The research team, led by Citra Windani Mambang Sari of the Doctoral Program in Medical Science and the Department of Community Health Nursing at Universitas Padjadjaran, used a sequential model-development design. Rather than testing a finished intervention, the study focused on the crucial early stages of building one: synthesising existing concepts, drafting the model and its supporting modules, submitting them to multidisciplinary expert scrutiny, refining the materials and finally checking whether the intended users could actually read and use them. This staged approach reflects a growing recognition in implementation science that interventions fail in the field far more often because of weak design and validation than because of poor ideas.

The intellectual architecture of the model draws on several complementary frameworks. The researchers integrated the Functional Consequences framework, which foregrounds how diabetes and its treatments interact with age-related changes in function; King’s Goal Attainment Theory, which frames care as a negotiated process in which nurse and patient jointly set and pursue goals; and Meiqari and colleagues’ continuity-of-care framework, which maps the informational, management and relational dimensions of seamless care. These theoretical anchors were combined with unpublished formative project findings, focus group discussions with community nurses, and systematic review evidence on continuity-of-care strategies for older adults with diabetes across Asia. The result is a model grounded simultaneously in theory, local practice experience and the best available regional evidence.

What emerged from this synthesis is a comprehensive care package in which the community nurse acts as the coordinating hub. Under the model, the nurse orchestrates physician-led structured diabetes education, shared goal setting with the patient, interprofessional home visits carried out by community nurses working alongside nutritionists and pharmacists, telephone follow-up with patients, multidisciplinary case conferences, family follow-up, and dedicated education sessions for patients and their families. Each element targets a known weak point in fragmented primary care: education that ends at the clinic door, home environments that health professionals never see, families left without guidance, and specialists and generalists who never compare notes.

Validation was handled with quantitative precision. Twelve purposively selected multidisciplinary experts — spanning community and primary care nursing, programme leadership, academia, medicine, pharmacy and geriatric diabetes care, each meeting predefined eligibility criteria — rated the model book and two accompanying modules on a four-point scale. The researchers quantified agreement using the item-level content validity index, calculated as the proportion of experts rating an item 3 or 4, and the scale-level content validity index average, with an acceptability threshold set in advance at 0.90 or above. The results were striking: because no expert rated any item below 3, every item-level index reached 1.00, and the scale-level average was 1.00 for all three instruments. Mean item scores stood at 3.86 for the model book, 3.82 for the older-adult and family module, and 3.90 for the health-worker module.

A perfect validity score is rare in instrument development, and its significance deserves careful reading. It indicates unanimous expert endorsement that the model’s content is relevant, clear and appropriate for its purpose — not that the model has been proven to work. The authors are explicit on this point, noting that the findings support progression to pilot and feasibility testing but do not establish implementation feasibility or clinical effectiveness. That distinction matters for readers weighing the study’s implications: content validation is a gate through which promising interventions must pass, but it is the first gate, not the last.

The team also tested whether the materials would be usable by the people expected to rely on them. Twenty-two intended users — twelve health workers and ten older adults with diabetes — completed structured readability and practicality appraisals, with items scored as a percentage of the maximum possible. The health-worker module scored 90.52 percent and the older-adult and family module scored 97.13 percent; both fell within the appraisal instrument’s defined category of very practical, which requires scores above 81.25 percent. For a module designed to be read and acted upon by older patients and their families, a practicality score approaching 97 percent is a notable signal that the materials communicate in language and formats that real users can navigate.

Expert scrutiny was not merely confirmatory; it shaped the model. Feedback from the panel informed refinements across a wide range of content areas, including the scope of primary care activities, the implementation flow of the model, the delineation of interprofessional roles, the involvement of family members, telehealth monitoring, emergency action guidance, nutrition, medication management, foot care and stress-management content. This iterative refinement loop — draft, rate, revise — is precisely what content validation is designed to achieve, converting the collective judgement of a multidisciplinary panel into concrete improvements before any patient encounters the intervention in routine care.

