OBJECTIVES: We developed the concept of the extra-territorial translational team (ETTT) in 2014 as a more inclusive revision and extension of the team science concept. Translational thinking is largely marked by the perception of the team as a thing-like structure at the center of the scientific activity. Collaboration accordingly involves bringing external others (e.g., scientists, community members, and clinicians) into the team through limited or dependent participation. The ETTT is intended to frame the team as an idea: a schema for assembling and managing relationships among otherwise disparate individuals with vested interests in the problem at hand. Thus, the ETTT can be seen as a process as well as an object. Our initial focus was on the very successful SCI Café program (where Science and Communities Interact) conducted through the Institute for Translational Sciences and the Center for Translational Sciences Award at UTMB. We found that by looking beyond the taken-for-granted features of translational research teams, we are free to discover new ways of organizing research and community engagement that are innovative yet productive. The major area of growth, however, has been the Research, Education, And Community Health Coalition (REACH). The purpose of the current study is to outline strategies for inventorying and evaluating the emerging programs that are the major components of REACH and the SCI Café and to suggest implications for the extra-territorial translational team concept. METHODS/STUDY POPULATION: The assessment of the extraterritorial team concept in REACH and SCI Café is primary a process of qualitative content analysis. We use semi-structured interviews with project leadership, observations of the actual performance of the REACH teams, and the review of REACH and SCI Café documents, for example, Quantitatively, we have conducted a Community Health Needs Assessment (CHNA) to better understand community health and resource needs. RESULTS: Both the SCI Café program and the REACH initiative follow the principles of the ETTT concept for assembling and managing research and community outreach. The following are several key principles shared by both programs: (1) The importance of creative, applicable, and inclusive mission statements: (a) REACH seeks to facilitate communication, collaborative research, and service efforts between UTMB and Institute for Translational Sciences investigators and Galveston County community leaders; (b) The SCI Café hosts interactive dialogs that serve as a medium for priming, organizing, communicating and strategizing among the individuals involved in team science via community-based research projects. (2) Increasing scientific and health literacy: (a) REACH seeks to increase literacy through both short-term and long-term interactions; (b) The SCI Café focuses on short-term yet intensive interaction through conversations among researchers, clinicians, and the public. (3) Sharing timely scientific public health information with the community: (a) REACH seeks information from community leaders on relevant topics; (b) The SCI Café can mobilize quickly to respond to timely topics by direct communication with a wide range of stakeholders, academic as well as community based. (4) Sharing leadership with the community: (a) REACH establishes formal relationships with 23 UTMB units and 39 broad-based, high impact Galveston County organizations. (b) The SCI Café works primarily with “grass roots” community-level groups and organizations. (5) Creating resources and strategies for expansion: (a) REACH is working to expand its activities to other counties in the Gulf Coast area of Texas (e.g., Brazoria and Matagorda Counties); (b) The SCI Café is expanding its program to comfortable locations accessible to local residents (e.g., schools and libraries). (6) The value of regular and systematic scientific and evaluation: (a) REACH is conducting a Community Health Needs Assessment (CHNA) that has already discovered major issues of relevance to community leaders including mental health, vaccination rates, food security, disaster preparedness, and caregiving. (b) The SCI Café conducts an evaluation survey at the conclusion of every event to stay current with participants interests and needs. DISCUSSION/SIGNIFICANCE OF IMPACT: (1) In order to maintain the ability to operate extra-territorially (i.e., beyond the safe organizational confines of the University), the 2 programs discussed here must maintain a fluid team structure. Different projects require different types of leadership, grass roots participation, university resources, communications/public relations, etc. (2) The strategy of accumulating and disseminating best practices appears to be one of the most valuable products of the extra-territorial team. (a) REACH’s “Offer and Ask” practice by which information of university and community resources (skills and expertise) are shared makes cooperation and shared leadership explicit. (b) The SCI Café’s interactional strategies for encouraging and enabling café participants to join the discussion/conversation are wonderful ways to convert an otherwise unidirectional lecture into a vibrant conversation. (3) Although the scope of these 2 programs is quite different, the message from both is that the principles of extra-territorial translational teams are application to all such endeavors to improve scientific and health literacy.

OBJECTIVES/SPECIFIC AIMS: Objective: The Rockefeller University Center for Clinical and Translational Science (RU-CCTS), Clinical Directors Network (CDN), and Carter Burden Network (CBN), a multisite senior services organization serving East Harlem, NY, formed a community-academic partnership to examine the use of a simple validated surrogate measure of overall health status and frailty in this population. Many CBN seniors are racial/ethnic minorities, low-income, and suffer from multiple chronic conditions, depression and food insecurity. Multiple biological, musculoskeletal, psychosocial and nutritional factors contribute to frailty, which has been defined variously in senior health outcomes research. The CTSA-funded Pilot Project aims to: (1) Engage CBN seniors and stakeholders in priority-setting, joint protocol development, research conduct, analysis, and dissemination; (2) Characterize the health status of the CBN seniors using validated measures; (3) Establish database infrastructure for current and future research; (4) Understand how health and senior activities information can be used to create programs to improve senior health. METHODS/STUDY POPULATION: Methods: (1) CEnR-Navigation, a collaborative program/process that consists of semistructured meetings and activities facilitated by expert Navigators, was used for partnership development and to engage Carter Burden seniors to refine priorities and research questions, provide feedback on study design and conduct, and analyze and disseminate results. (2) Standard physical measurements and validated survey instruments were used to collect health information; target enrollment is 240 seniors across 2 sites (1 hosted within a subsidized housing facility and Social Model Adult Day Program). (3) A REDCap-based platform was designed for data capture and import. Individual attendance at senior activities for the prior year was extracted from existing records. The primary outcome is frailty, as measured by validated walk/balance tests (Short Physical Performance Battery). Secondary outcomes include measures of engagement, and association of use of services/activities with the primary outcome. RESULTS/ANTICIPATED RESULTS: (1) In total, 29 residents and 14 other stakeholders engaged in partnership-building, study design and implementation. (2) From May to November 2017, 98 participants were enrolled from site 1 (a residential site). Enrollment at site 2 (a senior center), begun in November, is projected for February completion. Characteristics of site 1 participants: median age=63.6 years; Hispanic, 44.90% (44); White, 13.89% (10), Black, 62.50% (45); Asian, 4.17% (3); American Indian or Alaskan Native, 2.78% (2), and Other, 16.67% (12). Educational attainment: 51.04% (49) had not completed high school; 19.79% (19) were high school graduates; 18.75% (18) completed some college, and 10.42% (10) were college graduates. For the 85 participants reporting annual income: 64.71% (55) reported <$10,000; 28.24% (24) reported $10,000–$15,000; 7.06% (6) were among the ranges from $15,000 to $50,000. The average body mass index (BMI) was 30, which is obese. For 83.67% (82) of site 1 participants, the BMI was in the range of overweight or obese. Half of participants (49) reported health literacy barriers in the Single Item Health Literacy Survey. Demographics and Frailty assessments (walk and balance tests) for participants enrolled at both sites will be reported. (3) Activity participation data for July 2016–November 2017 were recovered for 507 sessions at site 1 and are being analyzed. DISCUSSION/SIGNIFICANCE OF IMPACT: Here we report progress in developing a sustainable community-academic partnership, infrastructure and research capacity with the CBN senior services organization, and characterizing this at-risk population, of whom 71% have a high school education or less, 93% live in extreme poverty, and 84% are overweight or obese. A simple validated frailty measure in seniors will enable the acceleration of community-based translational research addressing senior health, and examine changes in this measure in relationship to the utilization of senior services.

