BACKGROUND: Youth with foster care experience are disproportionality burdened with poor academic outcomes compared to non-foster experience youth. The Fostering Academic Success in Education (FASE) pilot program provides comprehensive onsite educational case management services to foster care youth.
OBJECTIVE: We used mixed methods to explore the effects of FASE on participating youth\'s academic performance and perceived self-efficacy to manage mental health services and support.
METHODS: Between 2020 and 2023, the FASE pilot program was delivered to 40 middle and high school students involved in child welfare services and out-of-home placements.
METHODS: Quantitative data comprised pre-post FASE intervention academic outcomes (GPA, attendance, and tardies) and the Youth Efficacy/Empowerment Scale-Mental Health (YES-MH). Paired sample t-tests and one-way ANOVA were used to assess difference in time outcomes. Qualitative generating questionnaires were administered to FASE youth and school personnel annually.
RESULTS: After participating in FASE for one academic year, youths\' GPA significantly improved (mean 2.38-2.80, p = .001), tardies significantly reduced (mean 3.78-3.1, p = .011), unexcused periods significantly reduced (mean 17.30-9.51, p = .018) and there was a significant improvement in YES-MH scores (mean 46.9-55, p = .001). Female youth had larger GPA and YES-MH score increases than male youth. FASE youth and personnel attributed academic success to the comprehensive support received by the program\'s educational social worker.
CONCLUSIONS: The FASE program holds promise in improving academic performance and mental health self-efficacy among foster care-involved youth.

UNASSIGNED: The population health burden of adverse childhood experiences (ACEs) reflects a critical need for evidence-based provider training. Rural children are also more likely than urban children to have any ACEs. A large proportion of providers are unaware of the detrimental effects of ACEs. There is a significant documented need for training providers about ACEs and trauma-informed care, in addition to a demand for that training.
UNASSIGNED: The objective was to develop, implement, and evaluate an online ACEs training curriculum tailored to Missouri providers, particularly those in rural areas given the higher prevalence of ACEs.
UNASSIGNED: From July 2021 to June 2022, we conducted literature reviews and environmental scans of training videos, partner organizations, clinical practice guidelines, and community-based resources to curate appropriate and tailored content for the course. We developed the ACEs training course in the Canvas learning platform (Instructure) with the assistance of an instructional designer and media designer. The course was certified for continuing medical education, as well as continuing education for licensed professional counselors, psychologists, and social workers. Recruitment occurred via key stakeholder email invitations and snowball recruitment.
UNASSIGNED: Overall, 135 providers across Missouri requested enrollment, with 72.6% (n=98) enrolling and accessing the training. Of the latter, 49% (n=48) completed course requirements, with 100% of respondents agreeing that the content was relevant to their work, life, or practice; they intend to apply the content to their work, life, or practice; they feel confident to do so; and they would recommend the course to others. Qualitative responses supported active intent to translate knowledge into practice.
UNASSIGNED: This study demonstrated the feasibility, acceptability, and effectiveness of interprofessional workforce ACEs training. Robust interest statewide reflects recognition of the topic\'s importance and intention to translate knowledge into practice.

OBJECTIVE: Emergency departments (EDs) provide an opportunity to identify people at risk of overdose and reduce the risk. We evaluated the effect of an ED behavioral intervention delivered by peer recovery support specialists (PRSSs) on non-fatal opioid overdose.
METHODS: Two-arm, randomized trial.
METHODS: Two EDs in Rhode Island, USA.
METHODS: ED patients presenting with an opioid overdose, complications of opioid use disorder or a recent history of opioid overdose (November 2018-May 2021). Among 648 participants, the mean age was 36.9 years, 68.2% were male and 68.5% were White.
UNASSIGNED: Participants were randomized to receive a behavioral intervention from a PRSS (n = 323) or a licensed clinical social worker (LICSW) (n = 325). PRSS and LICSW used evidence-based interviewing and intervention techniques, informed by their lived experience (PRSS) or clinical theory and practice (LICSW).
METHODS: We identified non-fatal opioid overdoses in the 18 months following the ED visit through linkage to statewide emergency medical services data using a validated case definition. The primary outcome was any non-fatal opioid overdose during the 18-month follow-up period.
RESULTS: Among 323 participants randomized to the PRSS arm, 81 (25.1%) had a non-fatal opioid overdose during follow-up, compared with 95 (29.2%) of 325 participants randomized to the LICSW arm (P = 0.24). There was no statistically significant difference in the effectiveness of randomization to the PRSS arm versus the LICSW arm on the risk of non-fatal opioid overdose, adjusting for the history of previous overdose (relative risk = 0.86, 95% confidence interval = 0.67-1.11).
CONCLUSIONS: In Rhode Island, USA, over one-in-four emergency department patients at high risk of overdose experience a non-fatal opioid overdose in the 18 months post-discharge. We found no evidence that the risk of non-fatal opioid overdose differs for emergency department patients receiving a behavioral intervention from a peer recovery support specialist versus a licensed clinical social worker.