The study’s context gives it broader resonance. Indonesia’s population is ageing rapidly, and community health centres are the frontline for chronic disease management for millions of older people. Diabetes care in later life demands coordination across time and across professions, yet the components that deliver it — education, follow-up, home visiting, referral, family engagement and interprofessional communication — often operate in silos. A model that positions the community nurse as the connective tissue, supported by explicit modules for both health workers and families, offers a structurally plausible answer to a systems problem rather than a purely clinical one. The two-day training curriculum and twelve-week intervention pathway documented in the study’s supplementary materials suggest the team has already thought through how the model would be operationalised on the ground.

The researchers are careful to frame what comes next. The readability and practicality scores represent preliminary user appraisal among a sampled group of intended users and do not establish practicality in routine care. Future studies, the authors write, should assess caregiver usability, feasibility, fidelity, acceptability, workforce and resource requirements, and the model’s effects on self-management, glycaemic outcomes as measured by markers such as HbA1c, and functional well-being. Ethics approval for the work was granted by the Health Research Ethics Committee of Universitas Padjadjaran, and the publication was supported by Universitas Padjadjaran through the Indonesian Endowment Fund for Education under the EQUITY Program, with the funder playing no role in study design or reporting. If subsequent pilot and feasibility studies bear out the promise suggested by the unanimous expert endorsement and near-perfect practicality scores, Indonesia may gain a replicable template for nurse-led chronic care coordination — one built not on imported assumptions but on the realities of its own primary care system and the lived circumstances of its older patients and their families.

Subject of Research: Nurse-led continuity of care model development and content validation for older adults with type 2 diabetes in Indonesian primary care

Article Title: Development and content validation of a nurse-led continuity of care model for older adults with type 2 diabetes in Indonesian primary care

Article References: Sari, C. W. M., Haroen, H., Juniarti, N., Amalia, L., & Pardosi, J. F. (2026). Development and content validation of a nurse-led continuity of care model for older adults with type 2 diabetes in Indonesian primary care. BMC Nursing. https://doi.org/10.1186/s12912-026-05432-y

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05432-y

Keywords: continuity of care, community nursing, older adults, type 2 diabetes, primary care, model development, content validity, self-management, Indonesia, interprofessional care, family engagement, nurse-led care

The schools at the heart of the study are part of an international network spanning Spain, Portugal and Latin American countries including Chile, Brazil and Peru. Many serve socio-economically deprived neighbourhoods, yet they have produced extraordinary outcomes. The European Commission has recommended their model as a successful approach to preventing early school leaving and improving school performance. At the core of the model are seven Successful Educational Actions: Dialogic Gatherings, Interactive Groups, Family Education, Educational Participation of the Community, a Dialogic Model for Prevention and Conflict Resolution, Dialogic Pedagogical Training, and Extended Learning Time. More than 15,000 schools worldwide now run Dialogic Literary Gatherings, one of the most widely replicated actions.

What has remained under-researched, the authors argue, is the specific role of the principal in these transformations. Educational leadership research has long documented the effects of shared, distributed, instructional and transformational leadership models on achievement in areas such as mathematics and reading. Landmark reviews, including the influential analysis by York-Barr and Duke on teacher leadership, identified parental and community involvement as a key dimension of school leadership practice, and OECD studies have concluded that school leaders contribute most when they work successfully beyond their institution’s borders. Dialogic leadership, the process through which the leadership practices of all members of the educational community are created, developed and consolidated, has received far less empirical attention.

To fill that gap, the research team used Communicative Methodology, an approach that treats knowledge as dialogically constructed and requires researchers to contrast scientific expertise with the lived perspectives of social agents. The methodology has a distinguished pedigree, having been deployed in the European Union-funded INCLUD-ED project, which identified the Successful Educational Actions that improved student outcomes across Europe. The team selected ten schools, seven elementary, one special education and two secondary, chosen to capture diversity in size, location, socio-economic status and the length of time each had operated as a Learning Community, from under five years to more than twenty. One school was in Brazil, chosen for the director’s extensive experience in secondary education. Semi-structured, open-ended interviews were conducted with each principal, and the transcripts were analysed inductively, identifying critical episodes and grouping them into themes while attending to both obstacles and transformative dimensions.

