Barriers to Social Services for HIV-Infected Urban Migrators

As a community, aligning efforts across a community to support the safety and well-being of vulnerable and underserved individuals is extraordinarily difficult. These individuals suffer disproportionally from health issues, job loss, a lack of stable housing, high utility costs, substance abuse, and homelessness. In addition to medical care, these individuals often critically need access to community social sector organizations that provide a distinct and complementary set of services, such as housing, food services, emergency utility assistance, and employment assistance. These services are just as vital as healthcare services to these individuals’ long-term health and well-being, with data suggesting that 80–90% of health outcomes can be attributed to factors beyond direct medical intervention. This book proposes a novel approach to the coordination of medicine and social services through the use of people, process, and technology, with the goal being to streamline coordination between medical and Community-Based Organizations and to promote true cross-sector patient and client advocacy. The book is based on the experience of Dallas, TX, which was one of the first metropolitan regions to develop a comprehensive foundation for partnership between a community’s clinical and social sectors using web-based information exchange. In the 5 years since the initial launch, the authors have been able to provide seamless connection, communication, and coordination between healthcare providers and a wide array of community-based social service organizations (a/k/a Community-Based Organizations or CBOs), criminal justice entities, and various other community organizations, including non-collegiate educational systems. This practical how-to guide is the codification of transferrable lessons from successes and challenges faced when working with clinical, community, and government leaders. By reading this playbook, leaders interested in building (or expanding) connected clinical-community services will learn how to: 1) facilitate cross-sector care coordination; 2) enable community care partners to better provide targeted services to community residents; 3) reduce duplication of services across partnering organizations; and 4) help to bridge service gaps in the currently fragmented system. Implementation of services, as recommended in this book, will ultimately streamline assistance efforts, reduce repeat crises and emergency funding requests, help address disparities of care, and improve the health, safety, and well-being of the most vulnerable community residents.

Food access for patients remains a critical need for health systems to address given varying resource availability and inefficient coordination among health and food services. Develop and evaluate the Food Access Support Technology (FAST), a centralized digital platform for food access that pairs health systems with food and delivery community-based organizations (CBOs). Two health systems, 12 food partners, and 2 delivery partners in Philadelphia, PA. Using FAST, referrers can post requests for food delivery on recipients' behalf, which are reviewed and claimed by eligible CBOs that can prepare food boxes for delivery to people's homes. Between March 2021 and July 2022, FAST received 364 requests, representing 207 food insecure households in 51 postal codes. The platform facilitated the completion of 258 (70.9%) requests, with a median completion time of 5 (IQR 0-7) days and a median of only 1.5days (IQR 0-5) for requests marked "urgent." Qualitative interviews with FAST end-users endorsed the usability of the FAST platform and its effectiveness in facilitating resource-sharing between partners. Our findings suggest that centralized platforms can address household food insecurity by (1) streamlining partnerships between health systems and CBOs for food delivery and (2) facilitating the real-time coordination of resources among CBOs.

Like many fast-growing cities with a history as a major food production area, San Jose, California, has largely left its agricultural heritage behind. Much of its famed Valley of the Heart’s Delight, so-called because of the vista of springtime blos­soms and once a nationally important fruit produc­tion region, has been developed into the Silicon Valley, now a global high-tech center. The San Jose Food Works study makes a case that the food sector can be an important driver for achiev­ing the city’s goals for economic development, place-making, public health, and sustainability. The study analyzes the economic contributions to the city from each food supply chain sector––produc­tion, distribution, processing, retail, and food service. It also engages stakeholders from agencies, busi­nesses, and community-based organizations in identifying gaps and opportunities for strengthen­ing these contributions. The recommendations developed with these stakeholders reflect a new commitment to collaborate on building a more robust, equitable, vibrant, and sustainable local food system. This reflective essay describes the practitioner-led development of a city-scale food supply chain assessment, as a process and product that demonstrate the methodology presented in the U.S. Department of Agriculture’s Economics of Local Food Systems Toolkit (Thilmany McFadden et al., 2016).

