A significant number of youth in the United States experience traumatic events that substantially increase the risk of physical and behavioral health problems across the life span. This public health concern warrants concerted efforts to promote trauma-informed, evidence-based practices that facilitate recovery. Although youth-focused trauma-specific treatments exist, determining effective ways to disseminate and implement these services-so that they are available, accessible, and sustainable-poses an ongoing challenge. This paper describes a comprehensive model for such implementation, the community-based learning collaborative (CBLC), developed as part of Project BEST, a four-phase statewide initiative to promote trauma-focused practices. The CBLC augments the learning collaborative model by including clinical and nonclinical (i.e., broker) professionals from multiple service organizations within a targeted community. CBLCs aim to build capacity for sustained implementation of trauma-focused practices by promoting interprofessional collaboration among those involved in the coordination and provision of these services. This paper describes the iterative development of the CBLC by examining participant completion data across the three completed phases of Project BEST (N ϭ 13 CBLCs; 1,190 participants). Additionally, data from Project BEST's third phase (N ϭ 6 CBLCs; 639 participants) were used to evaluate changes in the frequency of specific practices, pre-to post-CBLC, and post-CBLC perceived utility of CBLC components. High participant completion rates, significant increases in reported trauma-focused practices, and positive ratings of the CBLC's utility provisionally support the feasibility and efficacy of the model's final iteration. Implications for implementation and CBLC improvements are discussed.

Background Women with chronic disease are at increased risk of adverse pregnancy outcomes. Pregnancies which pose higher risk, often require increased medical supervision and intervention. How women perceive their pregnancy risk and its impact on health behaviour is poorly understood. The aim of this systematic review of qualitative literature is to evaluate risk perceptions of pregnancy in women with chronic disease. Methods Eleven electronic databases including grey literature were systematically searched for qualitative studies published in English which reported on pregnancy, risk perception and chronic disease. Full texts were reviewed by two researchers, independently. Quality was assessed using the Critical Appraisal Skills Programme Qualitative checklist and data were synthesised using a thematic synthesis approach. The analysis used all text under the findings or results section from each included paper as data. The protocol was registered with PROSPERO. Results Eight studies were included in the review. Three themes with sub-themes were constructed from the analysis including: Information Synthesis (Sub-themes: Risk to Self and Risk to Baby), Psychosocial Factors (Sub-themes: Emotional Response, Self-efficacy, Healthcare Relationship), and Impact on Behaviour (Sub-themes: Perceived Risk and Objective Risk). Themes fitted within an overarching concept of Balancing Act. The themes together inter-relate to understand how women with chronic disease perceive their risk in pregnancy. Conclusions Women’s pregnancy-related behaviour and engagement with healthcare services appear to be influenced by their perception of pregnancy risk. Women with chronic disease have risk perceptions which are highly individualised. Assessment and communication of women’s pregnancy risk should consider their own understanding and perception of risk. Different chronic diseases introduce diverse pregnancy risks and further research is needed to understand women’s risk perceptions in specific chronic diseases.

Given the high prevalence and severe consequences of child trauma, effective implementation strategies are needed to increase the availability and utilization of evidence-based child trauma services. One promising strategy, the Community-Based Learning Collaborative (CBLC), augments traditional Learning Collaborative activities with a novel set of community-focused strategies. This prospective, observational study examined pre-to post-changes in CBLC participant reports of interprofessional collaboration (IPC), barriers to, and utilization of evidence-based child trauma treatment in their communities. Participants of five CBLCs from a statewide dissemination initiative, comprising 572 child abuse professionals (296 clinicians, 168 brokers, and 108 senior leaders), were surveyed pre-and post-CBLC participation. Results suggested that CBLCs significantly decreased barriers to child trauma treatment and significantly increased IPC and perceived utilization of evidence-based child trauma treatment. Further, changes in barriers partially mediated this relationship. Finally, small to medium differences in participants’ reports were detected, such that senior leaders perceived significantly greater IPC than clinicians and brokers did, while brokers perceived significantly greater barriers to child trauma treatment than clinicians and senior leaders did. Collectively, these preliminary findings suggest the CBLC implementation model–which augments traditional Learning Collaborative models with a focus on fostering IPC–can reduce barriers and increase the utilization of evidence-based mental health treatment services.

