Search

Bridging Mental Health and Education (BRIDGE) is an evidence-based model for embedding teacher consultation and coaching activities into school-based mental health clinicians' regular workflow. Here we describe the process of adapting BRIDGE in partnership with a large urban school district and a local managed care organization during a large-scale implementation effort. We also report the feasibility and perceived effectiveness of the adapted training and consultation model as reported by clinicians in one school year. Over 93% of trained clinicians (n = 75) initiated coaching sessions with assigned teachers. Eighty-five percent of coaching sessions were completed as scheduled (n = 505 of 592). After the completion of coaching visits, clinicians attended bi-weekly virtual group sessions for two months. Ninety percent of virtual group sessions were completed as scheduled. Clinicians indicated high levels of satisfaction and high likelihood of using BRIDGE in future. Additionally, clinicians' self-reported knowledge of BRIDGE practices and their comfort with training others in these evidence-based classroom practices improved from pre- to post- training and coaching. Expert coaches indicated that clinicians' knowledge of BRIDGE strategies, commitment to BRIDGE consultation, and likelihood of continuing to use BRIDGE strategies were high. These findings suggest that the adapted BRIDGE model is feasible and was perceived to be effective. We share lessons learned related to community-partnered, school intervention adaptation and implementation.

Many schools face barriers that hinder access to services, including limited funding and staff trained in evidence-based interventions. In particular, rural schools must provide targeted intervention to promote academic growth and narrow achievement gaps despite these barriers. One seldom-considered solution to ease the resource costs in the provision of intervention services is to provide high school students with the training and supervision necessary to carry them out. Thirty elementary students participated in an explicit timing intervention administered by either a high school student or graduate student in school psychology. A 2 × 2 mixed factorial ANOVA found significant growth from pre- to post-test with no effects of interventionist education level. These findings imply that school-based interventionists may be able to expand the reach of their practice by recruiting and training older students to carry out interventions.

Hypoxia-ischaemia (HI) can result in structural brain abnormalities, which in turn can lead to behavioural deficits in various cognitive and motor domains, in both adult and paediatric populations. Cardiorespiratory arrest (CA) is a major cause of hypoxia-ischaemia in adults, but it is relatively rare in infants and children. While the effects of adult CA on brain and cognition have been widely studied, to date, there are no studies examining the neurodevelopmental outcome of children who suffered CA early in life. Here, we studied the long-term outcome of 28 children who suffered early CA (i.e., before age 16). They were compared to a group of control participants (n = 28) matched for age, sex and socio-economic status. The patient group had impairments in the domains of memory, language and academic attainment (measured using standardised tests). Individual scores within the impaired range were most commonly found within the memory domain (79%), followed by academic attainment (50%), and language (36%). The patient group also had reduced whole brain grey matter volume, and reduced volume and fractional anisotropy of the white matter. In addition, lower performance on memory tests was correlated with bilaterally reduced volume of the hippocampi, thalami, and striatum, while lower attainment scores were correlated with bilateral reduction of fractional anisotropy in the superior cerebellar peduncle, the main output tract of the cerebellum. We conclude that patients who suffered early CA are at risk of developing specific cognitive deficits associated with structural brain abnormalities.

Policy makers in California intend to provide free preschool to all 4-year-olds solely within public schools by 2026, becoming the nation's second largest single pre-K program in the United States after Head Start. This initiative builds on the state's existing Transitional Kindergarten (TK) option that has served a modest share of 4-year-olds since 2010. Tracing the historical growth in TK enrollments, we find that just 30, mostly urban school districts, enrolled two-fifths of all children served by 2020, responding to funding incentives and displaying stronger organizational capacity. Meanwhile, one-third of California's nearly one thousand districts enrolled fewer than 12 TK children. Black, white, and Asian children remained disproportionally under-enrolled as a share of their respective populations, as enrollments climbed past 90,000 children prior to the COVID-19 pandemic. Identifying factors that may explain widely differing gains in TK enrollment, merging education and local census data, we find the suburbs began to catch-up with cities in serving additional 4-year-olds, as well as districts offering school choice (e.g., charter schools). We discuss implications for other nations attempting to rapidly expand preschool, including the inequities that may inadvertently arise.

