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Introduction: Home visitor well-being is integral to delivering effective home visiting services and a core component of successful home visiting program implementation. While burnout (BO), compassion fatigue (CF), and compassion satisfaction (CS) have been studied extensively in physicians, nurses, and other health providers, little is known about the correlates of these phenomena in home visitors. Methods: This cross-sectional study examined demographic characteristics (age, race, gender), health and personal experiences (anxiety, physical health, and adverse childhood experiences), and job-related factors (caseload, role certainty, job satisfaction) as correlates of BO, CF and CS among a sample of 75 home visitors employed across six MIECHV-funded agencies in New York State. Descriptive statistics were used to characterize our sample; linear regressions were employed to investigate correlates with outcomes of interest. Results: Anxiety was significantly and positively associated with BO (β = 2.5, p < 0.01) and CF (β = 3.08, p < 0.01). Overall job satisfaction was significantly and inversely associated with BO only (β = -0.11, p < 0.001). Participants who identified as white were less likely to report higher levels of CS relative to non-white counterparts (β = -4.65, p = 0.014). Examinations of specific aspects of job satisfaction revealed significant associations between satisfaction with workplace operating conditions, nature of the work, and contingent rewards and select outcomes of interest. Discussion: Prioritizing preventive measures that target correlates of BO and CF, such as higher levels of anxiety and lower levels of job satisfaction – particularly operating conditions – may improve workforce well-being, continuity of service delivery, and ultimately quality of care provided to clients. Significance: What is known about this subject? Burnout (BO) and compassion fatigue (CF) pose serious threats to the home visiting workforce and quality of service delivery. Little is known about the relationships between demographic characteristics, health, child adversity, and job-related factors and outcomes of BO, CF, and compassion satisfaction (CS). What this study adds? Anxiety was significantly and positively associated with BO and CF. Job satisfaction was inversely associated with CF. Satisfaction with operating conditions was inversely correlated with BO and CF, suggesting that interventions that address organizational-level operating procedures may reduce risk of BO and CF in home visitors. [ABSTRACT FROM AUTHOR]

Although burnout has been increasingly well studied among medical (nurses, physicians, residents) and mental health providers (psychologists, psychiatrists, social workers), there continues to be a lack of attention on the well‐being of community‐based providers, such as Community Health Workers (CHWs), within the United States. Using cross‐sectional data from 75 CHWs employed in 14 agencies funded through the Maternal and Infant Community Health Collaboratives Initiative (MICHC) in New York, our study examined predictors (anxiety, physical health, adverse childhood experiences, job satisfaction, role certainty, demographic and work characteristics) of burnout, compassion fatigue (CF) and compassion satisfaction (CS). Descriptive statistics were used to characterize our sample and linear regression was employed to investigate the correlates of burnout, CF and CS. Results indicated that CHWs with higher levels of anxiety and lower job satisfaction were more likely to have higher burnout scores. CHWs with higher levels of anxiety, lower job satisfaction and fewer days of poorer health were more likely to report higher CF. Those who worked more than 35 h per week were less likely to report higher CS. The study provides recommendations for organizational‐level interventions to address risk factors of burnout and CF and promote CS among CHWs, such as bolstering supervision, encouraging greater communication, offering recognition/appreciation of CHWs and creating opportunities for self‐care. Findings should be considered when designing organizational‐level preventive measures that mitigate burnout and CF and promote CS. [ABSTRACT FROM AUTHOR]

To explore sociodemographic predictors for concern regarding COVID‐19 transmission and how these factors interact with the identities of others, we conducted a web‐based survey where we asked 568 respondents in the United States to indicate their level of COVID‐19 concern in response to a series of images with short vignettes of masked and unmasked individuals of different racial/ethnic backgrounds. Using a linear mixed effects model, we found that regardless of the race of the image being presented in the vignette, concern regarding COVID‐19 transmission was associated with respondents' older age (b = 0.029, p < 0.001), residing in NYC (b = 0.556, p = 0.009), being heterosexual (b = 1.075, p < 0.001), having higher levels of education, that is, completion of a Bachelor's degree (b = 1.10, p = 0.033) or graduate degree (b = 1.78, p < 0.001), and the person in the vignette being unmasked (b = 0.822, p < 0.001). Asian respondents were more likely than White respondents to be concerned regarding COVID‐19. Individuals who self‐reported themselves to be at high risk for COVID‐19 were more likely to be concerned about COVID‐19 over those who considered themselves to be low risk. These findings highlight the importance of acknowledging interactions between race, mask status, and residency in predicting COVID‐19 concern. [ABSTRACT FROM AUTHOR]

