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Stimulant-involved overdose deaths: Constructing dynamic hypotheses

INTERNATIONAL JOURNAL OF DRUG POLICY 2025年 136卷 104702-104702页

作者： Hasgul, Zeynep Deutsch, Arielle R. Jalali, Mohammad S. Stringfellow, Erin J. Harvard Med Sch MGH Inst Technol Assessment Boston MA 02114 USA Avera Hlth Avera Res Inst Sioux Falls SD 57108 USA

The overdose epidemic in the United States is evolving, with a rise in stimulant (cocaine and/or methamphetamine)-only and opioid and stimulant-involved overdose deaths for reasons that remain unclear. We conducted interviews and group model building workshops in Massachusetts and South Dakota. Building on these data and extant research, we identified six dynamic hypotheses, explaining changes in stimulant-involved overdose trends, visualized using causal loop diagrams. For stimulant- and opioid-involved overdose deaths, three dynamic hypotheses emerged: (1) accidental exposure to fentanyl from stimulants;(2) primary stimulant users increasingly using opioids, often with resignation;(3) primary opioid (especially fentanyl) users increasingly using stimulants to balance the sedating effect of fentanyl. For stimulant-only overdose deaths, three additional dynamic hypotheses emerged: (1) disbelief that death could occur from stimulants alone, and doubt in testing capabilities to detect fentanyl;(2) the stimulant supply has changed, leading to higher unpredictability and thus higher overdose risk;and (3) long-term stimulant use contributing to deteriorating health and increasing overdose risk. These hypotheses likely each explain a portion of the recent trends in stimulant- involved overdoses. However, confusion and uncertainty around the drug supply emerged as a central theme, underscoring the chaotic and unpredictable nature of the stimulant market. Our findings indicate the need for research to develop targeted public health interventions, including analyzing the extent of the effect of contamination on overdoses, reducing confusion about the stimulant supply, and examining historical stimulant use trends.

关键词： Stimulant overdose deaths Polysubstance use Dynamic hypothesis systems perspective community-based system dynamics

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A systemic approach to identifying sustainable community-based interventions for improving adolescent mental health: a participatory group model building and design protocol

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HEALTH RESEARCH POLICY AND systemS 2025年第1期23卷 1-15页

作者： Keenan, Megan Freeman, Leanne de Lima, Ediane Santana Potter, Katie Hobbs, Tim Ballard, Ellis Fonagy, Peter UCL Dartington Serv Design Lab London England Dartington Serv Design Lab Buckfastleigh England Washington Univ St Louis Brown Sch St Louis MO USA UCL London England

BackgroundThe deteriorating mental health of children and young people in the United Kingdom poses a challenge that services and policy makers have found difficult to tackle. Kailo responds to this issue with a community-based participatory and systemically informed strategy, perceiving mental health and well-being as a dynamic state shaped by the interplay of broader health determinants. The initiative works to explore, define and implement locally relevant solutions to challenges shaping the mental health and well-being of young people. Kailo unfolds in three stages within each locale. These stages encompass: "early discovery", "deeper discovery and co-design" and "implementation". This document delves into the participatory group model building and design protocol occurring in the "deeper discovery and co-design" stage of the *** methods, such as group model building, are effective in articulating and building consensus on complex issues like the social determinants of adolescent mental health. This paper describes the protocol for application of group model building within the Kailo design process to develop causal loop diagrams and pinpoint leverage points for improving adolescent mental health. It also suggests a method for considering modifications to delivery within a unique project context and in alignment with participants' needs. This paper sets out to define the approach and clarify the objectives these engagements aim to fulfil. The method adapts existing group model building (GMB) protocols for use in a community setting. The engagements will involve groups of local young people and existing community members. To assess the success of the session's implementation post-delivery, the study utilizes existing frameworks for fidelity evaluations, which define a core and flex *** method described enables an integration of diverse local understandings of complex processes which provides a platform for creating co-desig

关键词： Mental health Children and young people community-based system dynamics Human-centred design Social determinants Place-based

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dynamics of prescribing and accessing medications for opioid use disorder: a community-based systems analysis

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ADDICTION RESEARCH & THEORY 2025年第3期33卷 231-242页

作者： Herman, Tianna Hasgul, Zeynep Lim, Tse Yang Jalali, Mohammad S. Stringfellow, Erin J. Harvard Med Sch MGH Inst Technol Assessment Boston MA 02115 USA Harvard TH Chan Sch Publ Hlth Dept Epidemiol Boston MA USA