OBJECTIVES/SPECIFIC AIMS: Clostridium difficile infection (CDI) is the most common cause of antibiotic-associated diarrhea and an increasingly common infection in children in both hospital and community settings. Between 20% and 30% of pediatric patients will have a recurrence of symptoms in the days to weeks following an initial infection. Multiple recurrences have been successfully treated with fecal microbiota transplantation (FMT), though the body of evidence in pediatric patients is limited primarily to case reports and case series. The goal of our study was to better understand practices, success, and safety of FMT in children as well as identify risk factors associated with a failed FMT in our pediatric patients. METHODS/STUDY POPULATION: This multicenter retrospective analysis included 373 patients who underwent FMT for CDI between January 1, 2006 and January 1, 2017 from 18 pediatric centers. Demographics, baseline characteristics, FMT practices, C. difficile outcomes, and post-FMT complications were collected through chart abstraction. Successful FMT was defined as no recurrence of CDI within 60 days after FMT. Of the 373 patients in the cohort, 342 had known outcome data at two months post-FMT and were included in the primary analysis evaluating risk factors for recurrence post-FMT. An additional six patients who underwent FMT for refractory CDI were excluded from the primary analysis. Unadjusted analysis was performed using Wilcoxon rank-sum test, Pearson χ2 test, or Fisher exact test where appropriate. Stepwise logistic regression was utilized to determine independent predictors of success. RESULTS/ANTICIPATED RESULTS: The median age of included patients was 10 years (IQR; 3.0, 15.0) and 50% of patients were female. The majority of the cohort was White (89.0%). Comorbidities included 120 patients with inflammatory bowel disease (IBD) and 14 patients who had undergone a solid organ or stem cell transplantation. Of the 336 patients with known outcomes at two months, 272 (81%) had a successful outcome. In the 64 (19%) patients that did have a recurrence, 35 underwent repeat FMT which was successful in 20 of the 35 (57%). The overall success rate of FMT in preventing further episodes of CDI in the cohort with known outcome data was 87%. Unadjusted predictors of a primary FMT response are summarized. Based on stepwise logistic regression modeling, the use of fresh stool, FMT delivery via colonoscopy, the lack of a feeding tube, and a lower number of CDI episodes before undergoing FMT were independently associated with a successful outcome. There were 20 adverse events in the cohort assessed to be related to FMT, 6 of which were felt to be severe. There were no deaths assessed to be related to FMT in the cohort. DISCUSSION/SIGNIFICANCE OF IMPACT: The overall success of FMT in pediatric patients with recurrent or severe CDI is 81% after a single FMT. Children without a feeding tube, who receive an early FMT, FMT with fresh stool, or FMT via colonoscopy are less likely to have a recurrence of CDI in the 2 months following FMT. This is the first large study of FMT for CDI in a pediatric cohort. These findings, if confirmed by additional prospective studies, will support alterations in the practice of FMT in children.

OBJECTIVES/SPECIFIC AIMS: N/A. METHODS/STUDY POPULATION: Over a million people gained insurance in Los Angeles (LA) County under the Affordable Care Act (ACA). The vast majority gained Medicaid—government sponsored insurance with low-cost sharing. LA County also made significant investments in the safety net including a program called MyHealthLA, which provides primary and tertiary care for the residually uninsured including poor undocumented individuals at specific sites. Despite this insurance expansion, approximately 3 quarters of a million people in the county remain uninsured. Regardless of insurance status, nearly a quarter of LA County residents reported having difficulty obtaining needed medical care, and among those making less than the poverty level, 43% had difficulties. There is still much to understand about barriers to obtaining insurance and accessing healthcare in Los Angeles in the post-ACA era. Our primary objective was to understand how safety net patients are obtaining, maintaining and using their insurance after the ACA. Specifically we hope to understand the barriers and drivers of these three processes. RESULTS/ANTICIPATED RESULTS: We conducted a qualitative study of 34 safety net patients with 3 different insurance types in LA County. We conducted in-person interviews with adult patients (ages 18–64 years), who had either MediCal, MyHealthLA, or were unsinsured. Our interview guide was based on existing literature, a previous qualitative study conducted in Massachusetts and input from experts in the field. We pilot tested our interviews in English and Spanish and then recruited our participants from 3 sites: LAC+USC (a publically funded county hospital), The Wellness Center (a resource center for safety net patients), and White Memorial Medical Center (a private safety net hospital). We approached patients in the ED and urgent care waiting rooms and obtained informed consent for this IRB approved study. We excluded patients who were non-English and non-Spanish speaking or too ill to interview. We recorded interviews, which were then transcribed and translated into English by a contracted agency. We analyzed our interviews using a framework approach, which included a set of a priori codes from the literature as well as emerging codes from patient responses. We will check a sample of our transcripts for coding consistency (aiming for an inter-rater reliability of >80%). DISCUSSION/SIGNIFICANCE OF IMPACT: We recruited a diverse group of patients that were demographically representative of those who gained insurance under the ACA (childless adults making less than 138% of the Federal Poverty Level). Our preliminary results (based on 17 transcripts), suggest that patients, regardless of insurance type have difficulty accessing primary care. We identified seven domains under the broader theme of barriers to accessing primary care: finding a primary care clinic or physician (PCP), getting timely appointments, geography and transportation, continuity of care, using the Emergency Department (ED) or urgent care as a PCP, switching PCPs or clinics, and cost or coverage.

