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Eliminating mental health disparities requires simultaneously addressing numerous determinants of health, including social inequities. Although emphasis on multilevel change is growing, interventions typically involve separate efforts or people focusing on each level. We propose a trans-level conceptual model for mental health intervention that simultaneously facilitates change across multiple intersecting levels with four guiding principles: (1) emphasis on structural change; (2) involvement of people experiencing health and social inequities in achieving structural change by addressing the necessary preconditions of access to resources for basic needs, community membership and belonging, and knowledge or information to participate in social change efforts; (3) valuing and building on the expertise and strengths of individuals, families, and communities experiencing health inequities; and (4) dismantling unequal power dynamics of helping relationships through a focus on mutual learning and support and cocreation of change. Tracing the trajectory of a 23-year community-based mental health intervention partnership (the Refugee and Immigrant Well-Being Project), we illustrate the trans-level intervention model and describe its impact on individual mental health and sustainable change at multiple levels. Public Policy Relevance Statement: Violence, unequal distribution of resources, and climate change are contributing to increasing levels of displacement and psychological distress. We propose a trans-level model of mental health intervention that empowers and builds on the strengths of those experiencing mental health disparities by simultaneously addressing their immediate needs and involving them in mutual learning with researchers, practitioners, community organization staff, and policymakers to transform inequitable systems. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of polishing and denture cleansers on the surface roughness (Ra) of new‐generation denture base materials that are additively, subtractively, and conventionally fabricated, while also assessing their color change after cleansing. Material and Methods: One hundred and fifty disk‐shaped specimens (Ø10 × 2 mm) were prepared from five denture base materials (one subtractively manufactured nanographene‐reinforced prepolymerized polymethylmethacrylate (PMMA) (SM‐GC), one subtractively manufactured prepolymerized PMMA (SM‐PM), two additively manufactured denture base resins (AM‐DT and AM‐ND), and one heat‐polymerized PMMA (CV) (n = 30). The Ra of the specimens was measured before and after conventional laboratory polishing, while color coordinates were measured after polishing. Specimens were then divided into three subgroups based on the denture cleanser: distilled water, 1% sodium hypochlorite (NaOCl), and effervescent tablet (n = 10). The Ra and color coordinates were remeasured after nine cleansing cycles over a period of 20 days. The CIEDE2000 formula was used to calculate the color differences (ΔE00). Two‐way analysis of variance (ANOVA) was used to analyze the Ra values before (n = 30) and after (n = 10) cleansing, while repeated measures ANOVA was used to analyze the Ra of material‐time point pairs within each denture cleanser (n = 10). ΔE00 data after denture cleansing was also analyzed by using two‐way ANOVA (n = 10) (α = 0.05). Results: Before polishing, Ra varied significantly among the materials. SM‐GC and SM‐PM had the lowest and AM‐ND the highest Ra values (P < 0.001). Polishing significantly reduced Ra of all materials (P < 0.001), and after polishing, Ra differences among materials were nonsignificant (P ≥ 0.072). Regardless of the denture cleanser, the Ra of AM‐DT, AM‐ND, and CV was the highest before polishing when different time points were considered (P < 0.001). After cleansing, AM‐ND had the highest Ra of all the materials, regardless of the cleanser (P ≤ 0.017). AM‐DT had higher Ra than SM‐PM when distilled water (P = 0.040) and higher Ra than SM‐GC, SM‐PM, and CV when NaOCl was used (P < 0.001). The type of cleanser significantly influenced the Ra of AM‐DT, AM‐ND, and CV. For AM‐DT, NaOCl led to the highest Ra and the tablet led to the lowest Ra (P ≤ 0.042), while for AM‐ND, distilled water led to the lowest Ra (P ≤ 0.024). For CV, the tablet led to lower Ra than distilled water (P = 0.009). Color change varied among the materials. When distilled water was used, SM‐GC had higher ΔE00 than SM‐PM and AM‐DT (P ≤ 0.034). When NaOCl was used, AM‐ND had higher ΔE00 than SM‐GC, SM‐PM, and AM‐DT, while CV and SM‐GC had higher ΔE00 than SM‐PM and AM‐DT (P ≤ 0.039). Finally, when the tablet was used, AM‐ND and CV had the highest ΔE00, while AM‐DT had lower ΔE00 than SM‐GC (P ≤ 0.015). Conclusions: The tested materials had unacceptable surface roughness (>0.2 μm) before polishing. Roughness decreased significantly after polishing (<0.2 μm). Denture cleansers did not significantly affect the surface roughness of the materials, and roughness remained clinically acceptable after cleansing (<0.2 μm). Considering previously reported color thresholds, AM‐ND and CV had unacceptable color change regardless of the denture cleanser, and the effervescent tablet led to perceptible, but acceptable color change for SM‐GC, SM‐PM, and AM‐DT. [ABSTRACT FROM AUTHOR]

