Schuler Brittany R, Shipe Stacey L, Uhl Astrid, Smith Samantha, Majeed LaShanta, O'Reilly Nicole, Carter Cheri, Collins Bradley N
School of Social Work, College of Public Health, Temple University, 1301 Cecil B. Moore Ave., Ritter Annex 549, Philadelphia, PA 19122, USA.
Social Work, Binghamton University, State University of New York, University Downtown Center, 67 Washington St., Binghamton, NY 13902, USA.
Int J Environ Res Public Health. 2025 Apr 2;22(4):550. doi: 10.3390/ijerph22040550.
Health equity is shaped by multiple factors intersecting with service delivery in community-based organizations (CBOs). Providers in under-resourced areas are often the first point of contact for families seeking child development, mental health, and behavioral support. However, system-level barriers hinder service delivery and access. This study explores provider perspectives to identify barriers and inform system-level changes that promote equity in child and family health. Using a narrative qualitative design, in-depth interviews were conducted with 21 health and mental health professionals from child- and family-serving CBOs. Guided by ecological and strengths-based frameworks, interviews examined provider insights on challenges, strengths, and supports affecting service delivery. Key themes emerged across macro (rights-based policies, racism/oppression), community (environmental impacts, social cohesion), organizational (secondary stress, system fragmentation, provider supports), and family levels (basic needs, parenting support, service access). Findings highlight the need for a multilevel approach that prioritizes rights-based policies, strengthens community cohesion, and improves system integration. Enhancing CBO capacity to address these determinants could advance equity-oriented service delivery and mitigate structural barriers that perpetuate health disparities.
健康公平受到多种因素的影响，这些因素与社区组织（CBO）的服务提供相互交织。资源匮乏地区的服务提供者往往是寻求儿童发展、心理健康和行为支持的家庭的第一接触点。然而，系统层面的障碍阻碍了服务的提供和获取。本研究探讨服务提供者的观点，以识别障碍并为促进儿童和家庭健康公平的系统层面变革提供信息。采用叙事性定性设计，对来自为儿童和家庭服务的社区组织的21名健康和心理健康专业人员进行了深入访谈。在生态和优势为本的框架指导下，访谈考察了服务提供者对影响服务提供的挑战、优势和支持的见解。关键主题出现在宏观（基于权利的政策、种族主义/压迫）、社区（环境影响、社会凝聚力）、组织（继发性压力、系统碎片化、服务提供者支持）和家庭层面（基本需求、育儿支持、服务获取）。研究结果强调需要采取多层次方法，优先考虑基于权利的政策，加强社区凝聚力，并改善系统整合。提高社区组织应对这些决定因素的能力可以推进以公平为导向的服务提供，并减轻长期存在健康差距的结构性障碍。