OBJECTIVES/SPECIFIC AIMS: Stakeholder engagement has been proposed to help realign clinical and translational research with the needs of clinicians, patients, and policymakers. Increasingly, funders and researchers seek to partner with stakeholders to inform study design, execution and dissemination of results. Kids and families Impacting Disease through Science (KIDS) is a program of the American Academy of Pediatrics that seeks to engage youth in clinical research. United States KIDS programs participate in International Children’s Advisory Network activities. The Chicago KIDS Advisory Board program at Walter Payton College Preparatory School, a Chicago Public School, was initiated in 2015 to foster and develop interest in careers in science, research and healthcare and provide youth perspectives to academic and industry researchers on the design and development of pediatric research studies. This project engaged youth advisors in creation and evaluation of a video explaining clinical research and informed consent for Ann & Robert H. Lurie Children’s Hospital, a clinical partner of the Northwestern University Clinical and Translational Sciences Institute. METHODS/STUDY POPULATION: The Payton program advisory board sessions are 1.5hr interactive seminars held on 1–2 school days each month. During the 2016–2017 school year, students participated in 3 stakeholder sessions, led by Lurie Children’s hospital researchers, to advise development of a script, storyboards, and ultimately an animated video that informs children and families about participation in clinical research to aid in the decision-making process. Qualitative research methods were used to examine attitudes towards clinical research and assess the video on content objectives, clarity of concept, and appropriateness for a pediatric audience. Following production, students from the 2017–2018 advisory board viewed the final video and presurvey and postsurvey were administered to assess the effect of video on the comprehension of 8 key concepts of informed consent on a 5-point Likert scale. The Wilcoxon signed-rank test was used to compare median pretest and post-test ranks. Results of this analysis were reviewed in seminar and students provided written contribution to this abstract. RESULTS/ANTICIPATED RESULTS: In total, 11 Walter Payton high school students participated in video development and 27, who were naïve to development, participated in the pre and post evaluation sessions. Students ranged from Freshman to Seniors and reflected the diverse ethnic and racial background of Chicago. A positive change from pre to post-test survey was observed in all questions presented assessing comprehension of key concepts of informed consent. The median post-test ranks were statistically significantly higher than the median pre-test ranks for all questions (p<0.01 in all). DISCUSSION/SIGNIFICANCE OF IMPACT: Chicago KIDS youth advisors were engaged in all aspects of the design of the research tool and gained experience in stakeholder contribution from study design to evaluation and publication. The students will next be involved in the design of a prospective randomized study to test the efficacy of the video compared with standard recruitment and consent practices. Given the difficulty of recruiting youth for clinical trials, development of effective engagement practices in is critically important. Our findings demonstrate the feasibility of utilizing youth advisors in a public school based setting.

OBJECTIVES/SPECIFIC AIMS: This case-control study aims to determine the relationships among childhood adversity, attachment style, and the likelihood of accepting or declining a referral for HV. The study will serve as a pilot to inform the power analysis of a subsequently proposed full-scale study. METHODS/STUDY POPULATION: Using a case-control study design, 25 women who decline HV referral (cases) will be compared with 25 women who accept HV referral (controls) on their exposure to childhood adversity and attachment style. Women who are eligible for the study are English-speaking mothers who have been offered HV services by Health Care Access Maryland. Surveys are administered in-person, either in the participant’s home or at another location (e.g., public library), based on participant preference. The dependent variable is participant’s verbal response to the HV referral (accept/decline). The independent variable, childhood adversity, will be measured using the Philadelphia Urban Adverse Childhood Experiences (ACEs) Survey and the Attachment Style Questionnaire (ASQ). Control variables include demographics (i.e., age, race, education, employment, housing, marital status), obstetric history (i.e., previous preterm birth, miscarriage, fetal death, infant death, abortion), and current psychosocial risk factors (i.e., history of substance use, intimate partner violence, depression). Descriptive comparisons will be done for the independent and control variables in controls versus cases. Bivariate analysis will examine associations between the odds of being a case and ACE score and ASQ score. Multivariate logistic regression models will be used to examine the relationship between ACE total and ASQ score; exposure to ACE in cases versus controls; and the odds of an avoidant and anxious attachment styles in cases versus controls. RESULTS/ANTICIPATED RESULTS: We hypothesize that (a) higher ACE scores will be positively associated with a higher level of avoidant attachment; (b) higher ACE scores will be positively associated with declining a HV referral; and (c) higher levels of avoidant attachment will be associated with declining a HV referral. DISCUSSION/SIGNIFICANCE OF IMPACT: Racial inequities in birth outcomes are pervasive and unjust. Non-Hispanic Black women experience births that result in infant mortality, fetal mortality, preterm birth, and low birth weight babies at more than double the rate of non-Hispanic White women in Baltimore and nationally. Prenatal and early childhood home visiting programs have been found to decrease maternal smoking and hypertensive disorder which are associated with PTB, reduce closely spaced births which is associated with fetal and infant death, and improve women’s long-term economic self-sufficiency, child health and social outcomes. However, as community-based programs, these services are not reaching the majority of eligible women in low-income urban settings—women who are also disproportionately burdened with poor pregnancy-related health outcomes. Considering the potential to improve outcomes, the importance of eliminating health disparities, and the national and local investment in HV services, it is vital to understand why some women are not enrolling in prenatal HV programs. The findings from this and subsequent studies will inform the translation of evidence-based HV program outreach efforts for women with complex social history. It will inform the design of enhanced outreach and engagement efforts of HV programs to more reliably engage women.

OBJECTIVES/SPECIFIC AIMS: As the sole Clinical and Translational Science Award (CTSA) site in Michigan, the Michigan Institute for Clinical & Health Research (MICHR) at the University of Michigan (UM) is working to develop community networks that drive clinical and translational research on community-identified health priorities. METHODS/STUDY POPULATION: These CBRNs will be modeled from successful work that has been accomplished in Jackson, MI where stakeholders from the local healthcare community, County Health Department, Health Improvement Organization, and grassroots community members created a Community of Solution to address the unmet behavioral health and social needs of community members. The CBRN’s will focus on identifying community health priorities by receiving input from community members in underserved communities using deliberative software called Choosing All Together (CHAT). RESULTS/ANTICIPATED RESULTS: In the fall of 2017, 3 focus groups were held in Northern Michigan to identify community health priorities. The top 5 community health priorities include; (1) mental wellness, (2) long-term illness, (3) alcohol and drugs, (4) air, water, and land, and (5) affording care. Additional focus groups are scheduled for the winter in 2 additional geographic areas. DISCUSSION/SIGNIFICANCE OF IMPACT: Future work for the creation of CBRNs includes building leadership groups comprised of clinicians, community leaders, public health leaders, health system leaders and researchers to inform the leadership groups of community-identified health priorities. In addition, the team is working to identify a platform to connect academic investigators across UM and community partners on shared research priorities in real time. In order to measure and map relationships within the networks, we are planning to utilize Social Network Analysis as an evaluation tool.

