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Sample records for breathlessness intervention service

  1. Breathlessness

    MedlinePlus

    ... supplemental (extra) oxygen. The first step in the control of breathlessness is to find out what is causing the problem. Once your health care provider has evaluated your breathlessness, determined the likely cause and recommended the best treatment strategy, you can become a partner in your own ...

  2. The clinical and cost effectiveness of a Breathlessness Intervention Service for patients with advanced non-malignant disease and their informal carers: mixed findings of a mixed method randomised controlled trial.

    PubMed

    Farquhar, Morag C; Prevost, A Toby; McCrone, Paul; Brafman-Price, Barbara; Bentley, Allison; Higginson, Irene J; Todd, Chris J; Booth, Sara

    2016-04-04

    Breathlessness is the most common and intrusive symptom of advanced non-malignant respiratory and cardiac conditions. The Breathlessness Intervention Service (BIS) is a multi-disciplinary complex intervention, theoretically underpinned by a palliative care approach, utilising evidence-based non-pharmacological and pharmacological interventions to support patients with advanced disease in managing their breathlessness. Having published the effectiveness and cost effectiveness of BIS for patients with advanced cancer and their carers, we sought to establish its effectiveness, and cost effectiveness, in advanced non-malignant conditions. This was a single-centre Phase III fast-track single-blind mixed method RCT of BIS versus standard care for breathless patients with non-malignant conditions and their carers. Randomisation was to one of two groups (randomly permuted blocks). Eighty-seven patients referred to BIS were randomised (intervention arm n = 44; control arm n = 43 received BIS after four-week wait); 79 (91 %) completed to key outcome measurement. The primary outcome measure was 0-10 numeric rating scale for patient distress due to breathlessness at four weeks. Secondary outcome measures were Chronic Respiratory Questionnaire, Hospital Anxiety and Depression Scale, Client Service Receipt Inventory, EQ-5D and topic-guided interviews. Qualitative analyses showed the positive impact of BIS on patients with non-malignant conditions and their carers; quantitative analyses showed a non-significant greater reduction in the primary outcome ('distress due to breathlessness'), when compared to standard care, of -0.24 (95 % CI: -1.30, 0.82). BIS resulted in extra mean costs of £799, reducing to £100 when outliers were excluded; neither difference was statistically significant. The quantitative findings contrasted with those previously reported for patients with cancer and their carers, which showed BIS to be both clinically and cost effective. For patients

  3. Six key topics informal carers of patients with breathlessness in advanced disease want to learn about and why: MRC phase I study to inform an educational intervention.

    PubMed

    Farquhar, Morag; Penfold, Clarissa; Benson, John; Lovick, Roberta; Mahadeva, Ravi; Howson, Sophie; Burkin, Julie; Booth, Sara; Gilligan, David; Todd, Christopher; Ewing, Gail

    2017-01-01

    Breathlessness is a common symptom of advanced disease placing a huge burden on patients, health systems and informal carers (families and friends providing daily help and support). It causes distress and isolation. Carers provide complex personal, practical and emotional support yet often feel ill-prepared to care. They lack knowledge and confidence in their caring role. The need to educate carers and families about breathlessness is established, yet we lack robustly developed carer-targeted educational interventions to meet their needs. We conducted a qualitative interview study with twenty five purposively-sampled patient-carer dyads living with breathlessness in advanced disease (half living with advanced cancer and half with advanced chronic obstructive pulmonary disease (COPD). We sought to identify carers' educational needs (including what they wanted to learn about) and explore differences by diagnostic group in order to inform an educational intervention for carers of patients with breathlessness in advanced disease. There was a strong desire among carers for an educational intervention on breathlessness. Six key topics emerged as salient for them: 1) understanding breathlessness, 2) managing anxiety, panic and breathlessness, 3) managing infections, 4) keeping active, 5) living positively and 6) knowing what to expect in the future. A cross-cutting theme was relationship management: there were tensions within dyads resulting from mismatched expectations related to most topics. Carers felt that knowledge-gains would not only help them to support the patient better, but also help them to manage their own frustrations, anxieties, and quality of life. Different drivers for education need were identified by diagnostic group, possibly related to differences in caring role duration and resulting impacts. Meeting the educational needs of carers requires robustly developed and evaluated interventions. This study provides the evidence-base for the content of an

  4. The effectiveness of a group cognitive-behavioural breathlessness intervention on health status, mood and hospital admissions in elderly patients with chronic obstructive pulmonary disease.

    PubMed

    Howard, Claire; Dupont, Simon; Haselden, Brigitte; Lynch, Johanna; Wills, Peter

    2010-08-01

    Non-pharmacological breathlessness interventions in lung cancer have proven beneficial. Breathlessness is also a major symptom in chronic obstructive pulmonary disease (COPD). This study measured the effectiveness of a non-exercise-based four-week cognitive-behavioural breathlessness intervention, delivered in a group setting for elderly patients with severe COPD. The results of the one-year feasibility study are presented. Patients with COPD were asked to complete the St. George's Respiratory Questionnaire and Hospital Anxiety and Depression Scale six weeks before the intervention, at the start and end of the intervention and at six weeks follow-up. The multidisciplinary intervention used a cognitive-behavioural format to address understanding of COPD and medication, anxiety, panic and depression, activity pacing, relaxation, breathing retraining and goal-setting. Retrospective data on accident & emergency (A&E) attendances and length of hospital stay was collected six months before and six months after the intervention and the data compared to a matched waiting list control group. The results showed significant improvements in depression and health status. There was a non-significant improvement in anxiety. There was a significant reduction in A&E attendance and a non-significant reduction in length of hospital stay in the intervention group, compared to comparative increases in the control group, highlighting the cost-effectiveness of the intervention.

  5. Neuroimaging of central breathlessness mechanisms.

    PubMed

    Pattinson, Kyle T S; Johnson, Miriam J

    2014-09-01

    Breathlessness debilitates millions of people with cardiorespiratory conditions and cancer. Symptoms correlate poorly with the objective measures of disease (e.g. spirometry). Altered brain processing of respiratory sensations may contribute to this disparity. This article summarizes how functional neuroimaging works, focussing on functional MRI (FMRI) and magnetoencephalography, how neuroimaging has shed light on the central mechanisms of breathlessness and thus how it may help target new therapies. Current understanding of central neural activity in breathlessness comes mainly from a small number of studies in healthy volunteers using models of induced acute breathlessness. Parallels with neuroimaging findings in pain and fear or anxiety have been used to interpret the neuroimaging studies of breathlessness to form hypotheses. Despite the lack of recent neuroimaging studies in breathlessness, there have been methodological advances in overcoming confounders with respiratory FMRI. In addition, developing interest in the distinction of emotional from the sensory aspects of breathlessness and the use of opioids for breathlessness has driven mechanistic understandings. Neuroimaging of breathlessness remains in its infancy. However, advances in the understanding of central perception, combined with novel neuroimaging techniques, means that we are poised to increase our understanding of the brain processes of breathlessness and their modulation.

  6. ‘The COPD breathlessness manual’: a randomised controlled trial to test a cognitive-behavioural manual versus information booklets on health service use, mood and health status, in patients with chronic obstructive pulmonary disease

    PubMed Central

    Howard, Claire; Dupont, Simon

    2014-01-01

    Background: Chronic obstructive pulmonary disease (COPD) is a costly long-term condition associated with frequent Accident and Emergency (A&E) and hospital admissions. Psychological difficulties and inadequate self-management can amplify this picture. Aims: To compare a cognitive-behavioural manual versus information booklets (IB) on health service use, mood and health status. Methods: Two hundred and twenty-two COPD patients were randomly allocated to receive either the COPD breathlessness manual (CM) or IB. They were instructed to work through their programme at home, over 5 weeks. Guidance from a facilitator was provided at an initial home visit plus two telephone call follow-ups. Results: After 12 months, total A&E visits had reduced by 42% in the CM group, compared with a 16% rise in the IB group. The odds of people in the IB group attending A&E 12 months post-intervention was 1.9 times higher than for the CM group (CI 1.05–3.53). Reduction in hospital admissions and bed days were greatest in the CM group. At 6 months, there were significantly greater improvements in anxiety (F (2,198)=5.612, P=0.004), depression (F (1.8,176.1)=10.697, P⩽0.001) and dyspnoea (F (2,198)=18.170, P⩽0.001) in the CM group. Estimated savings at 12 months were greatest in the CM group, amounting to £30k or £270 per participant. Conclusion: The COPD manual, which addresses physical and mental health, is a straightforward cost-effective intervention that is worth offering to COPD patients within primary or secondary care. PMID:25322078

  7. Building consensus for provision of breathlessness rehabilitation for patients with chronic obstructive pulmonary disease and chronic heart failure

    PubMed Central

    Chowdhury, Faiza; Taylor, Rod S; Evans, Rachael A; Doherty, Patrick; Singh, Sally J; Booth, Sara; Thomason, Davey; Andrews, Debbie; Lee, Cassie; Hanna, Jackie; Morgan, Michael D; Bell, Derek; Cowie, Martin R

    2016-01-01

    The study aimed to gain consensus on key priorities for developing breathlessness rehabilitation services for patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). Seventy-four invited stakeholders attended a 1-day conference to review the evidence base for exercise-based rehabilitation in COPD and CHF. In addition, 47 recorded their views on a series of statements regarding breathlessness rehabilitation tailored to the needs of both patient groups. A total of 75% of stakeholders supported symptom-based rather than disease-based rehabilitation for breathlessness with 89% believing that such services would be attractive for healthcare commissioners. A total of 87% thought patients with CHF could be exercised using COPD training principles and vice versa. A total of 81% felt community-based exercise training was safe for patients with severe CHF or COPD, but only 23% viewed manual-delivered rehabilitation an effective alternative to supervised exercise training. Although there was strong consensus that exercise training was a core component of rehabilitation in CHF and COPD populations, only 36% thought that this was the ‘most important’ component, highlighting the need for psychological and other non-exercise interventions for breathlessness. Patients with COPD and CHF face similar problems of breathlessness and disability on a background of multi-morbidity. Existing pulmonary and cardiac rehabilitation services should seek synergies to provide sufficient flexibility to accommodate all patients with COPD and CHF. Development of new services could consider adopting a patient-focused rather than disease-based approach. Exercise training is a core component, but rehabilitation should include other interventions to address dyspnoea, psychological and education needs of patients and needs of carers. PMID:27072018

  8. Breathlessness in the primary care setting.

    PubMed

    Baxter, Noel

    2017-09-01

    Breathlessness is a high-volume problem with 10% of adults experiencing the symptom daily placing a heavy burden on the health and wider economy. As it worsens, they enter the specialist and hospital-based symptom services where costs quickly escalate and people may find themselves in a place not of their choosing. For many, their care will be delivered by a disease or organ specialist and can find themselves passing between physicians without coordination for symptom support. General practitioners (GPs) will be familiar with this scenario and can often feel out of their depth. Recent advances in our thinking about breathlessness symptom management can offer opportunities and a sense of hope when the GP is faced with this situation. Original research, reviews and other findings over the last 12-18 months that pertain to the value that general practice and the wider primary care system can add, include opportunities to help people recognize they have a problem that can be treated. We present systems that support decisions made by primary healthcare professionals and an increasingly strong case that a solution is required in primary care for an ageing and frail population where breathlessness will be common. Primary care practitioners and leaders must start to realize the importance of recognizing and acting early in the life course of the person with breathlessness because its impact is enormous. They will need to work closely with public health colleagues and learn from specialists who have been doing this work usually with people near to the end of life translating the skills and knowledge further upstream to allow people to live well and remain near home and in their communities.

  9. Expenditures for Early Intervention Services

    ERIC Educational Resources Information Center

    Hebbeler, Kathleen; Levin, Jesse; Perez, Maria; Lam, Irene; Chambers, Jay G.

    2009-01-01

    What does it cost to provide early intervention services? Data collected as part of the National Early Intervention Longitudinal Study were used to determine expenditures for infants, toddlers, and their families receiving services through Part C programs. The study found that the national average total expenditure for early intervention services…

  10. Excessive breathlessness through emotional imagery in asthma.

    PubMed

    Rietveld, S; Everaerd, W; van Beest, I

    2000-10-01

    Breathlessness and negative emotions during asthma attacks interact in complex patterns. This study tested the influence of emotional imagery on breathlessness during voluntary breath holding. Adolescents with and without asthma (n = 36 + 36) were assigned to positive imagery, negative imagery, or no imagery. There were four trials with close to thresholds for breath holding combined with imagery. Breathlessness and quality of imagery were measured by the end of breath holding. Additional measures were lung function and anxiety. The results showed that positive and negative imagery were only influencing breathlessness in participants with asthma. Although threshold duration for the groups were not significantly different, participants with asthma reported more breathlessness. The intensity of imagery enhanced breathlessness but diminished the accuracy of symptom perception. Positive imagery diminished breathlessness in participants with asthma, but also the difference in breathlessness between 75% and 95% of threshold duration. Breathlessness did not correlate with lung function, anxiety or other variables. It was concluded that emotional imagery during asthma attacks distracts from accurate introspection or enhances breathlessness, irrespective of anxiety.

  11. Persistent disabling breathlessness in chronic obstructive pulmonary disease

    PubMed Central

    Sundh, Josefin; Ekström, Magnus

    2016-01-01

    Objective To determine the prevalence, change in breathlessness status over time, and risk factors for disabling and persistent disabling breathlessness in relation to treatments in chronic obstructive pulmonary disease (COPD). Materials and methods Longitudinal analysis of data from the Swedish National Register of COPD with breathlessness measured using modified Medical Research Council (mMRC) scores at two subsequent visits. Prevalence of disabling breathlessness (mMRC ≥2 at baseline) and persistent disabling breathlessness (disabling breathlessness at baseline and follow-up) was investigated in relation to COPD treatment. Risk factors for disabling breathlessness, change from non-disabling to disabling breathlessness, and persistent disabling breathlessness were analyzed using multiple logistic regression. Results A total of 1,689 patients were included in the study with a median follow-up of 12 months (interquartile range: 4 months). Prevalence of disabling breathlessness was 54% at baseline. Persistent disabling breathlessness was present in 43% of patients despite treatment and in 74% of patients despite combined inhaled triple therapy and physiotherapy. Risk factors for disabling breathlessness or change to disabling breathlessness were higher age, lower lung function, frequent exacerbations, obesity, heart failure, depression, and hypoxic respiratory failure (all P<0.05). Persistent disabling breathlessness was associated with lower lung function and ischemic heart disease (all P<0.05). Conclusion Disabling breathlessness is common in COPD despite treatment, which calls for improved symptomatic treatments and consideration of factors influencing disabling breathlessness. Factors influencing disabling breathlessness should be considered for COPD management. PMID:27877034

  12. An integrative review of systematic reviews related to the management of breathlessness in respiratory illnesses

    PubMed Central

    2010-01-01

    Background Breathlessness is a debilitating and distressing symptom in a wide variety of diseases and still a difficult symptom to manage. An integrative review of systematic reviews of non-pharmacological and pharmacological interventions for breathlessness in non-malignant disease was undertaken to identify the current state of clinical understanding of the management of breathlessness and highlight promising interventions that merit further investigation. Methods Systematic reviews were identified via electronic databases between July 2007 and September 2009. Reviews were included within the study if they reported research on adult participants using either a measure of breathlessness or some other measure of respiratory symptoms. Results In total 219 systematic reviews were identified and 153 included within the final review, of these 59 addressed non-pharmacological interventions and 94 addressed pharmacological interventions. The reviews covered in excess of 2000 trials. The majority of systematic reviews were conducted on interventions for asthma and COPD, and mainly focussed upon a small number of pharmacological interventions such as corticosteroids and bronchodilators, including beta-agonists. In contrast, other conditions involving breathlessness have received little or no attention and studies continue to focus upon pharmacological approaches. Moreover, although there are a number of non-pharmacological studies that have shown some promise, particularly for COPD, their conclusions are limited by a lack of good quality evidence from RCTs, small sample sizes and limited replication. Conclusions More research should focus in the future on the management of breathlessness in respiratory diseases other than asthma and COPD. In addition, pharmacological treatments do not completely manage breathlessness and have an added burden of side effects. It is therefore important to focus more research on promising non-pharmacological interventions. PMID:21143887

  13. Physiology of breathlessness associated with pleural effusions.

    PubMed

    Thomas, Rajesh; Jenkins, Susan; Eastwood, Peter R; Lee, Y C Gary; Singh, Bhajan

    2015-07-01

    Pleural effusions have a major impact on the cardiorespiratory system. This article reviews the pathophysiological effects of pleural effusions and pleural drainage, their relationship with breathlessness, and highlights key knowledge gaps. The basis for breathlessness in pleural effusions and relief following thoracentesis is not well understood. Many existing studies on the pathophysiology of breathlessness in pleural effusions are limited by small sample sizes, heterogeneous design and a lack of direct measurements of respiratory muscle function. Gas exchange worsens with pleural effusions and improves after thoracentesis. Improvements in ventilatory capacity and lung volumes following pleural drainage are small, and correlate poorly with the volume of fluid drained and the severity of breathlessness. Rather than lung compression, expansion of the chest wall, including displacement of the diaphragm, appears to be the principle mechanism by which the effusion is accommodated. Deflation of the thoracic cage and restoration of diaphragmatic function after thoracentesis may improve diaphragm effectiveness and efficiency, and this may be an important mechanism by which breathlessness improves. Effusions do not usually lead to major hemodynamic changes, but large effusions may cause cardiac tamponade and ventricular diastolic collapse. Patients with effusions can have impaired exercise capacity and poor sleep quality and efficiency. Pleural effusions are associated with abnormalities in gas exchange, respiratory mechanics, respiratory muscle function and hemodynamics, but the association between these abnormalities and breathlessness remains unclear. Prospective studies should aim to identify the key mechanisms of effusion-related breathlessness and predictors of improvement following pleural drainage.

  14. WITHDRAWN: Opioids for the palliation of breathlessness in advanced disease and terminal illness.

    PubMed

    Jennings, Anne Louise; Davies, Andrew N; Higgins, Julian P T; Anzures-Cabrera, Judith; Broadley, Karen E

    2012-07-11

    Breathlessness is a common symptom in people with advanced disease. The most effective treatments are aimed at treating the underlying cause of the breathlessness but this may not be possible and symptomatic treatment is often necessary. Strategies for the symptomatic treatment of breathlessness have never been systematically evaluated. Opioids are commonly used to treat breathlessness: the mechanisms underlying their effectiveness are not completely clear and there have been few good-sized trials in this area. To determine the effectiveness of opioid drugs given by any route in relieving the symptom of breathlessness in patients who are being treated palliatively. An electronic search was carried out of Medline, Embase, CINAHL, T he Cochrane L ibrary, Dissertation Abstracts, Cancercd and SIGLE. Review articles and reference lists of retrieved articles were hand searched. Date of most recent search: May 1999. Randomised double-blind, controlled trials comparing the use of any opioid drug against placebo for the relief of breathlessness were included. Patients with any illness suffering from breathlessness were included and the intervention was any opioid, given by any route, in any dose. Studies identified by the search were imported into a reference manager database. The full texts of the relevant studies were retrieved and data were independently extracted by two review authors. Studies were quality scored according to the Oxford Quality scale. The primary outcome measure used was breathlessness and the secondary outcome measure was exercise tolerance. Studies were divided into non-nebulised and nebulised and were analysed both separately and together. A qualitative analysis was carried out of adverse effects of opioids. Where appropriate, meta-analysis was carried out. Eighteen studies were identified of which nine involved the non-nebulised route of administration and nine the nebulised route. A small but statistically significant positive effect of opioids was

  15. [Descriptors of breathlessness in Mexican Spanish].

    PubMed

    Vázquez-García, J C; Balcázar-Cruz, C A; Cervantes-Méndez, G; Mejía-Alfaro, R; Cossío-Alcántara, J; Ramírez-Venegas, A

    2006-05-01

    Breathlessness is the most common symptom of cardiovascular or pulmonary disease. The term encompasses a wide range of descriptors used by patients, however. Identifying those descriptors can be useful for analyzing symptoms and understanding how they arise. The aim of this study was to characterize the descriptors of breathlessness used in Mexican Spanish and to consider their association with various states of respiratory distress and cardiovascular or pulmonary disease. A questionnaire was based on 21 descriptors of breathlessness, some of which had no equivalents in English. The subjects included 15 healthy individuals during a cardiopulmonary stress test, 13 healthy subjects after a carbon dioxide rebreathing procedure, and 10 healthy women during pregnancy. We also included 16 patients with confirmed heart disease in stable condition, 15 patients during exacerbation of asthma, 20 with stable chronic obstructive pulmonary disease, and 15 with diffuse interstitial lung disease also in stable condition. Descriptors of breathlessness were then grouped based on the results of cluster analysis. Seven clusters of phrasal descriptors were identified as possibly representative of types of dyspnea. These clusters of descriptors were categorized as follows: agitation, suffocation, smothering, inhalation, exhalation, panting, and rapidity. Associations between types of dyspnea and the groups of participants were identified based on how frequently they used the terms. At least 7 clusters or groups of descriptors of breathlessness were identified as equivalent to 7 types of dyspnea; some items have no equivalent in English. Healthy subjects with respiratory distress or certain groups of patients with cardiovascular or pulmonary disease are associated with certain types of dyspnea.

  16. Perceived breathlessness and psychological distress among patients with chronic obstructive pulmonary disease and their spouses.

    PubMed

    Al-Gamal, Ekhlas; Yorke, Janelle

    2014-03-01

    The purpose of this study was to describe the impact of breathlessness on Jordanian patients with chronic obstructive pulmonary disease (COPD) and their spouses' perception of the patients' breathlessness. A cross-sectional, descriptive, correlational design was used with a sample of 67 Jordanian patients with COPD related breathlessness and their spouses. The Dyspnoea 12 Scale (D-12) and Hospital Anxiety and Depression Scale (HADS) were administered to both patients and spouses. There was a significant positive correlation between total patients' D-12 scores and total HADS scores. Spouses who perceived the patients to have more severe breathlessness affect (D-12 affect subscale) were more likely to experience a higher level of psychological distress (HADS total). Both patients and spouses reported clinically significant levels of anxiety and depression. There was no statistical difference in total D-12 and HADS scores between COPD patients and their spouses. The finding of this study indicates the importance of healthcare providers in supporting both patients with breathlessness and their spouses and the need to develop family-centred services.

  17. Breathlessness with pulmonary metastases: a multimodal approach.

    PubMed

    Brant, Jeannine M

    2013-11-01

    Case Study  Sarah is a 58-year-old breast cancer survivor, social worker, and health-care administrator at a long-term care facility. She lives with her husband and enjoys gardening and reading. She has two grown children and three grandchildren who live approximately 180 miles away. SECOND CANCER DIAGNOSIS  One morning while showering, Sarah detected a painless quarter-sized lump on her inner thigh. While she thought it was unusual, she felt it would probably go away. One month later, she felt the lump again; she thought that it had grown, so she scheduled a visit with her primary care physician. A CT scan revealed a 6.2-cm soft-tissue mass in the left groin. She was referred to an oncologic surgeon and underwent an excision of the groin mass. Pathology revealed a grade 3 malignant melanoma. She was later tested and found to have BRAF-negative status. Following her recovery from surgery, Sarah was further evaluated with an MRI scan of the brain, which was negative, and a PET scan, which revealed two nodules in the left lung. As Sarah had attended a cancer support group during her breast cancer treatment in the past, she decided to go back to the group when she learned of her melanoma diagnosis. While the treatment options for her lung lesions included interleukin-2, ipilimumab (Yervoy), temozolomide, dacarbazine, a clinical trial, or radiosurgery, Sarah's oncologist felt that ipilimumab or radiosurgery would be the best course of action. She shared with her support group that she was ambivalent about this decision, as she had experienced profound fatigue and nausea with chemotherapy during her past treatment for breast cancer. She eventually opted to undergo stereotactic radiosurgery. DISEASE RECURRENCE  After the radiosurgery, Sarah was followed every 2 months. She complained of shortness of breath about 2 weeks prior to each follow-up visit. Each time her chest x-ray was normal, and she eventually believed that her breathlessness was anxiety

  18. Study protocol: a phase III randomised, double-blind, parallel arm, stratified, block randomised, placebo-controlled trial investigating the clinical effect and cost-effectiveness of sertraline for the palliative relief of breathlessness in people with chronic breathlessness

    PubMed Central

    Clark, Katherine; Agar, Meera; Davidson, Patricia M; McDonald, Christine; Doogue, Matthew; Currow, David C

    2016-01-01

    Introduction Breathlessness remains a highly prevalent and distressing symptom for many patients with progressive life-limiting illnesses. Evidence-based interventions for chronic breathlessness are limited, and there is an ongoing need for high-quality research into developing management strategies for optimal palliation of this complex symptom. Previous studies have suggested that selective serotonin reuptake inhibitors such as sertraline may have a role in reducing breathlessness. This paper presents the protocol for a large, adequately powered randomised study evaluating the use of sertraline for chronic breathlessness in people with progressive life-limiting illnesses. Methods and analysis A total of 240 participants with modified Medical Research Council Dyspnoea Scale breathlessness of level 2 or higher will be randomised to receive either sertraline or placebo for 28 days in this multisite, double-blind study. The dose will be titrated up every 3 days to a maximum of 100 mg daily. The primary outcome will be to compare the efficacy of sertraline with placebo in relieving the intensity of worst breathlessness as assessed by a 0–100 mm Visual Analogue Scale. A number of other outcome measures and descriptors of breathlessness as well as caregiver assessments will also be recorded to ensure adequate analysis of participant breathlessness and to allow an economic analysis to be performed. Participants will also be given the option of continuing blinded treatment until either study data collection is complete or net benefit ceases. Appropriate statistical analysis of primary and secondary outcomes will be used to describe the wealth of data obtained. Ethics and dissemination Ethics approval was obtained at all participating sites. Results of the study will be submitted for publication in peer-reviewed journals and the key findings presented at national and international conferences. Trial registration number ACTRN12610000464066. PMID:27899400

  19. An index for breathlessness and leg fatigue.

    PubMed

    Borg, E; Borg, G; Larsson, K; Letzter, M; Sundblad, B-M

    2010-08-01

    The features of perceived symptoms causing discontinuation of strenuous exercise have been scarcely studied. The aim was to characterize the two main symptoms causing the discontinuation of heavy work in healthy persons as well as describe the growth of symptoms during exercise. Breathlessness (b) and leg fatigue (l) were assessed using the Borg CR10 Scale and the Borg CR100 (centiMax) Scale, during a standardized exercise test in 38 healthy subjects (24-71 years). The b/l-relationships were calculated for terminal perceptions (ERI(b/l)), and the growth of symptoms determined by power functions for the whole test, as well as by growth response indexes (GRI). This latter index was constructed as a ratio between power levels corresponding to a very strong and a moderate perception. In the majority (71%) of the test subjects, leg fatigue was the dominant symptom at the conclusion of exercise (P<0.001) and the b/l ratio was 0.77 (CR10) and 0.75 (CR100), respectively. The GRI for breathlessness and leg fatigue was similar, with good correlations between GRI and the power function exponent (P<0.005). In healthy subjects, leg fatigue is the most common cause for discontinuing an incremental exercise test. The growth functions for breathlessness and leg fatigue during work are, however, almost parallel.

  20. Can variability in the effect of opioids on refractory breathlessness be explained by genetic factors?

    PubMed Central

    Currow, David C; Quinn, Stephen; Ekstrom, Magnus; Kaasa, Stein; Johnson, Miriam J; Somogyi, Andrew A; Klepstad, Päl

    2015-01-01

    Objectives Opioids modulate the perception of breathlessness with a considerable variation in response, with poor correlation between the required opioid dose and symptom severity. The objective of this hypothesis-generating, secondary analysis was to identify candidate single nucleotide polymorphisms (SNP) from those associated with opioid receptors, signalling or pain modulation to identify any related to intensity of breathlessness while on opioids. This can help to inform prospective studies and potentially lead to better tailoring of opioid therapy for refractory breathlessness. Setting 17 hospice/palliative care services (tertiary services) in 11 European countries. Participants 2294 people over 18 years of age on regular opioids for pain related to cancer or its treatment. Primary outcome measures The relationship between morphine dose, breathlessness intensity (European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire; EORTCQLQC30 question 8) and 112 candidate SNPs from 25 genes (n=588). Secondary outcome measures The same measures for people on oxycodone (n=402) or fentanyl (n=429). Results SNPs not in Hardy-Weinberg equilibrium or with allele frequencies (<5%) were removed. Univariate associations between each SNP and breathlessness intensity were determined with Benjamini-Hochberg false discovery rate set at 20%. Multivariable ordinal logistic regression, clustering over country and adjusting for available confounders, was conducted with remaining SNPs. For univariate morphine associations, 1 variant on the 5-hydroxytryptamine type 3B (HTR3B) gene, and 4 on the β-2-arrestin gene (ARRB2) were associated with more intense breathlessness. 1 SNP remained significant in the multivariable model: people with rs7103572 SNP (HTR3B gene; present in 8.4% of the population) were three times more likely to have more intense breathlessness (OR 2.86; 95% CIs 1.46 to 5.62; p=0.002). No associations were seen with fentanyl nor with

  1. Weighing up the evidence -- a systematic review of measures used for the sensation of breathlessness in obesity.

    PubMed

    Gerlach, Y; Williams, M T; Coates, A M

    2013-03-01

    Breathlessness on exertion is common in people with obesity. Assessments of breathlessness may include sensation (intensity, sensory quality or unpleasantness) and/ or the behavioral/emotional consequences of the sensation (respiratory-related functional impairment, disability or quality of life). This systematic review of primary studies published since 2005 evaluated how has the sensation of breathlessness been assessed in adults with increased adiposity. A total of 41 articles were retained from the systematic search strategy resulting in 20 instruments. The Modified Borg Scale (perceived exertion-intensity), the Medical Research Council (MRC) Scale and Baseline Dyspnea Index (BDI; both assess respiratory-related functional impairment) were, respectively, the most frequently reported instruments. Few instruments had been tested for reliability and validity in people with increased adiposity. Visual Analog Scale, Modified Borg Scale, descriptors of sensory quality, MRC and BDI can be recommended as instruments based on their psychometric properties (reliability (correlations >0.8) and concurrent validity (correlation with severity of airways obstruction and walking distance)). A greater number of instruments were identified that assessed the consequences of the breathlessness rather than breathlessness as a sensation. If sensation drives behavior, comprehensive data on the sensation of breathlessness might assist in understanding the behavioral consequences of interventions.

  2. Telerehabilitation: An Adjunct Service Delivery Model For Early Intervention Services

    PubMed Central

    Cason, Jana

    2011-01-01

    Early Intervention (EI) services for children birth through two years of age are mandated by Part C of the Individuals with Disabilities Education Act (IDEA); however, personnel shortages, particularly in rural areas, limit access for children who qualify. Telerehabilitation has the potential to build capacity among caregivers and local providers as well as promote family-centered services through remote consultation. This article provides an overview of research related to telerehabilitation and early intervention services; discusses the feasibility of telerehabilitation within traditional EI service delivery models; examines telecommunications technology associated with telerehabilitation; and provides hypothetical case examples designed to illustrate potential applications of telerehabilitation in early intervention. PMID:25945179

  3. Qualitative aspects of breathlessness in health and disease.

    PubMed

    Smith, J; Albert, P; Bertella, E; Lester, J; Jack, S; Calverley, P

    2009-08-01

    Patients with respiratory disease use many different expressions to describe the sensation they experience as breathlessness. Although previous analyses have identified multiple dimensions of breathlessness, there is little agreement about their number and nature. This study has applied a novel approach, principal component analysis (PCA), to understanding descriptions of breathlessness in health and disease and extracting representative components. 202 patients (asthma n = 60, chronic obstructive pulmonary disease n = 65, interstitial lung disease n = 41, idiopathic hyperventilation n = 36) and 30 healthy volunteers were studied. All subjects performed spirometry and gave binary responses to 45 descriptions recalling their experience of breathlessness at the end of exercise; patients repeated this for resting breathlessness. PCA identified response patterns in the questionnaire data and extracted discriminatory components. Component scores were calculated for each individual using the regression method. PCA identified six distinct components of breathlessness on exercise, explaining 62.8% of the variance: (1) air hunger, (2) affective, (3) nociceptive, (4) regulation, (5) attention and (6) miscellaneous qualities. Rest components explaining 63.1% of variance were (1) affective, (2) air hunger, (3) nociceptive, (4) wheeze, (5) regulation and (6) miscellaneous. Components identified on exercise differed significantly between disease groups and controls and were related to percentage predicted forced vital capacity. This analysis suggests that air hunger is the dominant sensation during exercise, while affective distress characterises resting breathlessness in patients with a range of respiratory disorders including idiopathic hyperventilation where lung mechanics are normal. This suggests that common mechanisms operate in qualitative aspects of breathlessness.

  4. Effectiveness of a hand-held fan for breathlessness: a randomised phase II trial

    PubMed Central

    2010-01-01

    Background Breathlessness is common and distressing in advanced disease. This phase II study aimed to determine the use and acceptance of a hand-held fan (HHF) to relieve breathlessness, to test the effectiveness of the HHF and to evaluate the recruitment into the study. Methods RCT embedded within a longitudinal study testing a HHF over time compared to a wristband. Patients were included in the longitudinal study when suffering from breathlessness due to advanced cancer or COPD III/IV and could opt in the RCT. Primary outcome was use of the HHF and the wristband after two months. Secondary outcomes were recruitment into the trial and change of breathlessness severity after two months, measured on the modified Borg scale. Baseline data were collected in a personal interview and follow-up data by monthly postal questionnaires. Results 109 patients were recruited in the longitudinal study of which 70 patients (64%) participated in the RCT. Non-participants had statistically significant less breathlessness (Borg mean 2.6 (SD 1.48) versus 3.7 (SD 1.83); p = 0.003) and a better functional status (Karnofsky status mean 61.9 (SD 11.2) versus 66.7 (SD 11.0); p = 0.03). Attrition due to drop out or death was high in both groups. After two months, about half of the patients used the HHF but only 20% the wristband without a statistical difference (Fisher's exact test p = 0.2). 9/16 patients judged the HHF as helpful after two months and 4/5 patients the wristband. There was no difference in mean breathlessness change scores between the HHF (Borg change score: mean 0.6 (SD 2.10)) and the wristband (mean 0.8 (SD 2.67)) after two months (p = 0.90). Conclusions Symptom burden and low functional status did not restrain patients from participation in the study. Finding a control for a visible intervention is challenging and needs careful consideration to what is acceptable to patients. The preliminary evidence of effectiveness of the HHF could not be proved. Patients often stopped

  5. Intervention Through Adult Protective Services Programs

    ERIC Educational Resources Information Center

    Regan, John J.

    1978-01-01

    Traditional guardianship laws are often inappropriate and repressive in protective services settings. Guidelines for their revision are proposed. Current legal mechanisms for emergency intervention should be amended to protect client's civil rights. Primacy of client consent and limiting of intervention to the least necessary restriction on…

  6. Early Intervention Services in Youth Mental Health

    ERIC Educational Resources Information Center

    Wade, Darryl; Johnston, Amy; Campbell, Bronwyn; Littlefield, Lyn

    2007-01-01

    Mental and substance use disorders are leading contributors to the burden of disease among young people in Australia, but young people experience a range of barriers to accessing appropriate treatment for their mental health concerns. The development of early intervention services that provide accessible and effective mental health care has the…

  7. Introducing breathlessness as a significant animal welfare issue.

    PubMed

    Beausoleil, N J; Mellor, D J

    2015-01-01

    Breathlessness is a negative affective experience relating to respiration, the animal welfare significance of which has largely been underestimated in the veterinary and animal welfare sciences. In this review, we draw attention to the negative impact that breathlessness can have on the welfare of individual animals and to the wide range of situations in which mammals may experience breathlessness. At least three qualitatively distinct sensations of breathlessness are recognised in human medicine--respiratory effort, air hunger and chest tightness--and each of these reflects comparison by cerebral cortical processing of some combination of heightened ventilatory drive and/or impaired respiratory function. Each one occurs in a variety of pathological conditions and other situations, and more than one may be experienced simultaneously or in succession. However, the three qualities vary in terms of their unpleasantness, with air hunger reported to be the most unpleasant. We emphasise the important interplay among various primary stimuli to breathlessness and other physiological and pathophysiological conditions, as well as animal management practices. For example, asphyxia/drowning of healthy mammals or killing those with respiratory disease using gases containing high carbon dioxide tensions is likely to lead to severe air hunger, while brachycephalic obstructive airway syndrome in modern dog and cat breeds increases respiratory effort at rest and likely leads to air hunger during exertion. Using this information as a guide, we encourage animal welfare scientists, veterinarians, laboratory scientists, regulatory bodies and others involved in evaluations of animal welfare to consider whether or not breathlessness contributes to any compromise they may observe or wish to avoid or mitigate.

