Rand health quarterly最新文献

The ACCESS pilot project - a farmworker health care access initiative - was developed to address toxic stress in farmworker communities and increase farmworker access to health care services through clinic and community connections. The authors present findings from farmworker leader trainings conducted by the ACCESS pilot project to understand leaders' preparedness for educational outreach in farmworker communities across California. They also present results from a farmworker community survey that explored health access in farmworker communities and the impact of the educational outreach intervention. The evaluation was conducted to inform local and statewide conversations on how to improve health and health access for farmworkers through programming and policy interventions. Farmworkers in California experience disproportionately high rates of uninsurance and typically live in rural areas that lack sufficient health resources. In a prior study, more than four out of five California farmworkers surveyed reported experiencing at least one Adverse Childhood Experience (ACE) in early childhood. ACEs are stressful or traumatic events, such as neglect, abuse, and household dysfunction, that can trigger a toxic stress response in the body, leading to poorer physical and mental health outcomes in adulthood. Results from the ACCESS pilot project evaluation demonstrate that a peer-to-peer outreach and education model can build the capacity of farmworker leaders to meaningfully engage their communities in learning about toxic stress and ways to mitigate its negative health outcomes. Insights from a farmworker community health survey reveal that these communities experience significant barriers to accessing affordable health care.

Advances in the biological knowledge and reasoning capabilities of large language models (LLMs) have sparked interest in assessing the potential of LLMs to facilitate emerging biological risks. The authors evaluated LLMs' abilities to answer knowledge-based questions and generate protocols that explain how to perform common laboratory techniques that could be used in the creation of proxies for biological threats. Because LLM evaluation approaches that rely on human subject-matter experts are often costly and time-intensive, the authors introduced an automated systematic and scalable method for evaluating the ability of LLMs to generate protocols for laboratory techniques. The results presented confirm prior work indicating that LLMs possess knowledge of the biological sciences. This study is intended to inform evaluators of artificial intelligence systems, academics, technical experts, and policymakers on techniques for examining the risks of the convergence of LLMs and biological threats.

The authors evaluated Phase II of the No More Adverse Childhood Experiences (NACES) pilot project that aimed to improve farmworker health and health access by increasing knowledge about Adverse Childhood Experiences (ACEs) and toxic stress among farmworkers and providing support to community health clinics that address ACEs in these rural communities. ACEs are traumatic or stressful events that occur in childhood and can negatively impact long-term mental and physical well-being and disproportionately affects low-income populations. More than 60 percent of Californians have experienced at least one ACE in their lifetime, and prior research found that as many as 87 percent of California farmworkers reported experiencing one ACE. In 2023, the California Department of Health Care Services (DHCS) funded the Futures Without Violence National Health Initiative on Violence and Trauma to implement the NACES Phase I pilot project to develop community- and clinic-based approaches to address ACEs in farmworker communities. RAND evaluated the clinic-based implementation of NACES Phase I and found early evidence for the feasibility and acceptability of an ACE education, screening and response model that is informed by farmworker voices. This phase of the project refined the training approach developed in Phase I and tested it in two additional clinic sites while adding a virtual clinical training option that is more accessible to clinicians across the state. Results from the NACES Phase II evaluation support Phase I findings on the feasibility and potential for the positive impact of an ACE education, screening, and response model informed by farmworkers.

Psychiatric advance directives (PADs) allow individuals with mental health conditions to document preferences for care that they might not otherwise be able to communicate during a crisis. Over the past several years, seven California counties have been collaborating on a Mental Health Services Act Innovation Project intended to increase the availability and uptake of PADs among persons with mental health needs, supported by peer worker outreach and facilitation. In this study, RAND researchers evaluate three aspects of the PADs Innovation Project pilot. First, they present findings from an assessment of post-training outcomes and experiences with real-world PAD facilitation, using surveys and interviews with peer workers. Second, they describe PAD creation rates and outcomes across the participating counties, using a combination of administrative metadata from the PAD platform, a brief user survey contained within the PAD platform, and a follow-up interview and survey with a subset of individuals who created a PAD. Third, they report the perspectives of county implementation staff, who provided overall reflections on the implementation of beta testing through interviews. Finally, the authors summarize their findings and provide a set of recommendations for future PAD implementation.