ObjectiveAs a new type of consumer subject in the market that was formerly dominated by multiple person families, single households are driving the change in the buying structure. Food purchase activities have undergone significant changes since the outbreak of the COVID‐19. The objective of this study was to assess and compare variations in food consumption, purchase and handling during the COVID-19 pandemic between single person households (SPH) and multiple person households.MethodA cross-sectional study conducted among 211 individuals in communities in Harris and Waller Counties, Texas. Sociodemographic, food purchase, food consumption and food handling activities during the COVID-19 pandemic were assessed with a validated COVID-19 Nutrition questionnaire.ResultsNon-Hispanic Black participants constituted 42.6%, and 28.4% were Hispanics. Participants were made up of mostly aged 18–24 years (39.3%), 47.9% single household composition, 30.4% in full time employment, and 29.1% partook in food assistance programs. A large proportion of them had never used grocery pickup services, online grocery shopping and a farmers’ market. During the COVID-19 pandemic, majority of the participants used more of large supermarkets, restaurant/fast food, and online grocery but food consumption seemed to remain the same for the majority of participants. For beverages, majority of participants consumed more water, less soda, and no alcohol. There was a significant association between single person household and higher restaurant/fast foods purchase. Many of the participants reported weight gain and less physical activity during the pandemic.ConclusionRestaurant meal purchases was more prevalent in single-person families. The results from the study have the potential to contribute to how public policy officials, food service, and health authorities forecast how different categories of consumers will react in pandemics and may be used to inform area-specific alleviation strategies to minimize the impact of the COVID-19 pandemic and future events.

Restaurants are the largest private sector employers in Texas. Yet only 48% of Texas restaurants have enough employees to support existing demand. The shortage of restaurant employees is an opportunity to develop culinary training programs for individuals that need employment, such as adults experiencing sheltered homelessness. Prior to program development it is important to understand their baseline knowledge of nutrition and food safety and potential attendance barriers. A cross-sectional survey was conducted among adults experiencing sheltered homelessness in Houston, Tx (October 16, 2024-November 13, 2024). Among 91 participants, on average, adults were 42 years old (SD = 12.98), 67% female, and 60% Black. Nutrition knowledge was low on 2 survey items (12% and 34% correct) and moderate on another 2 items (64% and 66% correct). Regarding food safety, 93% of the participants were able to answer 1 of the 5 items correctly. In terms of potential barriers, 82% of the sample experienced food insecurity. Seventy-seven percent of participants that had a car expressed not having money for gasoline and not making repairs to their car because of the expense. Forty-seven percent of the participants had children under the age of 18 and 44% of them needed childcare assistance in order attend a program. Curriculum associated with the culinary training program must include nutrition and food safety education. To address potential attendance barriers (food, transportation, childcare), it may be necessary to partner with community organizations that aim to reduce economic instability prior to developing and implementing the program.

Systems are investing in workers who come from the communities they serve to meet patient needs that extend well beyond clinic walls.

We agree with Renaud et al. that repeat testing among HIV-positive individuals who are aware of their status can falsely inflate positivity rates at the community level. To accurately account for previously undiagnosed infections, it is critical that community-based organizations conducting the social networks strategy in their HIV counseling and testing programs verify each identified case with their local or state health department. In the Social Networks Demonstration Project, the 9 funded community-based organizations were required to collaborate with their local or state health departments to properly distinguish between previously known cases and previously undiagnosed cases. As stated in our article,1 a total of 3222 network associates were tested with 227 positive cases identified. Based on data from local and state health departments, it was determined that 50 cases were previous HIV-positive cases; these cases were excluded from analyses (resulting in a drop in HIV prevalence rate from 7.0% to 5.6%). We believe that it was, in fact, the recruiters who were largely responsible for finding the high number of HIV-positive people who were previously undiagnosed in our project. Community-based organization staff received intensive training and on-demand technical assistance on how to coach and build relationships with recruiters who, as a result, focused on the highest-risk individuals in their networks using a “quality over quantity” approach. The previously undiagnosed positivity rate of 3.4% reported by Renaud et al. in their New York City–based social network testing program is quite good. We offer that the methods used and results from the New York City project and the Social Networks Demonstration Project are similar and consistent with one another. We agree that community-based organization staff implementing social networks testing strategies should collaborate with health departments to ensure that previously undiagnosed HIV infection cases are properly identified. Furthermore, we argue it is equally important that previously known HIV-positive individuals identified through social networks programs are successfully linked to proper HIV medical care and prevention services. Successful linkage is important from both an individual health perspective and a public health perspective because HIV-positive individuals who receive care and treatment and are enrolled in behavioral interventions may be less likely to transmit the virus to others.