  8. Protocol of the PLeural Effusion And Symptom Evaluation (PLEASE) study on the pathophysiology of breathlessness in patients with symptomatic pleural effusions.

    PubMed

    Thomas, Rajesh; Azzopardi, Maree; Muruganandan, Sanjeevan; Read, Catherine; Murray, Kevin; Eastwood, Peter; Jenkins, Sue; Singh, Bhajan; Lee, Y C Gary

    2016-08-03

    Pleural effusion is a common clinical problem that can complicate many medical conditions. Breathlessness is the most common symptom of pleural effusion of any cause and the most common reason for pleural drainage. However, improvement in breathlessness following drainage of an effusion is variable; some patients experience either no benefit or a worsening of their breathlessness. The physiological mechanisms underlying breathlessness in patients with a pleural effusion are unclear and likely to be multifactorial with patient-related and effusion-related factors contributing. A comprehensive study of the physiological and symptom responses to drainage of pleural effusions may provide a clearer understanding of these mechanisms, and may identify predictors of benefit from drainage. The ability to identify those patients whose breathlessness will (or will not) improve after pleural fluid drainage can help avoid unnecessary pleural drainage procedures, their associated morbidities and costs. The PLeural Effusion And Symptom Evaluation (PLEASE) study is a prospective study to comprehensively evaluate factors contributing to pleural effusion-related breathlessness. The PLEASE study is a single-centre prospective study of 150 patients with symptomatic pleural effusions that require therapeutic drainage. The study aims to identify key factors that underlie breathlessness in patients with pleural effusions and develop predictors of improvement in breathlessness following effusion drainage. Participants will undergo evaluation pre-effusion and post-effusion drainage to assess their level of breathlessness at rest and during exercise, respiratory and other physiological responses as well as respiratory muscle mechanics. Pre-drainage and post-drainage parameters will be collected and compared to identify the key factors and mechanisms that correlate with improvement in breathlessness. Approved by the Sir Charles Gairdner Group Human Research Ethics Committee (HREC number 2014

  9. Inspiring change: humanities and social science insights into the experience and management of breathlessness

    PubMed Central

    Oxley, Rebecca; Macnaughton, Jane

    2016-01-01

    Purpose of review Breathlessness can be debilitating for those with chronic conditions, requiring continual management. Yet, the meaning of breathlessness for those who live with it is poorly understood in respect of its subjective, cultural, and experiential significance. This article discusses a number of current issues in understanding the experience of breathlessness. Recent findings Effective communication concerning the experience of breathlessness is crucial for diagnosis, to identify appropriate treatment, and to provide patients with the capacity to self-manage their condition. However, there is an evident disconnect between the way breathlessness is understood between clinical and lay perspectives, in terms of awareness of breathlessness, the way symptoms are expressed, and acknowledgement of how it affects the daily lives of patients. Summary The review highlights the need for integrated multidisciplinary work on breathlessness, and suggests that effective understanding and management of breathlessness considers its wider subjective and social significance. PMID:27490147

  10. Nurses' decision-making in ethically relevant clinical situations using the example of breathlessness: study protocol of a reflexive grounded theory integrating Goffman's framework analysis.

    PubMed

    Dunger, Christine; Schnell, Martin W; Bausewein, Claudia

    2017-02-22

    Decision-making (DM) in healthcare can be understood as an interactive process addressing decision makers' reasoning as well as their visible behaviour after the decision is made. Other key elements of DM are ethical aspects and the role as well as the treatment options of the examined professions. Nurses' DM to choose interventions in situations of severe breathlessness is such interactions. They are also ethically relevant regarding the vulnerability of affected patients and possible restrictions or treatment options. The study aims to explore which factors influence nurses' DM to use nursing interventions in situations where patients suffer from severe breathlessness. Qualitative study including nurses in German hospital wards and hospices. A triangulation of different methods of data collection-participant observation and qualitative expert interviews-and analysis merge in a reflexive grounded theory approach which integrates Goffman's framework analysis. It allows an analysis of nurses' self-statements about DM, their behaviour in relevant clinical situations and its influences. Data collection and analysis will be examined simultaneously. Informed consent will be gained from all participants and the institutional stakeholders. Ongoing consent has to be ensured since observations will take place in healthcare institutions and many patients will be highly vulnerable. The study has been evaluated and approved by the Witten/Herdecke University Ethics Committee, Witten, Germany. Results of the study will be published at congresses and in journal papers. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  11. The importance of the feasibility study: Lessons from a study of the hand-held fan used to relieve dyspnea in people who are breathless at rest.

    PubMed

    Booth, Sara; Galbraith, Sarah; Ryan, Richella; Parker, Richard A; Johnson, Miriam

    2016-05-01

    The dyspnea accompanying advanced cardiorespiratory disease is often refractory to palliation. It is disabling, distressing and associated with the diseases most common everywhere in the world. The hand-held fan, used to generate a draught across the face, is a simple, cost-effective, safe, and universally applicable palliative breathlessness intervention, consistently described as valuable in qualitative research. A previous crossover trial confirmed its benefit in patients breathless at rest, but the washout period was uncertain. To determine the washout period after use of the hand-held fan to inform accurate randomized controlled trial design. An observational methodological study. Breathlessness intensity was measured using 100 mm visual analog scale and numerical rating scale, and "relief of breathlessness" was measured on a 5-point scale. Those benefitting from the fan provided visual analog scale/numerical rating scale scores until (1) scores returned to baseline values or (2) until response had plateaued. The primary outcome measure was the time (in minutes) to reach either component of the primary study endpoint. Four in-/out-patient hospice/hospital units; participants had chronic refractory breathlessness using the fan. Overall, 31 patients participated (mean age: 74.8 years; range: 49-98 years, standard deviation = 11.5 years); 64% were males. Approximately, half of the sample experienced benefit of moderate effect size. The relative reduction in breathlessness relative to the mean baseline score for the sample was 27% for the visual analog scale and 19% for the numerical rating scale. Feasibility work is essential, even for simple widely employed interventions. © The Author(s) 2015.

  12. Opioids for the palliation of refractory breathlessness in adults with advanced disease and terminal illness.

    PubMed

    Barnes, Hayley; McDonald, Julie; Smallwood, Natasha; Manser, Renée

    2016-03-31

    Breathlessness is a common and disabling symptom which affects many people with advanced cardiorespiratory disease and cancer. The most effective treatments are aimed at treating the underlying disease. However, this may not always be possible, and symptomatic treatment is often required in addition to maximal disease-directed therapy. Opioids are increasingly being used to treat breathlessness, although their mechanism of action is still not completely known. A few good sized, high quality trials have been conducted in this area. To determine the effectiveness of opioid drugs in relieving the symptom of breathlessness in people with advanced disease due to malignancy, respiratory or cardiovascular disease, or receiving palliative care for any other disease. We performed searches on CENTRAL, MEDLINE, EMBASE, CINAHL, and Web of Science up to 19 October 2015. We handsearched review articles, clinical trial registries, and reference lists of retrieved articles. We included randomised double-blind controlled trials that compared the use of any opioid drug against placebo or any other intervention for the relief of breathlessness. The intervention was any opioid, given by any route, in any dose. We imported studies identified by the search into a reference manager database. We retrieved the full-text version of relevant studies, and two review authors independently extracted data. The primary outcome measure was breathlessness and secondary outcome measures included exercise tolerance, oxygen saturations, adverse events, and mortality. We analysed all studies together and also performed subgroup analyses, by route of administration, type of opioid administered, and cause of breathlessness. Where appropriate, we performed meta-analysis. We assessed the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and created three 'Summary of findings' tables. We included 26 studies with 526 participants. We assessed the studies as

  13. Service Users' Experiences of a Brief Intervention Service for Children and Adolescents: A Service Evaluation

    ERIC Educational Resources Information Center

    Gallagher, Jen; Schlösser, Annette

    2015-01-01

    Ten per cent of young people experience mental health difficulties at any one time. Prevention and early intervention leads to better prognosis for young people's mental well-being in the short and long term. Child and Adolescent Mental Health Services (CAMHS) must be able to provide swift and effective interventions for a range of difficulties to…

  14. Service Users' Experiences of a Brief Intervention Service for Children and Adolescents: A Service Evaluation

    ERIC Educational Resources Information Center

    Gallagher, Jen; Schlösser, Annette

    2015-01-01

    Ten per cent of young people experience mental health difficulties at any one time. Prevention and early intervention leads to better prognosis for young people's mental well-being in the short and long term. Child and Adolescent Mental Health Services (CAMHS) must be able to provide swift and effective interventions for a range of difficulties to…

  15. Contributions of a hand-held fan to self-management of chronic breathlessness

    PubMed Central

    Phillips, Jane; Johnson, Miriam J.; Farquhar, Morag; Swan, Flavia; Assen, Teresa; Bhattarai, Priyanka; Booth, Sara

    2017-01-01

    This study explored the benefits of a hand-held fan as perceived by patients with chronic breathlessness and their carers. A secondary multimethod analysis was conducted of interview data collected in three clinical trials. Two researchers independently coded level of benefit qualitatively reported by each patient. Univariate and multivariate statistics were used to explore perceived benefit as a factor of sex, age and diagnosis. Qualitative analysis used an integrative method. 133 patients commented on the fan, of whom 72 had a carer. Diagnoses included nonmalignant (n=91, 68.4%) and malignant (n=21, 15.8%) conditions. Of 111 patients who provided codable data, four (3.6%) perceived no benefit, 16 (14.4%) were uncertain, 80 (72.0%) perceived some benefit and 11 (10.0%) perceived very substantial benefit. Multivariate analysis was inconclusive. Benefit was described in terms of shorter recovery time, especially after activity. 10 (7.5%) patients said the fan reduced their need for home oxygen or inhaled β-agonist medications. Negative perceptions of a few included dislike of the cooling sensation and embarrassment in public. Findings suggest that a hand-held fan is a portable intervention with few disadvantages from which most patients with chronic breathlessness will derive benefit alongside other nonpharmacological and pharmacological strategies. Research is needed to optimise guidance on fan administration. PMID:28818884

  16. Validation of the breathlessness, cough and sputum scale to predict COPD exacerbation

    PubMed Central

    DeVries, Rebecca; Kriebel, David; Sama, Susan

    2016-01-01

    The breathlessness, cough and sputum scale (BCSS) is a three-item questionnaire rating breathlessness, cough and sputum on a 5-point Likert scale from 0 (no symptoms) to 4 (severe symptoms). Researchers have explored the utility of this tool to quantify efficacy of treatment following a chronic obstructive pulmonary disease (COPD) exacerbation; however, little work has been done to investigate the ability of the BCSS to predict COPD exacerbation. As part of a prospective case-crossover study among a cohort of 168 COPD patients residing in central Massachusetts, patients were asked standard BCSS questions during exacerbation and randomly identified non-exacerbation (or healthy) weeks. We found that the BCSS was strongly associated with COPD exacerbation (OR=2.80, 95% CI=2.27–3.45) and that a BCSS sum score of 5.0 identified COPD exacerbation with 83% sensitivity and 68% specificity. These results may be useful in the clinical setting to expedite interventions of exacerbation. PMID:27906157

  17. Palliative drug treatments for breathlessness in cystic fibrosis.

    PubMed

    Jaiswal, Nishant; Singh, Meenu; Agarwal, Amit; Thumburu, Kiran K

    2017-08-10

    Cystic fibrosis is a life-limiting autosomal recessive genetic illness. A feeling of shortness of breath is common in cystic fibrosis, especially as the disease progresses. Reversing the underlying cause is the priority when treating breathlessness (dyspnoea), but when it is not feasible, palliation (easing) becomes the primary goal to improve an individual's quality of life. A range of drugs administered by various routes have been used, but no definite guidelines are available. A systematic review is needed to evaluate such treatments. To assess the efficacy and safety of drugs used to ease breathlessness in people with cystic fibrosis. We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books.Date of last search: 24 July 2017.We searched databases (clinicaltrials.gov, the ISRCTN registry, the Clinical Trials Registry India and WHO ICTRP) for ongoing trials. These searches were last run on 31 July 2017. We planned to include randomised and quasi-randomised controlled trials in people with cystic fibrosis (diagnosed by a positive sweat chloride test or genetic testing) who have breathlessness. We considered studies comparing any drugs used for easing breathlessness to another drug administered by any route (inhaled (nebulised), intravenous, oral, subcutaneous, transmucosal (including buccal, sublingual and intra-nasal) and transdermal). The authors assessed the search results according to the pre-defined inclusion criteria. The search yielded only one study (cross-over in design), which did not fulfil the inclusion criteria as no data were available from the first treatment period alone. Due to the lack of available evidence, this review cannot provide any information for clinical practice. The authors call for specific research in this area after taking into account relevant ethical considerations. The research should focus on the efficacy and safety of the

  18. Bridging community intervention and mental health services research.

    PubMed

    Wells, Kenneth; Miranda, Jeanne; Bruce, Martha L; Alegria, Margarita; Wallerstein, Nina

    2004-06-01

    This article explores the potential of community intervention perspectives for increasing the relevance, reach, and public health impact of mental health services research. The authors reviewed community intervention strategies, including public health and community development and empowerment interventions, and contrast community intervention with practice-based quality improvement and policy research. A model was proposed to integrate health services and community intervention research, building on the evidence-based strength of quality improvement and participatory methods of community intervention to produce complementary functions, such as linking community-based case finding and referral with practice-based quality improvement, enhanced by community-based social support for treatment adherence. The community intervention approach is a major paradigm for affecting public health or addressing health disparities. Despite challenges in implementation and evaluation, it represents a promising approach for extending the reach of mental health services interventions into diverse communities.

  19. Breathlessness and blood: a combustible combination.

    PubMed

    Popovsky, Mark A

    2002-08-01

    Pulmonary complications are increasingly recognized as serous hazards of transfusion. The evidence suggests that transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are underrecognized. Both present with dyspnea but other signs and symptoms assist in determining the proper diagnosis. Males and females are equally affected. Morbidity is significant with both complications and in the case of TRALI, the mortality is in the range of 6-10%. Although the clinical descriptions of both entities are well established, the clinical profile of the at-risk population for both TRALI and TACO is not well understood. Because early intervention can reduce morbidity, it is important that clinicians recognize these disorders and apply appropriate treatment.

  20. Early Intervention Services for Young Boys with Fragile X Syndrome.

    ERIC Educational Resources Information Center

    Hatton, Deborah D.; Bailey, Donald B., Jr.; Roberts, Jennifer P.; Skinner, Martie; Mayhew, Lisa; Clark, Renee Duffee; Waring, Elizabeth; Roberts, Jane E.

    2000-01-01

    A study of 50 boys with fragile X syndrome, their parents, and teachers, found early intervention started on average at 21.6 months and there was a steady increase in the amount of early intervention across age periods. Although parents reported satisfaction with services, most would have preferred more services. (Contains references.) (Author/CR)

  1. The Impact of Arbitration Intervention Services on Arbitration Program Completion

    ERIC Educational Resources Information Center

    Dembo, Richard; Wareham, Jennifer; Poythress, Norman G.; Cook, Brittany; Schmeidler, James

    2006-01-01

    We report the impact of case management services and youth psychopathy on Juvenile Diversion program completion for youths involved in a clinical trial, and evaluation of an innovative intervention service providing 16 weeks of intensive case management services to youths and their families. The present study examines baseline interview data for…

  2. Episodes of breathlessness: types and patterns - a qualitative study exploring experiences of patients with advanced diseases.

    PubMed

    Simon, Steffen T; Higginson, Irene J; Benalia, Hamid; Gysels, Marjolein; Murtagh, Fliss Em; Spicer, James; Bausewein, Claudia

    2013-06-01

    Despite the high prevalence and impact of episodic breathlessness, information about characteristics and patterns is scarce. To explore the experience of patients with advanced disease suffering from episodic breathlessness, in order to describe types and patterns. Qualitative design using in-depth interviews with patients suffering from advanced stages of chronic heart failure, chronic obstructive pulmonary disease, lung cancer or motor neurone disease. As part of the interviews, patients were asked to draw a graph to illustrate typical patterns of breathlessness episodes. Interviews were tape-recorded, transcribed verbatim and analysed using Framework Analysis. The graphs were grouped according to their patterns. Fifty-one participants (15 chronic heart failure, 14 chronic obstructive pulmonary disease, 13 lung cancer and 9 motor neurone disease) were included (mean age 68.2 years, 30 of 51 men, mean Karnofsky 63.1, mean breathlessness intensity 3.2 of 10). Five different types of episodic breathlessness were described: triggered with normal level of breathlessness, triggered with predictable response (always related to trigger level, e.g. slight exertion causes severe breathlessness), triggered with unpredictable response (not related to trigger level), non-triggered attack-like (quick onset, often severe) and wave-like (triggered or non-triggered, gradual onset). Four patterns of episodic breathlessness could be identified based on the graphs with differences regarding onset and recovery of episodes. These did not correspond with the types of breathlessness described before. Patients with advanced disease experience clearly distinguishable types and patterns of episodic breathlessness. The understanding of these will help clinicians to tailor specific management strategies for patients who suffer from episodes of breathlessness.

  3. Psychophysical Differences in Ventilatory Awareness and Breathlessness between Athletes and Sedentary Individuals

    PubMed Central

    Faull, Olivia K.; Cox, Pete J.; Pattinson, Kyle T. S.

    2016-01-01

    Purpose: Breathlessness is a complex set of symptoms that are comprised of both sensory and affective (emotional) dimensions. While ventilation is now understood to be a potential limiter to performance in highly-trained individuals, the contribution of breathlessness-anxiety in those nearing maximal ventilation during intense exercise has not yet been considered as a limiter to performance. Methods: In this study, we compared the physiology and psychology of breathlessness in 20 endurance athletes with 20 untrained age- and sex-matched sedentary controls. Subjects completed baseline spirometry and anxiety questionnaires, an incremental exercise test to exhaustion and a steady-state hypercapnic ventilatory response test, with concurrent measures of breathlessness intensity and breathlessness-anxiety. Results: Compared with sedentary subjects, athletes reported equivalent breathlessness intensity but greater breathlessness-anxiety at maximal exercise (athletes vs. sedentary (mean ± SD): breathlessness intensity (0–100%) 80.7 (22.7) vs. 72.5 (17.2), p = 0.21; breathlessness-anxiety (0–100%), 45.3 (36.3) vs. 22.3 (20.0), p = 0.02). Athletes operated at higher proportions of their maximal ventilatory capacity (MVV) (athletes vs. sedentary (mean ventilation ± SD; % MVV): 101.6 (27.2) vs. 73.7 (30.1), p = 0.003). In the athletes there was a positive linear correlation between ventilation and breathlessness score during the hypercapnic challenge that was not observed in the sedentary controls. Conclusion: The results of this study indicate that whilst operating at high proportions of maximal ventilation, breathlessness-anxiety becomes increasingly prominent in athletes. Our results suggest that ventilatory perception pathways may be a target for improved athletic performance in some individuals. PMID:27378940

  4. 34 CFR 303.112 - Availability of early intervention services.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... intervention services are based on scientifically based research, to the extent practicable, and are available...; and (b) Infants and toddlers with disabilities who are homeless children and their families. (Approved...

  5. 34 CFR 303.112 - Availability of early intervention services.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... intervention services are based on scientifically based research, to the extent practicable, and are available...; and (b) Infants and toddlers with disabilities who are homeless children and their families. (Approved...

  6. Management of refractory breathlessness with morphine in patients with chronic obstructive pulmonary disease.

    PubMed

    Smallwood, N; Le, B; Currow, D; Irving, L; Philip, J

    2015-09-01

    Chronic obstructive pulmonary disease (COPD) is a progressive, incurable illness, which leads to significant morbidity over long periods of time and mortality. Treatment aims to reduce symptoms, improve exercise capacity and quality of life, reduce exacerbations, slow disease progression and reduce mortality. However, breathlessness is common in patients with advanced COPD and remains undertreated. As all reversible causes of breathlessness are being optimally managed, consideration should be given to specific non-pharmacological and pharmacological treatment strategies for breathlessness. Low dose morphine has been shown to reduce safely and effectively breathlessness in patients with severe COPD and refractory dyspnoea. However, despite numerous guidelines recommending opioids in this clinical setting, many barriers limit their uptake by clinicians. Integration of palliative care earlier in the disease course can help to improve symptom control for people with severe COPD and refractory breathlessness. A multidisciplinary approach involving both respiratory and palliative care teams offers a new model of care for these patients.

  7. Preschool Intervention: A Behavioral Service Delivery System.

    ERIC Educational Resources Information Center

    Ora, John P.; Reisinger, James J.

    Described is a preschool intervention demonstration project for emotionally disturbed children said to be based on the functional analysis of behavior and behavior change. The project's organizational patterns and procedures are compared to those described by B.F. Skinner in Walden Two. The description emphasizes the concepts of measurement and…

  8. Preschool Intervention: A Behavioral Service Delivery System.

    ERIC Educational Resources Information Center

    Ora, John P.; Reisinger, James J.

    Described is a preschool intervention demonstration project for emotionally disturbed children said to be based on the functional analysis of behavior and behavior change. The project's organizational patterns and procedures are compared to those described by B.F. Skinner in Walden Two. The description emphasizes the concepts of measurement and…

  9. Service Provider Combinations and the Delivery of Early Intervention Services to Children and Families

    ERIC Educational Resources Information Center

    Raspa, Melissa; Hebbeler, Kathleen; Bailey, Donald B., Jr.; Scarborough, Anita A.

    2010-01-01

    Using data from the National Early Intervention Longitudinal Study, this study provides a framework for characterizing the delivery of early intervention services based on the combinations of service providers who work with infants and toddlers with disabilities and their families. Five groups of providers were identified. Results showed that the…

  10. Service Provider Combinations and the Delivery of Early Intervention Services to Children and Families

    ERIC Educational Resources Information Center

    Raspa, Melissa; Hebbeler, Kathleen; Bailey, Donald B., Jr.; Scarborough, Anita A.

    2010-01-01

    Using data from the National Early Intervention Longitudinal Study, this study provides a framework for characterizing the delivery of early intervention services based on the combinations of service providers who work with infants and toddlers with disabilities and their families. Five groups of providers were identified. Results showed that the…

  11. Participation Patterns among Families Receiving Part C Early Intervention Services

    ERIC Educational Resources Information Center

    Khetani, Mary Alunkal

    2010-01-01

    Participation in the natural settings of home and community is one of four major goals for families receiving Part C early intervention services. While participation has been formally recognized as an important service-related outcome, there is a need to build knowledge about its key features to adequately apply the concept in practice. The need…

  12. Participation Patterns among Families Receiving Part C Early Intervention Services

    ERIC Educational Resources Information Center

    Khetani, Mary Alunkal

    2010-01-01

    Participation in the natural settings of home and community is one of four major goals for families receiving Part C early intervention services. While participation has been formally recognized as an important service-related outcome, there is a need to build knowledge about its key features to adequately apply the concept in practice. The need…

  13. Early Intervention Services: Effectively Supporting Maori Children and their Families

    ERIC Educational Resources Information Center

    Berryman, Mere; Woller, Paul

    2011-01-01

    This paper examines Early Intervention (EI) service provision from within one Ministry of Education region in New Zealand. It does this in order to better understand what works well and what needs to change if children from Maori families, of Early Childhood age, are to be provided with the most effective EI services. By engaging with Maori…

  14. Effective interventions on service quality improvement in a physiotherapy clinic.

    PubMed

    Gharibi, Farid; Tabrizi, JafarSadegh; Eteraf Oskouei, MirAli; AsghariJafarabadi, Mohammad

    2014-01-01

    Service quality is considered as a main domain of quality associ-ated with non-clinical aspect of healthcare. This study aimed to survey and im-proves service quality of delivered care in the Physiotherapy Clinic affiliated with the Tabriz University of Medical Sciences, Tabriz, Iran. A quasi experimental interventional study was conducted in the Physiotherapy Clinic, 2010-2011. Data were collected using a validated and reli-able researcher made questionnaire with participation of 324 patients and their coadjutors. The study questionnaire consisted of 7 questions about demographic factors and 38 questions for eleven aspects of service quality. Data were then analyzed using paired samples t-test by SPSS16. In the pre intervention phase, six aspects of service quality including choice of provider, safety, prevention and early detection, dignity, autonomy and availability achieved non-acceptable scores. Following interventions, all aspects of the service quality improved and also total service quality score improved from 8.58 to 9.83 (P<0.001). Service quality can be improved by problem implementation of appropriate interventions. The acquired results can be used in health system fields to create respectful environments for healthcare customers.

  15. Effective Interventions on Service Quality Improvement in a Physiotherapy Clinic

    PubMed Central

    Gharibi, Farid; Tabrizi, JafarSadegh; Eteraf Oskouei, MirAli; AsghariJafarabadi, Mohammad

    2014-01-01

    Background: Service quality is considered as a main domain of quality associ­ated with non-clinical aspect of healthcare. This study aimed to survey and im­proves service quality of delivered care in the Physiotherapy Clinic affiliated with the Tabriz University of Medical Sciences, Tabriz, Iran. Methods: A quasi experimental interventional study was conducted in the Physiotherapy Clinic, 2010-2011. Data were collected using a validated and reli­able researcher made questionnaire with participation of 324 patients and their coadjutors. The study questionnaire consisted of 7 questions about demographic factors and 38 questions for eleven aspects of service quality. Data were then analyzed using paired samples t-test by SPSS16. Results: In the pre intervention phase, six aspects of service quality including choice of provider, safety, prevention and early detection, dignity, autonomy and availability achieved non-acceptable scores. Following interventions, all aspects of the service quality improved and also total service quality score improved from 8.58 to 9.83 (P<0.001). Conclusion: Service quality can be improved by problem implementation of appropriate interventions. The acquired results can be used in health system fields to create respectful environments for healthcare customers. PMID:25097838

  16. Junior doctors' attitudes to opioids for refractory breathlessness in patients with advanced chronic obstructive pulmonary disease.

    PubMed

    Smallwood, Natasha; Gaffney, Nicole; Gorelik, Alexandra; Irving, Louis; Le, Brian; Philip, Jennifer

    2017-06-06

    Refractory breathlessness is a common, distressing symptom in patients with advanced chronic obstructive pulmonary disease (COPD). The judicious, off-licence prescription of opioids, together with other management strategies, can improve breathlessness, however, internationally there is profound reluctance to prescribe opioids for breathlessness in COPD. To understand Australian junior doctors' knowledge and attitudes regarding the management of refractory breathlessness and the role of opioids in COPD. All junior doctors undertaking basic training in internal medicine in Victoria were invited to complete an online survey. Knowledge, willingness, and experience prescribing opioids to COPD patients with refractory breathlessness, were examined. Of the 243 responses received, most trainees (193, 86.5%) believed opioids have a role in treating refractory breathlessness in stable COPD outpatients, with 143 (64.1%) recommending morphine as first line treatment for refractory breathlessness. One quarter (55, 24.7%) reported having themselves initiated an opioid and 102 (45.7%) had prescribed an opioid under senior supervision for management of breathlessness in COPD. Concern regarding adverse opioid effects was low, with 58 (26.0%) having no concerns prescribing an opioid to COPD patients. This is the first study of doctors to demonstrate high awareness, confidence, willingness and experience in prescribing opioids for the off-licence indication of refractory breathlessness in COPD. These findings differ significantly from attitudes reported overseas and are unexpected given the doctors surveyed were recently qualified. The low awareness of possible adverse events and limited insight regarding knowledge gaps is concerning and highlights the significant need for greater education in palliative care. This article is protected by copyright. All rights reserved.

  17. Diaphragm weakness as a cause of breathlessness after anatomically distant surgery

    PubMed Central

    Moore, A; Moxham, J; Polkey, M

    2005-01-01

    The case histories are presented of two patients in whom breathlessness developed following surgery to an anatomically distant site. Respiratory muscle testing demonstrated diaphragm weakness in both patients. PMID:16135683

  18. The Application of a Transdisciplinary Model for Early Intervention Services

    ERIC Educational Resources Information Center

    King, Gillian; Strachan, Deborah; Tucker, Michelle; Duwyn, Betty; Desserud, Sharon; Shillington, Monique

    2009-01-01

    This article reviews the literature on the transdisciplinary approach to early intervention services and identifies the essential elements of this approach. A practice model describing the implementation of the approach is then presented, based on the experiences of staff members in a home visiting program for infants that has been in existence…

  19. A Framework for Providing Culturally Responsive Early Intervention Services

    ERIC Educational Resources Information Center

    Bradshaw, Wendy

    2013-01-01

    The purpose of this article is to provide a framework that offers a way for early intervention (EI) service providers to better meet the needs of the culturally diverse children and families they serve. This framework was created to organize existing research and literature on cultural responsiveness in a way that fit the unique context of EI. The…

  20. A Framework for Providing Culturally Responsive Early Intervention Services

    ERIC Educational Resources Information Center

    Bradshaw, Wendy

    2013-01-01

    The purpose of this article is to provide a framework that offers a way for early intervention (EI) service providers to better meet the needs of the culturally diverse children and families they serve. This framework was created to organize existing research and literature on cultural responsiveness in a way that fit the unique context of EI. The…

  1. Service Delivery Complexities: Early Intervention for Children with Physical Disabilities

    ERIC Educational Resources Information Center

    Ziviani, Jenny; Darlington, Yvonne; Feeney, Rachel; Rodger, Sylvia; Watter, Pauline

    2013-01-01

    Early intervention (EI) for children with physical disabilities is advocated as a means of enhancing child outcomes and family functioning. The issues confronted by service providers in delivering this support have received relatively little attention. The purpose of this study was to gain an understanding of the experiences of frontline EI staff…

  2. Creating a National Data Base on Early Intervention Services.

    ERIC Educational Resources Information Center

    Hebbeler, Kathleen M.

    1991-01-01

    This article describes data requirements in Public Law 99-457; discusses issues confronting states as they develop data systems, such as the problems of comprehensiveness, incompatibility, and confidentiality; examines data on numbers of infants and toddlers receiving early intervention services; and explores applications of a national database on…

  3. Response to Intervention (RTI) Services: An Ecobehavioral Perspective

    ERIC Educational Resources Information Center

    Greenwood, Charles R.; Kim, Joung Min

    2012-01-01

    Schoolwide Response to Intervention (RTI) services are growing in prevalence in U.S. schools. Most advanced are RTI programs in elementary schools, with preschool and secondary education programs beginning to discuss, develop, and experiment with schoolwide RTI. At its heart, RTI seeks to account for individual differences in student learning…

  4. Response to Intervention (RTI) Services: An Ecobehavioral Perspective

    ERIC Educational Resources Information Center

    Greenwood, Charles R.; Kim, Joung Min

    2012-01-01

    Schoolwide Response to Intervention (RTI) services are growing in prevalence in U.S. schools. Most advanced are RTI programs in elementary schools, with preschool and secondary education programs beginning to discuss, develop, and experiment with schoolwide RTI. At its heart, RTI seeks to account for individual differences in student learning…

  5. Service Delivery Complexities: Early Intervention for Children with Physical Disabilities

    ERIC Educational Resources Information Center

    Ziviani, Jenny; Darlington, Yvonne; Feeney, Rachel; Rodger, Sylvia; Watter, Pauline

    2013-01-01

    Early intervention (EI) for children with physical disabilities is advocated as a means of enhancing child outcomes and family functioning. The issues confronted by service providers in delivering this support have received relatively little attention. The purpose of this study was to gain an understanding of the experiences of frontline EI staff…

  6. The cortical connectivity of the periaqueductal gray and the conditioned response to the threat of breathlessness

    PubMed Central

    Faull, Olivia K; Pattinson, Kyle TS

    2017-01-01

    Previously we observed differential activation in individual columns of the periaqueductal grey (PAG) during breathlessness and its conditioned anticipation (Faull et al., 2016b). Here, we have extended this work by determining how the individual columns of the PAG interact with higher cortical centres, both at rest and in the context of breathlessness threat. Activation was observed in ventrolateral PAG (vlPAG) and lateral PAG (lPAG), where activity scaled with breathlessness intensity ratings, revealing a potential interface between sensation and cognition during breathlessness. At rest the lPAG was functionally correlated with cortical sensorimotor areas, conducive to facilitating fight/flight responses, and demonstrated increased synchronicity with the amygdala during breathlessness. The vlPAG showed fronto-limbic correlations at rest, whereas during breathlessness anticipation, reduced functional synchronicity was seen to both lPAG and motor structures, conducive to freezing behaviours. These results move us towards understanding how the PAG might be intricately involved in human responses to threat. DOI: http://dx.doi.org/10.7554/eLife.21749.001 PMID:28211789

  7. Acu-TENS Reduces Breathlessness during Exercise in People with Chronic Obstructive Pulmonary Disease

    PubMed Central

    Ngai, Shirley P. C.; Spencer, Lissa M.; Jones, Alice Y. M.

    2017-01-01

    Background. Exertional dyspnoea limits level of physical activity in people with Chronic Obstructive Pulmonary Disease (COPD). This randomized, double-blinded, crossover study evaluated the effect of Acu-TENS, application of Transcutaneous Electrical Nerve Stimulation on acupoints, on breathlessness during exercise in people with COPD. Methods. Twenty-one participants, mean% predicted FEV1  50 ± 21%, attended assessment followed by two intervention days, one week apart. On each intervention day, participants performed two endurance shuttle walk tests (ESWT) (Walk 1 and Walk 2). Walk 1 was performed without intervention and Walk 2 was performed with either Acu-TENS or Sham-TENS, in random order, for 45 minutes before and during Walk 2. Duration of each ESWT and dyspnoea score at isotime of Walk 1 and Walk 2 on each intervention day were compared. Between-group differences in ESWT duration and isotime dyspnoea were also compared. Results. At isotime of Walk 1 and Walk 2, Acu-TENS showed significant reduction in dyspnoea of −0.8 point (95% CI −0.2 to −1.4) but not in Sham-TENS [0.1 point (95% CI −0.4 to 0.6)]. Compared to Sham-TENS, Acu-TENS showed significant reduction in dyspnoea of −0.9 point (95% CI −0.2 to −1.6) while no between-group significance was found in ESWT duration. Conclusion. Acu-TENS alleviated dyspnoea during walking in people with COPD but did not increase walking duration. PMID:28303156

  8. The Provision of Interventional Radiology Services in Europe: CIRSE Recommendations.

    PubMed

    Tsetis, Dimitrios; Uberoi, Raman; Fanelli, Fabrizio; Roberston, Iain; Krokidis, Miltiadis; van Delden, Otto; Radeleff, Boris; Müller-Hülsbeck, Stefan; Szerbo-Trojanowska, Malgorzata; Lee, Michael; Morgan, Robert; Brountzos, Elias; Belli, Anna Maria

    2016-04-01

    Interventional Radiology (IR) is an essential part of modern medicine, delivering minimally invasive patient-focused care, which has been proven to be safe and effective in both elective and emergency settings. The aim of this document is to outline the core requirements and standards for the provision of Interventional Radiological services, including training, certification, manpower, and accreditation. The ultimate challenge will be the adoption of these recommendations by different countries and health economies around the world, in turn ensuring equal access to IR treatments for all patients, the appropriate distribution of resources for IR service provision as well as the continued development of safe and high-quality IR services in Europe and beyond.

  9. The Crime Victim Advocate Program: A New Service for Crisis Intervention Services.

    ERIC Educational Resources Information Center

    Thigpen, Joe D.; Jones, Elizabeth

    This paper presents an overview of problems confronting crime victims, identifies service approaches to assist crime victims, and discusses the advantages and disadvantages of providing victim advocate services as part of comprehensive crisis intervention centers. Victims not only may bear the suffering of financial loss and emotional trauma as a…

  10. Equitable service provision for inclusive education and effective early intervention.

    PubMed

    Wicks, K M

    1998-01-01

    This paper illustrates one model of providing an integrated paediatric speech and language therapy service which attempts to meet the demands of both inclusive education and effective early intervention. A move has been made from location-oriented therapy provision to offering children and their families equal opportunities to have appropriate intervention according to need. The model incorporates the philosophy of inclusive education and supports the development of current specialist educational establishments into resource bases of expertise for children with special needs in mainstream schools.

