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Xu DR, Samu GC, Chen J. Advancing mental health service delivery in low-resource settings. Lancet Glob Health 2024; 12:e543-e545. [PMID: 38408460 DOI: 10.1016/s2214-109x(24)00031-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/28/2024]
Affiliation(s)
- Dong Roman Xu
- Acacia Lab for Implementation Science, SMU Institute for Global Health and Center for World Health Organization Studies, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou 510515, China
| | | | - Jiangyun Chen
- Acacia Lab for Implementation Science, SMU Institute for Global Health and Center for World Health Organization Studies, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou 510515, China.
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Tong G, Spell VT, Horton N, Thornhill T, Keene D, Montgomery C, Spiegelman D, Wang EA, Roy B. Trusted residents and housing assistance to decrease violence exposure in New Haven (TRUE HAVEN): a strengths-based and community-driven stepped-wedge intervention to reduce gun violence. BMC Public Health 2023; 23:1545. [PMID: 37580653 PMCID: PMC10426138 DOI: 10.1186/s12889-023-15997-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/26/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND We describe the rationale and study design for "TRUsted rEsidents and Housing Assistance to decrease Violence Exposure in New Haven (TRUE HAVEN)," a prospective type 1 hybrid effectiveness/implementation study of a multi-level intervention using a stepped wedge design. TRUE HAVEN aims to lower rates of community gun violence by fostering the stability, wealth, and well-being of individuals and families directly impacted by incarceration through the provision of stable housing and by breaking the cycle of trauma. DESIGN TRUE HAVEN is an ongoing, multi-level intervention with three primary components: financial education paired with housing support (individual level), trauma-informed counseling (neighborhood level), and policy changes to address structural racism (city/state level). Six neighborhoods with among the highest rates of gun violence in New Haven, Connecticut, will receive the individual and neighborhood level intervention components sequentially beginning at staggered 6-month steps. Residents of these neighborhoods will be eligible to participate in the housing stability and financial education component if they were recently incarcerated or are family members of currently incarcerated people; participants will receive intense financial education and follow-up for six months and be eligible for special down payment and rental assistance programs. In addition, trusted community members and organization leaders within each target neighborhood will participate in trauma-informed care training sessions to then be able to recognize when their peers are suffering from trauma symptoms, to support these affected peers, and to destigmatize accessing professional mental health services and connect them to these services when needed. Finally, a multi-stakeholder coalition will be convened to address policies that act as barriers to housing stability or accessing mental healthcare. Interventions will be delivered through existing partnerships with community-based organizations and networks. The primary outcome is neighborhood rate of incident gun violence. To inform future implementation and optimize the intervention package as the study progresses, we will use the Learn As You Go approach to optimize and assess the effectiveness of the intervention package on the primary study outcome. DISCUSSION Results from this protocol will yield novel evidence for whether and how addressing structural racism citywide leads to a reduction in gun violence. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05723614. Registration date: February 01, 2023. Please refer to https://clinicaltrials.gov/ct2/show/NCT05723614 for public and scientific inquiries.
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Affiliation(s)
- Guangyu Tong
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA.
- Center for Methods of Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA.
