek eye care was inconclusive.ConclusionsEvaluation findings from the mobile eye health program and the telemedicine program may provide useful information for wider implementation in public health clinics and in optometrist clinics located in retail outlets.     

A Comparison of two analytic methods for the identification of neighborhoods as intervention and control sites for community-based programs

Study Objective: Interest in community as the focus of public health interventions is growing. However, choosing intervention and comparison neighborhoods when designing community based programs poses a challenge to program planners. Ideally, intervention neighborhoods should be chosen based upon risk profiles and demonstrated need for the program. Multiple sources of data that tap into neighborhood characteristics might be used to facilitate the selection of intervention and comparison neighborhoods for program implementation and evaluation.Design: We present and compare selected characteristics of two analytic methods that can be used to create perinatal risk profiles of neighborhoods within cities. For our example, we used information from several sources of routinely available data and used census tract level low birthweight as our intervention or outcome variable.Main Results: At the neighborhood level, we found average household wealth of the census tract, proportion of births to women with late or no prenatal care, proportion of teen births per census tract, per capita crime rates, proportion of housing violations, and number of community organizations as being important factors identifying neighborhoods at risk for high rates of low birthweight births. Advantages of both methods are discussed and risk profiles generated from either method can be used not only to identify high risk areas of the city for adverse perinatal outcomes but also for the identification of intervention and comparison neighborhoods for implementation of community based programs.     

A qualitative study to examine how differences in motivation can inform the development of targeted physical activity interventions for African American women

Self-Determination Theory proposes that some people are motivated to initiate physical activity by externally-controlled reasons (e.g., physical appearance, approval from others), whereas others feel compelled by more autonomous sources of motivation (e.g., enjoyment, personal importance). This study used qualitative methods to examine whether individual differences in autonomous motivation offers a useful framework for developing targeted intervention programs for African American women. Focus groups (k = 6) were conducted to examine how different levels of autonomous motivation for physical activity related to differences in physical activity barriers and facilitators among African American women (N = 31). Sessions were audiotaped, transcribed, and coded by independent raters (r = 0.70). QSR NVivo 11 was used to analyze data, and themes were identified separately for women with low, medium, or high autonomous motivation. Those with high autonomous motivation focused on themes of wanting novelty, excitement, and competition, whereas those with low autonomous motivation focused on themes of wanting instrumental support and financial incentives for increasing engagement in physical activity. Implications for developing physical activity intervention programs for African American women that are targeted toward differences in autonomous motivation are discussed.     

Using mixed method approach in measuring effects of training in firms: Case study of the European Social Fund support

Public support of training in firms corresponds to the long-term importance of the quality of human capital in the competitiveness of firms and nations. Thus, the EU supports such training via the European Social Fund (ESF). The evaluation community evaluates the support by using either qualitative or quantitative methods. The simultaneous application of these two approaches is rare. The purpose of this paper is to combine quantitative (counterfactual impact evaluation) and qualitative (qualitative comparative analysis) methods in order to fill the methodological gap. Based on the combination of both approaches, it explores their strengths, complementarity and disadvantages to evaluate public support for employee training in the Czech Republic. The combination of methods makes it possible to identify not only the impacts but also their causes. Linking the ESF support to corporate competitiveness is crucial for demonstrating the effectiveness of public spending.     

Building cultural competence: A systematic evaluation of the effectiveness of culturally sensitive interventions with ethnic minority youth

Growing diversity within the US population accentuates the need for the development and implementation of culturally competent services in the field of child welfare. Despite this, few studies exist that examine the effectiveness of culturally sensitive interventions (CSIs) with ethnic minority populations, who are considerably more at risk of developing psychosocial problems including substance and alcohol abuse, delinquency, low academic achievement, and poor self-esteem. With the demand for evidence-based practice it is imperative that we examine the effectiveness of CSIs designed to prevent and treat youth problems. The main goal of this review was to systematically analyze the methodology of recent CSI research with populations of ethnic minority youth in order to evaluate each intervention's ability to adhere to existing standards of evidence-based practice. The fifteen CSI studies examined in this review illustrate progress in their attempt to adhere to the methodological rigor required of evidence-based practice. This review encourages the field of child welfare to position itself analogously with and embrace the movement toward building cultural competence by further investigating the effectiveness of culturally-sensitive interventions with ethnic minority youth.     