BackgroundAlthough medications for opioid use disorder (MOUD) are effective for treating opioid use disorder (OUD), persistent barriers still prevent patients from accessing this life-saving care. Policies to increase MOUD access have produced suboptimal results. This study presents a qualitative system dynamics model that elucidates the complexities of accessing and staying in MOUD *** utilized a community-based system dynamics approach to modeling the MOUD treatment system. We engaged a cohort of system experts/stakeholders, including individuals who had received MOUD, treatment providers, and policymakers, in interviews and group model building to develop and refine a simulation model. We then created a qualitative causal loop diagram based on insights gained while developing the simulation model and a review of interview *** causal loop diagram captures four key factors affecting treatment initiation, retention, and leaving: (1) fraught interactions between patients and healthcare providers;(2) stigma-driven regulation of MOUD creating a culture of fear and defensive medicine;(3) a punitive culture in clinics and opioid treatment programs offering MOUD;and (4) the internalization of the abstinence narrative contributing to premature termination of *** analysis highlights how interdependent and non-linear feedback processes diminish or counteract the effectiveness and sustainability of MOUD policy interventions. Due to system memory and cultural resistance to change, even rolling back reactionary policies may do little to curb established behavioral patterns. In addition, conflicting and competing strategies among various actors within the system contribute to goal misalignment and a lack of standardization of care.

关键词： Medications for opioid use disorder community-based system dynamics opioid use disorder group model building opioid epidemic causal loop diagram

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Measuring Shifts in Mental Models in the Prevention of Childhood Obesity in Rural Australia

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HEALTH EDUCATION & BEHAVIOR 2023年第5期50卷 662-670页

作者： Felmingham, Tiana Bolton, Kristy A. Fraser, Penny Allender, Steven Brown, Andrew D. Deakin Univ Geelong Vic Australia Deakin Univ Inst Hlth Transformat Global Ctr Prevent Hlth & Nutr GLOBE Sch Hlth & Social Dev 221 Burwood Highway Geelong Vic 3125 Australia

Group model building is a participatory workshop technique used in system dynamics for developing community consensus to address complex problems by consensus building on individual assumptions. This study examines changes in individual mental models of the complex problem of childhood obesity following participation in group model building (GMB), as part of a larger community-based system dynamics project. Data are drawn from GMB participants across six community sites in the Whole of systems Trial of Prevention Strategies for Childhood Obesity (WHO STOPS) in rural and regional Victoria, Australia. Each community participated in two GMB sessions resulting in a causal loop diagram (CLD) of drivers of childhood obesity for each community. Presurvey and postsurvey captured participants' perspectives before and after (n = 25) participation in both GMB sessions and a blend of inductive and deductive qualitative content analysis was used to code individual responses. Three calculations were used to determine the number of responses, whether responses were a result of persuasion from others, and comparison of responses to those found in the CLD. Our study found participant mental models shifted during the course of the GMB sessions, with some responses persuaded by others and 75% of new insights identified in CLDs created by communities. The GMB process created a platform for participants to share ideas and learn from each other. In addition, participants listed new insights about childhood obesity in their community through developing CLDs.

关键词： childhood obesity systems thinking community-based system dynamics mental models prevention

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How the Senior community Service Employment Program Influences Participant Well-Being: A Participatory Research Approach With Program Recommendations

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RESEARCH ON AGING 2023年第1期45卷 77-91页

作者： Halvorsen, Cal J. Werner, Kelsey McColloch, Elizabeth Yulikova, Olga Boston Coll Sch Social Work 140 Commonwealth Ave Chestnut Hill MA 02467 USA Boston Coll Ctr Aging & Work Chestnut Hill MA 02467 USA Boston Coll Ctr Social Innovat Chestnut Hill MA 02467 USA Massachusetts Execut Off Elder Affairs Boston MA USA

The federal Senior community Service Employment Program (SCSEP) provides on-the-job training to people 55 years and older with incomes at or below 125% of the federal poverty level with multiple barriers to employment. This study examined the processes by which SCSEP may influence participant financial, physical, and mental well-being. We engaged 15 SCSEP participants and case managers over four virtual and one telephone session using a participatory research method called community-based system dynamics. Activities included identifying key problem trends, variable elicitation, developing a causal map, and identifying changes to the system to increase participant well-being. Respondents identified how individual, organizational, and program and policy factors relate to participant well-being (e.g., SCSEP participation reduces social isolation, which increases desire to participate) and suggested program and policy recommendations to strengthen SCSEP (e.g., benchmarks of success should include health and well-being outcomes). These findings highlight the benefits and potential of this long-running program.