Background: Despite the growing diversity among students in higher education, nonprogression to postsecondary education persists for many students with intellectual disabilities with low completion rates for those who do progress. Research suggests that occupational therapy (OT) support can be extremely beneficial in assisting students. Less is known however about the impact of OT in higher education. This study aims to examine the use of OT embedded in a postsecondary programme for students with intellectual disabilities. Methods: This study uses a scoping review of relevant literature and a qualitative analysis of OT working in a higher education programme specifically designed for students with intellectual disabilities in Ireland. Findings: This paper highlights how the OT support within this programme uses a four-fold collaborative approach supporting students, staff, business partners and wider organisational structures in the university. Conclusion: The analysis highlights the opportunities for collaboration between OT and curriculum developers, teaching and ancillary staff and students in higher education along with the significant OT input into work placements and internships with business partner mentors. Challenges in educating stakeholders to understand OT in the higher education environment would suggest a substantial need for further research.

Educational travel, and in particular study abroad programs, are generally beneficial to students, but less is known about impacts on the communities in which they are located. This study explores such impacts for a small rural community in Costa Rica that has hosted dozens of ecotourism and study abroad programs. Sixteen interviews were conducted in the community to explore the social and cultural rewards and costs of these programs, including cultural changes such as increases in community members speaking English, availability of drugs and alcohol, appreciation of nature, and adoption of sustainable living practices. We analyze these impacts by examining common programmatic assumptions about study abroad and borrowing biological constructs of symbiosis to diagram the potential trade-offs and costs for the local community -- as the basis for developing more mutualistic, decolonized programs in the future.

Abstract Background There is growing evidence that spending time with or in nature can be beneficial for health and wellbeing. Emerging evidence suggests potential benefits for staff and service users in healthcare settings, yet little is known about how to put Nature-based approaches (NBAs) into practice within the Child and Adolescent Mental Health Services (CAMHS) setting. The CAMHS Goes Wild project in Southwest England aimed to explore the implementation of NBAs within CAMHS, examining staff attitudes and understanding to identify potential benefits and challenges through a mixed methods study. Methods The study involved three phases of data collection: an online survey with two waves, the first wave prior to the training, and the second four months post-training, and semi-structured interviews. Data collection was designed to fit around NatureWell training, attended by sixty-four CAMHS staff, which took place alongside the study. All participants were sampled from one NHS Trust and the study was open to both those who had attended the NatureWell training and those who had not. Data were synthesised to produce an understanding of staff attitudes towards NBAs and perceived barriers and facilitators to the implementation of this approach. Results Ninety-seven staff responded to the wave 1 survey and 57 responded to the wave 2 survey. Fourteen staff members were interviewed. Data synthesis generated three themes: Tension between the culture of CAMHS and NBAs (Theme 1) and the need for buy-in and governance support (Theme 2). Theme three described the potential benefits of NBAs for staff and service users in CAMHS and is presented in a separate paper. The first two themes are presented in this paper. Conclusions The implementation of NBAs in mental health service settings for CYP presents both significant challenges and opportunities. Our findings suggest multiple barriers to implementation, often in the form of organisational or cultural factors, such as the risk averse nature of the service. Our work also elucidates several potential facilitators which may address or mitigate some of these barriers. These potential enablers, such as harnessing the role of firsthand experience, warrant further exploration in the implementation of NBAs in CAMHS.

Abstract Objective To evaluate implementation of a patient decision aid for symptomatic uterine fibroid management to improve shared decision-making at five clinical settings across the United States. Methods We used a type 3 hybrid effectiveness-implementation stepped-wedge design and the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) planning and evaluation framework. We conducted clinician training, monthly reach tracking with feedback to site clinical leads, patient and clinician surveys, and visit audio-recordings. Implementation strategies included assessment of organizational readiness for shared decision-making, synchronous clinician training, audit and feedback of decision aid reach, and access to multiple decision aid formats. Outcomes and analyses included patient-level reach, clinician-level adoption, and associations of patient-reported decision aid exposure (as treated) and setting-level implementation (intention-to-treat) with patient-reported (collaboRATE measure) and observed (OPTION-5 measure) shared decision-making. We also designed and assessed setting-level plans for sustainability and other factors impacting sustained decision aid use. Results The decision aid was adopted by 72 of the 74 eligible gynecologists (97%) and reached 2553 patients across five settings. CollaboRATE scores improved among patients who reported receiving the decision aid (as-treated analysis, 69% vs. 59%; OR 1.6, 95% CI 1.16–2.27). CollaboRATE scores remained consistent before and after setting-level decision aid implementation (intention-to-treat analysis, 64% vs. 63%; OR 0.86, 95% CI 0.61–1.22). Participants would prefer to receive a decision aid at multiple time points (91.9% before the visit, 90.7% during the visit, 86.5% after the visit). Shared decision-making experiences did not improve when comparing pre vs. post-implementation collaboRATE scores across included settings (intention-to-treat, 64% vs. 63%; OR 0.86, 95% CI 0.61–1.22). Conclusion When patients with symptomatic uterine fibroids are given decision aids, they report higher shared decision-making scores. However, the differences we observed between the as-treated and intention-to-treat results suggest that unaddressed implementation challenges continue to limit the extent to which patients receive decision aids and likely hinder their overall impact. Future efforts to implement decision aids should explore enhancing their integration into clinical workflows and standard operating procedures, supported by organizational incentives that prioritize shared decision-making. Trial registration ClinicalTrials.gov NCT03985449; registered 6 June 2019.