  11. Knowledge and Use of Intervention Practices by Community-Based Early Intervention Service Providers

    ERIC Educational Resources Information Center

    Paynter, Jessica M.; Keen, Deb

    2015-01-01

    This study investigated staff attitudes, knowledge and use of evidence-based practices (EBP) and links to organisational culture in a community-based autism early intervention service. An EBP questionnaire was completed by 99 metropolitan and regionally-based professional and paraprofessional staff. Participants reported greater knowledge and use…

  12. Towards improving service delivery in screening and intervention services in community pharmacies: a case study of an alcohol IBA service.

    PubMed

    Mackridge, A J; Krska, J; Stokes, E C; Heim, D

    2016-03-01

    Previous studies have demonstrated positive outcomes from a range of pharmacy public health services, but barriers to delivery remain. This paper explores the processes of delivering an alcohol screening and intervention service, with a view to improving service delivery. A mixed-methods, multi-perspective approach was used, comprising in-pharmacy observations and recording of service provision, follow-up interviews with service users and interactive feedback sessions with service providers. Observations and recordings indicate that staff missed opportunities to offer the service and that both availability and delivery of the service were inconsistent, partly owing to unavailability of trained staff and service restrictions. Most service users gave positive accounts of the service and considered pharmacies to be appropriate places for this service. Respondents also described positive impacts, ranging from thinking more about alcohol consumption generally to substantial reductions in consumption. Key facilitators to service provision included building staff confidence and service champions. Barriers included commissioning issues and staff perception of alcohol as a sensitive topic. Findings support expansion of pharmacies' role in delivering public health services and highlight benefits of providing feedback to pharmacy staff on their service provision as a possible avenue for service improvement. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  13. Incentive spirometry as a means to score breathlessness.

    PubMed

    Loh, Li-Cher; Teh, Pek-Ngor; Raman, Sree; Vijayasingham, Pillai; Thayaparan, Tarmizi

    2005-01-01

    Perceived breathlessness played an important role in guiding treatment in asthma. We developed a simple, user-friendly method of scoring perception of dyspnoea (POD) using an incentive spirometer, Triflo II (Tyco Healthcare, Mansfield, USA) by means of repetitive inspiratory efforts achieved within three minutes in 175 normal healthy subjects and 158 asthmatic patients of mild (n=26), moderate (n=78) and severe (n=54). Severity was stratified according to GINA guideline. The mean POD index in normal subjects, and asthmatic patients of mild, moderate and severe severity were: 6 (4-7) 16 (9-23), 25 (14-37), and 57 (14-100) respectively (p<0.001 One-Way ANOVA). Based on 17 asthmatic and 20 normal healthy subjects, intraclass correlation coefficients for POD index within subjects were high. In 14 asthmatic patients randomized to receiving nebulised b(2)-agonist or saline in a crossover, double-blind study, % FEV(1) change correlated with % changes in POD index [r(s) -0.46, p=0.012]. Finally, when compared with 6-minutes walking test (6MWT) in an open label study, respiratory POD index correlated with walking POD index in 21 asthmatic patients [r(s)= 0.58 (0.17 to 0.81) (p=0.007] and 26 normal subjects [0.50 (0.13 to 0.75) (p=0.008)]. We concluded that this test is discriminative between asthmatic patients of varying severity and from normal subjects, is reproducible, responsive to bronchodilator effect, and comparable with 6MWT. Taken together, it has the potential to score disability and POD in asthma effectively and simply.

  14. The Effect of Outpatient Interventional Audiology on Inpatient Audiology Services.

    PubMed

    Zitelli, Lori; Palmer, Catherine V

    2017-05-01

    Although older adults are likely to experience some degree of hearing loss that if untreated will interfere with treatment for other disorders and result in less-than-optimal health care outcomes, health care providers do not have a reliable and cost-effective way to identify these individuals when admitted to a hospital for inpatient care. This article addresses the impact of untreated hearing loss on health care in a hospital setting and shares how the implementation of interventional audiology in an outpatient clinic has impacted the inpatient audiology services provided at a large tertiary care hospital. A discussion of how these services can be further expanded is provided.

  15. Effects of opioids on breathlessness and exercise capacity in chronic obstructive pulmonary disease. A systematic review.

    PubMed

    Ekström, Magnus; Nilsson, Fredrik; Abernethy, Amy A; Currow, David C

    2015-07-01

    Patients with chronic obstructive pulmonary disease (COPD) commonly suffer from breathlessness, deconditioning, and reduced health-related quality of life (HRQL) despite best medical management. Opioids may relieve breathlessness at rest and on exertion in COPD. We aimed to estimate the efficacy and safety of opioids on refractory breathlessness, exercise capacity, and HRQL in COPD. This was a systematic review and metaanalysis using Cochrane methodology. We searched Cochrane Central Register of Controlled Trials, MEDLINE, and Embase up to 8 September, 2014 for randomized, double-blind, placebo-controlled trials of any opioid for breathlessness, exercise capacity, or HRQL that included at least one participant with COPD. Effects were analyzed as standardized mean differences (SMDs) with 95% confidence intervals (CIs) using random effect models. A total of 16 studies (15 crossover trials and 1 parallel-group study, 271 participants, 95% with severe COPD) were included. There were no serious adverse effects. Breathlessness was reduced by opioids overall: SMD, -0.35 (95% CI, -0.53 to -0.17; I(2), 48.9%), by systemic opioids (eight studies, 118 participants): SMD, -0.34 (95% CI, -0.58 to -0.10; I(2), 0%), and less consistently by nebulized opioids (four studies, 82 participants): SMD, -0.39 (95% CI, -0.71 to -0.07; I(2), 78.9%). The quality of evidence was moderate for systemic opioids and low for nebulized opioids on breathlessness. Opioids did not affect exercise capacity (13 studies, 149 participants): SMD, 0.06 (95% CI, -0.15 to 0.28; I(2), 70.7%). HRQL could not be analyzed. Findings were robust in sensitivity analyses. Risk of study bias was low or unclear. Opioids improved breathlessness but not exercise capacity in severe COPD.

  16. Blunted perception of neural respiratory drive and breathlessness in patients with cystic fibrosis

    PubMed Central

    Jolley, Caroline J.; Elston, Caroline; Moxham, John; Rafferty, Gerrard F.

    2016-01-01

    The electromyogram recorded from the diaphragm (EMGdi) and parasternal intercostal muscle using surface electrodes (sEMGpara) provides a measure of neural respiratory drive (NRD), the magnitude of which reflects lung disease severity in stable cystic fibrosis. The aim of this study was to explore perception of NRD and breathlessness in both healthy individuals and patients with cystic fibrosis. Given chronic respiratory loading and increased NRD in cystic fibrosis, often in the absence of breathlessness at rest, we hypothesised that patients with cystic fibrosis would be able to tolerate higher levels of NRD for a given level of breathlessness compared to healthy individuals during exercise. 15 cystic fibrosis patients (mean forced expiratory volume in 1 s (FEV1) 53.5% predicted) and 15 age-matched, healthy controls were studied. Spirometry was measured in all subjects and lung volumes measured in the cystic fibrosis patients. EMGdi and sEMGpara were recorded at rest and during incremental cycle exercise to exhaustion and expressed as a percentage of maximum (% max) obtained from maximum respiratory manoeuvres. Borg breathlessness scores were recorded at rest and during each minute of exercise. EMGdi % max and sEMGpara % max and associated Borg breathlessness scores differed significantly between healthy subjects and cystic fibrosis patients at rest and during exercise. The relationship between EMGdi % max and sEMGpara % max and Borg score was shifted to the right in the cystic fibrosis patients, such that at comparable levels of EMGdi % max and sEMGpara % max the cystic fibrosis patients reported significantly lower Borg breathlessness scores compared to the healthy individuals. At Borg score 1 (clinically significant increase in breathlessness from baseline) corresponding levels of EMGdi % max (20.2±12% versus 32.15±15%, p=0.02) and sEMGpara % max (18.9±8% versus 29.2±15%, p=0.04) were lower in the healthy individuals compared to the cystic fibrosis

  17. Blunted perception of neural respiratory drive and breathlessness in patients with cystic fibrosis.

    PubMed

    Reilly, Charles C; Jolley, Caroline J; Elston, Caroline; Moxham, John; Rafferty, Gerrard F

    2016-01-01

    The electromyogram recorded from the diaphragm (EMGdi) and parasternal intercostal muscle using surface electrodes (sEMGpara) provides a measure of neural respiratory drive (NRD), the magnitude of which reflects lung disease severity in stable cystic fibrosis. The aim of this study was to explore perception of NRD and breathlessness in both healthy individuals and patients with cystic fibrosis. Given chronic respiratory loading and increased NRD in cystic fibrosis, often in the absence of breathlessness at rest, we hypothesised that patients with cystic fibrosis would be able to tolerate higher levels of NRD for a given level of breathlessness compared to healthy individuals during exercise. 15 cystic fibrosis patients (mean forced expiratory volume in 1 s (FEV1) 53.5% predicted) and 15 age-matched, healthy controls were studied. Spirometry was measured in all subjects and lung volumes measured in the cystic fibrosis patients. EMGdi and sEMGpara were recorded at rest and during incremental cycle exercise to exhaustion and expressed as a percentage of maximum (% max) obtained from maximum respiratory manoeuvres. Borg breathlessness scores were recorded at rest and during each minute of exercise. EMGdi % max and sEMGpara % max and associated Borg breathlessness scores differed significantly between healthy subjects and cystic fibrosis patients at rest and during exercise. The relationship between EMGdi % max and sEMGpara % max and Borg score was shifted to the right in the cystic fibrosis patients, such that at comparable levels of EMGdi % max and sEMGpara % max the cystic fibrosis patients reported significantly lower Borg breathlessness scores compared to the healthy individuals. At Borg score 1 (clinically significant increase in breathlessness from baseline) corresponding levels of EMGdi % max (20.2±12% versus 32.15±15%, p=0.02) and sEMGpara % max (18.9±8% versus 29.2±15%, p=0.04) were lower in the healthy individuals compared to the cystic fibrosis

  18. Rethinking Pull-Out Services in Early Intervention: A Professional Resource.

    ERIC Educational Resources Information Center

    McWilliam, R. A., Ed.

    The 13 chapters of this book on early intervention services for young children with disabilities are organized into three sections covering issues in service provision in early intervention, application, and future directions. Chapter titles and authors include: (1) "Service Delivery Issues in Center-Based Early Intervention" (R. A. McWilliam);…

  19. Investigating service features to sustain engagement in early intervention mental health services.

    PubMed

    Becker, Mackenzie; Cunningham, Charles E; Christensen, Bruce K; Furimsky, Ivana; Rimas, Heather; Wilson, Fiona; Jeffs, Lisa; Madsen, Victoria; Bieling, Peter; Chen, Yvonne; Mielko, Stephanie; Zipursky, Robert B

    2017-08-23

    To understand what service features would sustain patient engagement in early intervention mental health treatment. Mental health patients, family members of individuals with mental illness and mental health professionals completed a survey consisting of 18 choice tasks that involved 14 different service attributes. Preferences were ascertained using importance and utility scores. Latent class analysis revealed segments characterized by distinct preferences. Simulations were carried out to estimate utilization of hypothetical clinical services. Overall, 333 patients and family members and 183 professionals (N = 516) participated. Respondents were distributed between a Professional segment (53%) and a Patient segment (47%) that differed in a number of their preferences including for appointment times, individual vs group sessions and mode of after-hours support. Members of both segments shared preferences for many of the service attributes including having crisis support available 24 h per day, having a choice of different treatment modalities, being offered help for substance use problems and having a focus on improving symptoms rather than functioning. Simulations predicted that 60% of the Patient segment thought patients would remain engaged with a Hospital service, while 69% of the Professional segment thought patients would be most likely to remain engaged with an E-Health service. Patients, family members and professionals shared a number of preferences about what service characteristics will optimize patient engagement in early intervention services but diverged on others. Providing effective crisis support as well as a range of treatment options should be prioritized in the future design of early intervention services. © 2017 John Wiley & Sons Australia, Ltd.

  20. Optimizing the interventional cardiology facility: services integration in routine workflow.

    PubMed

    Gortzis, Lefteris; Kalogeropoulos, A; Alexopoulos, D; Nikiforidis, G

    2007-01-01

    Integration of administrative and clinical data, imaging, and expert services, although challenging,is a key requirement in contemporary interventional cardiology facilities (ICF). We propose a workflow-oriented hybrid system to support the ICF and investigate its feasibility and effectiveness ina referral medical center. We have developed a Java-powered hybrid system (NetCARDIO), able to support over web synchronous and asynchronous data management, realtime multimedia data telemonitoring and continuous telementoring. Data regarding procedural rates, treatment planning and radiation exposure were collected over a two-year period of routine NetCARDIO implementation(July 2002 to June 2004) and compared with data from an immediately preceding period of equal duration (January 2000 to December 2001). During the NetCARDIO period, 163 +/- 17 coronary procedures per month were performed vs.77 +/- 15 during the control period (p <0.001). Percutaneous coronary intervention was delivered 'ad hoc' in 88% of eligible patients vs. 45% (p <0.001). Mean fluoroscopy time per coronary lesion treated decreased from 594 +/- 82 s to 540 +/- 94 s(p < 0.001). Annual radiation exposure of expert interventionists was decreased by 22%. Electronic storage significantly reduced archiving costs. Real-time multimodal services sharing combined with powerful database capabilities is feasible through a web-based structure, significantly enhancing performance and cost-effectiveness of ICF. Further research is needed to promote integration of additional data sources and services.

  1. Can paraprofessional home visitation enhance early intervention service delivery?

    PubMed

    Vogler, Stephen D; Davidson, Arthur J; Crane, Lori A; Steiner, John F; Brown, Jeffrey M

    2002-08-01

    A 1-year randomized trial compared intensive case management (ICM) versus basic case management (BCM) in facilitating early intervention (EI) service use among children in an urban health system. Of 159 participating families with delayed or at-risk preschool-aged children, 88 received ICM from paraprofessionals versus 71 families who received less comprehensive BCM from a nurse. In the ICM versus BCM group, a shorter interval to assessment (98 vs 140 d, p =.05) but similar assessment rate (86% vs 80%, p =.29) was observed. The ICM group had more services recommended per child (1.64 vs 1.16, p < .004) and initiated (1.20 vs 0.85, p < .04). There was no difference in median time to EI program initiation for ICM versus BCM (228 vs 200 d, p = .88) or initiation and visit compliance rate for EI services. Specific efforts to improve outcomes (e.g., decrease initiation time and increase use of EI services) are still needed.

  2. Breathlessness in everyday life from a patient perspective: a qualitative study using diaries.

    PubMed

    Ahmadi, Nasser S; Månsson, Jörgen; Lindblad, Ulf; Hildingh, Cathrine

    2014-06-01

    Breathlessness is a subjective symptom, which makes it difficult to define and understand. The aim of the present study was to illuminate how patients suffering from breathlessness experience their everyday life. The study was a qualitative study, and the focus of the analysis was the patients' descriptions of their experiences of breathlessness using a diary with two unstructured questions for a period of 7 consecutive days. Sixteen participants: 7 men, mean age 65 ± 7 (range 55-73 years old), and 9 women, mean age 65 ± 9 (range 50-72 years old) participated in the study. Two themes emerged from the analysis: 1) Impaired quality of life and 2) symptom tolerance and adaptation. The theme "impaired quality of life" included the categories limited physical ability, psychological burdens, and social life barriers. The theme "symptom tolerance and adaptation" included importance of health care, social support, hobbies and leisure activities, and coping strategies. The findings in our study showed that patients, in spite of considerable difficulties with shortness of breath, found relief in several types of activities, in addition to drug therapy. The result indicates that the "biopsychosocial model" is an appealing approach that should be discussed further to gain a better understanding of breathlessness.

  3. Bilingual Text4Walking Food Service Employee Intervention Pilot Study

    PubMed Central

    Ingram, Diana; Wilbur, JoEllen; Fogg, Louis; Sandi, Giselle; Moss, Angela; Ocampo, Edith V

    2016-01-01

    Background Half of all adults in the United States do not meet the level of recommended aerobic physical activity. Physical activity interventions are now being conducted in the workplace. Accessible technology, in the form of widespread usage of cell phones and text messaging, is available for promoting physical activity. Objective The purposes of this study, which was conducted in the workplace, were to determine (1) the feasibility of implementing a bilingual 12-week Text4Walking intervention and (2) the effect of the Text4Walking intervention on change in physical activity and health status in a food service employee population. Methods Before conducting the study reported here, the Text4Walking research team developed a database of motivational physical activity text messages in English. Because Hispanic or Latino adults compose one-quarter of all adults employed in the food service industry, the Text4Walking team translated the physical activity text messages into Spanish. This pilot study was guided by the Physical Activity Health Promotion Framework and used a 1-group 12-week pre- and posttest design with food service employees who self-reported as being sedentary. The aim of the study was to increase the number of daily steps over the baseline by 3000 steps. Three physical activity text messages were delivered weekly. In addition, participants received 3 motivational calls during the study. Results SPSS version 19.0 and R 3.0 were used to perform the data analysis. There were 33 employees who participated in the study (57.6% female), with a mean age of 43.7 years (SD 8.4). The study included 11 Hispanic or Latino participants, 8 of whom requested that the study be delivered in Spanish. There was a 100% retention rate in the study. At baseline, the participants walked 102 (SD 138) minutes/day (per self-report). This rate increased significantly (P=.008) to 182 (SD 219) minutes/day over the course of the study. The participants had a baseline mean of 10

  4. Bilingual Text4Walking Food Service Employee Intervention Pilot Study.

    PubMed

    Buchholz, Susan Weber; Ingram, Diana; Wilbur, JoEllen; Fogg, Louis; Sandi, Giselle; Moss, Angela; Ocampo, Edith V

    2016-06-01

    Half of all adults in the United States do not meet the level of recommended aerobic physical activity. Physical activity interventions are now being conducted in the workplace. Accessible technology, in the form of widespread usage of cell phones and text messaging, is available for promoting physical activity. The purposes of this study, which was conducted in the workplace, were to determine (1) the feasibility of implementing a bilingual 12-week Text4Walking intervention and (2) the effect of the Text4Walking intervention on change in physical activity and health status in a food service employee population. Before conducting the study reported here, the Text4Walking research team developed a database of motivational physical activity text messages in English. Because Hispanic or Latino adults compose one-quarter of all adults employed in the food service industry, the Text4Walking team translated the physical activity text messages into Spanish. This pilot study was guided by the Physical Activity Health Promotion Framework and used a 1-group 12-week pre- and posttest design with food service employees who self-reported as being sedentary. The aim of the study was to increase the number of daily steps over the baseline by 3000 steps. Three physical activity text messages were delivered weekly. In addition, participants received 3 motivational calls during the study. SPSS version 19.0 and R 3.0 were used to perform the data analysis. There were 33 employees who participated in the study (57.6% female), with a mean age of 43.7 years (SD 8.4). The study included 11 Hispanic or Latino participants, 8 of whom requested that the study be delivered in Spanish. There was a 100% retention rate in the study. At baseline, the participants walked 102 (SD 138) minutes/day (per self-report). This rate increased significantly (P=.008) to 182 (SD 219) minutes/day over the course of the study. The participants had a baseline mean of 10,416 (SD 5097) steps, which also increased

  5. Evaluating Educational Interventions That Induce Service Receipt: A Case Study Application of "City Connects"

    ERIC Educational Resources Information Center

    Bowden, A. Brooks; Shand, Robert; Belfield, Clive R.; Wang, Anyi; Levin, Henry M.

    2017-01-01

    Educational interventions are complex: Often they combine a diagnostic component (identifying student need) with a service component (ensuring appropriate educational resources are provided). This complexity raises challenges for program evaluation. These interventions, which we refer to as "service mediation interventions," affect…

  6. Reduced sensations of intensity of breathlessness enhances maintenance of intense intermittent exercise.

    PubMed

    Tong, Tom K; Fu, Frank H; Quach, Binh; Lu, Kui

    2004-07-01

    To identify the effect of normal breathlessness sensation elicited during intense intermittent exercise at exhaustion on limitation of exercise maintenance (Ex), the contribution of the flow-resistive unloading effect of normoxic helium-oxygen breathing on the breathlessness sensation to the change in the Ex was examined. Seven men repeatedly performed 12-s exercise at 160% maximal aerobic power output followed by passive recovery for 18-s under normal (CON) and unloaded (UL) breathing conditions until exhaustion. In UL, Ex was enhanced [mean (SD) 127.2 (11.8)% CON] concomitantly with reduction in averaged peak inhaled mouth pressure (PPmi) of recorded breathing cycles that reflected approximate true inspiratory muscle force output. At the iso-time point of CON exhaustion, the reduction in PPmi to [75.7(10.2)% CON] in UL was concomitant with the reductions in the rating of perceived breathlessness (RPB) [87.5 (13.1)% CON] and in the slope of time course for RPB (RPB/2-min period) [82.1 (17.2)% CON]. It was also concomitant with increases in ventilation and total oxygen consumption. However, the augmented oxygen consumption did not result in lowering of subjects' metabolic stress that was indicated by accumulations of blood lactate and plasma ammonia and uric acid. Nevertheless, the reductions in the RPB and RPB/2-min period, which reflected the breathlessness intensity, were correlated to the CON Ex enhancement in UL (RPB r=-0.57, RPB/2-min period r=-0.83; P<0.05). These findings implied that the normal noxious breathlessness sensation elicited during intense intermittent exercise at exhaustion might contribute to the limitation of subjects' exercise maintenance.

  7. Assessment of breathlessness perception by Borg scale in asthmatic patients: reproducibility and applicability to different stimuli.

    PubMed

    Chetta, Alfredo; Castagnaro, Antonio; Foresi, Antonio; Del Donno, Mario; Pisi, Giovanna; Malorgio, Roberto; Olivieri, Dario

    2003-05-01

    In asthmatics, the score of bronchoconstriction-associated breathlessness at 20% fall in forced expiratory volume at first second (FEV1) evaluated on a Borg scale (PS20) is a tool successfully used to measure the perception of symptoms. This prospective laboratory study evaluated the applicability of PS20 to assess the breathlessness induced by ultrasonically nebulized distilled water (UNDW) and methacholine (M) and its reproducibility. Twenty-two mild and clinically stable asthmatic patients performed UNDW and M challenge tests. The PS20 was calculated by linear interpolation of the last two points of the perception/fall in FEV1 curve of the UNDW and M tests. The reproducibility of PS20 M was assessed by repeating measurements on 2 separate days by 3 weeks. PS20 UNDW and PS20 M did not differ and were respectively 1.82 +/- 1.85 and 2.03 +/- 1.86. They were significantly related (rs=0.63; p<0.01) and the bias between PS20 UNDW and PS20 M was -0.21 with the limits of agreement ranging from -3.2 to 3.6. The intraclass correlation coefficient for repeated measurement of PS20 M was 0.82; the bias between the two measurements was 0.2 with the limits of agreement ranging from -2.8 to 3.2. All patients had a measurable breathlessness perception degree on a Borg scale during both distilled water challenges and methacholine. Asthmatic patients with normal, exaggerated or poor breathlessness perception were also similar for both stimuli. In addition, PS20 showed a good reproducibility and this allows the serial evaluation of patient's breathlessness perception by this technique in clinical settings and in the physiology laboratory.

  8. Prescription of opioids for breathlessness in end-stage COPD: a national population-based study

    PubMed Central

    Ahmadi, Zainab; Bernelid, Eva; Currow, David C; Ekström, Magnus

    2016-01-01

    Background Low-dose opioids can relieve breathlessness but may be underused in late-stage COPD due to fear of complications, contributing to poor symptom control. Objectives We aimed to study the period prevalence and indications of opioids actually prescribed in people with end-stage COPD. Methods The study was a longitudinal, population-based study of patients starting long-term oxygen therapy (LTOT) for COPD between October 1, 2005 and June 30, 2009 in Sweden. A random sample (n=2,000) of their dispensed opioid prescriptions was obtained from the national Prescribed Drugs Register from 91 days before starting LTOT until the first of LTOT withdrawal, death, or study end (December 31, 2009). We analyzed medication type, dispensed quantity, date of dispensing, and indications categorized as pain, breathlessness, other, or unknown. Results In total, 2,249 COPD patients (59% women) were included. During a median follow-up of 1.1 (interquartile range 0.6–2.0) years, 1,034 patients (46%) were dispensed ≥1 opioid prescription (N=13,722 prescriptions). The most frequently prescribed opioids were tramadol (23%), oxycodone (23%), morphine (16%), and codeine (16%). Average dispensed quantity was 9.3 (interquartile range 3.7–16.7) defined daily doses per prescription. In the random sample, the most commonly stated indication was pain (97%), with only 2% for breathlessness and 1% for other reasons. Conclusion Despite evidence that supported the use of opioids for the relief of breathlessness predating this study, opioids are rarely prescribed to relieve breathlessness in oxygen-dependent COPD, potentially contributing to less-than-optimal symptom control. This study creates a baseline against which to compare future changes in morphine prescribing in this setting. PMID:27799763

  9. Nurses' decision-making in ethically relevant clinical situations using the example of breathlessness: study protocol of a reflexive grounded theory integrating Goffman's framework analysis

    PubMed Central

    Dunger, Christine; Schnell, Martin W; Bausewein, Claudia

    2017-01-01

    Introduction Decision-making (DM) in healthcare can be understood as an interactive process addressing decision makers' reasoning as well as their visible behaviour after the decision is made. Other key elements of DM are ethical aspects and the role as well as the treatment options of the examined professions. Nurses' DM to choose interventions in situations of severe breathlessness is such interactions. They are also ethically relevant regarding the vulnerability of affected patients and possible restrictions or treatment options. The study aims to explore which factors influence nurses' DM to use nursing interventions in situations where patients suffer from severe breathlessness. Methods and analysis Qualitative study including nurses in German hospital wards and hospices. A triangulation of different methods of data collection—participant observation and qualitative expert interviews—and analysis merge in a reflexive grounded theory approach which integrates Goffman's framework analysis. It allows an analysis of nurses' self-statements about DM, their behaviour in relevant clinical situations and its influences. Data collection and analysis will be examined simultaneously. Ethics and dissemination Informed consent will be gained from all participants and the institutional stakeholders. Ongoing consent has to be ensured since observations will take place in healthcare institutions and many patients will be highly vulnerable. The study has been evaluated and approved by the Witten/Herdecke University Ethics Committee, Witten, Germany. Results of the study will be published at congresses and in journal papers. PMID:28399508

  10. Conceptualizing community interventions in social service needs of pregnant adolescents.

    PubMed

    Jones, M E; Bonte, C

    1990-01-01

    Traditional approaches to adolescent pregnancy have utilized the paradigm of single cause-single solution and have tended to define it as a pregnancy problem rather than as a parenting problem. The conceptual model presented emphasizes the importance of primary prevention efforts if approaches are to work. This model defines adolescent pregnancy as a parenting problem that is multicausal and thus requires multiple solutions. A community intervention model systematizes a coalition of effort that represent the three helping systems of the health, education, and community environment to ensure interaction among each of the systems to benefit the pregnant adolescent and her family. It uses a cost-effective pool of community volunteers to offer education and advocacy services. Of utmost importance is that it is guided by the belief that parenting is a continuum of experiences that requires the cooperation of all the helping systems to produce positive outcomes.

  11. Early intervention services in psychosis: from evidence to wide implementation.

    PubMed

    Csillag, Claudio; Nordentoft, Merete; Mizuno, Masafumi; Jones, Peter B; Killackey, Eóin; Taylor, Matthew; Chen, Eric; Kane, John; McDaid, David

    2016-12-01

    Early intervention (EI) in psychosis is a comprehensive and evidence-based approach aimed at detection and treatment of psychotic symptoms in their early stages. This paper presents core features and noteworthy aspects of the evidence basis and limitations of EI, the importance of programme fidelity, challenges for its widespread dissemination and economic perspectives related to it. This paper is a narrative review about the evidence supporting EI and the challenges to its widespread dissemination. In spite of evidence of a wide range of benefits, widespread dissemination has been slow, and even currently implemented programmes might be threatened. This reflects in part the shortcomings of mental health care in general, such as low priority for funding, stigma and structural problems. Successful examples of advocacy, mobilization and destigmatization campaigns have overcome these difficulties. Funding for mental health in general and for EI services appears low relative to need. One key argument for better funding for EI can be found in its favourable cost-effectiveness, but not all stakeholders beyond mental health administrators are aware of this. Positive impacts of EI programmes on excess unemployment and tax forgone suggest that social affairs and labour ministries - and not only health ministries - could be more involved in governance of mental health issues; ministries of justice and education are other sector stakeholders than can benefit. Wider dissemination of EI services will probably benefit from better integration of potential funders, promotion of joint targets and shared financial or budgetary incentives. © 2015 Wiley Publishing Asia Pty Ltd.

  12. Breathlessness in the Elderly During the Last Year of Life Sufficient to Restrict Activity: Prevalence, Pattern and Associated Factors

    PubMed Central

    Johnson, Miriam J.; Bland, J. Martin; Gahbauer, Evelyne A.; Ekström, Magnus; Sinnarajah, Aynharan; Gill, Thomas M.; Currow, David C.

    2015-01-01

    Objectives Breathlessness is prevalent in older people. Symptom control at the end of life is important. This study investigated relationships between age, clinical characteristics and breathlessness sufficient to have people spend at least one half a day in that month in bed or cut down on their usual activities (restricting breathlessness) during the last year of life. Design Secondary data-analysis Setting General community Participants 754 non-disabled persons, aged 70 and older. Monthly telephone interviews were conducted to determine the occurrence of restricting breathlessness. The primary outcome was the percentage of months with restricting breathlessness reported during the last year of life. Results Data regarding breathlessness were available for 548/589 (93.0%) decedents (mean age 86.7 years (range 71 to 106; males 38.8%). 311/548 (56.8%) reported restricting breathlessness at some time-point during the last year of life but no-one reported this every month. Frequency increased in the months closer to death irrespective of cause. Restricting breathlessness was associated with anxiety, (0.25 percentage point increase in months breathlessness per percentage point months reported anxiety, 95% CI 0.16 to 0.34, P<0.001), depression (0.14, 0.05 to 0.24, P=0.003) and mobility problems (0.07, 0.03 to 0.1, P<0.001). Percentage months of restricting breathlessness increased if chronic lung disease was noted at the most recent comprehensive assessment (6.62 percentage points, 95% CI 4.31 to 8.94, P<0.001), heart failure (3.34, 0.71 to 5.97, P<0.01), and ex-smoker status (3.01, 0.94 to 5.07, P=0.004), but decreased with older age (−0.19, −0.37 to −0.02, P=0.03). Conclusion Restricting breathlessness increased in this elderly population in the months preceding death from any cause. Breathlessness should be assessed and managed in the context of poor prognosis. PMID:26782854

  13. Effects of In-Service Training on Early Intervention Practitioners' Use of Family-Systems Intervention Practices in the USA

    ERIC Educational Resources Information Center

    Dunst, Carl J.; Trivette, Carol M.; Deal, Angela G.

    2011-01-01

    The effectiveness of three types of in-service training designed to improve early intervention practitioners' abilities to use family-systems intervention practices was evaluated in the study of 473 participants. Participants attended either conference presentations or one of two types of workshops (half day/full day or multi-day), or received one…

  14. Services for Young Children and Families: Evaluating Intervention Cycles.

    ERIC Educational Resources Information Center

    Simeonsson, Rune J.; And Others

    1996-01-01

    The importance of evaluation in early childhood interventions of infants and toddlers with developmental disabilities is discussed. Eight questions guiding the evaluation process are presented, focusing on intervention expectations, purposes of intervention, personalization of intervention, and specification of anticipated outcomes, among others.…

  15. Barriers to evaluation for early intervention services: parent and early intervention employee perspectives.

    PubMed

    Jimenez, Manuel E; Barg, Frances K; Guevara, James P; Gerdes, Marsha; Fiks, Alexander G

    2012-01-01

    To explore barriers to early intervention (EI) evaluation among referred infants and toddlers. We conducted semistructured interviews with parents of children referred for EI services and with EI staff. We purposively sampled families according to whether they received an EI evaluation. Families were recruited from a randomized controlled trial testing implementation of developmental screening. Parents filled out demographic surveys. Interviews were recorded, transcribed, and coded. We identified themes within and across respondent groups using modified grounded theory. We reached thematic saturation after interviewing 22 parents whose child was evaluated by EI, 22 not evaluated, and 14 EI employees. Mean child age at first referral was 16.7 months, and 80% were referred as the result of language concerns. We identified 5 primary themes: (1) Parents reported communication problems with their pediatrician, including misinterpreting reassurance and not understanding the referral process; (2) Many parents saw themselves as experts on their child's development and felt they should decide whether their child pursues EI services; (3) Some families preferred to wait for the developmental concern to resolve or work with their child on their own prior to seeking EI services; (4) For ambivalent parents, practical obstacles especially limited completion of evaluation, but highly motivated parents overcame obstacles; and (5) EI employees perceived that families avoid evaluation because they mistake EI for child protective services. Communication between pediatricians and families that addresses practical logistics, families' perceptions of their child's development and EI, and motivation to address developmental concerns may improve the completion of EI referrals. Copyright © 2012 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  16. Fulfilling the Promise of Early Intervention: Factors Related to Rates of Delivered IFSP Services.

    ERIC Educational Resources Information Center

    Kochanek, Thomas T.

    2001-01-01

    This response to an article evaluating Indiana's early intervention service delivery (EC 628 669) identifies implications of the study including: service intensity is relatively light; service location and context and the process of Individualized Family Service Plan formulation should be examined; implementation should be treated as an…

  17. Father Involvement in Early Intervention: Exploring the Gap between Service Providers' Perceptions and Practices

    ERIC Educational Resources Information Center

    McBride, Brent A.; Curtiss, Sarah J.; Uchima, Kelly; Laxman, Daniel J.; Santos, Rosa M.; Weglarz-Ward, Jenna; Dyer, Wm. Justin; Jeans, Laurie M.; Kern, Justin

    2017-01-01

    The purpose of this exploratory study was to examine early intervention (EI) service providers' perceptions of the roles played by fathers in services, as well as their perceptions of the barriers that limit fathers from being engaged in the services provided for families of children with disabilities. A total of 511 EI service providers…

  18. Could kinesiology taping help mitigate pain, breathlessness and abdominal-related symptoms in cancer?

    PubMed Central

    Banerjee, Gourav; Rose, Alison; Briggs, Michelle; Johnson, Mark I

    2017-01-01

    We present the case of a woman who was an amateur athlete diagnosed with primary breast cancer, and 10 years later with terminal metastatic cancer. This case report was prepared posthumously in co-operation with her next of kin (husband). The patient first presented to a sports physiotherapist (AR) for her pain-management and to help maintain physical fitness so that she could continue with sports and an active lifestyle. The patient continued with physiotherapy for several months to enable her to be active. However, when her health deteriorated significantly due to advancing cancer, the treatment was modified and aimed at improving the patient's general well-being. The physiotherapist applied kinesiology tape over the patient's lower rib cage, diaphragm and abdomen in an attempt to manage pain, breathlessness and abdominal bloating. The patient reported alleviation of pain, breathlessness, abdominal discomfort and nausea, accompanied by improvements in eating, drinking, energy levels and physical function. PMID:28237944

  19. Could kinesiology taping help mitigate pain, breathlessness and abdominal-related symptoms in cancer?

    PubMed

    Banerjee, Gourav; Rose, Alison; Briggs, Michelle; Johnson, Mark I

    2017-02-24

    We present the case of a woman who was an amateur athlete diagnosed with primary breast cancer, and 10 years later with terminal metastatic cancer. This case report was prepared posthumously in co-operation with her next of kin (husband). The patient first presented to a sports physiotherapist (AR) for her pain-management and to help maintain physical fitness so that she could continue with sports and an active lifestyle. The patient continued with physiotherapy for several months to enable her to be active. However, when her health deteriorated significantly due to advancing cancer, the treatment was modified and aimed at improving the patient's general well-being. The physiotherapist applied kinesiology tape over the patient's lower rib cage, diaphragm and abdomen in an attempt to manage pain, breathlessness and abdominal bloating. The patient reported alleviation of pain, breathlessness, abdominal discomfort and nausea, accompanied by improvements in eating, drinking, energy levels and physical function. 2017 BMJ Publishing Group Ltd.