Purpose: Broker professionals serve an important intermediary role in improving service access for youth but are often trained separately from clinicians. Community-Based Learning Collaboratives (CBLCs) include specific training/implementation strategies to foster collaboration and build community capacity for EBPs. Methods: The current study examined changes in trauma-related knowledge, practices, organizational culture, and interprofessional collaboration among 63 brokers. Brokers reported significant positive changes in trauma-related knowledge, practices, organizational culture, and interprofessional collaboration following CBLC participation. Results: Hierarchical regression analyses indicated statistically significant improvements in knowledge of treatment planning/case monitoring ( r = .41) and organizational culture ( r = .30) as significant predictors of changes in brokers’ use of child trauma evidence-based practices following CBLC participation. Discussion: Findings emphasize tailoring training to include topics and strategies most relevant to participants’ day-to-day responsibilities.

BACKGROUND AND AIMS Women with chronic kidney disease (CKD) are at increased risk of adverse pregnancy and renal outcomes, including preterm birth and progression of kidney disease. Women's risk perceptions of pregnancy impact behaviours and decisions including engagement with prenatal care, mode of delivery choices and adherence to medical advice, therefore, it is important that women perceive and understand their risk accurately. Pre-pregnancy counselling is recommended for all women with CKD, but it is unknown how women with CKD understand their pregnancy risk and if pre-pregnancy counselling affects women's perceptions. The aim of this study was to understand how a large cohort of diverse women with CKD perceive their pregnancy risk and compare differences in risk perceptions between those who have and have not received pre-pregnancy counselling. METHOD The ‘Perception of Pregnancy Risk Questionnaire’ (PPRQ;1) and ‘Desire to Avoid Pregnancy Questionnaire’ (2) were used to measure risk perception and pregnancy intention respectively. The PPRQ was adapted to assess risk perceptions in women with CKD including the severity of kidney disease. Content validity of the adapted PPRQ was confirmed by a panel of 21 experts including nephrologists, midwives, psychologists and obstetricians. Women aged between 18 and 50 years with CKD stages 1–5 were recruited from nine renal units in the United Kingdom and asked to complete an online survey (October 2020–December 2021). Clinical data were extracted from local databases. Data were analysed descriptively. RESULTS A total of 322 women completed the survey, mean age of 34.9 (SD 7.1) years. Women's obstetric history and pregnancy perspectives are described in the Table. Half of the respondents already had children (172/322; 54.1%) and three-quarters perceived pregnancy to be important or very important to themselves (241/322; 75.8%) and two-thirds (218/322; 66.7%) perceived pregnancy to be important or very important to their family. Only 109/321 (34%) of women with CKD had previously attended pre-pregnancy counselling, but those who had attended had a higher perception of pregnancy risk [51.4 (SD 21.4) versus 41.9 (SD 23.8); P < 0.0001] (0: not very severe to 100: extremely severe) and severity of kidney disease [51.3 (SD 24.9) versus 43.7 (SD 28.6); P = 0.014] compared to women who had not attended pre-pregnancy counselling. CONCLUSION This large multi-centre questionnaire study identified that risk perceptions of pregnancy for women with CKD appear to be higher than those of women with an uncomplicated pregnancy [PPRQ scores of 24.0 (SD 14.5)] [1]. However, women who had received pre-pregnancy counselling had a significantly higher perception of pregnancy risk and perceived severity of kidney disease. Limitations include a lack of measurement before and after attending a pre-pregnancy counselling clinic. Further assessment of the relationship between severity of kidney disease and perceived pregnancy risk and pregnancy intentions is needed.