Abstract Background To improve the efficient use of scarce resources, low- and middle-income countries and development partners are increasingly encouraged to deliver multiple vaccines and other interventions in a single integrated campaign. However, little is known regarding the cost of delivering vaccines through integrated campaigns, and the extent to which efficiencies are achieved. To fill this evidence gap, we estimated the cost of integrated immunization campaigns in Nigeria and Sierra Leone, and the potential savings from integration. Methods We conducted a retrospective ingredients-based costing study from a payer perspective of a campaign held in 2019 in Sierra Leone with measles-rubella vaccine and oral polio vaccine, during which nutrition supplements were also offered in part of the country, and yellow fever campaigns held in three states in Nigeria in 2019 and 2020, where in one state (Anambra) meningococcal A vaccines were co-delivered. We collected data from 108 health facilities, all relevant administrative levels, and implementing partners. We estimated the full financial and economic cost of each campaign, the average unit cost of delivery, as well as the cost by activity and resource type. We also estimated the cost savings from integration in Anambra state by modelling out the cost of the alternative of two standalone campaigns. Results The average financial delivery cost was $0.34 per dose in Sierra Leone, and the economic cost was $0.73 per dose. In Nigeria, the financial cost per dose was $0.29–$0.35 across the three states, and the economic cost per dose was $0.62–$0.85. Facilities and wards delivering more doses achieved a lower financial and economic unit cost of delivery, demonstrating evidence of economies of scale. We estimated that Anambra may have saved at least $1,204,133 in financial resources by integrating yellow fever and meningitis A vaccine delivery, amounting to $0.17 per dose delivered. When including opportunity costs, the economic cost saving was estimated at $0.34 per dose delivered. Conclusions The study offers evidence on what it costs to deliver integrated campaigns, and shows that integrated delivery is likely to result in significant cost savings. Where high delivery volumes can be achieved, integrated campaigns can benefit from economies of scale. The findings can be used to inform planning and budgeting for immunization campaigns in low- and middle-income countries.

Abstract Brain microvascular dysfunction is an important feature of Alzheimer’s disease (AD). To better understand the brain microvascular molecular signatures of AD, we processed and analyzed isolated human brain microvessels by data-independent acquisition liquid chromatography with tandem mass spectrometry (DIA LC–MS/MS) to generate a quantitative dataset at the peptide and protein level. Brain microvessels were isolated from parietal cortex grey matter using protocols that preserve viability for downstream functional studies. Our cohort included 23 subjects with clinical and neuropathologic concordance for Alzheimer’s disease, and 21 age-matched controls. In our analysis, we identified 168 proteins whose abundance was significantly increased, and no proteins that were significantly decreased in AD. The most highly increased proteins included amyloid beta, tau, midkine, SPARC related modular calcium binding 1 (SMOC1), and fatty acid binding protein 7 (FABP7). Additionally, Gene Ontology (GO) enrichment analysis identified the enrichment of increased proteins involved in cellular detoxification and antioxidative responses. A systematic evaluation of protein functions using the UniProt database identified groupings into common functional themes including the regulation of cellular proliferation, cellular differentiation and survival, inflammation, extracellular matrix, cell stress responses, metabolism, coagulation and heme breakdown, protein degradation, cytoskeleton, subcellular trafficking, cell motility, and cell signaling. This suggests that AD brain microvessels exist in a stressed state of increased energy demand, and mount a compensatory response to ongoing oxidative and cellular damage that is associated with AD. We also used public RNAseq databases to identify cell-type enriched genes that were detected at the protein level and found no changes in abundance of these proteins between control and AD groups, indicating that changes in cellular composition of the isolated microvessels were minimal between AD and no-AD groups. Using public data, we additionally found that under half of the proteins that were significantly increased in AD microvessels had concordant changes in brain microvascular mRNA, implying substantial discordance between gene and protein levels. Together, our results offer novel insights into the molecular underpinnings of brain microvascular dysfunction in AD.