  20. General Education Teachers' Knowledge and Self-Reported Use of Classroom Interventions for Working with Difficult-To-Teach Students: Implications for Consultation, Prereferral Intervention and Inclusive Services.

    ERIC Educational Resources Information Center

    Wilson, Caryll Palmer; Gutkin, Terry B.; Hagen, Kenneth M.; Oats, Robert G.

    1998-01-01

    Teachers (N=20) described problems, goals, interventions, data collection, and consultation practices employed across prereferral, prereferral intervention, referral, and postreferral phases of service delivery for mildly handicapped students. Findings highlight teachers' difficulties with data collection and intervention practices. Implications…

  1. General Education Teachers' Knowledge and Self-Reported Use of Classroom Interventions for Working with Difficult-To-Teach Students: Implications for Consultation, Prereferral Intervention and Inclusive Services.

    ERIC Educational Resources Information Center

    Wilson, Caryll Palmer; Gutkin, Terry B.; Hagen, Kenneth M.; Oats, Robert G.

    1998-01-01

    Teachers (N=20) described problems, goals, interventions, data collection, and consultation practices employed across prereferral, prereferral intervention, referral, and postreferral phases of service delivery for mildly handicapped students. Findings highlight teachers' difficulties with data collection and intervention practices. Implications…

  2. Magnetoencephalography to investigate central perception of exercise-induced breathlessness in people with chronic lung disease: a feasibility pilot

    PubMed Central

    Johnson, Miriam J; Simpson, Michael IG; Currow, David C; Millman, Rebecca E; Hart, Simon P; Green, Gary

    2015-01-01

    Objectives Neuroimaging in chronic breathlessness is challenging. The study objective was to test the feasibility of magnetoencephalography (MEG) for functional neuroimaging of people with chronic breathlessness. Design Feasibility pilot study. Setting Respiratory clinic out-patients. Participants 8 patients (mean age=62; (range 47–83); 4 men) with chronic non-malignant lung disease; modified MRC breathlessness score ≥3 (median mMRC=4), intensity of exercise-induced breathlessness >3/10; no contraindication to MRI scanning. Methods and measures 4 MEG scans were conducted for each participant: (1) at rest (5 mins), (2) postseated leg exercise-induced breathlessness during recovery (10 mins). Recovery scans (2) were conducted with/without facial airflow in random order; both scans were repeated 1 h later. Participants rated breathlessness intensity (0–10 Numerical Rating Scale (NRS)) at baseline, maximal exertion and every minute during recovery, and rated acceptability of study procedures at the end of the study (0–10 NRS). A structural MRI scan was conducted for MEG coregistration and source-space analyses. Rest data were compared with data from healthy volunteers (N=6; 5 men; mean age=30.7 years±3.9 years). Results Exercises and MEG scanning were acceptable to all participants; 7/8 completed the MRI scans. Maximum breathlessness intensity was induced by 5 min’ exercise. The same level was induced for repeat scans (median=8; IQR=7–8). All recovered to baseline by 10 min. Time-frequency profiles of data from the first and last 3 min were analysed in MEG source space based on breathlessness location estimates. Source localisation was performed, but anatomical source inference was limited to the level of the lobe. Differences in areas of activity were seen: during recovery scans; with and without airflow; and between participants/normal volunteers at rest. Conclusions MEG is a feasible method to investigate exercise-induced breathlessness

  3. Effects of low-dose morphine on perceived sleep quality in patients with refractory breathlessness: A hypothesis generating study.

    PubMed

    Martins, Rodrigo T; Currow, David C; Abernethy, Amy P; Johnson, Miriam J; Toson, Barbara; Eckert, Danny J

    2016-02-01

    The management of chronic refractory breathlessness is one of the indications for regular low-dose (≤30 mg/24 h) oral sustained release morphine. Morphine may disrupt sleep in some conditions and improve sleep quality in others. This study aimed to determine any signal of regular, low-dose morphine on perceived sleep disruption due to breathlessness and perceived sleep quality. This is a secondary analysis of data from 38 participants with refractory breathlessness (30 male; 33 with COPD) aged 76 ± 0.9 years who completed a double-blind, randomized, placebo-controlled, cross-over study in which they received 20 mg oral sustained release morphine daily and placebo for 4 days each. Participant ratings of sleep disruption due to breathlessness and perceived sleep quality were obtained daily throughout the 8-day trial. Perceived sleep disruption due to breathlessness over the 4-day period ranged between 13% and 32% of participants for placebo and 13% and 26% for morphine, decreasing by each day of the study during the morphine arm. Most participants reported 'very good' or 'quite good' sleep throughout the trial and were less likely to perceive poor sleep quality during the morphine arm (odds ratio = 0.55, 95% confidence interval: 0.34-0.88, P = 0.01). Participants who reported decreased breathlessness during the 4 days on morphine were also likely to report improved sleep quality with morphine (P = 0.039). Four days of low-dose morphine improved perceived sleep quality in elderly participants with refractory breathlessness. Regular low-dose morphine targeted to reduce refractory breathlessness may yield associated benefits by reducing sleep disruption and improving sleep quality. © 2015 Asian Pacific Society of Respirology.

  4. Response to Intervention (RTI) Services: An Ecobehavioral Perspective

    PubMed Central

    Greenwood, Charles R.; Kim, Joung Min

    2014-01-01

    School-wide Response to Intervention (RTI) services are growing in prevalence in U.S. schools. Most advanced are RTI programs in elementary schools, with preschool and secondary education programs beginning to discuss, develop, and experiment with school-wide RTI. At its heart, RTI seeks to account for individual differences in student learning success by discovering the instructional situations in which each student learns best and providing them for all who need them. RTI is an early intervening approach to the prevention of learning and behavior problems before they become disabilities later. The implementation of school-wide RTI approaches reorganizes school ecology at multiple levels and when implemented with fidelity, RTI schools have a distinctive “ecological footprint” that differentiates them from traditional, non-RTI schools. Implementers of RTI need consultation that provides them with information on the structure and function of their programs for use in problem solving and decision making. The purpose of this paper is to describe RTI and illustrate an ecobehavioral approach to providing RTI school staff with information they need. PMID:24851036

  5. Pilot evaluation of a web-based intervention targeting sexual health service access.

    PubMed

    Brown, K E; Newby, K; Caley, M; Danahay, A; Kehal, I

    2016-04-01

    Sexual health service access is fundamental to good sexual health, yet interventions designed to address this have rarely been implemented or evaluated. In this article, pilot evaluation findings for a targeted public health behavior change intervention, delivered via a website and web-app, aiming to increase uptake of sexual health services among 13-19-year olds are reported. A pre-post questionnaire-based design was used. Matched baseline and follow-up data were identified from 148 respondents aged 13-18 years. Outcome measures were self-reported service access, self-reported intention to access services and beliefs about services and service access identified through needs analysis. Objective service access data provided by local sexual health services were also analyzed. Analysis suggests the intervention had a significant positive effect on psychological barriers to and antecedents of service access among females. Males, who reported greater confidence in service access compared with females, significantly increased service access by time 2 follow-up. Available objective service access data support the assertion that the intervention may have led to increases in service access. There is real promise for this novel digital intervention. Further evaluation is planned as the model is licensed to and rolled out by other local authorities in the United Kingdom. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  6. Equine Welfare during Exercise: An Evaluation of Breathing, Breathlessness and Bridles

    PubMed Central

    Mellor, David J.; Beausoleil, Ngaio J.

    2017-01-01

    Simple Summary Horses have superior athletic capabilities due largely to their exceptional cardiorespiratory responses during exercise. This has particular relevance to horses’ potential to experience breathlessness, especially when their athletic performance is reduced by impaired respiratory function. Breathlessness, incorporating three types of unpleasant experiences, has been noted as of significant animal welfare concern in other mammals. However, the potential for breathlessness to occur in horses as usually ridden wearing bitted bridles has not yet been evaluated in detail. Accordingly, key physiological responses to exercise and the consequences of impaired respiratory function are outlined. Then the physiological control of breathing and the generation of the aversive experiences of breathlessness are explained. Finally, the potential for horses with unimpaired and impaired respiratory function to experience the different types of breathlessness is evaluated. This information provides a basis for considering the circumstances in which breathlessness may have significant negative welfare impacts on horses as currently ridden wearing bitted bridles. Potential beneficial impacts on respiratory function of using bitless bridles are then discussed with emphasis on the underlying mechanisms and their relevance to breathlessness. It is noted that direct comparisons of cardiorespiratory responses to exercise in horses wearing bitless and bitted bridles are not available and it is recommended that such studies be undertaken. Abstract Horses engaged in strenuous exercise display physiological responses that approach the upper functional limits of key organ systems, in particular their cardiorespiratory systems. Maximum athletic performance is therefore vulnerable to factors that diminish these functional capacities, and such impairment might also lead to horses experiencing unpleasant respiratory sensations, i.e., breathlessness. The aim of this review is to use

  7. Physical Deconditioning as a Cause of Breathlessness among Obese Adolescents with a Diagnosis of Asthma

    PubMed Central

    Herring, Richard C.; Weltman, Judith; Patrie, James T.; Weltman, Arthur L.; Platts-Mills, Thomas A.

    2013-01-01

    Background Obese children frequently complain of breathlessness. Asthma and obesity can both contribute to the symptoms during exercise, and this symptom can contribute to a diagnosis of asthma in these children. Despite the high prevalence of obesity few studies have investigated the cardiopulmonary physiology of breathlessness in obese children with a diagnosis of asthma. Methods In this case-control study, thirty adolescents between age 12 and 19 were studied with baseline spirometry and a cardiopulmonary exercise test. Ten adolescents were normal controls, ten had obesity without a diagnosis of asthma, and ten had obesity with a history of physician-diagnosed asthma. Results Baseline characteristics including complete blood count and spirometry were comparable between obese adolescents with and without a diagnosis of asthma. During exercise, obese asthmatic and obese non-asthmatic adolescents had significantly reduced physical fitness compared to healthy controls as evidenced by decreased peak oxygen uptake after adjusting for actual body weight (21.7±4.5 vs. 21.4±5.4 vs. 35.3±5.8 ml/kg/min, respectively). However, pulmonary capacity at the peak of exercise was comparable among all three groups as evidenced by similar pulmonary reserve. Conclusion In this study, breathlessness was primarily due to cardiopulmonary deconditioning in the majority of obese adolescents with or without a diagnosis of asthma. PMID:23637784

  8. An exploration of clinical interventions provided by pharmacists within a complex asthma service

    PubMed Central

    Lemay, Kate S.; Saini, Bandana; Bosnic-Anticevich, Sinthia; Smith, Lorraine; Stewart, Kay; Emmerton, Lynne; Burton, Deborah L.; Krass, Ines; Armour, Carol L.

    2014-01-01

    Background: Pharmacists in Australia are accessible health care professionals, and their provision of clinical pharmacy interventions in a range of areas has been proven to improve patient outcomes. Individual clinical pharmacy interventions in the area of asthma management have been very successful. An understanding of the nature of these interventions will inform future pharmacy services. What we do not know is when pharmacists provide a complex asthma service, what elements of that service (interventions) they choose to deliver. Objective: To explore the scope and frequency of asthma-related clinical interventions provided by pharmacists to patients in an evidence-based complex asthma service. Methods: Pharmacists from 4 states/territories of Australia were trained in asthma management. People with asthma had 3 or 4 visits to the pharmacy. Guided by a structured patient file, the pharmacist assessed the patient’s asthma and management and provided interventions where and when considered appropriate, based on their clinical decision making skills. The interventions were recorded in a checklist in the patient file. They were then analysed descriptively and thematically. Results: Pharmacists provided 22,909 clinical pharmacy interventions over the service to 570 patients (398 of whom completed the service). The most frequently delivered interventions were in the themes ’Education on asthma’, ’Addressing trigger factors’, ’Medications - safe and effective use’ and ’Explore patient perspectives’. The patients had a high and ongoing need for interventions. Pharmacists selected interventions based on their assessment of perceived need then revisited and reinforced these interventions. Conclusion: Pharmacists identified a number of areas in which patients required interventions to assist with their asthma management. Many of these were perceived to require continuing reinforcement over the duration of the service. Pharmacists were able to use their

  9. The role of benzodiazepines in breathlessness: a single site, open label pilot of sustained release morphine together with clonazepam.

    PubMed

    Allcroft, Peter; Margitanovic, Vera; Greene, Aine; Agar, Meera R; Clark, Katherine; Abernethy, Amy P; Currow, David C

    2013-07-01

    Breathlessness at rest or on minimal exertion despite optimal treatment of underlying cause(s) is distressing and prevalent. Opioids can reduce the intensity of chronic refractory breathlessness and an anxiolytic may be of benefit. This pilot aimed to determine the safety and feasibility of conducting a phase III study on the intensity of breathlessness by adding regular benzodiazepine to low-dose opioid. This is a single site, open label phase II study of the addition of regular clonazepam 0.5 mg nocte orally to Kapanol(R) 10 mg (sustained release morphine sulphate) orally mane together with docusate/sennosides in people with modified Medical Research Council Scale ≥2. Breathlessness intensity on day four was the efficacy outcome. Participants could extend for another 10 days if they achieved >15% reduction over their own baseline breathlessness intensity. Eleven people had trial medication (eight males, median age 78 years (68 to 89); all had COPD; median Karnofsky 70 (50 to 80); six were on long-term home oxygen. Ten people completed day four. One person withdrew because of unsteadiness on day four. Five participants reached the 15% reduction, but only three went on to the extension study, all completing without toxicity. This study was safe, feasible and there appears to be a group who derive benefits comparable to titrated opioids. Given the widespread use of benzodiazepines for the symptomatic treatment of chronic refractory breathlessness and its poor evidence base, there is justification for a definitive phase III study.

  10. 34 CFR 303.126 - Early intervention services in natural environments.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 34 Education 2 2012-07-01 2012-07-01 false Early intervention services in natural environments... environments. Each system must include policies and procedures to ensure, consistent with §§ 303.13(a)(8) (early intervention services), 303.26 (natural environments), and 303.344(d)(1)(ii) (content of an IFSP...

  11. 34 CFR 303.126 - Early intervention services in natural environments.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 34 Education 2 2014-07-01 2013-07-01 true Early intervention services in natural environments. 303... environments. Each system must include policies and procedures to ensure, consistent with §§ 303.13(a)(8) (early intervention services), 303.26 (natural environments), and 303.344(d)(1)(ii) (content of an IFSP...

  12. 34 CFR 303.126 - Early intervention services in natural environments.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 34 Education 2 2013-07-01 2013-07-01 false Early intervention services in natural environments... environments. Each system must include policies and procedures to ensure, consistent with §§ 303.13(a)(8) (early intervention services), 303.26 (natural environments), and 303.344(d)(1)(ii) (content of an IFSP...

  13. Pilot Evaluation of a Web-Based Intervention Targeting Sexual Health Service Access

    ERIC Educational Resources Information Center

    Brown, K. E.; Newby, K.; Caley, M.; Danahay, A.; Kehal, I.

    2016-01-01

    Sexual health service access is fundamental to good sexual health, yet interventions designed to address this have rarely been implemented or evaluated. In this article, pilot evaluation findings for a targeted public health behavior change intervention, delivered via a website and web-app, aiming to increase uptake of sexual health services among…

  14. Pilot Evaluation of a Web-Based Intervention Targeting Sexual Health Service Access

    ERIC Educational Resources Information Center

    Brown, K. E.; Newby, K.; Caley, M.; Danahay, A.; Kehal, I.

    2016-01-01

    Sexual health service access is fundamental to good sexual health, yet interventions designed to address this have rarely been implemented or evaluated. In this article, pilot evaluation findings for a targeted public health behavior change intervention, delivered via a website and web-app, aiming to increase uptake of sexual health services among…

  15. The Role of Maternal Depression in Accessing Early Intervention Services for Children with Developmental Delay

    ERIC Educational Resources Information Center

    Colgan, Siobhan Eileen

    2012-01-01

    This study investigated the relationship between maternal depression and children's access to early intervention services among a sample of children with developmental delay at age two who were determined to be eligible for early intervention services, were full term and of normal birth weight, and were not previously identified with any special…

  16. 34 CFR 303.13 - Early intervention services.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... services to address the promotion of sensorimotor function through enhancement of musculoskeletal status... enhance the child's development. (15) Speech-language pathology services include— (i) Identification of...

  17. 34 CFR 303.13 - Early intervention services.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... services to address the promotion of sensorimotor function through enhancement of musculoskeletal status... enhance the child's development. (15) Speech-language pathology services include— (i) Identification of...

  18. 34 CFR 303.13 - Early intervention services.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... services to address the promotion of sensorimotor function through enhancement of musculoskeletal status... enhance the child's development. (15) Speech-language pathology services include— (i) Identification of...

  19. 78 FR 56910 - Proposed Information Collection for Public Comment: Impact of Housing and Services Interventions...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-16

    ... Interventions on Homeless Families--36-Month Follow-Up Data Collection AGENCY: Office of Policy Development and... Interventions on Homeless Families--36-month Follow-up Data Collection. OMB Approval Number: N/A. Type of... Study, formerly referred to as The Impact of Housing and Services Interventions on Homeless Families...

  20. Family Involvement in Early Intervention Service Planning: Links to Parental Satisfaction and Self-Efficacy

    ERIC Educational Resources Information Center

    Popp, Tierney K.; You, Hyun-Kyung

    2016-01-01

    The mediating role of parental satisfaction in the relation between family involvement in early intervention service planning and parental self-efficacy was explored. Participants included families of children with disability or delay involved in early intervention (n = 2586). Data were examined upon entry into early intervention (T1) and at…

  1. Family Involvement in Early Intervention Service Planning: Links to Parental Satisfaction and Self-Efficacy

    ERIC Educational Resources Information Center

    Popp, Tierney K.; You, Hyun-Kyung

    2016-01-01

    The mediating role of parental satisfaction in the relation between family involvement in early intervention service planning and parental self-efficacy was explored. Participants included families of children with disability or delay involved in early intervention (n = 2586). Data were examined upon entry into early intervention (T1) and at…

  2. Reproductive health services in Malawi: an evaluation of a quality improvement intervention.

    PubMed

    Rawlins, Barbara J; Kim, Young-Mi; Rozario, Aleisha M; Bazant, Eva; Rashidi, Tambudzai; Bandazi, Sheila N; Kachale, Fannie; Sanghvi, Harshad; Noh, Jin Won

    2013-01-01

    this study was to evaluate the impact of a quality improvement initiative in Malawi on reproductive health service quality and related outcomes. (1) post-only quasi-experimental design comparing observed service quality at intervention and comparison health facilities, and (2) a time-series analysis of service statistics. sixteen of Malawi's 23 district hospitals, half of which had implemented the Performance and Quality Improvement (PQI) intervention for reproductive health at the time of the study. a total of 98 reproductive health-care providers (mostly nurse-midwives) and 139 patients seeking family planning (FP), antenatal care (ANC), labour and delivery (L&D), or postnatal care (PNC) services. health facility teams implemented a performance and quality improvement (PQI) intervention over a 3-year period. Following an external observational assessment of service quality at baseline, facility teams analysed performance gaps, designed and implemented interventions to address weaknesses, and conducted quarterly internal assessments to assess progress. Facilities qualified for national recognition by complying with at least 80% of reproductive health clinical standards during an external verification assessment. key measures include facility readiness to provide quality care, observed health-care provider adherence to clinical performance standards during service delivery, and trends in service utilisation. intervention facilities were more likely than comparison facilities to have the needed infrastructure, equipment, supplies, and systems in place to offer reproductive health services. Observed quality of care was significantly higher at intervention than comparison facilities for PNC and FP. Compared with other providers, those at intervention facilities scored significantly higher on client assessment and diagnosis in three service areas, on clinical management and procedures in two service areas, and on counselling in one service area. Service statistics

  3. Continuous Positive Airway Pressure and Breathlessness in Obese Patients with Obstructive Sleep Apnea: A Pilot Study

    PubMed Central

    Xiao, Sichang; Bastianpillai, Johan; Ratneswaran, Culadeeban; Pengo, Martino F.; Luo, Yuanming; Jolley, Caroline J.; Moxham, John; Steier, Joerg

    2016-01-01

    Study Objectives: Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnea (OSA). However, long-term compliance with CPAP is limited. We tested the hypothesis that CPAP levels routinely used during sleep increase neural respiratory drive (NRD) and breathlessness, which may discourage compliance. Methods: This was an observational physiological cohort study in a respiratory physiology and sleep unit, University Hospital. Patients with a body mass index (BMI) > 25 kg/m2 and confirmed OSA were studied supine and awake on CPAP (4–20 cm H2O, increments of 2 cm H2O/3 min). We measured NRD during awake CPAP titration in obese subjects to quantify the response to the load of the respiratory system and compared it to the CPAP used for nocturnal treatment, with the modified Borg Scale (mBorg) for dyspnea recorded (from 0 to 10 points, with higher numbers indicating more breathlessness). Results: Fifteen patients (age 48 ± 10 years, 12 male, BMI 38.9 ± 5.8 kg/m2) with OSA (AHI 32.2 ± 21.1/h, 95th percentile of CPAP 14.1 ± 3.8 cm H2O) were studied and NRD (electromyogram of the parasternal intercostals, EMGpara; EMG of the external oblique, EMGabdomen) was recorded (awake, supine). Awake, EMGpara declined from baseline to 70.2% ± 17.1% when CPAP of 10.7 ± 3.4 cm H2O (P = 0.026) was applied. Further increase in CPAP led to a rise in EMGpara and increased breathlessness (P = 0.02). CPAP compliance (nights used) correlated negatively with mBorg scores (r = −0.738, P = 0.006). Conclusions: Awake, the respiratory system is maximally offloaded with lower than therapeutic CPAP levels in obese patients with OSA. Levels of NRD observed at effective CPAP levels while asleep are associated with breathlessness which may limit long-term CPAP compliance. Citation: Xiao S, Bastianpillai J, Ratneswaran C, Pengo MF, Luo Y, Jolley CJ, Moxham J, Steier J. Continuous positive airway pressure and breathlessness in obese patients with obstructive

  4. 75 FR 3746 - Ryan White HIV/AIDS Part C Early Intervention Services (EIS) Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-22

    ... HUMAN SERVICES Health Resources and Services Administration Ryan White HIV/AIDS Part C Early..., Florida, that will ensure continuity of Part C, Early Intervention Services (EIS), HIV/AIDS care and...: Critical funding for HIV/AIDS care and treatment to the target populations in Orange County,...

  5. The Preschool Puzzle: A Study of Early Intervention Programs and Services.

    ERIC Educational Resources Information Center

    Bird, William; And Others

    The New York State Office of Mental Retardation and Developmental Disabilities initiated a project to produce a description of existing state and local programs and models of service delivery for early intervention services for children aged 0-5. A survey of 72 public and private service providers in 12 New York counties determined that 11,185…

  6. The Impact of Arbitration Intervention Services on Psychosocial Functioning: A Follow-Up Study

    ERIC Educational Resources Information Center

    Dembo, Richard; Wareham, Jennifer; Poythress, Norman G.; Cook, Brittany; Schmeidler, James

    2006-01-01

    We report the impact of case management services on drug use and self-reported delinquency for youths involved in a clinical trial of the Juvenile Arbitration program. The project evaluated an innovative intervention service providing 16 weeks of intensive case management services to youths and their families. The present study examines interview…

  7. Professionals' Perceptions of the Role of Literacy in Early Intervention Services

    ERIC Educational Resources Information Center

    Thatcher, Karen; Fletcher, Kathryn

    2008-01-01

    The purpose of the current study was to examine therapists' perceptions about literacy in early intervention services. Little effort has been devoted to the incorporation of literacy into therapy services for very young children with special needs. In an attempt to understand how therapy providers view the role of literacy in their services, 168…

  8. Toddlers Receiving Early Intervention in Childcare Centers: A Description of a Service Delivery System.

    ERIC Educational Resources Information Center

    Bruder, Mary Beth; Staff, Ilene; McMurrer-Kaminer, Eileen

    1997-01-01

    Early intervention services provided to 68 toddler-age children with disabilities were analyzed. Data were collected across family, child, and service characteristics. Children received services distributed across special instruction, speech therapy, occupational therapy, and physical therapy delivered primarily at the childcare center. Individual…

  9. Professionals' Perceptions of the Role of Literacy in Early Intervention Services

    ERIC Educational Resources Information Center

    Thatcher, Karen; Fletcher, Kathryn

    2008-01-01

    The purpose of the current study was to examine therapists' perceptions about literacy in early intervention services. Little effort has been devoted to the incorporation of literacy into therapy services for very young children with special needs. In an attempt to understand how therapy providers view the role of literacy in their services, 168…

  10. Effects of pregnancy, obesity and aging on the intensity of perceived breathlessness during exercise in healthy humans.

    PubMed

    Jensen, Dennis; Ofir, Dror; O'Donnell, Denis E

    2009-05-30

    The healthy human respiratory system has impressive ventilatory reserve and can easily meet the demands placed upon it by strenuous exercise. Several acute physiological adaptations during exercise ensure harmonious neuromechanical coupling of the respiratory system, which allow healthy humans to reach high levels of ventilation without perceiving undue respiratory discomfort (breathlessness). However, in certain circumstances, such as pregnancy, obesity and natural aging, ventilatory reserve becomes diminished and exertional breathlessness is present. In this review, we focus on what is known about the mechanisms of increased activity-related breathlessness in these populations. Notwithstanding the obvious physiological differences between the three conditions, they share some common perceptual and ventilatory responses to exercise. Breathlessness intensity ratings (described as an increased "sense of effort") are consistently higher than normal at any given submaximal power output; and central motor drive to the respiratory muscles is consistently increased, reflecting increased ventilatory stimulation. The increased contractile respiratory muscle effort required to support the increased ventilatory requirements of exercise remains the most plausible source of increased activity-related breathlessness in pregnant, obese and elderly humans. In all three conditions, static and dynamic respiratory mechanical/muscular function is, to some extent, altered or impaired. Nevertheless, breathlessness intensity ratings are not significantly increased (compared to normal) at any given exercise ventilation in any of these three conditions. This strongly suggests that respiratory mechanical/muscular factors, per se, may be less important in the genesis of breathlessness. Moreover, in pregnancy and obesity, we present evidence that effective physiological adjustments exist to counterbalance the potentially negative sensory consequences of the altered respiratory mechanical

  11. Treating Female Perpetrators: State Standards for Batterer Intervention Services

    ERIC Educational Resources Information Center

    Kernsmith, Poco; Kernsmith, Roger

    2009-01-01

    Although domestic violence has historically been considered primarily a crime perpetrated by men, increasing numbers of women are being arrested and mandated into batterer intervention programs. This study examined existing state policies to explore the degree to which they address the unique needs of women in batterer intervention programs.…

  12. Differences in Family Participation in Early Intervention Services.

    ERIC Educational Resources Information Center

    Upshur, Carole C.

    This speech reports on data collected by the Early Intervention Collaborative Study (EICS), which is a longitudinal study following the development of 190 young children with disabilities (and their families) who entered 29 publicly funded early intervention programs in Massachusetts and New Hampshire in the period from 1985 to 1987. The…

  13. Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults.

    PubMed

    Simon, Steffen T; Higginson, Irene J; Booth, Sara; Harding, Richard; Weingärtner, Vera; Bausewein, Claudia

    2016-10-20

    This is an updated version of the original Cochrane review published in Issue 1, 2010, on 'Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults'. Breathlessness is one of the most common symptoms experienced in the advanced stages of malignant and non-malignant disease. Benzodiazepines are widely used for the relief of breathlessness in advanced diseases and are regularly recommended in the literature. At the time of the previously published Cochrane review, there was no evidence for a beneficial effect of benzodiazepines for the relief of breathlessness in people with advanced cancer and chronic obstructive pulmonary disease (COPD). The primary objective of this review was to determine the efficacy of benzodiazepines for the relief of breathlessness in people with advanced disease. Secondary objectives were to determine the efficacy of different benzodiazepines, different doses of benzodiazepines, different routes of application, adverse effects of benzodiazepines, and the efficacy in different disease groups. This is an update of a review published in 2010. We searched 14 electronic databases up to September 2009 for the original review. We checked the reference lists of all relevant studies, key textbooks, reviews, and websites. For the update, we searched CENTRAL, MEDLINE, and EMBASE and registers of clinical trials for further ongoing or unpublished studies, up to August 2016. We contacted study investigators and experts in the field of palliative care asking for further studies, unpublished data, or study details when necessary. We included randomised controlled trials (RCTs) and controlled clinical trials (CCTs) assessing the effect of benzodiazepines compared with placebo or active control in relieving breathlessness in people with advanced stages of cancer, chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), motor neurone disease (MND), and idiopathic pulmonary fibrosis (IPF

  14. 78 FR 25458 - Ryan White HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-01

    ... HUMAN SERVICES Health Resources and Services Administration Ryan White HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services Administration (HRSA), HHS. ACTION: Notice of Ryan White HIV/AIDS Program Part C Early Intervention Services...

  15. Attitudes of relatives and staff towards family intervention in forensic services using Q methodology.

    PubMed

    Absalom-Hornby, V; Hare, D J; Gooding, P; Tarrier, N

    2012-03-01

    Attitudes about family interventions have been identified as a possible reason for the poor implementation of such treatments. The current study used Q methodology to investigate the attitudes of relatives of forensic service users and clinical staff towards family interventions in medium secure forensic units, particularly when facilitated by a web camera. Eighteen relatives and twenty-nine staff completed a sixty-one item Q sort to obtain their idiosyncratic views about family intervention. The results indicated that relatives and staff mostly held positive attitudes towards family intervention. Relatives showed some uncertainty towards family intervention that may reflect the lack of involvement they receive from the forensic service. Staff highlighted key barriers to successful implementation such as lack of dedicated staff time for family work and few staff adequately trained in family intervention. Despite agreement with the web-based forensic family intervention technique and its benefits, both staff and relatives predicted problems in the technique. © 2011 Blackwell Publishing.

  16. Rural and remote early psychosis intervention services: the Gordian knot of early intervention.

    PubMed

    Cheng, Chiachen; Dewa, Carolyn S; Langill, Gord; Fata, Mirella; Loong, Desmond

    2014-11-01

    One of the basic challenges of Early Psychosis Intervention (EPI) programs for rural populations is translating best practice which developed for urban high-population density areas to rural and remote settings. This paper presents data from two different models (hub and spoke and specialist outreach) of rural EPI practice in Ontario, Canada. This cross-sectional study used a convenience sample of clients from two rural EPI programs between 2005 and 2007. Data about client outcomes specific to general functioning, admissions to hospital and emergency room (ER) visits were collected. For all dichotomous variables, chi-square tests were used to test differences between two groups. The total clients served in hub and spoke were 457 compared to 91 in specialist outreach. Although not statistically significant, the hub and spoke group showed better functioning in the community. There was a significant difference between the two groups with regard to hospital admissions. Although not significant, there was a greater percentage (58.3%) of specialist outreach clients who visited the ER in the previous 12 months as compared to clients serviced by the hub and spoke model (34.9%). The observed data from these two rural models suggest that there may be differing outcomes. There are limitations to this study, and this paper does not address why there are differences. Future work needs to continue to further explore why differences exist and whether they persist so we can provide equity and quality care for rural and remote populations. © 2013 Wiley Publishing Asia Pty Ltd.

  17. VALUING AN INTERVENTION: MARSH MIGRATION AND ECOSYSTEM SERVICES

    EPA Science Inventory

    There is growing interest in valuing ecosystem services provided by marsh systems. Ecosystem services represent a flow of benefits to society from the existence or functioning of the marsh. Therefore, to “put a value on” the marsh itself, or estimate a value of the na...

  18. VALUING AN INTERVENTION: MARSH MIGRATION AND ECOSYSTEM SERVICES

    EPA Science Inventory

    There is growing interest in valuing ecosystem services provided by marsh systems. Ecosystem services represent a flow of benefits to society from the existence or functioning of the marsh. Therefore, to “put a value on” the marsh itself, or estimate a value of the na...

  19. Service and Conservation Corps. What Works Clearinghouse Intervention Report

    ERIC Educational Resources Information Center

    What Works Clearinghouse, 2010

    2010-01-01

    "Service and Conservation Corps" engages young adults in full-time community service, job training, and educational activities. The program serves youth who are typically between the ages of 17 and 26 and who have dropped out of school, been involved with the criminal justice system, or face other barriers to success. Participants are…

  20. Private and Public Health Insurance for Early Intervention Services.

    ERIC Educational Resources Information Center

    Fox, Harriette B.; And Others

    1992-01-01

    Data were gathered from all state Medicaid programs, 11 health insurance carriers, and 140 firms offering health insurance to employees, concerning coverage of various services needed by young children with disabilities, including ancillary therapies, mental health services, and case management. Results revealed that Medicaid offered the greatest…

  1. K-12 School Food Service Staff Training Interventions: A Review of the Literature.

    PubMed

    Stephens, Lacy; Byker Shanks, Carmen

    2015-12-01

    School food service professionals are vital to implementing national nutrition standards in school meal programs. Appropriate and effective training for these professionals may be one key to producing healthful meals that students are excited to eat and also meet United States Department of Agriculture (USDA) nutrient guidelines. A systematic literature review was conducted to understand the scope of interventions conducted with food service staff. PubMed, Web of Knowledge, and Science Direct databases were searched for articles detailing school food service training interventions in K-12 school settings within the United States. Of 2341 articles retrieved, 17 articles describing 14 food service training interventions met the inclusion criteria. While food service staff training was an important component of many comprehensive school health and school meal interventions, there were few studies that specifically addressed school food service staff trainings. Although some best practices can be concluded from the current literature, major gaps in knowledge about effective school food service training interventions and validated research tools remain. As new professional standards are mandated by the USDA, a more thorough evaluation and understanding of best practices is vital to maximize the effectiveness of food service staff training. © 2015, American School Health Association.

  2. Prospectively Collected Characteristics of Adult Patients, Their Consultations and Outcomes as They Report Breathlessness When Presenting to General Practice in Australia

    PubMed Central

    Currow, David C.; Clark, Katherine; Mitchell, Geoffrey K.; Johnson, Miriam J.; Abernethy, Amy P.

    2013-01-01

    Introduction Breathlessness is a subjective sensation, so understanding its impacts requires patients’ reports, including prospective patient-defined breathlessness as a reason for presenting to general practitioners (GP).The aim of this study was to define the prevalence of breathlessness as a reason for GP consultations while defining the clinico-demographic factors of these patients and the characteristics and outcomes of those consultations. Methods Using nine years of the Family Medicine Research Centre database of 100 consecutive encounters from 1,000 practices annually, the patient-defined reason for encounter ‘breathlessness’ was explored using prospectively collected data in people ≥18 years with clinical data coded using the International Classification for Primary Care V2. Dichotomous variables were analysed using chi square and 95% confidence intervals calculated using Kish’s formula for a single stage clustered design. Results Of all the 755,729 consultations collected over a nine year period from 1 April, 2000, 7255 included breathlessness as a reason for encounter (0.96%; 95% CI 0.93 to 0.99) most frequently attributed to chronic obstructive pulmonary disease. Only 48.3% of GPs saw someone reporting breathlessness. The proportion of consultations with breathlessness increased with age. Breathlessness trebled the likelihood that the consultation occurred in the community rather than the consulting room (p<0.0001) and increased 2.5 fold the likelihood of urgent referral to hospital (p<0.0001). Of those with breathlessness, 12% had undiagnosed breathlessness at the end of the consultation (873/7255) with higher likelihood of being younger females. Discussion Breathlessness is a prevalent symptom in general practitioner. Such prevalence enables future research focused on understanding the temporal pattern of breathlessness and the longitudinal care offered to, and outcomes for these patients, including those who leave the consultation without a

  3. 29 CFR 25.4 - Contents of requests; service on other parties; answer; intervention.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 1 2010-07-01 2010-07-01 true Contents of requests; service on other parties; answer; intervention. 25.4 Section 25.4 Labor Office of the Secretary of Labor RULES FOR THE NOMINATION OF ARBITRATORS...; intervention. (a) Requests for nominations 1 shall be in triplicate and contain the following information: 1...