OBJECTIVES/SPECIFIC AIMS: Background: Failure to involve hard-to-reach populations in clinical research denies the potential benefits of research to the excluded groups, perpetuating health disparities. Employing community health workers (CHWs) may be an effective strategy to increase outreach and engagement of marginalized groups. CHWs are members of the target communities with a personal commitment to help their neighbors, and who serve as informants and communicators among their peers. CHWs may be particularly effective in addressing individual and cultural barriers to research participation. Because of their unique background and community-based roles, tailored training programs for CHWs are needed. The Recruitment, Retention, and Community Engagement Program at the UIC Center for Clinical and Translational Sciences seeks to train CHWs to be involved in the recruitment and enrollment of participants in clinical trials. We developed an 8-hour training that covers basic research methods (e.g., randomized clinical trials, longitudinal studies); research activities (e.g., surveys, interviews); and research ethics. The training focuses on the development of communication skills necessary for ethical recruitment and informed consent, providing strategies for addressing mistrust, fear and misunderstanding around the research process. Aim 1: To evaluate the feasibility of the CHW training by assessing. Aim 1.1: Recruitment of participants; Aim 1.2: Completion of training session (8 hr). Aim 2: To evaluate acceptability of training by assessing. Aim 2.1: Satisfaction with training; Aim 2.2: Cultural competence of training content; Aim 2.3: Participant self-efficacy in reproducing information. Aim 3: To collect performance measures by assessing. Aim 3.1: Knowledge gain and retention; Aim 3.2: Self-efficacy in identifying and addressing negative beliefs about research; Aim 3.3: Participants’ readiness to refer and/or recommend participation in clinical trials. METHODS/STUDY POPULATION: Methods: This is a pilot study with a single-group repeated-measures design with assessments at baseline, 1 week post-test, and 3- and 6-month follow-ups. We aim to recruit 25 CHWs working with organizations serving the needs of ethnic minorities in Chicago. We will evaluate feasibility (recruitment, completion of training and assessments) and acceptability of the training (satisfaction with training, cultural appropriateness of content and delivery, participant self-efficacy in reproducing information). Performance measures assessed through self-administered surveys at baseline, 1 week post-training, 3 months, and 6 months will include knowledge, attitudes toward research, and self-efficacy in identifying and addressing barriers to participation. Readiness to recruit and obtain informed consent will be assessed during an observed simulation activity with a standardized participant. Data analysis: Demographic data will be collected, and descriptive and inferential analyses will be conducted. Pretest and post-test questionnaire data will be compared using t-tests. In the informed consent simulation, individuals will be scored on whether they adequately addressed required elements of the informed consent process. Data gathered from the informed consent simulation will also be used for program evaluation and formative purposes; feedback on strengths and areas for improvement will be provided to participants. RESULTS/ANTICIPATED RESULTS: Expected results: It will be feasible to implement the training of CHWs, reaching the expected goal of 25 participants, with at least 70% of them completing the 8-hour training. We expect to collect data demonstrating acceptability of the training with a score of “good” or “excellent” by 70% of participants. At least 70% will rate the training as “culturally acceptable” or better, and will show improved self-efficacy in the delivery of information from pretest to post-test by at least 30%. Performance measures will demonstrate improvements in research knowledge by 30% from pretest to post-test; increased self-efficacy in identifying and addressing negative beliefs about research process, by at least 30%. A minimum of 70% of participants will demonstrate readiness to refer and/or recommend participation in clinical trials by scoring at or above 70% in evaluation of performance with standardized participants. Evaluation of knowledge retention at 3 and 6 months post-training will not take place before the Translational Science Conference in March 2018. DISCUSSION/SIGNIFICANCE OF IMPACT: Discussion/Impact. The outcomes of this evaluation may advance our knowledge of community obstacles to participation in research, and shed light on successful strategies to address them. Information obtained will be used to address limitations of the training. Even though the sample is small we expect to identify trends in quantitative measures that will support an application for funding for a larger randomized study. Once we have developed an effective training model, we expect to disseminate it to other CTSAs for broad implementation.

OBJECTIVES/SPECIFIC AIMS: Explore perceptions of Flint stakeholders on the water crisis regarding trust and the capacity of faith and community-based organizations providing public health services to address community needs. Analyze the community’s voice shared at (1) 17 key community communications (community/congressional meetings and events), and (2) during 9 focus group sessions, in which residents, faith-based leadership and other stakeholders discuss issues and concerns on the Flint Water Crisis, and recommend ways to address them. Develop a framework that defines core theories, concepts and strategies recommended by the community to help rebuild trust and the quality of life in Flint, Michigan, and support other communities experiencing environmental stress. METHODS/STUDY POPULATION: Study population: faith-based leaders, seniors, youth, Hispanic/Latino and African American stakeholders, and others experiencing inequities in the city of Flint. Convene 9 focus group sessions (recorded and transcribed) to learn community perceptions on trust and ways to address it. Validate accuracy of the transcriptions with community consultants to reconcile any inaccurate information. Through a community engaged research (CEnR) process, review and analyze qualitative data from the 9 focus group sessions, and quantitative data from 2 surveys documenting (1) demographic backgrounds of focus group participants, and (2) their perceptions on trust and mistrust. Prepare a codebook to qualitatively analyze the focus group data summarizing community input on trust, mistrust, changes in service delivery among community and faith-based organizations, and ways to re-build trust in the city of Flint. Transcribe the community’s voice shared during 17 key events, identified by a team of community-academic stakeholders (i.e., UM Flint water course, congressional and community events, etc.), in which residents and other stakeholders discuss issues and concerns on the Flint Water Crisis, and recommend ways to address it. Qualitatively analyze the transcriptions, using a CEnR process to prepare a codebook on key themes from the community’s voice shared at these events, and recommendations on ways to address it. Compare and contrast findings between the two codebooks developed from (1) the focus group data and (2) qualitative analysis of community voice during public meetings and events. Synthesize this information into a framework of core theories, concepts and rebuilding strategies for Flint, Michigan. RESULTS/ANTICIPATED RESULTS: It is important to note many undocumented immigrant populations in Flint fear deportation and other consequences, hampering their ability to obtain service and provide community voice. Through our purposive sampling approach, we will hear from community voices not often included in narratives (i.e., seniors, youth, Hispanic/Latino residents). The presentation will present findings documenting levels of trust and mistrust in the city of Flint; and a framework of recommendations, core theories and concepts on ways to reduce, rebuild and eliminate stress that will be helpful to other communities experiencing distress. DISCUSSION/SIGNIFICANCE OF IMPACT: To our knowledge, levels of trust and mistrust in Flint have not been documented thus far. We will compare and contrast common themes presented by the community at public meetings and events with themes presented in our focus group effort on trust. Faith and community-based providers were among the first responders to the Flint Water Crisis. The effort will also share perceptions on changes in public health service delivery, and observations on preparedness for these roles that occurred among community and faith-based providers. Finally, the effort will (1) support the design of a research agenda, (2) define a framework of core theories, concepts and recommendations developed by the community to help rebuild trust in Flint, Michigan; and (3) support other communities addressing environmental distress.