Interventions for Internationally Adopted Children and Families: A Review of the Literature

Internationally adopted (IA) children are at increased risk for health-related, developmental, and behavioral difficulties. This article reviews the literature on various interventions currently used with IA populations; including health-related interventions provided by medical specialists, preparation programs provided by adoption agencies and other social service organizations, treatments for attachment and behavioral disorders, psychoeducational services, programs designed to improve children’s care prior to adoption, and parent-based initiatives. Surprisingly, very little systematic information exists regarding the effectiveness of interventions designed to prevent and remediate these difficulties in IA children. Recommendations for future research activity and for best practice approaches to intervention are discussed.     

A Focus on the Program of All-Inclusive Care for the Elderly (PACE)

For over four decades, the Program of All-Inclusive Care for the Elderly (PACE) has been operated by nonprofit organizations. Research has demonstrated that nonprofit PACE provides quality, cost-effective community-based care to older adults who would otherwise require a nursing home level of care. Recently, the U.S. Secretary of the Department of Health and Human Services has authorized for-profit entities to operate PACE, contingent on their ability to demonstrate that they can provide care that is similar to nonprofit PACE with regard to access to care, quality of care, and cost-effectiveness. In 2013, a study was conducted to evaluate how PACE operates under for-profit versus nonprofit status. The results were presented to Congress which, in turn, authorized for-profit PACE providers. This article critiques the 2013 study, offers a comparison to for-profit hospice, and argues that at best there is not enough evidence to conclude that for-profit PACE provides the same quality of care as existing nonprofit operators.     

Knowledge translation and implementation of housing first in Canada: A qualitative assessment of capacity building needs for an evidence-based program

We examined communities’ expressed needs for capacity building in the implementation of Housing First (HF) for persons experiencing homelessness. The findings are based on thematic analyses of qualitative data obtained from participants (n = 77) in 11 focus groups conducted in seven Canadian cities. We identified capacity building needs in the areas of training (e.g., HF principles, clinical services, landlord engagement) and technical assistance (e.g., intake coordination, client prioritization, fidelity assessment). These findings were used to tailor training and technical assessment (TTA) to the stages of HF implementation in these cities. Limitations and implications for future theory, research, and practice are discussed.     

Brief online surveys to monitor and evaluate facilitated peer support groups for caregivers of children with special needs

BackgroundThere have been few systematic evaluations of experiences of participating in peer support groups for parents and other caregivers of children with special needs. In Australia, facilitated groups are available to caregivers in community settings, through a nationally funded program, MyTime. Mechanisms for ongoing monitoring and evaluation have not yet been instituted.AimTo establish whether brief, online surveys can be used for monitoring and evaluating peer support groups for caregivers of children with special needs.MethodsTwo brief, online surveys, with both fixed-choice and open-ended questions, were developed. All caregivers who attended any MyTime group during a 1-month period were invited to participate.ResultsOf 89 caregivers who expressed interest in participating, 54 and 31 respondents completed respectively. Respondents represented a variety of backgrounds and circumstances. Responses revealed both positive and negative aspects of group participation. Linked data on expectations and experiences provided important feedback for the program.ConclusionBrief, online surveys are a suitable mechanism for ongoing monitoring and evaluation of peer support group programs for caregivers.     

Home for now: A mixed-methods evaluation of a short-term housing support program for homeless families

The use of short-term rental subsidy vouchers offers a new approach to addressing the housing needs of families facing homelessness. In Massachusetts, the Family Home pilot program placed homeless families in housing instead of shelter, providing two years of rental subsidy plus support services with the goal of enabling families to maintain market rate housing. This mixed-method case study complements staff and participant interview data with participant survey and administrative data to evaluate the implementation and short-term outcomes of Family Home in one region. Data point to improved family well-being in housing but also persistent barriers to achieving longer-term housing and economic stability. Of the families who had exited the program at the end of the study, one quarter were able to retain their housing at market rate, only 9% returned to shelter, and one in five moved in with families/friends. Lack of affordable housing in a high rental cost region and jobs that pay living wages were among the major reasons that families struggled to maintain housing. This research points to the need for integrating supportive services from the program's start, including targeted workforce development, to plan for the end of the short-term rental subsidy.     