  4. Positioning the arts for intervention design research in the human services.

    PubMed

    Moxley, David P; Calligan, Holly Feen

    2015-12-01

    The arts have been integral to the human experience fostering innovation in social arrangements, strengthening group cohesion, and merging esthetics with the utilitarian properties of technology. For intervention design research in the human services the arts can harness innovation and creativity in meeting human needs and addressing social issues. Given their capacities to stimulate expression of first person experience through interpretative strategies, the arts can equip people and groups, including researchers, with opportunities to express primary experiential knowledge through creative means, portray useful ways of meeting human needs, educate others about the social issues people experience, and formulate intervention strategies or even models to address the causes and consequences of those issues. In this paper, the authors discuss how the arts can inform and deepen human service intervention design and development and, as a result, advance innovation in the human services. They offer a rationale supporting the inclusion of the arts in the design of human service interventions, examine the contributions of the arts to the formulation of intervention concept and developmental research to further improve interventions, and consider how the arts can advance the reflexivity of intervention designers. The authors draw implications for how researchers can position the arts in the nine steps of intervention design and development the authors offer in this paper.

  5. Effects of Three Levels of Early Intervention Services on Children Prenatally Exposed to Cocaine

    ERIC Educational Resources Information Center

    Claussen, Angelika H.; Scott, Keith G.; Mundy, Peter C.; Katz, Lynne F.

    2004-01-01

    Cocaine use during pregnancy is a high-risk indicator for adverse developmental outcomes. Three levels of intervention (center, home, and primary care) were compared in a full service, birth to age 3, early intervention program serving children exposed to cocaine prenatally. Data were collected on 130 children from urban, predominantly poor,…

  6. Young Children with Disabilities in Israel: System of Early Intervention Service Delivery

    ERIC Educational Resources Information Center

    Shulman, Cory; Meadan, Hedda; Sandhaus, Yoram

    2012-01-01

    This article aims to analyze early intervention programs in Israel according to the Developmental Systems Model (Guralnick, 2001), in an attempt to identify strengths and areas for further development for service delivery for young children with disabilities in Israel. Early intervention in Israel is part of a comprehensive healthcare model…

  7. Young Children with Disabilities in Israel: System of Early Intervention Service Delivery

    ERIC Educational Resources Information Center

    Shulman, Cory; Meadan, Hedda; Sandhaus, Yoram

    2012-01-01

    This article aims to analyze early intervention programs in Israel according to the Developmental Systems Model (Guralnick, 2001), in an attempt to identify strengths and areas for further development for service delivery for young children with disabilities in Israel. Early intervention in Israel is part of a comprehensive healthcare model…

  8. The Missing Link: Self Study Continuing Education for Nutrition Services Awareness in Early Intervention. Workbook.

    ERIC Educational Resources Information Center

    Johnson, Lara; And Others

    This workbook is a companion to an 18-minute instructional video on nutrition services in early intervention programs. Both the workbook and the video are designed to assist early intervention professionals concerning nutrition and feeding concerns of children with special health care needs. The following issues are addressed: importance of…

  9. A Brief Exposure-Based Intervention for Service Members with PTSD

    ERIC Educational Resources Information Center

    Steenkamp, Maria M.; Litz, Brett T.; Gray, Matt J.; Lebowitz, Leslie; Nash, William; Conoscenti, Lauren; Amidon, Amy; Lang, Ariel

    2011-01-01

    The growing number of service members in need of mental health care requires that empirically based interventions be tailored to the unique demands and exigencies of this population. We discuss a 6-session intervention for combat-related PTSD designed to foster willingness to engage with and disclose difficult deployment memories through a…

  10. Family-Centered Early Intervention Visual Impairment Services through Matrix Session Planning

    ERIC Educational Resources Information Center

    Ely, Mindy S.; Gullifor, Kateri; Hollinshead, Tara

    2017-01-01

    Early intervention visual impairment services are built on a model that values family. Matrix session planning pulls together parent priorities, family routines, and identified strategies in a way that helps families and early intervention professionals outline a plan that can both highlight long-term goals and focus on what can be done today.…

  11. Improving the Design and Implementation of In-Service Professional Development in Early Childhood Intervention

    ERIC Educational Resources Information Center

    Dunst, Carl J.

    2015-01-01

    A model for designing and implementing evidence-­based in­-service professional development in early childhood intervention as well as the key features of the model are described. The key features include professional development specialist (PDS) description and demonstration of an intervention practice, active and authentic job-­embedded…

  12. A Brief Exposure-Based Intervention for Service Members with PTSD

    ERIC Educational Resources Information Center

    Steenkamp, Maria M.; Litz, Brett T.; Gray, Matt J.; Lebowitz, Leslie; Nash, William; Conoscenti, Lauren; Amidon, Amy; Lang, Ariel

    2011-01-01

    The growing number of service members in need of mental health care requires that empirically based interventions be tailored to the unique demands and exigencies of this population. We discuss a 6-session intervention for combat-related PTSD designed to foster willingness to engage with and disclose difficult deployment memories through a…

  13. Interventions to improve patient access to and utilisation of genetic and genomic counselling services

    PubMed Central

    Benjamin, Caroline M; Thomas, Lois H; Skirton, Heather; Gustafson, Shanna; Coupe, Jacqueline; Patch, Christine; Belk, Rachel; Tishkovskaya, Svetlana; Calzone, Kathleen; Payne, Katherine

    2015-01-01

    This is the protocol for a review and there is no abstract. The objectives are as follows: Primary objective The primary objective is to assess the effectiveness of interventions to improve patient identification, access to and utilisation of genetic and genomic counselling services when compared to: No intervention; Usual or current practice; and Other active intervention. Secondary objective The secondary objective is to explore the resource use and costs associated with interventions aimed at improving patient identification, access to and utilisation of genetic and genomic counselling services from studies meeting the eligibility criteria. We will report on factors that may explain variation in the effectiveness of interventions aimed at improving patient identification, access to and utilisation of genetic and genomic counselling services from studies meeting the eligibility criteria. Another secondary objective is to explore how interventions which target improved patient identification, access to and utilisation of genetic and genomic counselling services affect the subsequent appropriate use of health services for the prevention or early detection of disease. It is also possible that the genetic counselling interaction itself will contribute to the possible use of preventative services. PMID:26989348

  14. Early Intervention and Prevention--Issues and Services.

    ERIC Educational Resources Information Center

    Kopfstein, Rosalind

    This paper reviews the American Association on Mental Retardation's (AAMR's) presentation of issues surrounding the field of early intervention. AAMR's publications are the primary sources of information in the paper. Specific sections address: (1) the impact of public laws on the rights of children and families to a free and appropriate public…

  15. Program- and service-level costs of seven screening, brief intervention, and referral to treatment programs

    PubMed Central

    Bray, Jeremy W; Mallonee, Erin; Dowd, William; Aldridge, Arnie; Cowell, Alexander J; Vendetti, Janice

    2014-01-01

    This paper examines the costs of delivering screening, brief intervention, and referral to treatment (SBIRT) services within the first seven demonstration programs funded by the US Substance Abuse and Mental Health Services Administration. Service-level costs were estimated and compared across implementation model (contracted specialist, inhouse specialist, inhouse generalist) and service delivery setting (emergency department, hospital inpatient, outpatient). Program-level costs were estimated and compared across grantee recipient programs. Service-level data were collected through timed observations of SBIRT service delivery. Program-level data were collected during key informant interviews using structured cost interview guides. At the service level, support activities that occur before or after engaging the patient comprise a considerable portion of the cost of delivering SBIRT services, especially short duration services. At the program level, average costs decreased as more patients were screened. Comparing across program and service levels, the average annual operating costs calculated at the program level often exceeded the cost of actual service delivery. Provider time spent in support of service provision may comprise a large share of the costs in some cases because of potentially substantial fixed and quasifixed costs associated with program operation. The cost structure of screening, brief intervention, and referral to treatment is complex and discontinuous of patient flow, causing annual operating costs to exceed the costs of actual service provision for some settings and implementation models. PMID:25114610

  16. The effectiveness of housing interventions and housing and service interventions on ending family homelessness: a systematic review.

    PubMed

    Bassuk, Ellen L; DeCandia, Carmela J; Tsertsvadze, Alexander; Richard, Molly K

    2014-09-01

    Family homelessness has become a growing public health problem over the last 3 decades. Despite this trend, few studies have explored the effectiveness of housing interventions and housing and service interventions. The purpose of this systematic review is to appraise and synthesize evidence on effective interventions addressing family homelessness. We searched 10 major electronic databases from 2007 to 2013. Empirical studies investigating effectiveness of housing interventions and housing and service interventions for American homeless families regardless of publication status were eligible for inclusion. Outcomes included housing status, employment, parental trauma and mental health and substance use, children's behavioral and academic status, and family reunification. Study quality was appraised using the Effective Public Health Practice Project tool. Six studies were included in this review. Overall, there was some postintervention improvement in housing and employment, but ongoing residential and work stability were not achieved. Methodological limitations, poor reporting quality, and inconsistent definitions across outcomes hindered between-study comparisons. Substantial limitations in research underscore the insufficiency of our current knowledge base for ending homelessness. Although many families were no longer literally homeless, long-term residential stability and employment at a livable wage were not ensured. Developing and implementing evidence-based approaches for addressing homelessness are long overdue.

  17. Services in Counseling/Intervention and Life Skills Education (S.C.I.L.S.E.).

    ERIC Educational Resources Information Center

    Kirk, Mimi

    The report describes the Services in Counseling/Intervention and Life Skills Education (SCILSE) Program, a comprehensive program providing services to emotionally disturbed children in their own homes, under the auspices of the Southern Home for Children, a residential treatment center in Philadelphia. The history of the Southern Home for Children…

  18. Perspectives of Therapist's Role in Care Coordination between Medical and Early Intervention Services

    ERIC Educational Resources Information Center

    Ideishi, Roger I.; O'Neil, Margaret E.; Chiarello, Lisa A.; Nixon-Cave, Kim

    2010-01-01

    This study explored perspectives of therapist's role in care coordination between early intervention (EI) and medical services, and identified strategies for improving service delivery. Fifty adults participated in one of six focus groups. Participants included parents, pediatricians, and therapists working in hospital and EI programs. Structured…

  19. Collaborative Practice in Early Childhood Intervention from the Perspectives of Service Providers

    ERIC Educational Resources Information Center

    Yang, Chih-Hung; Hossain, Syeda Zakia; Sitharthan, Gomathi

    2013-01-01

    Effective early childhood intervention (ECI) relies on collaboration among agencies, service providers, and families. Although previous literature has primarily focused on segments of collaboration within ECI service delivery, the actual process and how the adult stakeholders perceive and engage in collaborative practice have important…

  20. The Impact of Arbitration Intervention Services on Youth Recidivism: One-Year Follow-Up

    ERIC Educational Resources Information Center

    Dembo, Richard; Wareham, Jennifer; Poythress, Norman G.; Cook, Brittany; Schmeidler, James

    2006-01-01

    We report the impact of case management services and youth psychopathic features on twelve-month recidivism rates for youths involved in a Center for Substance Abuse Treatment funded clinical trial conducted in a juvenile diversion program. The project is evaluating an innovative intervention service providing 16 weeks of intensive case management…

  1. Family Outcomes of Early Intervention: Families' Perceptions of Need, Services, and Outcomes

    ERIC Educational Resources Information Center

    Epley, Pamela H.; Summers, Jean Ann; Turnbull, Ann P.

    2011-01-01

    Relationships between parent ratings of Part C/early intervention (EI) services and family outcomes for families of young children with disabilities were examined--specifically, the early childhood outcomes (ECO)-recommended family outcomes and family quality of life (FQOL). Measures included the Early Childhood Services Survey, the ECO Center…

  2. Collaborative Practice in Early Childhood Intervention from the Perspectives of Service Providers

    ERIC Educational Resources Information Center

    Yang, Chih-Hung; Hossain, Syeda Zakia; Sitharthan, Gomathi

    2013-01-01

    Effective early childhood intervention (ECI) relies on collaboration among agencies, service providers, and families. Although previous literature has primarily focused on segments of collaboration within ECI service delivery, the actual process and how the adult stakeholders perceive and engage in collaborative practice have important…

  3. Perceptions of Early Intervention Services: Adolescent and Adult Mothers in Two States

    ERIC Educational Resources Information Center

    Thompson, Stacy D.; Bruns, Deborah A.

    2013-01-01

    Early intervention (EI) provides critical services to families with young children who have diagnosed disabilities, developmental delays, or who are at-risk for developmental delays. Very little is known about the experiences of adolescent mothers who have children who qualify for EI services. The authors investigated the perceptions of adolescent…

  4. A Model Human Sexuality--HIV/AIDS Prevention and Intervention Service-Learning Program

    ERIC Educational Resources Information Center

    Stewart, Clarence, M., Jr.

    2005-01-01

    This article deals with a service-learning program focused on human sexuality and HIV/AIDS prevention and intervention at the Howard University Department of Health, Human Performance and Leisure Studies. Topics discussed include how this program was created, an overview of peer education, HIV/AIDS peer education training, and services provided to…

  5. Health Care Policy and Part H Services: Early Intervention as a Concept (Not a Separate Program).

    ERIC Educational Resources Information Center

    Shonkoff, Jack P.

    This paper argues that there is a critical need to reframe the fundamental policy questions which fragment early childhood intervention services and health care, in order to construct an integrated system of comprehensive services that includes basic health care and developmental support for all children and their families and that provides…

  6. Early Intervention and Early Childhood Services for Families in Rural Settings.

    ERIC Educational Resources Information Center

    Haring, Kathryn A.; Lovett, David L.

    2001-01-01

    An 8-year study examined the experiences of 23 rural families in the Early Intervention Early Childhood process. Findings indicated a lack of prenatal care and limited access to medical care, specialists, and local doctors due to geographic isolation and shortages of service personnel. Recommendations for improving rural service delivery are…

  7. Community Consultation and Intervention: Supporting Students Who Do Not Access Counseling Services

    ERIC Educational Resources Information Center

    Mier, Sharon; Boone, Matthew; Shropshire, Sonya

    2009-01-01

    Although the severity of psychological problems among college students and the demand for campus counseling services has increased, many students who could benefit from mental health services still do not access them. This article describes Community Consultation and Intervention, a program designed to support students who are unlikely to access…

  8. Family Outcomes of Early Intervention: Families' Perceptions of Need, Services, and Outcomes

    ERIC Educational Resources Information Center

    Epley, Pamela H.; Summers, Jean Ann; Turnbull, Ann P.

    2011-01-01

    Relationships between parent ratings of Part C/early intervention (EI) services and family outcomes for families of young children with disabilities were examined--specifically, the early childhood outcomes (ECO)-recommended family outcomes and family quality of life (FQOL). Measures included the Early Childhood Services Survey, the ECO Center…

  9. Perspectives of Therapist's Role in Care Coordination between Medical and Early Intervention Services

    ERIC Educational Resources Information Center

    Ideishi, Roger I.; O'Neil, Margaret E.; Chiarello, Lisa A.; Nixon-Cave, Kim

    2010-01-01

    This study explored perspectives of therapist's role in care coordination between early intervention (EI) and medical services, and identified strategies for improving service delivery. Fifty adults participated in one of six focus groups. Participants included parents, pediatricians, and therapists working in hospital and EI programs. Structured…

  10. Acceptability and availability of pharmacological interventions for substance misuse by British NHS treatment services.

    PubMed

    Rosenberg, Harold; Melville, John; McLean, P C

    2002-01-01

    Despite their potential advantages, many of the pharmacological interventions available to treat substance misuse are controversial and their acceptability within the United Kingdom (and other countries) has only recently begun to be investigated. A questionnaire mailed to British National Health Service (NHS) alcohol and drug treatment services asked respondents to rate the acceptability and availability of 11 pharmacological interventions for substance misuse employed to relieve withdrawal, reduce the likelihood of relapse and opiate overdose and substitute pharmaceuticals for illicit drugs. A sample of NHS substance misuse services (n = 265) listed in one or more directories of services in England, Wales and Scotland. Substitute methadone for opiate addiction, substitute benzodiazepines for benzodiazepine-dependent patients, lofexidine for opiate detoxification, naltrexone for opiate relapse prevention and acamprosate for alcohol relapse prevention were widely acceptable and available interventions. Another subset of medications-buprenorphine for opiate detoxification, take-home naloxone for overdose prevention and substitute prescribing of levo-alpha-acetyl-methadol (LAAM), heroin and dexamphetamine-garnered less support, but the majority of participants rated even these therapies as acceptable. Ultra-rapid detoxification under sedation was the intervention rated as least acceptable to, and was one of the two least frequently available from, responding NHS services. Differences among specific medications notwithstanding, a wide range of harm-reduction and abstinence-orientated interventions were acceptable to and available from NHS services. Acceptance and availability are probably limited by a combination of practical, economic, safety, efficacy and theoretical considerations.

  11. 75 FR 68613 - Part C Early Intervention Services Grant

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-08

    ... be transferring Ryan White HIV/AIDS Program, Part C funds as a Non-Competitive Replacement Award, to... treatment services and avoid a disruption of HIV/AIDS clinical care to clients in East and Central Harlem... Health will receive $577,174 of fiscal year (FY) 2010 funds to ensure ongoing clinical HIV/ AIDS...

  12. Why Young Children Enter Early Intervention Services. FPG Snapshot. #38

    ERIC Educational Resources Information Center

    FPG Child Development Institute, 2007

    2007-01-01

    Part C of the Individuals with Disabilities Education Act (IDEA) provides funding to states to provide services for children from birth to three years of age with developmental delays and disabilities. States have flexibility--and therefore variation--in determining the criteria for eligibility. A study published in the Journal of Policy and…

  13. Law Enforcement and Crisis Intervention Services: A Critical Relationship

    ERIC Educational Resources Information Center

    Cesnik, Bernard I.; And Others

    1977-01-01

    Because of their traditional base as the primary available emergency "field" service in a community, a mental health emergency program must have a cooperative working relationship with law enforcement. Presented at the Ninth Annual Meeting of the American Association of Suicidology, Los Angeles, California, April 29-May 2, 1976. (Author)

  14. Factors influencing the suicide intervention skills of emergency medical services providers

    PubMed Central

    Lygnugaryte-Griksiene, Aidana; Leskauskas, Darius; Jasinskas, Nedas; Masiukiene, Agne

    2017-01-01

    ABSTRACT Background: Lithuania currently has the highest suicide rate in Europe and the fifth highest worldwide. Aims: To identify the factors that influence the suicide intervention skills of emergency medical services (EMS) providers (doctors, nurses, paramedics). Method: Two hundred and sixty-eight EMS providers participated in the research. The EMS providers were surveyed both prior to their training in suicide intervention and six months later. The questionnaire used for the survey assessed their socio-demographic characteristics, suicide intervention skills, attitudes towards suicide prevention, general mental health, strategies for coping with stress, and likelihood of burnout. Results: Better suicide intervention skills were more prevalent among EMS providers with a higher level of education, heavier workload, more positive attitudes towards suicide prevention, better methods of coping with stress, and those of a younger age. Six months after the non-continuous training in suicide intervention, the providers’ ability to assess suicide risk factors had improved, although there was no change in their suicide intervention skills. Conclusions: In order to improve the suicide intervention skills of EMS providers, particular attention should be paid to attitudes towards suicide prevention, skills for coping with stress, and continuous training in suicide intervention. Abbreviations: EMS: Emergency medical services; SIRI: Suicide intervention response inventory PMID:28235388

  15. Maternity Care Services and Culture: A Systematic Global Mapping of Interventions

    PubMed Central

    Coast, Ernestina; Jones, Eleri; Portela, Anayda; Lattof, Samantha R.

    2014-01-01

    Background A vast body of global research shows that cultural factors affect the use of skilled maternity care services in diverse contexts. While interventions have sought to address this issue, the literature on these efforts has not been synthesised. This paper presents a systematic mapping of interventions that have been implemented to address cultural factors that affect women's use of skilled maternity care. It identifies and develops a map of the literature; describes the range of interventions, types of literature and study designs; and identifies knowledge gaps. Methods and Findings Searches conducted systematically in ten electronic databases and two websites for literature published between 01/01/1990 and 28/02/2013 were combined with expert-recommended references. Potentially eligible literature included journal articles and grey literature published in English, French or Spanish. Items were screened against inclusion and exclusion criteria, yielding 96 items in the final map. Data extracted from the full text documents are presented in tables and a narrative synthesis. The results show that a diverse range of interventions has been implemented in 35 countries to address cultural factors that affect the use of skilled maternity care. Items are classified as follows: (1) service delivery models; (2) service provider interventions; (3) health education interventions; (4) participatory approaches; and (5) mental health interventions. Conclusions The map provides a rich source of information on interventions attempted in diverse settings that might have relevance elsewhere. A range of literature was identified, from narrative descriptions of interventions to studies using randomised controlled trials to evaluate impact. Only 23 items describe studies that aim to measure intervention impact through the use of experimental or observational-analytic designs. Based on the findings, we identify avenues for further research in order to better document and measure

  16. Effect of diabetic case management intervention on health service utilization in Korea.

    PubMed

    Shin, Soon Ae; Kim, Hyeongsu; Lee, Kunsei; Lin, Vivian; Liu, George

    2015-12-01

    This study is to estimate the effectiveness of a diabetic case management programme on health-care service utilization. The study population included 6007 as the intervention group and 956,766 as the control group. As the indicators of health-care service utilization, numbers of medical ambulatory consultations, days of medication prescribed and medical expenses for one year were used, and we analysed the claim data of the health insurance from 2005 to 2007. The study population was classified into three subgroups based on the number of medical ambulatory consultations per year before this intervention. In the under-serviced subgroup, the intervention group showed a significant increase in the number of consultations (3.2), days of prescribed medication (66.4) and medical expenses (287,900 KRW) compared with the control group. Conversely, in the over-serviced subgroup, the intervention group showed a less decrease days of prescribed medication (1.6) compared with the control group. This showed that the case management programme led the intervention group to optimize their utilization of health-care services by subgroups. It is necessary to evaluate the appropriateness of health-care usage and clinical outcome to show the direct effectiveness of the case management programme by subgroups.

  17. A brief intervention is sufficient for many adolescents seeking help from low threshold adolescent psychiatric services

    PubMed Central

    2010-01-01

    Background There has been a considerable increase in the need for psychiatric services for adolescents. Primary health care practitioners have a major role in detecting, screening and helping these adolescents. An intervention entitled SCREEN is described in this article. The SCREEN intervention was developed to help practitioners to detect and screen adolescent needs, to care for adolescents at the primary health care level and to facilitate the referral of adolescents to secondary care services in collaboration between primary and secondary health care. Secondly, the article presents the background and clinical characteristics of youths seeking help from the SCREEN services, and compares the background factors and clinical characteristics of those patients referred and not referred to secondary care services. Methods The SCREEN intervention consisted of 1 to 5 sessions, including assessment by a semi-structured anamnesis interview, the structured Global Assessment Scale, and by a structured priority rating scale, as well as a brief intervention for each adolescent's chosen problem. Parents took part in the assessment in 39% of cases involving girls and 50% involving boys. During 34 months, 2071 adolescents (69% females) entered the intervention and 70% completed it. The mean age was 17.1 years for boys and 17.3 years for girls. Results For 69% of adolescents, this was the first contact with psychiatric services. The most common reasons for seeking services were depressive symptoms (31%). Self-harming behaviour had occurred in 25% of girls and 16% of boys. The intervention was sufficient for 37% of those who completed it. Psychosocial functioning improved during the intervention. Factors associated with referral for further treatment were female gender, anxiety as the main complaint, previous psychiatric treatment, self-harming behaviour, a previous need for child welfare services, poor psychosocial functioning and a high score in the priority rating scale

  18. Nutrition: Intervention Guidance for Service Providers and Families. Connecticut Birth to Three System, Service Guideline 6.

    ERIC Educational Resources Information Center

    Connecticut Birth to Three System, Hartford.

    This guide was developed to assist families and service providers in Connecticut with nutrition services for infants and toddlers with disabilities. Individual sections provide information about the following topics: laws and regulations related to nutrition services; eligibility for the Connecticut Birth to Three System and nutrition; nutrition…

  19. 78 FR 31568 - Ryan White HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-24

    ... White HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program.... ACTION: Notice of Ryan White HIV/AIDS Program Part C Early Intervention Services One-Time Noncompetitive... care services for persons living with HIV/AIDS, HRSA will provide a one-time noncompetitive Ryan...

  20. 78 FR 10183 - Ryan White HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-13

    ... HUMAN SERVICES Health Resources and Services Administration Ryan White HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services Administration (HRSA), Department of Health and Human Services. ACTION: Notice of Ryan White HIV/AIDS...

  1. 78 FR 10183 - Ryan White HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-13

    ... HUMAN SERVICES Health Resources and Services Administration Ryan White HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services... a lapse in comprehensive primary care services for persons living with HIV/AIDS, HRSA will...

  2. 78 FR 10183 - Ryan White HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-13

    ... HUMAN SERVICES Health Resources and Services Administration Ryan White HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services... prevent a lapse in comprehensive primary care services for persons living with HIV/AIDS, HRSA will...

  3. 78 FR 78976 - Ryan White HIV/AIDS Program Part C Early Intervention Services Grant Under the Ryan White HIV...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-27

    ... HUMAN SERVICES Health Resources and Services Administration Ryan White HIV/AIDS Program Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services Administration (HRSA), Department of Health and Human Services. ACTION: Notice of Ryan White HIV/AIDS...

  4. 78 FR 10182 - Ryan White HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-13

    ... HUMAN SERVICES Health Resources and Services Administration Ryan White HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services Administration (HRSA), Department of Health and Human Services. ACTION: Notice of Ryan White HIV/AIDS...

  5. 78 FR 18989 - Ryan White HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-28

    ... HUMAN SERVICES Health Resources and Services Administration Ryan White HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services Administration (HRSA), Department of Health and Human Services. ACTION: Notice of Ryan White HIV/AIDS...

  6. Disability and breathlessness in asthmatic patients--a scoring method by repetitive inspiratory effort.

    PubMed

    Loh, Li-Cher; Puah, Ser-Hon; Ho, Chiak Vun; Chow, Chong Yeow; Chua, Chui Yin; Jayaram, Jacynta; Kavetha, Clarence; Wong, Sue Jiun

    2005-12-01

    Measurement of disability and breathlessness in asthma is important to guide treatment. Using an incentive spirometer, Triflo II (Tyco Healthcare, Mansfield, MA, USA), we developed a three-minute respiratory exercise test (3-MRET) to score the maximal breathing capacity (MBC) and perception of dyspnea (POD) index by means of repetitive inspiratory efforts achieved within 3 minutes. POD index was calculated based on the ratio of breathlessness on visual analogue scale over MBC score. In 175 normal healthy subjects and 158 asthmatic patients of mild (n = 26), moderate (n = 78), and severe (n = 54), severity, the mean (95% CI) MBC scores in mild, moderate, and severe asthma patients were 168 (145-192), 153 (136-169), and 125 (109-142) respectively, and 202 (191-214) in normal subjects (p < 0.001). The mean POD index in mild, moderate, and severe asthma patients was 16 (9-23), 25 (14-37), and 57 (14-100), respectively, and 6 (4-7) in normal subjects (p < 0.001). Intraclass correlation coefficients for MBC score and POD index in 17 asthmatic and 20 normal subjects were high. In 14 asthmatic patients randomized to receiving nebulized beta2-agonist or saline in a cross-over, double-blind study, % forced expiratory volume in one second (FEV1) change correlated with % change in MBC score [r(s) = 0.49, p < 0.01] and POD index [r(s)-0.46, p = 0.012]. In 21 asthmatic and 26 normal subjects, the MBC score and POD index correlated with the walking distance and walking POD index of the six-minute walking test (6MWT). We conclude that 3MRET is discriminative between asthmatic patients of varying severity and normal subjects, is reproducible, is responsive to bronchodilator effect, and is comparable with 6MWT. Taken together, it has the potential to score disability and POD in asthma simply and effectively.

  7. Interoceptive fear learning to mild breathlessness as a laboratory model for unexpected panic attacks.

    PubMed

    Pappens, Meike; Vandenbossche, Evelien; Van den Bergh, Omer; Van Diest, Ilse

    2015-01-01

    Fear learning is thought to play an important role in panic disorder. Benign interoceptive sensations can become predictors (conditioned stimuli - CSs) of massive fear when experienced in the context of an initial panic attack (unconditioned stimulus - US). The mere encounter of these CSs on a later moment can induce anxiety and fear, and precipitate a new panic attack. It has been suggested that fear learning to interoceptive cues would result in unpredictable panic. The present study aimed to investigate whether fear learning to an interoceptive CS is possible without declarative knowledge of the CS-US contingency. The CS consisted of mild breathlessness (or: dyspnea), the US was a suffocation experience. During acquisition, the experimental group received six presentations of mild breathlessness immediately followed by suffocation; for the control group both experiences were always separated by an intertrial interval. In the subsequent extinction phase, participants received six unreinforced presentations of the CS. Expectancy of the US was rated continuously and startle eyeblink electromyographic, skin conductance, and respiration were measured. Declarative knowledge of the CS-US relationship was also assessed with a post-experimental questionnaire. At the end of acquisition, both groups displayed the same levels of US expectancy and skin conductance in response to the CS, but the experimental group showed a fear potentiated startle eyeblink and a different respiratory response to the CS compared to the control group. Further analyses on a subgroup of CS-US unaware participants confirmed the presence of startle eyeblink conditioning in the experimental group but not in the control group. Our findings suggest that interoceptive fear learning is not dependent on declarative knowledge of the CS-US relationship. The present interoceptive fear conditioning paradigm may serve as an ecologically valid laboratory model for unexpected panic attacks.

  8. Therapeutic interventions in perinatal and infant mental health services: a mixed methods inquiry.

    PubMed

    Myors, Karen Anne; Schmied, Virginia; Johnson, Maree; Cleary, Michelle

    2014-05-01

    Perinatal mental health disorders potentially have long-term negative sequelae for women, their infants and their families. Multidisciplinary perinatal and infant mental health (PIMH) services are an emerging specialty in mental health designed to improve mother-infant outcomes. This mixed methods study explored the characteristics of women referred to a specialist PIMH service and the therapeutic interventions that PIMH clinicians use. Women referred to the service were identified with multiple and complex risk factors. Perinatal and infant mental health clinicians use a range of interventions, dependent upon their training, such as family of origin work/genograms, non-directive counseling, and strategies to manage anxiety and depression. Clinicians also emphasized the therapeutic relationship and the interventions they use within an attachment-based framework, which warrants further research.

  9. Geriatric interventions: the evidence base for comprehensive health care services for older people.

    PubMed

    Cordato, Nicholas J; Saha, Sabari; Price, Michael A

    2005-05-01

    Specialist geriatric services apply a comprehensive, multidisciplinary evaluation and management approach to the multidimensional and usually interrelated medical, functional and psychosocial problems faced by at-risk frail elderly people. This paper examines currently available data on geriatric interventions and finds ample evidence supporting both the efficacy and the cost-effectiveness of these specialist interventions when utilised in appropriately targeted patients. It is proposed that substantial investment in these programs is required to meet the future demands of Australia's ageing population.

  10. Is Your Interventional Radiology Service Ready for SARS?: The Singapore Experience

    SciTech Connect

    Lau, Te-Neng; Teo, Ngee; Tay, Kiang-Hiong; Chan, Ling-Ling; Wong, Daniel; Lim, Winston E.H.; Tan, Bien-Soo

    2003-09-15

    The recent epidemic of severe acute respiratory syndrome caught many by surprise. Hitherto, infection control has not been in the forefront of radiological practice. Many interventional radiology (IR) services are therefore not equipped to deal with such a disease. In this review, we share our experience from the interventional radiologist's perspective, report on the acute measures instituted within our departments and explore the long-term effects of such a disease on the practice of IR.

  11. Development of an Intervention to Increase Sexual Health Service Uptake by Young People.

    PubMed

    Newby, Katie V; Brown, Katherine E; Bayley, Julie; Kehal, Isher; Caley, Mike; Danahay, Amy; Hunt, Jonny; Critchley, George

    2017-05-01

    This study aimed to develop and implement an intervention, delivered via a website and Web app, to increase the uptake of sexual health services by young people. The intervention was co-designed with a group of 10 young people. Intervention mapping was used to guide development. To identify barriers and facilitators of access to sexual health services, three focus groups with 24 young people aged 13 to 19 years, and interviews with 12 professionals recruited from across a range of health and social services, were conducted. Data were analyzed using content analysis. Evidence was supplemented through a literature review. Barriers and facilitators were categorized as theoretical determinants and then suitable behavior change techniques (BCTs) for targeting them were selected. Targeted determinants were attitude, subjective norm, perceived behavioral control, and knowledge. Selected BCTs included "information about others' approval," "framing/reframing," and "credible source." The website/app enable users to search for services, access key information about them, watch videos about what to expect, and have key concerns removed/addressed. This is the first known digital evidence-based intervention to target this behavior described in the literature. A clear and full description of intervention development and content, including of theorized causal pathways, is provided to aid interpretation of future outcome evaluations.

  12. Intervention recommendations and subsequent access to services following clinical assessment for fetal alcohol spectrum disorders.

    PubMed

    Pei, Jacqueline; Baugh, Lauren; Andrew, Gail; Rasmussen, Carmen

    2017-01-01

    Children with fetal alcohol spectrum disorders (FASD) and prenatal alcohol exposure (PAE) experience multiple difficulties requiring various interventions. Researchers have called for investigation into service use with respect to clinically recommended interventions. To examine intervention recommendations for children with FASD/PAE and subsequent access to these recommended interventions. Intervention recommendations following FASD assessment were examined for children (1-17 years). Recommendations were compared according to diagnostic status and demographic and environmental variables. Subsequent access to several interventions was examined for 45 participants. A variety of recommendations were given. Children with FASD received more recommendations overall and received more education, anticipatory guidance, family support, and safety recommendations than undiagnosed children with PAE. Undiagnosed children received more mental health and reassessment recommendations. Older children received fewer family support and developmental therapy recommendations but more mental health recommendations than younger age groups. Many families accessed modified school programming, developmental therapy, psychiatry, child counseling, and parent support as recommended. Children with FASD and PAE have extensive needs and should receive individualized recommendations. An assessment is valuable even without an FASD diagnosis. Areas of high/low service access may provide insight into accessibility and perceived importance of interventions. This study responds to important research questions regarding the intervention needs of individuals with FASD. It is novel in its exploration of intervention recommendations given to children prenatally exposed to alcohol without an FASD diagnosis (rather than only children with FASD) and in its examination of post-assessment service use patterns specifically in relation to clinical recommendations. Crown Copyright © 2016. Published by Elsevier

  13. Lessons learned from an emergency medical services fire safety intervention.

    PubMed

    Pirrallo, Ronald G; Cady, Charles E

    2004-01-01

    The authors conducted a pilot study, finding that many households that experienced fires had received prior emergency medical services (EMS) visits, but few had operational smoke alarms. The study hypothesis is that dwellings that received smoke alarms and/or batteries during an EMS call were more likely to have an operational alarm, less property dollar loss, and decreased morbidity and mortality at the time of a subsequent fire. Smoke detectors and batteries were provided to an urban fire department for placement in unprotected homes at the time of an EMS call from March 1, 1999, through January 31, 2001. After addressing the reason for the 911 EMS call, verification or installation of an operational smoke alarm was performed. The authors examined records for dwellings that had a subsequent fire for outcomes of smoke alarm status, estimated property dollar loss, and number of injuries and fatalities. This program placed 1,335 smoke detectors. Of these, 99 dwellings were found to have a fire or smoke condition with 20 exclusions. Our final number was 79; 28 (35%) still had an operating smoke alarm. In homes with operational alarms, the mean dollar loss was 2,870 dollars (U.S. 2001) (95% confidence interval [CI], 143-5,596). In homes without operational alarms, mean loss was 10,468 dollars (U.S. 2001) (95% CI, 5,875-15,061). No injuries or fatalities occurred in either group. This program was successful in placing 1,335 smoke alarms in at-risk dwellings and reaffirmed that an operational smoke alarm significantly decreases property dollar loss. However, if the goal is to have all homes protected by smoke alarms, this program has long-term effectiveness limitations.