The first major finding is that these principals exercise leadership within and beyond the school walls. Marta, who leads a large urban school, described the difference starkly: the defining feature of a Learning Community is its openness, with every action projecting outside the school because relatives and volunteers permanently observe and collaborate in the work, turning the environment into what she called an ally in teaching. Joan, another principal, described going out of the school door every morning to talk with community members about everything from the weather to letters from the town hall they did not understand, building the trust that later draws them into the classroom.

The transformative power of that trust is captured in one of the study’s most vivid episodes. Joan recounted a grandmother who initially dismissed the school project with frustration, reluctant to enter because she had never studied and did not feel safe among teachers. She began by spending time in the library, where activities extended learning time for students and families. Through dialogue with teachers, her participation gradually expanded until she was attending Interactive Groups twice a week and contributing significantly to the school community. Her story illustrates how egalitarian dialogue can convert scepticism into engagement, and engagement into leadership.

The principals also created formal structures that distribute leadership across the whole community. Silvia described the mixed committees, management boards composed of teachers, pupils, parents and other community members, as essential shared spaces where everyone can freely express ideas and, where necessary, take decisions. Since her school became a Learning Community and adopted these committees, pupil performance improved by 58 percent within five years. In Brazil, Ana reported that mixed committees in her large urban school, serving a predominantly African Brazilian community in a very poor area, gave space to the voices of students and families in daily decisions, whereas she previously had to make decisions alone. Patricia, leading a small rural school in Spain, asks parents and even children for advice, sometimes posing the question of what they would do if they were the principal, and finds their contributions sharpen her own reflection.

The second theme concerns how this dialogic leadership produces school improvement and social transformation. The principals described deliberately involving teachers in shaping the school programme; Marta noted that she sometimes leaves her proposals incomplete so that colleagues intervene and take responsibility for writing them, a slower process that yields a programme created by everyone. Leadership grounded in equity also emerged as a recurring principle: the principals spoke of re-situating themselves in more equal relationships built on dialogue, honesty and argumentation, reaching broad consensus through debate with all members of the community. Miren, whose school has run the Learning Communities project since 1995, defined leadership as transmitting trust and enthusiasm and ensuring that everyone feels like a protagonist.

Crucially, the leadership in these schools is anchored in scientific evidence rather than charisma alone. Miren recalled the training session in which researchers explained egalitarian dialogue, cultural intelligence, transformation instead of adaptation, and equality of differences, a sentence in particular striking her: the school you want for your children is the school for all. That experience changed her teaching practices and led her to become principal. Patricia, whose school joined the project only two years ago, reported that reading the scientific evidence made her stronger and better able to put the principles into practice daily. The enthusiasm of the most experienced principals, sustained over twelve and fourteen years, is nourished by results, by what Silvia called credible solutions reflecting the direct experience of children’s success.

The study is not without limits. The evidence rests on ten schools, and the authors acknowledge that a larger sample would strengthen the findings, though the qualitative and communicative approach allowed them to identify transferable elements across urban and rural, public and private, and cross-cultural settings. Newly appointed principals also flagged risks to sustainability: turnover in teaching staff and new teachers unfamiliar with the scientific basis of the project. Yet experienced leaders pointed to a built-in safeguard, because leadership developed among families and pupils endures; mothers from minority groups support new teachers, and children explain to newcomers how the interactive groups and coexistence committees work. The authors conclude that dialogic leadership enhances participants’ sense of self-efficacy and connection to the task, demonstrating that with egalitarian dialogue the school context can be transformed and that efforts to guarantee educational success for all children are worthwhile.

Subject of Research: Dialogic leadership practices of principals in schools as Learning Communities

Article Title: Leading schools through dialogue: the role of principals in schools as Learning Communities

Article References: Leading schools through dialogue: the role of principals in schools as Learning Communities. (n.d.). https://doi.org/10.1007/s44322-025-00033-0

Image Credits: AI Generated

DOI: 10.1007/s44322-025-00033-0

Keywords: dialogic leadership, school principals, Learning Communities, Successful Educational Actions, educational leadership, school improvement, community participation, social cohesion, egalitarian dialogue, family engagement, Communicative Methodology, educational equity

The stakes of this gap are considerable. Serious emotional disturbance, defined as a mental, behavioral, or emotional disorder diagnosed before age 18 that causes significant functional impairment in family, school, and community life, affects an estimated 7 to 12 percent of the total U.S. youth population. Left untreated, these conditions carry a cascade of risks: school dropout, involvement with the juvenile justice system, repeated hospitalizations, and long-term residential placement. Roughly one-third of children with serious emotional disturbance also live with a chronic physical illness, with asthma the most common comorbidity. For families, the toll extends to relationships, employment, income, and physical health, and children with mental health disorders account for a remarkable 55 percent of Medicaid spending among 3-to-17-year-olds.

