Background Despite the positive effects of community health workers (CHWs) on addressing social determinants of health, improving patient health outcomes, and decreasing overall healthcare costs, there is a lack of standardization in training and certifying this workforce, resulting in different approaches to integrating this role into medical home models. The purpose of the current study is to evaluate the application of Project ECHO (Extension for Community Healthcare Outcomes) in enhancing CHWs’ capacity to address health and social issues of vulnerable populations. Methods An explanatory sequential mixed methods design was applied in which all participants (N = 49) completed pre (January 2019) and post (July 2019) quantitative online surveys measuring changes in self-efficacy, behavior change intent, and knowledge. Virtual focus groups were conducted with a subset of participants (n = 20) in July 2019 to assess the feasibility, acceptability, and impact of Project ECHO. Results There was a statistically significant difference of + 0.453 in the composite self-efficacy mean score pre- to post-series. For every 1 additional Project ECHO CHW session attended, there was a .05 improvement in participants’ self-efficacy to perform CHW-related job duties and address social determinants of health (SDOH). Four major themes emerged from the qualitative focus group data: value in learning from other participants’ caseloads, CHW-care team integration, availability of training and resources, and shared decision-making with patients. Conclusions This evaluation suggests that ECHO is a viable means of increasing access to training resources for CHWs. Future studies on the ECHO model as a means of educating and broadening implementation of CHWs are warranted. Programs such as Project ECHO can support CHWs by providing continuing education opportunities, as well as standardizing training content across large geographic areas.

ObjectivesHealth systems must rapidly move knowledge into practice to address disparities impacting sexual and gender minority (SGM) patients. This qualitative study explores barriers and facilitators that arose during an initiative to improve care for SGM patients in federally qualified health centres (FQHCs) from the perspectives of FQHC staff.DesignCross-sectional qualitative content analysis, using a general inductive approach, of secondary data from transcripts of intervention events offered to FQHC staff and semistructured interviews with staff and FQHC leadership during the intervention.Setting10 FQHCs from nine states in the USA.ParticipantsFQHC quality improvement (QI) and clinical care staff, and leaders at each FQHC.InterventionsThe transforming care for lesbian, gay, bisexual and transgender people QI initiative combined two evidence-based programmes, Learning Collaborative (LC) and Project Extension for Community Healthcare Outcomes (ECHO), to assist primary care health centres in developing capacity to identify SGM patients, monitor their health and care, and improve disparities.Primary and secondary outcome measuresThe primary outcome was identification of barriers and facilitators to implementing initiatives to improve care for SGM patients. The secondary outcome was clarification of how intervention participants used Project ECHO sessions versus LC meetings to obtain information that influenced implementation of the initiative at their FQHC.ResultsBarriers and facilitators mapped to two major themes: ‘Clinical’ (patients’ health, wellness, and available treatment) and Health Systems and Institutional Culture (FQHC operations, and customs and social institutions within the FQHCs and in the external environment). Common ‘Clinical’ inquiries were for assistance with behavioural health, pre-exposure prophylaxis and transgender hormone therapy. Prevalent facilitators included workflow change and staff training, while adapting electronic health records for data collection, decision support and data extraction was the most prevalent barrier.ConclusionsProject ECHO and LC provided complimentary forums to explore clinical and operational changes needed to improve care for SGM at FQHCs.

Aims This study was an evaluation of an afterschool music program that serves primarily low‐income, urban children, and adolescents. The evaluation examined academic and nonacademic outcomes through a mixed‐method design. Methods Focus group participants included 10 parents/caregivers and 8 youth. Focus groups yielded several themes regarding academic and nonacademic (musical skills, responsibility/discipline, self‐efficacy, empowerment, social competence, and family bonding) benefits of involvement with the program. An annual questionnaire for the program was created based on these themes. Results Fifty‐three parents/caregivers completed the questionnaire and rated their children highly on all outcomes. The independent t tests revealed that lower‐income students were rated higher on responsibility/discipline than higher‐income students and that those children who attended the program more than three times per week were rated higher on responsibility/discipline than those who attended less. Conclusion Implications of these results, particularly the need for increased access to afterschool music programs for low‐income youth, are discussed.