OBJECTIVES/SPECIFIC AIMS: We propose to adapt a curriculum for group well-child care in order to (1) improve the experience of care for Latino immigrant families, (2) better address maternal psychosocial concerns impacting parenting and (3) teach parenting practices that promote healthy behaviors, and (4) improve LEP parent health literacy, engagement, and self-management in care. METHODS/STUDY POPULATION: This study is composed of a series of focus groups with 4 target populations: (1) The Johns Hopkins Bayview Children’s Medical Practice Latino Family Advisory Board (LFAB) (multiple meetings). The LFAB has been in existence since 2011, and has experience in iteratively adapting educational materials, both written and video, and in providing input on social work services and healthcare utilization. We will meet with the LFAB over the course of up to 8 meetings. During these meetings, the following themes will be discussed: (A) The concept of Group Well Child Care will be discussed and LFAB members will be asked about potential benefits and drawbacks of this format. (B) LFAB members will also be asked about group discussion topics that should be prioritized. Study staff will both bring up a list of topics (feeding, sleep, development, behavior, parent stress) and ask for input on additional items that should be discussed. (C) Core components of the mothers and babies course, a group perinatal depression intervention originally developed with Latina mothers, will be presented and discussed with board members, who will be asked to prioritize the components for salience and perceived helpfulness as well as inclusion in the Group Visit Curriculum. Potential benefits and drawbacks of including components of this program will also be asked of LFAB members. Members will not be asked about their depressive symptoms. (2) Pediatric providers (including social workers, MDs, NPs, and RNs) (1 focus group) who agree to participate will also be asked about perceived benefits and drawbacks of the group well-child care model, topics that should be prioritized in the educational components, and the benefits and drawbacks of including components of a perinatal depression prevention program in the group well child visit curriculum. (3) Obstetric group visit providers—Obstetric providers of group prenatal care to LEP Latinas at JHBMC will be asked about the benefits and drawbacks of group prenatal care with their patient population, as well as topics perceived to be of relevance to the patient population based on their experience with group prenatal care and discussions that emerged during the course of the facilitated groups. (4) Obstetric group visit patients (3 focus groups) LEP Latina patients who have participated in at least 3 group prenatal visits will be invited to participate in focus groups exploring the aforementioned topics. The experience of discussing psychosocial issues, including maternal depressive symptoms, in the group visit format will be emphasized. RESULTS/ANTICIPATED RESULTS: One focus group with obstetric providers and has thus far been conducted. Obstetric providers reported that patients were very open in discussing prior experiences with postpartum depression, and discussed feelings of loneliness with their peers in this setting. Anxiety was also frequently discussed. History of domestic violence was discussed more frequently than current domestic violence. DISCUSSION/SIGNIFICANCE OF IMPACT: Group visits may represent an opportunity to more effectively address psychosocial concerns in Latinas. Work needs to be done to understand which topics are most effectively and appropriately addressed in the group Versus individual format.

OBJECTIVES/SPECIFIC AIMS: This poster will present preliminary results from a study examining whether person-centered care planning—a new innovation in community mental health care—responds to the culture of, and helps reduce health disparities among, Latinx and Asian populations. METHODS/STUDY POPULATION: The study was funded by an NIMH/NIH Administrative Supplement for Minority Health and Mental Health Disparities Research and approved by the Institutional Review Board of the authors’ university. Participants included 26 mental health clients and 12 mental health providers of diverse backgrounds. The study employed empirical qualitative methods to explore client understandings of mental health, client experiences of culture and discrimination, and the process of care engagement and care planning from both client and provider perspectives. The analysis team itself included people of Latinx and Asian background, as well as a person with lived experience of mental health recovery. RESULTS/ANTICIPATED RESULTS: We anticipate that the results will show ways in which person-centered care successfully incorporates clients’ goals, but that there will also be evidence of ways in which the clinical encounter struggles to incorporate more social, collective, and cultural values and approaches. DISCUSSION/SIGNIFICANCE OF IMPACT: The poster will present up-to-date findings on this project, which speaks to pressing issues of health equity and community engagement for 2 of the fastest growing populations in the country.

OBJECTIVES/SPECIFIC AIMS: Improving human papillomavirus (HPV) vaccination rates ultimately decreases the morbidity and mortality of HPV-associated diseases. A school-based program was piloted in the Rio Grande City Consolidated Independent School District (RGCCISD) to increase HPV vaccination. METHODS/STUDY POPULATION: We assessed baseline HPV vaccination; surveyed 622 parents of eligible children aged ≥9 years; and piloted and developed a school-based HPV education and vaccination program in 1 middle school in 2017 and 4 additional middle schools in 2018. The parent survey included (1) demographic information, (2) an assessment of parental knowledge about the HPV vaccine, and (3) information about their children and HPV vaccine experience. Results of the parent survey and pilot program are in progress. RESULTS/ANTICIPATED RESULTS: As of 9/1/2016, 20.4% of the 7527 RGCCISD eligible students (≥9 years) had completed the HPV vaccine. Baseline completion rates were higher for RGCCISD students aged 12–14 years compared with students aged 9–11 and ≥15 years (28.4% vs. 16.5%). Baseline completion rates for RGCCISD adolescents were substantially lower than those reported in NIS-Teen and for Texas (42% females and 28% males for NIS-Teen vs. 41% and 24% for the state of Texas). DISCUSSION/SIGNIFICANCE OF IMPACT: Initial results show that engagement with key stakeholders is important and schools are a great venue for delivering and increasing HPV vaccination.

OBJECTIVES/SPECIFIC AIMS: Diabetic retinopathy is the leading cause of blindness in adults aged 25–64 years. The prevalence of diabetic retinopathy is projected to increase 4-fold by 2050. Racial and ethnic minorities have a higher prevalence and greater severity of diabetic retinopathy. Over 50% of racial and ethnic minorities are not screened for diabetic retinopathy per guidelines. With timely diagnosis and sight-saving treatment, blindness from diabetic retinopathy is largely preventable. The objective of this study is to identify racial and ethnic disparities in the population that do not know they have diabetic retinopathy and to compare those disparities to those in the population that do know they have diabetic retinopathy. METHODS/STUDY POPULATION: Specifically, we have identified a nationally representative survey and clinical examination data to estimate the prevalence of undiagnosed diabetic retinopathy, to identify racial and ethnic disparities in that population, and to compare those disparities in the population with known diabetic retinopathy. We hypothesize that racial and ethnic disparities will be higher in the population with undiagnosed diabetic retinopathy in comparison to the population with known diabetic retinopathy. RESULTS/ANTICIPATED RESULTS: We hypothesize that racial and ethnic disparities will be higher in the population with undiagnosed diabetic retinopathy in comparison to the population with known diabetic retinopathy. The results of that analysis will instruct qualitative interviews that will advance the understanding of the factors that contribute to the decision whether to be screened for diabetic retinopathy. A decision tree will be created to categorize the hierarchy of barriers and facilitators. DISCUSSION/SIGNIFICANCE OF IMPACT: A better understanding of the population with undiagnosed diabetic retinopathy and the factors that influence the decision to get screened will help us not only to address disparities in diabetic retinopathy, but also to prevent blindness from retinopathy.