The Behavioral Health Home model was created under Section 2703 of the Affordable Care Act in 2010 as a way to knit together fragmented care. Its intellectual roots reach back to the Patient Centered Medical Home, a concept the American Academy of Pediatrics developed in the 1960s, but the Medicaid version targets high-need, high-cost populations and focuses on integrating mental, physical, and social care. The model pursues the so-called triple aim—better population health, better care quality, and lower costs—by embedding primary care services into community behavioral health settings, where many people with mental illness receive most of their care. Core components include preventive services, care coordination, population health management, transitional care, patient and family support, and referrals to community and social supports.

Typically nurse-led and team-based, though not standardized, the model gives states wide flexibility in design. Caseworkers, mental health counselors, psychiatrists, and peer support providers often play central roles, physician consultation is required, and expanded hours and service locations aim to improve access. Because federal rules require states offering health homes for serious mental health conditions to serve both adults and children, youth are enrolled in substantial numbers: roughly 20 percent of enrollment in Missouri, 13 percent in Maryland, and, under a dedicated State Plan Amendment, 100 percent of a Rhode Island program for children and youth with special healthcare needs.

Yet the evidence base underpinning the model was built almost entirely on adults with serious mental illness. Randomized trials and evaluations in adult populations have linked behavioral health home participation to improved primary care access, better screening and monitoring of cardiometabolic conditions, healthcare savings, reduced inpatient utilization, and higher patient satisfaction. But other comprehensive reviews found no significant effects on diabetes control, weight management, or smoking cessation, and only modest reductions in cardiometabolic risk with wide variability across studies. Researchers attribute these mixed real-world results to variations in implementation and the highly context-specific nature of a multilevel, multisystem intervention. Documented barriers in adult implementations include increased administrative load, financial constraints, difficulties with patient recruitment and retention, staffing problems, health information technology challenges, and misalignment between the model’s values and those of the host community mental health center.

Crucially, the review’s authors argue that children are not simply small adults in this context. Children with serious emotional disturbance typically have shorter enrollment periods, since their conditions often resolve with proper care, whereas adult behavioral health homes are designed as lifetime homes. Prevention carries greater weight in pediatric care, and children generally have fewer comorbid conditions. Most importantly, care coordination differs fundamentally: adult coordinators work mainly with primary and specialty medical providers, while children require coordination across child welfare, juvenile justice, and special education systems, each governed by legal mandates such as expedited health evaluations for children entering foster care. And where adult care is person-centered, pediatric care must be patient and family centered, incorporating the social and economic needs of the whole household.

The review itself followed rigorous PRISMA guidelines, with a protocol registered in PROSPERO. The team searched PubMed, CINAHL, and PsycINFO for studies published from 2010 through mid-2026, supplemented by a targeted gray literature search of state Medicaid agency websites and reports from policy research organizations. After removing 1,529 duplicates, reviewers screened 3,171 titles and abstracts, excluding 3,144 as unrelated to the intervention, focused on adults, or non-empirical. Twenty-seven full-text articles underwent independent dual review, and all 27 were excluded—most because they studied related integrated care models rather than the Medicaid Behavioral Health Home itself. Fifteen gray literature documents, including state program reports and evaluations from organizations such as the Urban Institute, were also assessed and all excluded for reasons ranging from unrelated outcomes to insufficient methodological rigor. Data extraction and coding using the Consolidated Framework for Implementation Research, the planned analytical lens, proved impossible because there was nothing to extract.