PurposeThe purpose of this study is to explore the role of continuous learning and the mitigation or elimination of knowledge barriers affecting information technology (IT) assimilation in the health-care sector. Most of the problems with IT assimilations stem from a poor understanding of the nature of suitable information, the lack of trust, cultural differences, the lack of appropriate training and hierarchical bureaucratic structures and procedures. To overcome these barriers, this study provides evidence that a continuous learning process can play a part in overcoming some of the obstacles to the assimilation of IT.Design/methodology/approachThis study investigates how a continuous learning environment can counteract the presence of knowledge barriers, and, along with such an environment, can, in turn, facilitate IT assimilation. The study uses ADANCO 2.0.1 Professional for Windows and involves the collection and analysis of data provided by 210 health-care end users.FindingsThe study provides evidence in support of the proposition that continuous learning may facilitate the assimilation of IT by health-care end users through the mitigation of knowledge barriers (e.g. lack of trust or resistance to change). The mitigation of these barriers requires the gathering and utilization of new knowledge and knowledge structures. The results support the hypothesis that one way in which this can be achieved is through continuous learning (i.e. through assessing the situation, consulting experts, seeking feedback and tracking progress).Research limitations/implicationsA limitation of the study is the relatively simple statistical method that has been used for the analysis. However, the results provided here will serve as a preliminary basis for more sophisticated analysis which is currently underway.Practical implicationsThe study provides useful insights into ways of using continuous learning to facilitate IT assimilation by end users in the health-care domain. This can be of use to hospitals seeking to implement end user IT technologies and, in particular, telemedicine technologies. It can also be used to develop awareness of knowledge barriers and possible approaches to mitigate the effects of such barriers. Such an awareness can assist hospital staff in finding creative solutions for using technology tools. This potentially augments the ability of hospital staff to work with patients and carers, encouraging them to take initiative (make choices and solve problems relevant to them). This, in turn, allows hospitals to avoid negative and thus de-motivating experiences involving themselves and their end users (patients) and improving IT assimilation. This is liable to lead to improved morale and improved assimilation of IT by end users (patients).Social implicationsAs ICT systems and services should entail participation of a wide range of users, developers and stakeholders, including medical doctors, nurses, social workers, patients and programmers and interaction designers, the study provides useful social implication for health management and people well-being.Originality/valueThe paper contributes to a better understanding of the nature and impacts of continuous learning. Although previous studies in the field of knowledge management have shown that knowledge management procedures and routines can provide support to IT assimilation, few studies, if any, have explored the relationship between continuous learning and IT assimilation with particular emphasis on knowledge barriers in the health-care domain.