  14. Pre-Service Physical Education Teachers' Indigenous Knowledge, Cultural Competency and Pedagogy: A Service Learning Intervention

    ERIC Educational Resources Information Center

    Peralta, Louisa R.; O'Connor, Donna; Cotton, Wayne G.; Bennie, Andrew

    2016-01-01

    In this paper, we investigate the effects of a community- and school-based service learning experience (SLE) on pre-service physical education teachers' Indigenous knowledge, cultural competency and pedagogy. Informed by the theoretical tenets of Indigenous research methodologies, experiential learning and critical reflection, we examine 55…

  15. A Comparison of Service Delivery Models for Special Education Middle School Students Receiving Moderate Intervention Services

    ERIC Educational Resources Information Center

    Jones-Mason, Keely S.

    2012-01-01

    In an effort to improve academic performance for students receiving special education services, a large urban school district in Tennessee has implemented Integrated Service Delivery Model. The purpose of this study was to compare the performance of students receiving instruction in self-contained classrooms to the performance of students…

  16. School Bullying Episodes: Attitudes and Intervention in Pre-Service and In-Service Italian Teachers

    ERIC Educational Resources Information Center

    Begotti, Tatiana; Tirassa, Maurizio; Acquadro Maran, Daniela

    2017-01-01

    We compared the respective attitudes of pre-service teachers (PST) and in-service teachers (IST) towards bullying. A questionnaire survey was administered to 110 PST and 128 IST. Self-efficacy beliefs, external locus of causality and empathy for the victims were higher in IST than PST. Perceived seriousness of bullying and likelihood of…

  17. Pre-Service Physical Education Teachers' Indigenous Knowledge, Cultural Competency and Pedagogy: A Service Learning Intervention

    ERIC Educational Resources Information Center

    Peralta, Louisa R.; O'Connor, Donna; Cotton, Wayne G.; Bennie, Andrew

    2016-01-01

    In this paper, we investigate the effects of a community- and school-based service learning experience (SLE) on pre-service physical education teachers' Indigenous knowledge, cultural competency and pedagogy. Informed by the theoretical tenets of Indigenous research methodologies, experiential learning and critical reflection, we examine 55…

  18. School Bullying Episodes: Attitudes and Intervention in Pre-Service and In-Service Italian Teachers

    ERIC Educational Resources Information Center

    Begotti, Tatiana; Tirassa, Maurizio; Acquadro Maran, Daniela

    2017-01-01

    We compared the respective attitudes of pre-service teachers (PST) and in-service teachers (IST) towards bullying. A questionnaire survey was administered to 110 PST and 128 IST. Self-efficacy beliefs, external locus of causality and empathy for the victims were higher in IST than PST. Perceived seriousness of bullying and likelihood of…

  19. Service user experiences of REFOCUS: a process evaluation of a pro-recovery complex intervention.

    PubMed

    Wallace, Genevieve; Bird, Victoria; Leamy, Mary; Bacon, Faye; Le Boutillier, Clair; Janosik, Monika; MacPherson, Rob; Williams, Julie; Slade, Mike

    2016-09-01

    Policy is increasingly focused on implementing a recovery-orientation within mental health services, yet the subjective experience of individuals receiving a pro-recovery intervention is under-studied. The aim of this study was to explore the service user experience of receiving a complex, pro-recovery intervention (REFOCUS), which aimed to encourage the use of recovery-supporting tools and support recovery-promoting relationships. Interviews (n = 24) and two focus groups (n = 13) were conducted as part of a process evaluation and included a purposive sample of service users who received the complex, pro-recovery intervention within the REFOCUS randomised controlled trial (ISRCTN02507940). Thematic analysis was used to analyse the data. Participants reported that the intervention supported the development of an open and collaborative relationship with staff, with new conversations around values, strengths and goals. This was experienced as hope-inspiring and empowering. However, others described how the recovery tools were used without context, meaning participants were unclear of their purpose and did not see their benefit. During the interviews, some individuals struggled to report any new tasks or conversations occurring during the intervention. Recovery-supporting tools can support the development of a recovery-promoting relationship, which can contribute to positive outcomes for individuals. The tools should be used in a collaborative and flexible manner. Information exchanged around values, strengths and goals should be used in care-planning. As some service users struggled to report their experience of the intervention, alternative evaluation approaches need to be considered if the service user experience is to be fully captured.

  20. Early identification and intervention services for children with autism in Vietnam.

    PubMed

    Van Cong, Tran; Weiss, Bahr; Toan, Khuc Nang; Le Thu, Tran Thi; Trang, Nguyen Thi Nha; Hoa, Nguyen Thi Kim; Thuy, Dao Thi Thu

    In high income countries in Europe and North America, early identification and intervention for autism spectrum disorders (ASD) have been linked to improved long-term outcomes. However, in most low and middle income countries (LMIC) little is known about use or availability of such services, which limits the ability of policy and development planning. The purpose of the present study was assess the use of ASD services in Vietnam, an Asian LMIC, in order to identify areas within the field that should be specifically targeted to improve ASD services in Vietnam. Surveys were conducted in six different cities across Vietnam with 90 parents/caregivers of children with ASD, 115 professionals working with children with ASD, and 10 directors of agencies providing ASD services. Parents/caregivers' survey assessed demographics and information regarding their child's symptoms and services the child received. Professionals' survey assessed their demographic and professional background, the ASD services they provide, and their perspective on the quality of ASD services at their agency. Directors' survey included these same questions as well as additional questions regarding the operation of the agency. Early identification and intervention ASD services are available in Vietnam, at least in major cities. However, there is a lack of well-trained professionals, the tools used for evaluation and diagnosis are limited, outdated and unstandardized, and the quality of services is questionable. Most importantly, a scientific evidence base for services is absent, and the country lacks an official governmental policy for supporting children with ASD. Research directly assessing the quality of ASD services in Vietnam is needed. Most centrally, efforts at facilitating governmental policy and support advocacy are needed to increase the likelihood that families and children with ASD will receive appropriate and effective services.

  1. Barriers and facilitators to partnership working between Early Intervention Services and the voluntary and community sector.

    PubMed

    Lester, Helen; Birchwood, Max; Tait, Lynda; Shah, Sonal; England, Elizabeth; Smith, Jo

    2008-09-01

    Partnership working between health and the voluntary and community sector has become an increasing political priority. This paper describes and explores the extent and patterns of partnership working between health and the voluntary and community sector in the context of Early Intervention Services for young people with a first episode of psychosis. Data were collected from 12 Early Intervention Services and through semistructured interviews with 47 voluntary and community sector leads and 42 commissioners across the West Midlands of England. Most partnerships were described as ad hoc and informal in nature although four formal partnerships between Early Intervention Services and voluntary and community sector organizations had been established. Shared agendas, the ability to refer clients onto an organization that could provide a service they could not and shared training facilitated partnership working in this context. Barriers to closer working included differences in culture such as managing risk, the time required to make and maintain relationships and recognition of the advantages of remaining a small and autonomous organization. The four more formal partnerships were also built on the organizations' experience of working together informally, in one case through a specific pilot project. The voluntary and community organizations involved were also branches of larger national organizations for whom finding sustainable funding was less of an issue. In theoretical terms, eight Early Intervention Service: voluntary and community sector partnerships were at a stage of 'pre-partnership collaboration', three at 'partnership creation and consolidation' and one at 'partnership programme delivery'. The empirical data viewed through the lens of the partnership life-cycle model could help early intervention services, and voluntary and community sector professionals better understand where they are, why they are there and the conditions needed to realise the full

  2. A Retrospective Evaluation of Remote Pharmacist Interventions in a Telepharmacy Service Model Using a Conceptual Framework

    PubMed Central

    Murante, Lori J.; Moffett, Lisa M.

    2014-01-01

    Abstract Objectives: This retrospective cross-sectional study evaluated a telepharmacy service model using a conceptual framework to compare documented remote pharmacist interventions by year, hospital, and remote pharmacist and across rural hospitals with or without an on-site rural hospital pharmacist. Materials and Methods: Documented remote pharmacist interventions for patients at eight rural hospitals in the Midwestern United States during prospective prescription order review/entry from 2008 to 2011 were extracted from RxFusion® database (a home-grown system, i.e., internally developed program at The Nebraska Medical Center (TNMC) for capturing remote pharmacist-documented intervention data). The study authors conceptualized an analytical framework, mapping the 37 classes of remote pharmacist interventions to three broader-level definitions: (a) intervention, eight categories (interaction/potential interaction, contraindication, adverse effects, anticoagulation monitoring, drug product selection, drug regimen, summary, and recommendation), (b) patient medication management, two categories (therapy review and action), and (c) health system-centered medication use process, four categories (prescribing, transcribing and documenting, administering, and monitoring). Frequencies of intervention levels were compared by year, hospital, remote pharmacist, and hospital pharmacy status (with a remote pharmacist and on-site pharmacist or with a remote pharmacist only) using chi-squared test and univariate logistic regression analyses, as appropriate. Results: For 450,000 prescription orders 19,222 remote pharmacist interventions were documented. Frequency of interventions significantly increased each year (36% in 2009, 55% in 2010, and 7% in 2011) versus the baseline year (2008, 3%) when service started. The frequency of interventions also differed significantly across the eight hospitals and 16 remote pharmacists for the three defined intervention levels and categories

  3. Can Housing and Service Interventions Reduce Family Separations for Families Who Experience Homelessness?

    PubMed

    Shinn, Marybeth; Brown, Scott R; Gubits, Daniel

    2016-12-24

    Family break-up is common in families experiencing homelessness. This paper examines the extent of separations of children from parents and of partners from each other and whether housing and service interventions reduced separations and their precursors among 1857 families across 12 sites who participated in the Family Options Study. Families in shelters were randomized to offers of one of three interventions: permanent housing subsidies that reduce expenditures for rent to 30% of families' income, temporary rapid re-housing subsidies with some services directed at housing and employment, and transitional housing in supervised facilities with extensive psychosocial services. Each group was compared to usual care families who were eligible for that intervention but received no special offer. Twenty months later, permanent housing subsidies almost halved rates of child separation and more than halved rates of foster care placements; the other interventions did not affect separations significantly. Predictors of separation were primarily homelessness and drug abuse (all comparisons), and alcohol dependence (one comparison). Although housing subsidies reduced homelessness, alcohol dependence, intimate partner violence, and economic stressors, the last three variables had no association with child separations in the subsidy comparison; thus subsidies had indirect effects via reductions in homelessness. No intervention reduced partner separations. © Society for Community Research and Action 2016.

  4. The Integration of Behavioral Health Interventions in Children’s Health Care: Services, Science, and Suggestions

    PubMed Central

    Kolko, David J.; Perrin, Ellen C.

    2014-01-01

    Objective Because the integration of mental or behavioral health services in pediatric primary care is a national priority, a description and evaluation of the interventions applied in the healthcare setting is warranted. This paper examines several intervention research studies based on alternative models for delivering behavioral health care in conjunction with comprehensive pediatric care. Method This review describes the diverse methods applied to different clinical problems, such as brief mental health skills, clinical guidelines, and evidence-based practices (EBP), and the empirical outcomes of this research literature. Next, several key treatment considerations are discussed to maximize the efficiency and effectiveness of these interventions. Some practical suggestions for overcoming key service barriers are provided to enhance the capacity of the practice to deliver behavioral health care. Results There is moderate empirical support for the feasibility, acceptability, and clinical utility of these interventions for treating internalizing and externalizing behavior problems. Practical strategies to extend this work and addressing methodological limitations are provided that draw upon recent frameworks designed to simplify the treatment enterprise (e.g., common elements). Discussion Pediatric primary care has become an important venue for providing mental health services to children and adolescents due, in part, to its many desirable features (e.g., no stigma, local setting, familiar providers). Further adaptation of existing delivery models may promote the delivery of effective integrated interventions with primary care providers as partners designed to address mental health problems in pediatric healthcare. PMID:24588366

  5. The integration of behavioral health interventions in children's health care: services, science, and suggestions.

    PubMed

    Kolko, David J; Perrin, Ellen

    2014-01-01

    Because the integration of mental or behavioral health services in pediatric primary care is a national priority, a description and evaluation of the interventions applied in the healthcare setting is warranted. This article examines several intervention research studies based on alternative models for delivering behavioral health care in conjunction with comprehensive pediatric care. This review describes the diverse methods applied to different clinical problems, such as brief mental health skills, clinical guidelines, and evidence-based practices, and the empirical outcomes of this research literature. Next, several key treatment considerations are discussed to maximize the efficiency and effectiveness of these interventions. Some practical suggestions for overcoming key service barriers are provided to enhance the capacity of the practice to deliver behavioral health care. There is moderate empirical support for the feasibility, acceptability, and clinical utility of these interventions for treating internalizing and externalizing behavior problems. Practical strategies to extend this work and address methodological limitations are provided that draw upon recent frameworks designed to simplify the treatment enterprise (e.g., common elements). Pediatric primary care has become an important venue for providing mental health services to children and adolescents due, in part, to its many desirable features (e.g., no stigma, local setting, familiar providers). Further adaptation of existing delivery models may promote the delivery of effective integrated interventions with primary care providers as partners designed to address mental health problems in pediatric healthcare.

  6. The impact of two organizational interventions on the health of service sector workers.

    PubMed

    Dahl-Jørgensen, Carla; Saksvik, Per Oystein

    2005-01-01

    Studies focusing on interactive service work that involves face-to-face interactions between employees and customers/clients have shown that employees tend to show symptoms of job dissatisfaction, stress, and emotional exhaustion because they are expected to display or suppress certain emotions in the performance of their jobs. To meet the health challenges and reduce sickness absenteeism among employees in this sector, two organizational interventions were implemented among service workers employed by the municipality and in a shopping mall in a medium-sized Norwegian city. In a field experiment, the authors evaluated the effect of this type of intervention on employee health. The experiment combined survey measures (pre- and post-intervention) with observations and unstructured interviews. The survey data showed positive changes on only two of the measured variables among the shopping mall employees, and no effect on the municipal employees. This article focuses on the qualitative data, which show how constraints related to time and to interactional and organizational practices impeded full involvement of the employees during implementation of the interventions. The authors discuss the results from the perspective of the general challenges of implementing interventions in the service sector.

  7. Perceptions of Pre-Service Teachers Regarding the Response-to-Intervention Model

    ERIC Educational Resources Information Center

    Arroyo, Kimberly A.

    2014-01-01

    A Response-to-Intervention (RTI) model of educational service delivery is a multi-tiered, preventative approach designed to meet the educational and behavioral needs of all learners. While the New York State (NYS) Department of Education has mandated the use of this model in grades K-4, the extent to which RTI competencies are taught within…

  8. Announcement: Community Preventive Services Task Force Recommendation for Built Environment Interventions to Increase Physical Activity.

    PubMed

    2017-05-05

    The Community Preventive Services Task Force recently posted new information on its website: "Physical Activity: Built Environment Approaches Combining Transportation System Interventions with Land Use and Environmental Design." This information is available at https://www.thecommunityguide.org/findings/physical-activity-built-environment-approaches.

  9. Ethnicity and Adolescent Depression: Prevalence, Access to Services, and Promising Interventions

    ERIC Educational Resources Information Center

    Wagstaff, Amanda E.; Polo, Antonio J.

    2012-01-01

    Depression is more common among adolescents of ethnic minority backgrounds, who also are less likely to receive professional help. This article presents information about prevalence of depression and service use across ethnic groups, and then outlines several promising intervention programs that are designed for adolescents suffering from…

  10. Elder Abuse and Neglect: Assessment Tools, Interventions, and Recommendations for Effective Service Provision

    ERIC Educational Resources Information Center

    Imbody, Bethany; Vandsburger, Etty

    2011-01-01

    With our communities rapidly aging, there is always a clear need for greater knowledge on how to serve elders. Professionals must be able to recognize cases of abuse and neglect and provide appropriate follow up services. Through reviewing recent literature, this paper surveys existing assessment tools and interventions, describes characteristics…

  11. Conceptualizing Child and Family Outcomes of Early Intervention Services for Children with ASD and Their Families

    ERIC Educational Resources Information Center

    Noyes-Grosser, Donna M.; Rosas, Scott R.; Goldman, Alyssa; Elbaum, Batya; Romanczyk, Ray; Callahan, Emily H.

    2013-01-01

    State early intervention programs (EIPs) have been encouraged to develop and implement comprehensive outcomes measurement systems. As the number of children with autism spectrum disorders (ASD) and their families receiving services in state EIPs increases, disability-specific outcomes data are needed to better understand issues of access, costs,…

  12. Personalized Learning for the At-Risk through Intervention and Referral Services

    ERIC Educational Resources Information Center

    DePass Pipkin, Tamika S.

    2012-01-01

    The purpose of this mixed-methodology study was to examine whether Personalized Student Learning Plans (PSLPs) could reduce at-risk students' academic and social dysfunction. At-risk students were referred to Intervention & Referral Services (I&RS) and PSLPs were used to develop a personal plan for progress. Data sources included…

  13. InReach: Connecting NICU Infants and Their Parents with Community Early Intervention Services

    ERIC Educational Resources Information Center

    Akers, Adrienne L.; Boyce, Glenna; Mabey, Vanya; Boyce, Lisa

    2007-01-01

    Infants who are born prematurely may experience developmental delays and impairments during infancy and beyond. Those who are born at extremely low birthweight face the greatest challenges. Many families could benefit from early intervention services through their local Part C of Individuals With Disabilities Education Act (IDEA) programs, but…

  14. Providing Early Intervention Services to Diverse Populations: Are Speech-Language Pathologists Prepared?

    ERIC Educational Resources Information Center

    Caesar, Lena G.

    2013-01-01

    This study used a survey approach to investigate the current state of speech-language preservice academic and clinical preparation for providing early intervention (EI) services to culturally and linguistically diverse (CLD) populations. Information was obtained from speech-language pathologists (SLPs) employed in EI settings regarding their…

  15. Accuracy of Knowledge of Child Development in Mothers of Children Receiving Early Intervention Services

    ERIC Educational Resources Information Center

    Zand, Debra H.; Pierce, Katherine J.; Bultas, Margaret W.; McMillin, Stephen Edward; Gott, Rolanda Maxim; Wilmott, Jennifer

    2015-01-01

    Parents' involvement in early intervention (EI) services fosters positive developmental trajectories in young children. Although EI research on parenting skills has been abundant, fewer data are available on parents' knowledge of normative child development. Sixty-seven mothers of children participating in a Midwestern city's EI program completed…

  16. The Effect of Early Intervention Services on Maternal Well-Being.

    ERIC Educational Resources Information Center

    Warfield, Marji Erickson; Hauser-Cram, Penny; Krauss, Marty Wyngaarden; Shonkoff, Jack P.; Upshur, Carole C.

    2000-01-01

    Examined relation between intensity, duration, and comprehensiveness of early intervention and changes in parenting stress, social support, and family cohesion. Found that mothers of children without motor impairment reported greater increases in family cohesion than mothers of children with motor impairment. Service intensity and…

  17. Families' Perceptions of Early Intervention Services for Children with Hearing Loss.

    ERIC Educational Resources Information Center

    Harrison, Melody; And Others

    1996-01-01

    Analysis of a national survey of 398 parents of preschool children with deafness or partial hearing found that, although Individualized Family Service Plans had not been developed for almost one-half of respondents, parents reported overall satisfaction with their child's early intervention program. (Author/DB)

  18. Caregiver Descriptions of the Developmental Skills of Infants and Toddlers Entering Early Intervention Services

    ERIC Educational Resources Information Center

    Scarborough, Anita A.; Hebbeler, Kathleen M.; Simeonsson, Rune J.; Spiker, Donna

    2007-01-01

    The present study was conducted to describe the developmental skills of a national sample of infants and toddlers at entry into early intervention services. Caregivers were asked about their child's skills during a telephone interview. Summary values were derived from descriptions of motor, communication, independence, and cognitive skills. More…

  19. Mobile Device Intervention for Student Support Services in Distance Education Context--FRAME Model Perspective

    ERIC Educational Resources Information Center

    Kumar, Lalita S.; Jamatia, Biplab; Aggarwal, A. K.; Kannan, S.

    2011-01-01

    This paper reports the findings of a study conducted to analyse the effect of mobile device intervention for student support services and to gauge its use for enhancing teaching--learning process as a future study in the context of offer of Distance Education programmes. The study was conducted with the learners of the coveted Post Graduate…

  20. Accuracy of Knowledge of Child Development in Mothers of Children Receiving Early Intervention Services

    ERIC Educational Resources Information Center

    Zand, Debra H.; Pierce, Katherine J.; Bultas, Margaret W.; McMillin, Stephen Edward; Gott, Rolanda Maxim; Wilmott, Jennifer

    2015-01-01

    Parents' involvement in early intervention (EI) services fosters positive developmental trajectories in young children. Although EI research on parenting skills has been abundant, fewer data are available on parents' knowledge of normative child development. Sixty-seven mothers of children participating in a Midwestern city's EI program completed…

  1. The Effect of an Instructional Intervention on Enhancement Pre-Service Science Teachers' Science Processes Skills

    ERIC Educational Resources Information Center

    Durmaz, Hüsnüye

    2016-01-01

    The aim of this study is to investigate the effects of an instructional intervention on enhancement the pre-service science teachers' (PSTs) science process skills (SPSs) and to identify problems in using SPSs through Laboratory Applications in Science Education-I course (LASE-I). One group pretest-posttest pre-experimental design was employed. An…

  2. Care Coordination Practices among Illinois Pediatricians and Early Intervention Service Coordinators

    ERIC Educational Resources Information Center

    Baxter, Marissa

    2015-01-01

    Over the course of the past three decades, largely due to advances in technology, there has been growth in the fields of early intervention (EI) and pediatrics for infants/toddlers with special health care needs (SHCN). This growth has also brought about a change in the relationship between pediatricians and EI service coordinators, creating an…

  3. Parent Perspectives of Participation in Home and Community Activities when Receiving Part C Early Intervention Services

    ERIC Educational Resources Information Center

    Khetani, Mary A.; Cohn, Ellen S.; Orsmond, Gael I.; Law, Mary C.; Coster, Wendy J.

    2013-01-01

    The authors examined the extent to which parent expectations, perceptions about resource availability and supports, and strategies used to promote participation in home and community activities varied by setting and activity type. Sixteen 90-min semistructured interviews were completed with families receiving Part C early intervention services in…

  4. Family Intervention Services Program Evaluation: A Brief Report on Initial Outcomes for Families.

    ERIC Educational Resources Information Center

    Cann, Warren; Rogers, Helen; Matthews, Jan

    2003-01-01

    Reports on a preliminary evaluation of the Metropolitan Family Intervention Service at the Victorian Parenting Centre, Melbourne, Australia. It presents an analysis of pre-post data collected from 589 mothers who commenced and completed parenting programs between 1999 and early 2003. Significant improvements were noted in measures of parental…

  5. Service Coordinators' Perceptions of Autism-Specific Screening and Referral Practices in Early Intervention

    ERIC Educational Resources Information Center

    Pizur-Barnekow, Kris; Muusz, Marta; McKenna, Catherine; O'Connor, Emily; Cutler, Ann

    2013-01-01

    Service coordinators in a statewide early intervention program were surveyed to develop an understanding of screening and referral practices to identify children on the autism spectrum. Quantitative and qualitative data summarizing autism-specific screening and referral practices are reported. More than 50% of the respondents reported that they…

  6. Maintaining Focus on Cultural Competence in Early Intervention Services to Linguistically and Culturally Diverse Families.

    ERIC Educational Resources Information Center

    Madding, Carolyn Conway

    2000-01-01

    This article discusses the increasing population of children from diverse backgrounds and suggests commonsense methods for team development of cultural competence for the provision of appropriate early intervention services to linguistically and culturally diverse families. Recommendations for using interpreters and developing models for family…

  7. Helping Teachers and Students: A Study of Intervention and Referral Services at the Elementary Level

    ERIC Educational Resources Information Center

    Berger, Audra

    2013-01-01

    The purpose of this mixed methods action research study was to identify the extent to which the Intervention and Referral Services program at the elementary schools in District M are effective at meeting the stated goals of helping students who struggle and helping teachers who work with those students. Both quantitative and qualitative methods…

  8. Care Coordination Practices among Illinois Pediatricians and Early Intervention Service Coordinators

    ERIC Educational Resources Information Center

    Baxter, Marissa

    2015-01-01

    Over the course of the past three decades, largely due to advances in technology, there has been growth in the fields of early intervention (EI) and pediatrics for infants/toddlers with special health care needs (SHCN). This growth has also brought about a change in the relationship between pediatricians and EI service coordinators, creating an…

  9. Barriers to the Uptake of Eye Care Services in Developing Countries: A Systematic Review of Interventions

    ERIC Educational Resources Information Center

    Abdullah, Khadija Nowaira; Al-Sharqi, Omar Zayan; Abdullah, Muhammad Tanweer

    2013-01-01

    Objective: This research identifies effective and ineffective interventions for reducing barriers to the uptake of eye care services in developing countries. Design: Systematic literature review. Setting: Only research studies done in developing countries were included. Method: The review is restricted to English-language articles published…

  10. InReach: Connecting NICU Infants and Their Parents with Community Early Intervention Services

    ERIC Educational Resources Information Center

    Akers, Adrienne L.; Boyce, Glenna; Mabey, Vanya; Boyce, Lisa

    2007-01-01

    Infants who are born prematurely may experience developmental delays and impairments during infancy and beyond. Those who are born at extremely low birthweight face the greatest challenges. Many families could benefit from early intervention services through their local Part C of Individuals With Disabilities Education Act (IDEA) programs, but…

  11. Using Drawing as Intervention with Children for In-Service Preschool Teachers

    ERIC Educational Resources Information Center

    Chen, I Ju; Liu, Chu Chih

    2010-01-01

    This study provides a basic overview of in-service preschool teachers using drawing as intervention with children. Art therapy is used more often for the smaller children who have more difficulty to describe their emotions and feelings in recognizing words, such as anger, resentment, and different kind of abuses. As a matter of fact, the drawing…

  12. Barriers to the Uptake of Eye Care Services in Developing Countries: A Systematic Review of Interventions

    ERIC Educational Resources Information Center

    Abdullah, Khadija Nowaira; Al-Sharqi, Omar Zayan; Abdullah, Muhammad Tanweer

    2013-01-01

    Objective: This research identifies effective and ineffective interventions for reducing barriers to the uptake of eye care services in developing countries. Design: Systematic literature review. Setting: Only research studies done in developing countries were included. Method: The review is restricted to English-language articles published…

  13. The Effect of Early Intervention Services on Maternal Well-Being.

    ERIC Educational Resources Information Center

    Warfield, Marji Erickson; Hauser-Cram, Penny; Krauss, Marty Wyngaarden; Shonkoff, Jack P.; Upshur, Carole C.

    2000-01-01

    Examined relation between intensity, duration, and comprehensiveness of early intervention and changes in parenting stress, social support, and family cohesion. Found that mothers of children without motor impairment reported greater increases in family cohesion than mothers of children with motor impairment. Service intensity and…

  14. Using Drawing as Intervention with Children for In-Service Preschool Teachers

    ERIC Educational Resources Information Center

    Chen, I Ju; Liu, Chu Chih

    2010-01-01

    This study provides a basic overview of in-service preschool teachers using drawing as intervention with children. Art therapy is used more often for the smaller children who have more difficulty to describe their emotions and feelings in recognizing words, such as anger, resentment, and different kind of abuses. As a matter of fact, the drawing…

  15. Ethnicity and Adolescent Depression: Prevalence, Access to Services, and Promising Interventions

    ERIC Educational Resources Information Center

    Wagstaff, Amanda E.; Polo, Antonio J.

    2012-01-01

    Depression is more common among adolescents of ethnic minority backgrounds, who also are less likely to receive professional help. This article presents information about prevalence of depression and service use across ethnic groups, and then outlines several promising intervention programs that are designed for adolescents suffering from…

  16. School Psychology Services: Community-Based, First-Order Crisis Intervention during the Gulf War.

    ERIC Educational Resources Information Center

    Klingman, Avigdor

    1992-01-01

    Examines the community-based mental health preventive measures undertaken by the school psychology services in response to the missile attacks on Israel during the Gulf War. Attempts to report and delineate the major assumptions and components of some of the key interventions. (Author/NB)

  17. Perceptions of Pre-Service Teachers Regarding the Response-to-Intervention Model

    ERIC Educational Resources Information Center

    Arroyo, Kimberly A.

    2014-01-01

    A Response-to-Intervention (RTI) model of educational service delivery is a multi-tiered, preventative approach designed to meet the educational and behavioral needs of all learners. While the New York State (NYS) Department of Education has mandated the use of this model in grades K-4, the extent to which RTI competencies are taught within…

  18. An Identification Profile Chart for Use in Targeting Intervention Services for At-Risk Students.

    ERIC Educational Resources Information Center

    Canales, JoAnn; Bush, M. Joan

    An at-risk profile instrument was developed for identification and service delivery for high risk students to identify students in a timely manner so that intervention could occur on a proactive, rather than reactive, basis; and to assist school district personnel to implement, monitor, and modify programmatic and staffing patterns to best meet…

  19. Method for the systematic reviews on occupational therapy and early intervention and early childhood services.

    PubMed

    Arbesman, Marian; Lieberman, Deborah; Berlanstein, Debra R

    2013-01-01

    Systematic reviews of literature relevant to early intervention and early childhood services are important to the practice of occupational therapy. We describe the five questions that served as the focus for the systematic reviews of the effectiveness of occupational therapy interventions in early intervention and early childhood services. We include the background for the reviews; the process followed for each question, including search terms and search strategy; the databases searched; and the methods used to summarize and critically appraise the literature. The final number of articles included in each systematic review; a summary of the themes of the results; the strengths and limitations of the findings; and implications for practice, education, and research are presented.

  20. 75 FR 5603 - Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-03

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services Administration (HRSA),...

  1. Assessing Acceptability of Short Message Service Based Interventions towards Becoming Future Voluntary Blood Donors

    PubMed Central

    Sabih, Sidra; Khan, Ayisha Farooq; Jillani, Umaima Ayesha; Syed, Mujtaba Jamal; Mumtaz, Madiha; Mumtaz, Yasmeen; Dawani, Om; Khan, Saima; Munir, Sheheryar; Asad, Nava; Kazi, Abdul Nafey

    2014-01-01

    All blood bank services, especially those of developing countries, face a major shortfall of blood donations due to lack of voluntary blood donors. Our study aims to evaluate the acceptability of Short Message Service based interventions towards becoming voluntary blood donors among medical university students of Karachi, Pakistan. Methods. A total of 350 medical students were approached in medical universities of Karachi, Pakistan, using a nonprobability convenient sampling technique. Data collectors administered a self-made questionnaire to each participant using an interview based format. All data was recorded and analyzed on SPSS 16. Results. 350 participants, having a mean age of 21.47 ± 1.36, were included in our study with 30.6% (107/350) being males and 69.4% (243/350) being females. 93.4% (327/350) of participants agreed that donating blood was healthy, but only 26% had donated blood in the past with 79.1% donating voluntarily. 65.7% (230/350) of the participants agreed to take part in Short Message Service based behavioral interventions to become voluntary blood donors with 69.7% (244/350) also agreeing that Short Message Service reminders will promote them to donate blood more often. Conclusion. With university students willing to become voluntary blood donors, Pakistani blood banks can carry out Short Message Service based interventions to encourage them to donate blood. PMID:25436175

  2. Assessing Acceptability of Short Message Service Based Interventions towards Becoming Future Voluntary Blood Donors.

    PubMed

    Saleem, Sana; Wasim, Anum; Sabih, Sidra; Khan, Ayisha Farooq; Rizvi, Madiha Hasan; Jillani, Umaima Ayesha; Syed, Mujtaba Jamal; Mumtaz, Madiha; Mumtaz, Yasmeen; Shehzad, Abdul Moid; Dawani, Om; Khan, Saima; Munir, Sheheryar; Asad, Nava; Kazi, Abdul Nafey

    2014-01-01

    All blood bank services, especially those of developing countries, face a major shortfall of blood donations due to lack of voluntary blood donors. Our study aims to evaluate the acceptability of Short Message Service based interventions towards becoming voluntary blood donors among medical university students of Karachi, Pakistan. Methods. A total of 350 medical students were approached in medical universities of Karachi, Pakistan, using a nonprobability convenient sampling technique. Data collectors administered a self-made questionnaire to each participant using an interview based format. All data was recorded and analyzed on SPSS 16. Results. 350 participants, having a mean age of 21.47 ± 1.36, were included in our study with 30.6% (107/350) being males and 69.4% (243/350) being females. 93.4% (327/350) of participants agreed that donating blood was healthy, but only 26% had donated blood in the past with 79.1% donating voluntarily. 65.7% (230/350) of the participants agreed to take part in Short Message Service based behavioral interventions to become voluntary blood donors with 69.7% (244/350) also agreeing that Short Message Service reminders will promote them to donate blood more often. Conclusion. With university students willing to become voluntary blood donors, Pakistani blood banks can carry out Short Message Service based interventions to encourage them to donate blood.

  3. Preferences for Early Intervention Mental Health Services: A Discrete-Choice Conjoint Experiment.

    PubMed

    Becker, Mackenzie P E; Christensen, Bruce K; Cunningham, Charles E; Furimsky, Ivana; Rimas, Heather; Wilson, Fiona; Jeffs, Lisa; Bieling, Peter J; Madsen, Victoria; Chen, Yvonne Y S; Mielko, Stephanie; Zipursky, Robert B

    2016-02-01

    Early intervention services (EISs) for mental illness may improve outcomes, although treatment engagement is often a problem. Incorporating patients' preferences in the design of interventions improves engagement. A discrete-choice conjoint experiment was conducted in Canada to identify EIS attributes that encourage treatment initiation. Sixteen four-level attributes were formalized into a conjoint survey, completed by patients, family members, and mental health professionals (N=562). Participants were asked which EIS option people with mental illness would contact. Latent-class analysis identified respondent classes characterized by shared preferences. Randomized first-choice simulations predicted which hypothetical options, based on attributes, would result in maximum utilization. Participants in the conventional-service class (N=241, 43%) predicted that individuals would contact traditional services (for example, hospital location and staffed by psychologists or psychiatrists). Membership was associated with being a patient or family member and being male. Participants in the convenient-service class (N=321, 57%) predicted that people would contact services promoting easy access (for example, self-referral and access from home). Membership was associated with being a professional. Both classes predicted that people would contact services that included short wait times, direct contact with professionals, patient autonomy, and psychological treatment information. The convenient-service class predicted that people would use an e-health model, whereas the conventional-service class predicted that people would use a primary care or clinic-hospital model. Provision of a range of services may maximize EIS use. Professionals may be more apt to adopt EISs in line with their beliefs regarding patient preferences. Considering several perspectives is important for service design.

  4. Behavior change interventions delivered by mobile telephone short-message service.

    PubMed

    Fjeldsoe, Brianna S; Marshall, Alison L; Miller, Yvette D

    2009-02-01

    The expansion and adoption of new methods of communication provide new opportunities for delivering health behavior change interventions. This paper reviews the current research examining mobile telephone short-message service (SMS) for delivering health behavior change interventions via text messages. This service has wide population reach, can be individually tailored, and allows instant delivery with asynchronous receipt, suggesting potential as a delivery channel for health behavior interventions. An electronic database search was conducted for studies published between January 1990 and March 2008. Studies were included in the review if they (1) evaluated an intervention delivered primarily via SMS, (2) assessed change in health behavior using pre-post assessment, and (3) were published in English in a peer-reviewed scientific journal. Of 33 studies identified, 14 met the inclusion criteria. Four of the 14 studies reviewed targeted preventive health behaviors (e.g., smoking cessation), and ten focused on clinical care (e.g., diabetes self-management). Positive behavior change outcomes were observed in 13 of the 14 reviewed studies. Intervention initiation (researcher or participant), SMS dialogue initiation, tailoring of SMS content, and interactivity were found to be important features of SMS-delivered interventions. Methodologic issues with current SMS research were also identified. This review suggests that SMS-delivered interventions have positive short-term behavioral outcomes. Further research is required to evaluate interventions for preventive health behaviors that incorporate features found to affect behavioral outcomes and participant acceptance. The quality of studies in this emerging field of research needs to improve to allow the full potential of this medium to be explored.