The Aralkum is a new desert created by the desiccation of the Aral Sea and is an efficient source of dust aerosol which perturbs the regional Central Asian radiation balance. COSMO–MUSCAT model simulations are used to quantify the direct radiative effects (DREs) of Aralkum dust, and investigate the associated perturbations to the atmospheric environment. Considering scenarios of “Past” (end of 20th century) and “Present” (beginning of 21st century) defined by differences in surface water coverage, it is found that in the Present scenario the simulated yearly mean net surface DRE across the Aralkum is −1.34 W m−2 with a standard deviation (±) of 6.19 W m−2, of which −0.15 ± 1.19 W m−2 comes from dust emitted by the Aralkum. In the atmosphere the yearly mean DRE is −0.62 ± 2.91 W m−2, of which −0.05 ± 0.51 W m−2 is from Aralkum dust: on the yearly timescale, Aralkum dust is cooling both at the surface and in the atmosphere, due to its optically scattering properties. The daytime surface cooling effect (solar zenith angle ≲ 70–80°) outweighs the nighttime heating effect and the atmospheric daytime (solar zenith angle ≲ 60–70°) heating and nighttime cooling effects. Instantaneous Aralkum dust DREs contribute up to −116 W m−2 of surface cooling and +54 W m−2 of atmospheric heating. Aralkum dust perturbs the surface pressure in the vicinity of the Aralkum by up to +0.76 Pa on the monthly timescale, implying a strengthening of the Siberian High in winter and a weakening of the Central Asian heat low in summer. These results highlight the impacts of anthropogenic lakebed dust on regional atmospheric environments.

Abstract Intracranial pressure (ICP) is a physiological parameter that conventionally requires invasive monitoring for accurate measurement. Utilising multivariate predictive models, we sought to evaluate the utility of non-invasive, widely accessible MRI biomarkers in predicting ICP and their reversibility following cerebrospinal fluid (CSF) diversion. The retrospective study included 325 adult patients with suspected CSF dynamic disorders who underwent brain MRI scans within three months of elective 24-h ICP monitoring. Five MRI biomarkers were assessed: Yuh sella grade, optic nerve vertical tortuosity (VT), optic nerve sheath distension, posterior globe flattening and optic disc protrusion (ODP). The association between individual biomarkers and 24-h ICP was examined and reversibility of each following CSF diversion was assessed. Multivariate models incorporating these radiological biomarkers were utilised to predict 24-h median intracranial pressure. All five biomarkers were significantly associated with median 24-h ICP (p

Abstract Background Fibroids are non-cancerous uterine growths that can cause symptoms impacting quality of life. The breadth of treatment options allows for patient-centered preference. While conversation aids are known to facilitate shared decision making, the implementation of these aids for uterine fibroids treatments is limited. We aimed to develop two end-user-acceptable uterine fibroids conversation aids for an implementation project. Our second aim was to outline the adaptations that were made to the conversation aids as implementation occurred. Methods We used a multi-phase user-centered participatory approach to develop a text-based and picture-enhanced conversation aid for uterine fibroids. We conducted a focus group with project stakeholders and user-testing interviews with eligible individuals with symptomatic uterine fibroids. We analyzed the results of the user-testing interviews using Morville’s Honeycomb framework. Spanish translations of the conversation aids occurred in parallel with the English iterations. We documented the continuous adaptations of the conversation aids that occurred during the project using an expanded framework for reporting adaptations and modifications to evidence-based interventions (FRAME). Results The first iteration of the conversation aids was developed in December 2018. Focus group participants (n = 6) appreciated the brevity of the tools and suggested changes to the bar graphs and illustrations used in the picture-enhanced version. User-testing with interview participants (n = 9) found that both conversation aids were satisfactory, with minor changes suggested. However, during implementation, significant changes were suggested by patients, other stakeholders, and participating clinicians when they reviewed the content. The most significant changes required the addition or deletion of information about treatment options as newer research was published or as novel interventions were introduced into clinical practice. Conclusions This multi-year project revealed the necessity of continuously adapting the uterine fibroids conversation aids so they remain acceptable in an implementation and sustainability context. Therefore, it is important to seek regular user feedback and plan for the need to undertake updates and revisions to conversation aids if they are going to be acceptable for clinical use.