Congress mandates that the Department of Defense (DoD) assess and monitor the health readiness of the armed forces. Accordingly, DoD implements a suite of health assessments to monitor service members' health readiness. One annual and four additional deployment-related health assessments screen for issues with physical and behavioral health at specified intervals throughout the deployment cycle to facilitate early intervention and any medical care required to maintain force readiness. The content of many of the items in these assessments overlap, and the required time frames for assessment completion can be very close to one another. In addition, administration of similar assessments can involve unnecessary monetary and other resource costs. The Office of the Assistant Secretary of Defense for Health Affairs asked the RAND National Defense Research Institute to evaluate DoD's suite of health readiness assessments against their stated objectives and identify potential opportunities for improvement, increased efficiencies, and cost savings. In this study, the authors review the policies behind these health assessments at both department and service branch levels and the assessments themselves for overlaps and gaps, comparing them with U.S. guidelines for health screenings and the use of similar health assessments among high-risk civilian professions. Drawing from this analysis and interviews with military stakeholders, they offer recommendations for improving the health assessments' efficiency and effectiveness.

Promoting the well-being of all youth today can lead to productive, successful, and healthy adults and the health of society tomorrow. But promoting the well-being of all youth is not simple: It requires a multifaceted set of pathways and strategies that are still being defined in the research literature. A large and growing body of research on youth, well-being, and the arts exists, but it is fragmented across multiple disciplines (e.g., psychology, education) and areas (e.g., different art forms, different definitions of youth well-being and arts engagement). In this study, the authors summarize findings from a literature review they conducted to investigate global themes and gaps in the current multidisciplinary literature on the relationship between the arts and youth well-being. The authors used an equity-centered environmental scan to extract nuanced insights from the vast repository of information. Drawing on these insights, they provide recommendations that offer ways to fill gaps in current research and promote the cross-disciplinary partnerships needed to untangle the complex strands of literature and weave them back together in a meaningful way.

Homelessness continues to be one of the most pressing policy issues in Los Angeles County, California. Although substantial investments have been made to address it over the past several years, the number of people experiencing homelessness is still large. It is important to address transition age youth, ages 18 to 25, who are experiencing homelessness because resolving homelessness at an early age may prevent chronic homelessness and the consequences of living unsheltered, such as increased morbidity and earlier mortality. This study is the second publication from a project designed to better understand the needs of unstably housed transition age youth navigating both the housing and foster care systems in Los Angeles County. The authors present the findings from a longitudinal data collection effort among transition age youth with foster care involvement who were experiencing housing instability in 2023. The authors followed this group by conducting monthly interviews for up to one year to gain information about their experiences and perspectives regarding their interactions with the foster care system, becoming stably housed, and related supports. This is the first study of its kind to systematically track a group of unstably housed foster care-involved transition age youth in Los Angeles County. This study should interest those who are serving transition age youth experiencing housing instability and involved with the foster care system, including government, social service, and health care organizations, as well as educators, employers, practitioners, advocacy groups, researchers, and others interested in addressing the homelessness crisis in Los Angeles County.

The field of emergency management is changing rapidly. Emergency managers are being asked to carry out new missions-in particular, public health preparedness and response (as shown during the 2019 coronavirus pandemic), as well as addressing the consequences of increasingly frequent and severe weather events. As a result, and based on the insight that many emergency management approaches apply across all types of disasters, the field is moving toward an expanded all-hazards approach. As one step toward understanding these changes and charting a path forward for emergency management, the authors of this study assess the current state of thinking about the field by conducting literature reviews and analyses of both scholarly and practitioner-oriented sources, aggregating top issues in the field, identifying priorities for a research agenda, and suggesting ways for practitioners and researchers to engage with and learn from each other. While the study includes key findings and recommendations for emergency management going forward, it also serves as a pilot for a regular review of current issues in the emergency management field.

This study demonstrates that Asia faces high risks for global health security (GHS). The risk is made greater because of uneven capacities to respond among different countries and fragmented public health networks beyond influenza response, further demonstrated by the impacts of the coronavirus disease 2019 (COVID-19) pandemic. The study provides a comprehensive review of the capacity and gaps in Asia's GHS networks and U.S. agencies' GHS efforts in the region. The study includes recommendations aimed at helping U.S. policymakers develop practical steps to reassert GHS leadership in Asia with a whole-of-government approach under the 2024 U.S. Global Health Security Strategy (GHSS).