  5. Veterans service organization engagement in 'POWER,' a peer-led hypertension intervention.

    PubMed

    Mosack, Katie E; Wendorf, Angela R; Brouwer, Amanda M; Patterson, Leslie; Ertl, Kristyn; Whittle, Jeff; Morzinski, Jeff; Fletcher, Kathlyn

    2012-12-01

    The purpose of this study was to determine the influence of program factors on participant engagement in POWER, a peer-led intervention designed to reduce hypertension, increase hypertension knowledge, and improve other relevant health behaviors, such as diet and exercise, among US veterans involved in veterans service organizations throughout Southeastern Wisconsin. Two hundred and nineteen hypertensive members from 58 VSOs participated in a year-long peer-led intervention designed to improve hypertension knowledge, disease self-management behaviors, and health outcomes. This study represents a qualitative evaluation of post and participant engagement in this intervention. We triangulated data collected via three qualitative approaches (observations, focus groups, and in-depth interviews) from intervention posts to derive a model of engagement. Our findings indicate that discrete characteristics of the peer leaders, post members, posts, and the intervention itself contributed to intervention engagement. We make suggestions for future research studies, particularly as related to understanding how peer leader identities and cultural norms within VSOs might contribute to peer-led health intervention success.

  6. [Interventions to solve overcrowding in hospital emergency services: a systematic review].

    PubMed

    Bittencourt, Roberto José; Hortale, Virginia Alonso

    2009-07-01

    This review discusses interventions aimed at solving the problem of overcrowding in hospital emergency services (HES), characteristic of low organizational effectiveness. In free-access and restricted-access databases, the target descriptors were 'overcrowding; emergency; medicine; first aid'. The survey identified 66 citations of interventions, grouped in 47 related interventions. The majority of the studies used observational designs that evaluated the results before and after interventions. Of the 47 related interventions, 34 had results for organizational performance. Four were the most frequently cited: implementation of an observation unit for patients already hospitalized and awaiting diagnosis or clinical stabilization; designation of a dedicated nursing station for the patient's admission, discharge, or transfer; establishment of protocols with indicators of operational saturation and implementation of an emergency care unit. Analyzing 21 interventions that were intended to solve overcrowding in HES and with positive results for length-of-stay, 15 were related to patient stream improvement, interfering actively and positively in patient stream. Interventions that increased access barriers or that merely improved the HES structure were ineffective.

  7. Collaborating to provide early-intervention services to persons in England with first-episode psychosis.

    PubMed

    England, Elizabeth; Lester, Helen; Birchwood, Maximillian

    2009-11-01

    This qualitative study explores the experiences of stakeholders in implementing the guidance for early-intervention services (EIS) for first-episode psychosis in England. One important challenge in implementing early-intervention policy is to develop workable, integrated partnership across a number of diverse organizational boundaries, particularly with child and adolescent mental health services (CAMHS). A series of 142 semistructured interviews and six focus groups involving 31 people were undertaken between February 2004 and September 2007. A broad range of individuals were interviewed from different strategic, managerial, and operational levels of the health service. A main finding was the challenge experienced by a majority of EIS agencies in developing partnerships with CAMHS. Elements that led to more successful partnership development included joint learning and training, senior-level "champions" of the partnership, joint operational policy or protocol development, and use of specific CAMHS-EIS link workers. The most successful approach was to develop a separate youth-focused service that placed multiple teams and organizations responsive to younger people's needs (including education, employment guidance, social activities, pregnancy services, and peer support) under one roof. This study highlights that traditional hierarchical models of policy implementation may be less successful in achieving the goal of collaborative partnerships at the interface between CAMHS and EIS. The most successful model of working between CAMHS and EIS required an innovative approach to commissioning, policy implementation, and service development. The findings from this study may help determine the best model of partnership development for EIS and CAMHS in England.

  8. Early intensive behavioral intervention: emergence of a consumer-driven service model.

    PubMed

    Jacobson, J W

    2000-01-01

    Parents are becoming influential stimulators and shapers of public policy in regard to educational services for their children. Increasingly, this advocacy has created a controversy about the role of applied behavior analysis as a foundation for early intensive behavioral intervention in autism. Uncertainties exist in policy regarding the role of behavior analysis in early intervention and the capacity of behavior analysis to field a trained work force. Based on contacts with parents of children with autism and information available in a variety of forms on the Internet, there is a rising demand for fundamentally better early intervention services that are available and accessible, provide active intervention, and are based on principles of behavior analysis. Contemporary movements in special and early education, however, appear to be nonconducive to scientifically based treatments, and school districts seem hostile to an increasing role for behavior analysis and to the establishment of services that are responsive to changing parental priorities for the education of their children with autism and related disorders.

  9. Early intensive behavioral intervention: Emergence of a consumer-driven service model

    PubMed Central

    Jacobson, John W.

    2000-01-01

    Parents are becoming influential stimulators and shapers of public policy in regard to educational services for their children. Increasingly, this advocacy has created a controversy about the role of applied behavior analysis as a foundation for early intensive behavioral intervention in autism. Uncertainties exist in policy regarding the role of behavior analysis in early intervention and the capacity of behavior analysis to field a trained work force. Based on contacts with parents of children with autism and information available in a variety of forms on the Internet, there is a rising demand for fundamentally better early intervention services that are available and accessible, provide active intervention, and are based on principles of behavior analysis. Contemporary movements in special and early education, however, appear to be nonconducive to scientifically based treatments, and school districts seem hostile to an increasing role for behavior analysis and to the establishment of services that are responsive to changing parental priorities for the education of their children with autism and related disorders. PMID:22478344

  10. Content and quality of websites supporting self-management of chronic breathlessness in advanced illness: a systematic review.

    PubMed

    Luckett, Tim; Disler, Rebecca; Hosie, Annmarie; Johnson, Miriam; Davidson, Patricia; Currow, David; Sumah, Anthony; Phillips, Jane

    2016-05-26

    Chronic breathlessness is a common, burdensome and distressing symptom in many advanced chronic illnesses. Self-management strategies are essential to optimise treatment, daily functioning and emotional coping. People with chronic illness commonly search the internet for advice on self-management. A review was undertaken in June 2015 to describe the content and quality of online advice on breathlessness self-management, to highlight under-served areas and to identify any unsafe content. Google was searched from Sydney, Australia, using the five most common search terms for breathlessness identified by Google Trends. We also hand-searched the websites of national associations. Websites were included if they were freely available in English and provided practical advice on self-management. Website quality was assessed using the American Medical Association Benchmarks. Readability was assessed using the Flesch-Kincaid grades, with grade 8 considered the maximum acceptable for enabling access. Ninety-one web pages from 44 websites met the inclusion criteria, including 14 national association websites not returned by Google searches. Most websites were generated in the USA (n=28, 64%) and focused on breathing techniques (n=38, 86%) and chronic obstructive pulmonary disease (n=27, 61%). No websites were found to offer unsafe advice. Adherence to quality benchmarks ranged from 9% for disclosure to 77% for currency. Fifteen (54%) of 28 written websites required grade ⩾9 reading level. Future development should focus on advice and tools to support goal setting, problem solving and monitoring of breathlessness. National associations are encouraged to improve website visibility and comply with standards for quality and readability.

  11. [Interventions to improve access to health services by indigenous peoples in the Americas].

    PubMed

    Araujo, Miguel; Moraga, Cecilia; Chapman, Evelina; Barreto, Jorge; Illanes, Eduardo

    2016-11-01

    Synthesize evidence on effectiveness of interventions designed to improve access to health services by indigenous populations. Review of systematic reviews published as of July 2015, selecting and analyzing only studies in the Region of the Americas. The bibliographic search encompassed MEDLINE, Lilacs, SciELO, EMBASE, DARE, HTA, The Cochrane Library, and organization websites. Two independent reviewers selected studies and analyzed their methodological quality. A narrative summary of the results was produced. Twenty-two reviews met the inclusion criteria. All selected studies were conducted in Canada and the United States of America. The majority of the interventions were preventive, to surmount geographical barriers, increase use of effective measures, develop human resources, and improve people's skills or willingness to seek care. Topics included pregnancy, cardiovascular risk factors, diabetes, substance abuse, child development, cancer, mental health, oral health, and injuries. Some interventions showed effectiveness with moderate or high quality studies: educational strategies to prevent depression, interventions to prevent childhood caries, and multicomponent programs to promote use of child safety seats. In general, results for chronic non-communicable diseases were negative or inconsistent. Interventions do exist that have potential for producing positive effects on access to health services by indigenous populations in the Americas, but available studies are limited to Canada and the U.S. There is a significant research gap on the topic in Latin America and the Caribbean.

  12. Service delivery interventions to improve adolescents' linkage, retention and adherence to antiretroviral therapy and HIV care.

    PubMed

    MacPherson, Peter; Munthali, Chigomezgo; Ferguson, Jane; Armstrong, Alice; Kranzer, Katharina; Ferrand, Rashida A; Ross, David A

    2015-08-01

    Adolescents living with HIV face substantial difficulties in accessing HIV care services and have worse treatment outcomes than other age groups. The objective of this review was to evaluate the effectiveness of service delivery interventions to improve adolescents' linkage from HIV diagnosis to antiretroviral therapy (ART) initiation, retention in HIV care and adherence to ART. We systematically searched the Medline, SCOPUS and Web of Sciences databases and conference abstracts from the International AIDS Conference and International Conference on AIDS and STIs in Africa (ICASA). Studies published in English between 1st January 2001 and 9th June 2014 were included. Two authors independently evaluated reports for eligibility, extracted data and assessed methodological quality using the Cochrane risk of bias tool and Newcastle-Ottawa Scale. Eleven studies from nine countries were eligible for review. Three studies were randomised controlled trials. Interventions assessed included individual and group counselling and education; peer support; directly observed therapy; financial incentives; and interventions to improve the adolescent-friendliness of clinics. Most studies were of low to moderate methodological quality. This review identified limited evidence on the effectiveness of service delivery interventions to support adolescents' linkage from HIV diagnosis to ART initiation, retention on ART and adherence to ART. Although recommendations are qualified because of the small numbers of studies and limited methodological quality, offering individual and group education and counselling, financial incentives, increasing clinic accessibility and provision of specific adolescent-tailored services appear promising interventions and warrant further investigation. © 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  13. Issues regarding the delivery of early intervention psychiatric services to the South Asian population in England.

    PubMed

    Agius, Mark; Talwar, A; Murphy, S; Zaman, Rashid

    2010-06-01

    Little research has been done to ascertain how patients and families of South Asian origin access and use early intervention mental health services today. The aim of this retrospective study is to gain a better understanding of how well South Asian patients engage with standard psycho-social interventions. In June 2003 an audit was conducted amongst 75 patients from different ethnic groups in Luton. Measures of engagement with mental health services included; number of missed outpatient appointments over one year and compliance with medication regimes. The results of this audit showed that South Asian patients are more likely to miss appointments and refuse to take medication in comparison to their Caucasian or Afro- Caribbean counter-parts. Further analysis revealed that the Bangladeshi subgroup had missed more appointments and had a greater proportion of medication refusal in comparison to the other Asian subgroups. These results support the pioneering work by Dr Robin Pinto in the 1970s he observed that Asian patients perceive and utilise mental health services in a different way compared to the Caucasian population. The observations from our study depict the difficulties in engaging ethnic minority patients into existing services. Hence we argue that future interventions should be adapted and tailored to overcome cultural and language barriers with patients and their families.

  14. [Nurses end-of-life decision making. Professional nurses about the application of complementary care for patients with breathlessness].

    PubMed

    Dunger, Christine; Schnell, Martin W

    2012-03-01

    Aim of this study was to explore the nursing professionals' experiences and handling of decisions to provide complementary care for patients with breathlessness at the end of life. Therefore, it presents one of the first studies in the German speaking area addressing genuine nursing decisions belonging to their responsibility. Based on Grounded Theory Methodology the data were collected and analysed synchronously. Results show a high professional and emphatic decision making process always focussing on the patient. "To consider the patient" emanates from their general attitude and is influenced by the possibility to be human themselves and by reflecting ones limitations. At the same time participants described a repertoire of complementary care procedures which they use in their daily nursing routine. This study illustrates the decision making process and outlines the general attitude influencing all decisions and actions of nurses to relieve breathlessness. Furthermore, it shows for the first time a range of currently used complementary care procedures to treat patients with breathlessness at the end of life.

  15. Dyspnea-12 Is a Valid and Reliable Measure of Breathlessness in Patients With Interstitial Lung Disease

    PubMed Central

    Swigris, Jeffrey; Russell, Anne-Marie; Moosavi, Shakeeb H.; Ng Man Kwong, Georges; Longshaw, Mark; Jones, Paul W.

    2011-01-01

    Objective: In this study, we aimed to determine the validity and reliability of the Dyspnea-12 questionnaire (D-12) for the assessment of breathlessness in patients with interstitial lung disease (ILD). Methods: A total of 101 patients with ILD completed the D-12 (scale range, 0-36, with a high score indicating worse dyspnea), Medical Research Council (MRC) dyspnea scale, St. George Respiratory Questionnaire (SGRQ), and Hospital Anxiety and Depression Scale (HADS) at baseline, and 84 patients completed the D-12 and a global health transition score at follow-up 2 weeks later. D-12 psychometric properties, including floor and ceiling effects, internal consistency, test-retest reliability, and construct validity were examined. Results: The D-12 showed good internal consistency (Cronbach α, 0.93) and repeatability (intraclass correlation coefficient, 0.94). Its scores were significantly associated with MRC grade (r = 0.59; P < .001), SGRQ (symptoms, r = 0.57; activities, r = 0.78; impacts, r = 0.75; total, r = 0.79; P < .001). Factor analysis confirmed the previously determined structure of the D-12 in this patient group. Conclusion: In patients with ILD, the D-12, a patient-reported measure of dyspnea severity that requires no reference to activity, is a reliable and valid instrument. It is short, simple to complete, and easy to score. PMID:20595454

  16. Breathlessness at High Altitude: First Episode of Bronchoconstriction in an Otherwise Healthy Sojourner.

    PubMed

    Bhandari, Sanjeeb Sudarshan; Koirala, Pranawa; Lohani, Sadichhya; Phuyal, Pratibha; Basnyat, Buddha

    2017-06-01

    Bhandari, Sanjeeb Sudarshan, Pranawa Koirala, Sadichhya Lohani, Pratibha Phuyal, and Buddha Basnyat. Breathlessness at high altitude: first episode of bronchoconstriction in an otherwise healthy sojourner. High Alt Med Biol.. 18:179-181, 2017-High-altitude illness is a collective term for less severe acute mountain sickness and more severe high-altitude pulmonary edema (HAPE) and high-altitude cerebral edema, which we can experience while traveling to high altitude. These get better when we get down to the lower altitudes. People with many comorbidities also have been traveling to high altitudes from the dawn of civilization. Obstructive airway diseases can be confused with HAPE at high altitude. Asthma is one of those obstructive pulmonary diseases, but it is shown to get better with travel to the altitudes higher than the residing altitude. We present a case of 55-year-old nonsmoker, athletic, female, a lowland resident who developed difficulty breathing for the first time at high altitude. She did not get better with the descent to lower altitude and timely intake of acetazolamide. Her pulmonary function test showed obstructive airway pattern, which got better with salbutamol/ipratropium nebulization and oxygen.

  17. Implementing screening, brief intervention, and referral for alcohol and drug use: the trauma service perspective.

    PubMed

    Sise, Michael J; Sise, C Beth; Kelley, Dorothy M; Simmons, Charles W; Kelso, Dennis J

    2005-09-01

    Most trauma surgeons are unfamiliar with screening, brief intervention, and referral (SBIR) programs for substance use disorders, and few trauma centers provide them. This report describes how an urban private-teaching hospital adapted a protocol from an existing emergency department-based program to include patients treated by the trauma service. We recorded the rates of SBIR completion and reasons for failure during each phase of the implementation, interviewed trauma service staff and health educators to assess attitudes toward the program, and evaluated patient satisfaction surveys. By adding SBIR staff to the trauma outpatient clinic and to trauma morning rounds, the capture rate increased from 12 to 71%. Most screened patients (59%) were found at risk for problems or probably dependent on alcohol or drugs. Trauma service staff and health educators reported high satisfaction with the program. Patients reported higher satisfaction with SBIR. SBIR services can be effectively integrated into all components of a busy, urban trauma service by adding specially trained health educators to the trauma service staff. This collaboration provides effective SBIR services to both trauma and emergency service patients without interfering with patient flow or medical procedures. The relatively high percentage of patients at risk for alcohol or drug problems supports the inclusion of routine alcohol and drug screening for all eligible trauma patients.

  18. Combining child welfare and substance abuse services: a blended model of intervention.

    PubMed

    McAlpine, C; Marshall, C C; Doran, N H

    2001-01-01

    Montgomery County, Maryland's Child Welfare Services (CWS) and Adult Addiction Services (AAS) developed an initiative to address the requirements of the Adoption and Safe Families Act (ASFA) while meeting the needs of families and the community of providers. A blended model of intervention was determined to be the best strategy to achieve the dual mandates of CWS and alcohol and other drugs (AOD) providers. Drawing from criminal justice, systems theory, social work, and addiction treatment, the approach made use of graduated sanctions or levels of intensity in providing services, engaging client participation, and engendering motivation. This article proposes strategies at client and organizational levels to understand the process of adaptation to ASFA and to guide planning for blending services.

  19. Promoting Sun Safety Among US Postal Service Letter Carriers: Impact of a 2-Year Intervention

    PubMed Central

    Mayer, Joni A.; Slymen, Donald J.; Clapp, Elizabeth J.; Pichon, Latrice C.; Eckhardt, Laura; Eichenfield, Lawrence F.; Elder, John P.; Sallis, James F.; Weinstock, Martin A.; Achter, April; Balderrama, Cynthia; Galindo, Gabriel R.; Oh, Sam S.

    2007-01-01

    Objectives. We examined whether US Postal Service letter carriers who received a sun safety intervention would wear wide-brim hats and sunscreen significantly more often than those who did not receive the intervention. Methods. We used a 2-group randomized design with 2662 evaluation cohort participants from 70 US postal stations. Evaluations were conducted at baseline, 3 months, 1 year, and 2 years. Questionnaire items assessed occupational use of sun-screen and wide-brim hats. The 2-year sun safety intervention included the provision of wide-brim hats, accessible sunscreen, reminders, and 6 educational sessions. Results. At the 3-month follow-up evaluations, the odds ratio (OR) for regular sun-screen use was 2.8 times higher among the intervention group than among the control group (95% confidence interval [CI]=2.2, 3.5); at the 2-year follow-up evaluations, the rate was still significantly higher (OR=2.0; 95% CI=1.6, 2.6). Intervention group participants also had significantly higher rates of hat use, with the differences remaining consistent across all follow-ups (OR=2.9; 95% CI=2.3, 3.6). Conclusions. The intervention should be disseminated to postal stations nationwide and possibly to other occupational groups that work outdoors. PMID:17267715

  20. Evaluating the feasibility of complex interventions in mental health services: standardised measure and reporting guidelines.

    PubMed

    Bird, Victoria J; Le Boutillier, Clair; Leamy, Mary; Williams, Julie; Bradstreet, Simon; Slade, Mike

    2014-01-01

    The feasibility of implementation is insufficiently considered in clinical guideline development, leading to human and financial resource wastage. To develop (a) an empirically based standardised measure of the feasibility of complex interventions for use within mental health services and (b) reporting guidelines to facilitate feasibility assessment. A focused narrative review of studies assessing implementation blocks and enablers was conducted with thematic analysis and vote counting used to determine candidate items for the measure. Twenty purposively sampled studies (15 trial reports, 5 protocols) were included in the psychometric evaluation, spanning different interventions types. Cohen's kappa (κ) was calculated for interrater reliability and test-retest reliability. In total, 95 influences on implementation were identified from 299 references. The final measure - Structured Assessment of FEasibility (SAFE) - comprises 16 items rated on a Likert scale. There was excellent interrater (κ = 0.84, 95% CI 0.79-0.89) and test-retest reliability (κ = 0.89, 95% CI 0.85-0.93). Cost information and training time were the two influences least likely to be reported in intervention papers. The SAFE reporting guidelines include 16 items organised into three categories (intervention, resource consequences, evaluation). A novel approach to evaluating interventions, SAFE, supplements efficacy and health economic evidence. The SAFE reporting guidelines will allow feasibility of an intervention to be systematically assessed.

  1. Sustaining Screening, Brief Intervention and Referral to Treatment (SBIRT) services in health-care settings.

    PubMed

    Singh, Manu; Gmyrek, Amanda; Hernandez, Amy; Damon, Donna; Hayashi, Susan

    2017-02-01

    To assess the sustainability of Screening, Brief Intervention and Referral to Treatment (SBIRT) services after cessation of initial start-up funding. Descriptive study with quantitative and qualitative data collected from 34 staff participants from six grantees (comprising 103 sites) funded previously through a large, federally supported SBIRT program. Primary care out-patient clinics and hospitals in the United States. Thirty-four grantee-related staff members, including administrators, evaluators, key stakeholders and SBIRT service providers from six grantees. Changes to levels and types of service delivery activities after federal funding stopped, alternative sources of funding and obstacles to delivery of services. Of the 103 original sites in the six SBIRT grantee programs, 69 sites continued providing services in some capacity (same as before, reduced, modified or expanded). Most of the 69 sites (67%) adapted and redesigned the delivery of SBIRT services post-initial grant funding. In addition, new sites were added after grant funding ended, bringing the total number of sites to 88. Analysis of participant responses identified four primary factors that influenced SBIRT sustainability: presence of champions, funding availability, systemic change and SBIRT practitioner characteristics. Almost 70% of the Screening, Brief Intervention and Referral to Treatment (SBIRT) services in the United States funded initially through a federal program were able to sustain operations after federal funding ceased and some expanded SBIRT services beyond the original sites. The key factors related to sustainability were securing new funding, having champions, adapting and making system changes and managing program staffing challenges. © 2017 Society for the Study of Addiction.

  2. Child Disaster Mental Health Services: a Review of the System of Care, Assessment Approaches, and Evidence Base for Intervention.

    PubMed

    Pfefferbaum, Betty; North, Carol S

    2016-01-01

    Several decades of research have informed our knowledge of children's reactions to disasters and the factors that influence their reactions. This article describes the system of care for child disaster mental health services using population risk to determine needed services and a stepped care approach built on assessment and monitoring to advance children to appropriate services. To assess the evidence base for disaster interventions, recent reviews of numerous child disaster mental health interventions are summarized.

  3. Provision of Early Intervention and Special Education Services to Eligible DoD Dependents. Final rule.

    PubMed

    2015-06-25

    This rule reissues the current regulations and: Establishes policy, assigns responsibilities, and implements the non-funding and non-reporting provisions in DoD for: Provision of early intervention services (EIS) to infants and toddlers with disabilities and their families, as well as special education and related services to children with disabilities entitled under this part to receive education services from the DoD; implementation of a comprehensive, multidisciplinary program of EIS for infants and toddlers with disabilities and their families who, but for age, are eligible to be enrolled in DoD schools; provision of a free appropriate public education (FAPE), including special education and related services, for children with disabilities, as specified in their individualized education programs (IEP), who are eligible to enroll in DoD schools; and monitoring of DoD programs providing EIS, and special education and related services for compliance with this part. This rule also establishes a DoD Coordinating Committee to recommend policies and provide compliance oversight for early intervention and special education.

  4. PROTECTED-UK - Clinical pharmacist interventions in the UK critical care unit: exploration of relationship between intervention, service characteristics and experience level.

    PubMed

    Rudall, Nicola; McKenzie, Catherine; Landa, June; Bourne, Richard S; Bates, Ian; Shulman, Rob

    2017-08-01

    Clinical pharmacist (CP) interventions from the PROTECTED-UK cohort, a multi-site critical care interventions study, were further analysed to assess effects of: time on critical care, number of interventions, CP expertise and days of week, on impact of intervention and ultimately contribution to patient care. Intervention data were collected from 21 adult critical care units over 14 days. Interventions could be error, optimisation or consults, and were blind-coded to ensure consistency, prior to bivariate analysis. Pharmacy service demographics were further collated by investigator survey. Of the 20 758 prescriptions reviewed, 3375 interventions were made (intervention rate 16.1%). CPs spent 3.5 h per day (mean, ±SD 1.7) on direct patient care, reviewed 10.3 patients per day (±SD 4.2) and required 22.5 min (±SD 9.5) per review. Intervention rate had a moderate inverse correlation with the time the pharmacist spent on critical care (P = 0.05; r = 0.4). Optimisation rate had a strong inverse association with total number of prescriptions reviewed per day (P = 0.001; r = 0.7). A consultant CP had a moderate inverse correlation with number of errors identified (P = 0.008; r = 0.6). No correlation existed between the presence of electronic prescribing in critical care and any intervention rate. Few centres provided weekend services, although the intervention rate was significantly higher on weekends than weekdays. A CP is essential for safe and optimised patient medication therapy; an extended and developed pharmacy service is expected to reduce errors. CP services should be adequately staffed to enable adequate time for prescription review and maximal therapy optimisation. © 2016 Royal Pharmaceutical Society.

  5. A longitudinal study of outcome measures for children receiving early intervention services.

    PubMed

    Eigsti, Heidi Johnson; Chandler, Lynette; Robinson, Cordelia; Bodkin, Amy Winters

    2010-01-01

    The purpose of this study was to compare the Pediatric Evaluation of Disability Inventory (PEDI) and the Mullen Scales of Early Learning (MSEL) as measures of change in children who received early intervention services. Thirty-four children were stratified into 2 groups according to the presence of gross motor delay. The PEDI and MSEL were administered 3 times: at an average age of 18, 31, and 53 months of age. Data were analyzed using a repeated-measures multivariate analysis of variance. The findings suggest that PEDI Functional Skills Scaled Scores were capable of measuring change in both groups of children. The standard scores on the PEDI Functional Skills Social Scale were found to be more sensitive to change than the MSEL Receptive and Expressive Language scores for children with motor delays. Using PEDI scaled scores may be an effective strategy for measuring change in children receiving early intervention services.

  6. The epidemiology of sexually transmitted infections in the UK: impact of behavior, services and interventions.

    PubMed

    Hughes, Gwenda; Field, Nigel

    2015-01-01

    Sexually transmitted infections (STIs) are a major public health concern. The UK has some of the most advanced STI surveillance systems globally. This article uses national surveillance data to describe remarkable changes in STI epidemiology in the UK over the last century and explores the behavioral and demographic shifts that may explain these trends. The past 10 years have seen considerable improvements in STI service provision and the introduction of national public health interventions. However, sexual health inequalities persist and men who have sex with men, young adults and black ethnic minorities remain a priority for interventions. Technological advances in testing and a shift in sexual health service commissioning arrangements will present both opportunities and challenges in future.

  7. Developing an Interventional Pulmonary Service in a Community-Based Private Practice: A Case Study.

    PubMed

    French, Kim D; Desai, Neeraj R; Diamond, Edward; Kovitz, Kevin L

    2016-04-01

    Interventional pulmonology (IP) is a field that uses minimally invasive techniques to diagnose, treat, and palliate advanced lung disease. Technology, formal training, and reimbursement for IP procedures have been slow to catch up with other interventional subspecialty areas. A byproduct of this pattern has been limited IP integration in private practice settings. We describe the key aspects and programmatic challenges of building an IP program in a community-based setting. A philosophical and financial buy-in by stakeholders and a regionalization of services, within and external to a larger practice, are crucial to success. Our experience demonstrates that a successful launch of an IP program increases overall visits as well as procedural volume without cannibalizing existing practice volume. We hope this might encourage others to provide this valuable service to their own communities.

  8. Stuttering Intervention in Three Service Delivery Models (Direct, Hybrid, and Telepractice): Two Case Studies

    PubMed Central

    VALENTINE, DANIEL T.

    2015-01-01

    This study assessed outcomes in stuttering intervention across three service delivery models: direct, hybrid, and telepractice for two 11-year old children who stutter. The goal of the study was to investigate whether short-term goals were maintained through the telepractice sessions. The Stuttering Severity Instrument, Fourth Edition (SSI-4) was administered to each child before and after each intervention period and weekly fluency samples (percentage of stuttered syllables in a monologue) were obtained in each of the 10-week intervention periods. In addition, the Communication Attitudes Test-Revised was used to assess the children’s attitudes toward speaking. Following the telepractice period, parents and children completed a questionnaire concerning the therapy experience via telepractice. Both children continued to improve fluency as measured by the weekly fluency samples. SSI-4 severity ratings improved for one child and remained consistent for the other. These outcomes appear to demonstrate that telepractice is viable for improving and maintaining fluency. PMID:25945229

  9. Wheelchair Seating Assessment and Intervention: A Comparison Between Telerehabilitation and Face-to-Face Service

    PubMed Central

    Barlow, Ingrid G; Liu, Lili; Sekulic, Angela

    2009-01-01

    This study compared outcomes of wheelchair seating and positioning interventions provided by telerehabilitation (n=10) and face-to-face (n=20; 10 in each of two comparison groups, one urban and one rural). Comparison clients were matched to the telerehabilitation clients in age, diagnosis, and type of seating components received. Clients and referring therapists rated their satisfaction and identified if seating intervention goals were met. Clients recorded travel expenses incurred or saved, and all therapists recorded time spent providing service. Wait times and completion times were tracked. Clients seen by telerehabilitation had similar satisfaction ratings and were as likely to have their goals met as clients seen face-to-face; telerehabilitation clients saved travel costs. Rural referring therapists who used telerehabilitation spent more time in preparation and follow-up than the other groups. Clients assessed by telerehabilitation had shorter wait times for assessment than rural face-to-face clients, but their interventions took as long to complete. PMID:25945159

  10. Outcomes of a Bystander Intervention Community Health Service-Learning Project.

    PubMed

    Decker, Kim; Hensel, Desiree; Fasone, Leslie

    2016-01-01

    The purpose of this article is to describe the integration of a college bystander intervention service-learning project into an entry-level community clinical course in a prelicensure program and its outcomes. Two years of data from 118 students showed that students helped improve campus safety while growing as professionals and gaining leadership and health promotion skills. Approximately one-third of the students described a specific incident in which they intervened in an ambiguous situation.

  11. Effectiveness of case management interventions for frequent users of healthcare services: a scoping review

    PubMed Central

    Hudon, Catherine; Chouinard, Maud-Christine; Lambert, Mireille; Dufour, Isabelle; Krieg, Cynthia

    2016-01-01

    Objective Frequent users of healthcare services are a vulnerable population, often socioeconomically disadvantaged, who can present multiple chronic conditions as well as mental health problems. Case management (CM) is the most frequently performed intervention to reduce healthcare use and cost. This study aimed to examine the evidence of the effectiveness of CM interventions for frequent users of healthcare services. Design Scoping review. Data sources An electronic literature search was conducted using the MEDLINE, Scopus and CINAHL databases covering January 2004 to December 2015. A specific search strategy was developed for each database using keywords ‘case management’ and ‘frequent use’. Eligibility criteria for selecting studies To be included in the review, studies had to report effects of a CM intervention on healthcare use and cost or patient outcomes. Eligible designs included randomised and non-randomised controlled trials and controlled and non-controlled before–after studies. Studies limited to specific groups of patients or targeting a single disease were excluded. Three reviewers screened abstracts, screened each full-text article and extracted data, and discrepancies were resolved by consensus. Results The final review included 11 articles evaluating the effectiveness of CM interventions among frequent users of healthcare services. Two non-randomised controlled studies and 4 before–after studies reported positives outcomes on healthcare use or cost. Two randomised controlled trials, 2 before–after studies and 1 non-randomised controlled study presented mitigated results. Patient outcomes such as drug and alcohol use, health locus of control, patient satisfaction and psychological functioning were evaluated in 3 studies, but no change was reported. Conclusions Many studies suggest that CM could reduce emergency department visits and hospitalisations as well as cost. However, pragmatic randomised controlled trials of adequate power that

  12. Longitudinal Analyses of Geographic Differences in Utilization Rates of Children with Developmental Delays Who Participation in Early Intervention Services

    ERIC Educational Resources Information Center

    Lin, Jin-Ding; Chen, Yong-Chen; Chou, Yu-Ching

    2012-01-01

    The purposes of the present study were to describe the longitudinal utilization rates of participation in early intervention services of children with developmental delays, and to examine the geographical difference of services in this vulnerable population. We analyzed service utilization of the developmentally delayed children based on data of…

  13. Longitudinal Analyses of Geographic Differences in Utilization Rates of Children with Developmental Delays Who Participation in Early Intervention Services

    ERIC Educational Resources Information Center

    Lin, Jin-Ding; Chen, Yong-Chen; Chou, Yu-Ching

    2012-01-01

    The purposes of the present study were to describe the longitudinal utilization rates of participation in early intervention services of children with developmental delays, and to examine the geographical difference of services in this vulnerable population. We analyzed service utilization of the developmentally delayed children based on data of…

  14. [Educational intervention for the prevention of osteoporosis in a rural primary healthcare service].

    PubMed

    Pérez Fernández, María Reyes; Almazán Ortega, Raquel; Martínez Portela, José María; Alves Pérez, M Teresa; Segura Iglesias, M Carmen; Pérez Fernández, Román

    2013-12-21

    The aim of this study is to determine whether an educational intervention in perimenopausal women in rural environments achieves significant changes in risk behaviors related to osteoporosis. Randomized clinical trials of parallel groups: 216 women (45-54 years old) of a rural Primary Healthcare service. Pre- and post- intervention were covered: body mass index (BMI), densitometry and blood test (calcium [Ca], parathormone [PTH]). Intervention group (n1=110): 2 interactive workshops on the prevention of osteoporosis. Control group (n2=106): information by post. After the educational intervention, the intervention group maintained its BMI, increased its bone mineral density (BMD) (P<.001) and decreased the Ca (P ≤.048) and PTH (P<.001) levels. The control group increased its BMI (P<.001) and its BMD (P ≤.048), maintained its Ca levels and decreased the PTH values (P=.01). The improvement in the objective parameters related to osteoporosis indicates the importance of health education as a preventive measure in this group of women. It would be interesting to analyze the repercussions of this improvement on a long-term basis in terms of reducing the incidence of osteoporosis and fractures. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  15. The Ububele Baby Mat Service - A primary preventative mental health intervention in a culturally diverse setting.

    PubMed

    Dawson, N; Richards, J; Frost, K

    2017-05-01

    The Ububele Baby Mat Service is a community-based, parent-infant mental health intervention offered at five primary health care clinics in Alexandra Township, in Johannesburg. The aim of the intervention is to promote healthy caregiver-infant attachments. There has been a steady increase in the number of mother-baby dyads making use of the service. This paper aims to explore how the Baby Mat Service and Baby Mat practitioners position and locate themselves in a culturally diverse community setting where multiple meaning systems are drawn on for making sense of health concerns. Two key components of the Baby Mat Service are discussed: i) the presence of an inter-racial therapeutic couple on the mat; and ii) the stance adopted by the Baby Mat practitioners in relation to culturally diverse understandings of a presenting problem. The therapeutic couple engages with culturally-informed frames of reference in an attitude of wondering and tentative thinking ("mhlawumbe" in isiZulu). When a respectfully curious stance was taken by practitioners, it was found to help those accessing the mat to find symbolic meaning in the presenting problem and integrate this with cultural understandings.