이 연구의 목적은 서비스 제공환경의 변화에 따른 사회복지 행정교육 강화의 필요성과 발전방향을 제안하는 것이다. 기관평가, 성과관리 등 서비스 제공의 효과성과 책임성을 강조하는 상황에서 기관관리자의 역할이 중요시되고 있다. 이 연구에서는 한국사회복지사협회에서 2,479명의 사회복지사를 대상으로 수행한 '한국사회복지사 기초실태 및 인식조사' 결과를 이용하여, 사회복지사가 일상적으로 어떠한 직무를 수행하는지를 분석하였다. 직무분석결과, 사회복지기관에서 행정 및 관리업무는 전체 업무 중의 40%로 가장 많은 비중을 차지하였다. 사회복지사는 지역사회조직, 인적자원관리, 기획 및 재정관리 등의 기관운영 업무의 중요도와 난이도가 상대적으로 높은 것으로 인식하고 있다. 그러나 사회복지학 교육과정에서 기관관리에 대한 체계적인 교육은 매우 부족한 실정이다. 또한 사회복지사는 관리자로서 대부분의 생애경력을 쌓아 나갈 것이다. 따라서 사회복지행정교육의 목표는 실천가에 대한 지원활동을 넘어서, 관리자로서 기관관리 지식과 기술을 익히는 것으로 재정립되어야 한다. 기관관리자로서 조직환경과 조직내부 운영에 대한 폭넓은 안목을 기르고, 기관관리의 다양한 영역에 대한 전문성을 증진시킬 수 있는 교육이 이루어져야 한다. 이 연구에서는 학부교육, 전문대학원교육, 실습교육 등 각종 교육과정에서 발전방향을 제안하였다. 【The purpose of this study is to identify increasing needs for training students as managers in social service agencies and to suggest ways to develop the education of social welfare administration. Agency evaluations and performance management has increased demands for effectiveness and accountability of social service agencies, which also has increased the roles of managers in social service agencies. Using 'Korean Social Worker Survey' conducted by Korean Association of Social Workers, this study examines job characteristics of 2,479 social workers. The results show that administration/management activities take about 40% of social workers' daily activities. Community organization, human resource management, and planning/financial management are regarded as more important and difficult than other tasks. However, sufficient education for preparing students as social service managers is not provided in undergraduate and graduate level of college education. In addition, social workers make their life long careers as managers. Thus, the education of social welfare administration needs to refocus on the provision of knowledge and skills required for competent social service managers. This study suggests future directions for developing education of social welfare administration in undergraduate and graduate level of college education including field practice.】

