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\"The International Handbook of Workplace Trauma Support provides a comprehensive overview of contemporary standards and best practice techniques for organizations that draws from the latest research findings and experience of clinicians, academics, practitioners, and other leading authorities on trauma support from around the world\"--

Background Pediatric Support Services (PSS) is a Patient Navigation Program designed to address barriers from referral-to-service connection from primary care to health system and community-based services and resources. This study aimed to evaluate PSS’ implementation for mental health services along the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and identify factors throughout implementation to inform sustainability and delivery. Methods This study included descriptive analysis of all patients referred to PSS to assess reach, with a primary cohort analyses of a subset of patients referred specifically to mental health services. Data collection included triangulation of information extracted from electronic health records, direct contact with patients’ caregivers, and follow-up surveys completed by patients’ caregivers. Analyses were designed within each construct of the RE-AIM framework, and assessed for their tiered impact on the patient, provider, and system levels. Results From October 2019 to June 2023, 13,109 total referrals for 11,214 unique patients were triaged by PSS. The patient population overrepresented younger, Hispanic, female patients compared to the clinical population included in this health system’s service area. Of these patients, 3,929 were followed-up by trained navigators at two-weeks for mental health service connection, with 50.6% reported being connected to referred services and an additional 27.1% with pending appointments. There was a significant increase in referral connection rate as age increased and for Black patients, compared to other children. For patients considered connected to or pending services, a satisfaction survey found high satisfaction with PSS and the amount of navigator-patient contact (81.5 and 79.6%, respectively). Conclusion These findings highlight potential program modifications to optimize quality of care and health for children and families, while enhancing capacity among providers, navigators, and clinics. Further adaptations, including electronic health record integration, patient/family feedback, and automated navigation processes, are suggested next steps for comprehensive navigation. Trial registration This study was approved by the Institutional Review Board for Prisma Health, trial number 1,852,794, with the most recent approval for expanded evaluation received on June 15, 2022 (original application approved in 2016).

Background Communication among interprofessional healthcare worker teams is critical to ensure a thriving and resilient workforce. We will evaluate the implementation and effectiveness of the Alda Healthcare Experience (AHE), a novel medical improvisation (improv) workshop designed to improve interprofessional communication skills among healthcare professionals. The AHE workshop includes a two-hour experiential training workshop led by an improv specialist and a clinical co-facilitator. In July 2022 we began implementing the AHE workshop by training 18 clinical co-facilitators who will co-facilitate the workshops for 550 healthcare workers from five hospital departments at Stony Brook University Hospital over the course of a year and a half. Using mixed-methods, we will conduct an Effectiveness-Implementation Hybrid Design project that includes an outcome evaluation (effectiveness) and a process evaluation (implementation). Methods Our outcome evaluation will assess the impact of the AHE workshop on short- and long-term improvement in interprofessional communication, stress, and professional fulfillment. The process evaluation component will examine programmatic, organizational, and individual facilitators or barriers to effective implementation of the AHE workshop. Qualitative methods will include dimensional analysis employing individual interviews of 20–40 AHE Project Participants, 5–10 Selected Informants, and all the clinical co-facilitators. Quantitative methods will use a quasi-experimental longitudinal design with an intervention group and surveillance of a control group (wait-list) and repeated assessments using validated instruments measuring communications skills, professional fulfillment, stress, burnout, uncertainty tolerance, and teamwork. Discussion Effective and efficient communication within healthcare teams is fundamental to building team cohesion that, in turn, supports individual resilience and builds positive organizational culture. The AHE program is an innovative approach to improve interprofessional healthcare communication and reduce healthcare worker burnout. In addition to institutional buy-in, rigorous evaluations of medical improv programs are necessary as a critical step in making such programs scalable. Trial registration N/A

Changing the Course of AIDSis an in-depth evaluation of a new and exciting way to create the kind of much-needed behavioral change that could affect the course of the global health crisis of HIV/AIDS. This case study from the South African HIV/AIDS epidemic demonstrates that regular workers serving as peer educators can be as-or even more-effective agents of behavioral change than experts who lecture about the facts and so-called appropriate health care behavior. After spending six years researching the response of large South African companies to the epidemic that is decimating their workforce as well as South African communities, David Dickinson describes the promise of this grassroots intervention-workers educating one another in the workplace and community-and the limitations of traditional top-down strategies. Dickinson's book takes us right into the South African workplace to show how effective and yet enormously complex peer education really is. We see what it means when workers directly tackle the kinds of sexual, gender, religious, ethnic, and broader social and political taboos that make behavior change so difficult, particularly when that behavior involves sex and sexuality. Dickinson's findings show that people who are not officially health care experts or even health care workers can be skilled and effective educators. In this book we see why peer education has so much to offer societies grappling with the HIV/AIDS epidemic and why those interested in changing behaviors to ameliorate other health problems like obesity, alcoholism, and substance abuse have so much to learn from the South African example.

