Literature Collection

Childbearing families in the United States, especially in rural communities, face inconsistent access to high-quality maternity care, with many experiencing sparse and fragmented services. In response to long-standing disparities in Alabama, we created the Women and Children Health Initiative (WACHI), a coordinated hub that advances midwifery workforce growth, expands practice partnerships, and catalyzes policy change to support collaborative, risk-appropriate care. Central to WACHI is integrating certified nurse-midwives (CNMs) within systems that have historically imposed practice barriers. Grounded in the belief that Alabama can do better, WACHI convenes academic fields, health systems, public health sectors, and community partners to codesign and implement evidence-informed interventions. Program pillars include (1) reopening and expanding the state's nurse-midwifery education pathway, (2) embedding Nurse-Family Partnership home visiting with integrated behavioral health, (3) launching the Moms and Kids Mobile Health Clinic to reach underserved rural areas, and (4) building durable CNM-physician collaborations and standardized protocols for team-based care. These coordinated strategies align workforce development, health care delivery, and policy to increase first-trimester prenatal entry, improve postpartum follow-up, and reduce preventable complications. Early results include growth in the CNM workforce, new rural practice partnerships, and health-system engagement with respectful, team-based models that prioritize patient preferences and cultural safety. In this article we describe the WACHI model and early outcomes to inform adaptation and support replication by diverse regional coalitions and systems nationwide.

As the aging population in the United States grows, the need for an integrated approach to support older adults has become increasingly urgent. The SUNSHINE framework, Seniors Uniting Nationwide to Support Health, INtegrated Care, and Evolution, offers a model for advancing resilience, defined as the capacity of individuals, families, systems, and communities to adapt and thrive in the face of adversity. SUNSHINE promotes this goal through the alignment of older and aging adults, families, healthcare systems, public health agencies, social services, and community resources. Using the Theory of Change modeling, SUNSHINE emphasizes whole-person health, interdisciplinary collaboration, and the strategic use of technology to address the evolving needs of aging populations. The framework promotes systems integration supported by research infrastructure and multi-sector collaboration to enhance the well-being of older adults and family caregivers. SUNSHINE places a strong emphasis on mental health, particularly depression, and highlights the importance of social connection and prevention in addressing health disparities and care gaps associated with aging. It conceptualizes resilience as both a desired outcome and a driver of transformation, guiding the redesign and evaluation of health and social systems. The framework also identifies opportunities to leverage artificial intelligence and machine learning (AI/ML) technologies, grounded in scientific evidence, to support personalized prevention, treatment, and care strategies. These technologies are critical for optimizing decision-making, improving care delivery, and enhancing system flexibility. Finally, SUNSHINE aspires to advance a future of aging that is healthy, resilient, and fair, guided by principles of equity, defined as fairness and impartiality in health opportunities and outcomes.

Research suggests that household social risks are associated with worse mental health in adolescents, but prior studies have been limited. We evaluated the association between social risks and symptoms of depression and anxiety in adolescents 1 year later by conducting a retrospective cohort study at an integrated health system with 45 practices. Adolescents were screened for depression using the Patient Health Questionnaire-2 (PHQ-2) and anxiety using the Generalized Anxiety Disorder-2 (GAD-2). Of the 4748 adolescents, 1220 (25.7%) had at least 1 social risk, 226 (5.7%) reported symptoms of depression, and 410 (10.2%) reported symptoms of anxiety. Adolescents in households with at least 1 social risk were more likely to report symptoms of depression (β = 0.15, 95% confidence interval [CI] = 0.07-0.23) and anxiety (β = 0.21, 95% CI = 0.11-0.31) and had greater odds of a positive PHQ-2 (odds ratio [OR] = 1.50, 95% CI = 1.12-2.01) and positive GAD-2 (OR = 1.57; 95% CI = 1.32, 1.87).