St. Louis, Missouri, sits astride the confluence of the Mississippi and Missouri Rivers, a position that made the city the “Gateway to the West.” Its most famous monument, the Gateway Arch, memorializes the millions of pioneers who traveled to the city seeking transportation to the frontier lands of the West, and who were outfitted with the tools and knowledge they needed on the journey to these new lands of opportunity. The Clinical & Translational Science Awards (CTSA) program has enabled Washington University (WU) and its regional partners to create a gateway of another sort, aimed at helping researchers toward new opportunities and discoveries in clinical and translational research. The Washington University Institute of Clinical and Translational Sciences (ICTS) was founded in September 2007 to serve as the intellectual and physical home for clinical and translational research and clinical research training at WU and its partner institutions. ICTS was founded on WU's 4 prior clinical research and training grants—GCRC, K12, K30, and T32—and on an existing university-wide strategic initiative in multidisciplinary collaborative research emphasizing genome sciences, biological imaging, and clinical investigation. The formation of the ICTS resulted in a new level of regional partnership with other academic, health care, and industrial and community partners. In its second year of existence, the ICTS is increasingly able to integrate the different strengths of its partners to reach its goals of reinventing and reinvigorating CTS research and training. In designing the ICTS, we used a conceptual model that identified important phases in the progress of a clinical or translational research project (Figure 1). For each phase, we identifed needed resources and potential barriers to completion, and have structured the ICTS in a way that attempts to provide needed resources and expertise for each phase of research from development and refinement of research ideas through translation of results to clinical practice and community implementation. Education, training, and career development are at the heart of our ICTS, and are linked to all research phases and programmatic activities. Our ICTS has 15 key Program Functions, each linked to 1 or more research phases, and each with specific goals, milestones, and evaluation criteria for various services, cores, and programs. We will highlight 2 new and important program functions below: our community-based research efforts and our programs in biomedical informatics. Phases in the evolution of clinical research projects. The 3 CCBR arms serve as a model for community participation to improve research relevant to public health. A central transformative element offour ICTS was the establishment of the Center for Community-Based Research (CCBR), which has initiated community engagement ef orts in 3 important groups: community organizations, community-based health care providers, and individuals from medically underserved populations. Each of the 3 arms is designed to solicit community input to increase the relevance of research to community needs, and to encourage partnerships between academic researchers and community groups. Our Community Advisory Board, established by the 3 arms, meets quarterly, to ensure relevance of the CCBR programs and the ICTS programs as a whole. The Community Organizations program has focused on cultivating partnerships with community organizations and conducting community needs assessments. This new model has spearheaded a series of conferences with our Regional Health Commission to address how our academic medical center can better serve the needs of our local community and improve the public health. In the fall of 2009, we will begin a series of shared conferences with community organizations highlighting successful community-based participatory research projects. These conferences will include joint presentations by academics and community partners and will strive to facilitate the formation of new partnerships. To further stimulate new community-based participatory research projects, we will soon initiate a research grants program, supported by a regional coalition of universities and health care institutions, to fund research projects that include a high degree of cooperation between community organizations and academic researchers. The program has also initiated a traveling poster presentation forum that translates data in a community relevant fashion. The Community Health Care Practitioners program seeks to expand community networks of practitioners to increase opportunities for clinical and translational (T2 and T3) research. One such effort is the Washington University Pediatric and Adolescent Ambulatory Research Consortium (WU PAARC). Currently comprised of approximately 60 community pediatricians and 5 pediatric nurse practitioners, the network provides a formal structure to develop research ef orts that identify best practices and translate research findings into practice. Community pediatricians participate in the consortium in different ways, from contributing ideas and receiving study updates to helping develop study protocols and recruit patients from their practices. Some studies are initiated by WU PAARC physicians, such as a recent study on a Telephone Asthma Program that resulted from physicians’ frustration with patients not using their asthma maintenance medications. For this randomized controlled trial, 362 families with asthmatic children were recruited from 95 community pediatric offices over 13 months. The 12-month telephone asthma coaching intervention helped parents better manage their child's asthma care and improved children's asthma control and parents’ quality-of-life scores. An upcoming study will compare 2 corticosteroid treatments for croup, a disease commonly seen in community practice but never before studied in this setting. In addition to WU PAARC-sponsored studies, community pediatricians have opportunities to participate in other studies developed by ICTS researchers including participating in study development and implementation. An example is a prevalence study for community-acquired methicillin-resistant Staph aureu s for which 1,300 children were recruited from 11 WU PAARC practices over an 8-month period. WU PAARC serves as a model for cooperative research between academic and community physicians, and these examples show how those involved have a real opportunity to improve the health of children and adolescents. As our ICTS matures, we plan to expand our practice-based research network activities to include new patient and provider populations. The CCBR has also started HealthStreet, a project linking populations that have been underrepresented in research to health information, referrals to social, medical, and psychiatric services, as well as opportunities to participate in research studies. HealthStreet utilizes Community Health Workers and a comprehensive outreach approach to establish trust between the lay and medical communities. The hub of CCBR activity is a new storefront facility in an underserved neighborhood near our medical center where community members can receive free health screenings, health referrals, and information about WU clinical studies. Community Health Workers also reach people in sites such as beauty shops, laundromats, bus stops, and community agencies to spread the word about services offered, and opportunities for research. The 3 CCBR arms serve as a model for community participation to improve research relevant to public health. CCBR investigators are actively training and engaging other ICTS investigators to collaborate on community-based projects with the goal of addressing “outcomes that matter.” Major institutional goals for improving CTS research are the creation of efficient communication and coordination across key function activities; the creation of an informatics infrastructure capable of integrating ICTS program components for data sharing; and the development of electronic resources of existing clinical and biospecimen data that may be used to develop new clinical studies, identify potential research participants, and execute novel molecular correlative studies. The ICTS Center for Biomedical Informatics (CBMI) is addressing these complex core issues through industry-standard hardware infrastructure and software tools to store, integrate, query, analyze, and visualize complex clinical and molecular data sets. Among the several activities of CBMI are the integration and implementation of the research management tool ClinPortal, development and management of biospecimen tracking tools, and creation of the Clinical Investigation Data Exploration Repository (CIDER), a research repository of medical records. ClinPortal is a research management tool that allows investigators and study coordinators to integrate the data collection and management needs of a clinical study with critical regulatory compliance requirements. Investigators create case report forms using data elements (or variables) that are defined using controlled vocabularies, and ClinPortal then automatically generates the backend database schema as well as the forms to enter the data and conduct queries. Use of ClinPortal offers a number of advantages to the institution and to the investigator. By default, data stored in ClinPortal is available for sharing while following all HIPAA regulations, although the investigator that owns the data may turn of sharing if so desired. As a result, once an investigator has established his or her study within the ClinPortal system, there is potential for sharing relevant data with and from other studies. Data access is controlled both by investigator permissions and by regulatory requirements. Future phases include automated access to clinical data from our hospital and outpatient systems. Assuming appropriate release by the patient and access rights for the researcher, investigators using ClinPortal will eventually have access to clinical data from hospital and clinic sources for their study participants. Tissue Suite, a Web-based biospecimen inventory, tracking, and annotation tool, may be used for study-based biospecimen collection efforts and by other non-study investigators interested in identifying existing biospecimens throughout the medical campus that may be available for translational research. The ICTS Translational Pathology and Molecular Phenotyping (TPMP) Core supports the physical storage of biospecimens, while Tissue Suite is the application supported by both the CBMI and the TPMP to provide the informatics to manage data about those biospecimens. Investigators who are managing their own biospecimen collection efforts outside of the TPMP Core may still make use of the Tissue Suite application to manage their inventory in compliance with caBIG standards. Web accessibility, the ability to share biospecimens and biospecimen-related data, advanced search functionality, and capture of clinical, pathological, and quality assurance data for collected biospecimens are key features of Tissue Suite. Together, ClinPortal and Tissue Suite facilitate collaboration between investigators and data integration across studies. As clinical data becomes available through the ClinPortal tool, biospecimens referenced in the complementary Tissue Suite tool will gain increasing clinical annotation, making them even more valuable for translational research studies. Another major focus of the CBMI has been the development of a comprehensive research patient data warehouse. CIDER contains a wealth of data from the electronic medical records of most inpatients and outpatients seen at the WU medical center and affiliated hospitals in the BJC HealthCare system. This system will become available to ICTS investigators in 2009 and will initially contain data on patient encounters, laboratory testing, and medications. We sought community input in designing the patient notification and opt-out procedures and in strictly designating access and use of this information by qualified investigators. We expect that CIDER will become a very useful tool for many clinical and translational researchers to perform a review preparatory to research, identify potential participants to recruit to active clinical studies both by querying CIDER and as they are encountered in the health care system, and implement quality assurance and improvement initiatives. In addition to these highlighted functions, the CBMI is working on other ways to simplify communication and tracking within the ICTS. One new project is the creation of an electronic Research Concierge function to serve as the focal point to help clinical and translational researchers navigate through the study planning, design, review, and execution processes. This Research Concierge function will be added to WU's existing site that currently provides single sign-on access to the resources necessary to propose, manage, and close research projects and satisfy compliance requirements for research. In a nod to St. Louis history, these resources can be found at the WU Research Gateway Web site (http://research.wustl.edu). More information about the WU ICTS can be found at our main site http://icts.wustl.edu.