Our cross-sectional study seeks to understand how COVID-19 stigma, race/ethnicity [Asian, Black, Hispanic/Latinx, white] and residency [New York City (NYC) resident vs. non-NYC resident] associated with depression. Our sample includes 568 participants: 260 (45.77%) were NYC residents and 308 (54.3%) were non-NYC residents. A series of multiple linear regression were run to examine the relationship between race/ethnicity, COVID-19 stigma, and depressive symptoms. Irrespective of residency, older age and ever being diagnosed with COVID-19 were negatively associated with depressive symptoms. Stigma and thinking less of oneself significantly associates with depressive symptoms across residency. Our study expects to benefit mental health care providers and public health professionals in designing best practices to mitigate stigma in ongoing or future pandemics. [ABSTRACT FROM AUTHOR]

Background: Narrative medicine (NM) encourages health care providers to draw on their personal experiences to establish therapeutic alliances with patients of prevention and care services. NM medicine practiced by nurses and physicians has been well documented, yet there is little understanding of how community health workers (CHWs) apply NM concepts in their day-to-day practices from patient perspectives. Objective: To document how CHWs apply specific NM concepts in Brazil's Family Health Strategy (FHS), the key component of Brazil's Unified Health System. Design: We used a semi-structured interview, grounded in Charon's (2001) framework, including four types of NM relationships: provider–patient, provider–colleague, provider–society, and provider–self. A hybrid approach of thematic analysis was used to analyze data from 27 patients. Key Results: Sample: 18 females; 13 White, 12 "Pardo" (mixed races), 12 Black. We found: (1) provider–patient relationship—CHWs offered health education through compassion, empathy, trustworthiness, patience, attentiveness, jargon-free communication, and altruism; (2) provider–colleague relationship—CHWs lacked credibility as perceived by physicians, impacting their effectiveness negatively; (3) provider–society relationship—CHWs mobilized patients civically and politically to advocate for and address emerging health care and prevention needs; (4) provider–self relationship—patients identified possible low self-esteem among CHWs and a need to engage in self-care practices to abate exhaustion from intense labor and lack of resources. Conclusion: This study adds to patient perspectives on how CHWs apply NM concepts to build and sustain four types of relationships. Findings suggest the need to improve provider–colleague relationships by ongoing training to foster cooperation among FHS team members. More generous organizational supports (wellness initiatives and supervision) may facilitate the provider–self relationship. Public education on CHWs' roles is needed to enhance the professional and societal credibility of their roles and responsibilities. Future research should investigate how CHWs' personality traits may influence their ability to apply NM. [ABSTRACT FROM AUTHOR]

COVID-19 has served to exacerbate existing health disparities and inequities, most—if not all—of which can be traced to the social determinants of health (SDOH) that affect specific populations and communities. Essential to health and health systems long before, community health workers are experts in addressing SDOH in community-based settings; however, they have yet to be mobilized as part of the COVID-19 response both in the US and internationally. We use data from our mixed-methods study with supervisors (n=6), Executive Directors (EDs) (n=7), and CHWs (n=90) to describe the critical role that CHWs can play to assist in response to COVID-19 using New York State's (NYS) as a case example. Building on these findings, we raise specific CHW workforce issues and propose recommendations for how to mobilize this workforce in national pandemic response efforts. [ABSTRACT FROM AUTHOR]

Many individuals who are vulnerable to HIV infection and People Living with HIV (PLWH) experience fragmented prevention and care. Prevention and care service integration, pivotal for the HIV care continuum, depends on relationships among service providers and agencies offering HIV services. Case managers, counselors, and peer educators often work together to provide integrated services through interprofessional collaboration (IPC) in HIV prevention and care. Although these providers have distinct job titles, they typically offer complementary services on the HIV care continuum. To better train and allocate professional development resources for these providers, research is needed to assess the overall differences between provider-type and their demographics, intrapersonal factors, and job characteristics most likely to predict IPC engagement. We administered a cross-sectional survey to 75 counselors, 80 peer educators, and 112 case managers in 36 agencies in New York City. We performed a series of linear mixed effects models. Most of the HIV-service providers identified as Black and female and had been working for their agencies for less than a year. Knowledge and skills, self-efficacy, understanding of the community, and greater work hours (> 35 hours) were significant predictors of endorsement of IPC. Peer educators compared to case managers were more likely to reflect on the process as they provide myriad services. Eliciting perspectives from providers allows us to explore interventions, both intra-agency (trainings, greater exposure to collaborative initiatives, and supervision) and interagency (retention programs and websites promoting provider collaboration), that could facilitate IPC engagement and integrated services across the HIV care continuum. [ABSTRACT FROM AUTHOR]

