Fernanda Escobar

African immigrants in the U.S. face disproportionately high rates of HIV, yet existing services often lack alignment with their cultural and linguistic needs. Healthcare providers are rarely trained to address these gaps, contributing to persistent disparities in HIV prevention and care. Traditional in-house trainings for providers often have limited applicability. Collaborative, community-engaged approaches offer an opportunity to build culturally responsive, coordinated care. African Immigrant (AI) Health was a 5-year initiative integrating the Extension for Community Healthcare Outcomes model, Community of Practice model, and Commitment to Change (CtC) evaluation framework. We used an iterative process to improve the AI Health program based on participant feedback. Data were collected through pre/post-CtC questionnaires, case presentations, and discussion groups. CtCs were analyzed thematically and organized using the socioecological model. Over five years, 100+ providers enrolled, with 58 completing the program. Participants represented diverse healthcare roles, with a majority identifying as Black/African American (62%), female (81%), and residing in the Northeast region (57%). A total of 390 CtCs were developed, with the most common themes at the individual level. Most (54.5%) participants partially implemented their CtCs. Participants who implemented their CtCs reported improvements in culturally responsive care. Iterative adaptations enhanced engagement and retention. AI Health effectively supported providers in enhancing HIV care for African immigrants through culturally responsive training. Findings highlight the need for sustainable, longitudinal training models that integrate community expertise and call for policy and structural reforms to address systemic barriers to equitable HIV care.

Background: Deaf and hard of hearing (DHH) patients experience barriers to reproductive

healthcare and higher rates of adverse birth outcomes compared to their hearing peers.

Furthermore, perinatal clinicians are often ill-prepared to provide appropriate care for this

population. This qualitative research study explores the experiences and perspectives of

perinatal clinicians who have provided care for DHH patients to better understand barriers and

facilitators to providing optimal pregnancy-related healthcare.

Methods: Interviews were conducted with twelve perinatal clinicians from different specialties

with experience caring for DHH patients. This included nine semi-structured individual remote

interviews and one in-person focus group with 3 participants. A thematic analysis was

conducted.

Results: Eight obstetricians and four midwives participated in the study. Four major themes

emerged: (1) communication challenges and solutions, (2) training gaps, (3) implicit bias,

audism and patient mistrust and (4) limited resources to support DHH patients. Within each of

these major themes, we explored barriers that negatively impacted perinatal care and facilitators

that enhanced perinatal care. Communication difficulties were widely reported by clinicians and

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associated with inconsistencies in how accommodations were provided. Training and resources

for recommended communication and care practices for DHH patients were felt critical yet

lacking. Observed situations of implicit bias, audism and mistrust adversely affected perinatal

care quality and experiences for DHH patients. Lastly, clinicians reported knowledge gaps

among their DHH patients that complicated their ability to provide equitable care as providers.

Clinicians often struggled to locate accessible DHH perinatal resources.

Conclusions: Perinatal clinicians need to be more aware of DHH patients' communication and

support needs. Health care systems and training programs need to provide tools and training to

allow perinatal clinicians to effectively care for this population.

IntroductionThe ParentingWell Practice Approach is a family-focused practice approach for adults who are parents receiving mental health services. The ParentingWell Learning Collaborative (PWLC) was originally developed and tested within the Massachusetts behavioral health service system to prepare and support mental health practitioners in implementing ParentingWell. The purpose of the current study was to systematically adapt ParentingWell, including the PWLC, for further implementation and scaling-out in a new setting with a diverse target population, and address the following question: What are the essential considerations in adapting ParentingWell resources to a diverse, vulnerable, at-risk target population in an urban service delivery context?MethodsWe used a participatory approach, developmental evaluation design and mixed methods to document the adaptation process, and to assess preliminary acceptability, fit, and feasibility. The adaptation process included (1) establishment of an Adaptation Team consisting of a diverse and multi-disciplinary team of policy makers and practitioners; (2) review of ParentingWell content by community stakeholders; and (3) piloting of the PWLC model in the new context, with local agency personnel.ResultsThe Adaptation Team provided guidance related to enhancing the acceptability of ParentingWell and the PWLC, including considerations related to the training format and evaluation methods. Community stakeholders provided suggestions to strengthen the fit of ParentingWell resources, including the creation of plain language resources. Data from PWLC participants indicated that they benefitted from participation in the Learning Collaborative.DiscussionThis study provides preliminary evidence for the acceptability, fit, and feasibility of ParentingWell in an urban service context. Future research should include longitudinal data collection with both providers and parents to identify how providers use ParentingWell tools and strategies, and to evaluate the impact of ParentingWell on parents served and their children.

The current higher education financing regime sediments and exacerbates inequality, and student loans adversely affect the Black-White racial wealth gap. Black students—and students at for-profit universities, who are more likely to be students of color—often face the greatest challenges as they try to finance their degrees with student loans. They take on more loans, amass higher amounts of loans, and experience greater difficulty in paying off loans. Frequently without family financial wealth to support repayment and facing ongoing discrimination in the labor market,8 Black borrowers are much more likely to experience longterm financial insecurity due to student loans. Would anybody knowingly design a system where, two decades after starting college, many Black borrowers still are paying on virtually all of their student loans, while for the typical White borrower, a minimal debt burden remains? Would anybody knowingly design a system whereby 38 elite colleges have more students who come from families in the top 1 percent than students who come from the bottom 60 percent? Elite colleges, to be sure, historically served upper-class White males, yet access gained by
women and students of color has created only a lukewarm diversity in the context of today’s higher education financing regime.
This report highlights how student loans often create a long-term debt burden that blocks wealth accumulation, rendering mobility more fragile and impeding long-term security, particularly for young Black borrowers. While the crisis has grown nationally for all groups in recent years, the data below underscore that Black students are particularly harmed by the current student loan system. The role of higher education financing in contributing to the racial wealth gap and its widening are detailed in this report.

Occupational segregation results in racialized patterns in which people are distributed unequally across jobs in the labor market. The impact of this inequality goes far beyond paychecks. With incomes making up just about two-thirds of employee compensation, it is benefits that complete the entire employee compensation package. Historical legacy and contemporary employment practices concentrate Black and Latino working people disproportionately in jobs and industries stripped of or lacking in benefits that connect work to wealth and better livelihoods. For many employees, the workplace can be a crucial access point for asset-building opportunities through quality jobs that provide comprehensive employee compensation packages. However, Black and Latino workers face ongoing discrimination in hiring, higher unemployment rates, fewer sick days, and less workplace flexibility compared to White workers, which severely diminishes workplace stability and access to wealth-building benefits. To understand the institutional and policy mechanisms by which wealth is distributed and inequality worsened at the workplace, it is imperative that we identify and recognize how the total employment package—from income to benefits to additional workplace resources— contribute to growing inequality and the racial wealth gap. This report examines the impact of benefits disparities on the asset security of households of color. Our investigation results in a deeper understanding of the impacts of occupational segregation on access to workplace benefits, the racial wealth gap, and workers’ economic security.