A null result of this kind is not a dead end but a redirection. Drawing on adjacent literatures—adult behavioral health homes, pediatric integrated care, and evidence-based parenting programs—the authors identify three likely battlegrounds for youth implementation. The first is family engagement. Unlike adult models, pediatric care depends on caregivers as the prime movers of treatment: they set routines around diet, sleep, and activity, model healthy behavior, and maintain continuity of care. Unmet caregiver psychosocial needs, stigma, distrust of health systems, fear of child welfare involvement, chaotic routines, and frequent residential moves all demonstrably reduce engagement in related programs. The authors suggest embedding family support providers with lived experience into care teams, giving program managers flexible assistance funds for urgent needs like transportation or utility bills, and pursuing broader policies on caregiver Medicaid coverage, housing, and childcare.

The second battleground is cross-system coordination. Adult implementation studies document fragmented organizational relationships, difficulty engaging primary care providers, inconsistent communication, and weak external partnerships—and colocation of services or data exchange alone proved insufficient to ensure coordination. For children, where coordination must extend into schools and courts, these challenges are likely amplified. Emerging evidence points to facilitators such as alternative payment models like Vermont’s hub-and-spoke structure and collaborative agreements emphasizing shared purpose, as seen in Ohio. The third battleground is measurement. The mandatory Health Home Core Set of quality measures skews toward adult-relevant indicators: Missouri’s 2024 pediatric measures included asthma medication adherence, diabetes control, and tobacco use, which capture only a sliver of enrolled youth. The authors point to promising alternatives, including North Carolina’s Integrated Care for Kids program, school attendance data sharing led by Children’s National Hospital, and cross-sector outcomes such as recidivism used by Multisystemic Therapy. Looking forward, they call for research grounded in implementation frameworks like the CFIR, hybrid effectiveness-implementation designs, and multi-axis conceptions of integration spanning vertical, horizontal, and longitudinal dimensions. Until such studies exist, the fate of a model serving some of the nation’s most vulnerable children rests on evidence borrowed from adults.

Subject of Research: Implementation barriers and facilitators of the Medicaid Behavioral Health Home model for children with serious emotional disturbance

Article Title: Opportunities to Strengthen Implementation of the Medicaid Behavioral Health Home Model for Children with Serious Emotional Disturbance: A Systematic Review

Article References: Winning Verry, T., Eisen, S., Farabi, S., Lengnick-Hall, R., & Dell, N. A. (2026). Opportunities to Strengthen Implementation of the Medicaid Behavioral Health Home Model for Children with Serious Emotional Disturbance: A Systematic Review. Community Mental Health Journal. https://doi.org/10.1007/s10597-026-01709-3

Image Credits: AI Generated

DOI: 10.1007/s10597-026-01709-3

Keywords: Medicaid, Behavioral Health Home, serious emotional disturbance, children's mental health, integrated care, care coordination, implementation science, Affordable Care Act, family engagement, health services research, systematic review, population health

The study, published in the Early Childhood Education Journal, was conducted by Jennifer K. Chapman of McLennan Community College, Jes Fyall Cardenas of the University of North Carolina-Wilmington, and Malinda J. Colwell of Texas Tech University. Drawing on ecological systems theory and Ramona Mercer’s Maternal Role Attainment theory, the researchers set out to compare how first-time and second-time mothers experience the transition into formal child care, and how that experience is shaped by the quality of their collaborative relationship with the non-parental caregiver who cares for their child each day.

The theoretical framing matters. Bronfenbrenner’s ecological systems theory positions the parent-educator relationship as a microsystem interface, a place where two of the child’s most influential environments meet. Maternal Role Attainment theory, meanwhile, describes motherhood not as a fixed identity achieved at birth but as an evolving role that must be renegotiated with each new child. From this perspective, a second-time mother is not simply an expert; she is navigating a new configuration of her role, balancing an infant’s needs against those of a firstborn, and often doing so with noticeably less social scaffolding than she received the first time around.

Empirical work has long hinted at this paradox. Studies of parity have documented that multiparous women report distinct stressor profiles compared with primiparous women, including greater time pressure, more fragmented attention, and, in several samples, elevated psychological distress. Research on the ‘mental load’ has shown how cognitive and emotional labor accumulates across children, while life course analyses link the transition to parenthood with declines in maternal mental health, particularly under conditions of time scarcity. Crucially, prior studies also suggest that first-time mothers are frequently surrounded by congratulatory attention, structured support programs, and community curiosity, whereas second-time mothers are often presumed to have everything figured out.