OBJECTIVE: Household damp exposure is an important public health issue. We aimed to assess the impact of the location of household damp on respiratory outcomes during early life.
METHODS: Household damp exposure was ascertained in children recruited to the GO-CHILD multicentre birth cohort study. The frequency of respiratory symptoms, infections, healthcare utilisation and medication prescription for wheezing were collected by postal questionnaires at 12 and 24 months. Log binomial and ordered logistic regression models were fitted to the data.
RESULTS: Follow-up was obtained in 1344 children between August 2010 and January 2016. Visible damp was present in a quarter of households (25.3%) with 1 in 12 children\'s bedrooms affected (8.3%). Damp in the bathroom, kitchen or living room was not associated with any respiratory or infection-related outcomes. Damp in the child\'s bedroom was associated with an increased risk of dry cough (8.7% vs 5.7%) (adjusted relative risk 1.56, 95% CI 1.07 to 2.27; p=0.021) and odds of primary care attendance for cough and wheeze (7.6% vs 4.4%) (adjusted OR 1.37, 95% CI 1.07 to 1.76; p=0.009). There were also increased risk of inhaled corticosteroid (13.3% vs 5.9%) (adjusted RR 2.22, 95% CI 1.04 to 4.74; p=0.038) and reliever inhaler (8.3% vs 5.8%) (adjusted RR 2.01, 95% CI 1.21 to 2.79; p=0.018) prescription.
CONCLUSIONS: Damp in the child\'s bedroom was associated with increased respiratory morbidity. In children presenting with recurrent respiratory symptoms, clinicians should enquire about both the existence and location of damp, the presence of which can help prioritise those families requiring urgent household damp assessment and remediation works.

BACKGROUND: Food prescription programs are part of the broader social prescribing movement as an approach to address food insecurity and suboptimal diet in health care settings. These programs exist amid other social services, including income-based supports and food assistance programs; however, evaluations of the interactions between these programs and pre-existing services and supports are limited. This study was embedded within a larger evaluation of the 52-week Fresh Food Prescription (FFRx) program (April 2021-October 2022); the objective of this study was to examine how program participation influenced individuals\' interactions with existing income-based supports and food assistance programs.
METHODS: This study was conducted in Guelph, Ontario, Canada. One-to-one (n = 23) and follow-up (n = 10) interviews were conducted to explore participants\' experiences with the program. Qualitative data were analyzed thematically using a constant comparative analysis.
RESULTS: Participants described their experience with FFRx in relation to existing income-based supports and food assistance programs. FFRx reportedly extended income support further to cover living expenses, allowed participants to divert income to other necessities, and reduced the sacrifices required to meet basic needs. FFRx lessened the frequency of accessing other food assistance programs. Aspects of FFRx\'s design (e.g. food delivery) shaped participant preferences in favour of FFRx over other food supports.
CONCLUSIONS: As food prescribing and other social prescribing programs continue to expand, there is a need to evaluate how these initiatives interact with pre-existing services and supports and shape the broader social service landscape.
BACKGROUND: Les programmes de prescription alimentaire, qui font partie du mouvement de la prescription sociale, sont une stratégie de lutte contre l’insécurité alimentaire et l’alimentation sous-optimale dans les établissements de soins de santé. Ces programmes sont offerts conjointement à d’autres services sociaux, en particulier les mesures de soutien fondées sur le revenu et les programmes d’aide alimentaire, sans que les interactions entre ces programmes et les services préexistants aient été suffisamment évaluées. Cette étude, qui a été menée dans le cadre l’évaluation d’un programme de prescription alimentaire de 52 semaines intitulé Fresh Food Prescription (FFRx) (avril 2021 à octobre 2022), vise à déterminer la manière dont l’adhésion au programme a transformé l’attitude des participants envers les mesures de soutien fondées sur le revenu et les programmes d’aide alimentaire.
UNASSIGNED: Cette étude a été menée à Guelph (Ontario, Canada). Des entrevues individuelles (n = 23) et des entrevues de suivi (n = 10) ont été réalisées pour explorer les expériences des participants en lien avec le programme. Des données qualitatives ont été étudiées par thème au moyen d’une analyse comparative constante.
UNASSIGNED: Les participants ont décrit leur expérience du programme FFRx en relation avec les mesures de soutien fondées sur le revenu et les programmes d’aide alimentaire déjà en place. Le programme FFRx semble avoir accru leur revenu disponible pour les frais de subsistance, permis aux participants de consacrer leur revenu à d’autres besoins et réduit les sacrifices nécessaires pour répondre à leurs besoins de base. Ce programme a diminué la fréquence du recours aux autres programmes d’aide alimentaire. Certaines spécificités du programme FFRx (comme la livraison de nourriture) lui ont valu la préférence des participants par rapport aux autres mesures d’aide alimentaire.
CONCLUSIONS: À mesure que d’autres programmes de prescription alimentaire et de prescription sociale vont être mis au point, il est essentiel d’évaluer comment ces initiatives entrent en interaction avec les services déjà en place et comment elles renforcent et influencent les services sociaux en général.
This study examined how a food prescription program interacts with pre-existing services. Participants shared experiences with the program as related to other income-based supports and food assistance programs. For income-based supports: the Fresh Food Prescription (FFRx) program enabled participants to extend income further, divert it to other necessities and reduce incomerelated sacrifices. For food assistance programs: FFRx reduced frequency of accessing other food programs and was the preferred choice due to the program’s design (e.g. accessibility, food quality, delivery). As food and social prescribing initiatives expand, evaluations must consider how these programs interact with and influence the broader social service landscape.
Cette étude a permis d’explorer comment un programme de prescription alimentaire entre en interaction avec les services déjà en place. Les participants ont fait part de leur expérience du programme dans le cadre du recours aux mesures de soutien fondées sur le revenu et aux programmes d’aide alimentaire. Mesures de soutien fondées sur le revenu : le programme Fresh Food Prescription (FFRx) a permis aux participants d’optimiser leur revenu, de le consacrer à d’autres besoins et de réduire les sacrifices liés au manque de moyens financiers. Programmes d’aide alimentaire : le programme FFRx a réduit la fréquence du recours aux autres programmes d’aide alimentaire et il s’est révélé le premier choix des participants du fait de sa conception (accessibilité, qualité des aliments, livraison). À mesure que d’autres programmes de prescription alimentaire et de prescription sociale vont être développés, il faudra évaluer comment ces initiatives entrent en interaction avec les services sociaux en général et comment elles ont une influence sur ces services.