OBJECTIVES/SPECIFIC AIMS: Alabama (AL) experienced a 145% increase in its Latino population between 2000 and 2010; making it the state with the second fastest growing Latino population in the United States (US) during that time. Adolescent Latinas in the United States and in AL are disproportionately affected by sexual health disparities as evidenced by the disproportionate burden of HIV, STIs and early pregnancy compared with their non-Hispanic, White counterparts. In 2011, Alabama passed 1 of the harshest anti-immigration laws in the nation. Following the passing of this law, county health department visits among Latino adults decreased by 25% for STIs and 13% for family planning. Empirical data with adult Latinas in the Southeast suggest significant barriers to sexual healthcare access. However, to our knowledge, no other researchers have examined barriers and facilitators to sexual healthcare access for this subpopulation. Therefore, the goal of this 3-phase study is to: (a) better understand the factors underlying sexual health disparities and gaps in healthcare access among adolescent Latinas; (b) develop a conceptual model based on these data and the extant literature summarizing the theorized pathways through which factors at differing levels of the socioecological model of health (SEMH) impact sexual healthcare access for this group; and (c) develop community-driven, theory-based, culturally-relevant, multilevel intervention strategies to reduce sexual health disparities and increase sexual healthcare access for adolescent Latinas through a community-engaged, intervention mapping process. Community based participatory research (CBPR), which ensures equitable participation of stakeholder groups through partnerships, and the SEMH, which conceptualizes the individual as nested within a set of social structures, provide the philosophical and theoretical frameworks for the work. METHODS/STUDY POPULATION: From January of 2017 to December of 2017 we completed phase 1 of the study: conducting and analyzing 20 semi-structured qualitative interviews with adolescents who: self-identified as Latina, were between 15 and 20 years of age, had been in the United States for over 5 years, and lived in one of the counties of West AL and 15 semi-structured qualitative interviews with key stakeholders (healthcare providers, parents, policy makers, etc.) who regularly work with Latina adolescents. Interview participants were recruited through purposeful-convenience sampling. Two bilingual (in English and Spanish) coders used an iterative process (between independent coding and consensus building) to analyze the data using NVivo 11. Phase 2 of the study is currently underway: constructing a conceptual model on sexual healthcare access for young Latinas in Alabama. We have utilized an iterative process between qualitative interview data collected in phase 1 and review of the extant literature to draft a conceptual model of healthcare access among adolescent Latinas in the US South. This model will serve as the foundation of future studies including the development of intervention strategies through a CBPR process (phase 3), to commence in January 2018. RESULTS/ANTICIPATED RESULTS: PHASE 1: Several barriers and facilitators to sexual healthcare access emerged from the semi-structured qualitative research interviews with young women. These included: (1) parental approval/disapproval and embarrassment (“pena”); (2) structural barriers/facilitators to care (e.g., lack of transportation, flexible clinic hours); and (3) negative/positive experiences with providers (e.g., perceived discrimination based on immigrant status). Key stakeholders identified the following barriers and facilitators to sexual healthcare access for adolescent Latinas in their interviews: (1) language barriers/need for interpreters and outreach workers to work with young Latina women; (2) need for better sexual health education across the state; (3) lack of knowledge among young women and their parents about institutions in general and sexual healthcare, in specific; and (4) perceived lack of “deservingness” and discrimination from providers/“not my patients” phenomenon. PHASE 2: This presentation will summarize the development of our conceptual model (see drafts attached). For ease of interpretation, we have created 2 sub-models (centering gender and immigration, respectively) which summarize theorized pathways through which policy, community, organizational, and family-level factors influence young Latina women’s access to sexual healthcare services. DISCUSSION/SIGNIFICANCE OF IMPACT: The proposed research is significant because: (1) the state of AL experienced a dramatic increase in its Latino/a population over the last 15 years and adolescent Latinas in AL are disproportionately affected by sexual health disparities; (2) to our knowledge, this is the only study to examine the multilevel factors associated with sexual healthcare access for adolescent Latinas in the South and inform intervention strategies to promote sexual healthcare access in this population; (3) the work is being conducted under the philosophical lens of CBPR such that community members are involved in every step of the research process, resulting in culturally relevant and youth-specific intervention strategies.

OBJECTIVES/SPECIFIC AIMS: The overall goal of this project is to enhance the use of GCRA in Latina breast cancer survivors at high risk of hereditary breast and ovarian cancer to reduce disparities in GCRA uptake. The aims of the study are to (1) develop a cultural adaptation of an evidence-based TGC intervention that consists of phone genetic counseling and a booklet, (2) evaluate the impact of TGC Versus Usual Care, and (3) explore the communication patterns in TGC and genetic counseling sessions with an interpreter. METHODS/STUDY POPULATION: We are conducting a 2-phase, mixed methods study. In Phase I we will develop a cultural adaption of an evidence-based intervention (TGC) for high-risk Latina breast cancer survivors using the Learner Verification and Revision Framework (n=15). In Phase II we will use a cluster randomized design with four community sites randomized to Spanish TGC (n=2 sites) or usual care (n=2 sites) (n=60; 15 per site). The primary outcome is genetic counseling uptake. Among women who receive genetic counseling either through TGC (n~30) or with an interpreter (n~15), we will assess counseling quality by reviewing 20 randomly selected audiotaped sessions (10 TGC; 10 interpreters). We will evaluate women’s HBOC knowledge and satisfaction with counseling. Communication processes and outcomes will be assessed using gold standard RIAS quantitative coding system and qualitative discourse analysis. RESULTS/ANTICIPATED RESULTS: We elicited input from transdisciplinary team members to develop an initial adaptation of a TGC print booklet and intervention protocol for use with high-risk Latina breast cancer survivors with limited English proficiency. The booklet contains low-literacy information about HBOC, risk factors, pros and cons of testing, and management strategies. Based on these materials and prior work, we anticipate TGC will consist of one 1 hour or less TGC session by phone. Participants interested in pursuing testing will receive a saliva kit and will participate in a second TGC session (30 min) to discuss test results and management options. DISCUSSION/SIGNIFICANCE OF IMPACT: Given access barriers and the shortage of Spanish-speaking genetic counselors, adapting and translating TGC intervention is a promising strategy that could reduce disparities by broadening the reach and accessibility to genetic counseling while enhancing the quality of the service for Latinas with limited English proficiency.