Expansion of the Community Health Worker (CHW) workforce has become a national priority. It is critical to understand CHW strengths and individual challenges, associated professional development needs, and the utility of specific strategies that may meet needs from the perspectives of those who employ, manage, and supervise this growing workforce. Through a community-partnership with eight member organizations of the Association of Perinatal Networks of New York, we conducted two focus groups with 7 Executive Directors and 6 CHW Supervisors. Data were analyzed according to the six steps of thematic analysis. Analyses revealed seven salient themes across three superordinate categories of strengths, individual challenges, and mechanisms of support. Two strengths-related themes pertained to shared lived experiences/identities and commitment to client engagement, acquiring concrete resources and making referrals. Three themes emerged in the individual challenges category: boundary management, client empowerment, and documentation/reporting. Two support-related themes emphasized the need for skills-based training and supervision. CHWs are a critical component of the US health workforce given their core strengths, c2ommitment, and community connections. Challenges related to navigating boundaries, use of empowerment-focused approaches and effective documentation require skills-based training and trauma-informed workplace-based supports. Supervision is an effective mechanism through which CHWs receive support needed to optimize job performance. [ABSTRACT FROM AUTHOR]

Photovoice was used among 4 HIV providers and 4 managers at a NYC community-based HIV organization to engage in critical dialogs about the way they experience burnout and self-care measures taken. The study's objective was to empower participants to change aspects of their organizational culture and advocate for better working conditions to mitigate burnout. Common themes around causes of burnout were: perfectionism, isolation, multitasking, conflict in relationships. Common themes around self-care practices were: physical activity, recreational activities, being in nature, spirituality, self-expression, food/drinks, social support. The study offers strategies to social service agencies to inspire providers to create organizational change. [ABSTRACT FROM AUTHOR]

Objective: This study examined the perspectives of 18 health care providers (nurses, consultant doctors, residents, radiologists, and physiotherapists) and 18 patients regarding best practices for patient‐centred care (PCC) in a free private hospital in Pakistan, studying the congruence between provider and patient perspectives. Methods: Six focus group interviews (FGIs) were conducted from January to March 2017: three with providers and three with patients. Focus group interviews were audio‐recorded and transcribed verbatim. A deductive approach was used to analyse the data using the key dimensions of Scholl's framework, which was then complemented with constant comparison analysis to explore variability and similarity among participants across the six focus groups. Results: Findings indicated that providers and patients acknowledged maintaining a collaborative relationship with patients by using empathy. Patients and providers agreed that providers allocated time to counsel the patient and alleviated their fears. Family involvement was seen as a key indicator in decision making for patients. Some discrepancies were found between patient and provider perceptions of inhibitors to PCC, notably a lack of teamwork exhibited by providers and continuity of care offered postdischarge. Conclusions: We recommend practices of PCC that are congruent with non‐Western settings where religion and family play a primary role in matters dealing with patients' illnesses. Our findings suggest the need for recurrent training to improve teamwork among providers; questioning the implicit agreement of patients who may be vulnerable to decision making of authoritarian figures in their family; and the inclusion of peer‐support workers or community health workers to offer aftercare support to patients in their home. [ABSTRACT FROM AUTHOR]

• Perinatal maternal depression, interpersonal violence, (IPV) substance use and poor sexual health are critical public health concerns with significant negative impacts on child development. • Despite widespread calls for service integration at the systems/organizational level and well-documented benefits to children and families, predictors to service integration by community-based providers (Community Health Workers and Home Visitors) are not well understood. • Our findings elucidate areas for future investment for human services agency administrators and point to future areas of intervention that can bolster integrated service provision, thereby improve efficiency, cost effectiveness, and optimal maternal and child health care outcomes for at-risk populations. Perinatal maternal depression, interpersonal violence, (IPV) substance use and poor sexual health are critical public health concerns with significant negative impacts on child development. Despite widespread calls for service integration at the systems/organizational level and well-documented benefits to children and families, predictors to service integration are not well understood. Using cross-sectional data from 159 community-based providers (CBPs) who identify as community health workers (CHWs) or home visitors (HVs) in New York State, United States, our study aims to examine organizational and individual level predictors to service integration. Service integration in this study is defined as the screening, delivery and referral-making of two or more services over the course of six months. Services of interest in this study include mental health, IPV, sexual health, mental health, and substance abuse services. Descriptive statistics were performed to characterize our sample and show the distribution of service types. Multivariable logistic regression was used to identify salient organizational (job satisfaction: communication, contingent rewards, fringe benefits, operating conditions, and coworker; and training helpfulness) and individual characteristics (self-efficacy) that are associated with service integration, while controlling for demographic characteristics. Forty-four percent of participants (n = 70) integrated all four of the services: mental health, IPV, sexual health and mental health services. Training helpfulness (b = −2.48, p = 0.01), self-efficacy (b = 0.07, p < 0.01), and job satisfaction (b = −0.04, p = 0.01) were significantly associated with provision of integrated services. Specifically, elements of job satisfaction that were associated with integrated service provision included satisfaction with communication (b = −0.28, p < 0.01), coworkers (b = −0.29, p < 0.01), and pay (b = −015, p = 0.02). Findings elucidate areas for future investment for human services agency administrators and point to future areas of intervention that can bolster integrated service provision, thereby improve efficiency, cost effectiveness, and optimal maternal and child health care outcomes for at-risk populations. [ABSTRACT FROM AUTHOR]