UNASSIGNED: COVID-19 restrictions and lockdown measures have led to impact on the mental health and social service delivery, including the rapid adoption of digital solutions to mental healthcare delivery in Singapore. This study aims to rapidly document the quantitative and qualitative impact of the pandemic restrictions on mental health and social services.
UNASSIGNED: This descriptive mixed-methods study consisted of a survey arm and a qualitative arm. Providers and clients from eligible mental health organisations and social service agencies were recruited. The respondents completed a survey on changes to their service delivery and the extent of impact of the pandemic on their clients. In-depth interviews were also conducted with representatives of the organisations and clients.
UNASSIGNED: There were 31 organisation representatives to the survey, while 16 providers and 3 clients participated in the in-depth interviews. In the survey arm, all representatives reported pivoting to remote means of delivering care during the lockdown. An increase in new client referrals and more domestic violence were reported from primary and community health partners respondents who made up 55.5% of health partners respondents. Three distinct response themes were recorded in the in-depth interviews: impact on clients, impact on service provision and impact on mental health landscape.
UNASSIGNED: Two key findings are distilled: (1) mental health and social services have been challenged to meet the evolving demands brought about by the pandemic; (2) more societal attention is needed on mental health and social services. The findings indicate a necessary need for extensive studies on COVID-19 that can inform policies to build a more pandemic-resilient nation.

BACKGROUND: Around one in four people are living with multiple long-term conditions (MLTC). Integrated care to holistically manage both health and social needs could improve outcomes for people living with MLTC, including lower rates of hospitalisation and mortality. However, given the number of people with MLTC and increasing strain on health and social care, stratified approaches to identifying and addressing social care needs may be more efficient and cost-effective. We have developed data driven clusters that group people with similar health and social care needs, which could identify patients at the highest risk of poor outcomes related to social care need.
OBJECTIVE: To explore views about a future intervention based on these clusters.
METHODS: We aim to plan a cluster-based intervention that engages people living with MLTC and health and social care professionals to consider social care needs (SCNs) when consulting in primary care. We have conducted 14 interviews with professionals to explore their priorities and concerns about care delivery by MLTC clusters and 19 remote interviews with people living with MLTC to find out how well they identify with the MLTC clusters we have defined. Data were analysed using reflexive thematic analysis.
RESULTS: GPs are the \'starting point\' for conversations about SCNs but need an efficient system to enable effective conversations. The cluster-based intervention could fill this gap.
CONCLUSIONS: This research identifies key considerations needed for an intervention to engage people with MLTC and health and social care professionals to consider SCNs in primary care.