Federal funds for human trafficking victim programmes and services in the United States have increased from approximately USD 10 million in 2002 to more than USD 90 million in 2022. This increase in fund availability, however, has not necessarily translated into meaningful or accessible services for trafficking survivors. This paper examines the distribution of Department of Justice anti-trafficking funds through the Office for Victims of Crime (OVC), particularly looking at OVC recipients in Alaska. It highlights certain trends in OVC funding in the state, including changes in funding distribution, the emphasis on task force creation and collaboration between service providers and law enforcement, and discussions of equity and inclusion. The paper further explores institutional mechanisms of exclusion and harm of some victims, complexities in collaborating with law enforcement, criminalisation of trafficking survivors, and criteria to qualify for services. As the reality faced by trafficking survivors does not always align with OVC narratives, these mechanisms are illustrated through the experiences of a sex trafficking survivor who has been turned away as not qualifying for services by many of the OVC funded providers in Alaska. The paper concludes by exploring the implications of this research for policymakers and service providers.

Abstract By 2050, 1 in 4 people worldwide will be living with hearing impairment. We propose a digital Speech Hearing Screener (dSHS) using short nonsense word recognition to measure speech-hearing ability. The importance of hearing screening is increasing due to the anticipated increase in individuals with hearing impairment globally. We compare dSHS outcomes with standardized pure-tone averages (PTA) and speech-recognition thresholds (SRT). Fifty participants (aged 55 or older underwent pure-tone and speech-recognition thresholding. One-way ANOVA was used to compare differences between hearing impaired and hearing not-impaired groups, by the dSHS, with a clinical threshold of moderately impaired hearing at 35 dB and severe hearing impairment at 50 dB. dSHS results significantly correlated with PTAs/SRTs. ANOVA results revealed the dSHS was significantly different (F(1,47) = 38.1, p

Abstract Preventative treatment for Alzheimer’s Disease (AD) is dire, yet mechanisms underlying early regional vulnerability remain unknown. In AD, one of the earliest pathophysiological correlates to cognitive decline is hyperexcitability, which is observed first in the entorhinal cortex. Why hyperexcitability preferentially emerges in specific regions in AD is unclear. Using regional, cell-type-specific proteomics and electrophysiology in wild-type mice, we uncovered a unique susceptibility of the entorhinal cortex to human amyloid precursor protein (hAPP). Entorhinal hyperexcitability resulted from selective vulnerability of parvalbumin (PV) interneurons, with respect to surrounding excitatory neurons. This effect was partially replicated with an APP chimera containing a humanized amyloid-beta sequence. EC hyperexcitability could be ameliorated by co-expression of human Tau with hAPP at the expense of increased pathological tau species, or by enhancing PV interneuron excitability in vivo. This study suggests early interventions targeting inhibitory neurons may protect vulnerable regions from the effects of APP/amyloid and tau pathology.

Abstract Aspects of the acute experience induced by the serotonergic psychedelic psilocybin predict symptomatic relief in multiple psychiatric disorders and improved well-being in healthy participants, but whether these therapeutic effects are immediate or are based on memories of the experience is unclear. To examine this, we co-administered psilocybin (25 mg) with the amnestic benzodiazepine midazolam in 8 healthy participants and assayed the subjective quality of, and memory for, the dosing-day experience. We identified a midazolam dose that allowed a conscious psychedelic experience to occur while partially impairing memory for the experience. Furthermore, midazolam dose and memory impairment tended to associate inversely with salience, insight, and well-being induced by psilocybin. These data suggest a role for memory in therapeutically relevant behavioral effects occasioned by psilocybin. Because midazolam blocks memory by blocking cortical neural plasticity, it may also be useful for evaluating the contribution of the pro-neuroplastic properties of psychedelics to their therapeutic activity.

