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Disparities in geographic access to medication for opioid use disorder (OUD) are well documented. Further, historical implications of systemic racism and of the longstanding War on Drugs in the United States have driven both social and spatial inequities in access to treatment. This work builds on a previously published spatial access methodology that uses a gravity-based variant of the enhanced two-step floating catchment area model, to determine how OUD pharmacotherapy accessibility varies nationally at the census tract level. Medication for OUD (MOUD) accessibility scores are then analyzed by rurality and racial/ethnic segregation. The Getis-Ord Gi* statistic was used to identify clusters of high or low accessibility to MOUD, while the interaction index was used as a measure of segregation to assess the racial/ethnic population distribution. The results of the clustering statistic, and the associated significance values were then compared to rurality and interaction using the Chi-Square test to determine if hot or cold areas of access are independent of rurality and racial/ethnic spatial distributions. Lastly, the percentage of buprenorphine providers at capacity by census tract was calculated using the binary 'at-capacity' data attribute associated with each SAMHSA buprenorphine provider record. The results demonstrate distinct spatial variability of MOUD resources based on urbanicity and racial makeup that have significant implications for intervention or policy reform that seeks to encourage equal access to both treatment modalities. MOUD access varies by racial segregation and rurality Black segregated and integrated Black-White urban communities have greater accessibility to both MOUD types White urban communities have significantly lower levels of spatial access to MOUD Low urban MOUD induction and adherence rates of minority populations are likely not strongly driven by spatial access, rather structural, political, physical, and social components are more influential to intervention uptake. 97% of buprenorphine providers were at their patient capacity limit prior to the end of the federal DATA waiver process in June 2023.

Purpose - This study aims to investigate whether and how organizational culture moderates the influence of other organizational capacities on the uptake of new mental health care roles by non-medical primary health and social care services.Design methodology approach - Using a cross-sectional survey design, data were collected in 2004 from providers in 41 services in Victoria, Australia, recruited using purposeful sampling. Respondents within each service worked as a group to complete a structured interview that collected quantitative and qualitative data simultaneously. Five domains of organizational capacity were analyzed: leadership, moral support and participation; organizational culture; shared concepts, policies, processes and structures; access to resource support; and social model of health. A principal components analysis explored the structure of data about roles and capacities, and multiple regression analysis examined relationships between them. The unit of analysis was the service (n=41).Findings - Organizational culture was directly associated with involvement in two types of mental health care roles and moderated the influence of factors in the inter-organizational environment on role involvement.Research limitations implications - Congruence between the values embodied in organizational culture, communicated in messages from the environment, and underlying particular mental health care activities may play a critical role in shaping the emergence of intersectoral working and the uptake of new roles.Originality value - This study is the first to demonstrate the importance of organizational culture to intersectoral collaboration in health care, and one of very few to examine organizational culture as a predictor of performance, compared with other organizational-level factors, in a multivariate analysis. Theory is developed to explain the findings.

Background Numerous studies across international settings have highlighted a need to improve the appropriateness and continuity of services for young people experiencing mental ill health. This paper examines key features of a sub-acute youth mental health residential service model, Youth Prevention and Recovery Care (Y-PARC) service. Y-PARC provides up to 4 weeks care to 16 to 25 year-olds at risk of hospitalisation and to those transitioning out of hospital inpatient units. The research was conducted at one of three Y-PARCs located in Victoria, Australia. Methods This paper presents findings from analysis of two data sources collected during evaluation of a Y-PARC service in 2015–17. Routinely collected administrative data of Y-PARC residents ( n  = 288) were analysed and semi-structured interviews were conducted with 38 participants: a) former residents ( n  = 14); b) family members of group a) ( n  = 5); key stakeholders ( n  = 9); and, Y-PARC staff ( n  = 10 respondents in 3 group interviews). Analysis of the qualitative data was thematic and structured by the interview guide, which covered the key service aims. Results Consistent with the aims of the service, respondents described practice at Y-PARC that aligns with recovery-oriented care. Key features emphasised were: a safe and welcoming environment for residents and families; provision of person-centred care; promotion of autonomy and self-help; informal interactions with staff allowing for formation of naturalistic relationships; time spent with other young people with similar experiences; and, assurance upon exit that the ‘door is always open.’ High levels of satisfaction were reported. Outcomes described included: improved resilience; better understanding of mental health; the importance of seeking help; and, stronger connections to therapeutic services. Longer and multiple stays were associated with progressive and sustained change. Family members and stakeholders widely reported that the service fills a gap between community services and acute inpatient mental health hospital wards. Some challenging areas of practice identified included: integration of evidence-based psychosocial interventions; provision of care within a model that blends clinical and psychosocial support services; and, negotiation of family-inclusive practice. Conclusions The Y-PARC service model shows promise with young people experiencing mental ill health, particularly in improving the range and availability of options across a spectrum of need.