This study explores the experiences of Polish caregivers of children with rare disease (CRD) with health care and social services for CRD. A mixed-methods approach was employed, using an open-ended questionnaire with a convenience sample. Quantitative data presented through descriptive statistics, were complemented by thematic analysis applied to qualitative responses. Responses from 925 caregivers of 1002 children with CRD revealed that the duration of the diagnostic journey varied, spanning from 0 to 18 years, with an average time of 1.7 years. Similarly, the average number of physicians consulted before receiving the correct diagnosis was 4.8. The Internet was basic source of information about children\'s disease. Although caregivers were to some extent satisfied with the quality of health care for CRD, they complained at the accessibility of health care and social services, physicians\' ignorance regarding RDs, the lack of co-ordinated care and financial and psychological support. To break the cycle of the diagnostic and therapeutic odyssey that may aggravate the condition of CRD, cause parental stress and financial burden there is a need to change our view on CRD from cure to family-oriented care. Multifaceted challenges and needs of CRD families should be prioritized.

OBJECTIVE: To evaluate the impact on rural Veterans\' access to social work services of a Department of Veterans Affairs (VA) national program to increase social work staffing, by Veterans\' rurality, race, and complex care needs.
METHODS: Data obtained from VA Corporate Data Warehouse, including sites that participated in the social work program between October 1, 2016 and September 30, 2021.
METHODS: The study outcome was monthly number of Veterans per 1000 individuals with 1+ social work encounters. We used difference-in-differences to estimate the program effect on urban, rural, and highly rural Veterans. Among rural and highly rural Veterans, we stratified by race (American Indian or Alaskan Native, Asian, Black, Native Hawaiian or Other Pacific Islander, and White) and complex care needs (homelessness, high hospitalization risk, and dementia).
METHODS: We defined a cohort of 740,669 Veterans (32,434,001 monthly observations) who received primary care at a participating site.
RESULTS: Average monthly social work use was 8.7 Veterans per 1000 individuals. The program increased access by 49% (4.3 per 1000; 95% confidence interval, 2.2-6.3). Rural Veterans\' social work access increased by 57% (5.0; 3.6-6.3). Among rural/highly rural Veterans, the program increased social work access for those with high hospitalization risk by 63% (24.5; 18.2-30.9), and for Veterans experiencing homelessness, 35% (13.4; 5.2-21.7). By race, the program increased access for Black Veterans by 53% (6.1; 2.1-10.2) and for Asian Veterans by 82% (5.1; 2.2-7.9).
CONCLUSIONS: At rural VA primary care sites with social work staffing below recommended levels, Black and Asian Veterans and those experiencing homelessness and high hospitalization risk may have unmet needs warranting social work services.

BACKGROUND: Children and young people (CYP) who are in contact with social care are at higher risk of developing mental health difficulties compared to the general population. This has been attributed to their experience of significant childhood adversity. With an increased likelihood of experiencing poorer health outcomes which can persist into adulthood, it is crucial that key factors for their positive mental health development are identified.
OBJECTIVE: To identify factors associated with the poor mental health of CYP in contact with social care from the perspective of practitioners working in children\'s social care and mental health.
METHODS: Social care and mental health practitioners; three Local Authorities across the North-East of England.
METHODS: Four focus groups were conducted with 23 practitioners between April and May 2022. A semi-structured topic guide exploring the nature and associated factors of mental health was used to focus discussion. Data were thematically analysed and informed by the four levels of the socio-ecological model.
RESULTS: Individual level risk factors were associated with the CYP\'s emotional health and included what practitioners described as the \'sense of shame\'. Interpersonal level risk factors were most recurrent and included parental factors within the home environment. Community level risk factors consisted of characteristics of settings and institutions that increased the risk of the CYP developing mental health and wellbeing difficulties. Societal level risk factors included broader societal factors such as poverty. Practitioners maintained that certain protective factors possessed or developed by CYP including secure attachments, prevent the development of mental health difficulties.
CONCLUSIONS: Our current study provides strong evidence for the interlinkage between multiple levels of risk and their interacting impact on the CYP\'s mental health and emotional wellbeing. It is imperative that this, and the need to strengthen protective factors, whilst reducing risks are carefully considered for the development of effective support interventions for CYP in contact with social care.