In the last two decades, there has been a global movement towards pedagogies that create more inclusive school environments in order to meet the needs of diverse learners. One such approach is Universal Design for Learning (UDL), which foregrounds the design of flexible and accessible learning experiences for all, regardless of learner characteristics. Technology is a key enabler in this. To date, much of the research on UDL has focused on its impact in higher education, with less evidence available on the use of UDL within second-level education. This systematic literature review of n = 15 empirical studies selected from a wide-ranging search that returned an initial result of n = 1253 explores how the affordances of digital technology have been harnessed for UDL enactment at second level. The findings show that, to date, empirical research at second level has focused mostly on the easy wins within the UDL principle of Representation, where educators offer choice about how learners access content. However, there is a clear gap in UDL research on the use of technologies to support the Engagement and Action & Expression principles of UDL, supporting student self-regulation and self-assessment, and on technology-mediated communication and collaboration. The paper highlights the potential for future cross-pollination of research in educational technology with UDL.

Past research has found that intergenerational programmes can benefit the social and emotional development of participants in the early years. This paper presents a systematic review of studies that address the social and emotional outcomes of young children (aged between 1 and 6 years) who participate in intergenerational programmes. Objective: The aim of the present systematic review was to (1) provide an update on the state of literature in this area and, (2) gain insight into the ways that intergenerational programming can contribute to the development of social and emotional competencies in early childhood. Method: From a systematic search of four databases, 13 articles were selected for review. Results: Findings indicate intergenerational programmes can provide opportunities for children to develop several social and emotional competencies, including self-management, social awareness, relationship skills, and responsible decision making. Conclusion: This review identified a body of research which indicates intergenerational programmes can lead to positive social and emotional outcomes for young children. Suggestions for future research including more robust study designs are considered for how intergenerational programmes can be incorporated into mainstream early childhood education, which has the potential to lead to lasting benefits for children, older adults, and the wider community.

Background: Research on post-secondary training for individuals with intellectual disabilities has generally focused on programs, with little consideration of the structures and mechanisms that give rise to them. This article adopts a critical realist perspective to comparatively analyse and theorise about the contextual structures contributing to the introduction of post-secondary training programs in universities for individuals with intellectual disabilities. Method: Six stages in critical realist explanatory research were followed. They include (1) description, (2) analytical resolution, (3) abduction/theoretical redescription, (4) retroduction, (5) comparison between different theories and abstractions, and (6) concretisation and contextualisation. Results: Historical, socio-political, and educational policy structures and mechanisms, indicated three program typologies: program as niche, as a generalisable prototype, and as an evolutionary response to evolving conditions. Conclusions: By developing explanations about preconditions, the study draws out nuanced sub-types occurring within a single university-based program, theorises on trajectories for success, and lays the groundwork for future empirical and conceptual development.

Research suggests that exposure to microaggressions diminishes cognitive resources. Using "in vivo" experimental methodology, we found that engagement in a breathing exercise may mask the effects of cognitive depletion in Black college women who are exposed to racial microaggressions. Sixty-one Black college women were randomly assigned to one of four conditions in which a microaggressive script and coping suggestion were crossed. Participants who were exposed to microaggressions enacted by a white research assistant and asked to wait were more depleted than those who were not exposed to microaggressions at all. Participants who heard the microaggressive language and were prompted to cope were marginally less depleted than those who were exposed without prompting to engage in a coping exercise. These findings align with prior findings that racially hostile university environments may have harmful consequences on the cognitive functioning of Black women, but engagement in coping may diminish these effects. Implications, limitations, and future research are discussed.

This account of practice describes an online program started in 2022, which helps leaders at BNP Paribas to be more effective problem solvers and inclusive leaders by developing stronger questioning and listening skills. The goals of this program were aligned with action learning and could have been achieved with standard, coach-led action learning groups, however there was a desire at the bank to scale this program to support up to 80 participants at a time at a reasonable budget. Therefore, at Be Leadership we set out to design a program that met our learning outcomes in a scalable, cost-effective way. This account concludes that with the right set up and ongoing support, self-facilitated peer coaching groups can consistently reach the same rich learnings and positive outcomes as those using standard coach-led action learning. Across three cohorts and 47 peer coaching groups, 96 percent of participants said they were satisfied with the program and 92 percent said insights from this program would be useful in their career development. When asked if they would recommend this course to their peers, the experience received a Net Promoter Score (NPS) of 8.53 on a scale of 1-10.