Growing evidence supports the importance of culturally appropriate mental health interventions, yet it is not always feasible to develop culturally grounded interventions or adapt existing interventions for each cultural group. In addition, these approaches do not recognize the multiple intersecting aspects of culture and identity that individuals, families, and communities possess. Thus, an essential question is whether culturally appropriate mental health interventions have to be culturally specific. We address this question by examining processes of the Refugee Well‐being Project (RWP), a community‐based mental health intervention for refugees resettled in the United States, which included people from multiple cultural groups (Afghanistan, Great Lakes region of Africa, Iraq, and Syria) and was grounded in common experiences of forcibly displaced people from marginalized backgrounds. RWP incorporates a practice‐based concept of culture, an intersectional view of identity, and a multilevel approach to address postmigration stressors. Semistructured qualitative interviews were conducted with 290 participants at preintervention, followed by interviews at three timepoints with a purposively selected subsample (n = 66). Additional interviews (n = 101) were conducted with refugee and student partners. Four themes demonstrated key principles for creating culturally appropriate interventions with diverse groups: (a) recognize cultural complexity in practice; (b) focus on how racism and discrimination are experienced in everyday life; (c) de‐center dominant US culture; and (d) create an egalitarian, inclusive space to put principles into action. We conclude that mental health interventions implemented with multiple, diverse groups can be culturally appropriate and effective without being culturally specific. [ABSTRACT FROM AUTHOR]

Play spaces are important components of paediatric healthcare environments. They provide children with critical opportunities to experience the social, emotional, and developmental benefits of play while in healthcare settings for appointments or hospitalizations. These spaces can help to mitigate stress, provide a sense of normalcy in unfamiliar environments, and facilitate social engagement for children and their families. Given the benefits of play spaces in paediatric healthcare settings, it is important to understand how these spaces can be designed to enhance children's inclusion and quality of care. The aim of this scoping review was to explore the current understanding of paediatric play space design. Using search terms related to children, health care, and play space, six interdisciplinary databases were searched over a 30-year period. The search found 2,533 records from which eighteen were included for review. Findings suggest that although it is well-documented that play spaces offer valuable social and emotional benefits, little is known about the specific design features that can and should be incorporated to enhance play opportunities and ensure that they benefit all children and families. Further, the literature mostly considers play spaces in the context of designated play or recreational rooms. Scholars are encouraged to consider how play opportunities can be incorporated into the designs of paediatric healthcare environments beyond the boundaries of these rooms. Future studies should also consider the diversity of play space users, including children of varying ages and abilities, to create more accessible and inclusive paediatric play spaces for children and their families. Advancing knowledge on play space design can help to optimize the quality of these important spaces and to ensure their designs meaningfully enhance children's play experiences and quality of care. [ABSTRACT FROM AUTHOR]

Randomized controlled trials (RCTs) are a long-standing and important design for conducting rigorous tests of the effectiveness of health interventions. However, many questions have been raised about the external validity of RCTs, their utility in explicating mechanisms of intervention and participants' intervention experiences, and their feasibility and acceptability. In the current mixed-methods study, academic and community partners developed and implemented an RCT to test the effectiveness of a collaboratively developed community-based advocacy, learning, and social support intervention. The goals of the intervention were to address social determinants of health and build trust and connections with other mental health services in order to reduce mental health disparities among Afghan, Great Lakes Region African, and Iraqi refugee adults and to engage and retain refugees in trauma-focused treatment, if needed. Two cohorts completed the intervention between 2013 and 2015. Ninety-three adult refugees were randomly assigned to intervention or control group and completed four research interviews (pre-, mid-, and postintervention, and follow-up). Several challenges to conducting a community-based RCT emerged, including issues related to interviewer intervention to assist participants in the control group, diffusion of intervention resources throughout the small refugee communities, and staff and community concerns about the RCT design and what evidence is meaningful to demonstrate intervention effectiveness. These findings highlight important epistemological, methodological, and ethical challenges that should be considered when conducting community-based RCTs and interpreting results from them. In addition, several innovations were developed to address these challenges, which may be useful for other community-academic partnerships engaged in RCTs.