While the integration of community-based providers within interprofessional health teams has been recommended by policymakers worldwide, there is limited research on how medical and community-based providers inform and participate in health research. Our study uses cross-sectional data from 169 Community Health Workers (CHWs), 62 nurses, and 31 physicians within Brazil's Family Health Strategy Program. Using an integrated framework of social cognitive theories and Theory for Planned Behavior, a reliable and valid instrument was developed to examine differences in past research involvement, and opinions about health and public health research (research efficacy and perceptions of research process). Descriptive frequencies and ANOVA F-tests were performed. Results indicated that CHWs has greater mistrust in the research process, and were not involved in substantive aspects of research (specification of aims, data collection, analysis, dissemination). Nurses compared to CHWs recruited participants to research studies, and had greater willingness to learn, participate and implement research initiatives. Physicians compared to CHWs and nurses developed survey instruments and disseminated research. For community-based and medical providers to be involved in all aspects of research, researchers ought to set up structured infrastructures of community collaborative boards. Furthermore, researchers can test our scale with other providers working within health teams globally. [ABSTRACT FROM AUTHOR]

The roles and responsibilities of peer workers (PWs) are not well articulated. This scoping review aims to systematically identify and describe the roles of PWs in outpatient, community based mental health and substance use services, and compare their roles and responsibilities across these service settings The scoping review was a priori developed and implemented according to the Joanna Briggs Institute methodology, which includes stating the review objectives, conducting a three-step search method, and charting the results. Forty-four peer reviewed manuscripts were included in the review. PWs were used more often in mental health (n = 27) than substance use (n = 10) programs. Peers adopted a wide range of skills. Across program contexts, peers were frequently used as a source of informal support or mentorship and care coordination. Mental health programs often used peers to deliver manualized interventions, while substance use programs more frequently leveraged PWs to facilitate service linkage and engagement. Roles of peers differed between substance use and mental health programs, reflecting significant diversity in how peers are being integrated into the behavioral health workforce. Peer certification programs must balance consistency with the wide range of skills required of this workforce. • Poor role definition has inhibited the peer workforce in behavioral health. • Peers are most commonly used as mentors and care coordinators. • Peers are used in differently across substance use and mental health contexts. • Certification programs must be responsive to the diversity of the peer workforce. [ABSTRACT FROM AUTHOR]

The New York State Talent Development Consortium at the Office for People with Developmental Disabilities (OPWDD) mandated developmental disability programs to train and evaluate direct service providers (DSPs) on seven core competencies.  Utilizing community-based participatory research (CPBR) - an approach where clients, providers, and researchers share their knowledge and experience to identify study areas, formulate research questions, and use results to improve practice - a needs assessment was conducted by a New York-based developmental disability program to inform a training curriculum.  Six focus groups were conducted from a purposive sample of 14 DSPs, and 19 managers/supervisors. Staff identified skills that corresponded with six out of seven competencies. Staff recommended hands-on training on: appropriate communication to deal with individuals with severe disabilities; professionalism; person-centered care; and education on terminology in behavioral health plans, medication, and mental health illnesses. Empowering DSPs through CBPR allows for a training curriculum catered toward staff needs, which may be well-received and utilized. The CBPR process employed may be beneficial to other agencies within the intellectual and developmental disabilities field, particularly at a time when the demand for nonlicensure providers such as DSPs is increasing, and there is a need to train them to render quality and effective services. [ABSTRACT FROM AUTHOR]