关键词： older workers job training federal policy workforce issues senior community service employment program community-based system dynamics

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A Child-Centred Care Approach to the Learning Process: Lessons Learned from a Participatory Intervention in Primary Schools in Afghanistan and Pakistan

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JOURNAL OF HUMAN DEVELOPMENT AND CAPABILITIES 2025年第2期26卷 306-315页

作者： Bakhshi, Parul Taff, Steve Trani, Jean-Francois Washington Univ St Louis Occupat Therapy St Louis MO USA Washington Univ St Louis Sch Med St Louis MO USA Washington Univ St Louis Brown Sch 1 Brookings Dr St Louis MO 63130 USA Washington Univ Inst Publ Hlth 1 Brookings Dr St Louis MO 63130 USA Natl Conservatory Arts & Crafts Lab Sociol Econ Paris France Univ Johannesburg Dept Psychol Johannesburg South Africa

About 240 million children have disabilities globally. Sustainable Development Goal 4 calls for inclusive and equitable quality education for all, including children with disabilities. Compared to children without disabilities, children with disabilities are more likely to never attend school or to drop out from school due to barriers such as negative attitudes among teachers, parents and peers, lack of trained teachers, inadequate learning materials and inaccessible facilities. Our study examines the effect of a participatory child-centred pedagogy intervention on academic and non-academic learning outcomes of children with disabilities in primary rural schools of Afghanistan and Pakistan. We use an ICF-based disability measure, the Child Functioning Module, to identify children with disabilities. We built a participatory intervention on the ethics of care and the capability approach that aimed at improving the learning process. It did not significantly improve the learning outcomes of children with disabilities compared to non-disabled children. However, we found that children with disabilities overall progressed significantly more than non-disabled children on several learning outcomes while benefiting from a larger reduction in stigma and discrimination. The impact was secured overall for children despite school lockdowns associated with the COVID-19 pandemic and political unrest in both countries. Therefore, we argue that this type of intervention could potentially improve the inclusion of children with disabilities in school with more time for implementation and circumstances allowing schools to stay opened.

关键词： Capability Approach children with disabilities primary education Afghanistan Pakistan community-based system dynamics

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Developing Group Model-Building Workshops for Children's Healthy Living Food systems

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CURRENT DEVELOPMENTS IN NUTRITION 2025年第4期9卷 104583-104583页

作者： Hovmand, Peter S. Franck, Karen Butel, Jean Galbreath, Jennifer Esquivel, Monica Coleman, Patricia Aflague, Tanisha Shallcross, Leslie Ogland-Hand, Callie Oshiro, Jordan Belyeu-Camacho, Tayna Sikes, Amelia Novotny, Rachel Case Western Reserve Univ Div Med Sci Cleveland OH USA Univ Tennessee Dept Family & Consumer Sci Knoxville TN USA Univ Hawaii Manoa Dept Human Nutr Food & Anim Sci Honolulu HI 96822 USA Northern Marianas Coll Cooperat Res Extens & Educ Serv Saipan CM USA Univ Guam Cooperat Extens & Outreach Mangilao GU USA Univ Alaska Fairbanks Cooperat Extens Serv Fairbanks AK USA

This article reports on the development of group model-building workshops for understanding children's nutrition and health as a complex adaptive system. A community-based system dynamics approach was used to conduct workshops in 5 United States-Affiliated Pacific jurisdictions as part of the Children's Healthy Living Food systems project from October 2022 to March 2023. Workshops were cofacilitated by local teams using a facilitation guide with a series of structured small-group exercises or "scripts" and evaluated using a pre-post participant survey. Products generated through these workshops included causal maps of the food systems driving child nutrition and health and prioritized action ideas that can be used to inform program design, planning, and implementation of local initiatives. Workshop evaluation highlights the robustness of workshops across jurisdictions, cultural contexts, and varied experiences of facilitation teams. Implications for the future development of group model-building facilitation guides and child nutrition are discussed.

关键词： child diet nutrition group model building community-based system dynamics food systems

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dynamics of participation: system dynamics and participation-An empirical review

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systemS RESEARCH AND BEHAVIORAL SCIENCE 2019年第2期36卷 199-210页

作者： Kiraly, Gabor Miskolczi, Peter Corvinus Univ Budapest Budapest Business Sch Budapest Hungary Corvinus Univ Budapest Inst Sociol & Social Policy Budapest Hungary Corvinus Univ Budapest Doctoral Sch Sociol Budapest Hungary

The practice of participation has gained prominence in several disciplines recently. The present study discusses how participation meets system dynamics, a particular modelling method, which looks at complex systems from an endogenous viewpoint. system dynamics has always oriented itself towards practical problems and engaged with clients actively. This tradition is represented in contemporary participatory methods. We can underpin the involvement of stakeholders in a number of ways: with normative arguments (participation is a democratic right), substantive (involvement produces better knowledge), instrumental (participation improves the chance of success), and transformative ones (improvement of social capital). We discuss three schools of participatory system dynamics. First, group model building, a professional and practical method. Next, participatory system dynamics modelling, which is rooted in public policy decisions and aims to involve stakeholders actively. Finally, community-based system dynamics aims for the empowerment of communities, with long-term deep commitment on the part of the researcher.

关键词： community-based system dynamics group model building participation participatory system dynamics modelling system dynamics

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