The provision of specialized, professionally coordinated, and interdisciplinary care is relevant for the care of transgender and gender diverse (TGD) people diagnosed with gender incongruence or gender dysphoria. In remote areas outside the metropolitan regions, however, transgender health care structures are rarely adequate or within reach. In order to improve transgender health care for TGD people, an interdisciplinary, internet-based transgender health care program (i²TransHealth) has been developed. The aim of this study was to determine the cost-effectiveness of i²TransHealth for TGD people from remote areas with no or insufficient transgender health care structures either exploring their gender identity or being in an early phase of transition from a societal perspective. This study was conducted alongside a randomized controlled trial comparing the effectiveness of i²TransHealth with a waiting list. The i²TransHealth intervention consisted of a telehealth-based eHealth intervention including one-to-one chat conversations with study therapists in combination with office-based regular care provided by general physicians and psychiatrists when needed. As health effect measures, quality-adjusted life years (QALYs) were calculated based on the EuroQol 5-dimension 5-level index, and reliable improvement on the Global Severity Index of the Brief Symptom Inventory-18 (BSI-18 GSI) was used. Health care service usage was assessed using service receipt inventories. The cost-effectiveness of i²TransHealth compared with a waiting list was assessed using the adjusted incremental cost-effectiveness ratio (ICER) based on seemingly unrelated regressions. Furthermore, the uncertainty of the ICER was assessed using cost-effectiveness planes and cost-effectiveness acceptability curves. Participants in the intervention group (IG; n=88) and the control group (CG; n=80) were on average aged 26 and 27 years, respectively. The mean QALYs of participants in the IG and CG were both 0.28 (SE 0.00) during the 4-month follow-up period. With 23.02%, participants in the IG had statistically significantly higher reliable improvement on the BSI-18 GSI compared with participants in the CG (9.21%, P=.01). The mean 4-month total costs were statistically significantly higher among the participants in the IG (+€1390, P=.002; a currency exchange rate of €1=US $1.14 was applicable as of December 31, 2020). The corresponding ICER of i²TransHealth was €254,021 per additional QALY, and €10,786 per additional reliable improvement on the BSI-18 GSI, respectively. The corresponding probability of cost-effectiveness of i²TransHealth was 20% at a willingness-to-pay (WTP) of €150,000 per additional QALY and 75% at a WTP of €15,000 per additional reliable improvement on the BSI-18 GSI. From a societal perspective, i²TransHealth was unlikely to be cost-effective, even at high WTP per additional QALY. However, the comparison of i²TransHealth with a waiting list could have led to a distortion of the results with regard to health care service usage. When considering additional reliable improvement on the BSI-18 GSI as health effect measure, the probability of cost-effectiveness of i²TransHealth is unclear depending on the WTP.

Most patients with mild or moderate COVID infection did not require hospital admission, but depending on their personal history, they needed medical supervision. In monitoring these patients in primary care, the design of specific surveillance programs was of great help. Between February 2021 and March 2022, EDCO program was designed in Tenerife, Spain, to telemonitor patients with COVID infection who had at least one vulnerability factor to reduce hospital admissions and mortality. The aim of this study is to describe the clinical course of patients included in the EDCO program and to analyze which factors were associated with a higher probability of hospital admission and mortality. Retrospective cohort study. We included 3848 patients with a COVID-19 infection age over 60 years old or age over 18 years and at least one vulnerability factor previously reported in medical history. Primary outcome was to assess risk of admission or mortality. 278 (7.2%) patients required hospital admission. Relative risks (RR) of hospital admission were oxygen saturation ≤ 92% (RR: 90.91 (58.82-142.86)), respiratory rate ≥ 22 breaths per minute (RR: 20.41 (1.19-34.48), obesity (RR: 1.53 (1.12-2.10), chronic kidney disease (RR:2.31 (1.23-4.35), ≥ 60 years of age (RR: 1.44 (1.04-1.99). Mortality rate was 0.7% (27 patients). Relative risks of mortality were respiratory rate ≥ 22 breaths per minute (RR: 24.85 (11.15-55.38), patients with three or more vulnerability factors (RR: 4.10 (1.62-10.38), oxygen saturation ≤ 92% (RR: 4.69 (1.70-15.15), chronic respiratory disease (RR: 3.32 (1.43-7.69) and active malignancy (RR: 4.00 (1.42-11.23). Vulnerable patients followed by a primary care programme had admission rates of 7.2% and mortality rates of 0.7%. Supervision of vulnerable patients by a Primary Care team was effective in the follow-up of these patients with complete resolution of symptoms in 91.7% of the cases.