Given the shortage of medical providers and the need for medical decisions to be responsive to community needs, including lay health providers in health teams has been recommended as essential for the successful management of global health care systems. Brazil's Unified Health System (UHS) is a model for delivering community-based care through Family Health Strategy (FHS) interdisciplinary teams comprised of medical and lay health providers-Community Health Agents (CHAs), nurses, and physicians. This study aims to understand how medical and lay health providers' perceptions and attitudes could impact the delivery of community-based care. The study compares perceptions and attitudes of 168 CHAs, 62 nurses, and 32 physicians across their job context, professional capacities, professional skills, and work environment. Descriptive and bivariate analysis were performed. CHAs reported being the most efficacious amongst the providers. Physicians reported incorporating consumer-input to a lesser degree than nurses and CHAs. CHAs reported using a lesser variety of skills than physicians. A significant proportion of physicians compared to CHAs and nurses reported that they had decision-making autonomy. Providers did not report differences that lack of resources and poor work conditions interfered with their ability to meet consumer needs. This study offers technocratic perspectives of medical and lay health providers who as an inter-professional team provide community-based primary health care. Implications of the study include proposing training priorities and identifying strategies to integrate lay health providers into medical teams for Brazil's Unified Health System and other health systems that aim to deliver community-based care through inter-professional health teams. [ABSTRACT FROM AUTHOR]

Background: Brazil's "family health strategy" (ESF), provides primary care, mostly to individuals in impoverished communities through teams of physicians, nurses, and community health workers (CHWs). ESF workers are called upon to offer drug use services (e.g., referrals, counseling) as drug use represents an urgent public health crisis. New federal initiatives are being implemented to build capacity in this workforce to deliver drug use services, yet little is known about whether ESF workers are providing drug use services already. Guided by social cognitive theory, this study examines factors associated with ESF workers' provision of drug use services.Methods: Cross-sectional surveys were collected from 262 ESF workers (168 CHWs, 62 nurses, and 32 physicians) in Mesquita, Rio de Janeiro State and Santa Luzia, Minas Gerais State.Outcome Variable: provision of drug-use services.Predictors: capacity to engage in evidence-based practice (EBP), resource constraints, peer support, knowledge of EBP, and job title. Logistic regression was used to determine relative influence of each predictor upon the outcome.Results: Thirty-nine percent reported providing drug use services. Younger workers, CHWs, workers with knowledge about EBP and workers that report peer support were more likely to offer drug use services. Workers that reported resource constraints and more capacity to implement EBP were less likely to offer drug use services.Conclusion: ESF workers require education in locating, assessing and evaluating the latest research. Mentorship from physicians and peer support through team meetings may enhance workers' delivery of drug use services, across professional disciplines. Educational initiatives aimed at ESF teams should consider these factors as potentially enhancing implementation of drug use services. Building ESF workers' capacity to collaborate across disciplines and to gain access to tools for providing assessment and treatment of drug use issues may improve uptake of new initiatives. [ABSTRACT FROM AUTHOR]

Background Brazil's “family health strategy” (ESF), provides primary care, mostly to individuals in impoverished communities through teams of physicians, nurses, and community health workers (CHWs). ESF workers are called upon to offer drug use services (e.g., referrals, counseling) as drug use represents an urgent public health crisis. New federal initiatives are being implemented to build capacity in this workforce to deliver drug use services, yet little is known about whether ESF workers are providing drug use services already. Guided by social cognitive theory, this study examines factors associated with ESF workers’ provision of drug use services. Methods Cross-sectional surveys were collected from 262 ESF workers (168 CHWs, 62 nurses, and 32 physicians) in Mesquita, Rio de Janeiro State and Santa Luzia, Minas Gerais State. Outcome variable: provision of drug-use services. Predictors: capacity to engage in evidence-based practice (EBP), resource constraints, peer support, knowledge of EBP, and job title. Logistic regression was used to determine relative influence of each predictor upon the outcome. Results Thirty-nine percent reported providing drug use services. Younger workers, CHWs, workers with knowledge about EBP and workers that report peer support were more likely to offer drug use services. Workers that reported resource constraints and more capacity to implement EBP were less likely to offer drug use services. Conclusion ESF workers require education in locating, assessing and evaluating the latest research. Mentorship from physicians and peer support through team meetings may enhance workers’ delivery of drug use services, across professional disciplines. Educational initiatives aimed at ESF teams should consider these factors as potentially enhancing implementation of drug use services. Building ESF workers’ capacity to collaborate across disciplines and to gain access to tools for providing assessment and treatment of drug use issues may improve uptake of new initiatives. [ABSTRACT FROM AUTHOR]