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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.

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]

• 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]

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]