| | | | - Nadine Horton
- Yale School of Medicine, New Haven, CT, USA
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, USA
| | - Thomas Thornhill
- Public Health Modeling, Yale School of Public Health, New Haven, CT, USA
| | - Danya Keene
- Department of Social and Behavioral Health, Yale School of Public Health, New Haven, CT, USA
| | - Christine Montgomery
- Clifford Beers Guidance Clinic, New Haven, CT, USA
- Department of Social Work, Southern Connecticut State University, New Haven, CT, USA
| | - Donna Spiegelman
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
- Center for Methods of Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA
| | - Emily A Wang
- Yale School of Medicine, New Haven, CT, USA
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, USA
| | - Brita Roy
- Yale School of Medicine, New Haven, CT, USA
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
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Tong G, Spell VT, Horton N, Thornhill T, Keene D, Montgomery C, Spiegelman D, Wang EA, Roy B. TRUsted rEsidents and Housing Assistance to decrease Violence Exposure in New Haven (TRUE HAVEN): A strengths-based and community-driven stepped-wedge intervention to reduce gun violence. RESEARCH SQUARE 2023:rs.3.rs-2874381. [PMID: 37214890 PMCID: PMC10197755 DOI: 10.21203/rs.3.rs-2874381/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Background We describe the rationale and study design for " TRU sted r Esidents and H ousing A ssistance to decrease V iolence E xposure in N ew Haven (TRUE HAVEN)," a prospective type 1 hybrid effectiveness/implementation study of a multi-level intervention using a stepped wedge design. TRUE HAVEN aims to lower rates of community gun violence by fostering the stability, wealth, and well-being of individuals and families directly impacted by incarceration through the provision of stable housing and by breaking the cycle of trauma. Design: TRUE HAVEN is a multi-level intervention with three primary components: financial education paired with housing support (individual level), trauma-informed counseling (neighborhood level), and policy changes to address structural racism (city/state level). Six neighborhoods with among the highest rates of gun violence in New Haven, Connecticut, will receive the individual and neighborhood level intervention components sequentially beginning at staggered 6-month steps. Residents of these neighborhoods will be eligible to participate in the housing stability and financial education component if they were recently incarcerated or are family members of currently incarcerated people; participants will receive intense financial education and follow-up for six months and be eligible for special down payment and rental assistance programs. In addition, trusted community members and organization leaders within each target neighborhood will participate in trauma-informed care training sessions to then be able to recognize when their peers are suffering from trauma symptoms, to support these affected peers, and to destigmatize accessing professional mental health services and connect them to these services when needed. Finally, a multi-stakeholder coalition will be convened to address policies that act as barriers to housing stability or accessing mental healthcare. Interventions will be delivered through existing partnerships with community-based organizations and networks. The primary outcome is neighborhood rate of incident gun violence. To inform future implementation and optimize the intervention package as the study progresses, we will use the Learn As You Go approach to optimize and assess the effectiveness of the intervention package on the primary study outcome. Discussion Results from this protocol will yield novel evidence for whether and how addressing structural racism citywide leads to a reduction in gun violence. Trial registration ClinicalTrials.gov Identifier: NCT05723614. Registration date: February 01, 2023.
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Beidas RS, Dorsey S, Lewis CC, Lyon AR, Powell BJ, Purtle J, Saldana L, Shelton RC, Stirman SW, Lane-Fall MB. Promises and pitfalls in implementation science from the perspective of US-based researchers: learning from a pre-mortem. Implement Sci 2022; 17:55. [PMID: 35964095 PMCID: PMC9375077 DOI: 10.1186/s13012-022-01226-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 07/20/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Implementation science is at a sufficiently advanced stage that it is appropriate for the field to reflect on progress thus far in achieving its vision, with a goal of charting a path forward. In this debate, we offer such reflections and report on potential threats that might stymie progress, as well as opportunities to enhance the success and impact of the field, from the perspective of a group of US-based researchers. MAIN BODY Ten mid-career extramurally funded US-based researchers completed a "pre-mortem" or a group brainstorming exercise that leverages prospective hindsight to imagine that an event has already occurred and to generate an explanation for it - to reduce the likelihood of a poor outcome. We came to consensus on six key themes related to threats and opportunities for the field: (1) insufficient impact, (2) too much emphasis on being a "legitimate science," (3) re-creation of the evidence-to-practice gap, (4) difficulty balancing accessibility and field coherence, (5) inability to align timelines and priorities with partners, and (6) overly complex implementation strategies and approaches. CONCLUSION We submit this debate piece to generate further discussion with other implementation partners as our field continues to develop and evolve. We hope the key opportunities identified will enhance the future of implementation research in the USA and spark discussion across international groups. We will continue to learn with humility about how best to implement with the goal of achieving equitable population health impact at scale.
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