Purpose - Young people receiving services for substance use problems often experience high rates of other psychosocial problems in addition to mental disorders. This has implications for design of effective interventions. There is a lack of concisely organised practical information to help organisations serving this population establish contextually relevant and rigorous approaches to the design of evidence-based interventions. This paper aims to focus on these issues.Design methodology approach - Drawing on literature from clinical and implementation science, this paper describes a new approach to the development and implementation of evidence-based practice (EBP). Contributions of innovators, early adopters, evaluators, and other scholars are reviewed and synthesized.Findings - Traditional approaches to EBP relying on manualised programs targeting discrete diagnoses have not yielded meaningful progress in the dissemination of EBP to services that specialise in treatment and support for young people experiencing complex psychosocial needs. Recent initiatives are moving away from reliance on manualised programs and adopting a modular practice elements approach that enables maximum flexibility in responding to the unique needs of individual clients. This approach has potential to mitigate barriers to implementation of EBP in resource poor environments.Originality value - The complexity of needs presented by young people with dual mental health and substance use problems is increasingly recognised, but there is little information available that supports the formulation evidence-based interventions that directly address this complexity. This paper applies knowledge from research to the practical challenges faced by practice leaders in real-world services.

New metrics of household water insecurity have been validated for low- to middle-income countries, but it is unclear how these measurements apply to the experiences of people living in high-income countries. This project aims to develop and validate a novel metric for household water insecurity experiences in the United States (HWISE-USA) using a cross-sectional design and data from the Southwest, Midwest, and Western regions. We outline the protocol for the development and validation of a novel household water insecurity scale for the United States to address this scientific need, including the following key steps: (1) item development through literature and theory; (2) pre-testing of items and expert review; (3) scale development and item reduction; and (4) scale validation. To assess the performance of the HWISE-USA scale, we will follow the same scale development analytics on a separate, quasi-nationally-representative U.S. sample. The scale will be generated from household survey data collected from communities at risk of water insecurity throughout the United States. We explain how a novel metric of water insecurity experiences for households in the United States has important implications for resource allocation, structural interventions, public health and infrastructure planning, and reductions in inequalities. osf.io/zvqs4.

The scale and cadence of crises affecting large populations is on the rise. These crises or gradual onset disasters can be considered shocks or disruptions to social systems. The impacts of many of these shocks do not affect populations equally, but differentially based on social class, race, ethnicity, demographic category, and geographic location. This research seeks to investigate the spatial components of a complex system in response to a gradual onset crisis in an effort to develop a framework of spatial response. The context of the research will be the spatial system in which the health care system delivers care,; the crisis is the opioid overdose epidemic. The opioid overdose crisis in the United States (US) is well documented as overdose mortality has continued to climb year after year, is a leading cause of accidental death, and has contributed to a reduced life expectancy. Medication for opioid use disorder (MOUD) is the evidence-based treatment for opioid use disorder, however, substantial disparities and deficits in geographic access to MOUD exist. In an effort to improve the provision and allocation of MOUD, this research addresses a series of research questions to advance understanding regarding the spatial accessibility to MOUD, the landscape of risk for opioid overdose, and treatment expansion efforts via spatial optimization modelling. The four studies presented within this dissertation offer a roadmap for implementing a suite of geographic methods to improve the provision of MOUD. Moreover, the synthesis of these chapters provides a research framework for using the geographic advantage to address a modern, complex spatial problems; acknowledging the need to assess a problem from multiple angles for improved understanding of the problem context in order to promote more equitable and effective resource allocation. Emphasis is placed on the need for investigating social-spatial relationships with regard to the problem space as well as the response. These social-spatial insights are vital in informing optimization approaches for resource provision to modern, complex problems.