BackgroundLong duration of untreated psychosis (DUP) is associated with poor outcomes and low quality of life at first contact with mental health services. However, long DUP is common. In order to inform initiatives to reduce DUP, we investigated service users' and carers' experiences of the onset of psychosis and help-seeking in two multicultural, inner London boroughs and the roles of participants' social networks in their pathways to care.MethodIn-depth interviews were conducted with service users and carers from an early intervention service in North London, purposively sampled to achieve diversity in sociodemographic characteristics and DUP and to include service users in contact with community organisations during illness onset. Interviews covered respondents' understanding of and reaction to the onset of psychosis, their help-seeking attempts and the reactions of social networks and health services. Thematic analysis of interview transcripts was conducted.ResultsMultiple barriers to prompt treatment included not attributing problems to psychosis, worries about the stigma of mental illness and service contact, not knowing where to get help and unhelpful service responses. Help was often not sought until crisis point, despite considerable prior distress. The person experiencing symptoms was often the last to recognise them as mental illness. In an urban UK setting, where involved, workers in non-health community organisations were frequently willing to assist help-seeking but often lacked skills, time or knowledge to do so.ConclusionEven modest periods of untreated psychosis cause distress and disruption to individuals and their families. Early intervention services should prioritise early detection. Initiatives aimed at reducing DUP may succeed not by promoting swift service response alone, but also by targeting delays in initial help-seeking. Our study suggests that strategies for doing this may include addressing the stigma associated with psychosis and community education regarding symptoms and services, targeting not only young people developing illness but also a range of people in their networks, including staff in educational and community organisations. Initiatives to enhance the effective involvement of staff in community organisations working with young people in promoting help-seeking merit research.

