We evaluated a case management intervention to increase treatment entry among injecting drug users referred from a needle exchange program (NEP). A randomized trial of a strengths based case management (intervention) versus passive referral (control) was conducted among NEP attenders requesting and receiving referrals to subsidized, publicly funded opiate agonist treatment programs in Baltimore, MD. Logistic regression identified predictors of treatment entry within 7 days, confirmed through treatment program records. Of 247 potential subjects, 245 (99%) participated. HIV prevalence was 19%. Overall, 34% entered treatment within 7 days (intervention: 40% versus control: 26%, p = 0.03). In a multivariate "intention to treat' model (i.e., ignoring the amount of case management actually received), those randomized to case management were more likely to enter treatment within 7 days. Additional 'as treated' analyses revealed that participants who received 30 min or more of case management within 7 days were 33% more likely to enter treatment and the active ingredient of case management activities was provision of transportation. These findings demonstrate the combined value of offering dedicated treatment referrals from NEP, case management and transportation in facilitating entry into drug abuse treatment. Such initiatives could be implemented at more than 140 needle exchange programs currently operating in the United States. These data also support the need for more accessible programs such as mobile or office-based drug abuse treatment.

To reduce a community's risk of injury and sustain this lowered risk, the community 'ecological system' must have access to the resources necessary to maintain the desired outcome and the ability to mobilise these resources.

We describe a vision of screening and intervention for Intimate Partner Violence informed by deliberations during the December 2013 Intimate Partner Violence Screening and Counseling Research Symposium and the resultant manuscripts featured in this special issue of the Journal of Women's Health. Our vision includes universal screening and intervention, when indicated, which occurs routinely as part of comprehensive physical and behavioral health services that are both patient centered and trauma informed. Areas for future research needed to realize this vision are discussed. 2 The evidence showing a substantial prevalence of IPV among women, both lifetime and recent, is clear, 2,3,4 as is the evidence that both current and past IPV are associated with immediate and long-term physical and mental health problems. [5][6][7] Tools to screen for IPV have been validated 3,8 and at least one has been formulated as an ''app'' (R3 app containing HITS*) 9 for easy use by clinicians. There is also considerable evidence supporting the efficacy of interventions for IPV in both community and health care settings as well as promising new electronic intervention strategies. 10Routine screening for IPV is supported by evidence, reflected in policy briefs by professional associations, 11,12 and endorsed by both abused and non-abused women in population-based and setting-specific studies. 4In response, the United States Department of Health and Human Services (DHHS) has supported programmatic activities designed to increase IPV prevention, improve services to those affected, and better understand the nature, extent, and sequelae of current and lifetime exposure to IPV.13 Within the context of these ongoing investments, and bolstered by the Affordable Care Act's commitment to preventive services for women, 14 including IPV screening and counseling, the DHHS Coordinating Committee for Women's Health convened the Intimate Partner Violence Screening and Counseling Research Symposium on December 9, 2013. 13 The goal of the Symposium was to identify research gaps related to IPV screening and counseling in primary healthcare settings and to identify and inform future research priorities to address these gaps, with the ultimate goal of informing guidelines, services and practice.1,13 The meeting demonstrated both the power and the possibility of a multi-agency, multi-sector approach to shaping, building, and strengthening the evidence base for IPV screening and intervention. Building on this foundation, the goals of this paper are twofold: (1) to describe a vision for the effective implementation of evidence-based IPV screening, assessment and intervention strategies based on the research featured in this special issue; and (2) to highlight specific research gaps that must be filled in order to realize that vision. Screening and Counseling for IPV: A VisionAdvocates and practitioners have long called for the implementation of effective IPV screening and intervention in healthcare settings. 15 The passage of the Affordable Care A...

Many evidence-based interventions (EBIs) have been developed to prevent or treat major health conditions. However, many EBIs have exhibited limited adoption, reach, and sustainability when implemented in diverse community settings. This limitation is especially pronounced in low-resource settings that serve health disparity populations. Often, practitioners identify problems with existing EBIs originally developed and tested with populations different from their target population and introduce needed adaptations to make the intervention more suitable. Although some EBIs have been extensively adapted for diverse populations and evaluated, most local adaptations to improve fit for health disparity populations are not well documented or evaluated. As a result, empirical evidence is often lacking regarding the potential effectiveness of specific adaptations practitioners may be considering. We advocate an expansion in the emphasis of adaptation research from researcher-led interventions to research that informs practitioner-led adaptations. By presenting a research vision and strategies needed to build this area of science, we aim to inform research that facilitates successful adaptation and equitable implementation and delivery of EBIs that reduce health disparities.