Within the health services research community there is a growing strength of feeling that ongoing partnerships between researchers and decision-makers are critically important to effective transfer and exchange of knowledge generated from health services research. A body of literature is emerging around this idea that favours a particular model of partnership based on decision-maker involvement in research. This model is also gaining favour among health research funding bodies internationally. We argue that it is premature for the health services community to privilege any particular model of partnership between researchers and decision-makers. Rather a diversity of models should be conceptualized, explored in theory and practice, and evaluated. We identify seven dimensions that could be used to describe and differentiate models of partnerships for knowledge exchange and illustrate how these dimensions could be applied to analysing partnerships, using three case studies from recent and ongoing health services research partnerships in Australia.

Background Out-of-home care (OoHC) refers to young people removed from their families by the state because of abuse, neglect or other adversities. Many of the young people experience poor mental health and social function before, during and after leaving care. Rigorously evaluated interventions are urgently required. This publication describes the protocol for the Ripple project and notes early findings from a controlled trial demonstrating the feasibility of the work. The Ripple project is implementing and evaluating a complex mental health intervention that aims to strengthen the therapeutic capacities of carers and case managers of young people (12-17 years) in OoHC. Methods The study is conducted in partnership with mental health, substance abuse and social services in Melbourne, with young people as participants. It has three parts: 1. Needs assessment and implementation of a complex mental health intervention; 2. A 3-year controlled trial of the mental health, social and economic outcomes; and 3. Nested process evaluation of the intervention. Results Early findings characterising the young people, their carers and case managers and implementing the intervention are available. The trial Wave 1 includes interviews with 176 young people, 52% of those eligible in the study population, 104 carers and 79 case managers. Conclusions Implementing and researching an affordable service system intervention appears feasible and likely to be applicable in other places and countries. Success of the intervention will potentially contribute to reducing mental ill-health among these young people, including suicide attempts, self-harm and substance abuse, as well as reducing homelessness, social isolation and contact with the criminal justice system. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12615000501549 . Retrospectively registered 19 May 2015.

Within the health services research community there is a growing strength of feeling that ongoing partnerships between researchers and decision-makers are critically important to effective transfer and exchange of knowledge generated from health services research. A body of literature is emerging around this idea that favours a particular model of partnership based on decision-maker involvement in research. This model is also gaining favour among health research funding bodies internationally. We argue that it is premature for the health services community to privilege any particular model of partnership between researchers and decision-makers. Rather a diversity of models should be conceptualized, explored in theory and practice, and evaluated. We identify seven dimensions that could be used to describe and differentiate models of partnerships for knowledge exchange and illustrate how these dimensions could be applied to analysing partnerships, using three case studies from recent and ongoing health services research partnerships in Australia. Adapted from the source document.

Mouth ulcers are the most common ulcerative condition and encompass several clinical diagnoses, including recurrent aphthous stomatitis (RAS). Despite previous evidence for heritability, it is not clear which specific genetic loci are implicated in RAS. In this genome-wide association study ( n  = 461,106) heritability is estimated at 8.2% (95% CI: 6.4%, 9.9%). This study finds 97 variants which alter the odds of developing non-specific mouth ulcers and replicate these in an independent cohort ( n  = 355,744) (lead variant after meta-analysis: rs76830965, near IL12A , OR 0.72 (95% CI: 0.71, 0.73); P  = 4.4e−483). Additional effect estimates from three independent cohorts with more specific phenotyping and specific study characteristics support many of these findings. In silico functional analyses provide evidence for a role of T cell regulation in the aetiology of mouth ulcers. These results provide novel insight into the pathogenesis of a common, important condition. Oral ulcerations are sores of the mucous membrane of the mouth and highly prevalent in the population. Here, in a genome-wide association study, the authors identify 97 loci associated with mouth ulcers highlighting genes involved in T cell-mediated immunity and T H 1 responses.