266 Implementing a Community Engagement Program for Residents at an Urban Emergency Department

The current study examined various types of social services for older adults living with Alzheimer’s disease or related dementia (ADRD) and their family caregivers, as well as the methods of delivery employed by home- and community-based organizations. Using a qualitative study design, this study aimed to identify strategies for enhancing support for older adults with ADRD and their family caregivers. A convenience sample method was employed to recruit service providers from nine home- and community-based organizations working closely with older adults living with ADRD and their family caregivers. Semi-structured, individual interviews were conducted online and transcribed verbatim by professionals. Three themes emerged: (1) culturally tailored outreach and services, (2) engagement of older adults living with ADRD and their family caregivers, and (3) collaboration efforts between home- and community-based organizations. Our findings revealed that organizations have tried creative ways to reach their population and educate people on dementia and dementia care. Especially, nonconventional methods (e.g., religion-based outreach or edutainment – an approach combining educational content with entertaining/easy-to-understand elements, such as storytelling or drama) were more frequently discussed among organizations serving people from diverse cultural and ethnic backgrounds. While many organizations have adopted technology to deliver services, many mentioned technologies were not a long-term solution, specifically for older adults with ADRD, as non-verbal cues such as eye contact and physical touch were considered critical for communication and providing care for older adults with ADRD.

Background: The use of illicit and prescription drugs for non-medical purposes among youth and young adults living in Northern Ontario communities is a major public health concern. This problem is amplified in that there is insufficient knowledge on the types of services and treatment centers available for and utilized by young people with substance use issues in Northern Ontario. This needs assessment study aims to examine the service and treatment needs of youth and young adults who use drugs in Northern Ontario communities. Methods/Design: A mixed-methods study design will be used to assess the service and treatment needs of youth and young adults (aged 14-25) who have used one or more illicit drug (excluding cannabis) and/or psychoactive prescription drug for non-medical purposes for at least 3 months and on at least 10 days in the last month. Participants will be recruited from approximately ten Northern, remote and rural communities across Northern Ontario using a mobile research lab. Eligible study candidates from each community will be asked to partake in a focus group and questionnaire exploring service and treatment utilization and needs. We will additionally collect basic socio-demographic information as well as examine patterns of problematic drug use. Interviews with service providers and community organizers will also be conducted in each community. Discussion: Findings from our study will highlight the availability, accessibility and utilization of existing services; identify the gaps and barriers in current service provision; and provide insight into the service and treatment needs of youth and young adults who use drugs in Northern Ontario communities. Assessing the needs of young people who use drugs will allow service providers, community organizers and health policymakers to improve addiction-related services and treatment centers in Northern Ontario.

Although community-based organizations (CBOs) serving persons living with HIV/AIDS have proliferated, the role of advanced practice nurses in these CBOs has not been articulated. This article describes four components of the clinical nurse specialist (CNS) role in a CBO: a nutrition program for ambulatory persons living with HIV disease. The CNS educates clients about strategies to improve and maintain their health and manage complex treatment regimens in daily lives that are often chaotic and limited by severe financial constraints. As a member of a multidisciplinary team, the CNS provides a healthcare perspective in policy development and staff education for a predominantly social service agency.