To test what these disparities mean inside the child care setting, the researchers recruited 598 mothers who were asked to reflect on their experiences enrolling a child in a licensed child care center for the first time. Using a cross-sectional design, the team measured parenting stress and the degree of collaboration mothers perceived in their relationship with their child’s educator. The analytic strategy relied on linear regression, allowing the researchers to estimate whether the association between parenting stress and perceived collaboration differed systematically between first-time and experienced mothers.

The results were striking in their asymmetry. For experienced, multiparous mothers, parenting stress levels were significantly and more strongly associated with the level of collaboration they reported experiencing with their child’s caregiver. In other words, when seasoned mothers were under strain, the quality of the partnership with the educator appeared to matter more, with collaborative relationships potentially buffering stress and strained relationships potentially amplifying it. Among first-time mothers, no comparable pattern emerged; the link between stress and collaboration was weaker or absent in the statistical model.

The authors interpret this asymmetry through the lens of social support. First-time mothers, the literature suggests, tend to receive more external support during the perinatal period and the early months of parenting, from family members, health services, and peer networks oriented around the novelty of a first baby. Experienced mothers, by contrast, are known to receive less social support, partly because communities and services assume competence. Within that context, the early childhood educator may become one of the few adults in a second-time mother’s daily life who both understands her child’s needs and witnesses her family’s reality on a regular basis. A strong collaborative relationship in that setting could serve as a meaningful source of social and emotional support precisely where other supports have thinned out.

The findings also carry a practical edge for the early childhood workforce. If stress-collaboration dynamics differ by parity, then a one-size-fits-all approach to family engagement risks missing experienced mothers entirely. Educators trained to anticipate the anxieties of first-time parents may overlook the quieter, but potentially more consequential, needs of mothers managing two children, employment, and the emotional recalibration that Mercer’s theory describes. The researchers emphasize that parent-teacher relationships in early care are not merely transactional handoffs; they are partnerships that can shape the family’s experience of a major developmental transition and, downstream, child outcomes. Prior work on caregiver-mother partnership behavior has shown that the quality of these adult relationships can even influence the quality of caregiver-child and mother-child interactions, suggesting the stakes extend well beyond logistics.

There are, of course, limits to what a cross-sectional design can establish. The data capture a single moment in time, so the direction of the relationship between stress and collaboration remains open: stress may undermine collaboration, collaboration may buffer stress, or both processes may operate in tandem. The sample reflects mothers enrolling a child in center-based care for the first time with that child, which excludes families using other care arrangements. Still, the sheer size of the sample, nearly 600 mothers, and the consistency of the parity-based difference lend weight to the central conclusion that first-time and experienced mothers are not interchangeable partners in the child care relationship.

The broader message is one that resonates well beyond the classroom. Society tends to celebrate firsts and to assume that seconds take care of themselves, whether in parenting, in transitions, or in the quiet labor of family life. This study offers a technical, data-driven corrective: the second transition into motherhood carries its own distinctive risks, and the adults who stand beside parents every morning at the classroom door are positioned to do something about it. For early childhood educators, recognizing that an experienced mother’s stress is closely tied to the partnership she experiences with them reframes daily greetings, shared observations, and open communication not as courtesy, but as a form of support with measurable stakes for family well-being and, ultimately, for the children at the center of it all.

Subject of Research: A comparative study of first-time and experienced mothers' collaborative relationships with early childhood educators during the transition to child care

Article Title: When Parity Comes to Play: A Comparative Study of New and Experienced Mothers’ Relationships with Early Childhood Educators

Article References: When Parity Comes to Play: A Comparative Study of New and Experienced Mothers’ Relationships with Early Childhood Educators. (n.d.). https://doi.org/10.1007/s10643-026-02355-w

Image Credits: AI Generated

DOI: 10.1007/s10643-026-02355-w

Keywords: parent-teacher relationships, second-time motherhood, parenting stress, early childhood education, social support, maternal role attainment, ecological systems theory, parity, child care transition, family engagement, Comes, Play