OBJECTIVES/SPECIFIC AIMS: The prevalence of kidney stone disease has increased significantly in the United States in the last 2 decades. While several studies have reported that disparities in access to and quality of medical care exist, there is a need for a more thorough investigation of factors that negatively impact patients seeking care specifically for kidney stone disease. We sought to examine whether kidney stone patients received different standard of care in the emergency department (ED) according to their race/ethnicity, gender, age, body mass index, socioeconomic status (SES), and insurance status. METHODS/STUDY POPULATION: We conducted a retrospective study of patients presenting to the ED at Montefiore Medical Center between January 1, 2014 and December 31, 2016. Patients with a diagnosis of nephrolithiasis were identified using ICD-9/10 codes and electronic chart review was used to assess each patient’s ED course as well as to gather sociodemographic information. The primary outcomes of interest were administration of pain medication, prescription of alpha-1 antagonists to facilitate stone passage and whether or not patients received CT scan or ultrasound. Associations of these outcomes with age categories, sex, race/ethnicity, body mass index category, SES and insurance status were examined using multivariate logistic regression models. RESULTS/ANTICIPATED RESULTS: A total of 1200 patients were included in this analysis of which 616 (51%) were women. A large proportion of patients were minorities (40% Hispanic and 15% non-Hispanic African-American), whereas 21% were Caucasian and 24% declined to report race/ethnicity. Patients between the ages of 55–64 and those older than 65 were less likely to receive pain medication compared to younger patients aged <35 years (OR=0.48, 95% CI: 0.27–0.86 and OR=0.46, 95% CI: 0.21–1.00, respectively). Women were less likely than men to undergo any form of diagnostic imaging (OR=0.52, 95% CI: 0.35–0.76) including CT scan (OR=0.50, 95% CI: 0.35–0.72). Similarly, patients in the lowest quintile of SES received less imaging than patients in higher SES categories (OR=0.50; 95% CI: 0.27–0.90). Furthermore, African Americans (both genders) and women were less likely to be prescribed an alpha antagonist medication (e.g., tamsulosin) to facilitate stone passage compared with White patients (OR=0.61, 95% CI 0.36–1.03) and men (OR=0.68, 95% CI: 0.49–0.92), respectively. DISCUSSION/SIGNIFICANCE OF IMPACT: We found that multiple disparities exist among patients presenting to the ED for nephrolithiasis. A more thorough investigation into the causes of these disparities is warranted to limit their impact on patient care.

OBJECTIVES/SPECIFIC AIMS: (1) Provide basic brain knowledge about development and resiliency. (2) Develop an understanding of how a mother can impact a child’s brain development. (3) Foster a sense of agency to increase the likelihood that a mother will enact positive changes. (4) Develop the ability to recognize a connection between one’s own behaviors and a child’s development and behaviors. METHODS/STUDY POPULATION: Tested the efficacy of a 4-week intervention program on neurodevelopment for homeless mothers. Mothers (n=4) residing at the Center for the Homeless in South Bend, IN were recruited. Used community partner feedback, weekly surveys, and pre/post tests to look at changes in basic content knowledge, behavioral change, and self-efficacy. RESULTS/ANTICIPATED RESULTS: Preliminary results indicate an increase in knowledge about neurodevelopment, although results on behavioral changes are inconclusive. The program is anticipated to run a second time with a new group of parents residing in the Center for the Homeless to increase sample size. DISCUSSION/SIGNIFICANCE OF IMPACT: Anticipated that the results will add to the existing literature concerning effective interventions in strengthening parenting and neuroscience knowledge in vulnerable populations.

OBJECTIVES/SPECIFIC AIMS: This presentation will highlight the framework, domains, and approaches of the “Engaging the Voice of the CTS Customer and Collaborator System” created at the University of Minnesota Clinical and Translational Science Institute (CTSI) in response to the need to improve the stakeholder engagement, quality, efficiency, consistency, and transparency of the clinical and translational work. This system addresses 3 important results-based accountability measures/questions: “What should we do?”, “How well did we do it?”, and “Is anyone better off?”. According to Woolf (2008), “translational research means different things to different people.” Social networks and systems that support translational processes and outcomes are complex, nonlinear, and multidisciplinary (Smith et al., 2017). In this highly uncertain and fluid context, the input of program stakeholders is paramount to move translation forward. NCATS Strategic Plan (2016) directs the grantees to engage patients, community members and nonprofit organizations meaningfully in translational science and all aspects of translational research. Engagement of stakeholders throughout the lifecycle of a translational research project ensures the project processes and outcomes are relevant to and directly address their needs and will be more readily adopted by the community. “Customer” (among other terms are Beneficiary, Collaborator, Client, Community, Consumer, Service User, etc.) is a person, organization, or entity who directly benefits from service delivery or program (Friedman, 2005). Customers can be: direct and indirect, primary and secondary, internal and external. Our analysis of CTS stakeholders (“Who are our customers/collaborators?”) produced the following list of customers and collaborators: researchers, University departments, translational science workforce, patients, community members and entities, nonprofit organizations, industry collaborators, NCATS/NIH, CTSA hub partners, and CTSI staff. The “Voice of the Customer” (VOC) is the term used to describe the stated and unstated needs or requirements of the program’s customer. The “voice of the customer” is a process used to capture the feedback from the customer (internal or external) to provide the customers with the best quality of service, support, and/or product. This process is about being proactive and constantly innovative to capture the changing needs of the customers with time. Related to the VOC is the concept of user innovation that refers to innovations developed by consumers and end users. Experience shows that sometimes the best product or a process concept idea comes from a customer (Yang, 2007: p. 20). Capturing and utilizing such ideas are also relevant to VOC and can be operationalized and implemented as a valuable strategy. The University of Minnesota CTSI’s key objectives, goals, and uses of engaging the VOC and collaborator are as follows: (1) Engage CTSA customers (“relevant stakeholders”) in multiple aspects of translational science and look for opportunities to include their perspective (per NCATS strategic principles). (2) Inform continuous improvement, strategic management, and M&E efforts, the identification of customer needs and wants, comprehensive problem definition and ideation, new concept development and optimization. (3) Synergize NCATS and partner expectations and campus/hub needs. (4) Translate VOC into functional and measurable service requirements. METHODS/STUDY POPULATION: A case study of the programmatic and methodological approach/technique development. The VOC at the UMN CTSI has been captured in a variety of ways: regular and ad hoc surveys, interviews, focus groups, Engagement Studios, formal call for patient/community ideas and proposals, informal conversations, customer/community membership and participation in the Advisory Boards and Executive Leadership Team meetings, and observations. Our VOC variables and metrics assess customer needs, wants, knowledge, and skills; customer satisfaction with processes and outcomes; and customer ideas for improvement and innovation. The ensuing customer feedback and other data have been used to identify and incorporate the important attributes needed in the CTSI processes, products, and dissemination. UMN CTSI partners in engaging and capturing the VOC include our past, current, and potential customers and collaborators, communities, program staff and service providers, program administration, communication staff, M&E team, internal and external data collectors. RESULTS/ANTICIPATED RESULTS: The proposed comprehensive approach shows sound promise to enhance customer and collaborator engagement, critical thinking, learning, strategic management, evaluation capacity and improvement within clinical and translational science organizations. DISCUSSION/SIGNIFICANCE OF IMPACT: This structured approach’s impact is significant in that it fills the current gap in the practice, literature, and methodology and offers a practical example of a “practice that works” for CTR (and other) organizations and programs striving to improve their stakeholder engagement and program impact. Leveraging and synergizing the VOC and community engagement approaches can help CTS organizations advance beyond capturing individual project/service experiences to drawing a holistic portrait of an institution-level (and, potentially, a nation-level) translational science program.