Loneliness,social support,and preference for online social interaction: the mediating effects of identity experimentation online among children and adolescents

This study explores the practices of online social activities among children and adolescents in order to uncover the connections between preferences for online social interaction and loneliness, social support, and the mediating effect of identity experimentation online. Data were gathered from a random sample of 718 youngsters aged 9 to 19. Analyses revealed that individuals who are lonely and have a lower level of offline social support find opportunities for identity experimentation online more gratifying than those who are less lonely or not lonely. Both loneliness and social support offline were found significantly related to preference for online social interaction, but the relationships were mediated by identity experimentation online. Finally, it was found that age differences exist. In particular, individuals aged 9 to 14 who are lonely and those aged 15 to 19 with little social support show a significant preference for online social interaction. Implications for future research into identity experimentation online and social relationship are discussed.     

The potential of online social networking data for augmenting the study of high-risk personal networks among young men who have sex with men at-risk for HIV

Capturing dynamics in high-risk personal networks is essential for preventing HIV transmission. Online social networking data offer incentive to augment traditional selfreported approaches for network enumeration. To explore what online networks reveal about dynamics among high-risk associates, we examine the relationship between egocentric confidant and sex networks and personal Facebook friendship networks of a cohort of young Black men who have sex with men. Although overlap exists between self-reported and Facebook associates, the stabilities of each were unrelated. Confidants who were also Facebook friends with a respondent were, however, more likely to be retained. Thus, Facebook networks contain stable confidants.     

Toxic stress in children and youth: Exploring the role of community-based programming to support health and well-being in the United States

Children and youth exposed to toxic stress are at a greater risk for negative outcomes on health, well-being and occupational performance. Focus groups were conducted to gain understanding of the experiences and perspectives of youth at-risk who were currently receiving services from a community-based agency in a small city in the Western United States. Participants discussed acquiring life skills through agency programming including social skills and coping/self-regulation skills. Participants also reported a positive culture of the agency, expressing feelings of safety, trust and supportive relationships. Community-based programming may be in a pivotal position to provide services and supports that act as buffering protection against the effects of toxic stress.     

Online youth work and eYouth — A guide to the world of the digital natives

Our society is often called the post-modern or information society to differentiate it from earlier structures. This distinction is justified by completely new circumstances which are perceptible on a daily basis. For example, the forms of establishing and maintaining communication have undergone fundamental changes. ICT-aided solutions are playing an ever greater role, replacing interpersonal communication. However, what must never be forgotten is that - although the medium is different - there is always a person behind the digital tools and this is why the tasks of youth work extend into virtual space. The study deals with youth work that can be and is to be carried out in various digital spaces. The authors will introduce the characteristic features of this new area, and focuses on the general rules that define it, as well as the various features of individual media (applications). The author also introduces practical examples, of which success should be followed as models. He will formulate general fundamental rules that are worth maintaining if we wish to pursue youth work in the virtual space.     

No Lone Wolf: A Multidisciplinary Approach to Creating Safe Schools for LGBTQ Youth Through the Development of Allies

Research suggests that bullying of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth is a national problem that requires immediate intervention. The purpose of this article is to (a) discuss the critical need for a multidisciplinary approach to creating safe schools for sexual minority youth utilizing a social justice framework, (b) present an allyhood model to serve as a training framework, and (c) offer an exemplar for schools. By embracing a multidisciplinary approach to address the safety and belonging needs of LGBTQ youth, school psychologists and counselors can become leaders of systems-level change, poised to make a difference in the lives of LGBTQ students.     

Offering Social Support via the Internet: A Case Study of an Online Support Group for Social Workers

SUMMARY

Human service professionals have begun to explore the Internet's potential as a therapeutic medium for individuals, families and groups, but we still know very little about the ways that Internet-mediated communication affects interventions. This paper uses examples from a recent study of a short-term, listserv-based support group that helps social workers cope with job stress to discuss issues related to the use of online support groups.     

The operation was a success but the patient died: A critique of “the implementation and evaluation of a problem-solving training program for adolescents”

This critique examines George S. Tellado's account of his evaluation of a problem-solving program for adolescents in a public junior high school in Pennsylvania. The program was apparently successful (i.e., it was shown by the evaluation to improve students' problem-solving capacities), and the evaluation was, for the most part, technically sound, but the program did not survive. This critique suggests that by examining the problem-solving program as an organizational change intervention, several problems can be uncovered regarding the program's design, implementation, evaluation, and institutionalization. In particular, it appears that the school system's staff did not have sufficient ownership of the program to understand it or to wish to carry it on after the program's originator and evaluator were no longer present. This article addresses these problems in detail and recommends techniques from the field of organizational change consultation to increase the likelihood that such programs will live on into the future.     

A card game to renew urban parks: Face-to-face and online approach for the inclusive involvement of local community

Urban parks are often designed and renewed using standardized models that fail to incorporate the different functions and services required by the local communities served. Furthermore, when the citizens are involved in co-design, the participation processes are seldom fully inclusive, and the results are not representative of the entire local community. The paper starts from these considerations for developing an innovative participatory design method to renew urban parks. This method simultaneously uses multiple and alternative participation tools for adapting to the different technical skills of the citizens and to their inclinations. Furthermore, it entails the analysis and interpretation of the expectations of the local community in light of the urban green network. The method uses the conceptual framework of the SWOT analysis and the Trochim's concept mapping for developing a card game playable face to face or online. The results of the card game are processed using the statistical analysis to identify the main design themes (the clusters), and to split the participants’ suggestions into different design alternatives. Successively, the participants vote these alternatives for selecting the renewal design respondent to the local community's needs.     

Providing context to the implementation of health promoting schools: A case study

PurposeIssues related to program context are important components of population health interventions and particularly among complex, adaptive initiatives in schools. Health Promoting Schools (HPS) is a global approach to support early development of healthy behaviors among children and youth. The purpose of this study was to explicate the practical and contextual processes that influenced implementation of HPS in schools in Nova Scotia (Canada).MethodsUsing a case-study approach, data was collected using interviews (n = 14) with principals, teachers and parents, observations collected during school visits and document review in five diverse schools.ResultsCase study schools reported a variety of HPS practices and three key themes emerged that provided context to the processes that facilitated their implementation. The results suggest that although school characteristics (theme 1), like staff allocation, physical location and resources, are important, these barriers can be mitigated by building organizational capacity (theme 2) and establishing a supportive school community culture (theme 3).ConclusionsThe study provided insight to the variability in implementation by describing how contextual barriers were experienced and mitigated by schools. Establishing a broad system to support HPS, with collaboration across health and education sectors, could help to progress adoption, implementation and sustainability of HPS.     

A decision support tool to determine cost-to-benefit of a family-centered in-home program for at-risk adolescents

Family-centered program research has demonstrated its effectiveness in improving adolescent outcomes. However, given current fiscal constraints faced by governmental agencies, a recent report from the Institute of Medicine and National Research Council highlighted the need for cost-benefit analyses to inform decision making by policymakers. Furthermore, performance management tools such as balanced scorecards and dashboards do not generally include cost-benefit analyses. In this paper, we describe the development of an Excel-based decision support tool that can be used to evaluate a selected family-based program for at-risk children and adolescents relative to a comparison program or the status quo. This tool incorporates the use of an efficient, user-friendly interface with results provided in concise tabular and graphical formats that may be interpreted without need for substantial training in economic evaluation. To illustrate, we present an application of this tool to evaluate use of Boys Town’s In-Home Family Services (IHFS) relative to detention and out-of-home placement in New York City. Use of the decision support tool can help mitigate the need for programs to contract experts in economic evaluation, especially when there are financial or time constraints.