References

Friedman M. Trying Hard Is Not Good Enough: How to Produce Measurable Improvements for Customers and Communities. Trafford, 2005.

National Center for Advancing Translational Sciences. NCATS Strategic Plan [Internet], 2016. NIH (https://ncats.nih.gov/strategicplan)

Smith C,et al. Toward a science of translational science. Journal of Clinical and Translational Science 2017; 1: 253–255.

Woolf SH. The meaning of translational research and why it matters. JAMA 2008; 29: 211–213.

Yang, K. Voice of the Customer Capture and Analysis. US: McGraw-Hill Professional, 2007.

OBJECTIVES/SPECIFIC AIMS: (1) Identify current barriers to coordinated care between behavior consultation and PCIT services. (2) Identify current facilitators to coordinated care between behavior consultation and PCIT services. (3) Utilize this knowledge to create and pilot a coordinated care model that will enhance PCIT and behavior consultation service outcomes. METHODS/STUDY POPULATION: Objectives 1 and 2: Two focus groups consisting of 8–10 behavior consultants will be conducted to gather initial information on barriers and facilitators to coordinated care. Participants will be recruited from the state-funded behavior consultation team, to represent consultation occurring in rural and urban settings. All focus groups will be recorded and transcribed to capture questions and comments. Focus groups will be provided with an initial 10-minute overview of PCIT, including theory, prescribed strategies, and mode of intervention. A grand tour question will then be asked to elicit consultant perceptions of PCIT (e.g., “What are your thoughts on the compatibility between PCIT and behavior consultation services”), followed by probe questions deigned to elicit more detailed information about any perceived differences based on philosophical approach; differences in what is recommended in childcare settings Versus at home, etc.; and perceived barriers to coordinated care between school and outpatient services (e.g., “What factors make coordinating care with outpatient providers challenging?). Participants will be asked about their willingness to participate in a second focus group to review materials created to enhance coordinated care, based on their feedback. Objective 3. Based on feedback from the focus groups and quantitative data regarding factors associated with PCIT outcomes, we will develop an enhanced childcare component(s) for eventual implementation. To confirm our approach, we will invite the members of both focus groups back for a second session, in which we provide them with the created materials and elicit their feedback. We will start with a grand tour question (e.g., “How do you think parents and teachers would react to these materials?”) and then follow-up with probe questions related to feasibility (e.g., “How do you anticipate using these tools?”), appropriateness (e.g., “How adequately do you feel these materials address concerns with coordinated care?”), and acceptability (e.g., “How likely are you to begin using these tools within your consultation?”). Both focus groups will be recorded and transcribed to capture questions and comments. RESULTS/ANTICIPATED RESULTS: (1) Barriers and facilitators to coordinated care will include individual (e.g., acceptability of PCIT framework) and system-level factors (e.g., ease of communication between providers). (2) There will be significant overlap in coordination between the first phase of PCIT (which focuses on positive parenting strategies) and what is prescribed by behavior consultants. (3) There will be less compatibility between the second phase of PCIT (which focuses on disciplinary strategies) and what is prescribed by behavior consultants. (4) A coordinated are model will be rated as more feasible, appropriate, and acceptable to behavior consultants than PCIT services as currently prescribed. DISCUSSION/SIGNIFICANCE OF IMPACT: Childhood disruptive behaviors are among the most frequent reasons for referral to outpatient child/adolescent mental health clinics (Sukhodolsky et al., 2016). Disruptive and aggressive behaviors are problematic, not only for victims of children who are aggressive but also for aggressive children as they age. Although effective treatments exist, families are often provided with conflicting strategies for behavior management by outpatient clinicians and behavior consultants in the daycare setting, thus providing children inconsistent feedback which will delay their attainment of new skills. These data will provide the initial foundation for the development of a coordinated care model that promotes treatment efficacy by improving the compatibility between clinic-based PCIT and daycare-based behavior consultation services.

OBJECTIVES/SPECIFIC AIMS: This study will use face-to-face interviewers with Medicare-eligible stroke survivors, and adult caregivers of stroke survivors, to extend the aims of a quantitative study on healthcare utilization in elderly stroke survivors. The objective of this research is to better understand, in more detail, relevant barriers and facilitators to accessing healthcare among older stroke survivors. The ultimate goal of this research is to develop strategies to improve access to healthcare, such as home modifications; changes to the neighborhood physical environment; or interventions at the provider/service level. This research will also serve as a precursor for future intervention work that will be proposed as a part of a K01 proposal. METHODS/STUDY POPULATION: Participants were recruited from Ann Arbor and Flint, MI using an existing academic-community partnership as well as through the University of Michigan Stroke Clinic. A total of 8–10 stroke survivors and 1–2 caregivers were recruited through the partnership and clinic records, as well as some use of snowball sampling to obtain a socially, economically, and racially representative sample. Participants must be 65+ years old, eligible for Medicare, living in the community, identify as either White or Black, and have no major cognitive/language deficits that jeopardize informed consent. Face-to-face interviews were conducted, and open-ended questions emphasized environmental barriers and facilitators to accessing healthcare, with a focus on social and physical barriers in the home and neighborhood. Interviews were audio recorded and transcribed, and field notes from 1 to 2 sources were also documented and will be used to triangulate the data and increase coding validity. Audio recordings will be reviewed multiple times and quotes relevant to the research questions and underlying theoretical framework will be transcribed verbatim. The transcripts will be analyzed using thematic coding based on literature and the study objectives and hypotheses. I will identify primary themes related to environmental barriers and facilitators to accessing healthcare among the stroke-survivors. RESULTS/ANTICIPATED RESULTS: Preliminary results suggest that participants are primarily concerned about the social environment. Several interviews revealed that stroke survivors felt socially isolated and were often hesitant to ask for help because they did not want to be a burden on their family and friends. Transportation to appointments was also identified as a barrier due to the fact that many people are no longer able to drive, yet are not comfortable navigating other forms of transportation. We expect to identify additional physical and social environmental challenges to both health care utilization and well-being more generally, among older stroke survivors. Anticipated themes may include: barriers in the physical environment such as transportation to care and services, social support and social environmental factors to support feeling safe leaving home to access care. DISCUSSION/SIGNIFICANCE OF IMPACT: Despite the physical and economic burden of stroke, and attempts to improve outcomes for stroke survivors living in the community, stroke survivors have high rates of disability and unmet medical and psychological needs. The results from this research are anticipated to directly inform future partnerships and intervention in these, or in similar communities. Understanding how the environment influences access to healthcare for elderly stroke survivors is essential if we want to increase recommended preventative care and treatment in this vulnerable population with unique healthcare needs. The results of this study will be used to directly inform the aims and methods for other translational research projects, including a K01 proposal, in which I will develop and pilot a community-based intervention to ameliorate environmental barriers and enhance facilitators of access to healthcare for older, disabled adults.