  16. Examination of England's New Medicine Service (NMS) of complex health care interventions in community pharmacy.

    PubMed

    Latif, Asam; Waring, Justin; Watmough, Deborah; Barber, Nick; Chuter, Anthony; Davies, James; Salema, Nde-Eshimuni; Boyd, Matthew J; Elliott, Rachel A

    Community pharmacies are increasingly commissioned to deliver new, complex health interventions in response to the growing demands on family doctors and secondary health care services. Little is known about how these complex interventions are being accommodated and translated into the community pharmacy setting and whether their aims and objectives are realized in practice. The New Medicine Service (NMS) is a complex medicine management intervention that aims to support patients' adherence to newly prescribed medicines for a long-term condition. This study explores the recent implementation of the NMS in community pharmacies across England. It also seeks to understand how the service is becoming manifest in practice and what lessons can be learned for future service implementation. Structured, organizational ethnographic observations and in situ workplace interviews with pharmacists and support staff were undertaken within 23 English community pharmacies. Additionally, one-to-one, semi-structured interviews were carried out with 47 community pharmacists and 11 general practitioners (GPs). Observational and interview data were transcribed and analyzed thematically and guided by Damschroder's consolidated framework for implementation research. The NMS workload had been implemented and absorbed into pharmacists' daily routines alongside existing responsibilities with no extra resources and little evidence of reduction in other responsibilities. Pharmacists were pragmatic, simplifying, and adapting the NMS to facilitate its delivery and using discretion to circumvent perceived non-essential paperwork. Pharmacist understanding of the NMS was found to impact on what they believed should be achieved from the service. Despite pharmacists holding positive views about the value of the NMS, not all were convinced of its perceived benefits and necessity, with reports that many consultations did not identify any problems with the patients' medicines. GPs were generally

  17. Oxygen cost of breathing and breathlessness during exercise in nonobese women and men.

    PubMed

    Lorenzo, Santiago; Babb, Tony G

    2012-06-01

    Although it has been reported that the work of breathing may be higher in women, inconsistencies among studies leaves this important question unresolved. Also, the association between the oxygen cost of breathing and rating of perceived breathlessness (RPB) during exercise has not been examined between women and men. This study aimed to measure oxygen cost of breathing during eucapnic voluntary hyperpnea and RPB (Borg 0-10 scale) during 6 min of constant work rate cycling at 60 and 90 W, respectively, in healthy, nonobese women and men. A total of 9 women (27 yr, body mass index = 21 kg·m(-2)) and 10 men (29 yr, body mass index = 25 kg·m(-2)) participated. All subjects underwent pulmonary function testing, exercise cycling, and determination of oxygen cost of breathing during eucapnic voluntary hyperpnea. Oxygen cost of breathing was obtained from the slope of the oxygen uptake (mL·min(-1)) and ventilation (L·min(-1)) relationship. RPB and cardiorespiratory measures were collected during minute 6 of the exercise. Data were analyzed by independent t-test and regression analysis. Age and pulmonary function were similar between the nonobese women and men. Oxygen cost of breathing was similar between the nonobese women (1.17 ± 0.26 mL·L(-1)) and men (1.21 ± 0.42 mL·(-1)L). RPB during exercise was similar between the women (2.1 ± 1.3) and men (2.6 ± 1.2) and was correlated (P < 0.05) with relative oxygen uptake (r = 0.55) but not the oxygen cost of breathing. In nonobese women and men, oxygen cost of breathing is not different over the ventilatory ranges studied and RPB is similar at the same relative exercise intensity. In addition, the oxygen cost of breathing was not associated with RPB during constant work rate exercise.

  18. Oxygen Cost of Breathing and Breathlessness during Exercise in Nonobese Women and Men

    PubMed Central

    Lorenzo, Santiago; Babb, Tony G.

    2012-01-01

    Introduction Although it has been reported that the work of breathing may be higher in women, inconsistencies among studies leaves this important question unresolved. Also, the association between the oxygen cost of breathing and rating of perceived breathlessness (RPB) during exercise has not been examined between women and men. Purpose To measure oxygen cost of breathing during eucapnic voluntary hyperpnea and RPB (Borg 0-10 scale) during 6 minutes of constant work rate cycling at 60 and 90W, respectively, in healthy nonobese women and men. Methods Nine women (27yr,21BMI) and ten men (29yr,25BMI) participated. All subjects underwent pulmonary function testing, exercise cycling, and determination of oxygen cost of breathing during eucapnic voluntary hyperpnea. Oxygen cost of breathing was obtained from the slope of the oxygen uptake (ml/min) and ventilation (L/min) relationship. RPB and cardio-respiratory measures were collected during minute 6 of the exercise. Data were analyzed by independent t-test and regression analysis. Results Age and pulmonary function were similar between the nonobese women and men. Oxygen cost of breathing was similar between the nonobese women (1.17±0.26ml/L) and men (1.21±0.42ml/L). RPB during exercise was similar between the women (2.1±1.3) and men (2.6±1.2) and was correlated (p<0.05) with relative oxygen uptake (r=0.55), but not the oxygen cost of breathing. Conclusion In nonobese women and men, oxygen cost of breathing is not different over the ventilatory ranges studied and RPB is similar at the same relative exercise intensity. In addition, the oxygen cost of breathing was not associated with RPB during constant work rate exercise. PMID:22592277

  19. The Efficacy of a Standalone Protective Behavioral Strategies Intervention for Students Accessing Mental Health Services

    PubMed Central

    LaBrie, Joseph W.; Napper, Lucy E.; Grimaldi, Elizabeth M.; Kenney, Shannon R.; Lac, Andrew

    2015-01-01

    Objective Students with poor mental health are at increased risk for problematic alcohol use. These students also tend to underutilize alcohol-related protective behavioral strategies (PBS). Cross-sectional studies indicate that PBS use may be particularly useful for students with mental health challenges; however, it is unclear whether training these students to use PBS is an effective approach for reducing alcohol use and consequences. The current study evaluated the efficacy of a standalone PBS skills training and personalized feedback (PBS-STPF) intervention among students accessing mental health services. Method Participants (N = 251) were randomly assigned to either an individual facilitator-led PBS-STPF intervention or a health-related control condition. Participants completed online follow-up surveys 1- and 6-months post-intervention which included measures of alcohol use, negative consequences and a composite measure of PBS use. Results Relative to control participants, students in the PBS-STPF condition reported significantly greater PBS use, but no differences in alcohol use or consequences. Participants in both conditions reported decreases in drinking outcomes over time. Tests of mediation indicated that the intervention indirectly led to reduction in drinking outcomes at 6 months through increased PBS use. Conclusions Although the intervention resulted in changes in PBS use that were maintained for up to 6 months post-intervention, the effects of the intervention on drinking and consequences were limited. A brief standalone PBS training may need augmentation in order to promote effective use of PBS for substantial decreases in alcohol consequences. PMID:25728042

  20. Endurance-training in healthy men is associated with lesser exertional breathlessness that correlates with circulatory-muscular conditioning markers in a cross-sectional design.

    PubMed

    Plantier, Laurent; Al Dandachi, Ghanima; Londner, Cécile; Caumont-Prim, Aurore; Chevalier-Bidaud, Brigitte; Toussaint, Jean-François; Desgorces, François-Denis; Delclaux, Christophe

    2014-01-01

    Whether exertional dyspnoea can be attributed to poor circulatory-muscular conditioning is a difficult clinical issue. Because criteria of poor conditioning such as low oxygen pulse, low ventilatory threshold or high heart rate/oxygen consumption slope can be observed in heart or lung diseases and are not specific to conditioning, we assessed the relationships between physical exercise, conditioning and exertional breathlessness in healthy subjects, in whom the aforementioned criteria can confidently be interpreted as reflecting conditioning. To this end, healthy males with either low (inactive men, n = 31) or high (endurance-trained men, n = 31) physical activity evaluated using the International Physical Activity Questionnaire (IPAQ) underwent spirometry and incremental exercise testing with breathlessness assessment using Borg scale. No significant breathlessness was reported before the ventilatory threshold in the two groups. Peak breathlessness was highly variable, did not differ between the two groups, was not related to any conditioning criterion, but correlated with peak respiratory rate. Nevertheless, endurance-trained subjects reported lower breathlessness at the same ventilation levels in comparison with inactive subjects. Significant but weak associations were observed between isoventilation breathlessness and physical activity indices (Borg at 60 L/min and total IPAQ scores, rho = -0.31, p = 0.020), which were mainly attributable to the vigorous domain of physical activity, as well as with conditioning indices (Borg score at 60 L.min(-1) and peak oxygen pulse or heart rate/oxygen consumption slope, rho = -0.31, p = 0.021 and rho = 0.31, p = 0.020; respectively). In conclusion, our data support a weak relationship between exertional breathlessness and circulatory-muscular conditioning, the later being primarily related to vigorous physical activity.

  1. Overview of States' Use of Telehealth for the Delivery of Early Intervention (IDEA Part C) Services.

    PubMed

    Cason, Jana; Behl, Diane; Ringwalt, Sharon

    2012-01-01

    Early intervention (EI) services are designed to promote the development of skills and enhance the quality of life of infants and toddlers who have been identified as having a disability or developmental delay, enhance capacity of families to care for their child with special needs, reduce future educational costs, and promote independent living (NECTAC, 2011). EI services are regulated by Part C of the Individuals with Disabilities Education Improvement Act (IDEA); however, personnel shortages, particularly in rural areas, limit access for children who qualify. Telehealth is an emerging delivery model demonstrating potential to deliver EI services effectively and efficiently, thereby improving access and ameliorating the impact of provider shortages in underserved areas. The use of a telehealth delivery model facilitates inter-disciplinary collaboration, coordinated care, and consultation with specialists not available within a local community. A survey sent by the National Early Childhood Technical Assistance Center (NECTAC) to IDEA Part C coordinators assessed their utilization of telehealth within states' IDEA Part C programs. Reimbursement for provider type and services and barriers to implement a telehealth service delivery model were identified. Representatives from 26 states and one jurisdiction responded to the NECTAC telehealth survey. Of these, 30% (n=9) indicated that they are either currently using telehealth as an adjunct service delivery model (n=6) or plan to incorporate telehealth within the next 1-2 years (n=3). Identified telehealth providers included developmental specialists, teachers of the Deaf/Hard of Hearing (DHH), speech-language pathologists, occupational therapists, physical therapists, behavior specialists, audiologists, and interpreters. Reimbursement was variable and included use of IDEA Part C funding, Medicaid, and private insurance. Expressed barriers and concerns for the implementation of telehealth as a delivery model within Part

  2. Level and Intensity of Early Intervention Services for Infants and Toddlers with Disabilities: The Impact of Child, Family, System, and Community-Level Factors on Service Provision

    ERIC Educational Resources Information Center

    Hallam, Rena A.; Rous, Beth; Grove, Jaime; LoBianco, Tony

    2009-01-01

    Data from a statewide billing and information system for early intervention are used to examine the influence of multiple factors on the level and intensity of services provided in a state early intervention system. Results indicate that child and family factors including entry age, gestational age, Medicaid eligibility, access to third party…

  3. Level and Intensity of Early Intervention Services for Infants and Toddlers with Disabilities: The Impact of Child, Family, System, and Community-Level Factors on Service Provision

    ERIC Educational Resources Information Center

    Hallam, Rena A.; Rous, Beth; Grove, Jaime; LoBianco, Tony

    2009-01-01

    Data from a statewide billing and information system for early intervention are used to examine the influence of multiple factors on the level and intensity of services provided in a state early intervention system. Results indicate that child and family factors including entry age, gestational age, Medicaid eligibility, access to third party…

  4. Do Interventions that Promote Awareness of Rights Increase Use of Maternity Care Services? A Systematic Review.

    PubMed

    George, Asha S; Branchini, Casey; Portela, Anayda

    2015-01-01

    Twenty years after the rights of women to go through pregnancy and childbirth safely were recognized by governments, we assessed the effects of interventions that promote awareness of these rights to increase use of maternity care services. Using inclusion and exclusion criteria defined in a peer-reviewed protocol, we searched published and grey literature from one database of studies on maternal health, two search engines, an internet search and contact with experts. From the 707 unique documents found, 219 made reference to rights, with 22 detailing interventions promoting awareness of rights for maternal and newborn health. Only four of these evaluated effects on health outcomes. While all four interventions promoted awareness of rights, they did so in different ways. Interventions included highly-scripted dissemination meetings with educational materials and other visual aids, participatory approaches that combined raising awareness of rights with improving accountability of services, and broader multi-stakeholder efforts to improve maternal health. Study quality ranged from weak to strong. Measured health outcomes included increased antenatal care and facility birth. Improvements in human rights outcomes such as availability, acceptability, accessibility, quality of care, as well as the capacity of rights holders and duty bearers were also reported to varying extents. Very little information on costs and almost no information on harms or risks were described. Despite searching multiple sources of information, while some studies did report on activities to raise awareness of rights, few detailed how they did so and very few measured effects on health outcomes. Promoting awareness of rights is one element of increasing demand for and use of quality maternity care services for women during pregnancy, birth and after birth. To date efforts have not been well documented in the literature and the program theories, processes and costs, let alone health effects have

  5. Do Interventions that Promote Awareness of Rights Increase Use of Maternity Care Services? A Systematic Review

    PubMed Central

    George, Asha S.; Branchini, Casey; Portela, Anayda

    2015-01-01

    Twenty years after the rights of women to go through pregnancy and childbirth safely were recognized by governments, we assessed the effects of interventions that promote awareness of these rights to increase use of maternity care services. Using inclusion and exclusion criteria defined in a peer-reviewed protocol, we searched published and grey literature from one database of studies on maternal health, two search engines, an internet search and contact with experts. From the 707 unique documents found, 219 made reference to rights, with 22 detailing interventions promoting awareness of rights for maternal and newborn health. Only four of these evaluated effects on health outcomes. While all four interventions promoted awareness of rights, they did so in different ways. Interventions included highly-scripted dissemination meetings with educational materials and other visual aids, participatory approaches that combined raising awareness of rights with improving accountability of services, and broader multi-stakeholder efforts to improve maternal health. Study quality ranged from weak to strong. Measured health outcomes included increased antenatal care and facility birth. Improvements in human rights outcomes such as availability, acceptability, accessibility, quality of care, as well as the capacity of rights holders and duty bearers were also reported to varying extents. Very little information on costs and almost no information on harms or risks were described. Despite searching multiple sources of information, while some studies did report on activities to raise awareness of rights, few detailed how they did so and very few measured effects on health outcomes. Promoting awareness of rights is one element of increasing demand for and use of quality maternity care services for women during pregnancy, birth and after birth. To date efforts have not been well documented in the literature and the program theories, processes and costs, let alone health effects have

  6. Short‐term effects of light and heavy load interventions on service velocity and precision in elite young tennis players

    PubMed Central

    Ferrauti, Alexander; Bastiaens, Kenneth

    2007-01-01

    Objective This study was conducted to investigate the acute effects of a complex throwing intervention set‐up, with light or heavy loads, on the service velocity of elite junior tennis players. Methods On 3 separate test days, 13 elite juniors (mean (SD) 12.3 (0.8) years, 149 (9) cm, 37.5 (5.5) kg) performed four sets of six serves with different between‐set conditions. In a cross‐over design, the players performed respectively 6, 4 and 2 maximum effort throws with a 200 g ball (LI, light intervention), 6, 4 and 2 maximum effort throws with a 600 g ball (HI, heavy intervention) and no throws (NI, no intervention) during the 2 min in between‐set period. Participants were instructed to serve, with maximum speed, to a target near the midline of the deuce court service box. A two‐factor analysis of variance was used to determine the effects of intervention type and set number on “service velocity”, “service precision” (eg, percentage of serves in) and “service touch” (11 point rating scale). Results Mean (SD) service velocity decreased significantly in HI (124.3 (7.8) km/h) as compared to NI (126.6 (9.3) km/h, p<0.05, effect size d = 0.26), yet no such differences were found between LI (125.2 (7.9) km/h) and NI. Service velocity also remained constant between sets (p = 0.406). Service precision and service touch were unaffected by the interventions. Conclusions Under the conditions of our study, a heavy throwing intervention during service training has no beneficial effect on service velocity in young elite tennis players (under 14). PMID:17957011

  7. Health and social support services in older adults recently discharged from hospital: service utilisation and costs and exploration of the impact of a home-exercise intervention.

    PubMed

    Farag, I; Howard, K; O'Rourke, S; Ferreira, M L; Lord, S R; Close, J C T; Vogler, C; Dean, C M; Cumming, R G; Sherrington, C

    2016-04-18

    Admission to hospital can lead to persistent deterioration in physical functioning, particularly for the more vulnerable older population. As a result of this physical deterioration, older people who have been recently discharged from hospital may be particularly high users of health and social support services. Quantify usage and costs of services in older adults after hospitalisation and explore the impact of a home-exercise intervention on service usage. The present study was a secondary analysis of data from a randomised controlled trial (ACTRN12607000563460). The trial involved 340 participants aged 60 years and over with recent hospitalisation. Service use and costs were compared between intervention (12 months of home-exercise prescribed in 10 visits from a physiotherapist) and control groups. 33 % of participants were re-admitted to hospital, 100 % consulted a General Medical Practitioner and 63 % used social services. 56 % of costs were associated with hospital admission and 22 % with social services. There was reduction in General Medical Practitioner services provided in the home in the intervention group (IRR 0.23, CI 0.1 to 0.545, p < 0.01) but no significant between-group difference in service use or in costs for other service categories. There appears to be substantial hospital and social service use and costs in this population of older people. No significant impact of a home-based exercise program was evident on service use or costs. Australian and New Zealand Clinical Trial Registry ACTRN12607000563460 >TrialSearch.

  8. Integration of Technology-based Behavioral Health Interventions in Substance Abuse and Addiction Services.

    PubMed

    Ramsey, Alex

    2015-08-01

    The past decade has witnessed revolutionary changes to the delivery of health services, ushered in to a great extent by the introduction of electronic health record systems. More recently, a new class of technological advancements-technology-based behavioral health interventions, which involve the delivery of evidence-informed practices via computers, web-based applications, mobile phones, wearable sensors, or other technological platforms-has emerged and is primed to once again radically shift current models for behavioral healthcare. Despite the promise and potential of these new therapeutic approaches, a greater understanding of the impact of technology-based interventions on cornerstone issues of mental health and addiction services-namely access, quality, and cost-is needed. The current review highlights 1) relevant conceptual frameworks that guide this area of research, 2) key studies that inform the relevance of technology-based interventions for behavioral healthcare access, quality, and cost, 3) pressing methodological issues that require attention, 4) unresolved questions that warrant further investigation, and 5) practical implications that underscore important new directions for this emerging area of research.

  9. Identifying the common elements of treatment engagement interventions in children's mental health services.

    PubMed

    Lindsey, Michael A; Brandt, Nicole E; Becker, Kimberly D; Lee, Bethany R; Barth, Richard P; Daleiden, Eric L; Chorpita, Bruce F

    2014-09-01

    Difficulty engaging families in mental health treatment is seen as an underlying reason for the disparity between child mental health need and service use. Interpretation of the literature on how best to engage families is complicated by a diversity of operational definitions of engagement outcomes and related interventions. Thus, we sought to review studies of engagement interventions using a structured methodology allowing for an aggregate summary of the most common practices associated with effective engagement interventions. We identified 344 articles through a combination of database search methods and recommendations from engagement research experts; 38 articles describing 40 studies met our inclusion criteria. Following coding methods described by Chorpita and Daleiden (J Consul Clin Psychol 77(3):566-579, 2009, doi: 10.1037/a0014565 ), we identified 22 engagement practice elements from 89 study groups that examined or implemented family engagement strategies. Most frequently identified engagement practice elements included assessment, accessibility promotion, psychoeducation about services, homework assignment, and appointment reminders. Assessment and accessibility promotion were two practice elements present in at least 50 % of treatment groups that outperformed a control group in a randomized controlled trial. With the exception of appointment reminders, these frequently identified engagement practice elements had a high likelihood of being associated with winning treatments when they were used. This approach offers a novel way of summarizing the engagement literature and provides the foundation for enhancing clinical decision-making around treatment engagement.

  10. Communication intervention in Rett syndrome: a survey of speech language pathologists in Swedish health services.

    PubMed

    Wandin, Helena; Lindberg, Per; Sonnander, Karin

    2015-01-01

    To investigate communication intervention that speech language pathologists (SLPs) provide to people with Rett syndrome. A web-based survey targeting all Swedish SLPs working with people currently receiving support from habilitation services. The SLPs reportedly followed recommended practice in the following aspects: (1) Information on communicative function was collected from several sources, including observation in well-known settings and reports from the client s social network, (2) Multimodal communication was promoted and, (3) Responsive partner strategies were largely targeted in the intervention. However, few instruments or standard procedures were used and partner instruction was given informally. Most SLPs used communication aids in the intervention and their general impression of using communication aids was positive. Further, augmentative and alternative communication (AAC) was estimated to increase and clarify communicative contributions from the person. Communication aids were reported to have a positive influence on communicative functions. Swedish SLP services followed best practice in several aspects, but there are areas with potential for development. Tools and best practice guidelines are needed to support SLPs in the AAC process for clients with Rett syndrome. [Box: see text].

  11. Designing a theory-informed, contextually appropriate intervention strategy to improve delivery of paediatric services in Kenyan hospitals

    PubMed Central

    2013-01-01

    Background District hospital services in Kenya and many low-income countries should deliver proven, effective interventions that could substantially reduce child and newborn mortality. However such services are often of poor quality. Researchers have therefore been challenged to identify intervention strategies that go beyond addressing knowledge, skill, or resource inadequacies to support health systems to deliver better services at scale. An effort to develop a system-oriented intervention tailored to local needs and context and drawing on theory is described. Methods An intervention was designed to improve district hospital services for children based on four main strategies: a reflective process to distill root causes for the observed problems with service delivery; developing a set of possible intervention approaches to address these problems; a search of literature for theory that provided the most appropriate basis for intervention design; and repeatedly moving backwards and forwards between identified causes, proposed interventions, identified theory, and knowledge of the existing context to develop an overarching intervention that seemed feasible and likely to be acceptable and potentially sustainable. Results and discussion In addition to human and resource constraints key problems included failures of relevant professionals to take responsibility for or ownership of the challenge of pediatric service delivery; inadequately prepared, poorly supported leaders of service units (mid-level managers) who are often professionally and geographically isolated and an almost complete lack of useful information for routinely monitoring or understanding service delivery practice or outcomes. A system-oriented intervention recognizing the pivotal role of leaders of service units but addressing the outer and inner setting of hospitals was designed to help shape and support an appropriate role for these professionals. It aims to foster a sense of ownership while

  12. Efficacy of a Process Improvement Intervention on Delivery of HIV Services to Offenders: A Multisite Trial

    PubMed Central

    Shafer, Michael S.; Dembo, Richard; del Mar Vega-Debién, Graciela; Pankow, Jennifer; Duvall, Jamieson L.; Belenko, Steven; Frisman, Linda K.; Visher, Christy A.; Pich, Michele; Patterson, Yvonne

    2014-01-01

    Objectives. We tested a modified Network for the Improvement of Addiction Treatment (NIATx) process improvement model to implement improved HIV services (prevention, testing, and linkage to treatment) for offenders under correctional supervision. Methods. As part of the Criminal Justice Drug Abuse Treatment Studies, Phase 2, the HIV Services and Treatment Implementation in Corrections study conducted 14 cluster-randomized trials in 2011 to 2013 at 9 US sites, where one correctional facility received training in HIV services and coaching in a modified NIATx model and the other received only HIV training. The outcome measure was the odds of successful delivery of an HIV service. Results. The results were significant at the .05 level, and the point estimate for the odds ratio was 2.14. Although overall the results were heterogeneous, the experiments that focused on implementing HIV prevention interventions had a 95% confidence interval that exceeded the no-difference point. Conclusions. Our results demonstrate that a modified NIATx process improvement model can effectively implement improved rates of delivery of some types of HIV services in correctional environments. PMID:25322311

  13. Higher prevalence of breathlessness in elderly exposed to indoor aldehydes and VOCs in a representative sample of French dwellings.

    PubMed

    Bentayeb, Malek; Billionnet, Cécile; Baiz, Nour; Derbez, Mickaël; Kirchner, Séverine; Annesi-Maesano, Isabella

    2013-10-01

    The purpose of this study was to explore respiratory health effects of indoor exposures to aldehydes and volatile organic compounds (VOCs) in elderly living in a population-based representative sample of French dwellings and to compare them to the rest of the occupants of the dwellings. Twenty VOCs were objectively measured in 490 main dwellings. The respiratory conditions were assessed through a standardized questionnaire in 1012 inhabitants aged over 15 years, 144 of whom were aged over 65 years. Generalized estimating equations (GEE) were used to model the relationship between respiratory health outcomes and air pollutants concentrations using the median value of the distribution to define elevated exposure. Similar levels of indoor air pollutants were found in elderly and others. However, associations between breathlessness and living in dwellings with elevated concentrations of toluene and o-xylene respectively were statistically significant in elderly but not in the rest of the population (adjusted odds ratios (AOR(95% confidence interval) = 3.36(1.13, 9.98) and 2.85(1.06, 7.68) in elderly vs. 0.91(0.59, 1.39) and 0.79( 0.47, 1.34) in the others respectively). A more pronounced effect of n-decane on past year breathlessness was observed in case of poor ventilation in the dwellings. Our results showed a higher risk of breathlessness in elderly exposed to indoor air pollution than in the rest of the exposed population. Further investigations are needed to confirm whether this is related to frailty in elderly. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. Examining the reach of a brief alcohol intervention service in routine practice at a level 1 trauma center.

    PubMed

    Turner, Brianna J; McCann, Barbara S; Dunn, Christopher W; Darnell, Doyanne A; Beam, Christopher R; Kleiber, Blair; Nelson, Kimberly M; Fukunaga, Rena

    2017-08-01

    The American College of Surgeons requires Level I and II trauma centers to provide brief intervention services to traumatically injured patients who screen positive for alcohol. Despite evidence supporting substantial cost savings and reduced re-injury associated with these services, brief interventions may not be uniformly delivered owing to a variety of demographic, clinical and operational characteristics. To inform service adjustments that may improve the reach of such services, we compared trauma patients who did and did not receive brief alcohol intervention services during their hospitalizations. Electronic medical records of injured patients admitted to a Level I trauma center between September 27, 2013 and March 11, 2014 with a positive blood alcohol concentration (N=189) were coded for demographic and clinical variables. Records of those who did not receive a brief intervention during their admission were reviewed for possible reasons why interventions were not delivered. Of the total sample, 115 patients (60.8%) received brief interventions. Patients who did and did not receive brief interventions did not differ on age, sex, race, blood alcohol concentration at admission, or mechanism of injury, indicating that patient characteristics were unlikely to bias service delivery. Instead, common features of patients who were referred but did not receive SBIRT interventions included admissions lasting fewer than two working days (12.7%) and persistent cognitive impairment following injury (9.0%). These findings align with previous studies suggesting that service reach could be improved by promoting dedicated and flexible staffing and adapting services to allow for SBIRT delivery in follow-up care settings. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Primary care interventions to prevent child maltreatment: U.S. Preventive Services Task Force recommendation statement.

    PubMed

    Moyer, Virginia A

    2013-08-20

    Chinese translation Update of the child abuse and neglect portion of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for family and intimate partner violence. The USPSTF commissioned a systematic review on interventions to prevent child maltreatment for children at risk, focusing on new studies and evidence gaps that were unresolved at the time of the 2004 recommendation. Beneficial outcomes considered include reduced exposure to maltreatment and reduced harms to physical or mental health or mortality. This recommendation applies to children in the general U.S. population from newborn to age 18 years who do not have signs or symptoms of maltreatment. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care interventions to prevent child maltreatment. (I statement).

  16. The Student Profile, Service Delivery Model, and Support Practices of Four Early Childhood Intervention Environments in Singapore

    ERIC Educational Resources Information Center

    Poon, Kenneth K.; Yang, Xueyan

    2016-01-01

    The student profile, model of service delivery, and support practices for young children with disabilities receiving early childhood intervention (ECI) in Singapore is reported and contrasted in this study. The supervisors/managers/principals of eight Early Intervention Programme for Infants and Children (EIPIC) centres, eight Integrated Child…

  17. Early Intervention in Europe: Organisation of Services and Support for Children and Their Families: Trends in 17 European Countries.

    ERIC Educational Resources Information Center

    Soriano, Victoria, Ed.

    This study describes how European countries deal with the issues and practicalities surrounding early intervention services. The current situation in relation to early intervention is examined in Austria, Belgium, Denmark, England and Wales, Finland, France, Germany, Greece, Italy, Holland, Norway, Portugal, Spain, Ireland, Luxembourg, Iceland,…

  18. Internet-Based Intervention Training for Parents of Young Children with Disabilities: A Promising Service-Delivery Model

    ERIC Educational Resources Information Center

    Meadan, Hedda; Daczewitz, Marcus E.

    2015-01-01

    Efficient early intervention (EI) services are required to serve the needs of young children with disabilities and the needs of their families. Effective EI includes family-centred practices, evidence-based interventions, parent involvement/training, and delivery in children's natural environments. Due to the challenges of providing…

  19. The Student Profile, Service Delivery Model, and Support Practices of Four Early Childhood Intervention Environments in Singapore

    ERIC Educational Resources Information Center

    Poon, Kenneth K.; Yang, Xueyan

    2016-01-01

    The student profile, model of service delivery, and support practices for young children with disabilities receiving early childhood intervention (ECI) in Singapore is reported and contrasted in this study. The supervisors/managers/principals of eight Early Intervention Programme for Infants and Children (EIPIC) centres, eight Integrated Child…

  20. Considering Identification and Service Provision for Students with Autism Spectrum Disorders within the Context of Response to Intervention

    ERIC Educational Resources Information Center

    Hammond, Rachel K.; Campbell, Jonathan M.; Ruble, Lisa A.

    2013-01-01

    The Response to Intervention (RTI) framework, a preventive model of universal screening, tiered interventions, and ongoing progress monitoring, poses an interesting consideration for identification and service delivery for children with autism spectrum disorders (ASD). Upon examination of the existing literature, paucity exists regarding how RTI…

  1. 32 CFR Appendix E to Part 57 - DoD-CC on Early Intervention, Special Education, and Related Services

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 1 2013-07-01 2013-07-01 false DoD-CC on Early Intervention, Special Education... SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN PROVISION OF EARLY INTERVENTION AND SPECIAL EDUCATION..., Special Education, and Related Services A. Committee Membership The DoD-CC shall meet at least yearly...

  2. 32 CFR Appendix E to Part 57 - DoD-CC on Early Intervention, Special Education, and Related Services

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 1 2014-07-01 2014-07-01 false DoD-CC on Early Intervention, Special Education... SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN PROVISION OF EARLY INTERVENTION AND SPECIAL EDUCATION..., Special Education, and Related Services A. Committee Membership The DoD-CC shall meet at least yearly...

  3. 32 CFR Appendix E to Part 57 - DoD-CC on Early Intervention, Special Education, and Related Services

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 1 2011-07-01 2011-07-01 false DoD-CC on Early Intervention, Special Education... SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN PROVISION OF EARLY INTERVENTION AND SPECIAL EDUCATION..., Special Education, and Related Services A. Committee Membership The DoD-CC shall meet at least yearly...

  4. 32 CFR Appendix E to Part 57 - DoD-CC on Early Intervention, Special Education, and Related Services

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 1 2012-07-01 2012-07-01 false DoD-CC on Early Intervention, Special Education... SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN PROVISION OF EARLY INTERVENTION AND SPECIAL EDUCATION..., Special Education, and Related Services A. Committee Membership The DoD-CC shall meet at least yearly...

  5. Considering Identification and Service Provision for Students with Autism Spectrum Disorders within the Context of Response to Intervention

    ERIC Educational Resources Information Center

    Hammond, Rachel K.; Campbell, Jonathan M.; Ruble, Lisa A.

    2013-01-01

    The Response to Intervention (RTI) framework, a preventive model of universal screening, tiered interventions, and ongoing progress monitoring, poses an interesting consideration for identification and service delivery for children with autism spectrum disorders (ASD). Upon examination of the existing literature, paucity exists regarding how RTI…

  6. Internet-Based Intervention Training for Parents of Young Children with Disabilities: A Promising Service-Delivery Model

    ERIC Educational Resources Information Center

    Meadan, Hedda; Daczewitz, Marcus E.

    2015-01-01

    Efficient early intervention (EI) services are required to serve the needs of young children with disabilities and the needs of their families. Effective EI includes family-centred practices, evidence-based interventions, parent involvement/training, and delivery in children's natural environments. Due to the challenges of providing…

  7. Development and Initial Validation of a Professional Development Intervention to Enhance the Quality of Individualized Family Service Plans

    ERIC Educational Resources Information Center

    Ridgley, Robyn; Snyder, Patricia A.; McWilliam, R. A.; Davis, Jacqueline E.

    2011-01-01

    We describe a targeted professional development (PD) intervention designed to improve the quality of individualized family service plans (IFSPs) and to support IFSP planning, development, and decision making. The theoretical and empirical foundations for the PD intervention and its key components are reviewed. Building on an established online…

  8. Systematic review and narrative synthesis of the effectiveness of contraceptive service interventions for young people, delivered in educational settings.

    PubMed

    Blank, Lindsay; Baxter, Susan K; Payne, Nick; Guillaume, Louise R; Pilgrim, Hazel

    2010-12-01

    This review was undertaken to determine the effectiveness of contraception service interventions for young people that were delivered in educational settings. We conducted a systematic review and narrative synthesis. Interventions were included where they were delivered in educational institutions, including schools, colleges, and pupil referral units. Young people aged 19 and under. Studies of wider age groups were included if the majority of participants were aged under 19 years. We included interventions which consisted of contraceptive service provision, and also interventions to encourage young people to use existing contraceptive services. The main outcome measures used in the studies were: rate of teenage pregnancy, rate of contraceptive use, and sexual behavior. Many outcome measures were self reported. Twenty-nine papers were included which reported on interventions to prevent adolescent pregnancy (and repeat pregnancy), school-based health centers, contraceptive use in college students, and multicomponent interventions. Intensive case management intervention conducted by a culturally matched school-based social worker (along with other components including peer education) were shown to be effective in preventing repeat adolescent pregnancy, at least for the duration of the intervention. Also, school-based health centers appear to be most effective when contraception provision is made available on site. The evidence from these papers is limited, in terms of both quality and quantity, along with consistency of findings, but some recommendations in relation to effective interventions can be made. Copyright © 2010 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  9. Dose-dispensing service as an intervention to improve adherence to polymedication.

    PubMed

    Hersberger, Kurt E; Boeni, Fabienne; Arnet, Isabelle

    2013-07-01

    Given the importance of high adherence to long-term pharmacotherapy and the growing need to improve medication adherence, choosing the best intervention represents a challenge for healthcare providers. A dose-dispensing service is defined as the repackaging of solid oral medication into dose-dispensing aids by a healthcare provider, mostly in a community pharmacy or hospital pharmacy, in order to assist patients in the management of their polymedication. The personalized dose-dispensing aid organizes individual oral doses according to their prescribed intake schedule throughout the day and the week. This review aims to describe the pros and cons of different dose-dispensing services and technologies, summarizes current evidence and addresses research gaps.

  10. Stroke awareness among Dubai emergency medical service staff and impact of an educational intervention.

    PubMed

    Shire, Fatima; Kasim, Zahra; Alrukn, Suhail; Khan, Maria

    2017-07-06

    Emergency medical services (EMS) play a vital role in expediting hospital arrival in stroke patients. The objective of our study was to assess the level of awareness regarding pre-hospital identification and management of acute stroke among EMS Staff in Dubai and to evaluate the impact of an educational lecture on their knowledge. Ours was a cross-sectional study with a pre-test and post-test design. The intervention was an educational lecture, based on the updated guidelines in pre-hospital care of acute stroke. Participants were assessed before and after the intervention on various aspects of stroke care. Paired t test were used to compare the impact of the intervention. A total of 274 EMS workers participated in our study. The baseline knowledge of participants regarding stroke types was inadequate with only 68% correctly identifying these. 79% were able to name the cardinal stroke symptoms. Knowledge of stroke mimics was poor with only 6.6% identifying stroke mimics correctly. With respect to management, most participants were unable to correctly identify the points to illicit in the history of an acute stroke patient (25.2%) and also the steps in pre-hospital management (40%). All these aspects showed remarkable improvement post intervention. The baseline awareness of most aspects of acute stroke identification and management was poor in our EMS participants. Our educational lecture proved effective in improving this knowledge when tested immediately post intervention. However, there is a need to re-assess this at periodic intervals to identify the need for refresher courses on pre-hospital stroke management.

  11. Evaluation and management service in interventional pain practice: doing it right!

    PubMed

    Manchikanti, L

    2000-07-01

    Proper coding and documentation for evaluation and management services continuously and progressively are becoming not only complicated, but also confusing. Although medical evaluation of patients has been a fact of life since the beginnings of medical history, medicine has been substantially influenced by federal regulations since the enactment of Medicare. Physicians' fear of being prosecuted is increasing. This is reinforced by actions of the federal government in multiple cases with sky-high penalties and by the Office of the Inspector General's target of 600,000 physicians in practice in its work plan for the new millennium. Evaluation and management services utilization, medical necessity, and appropriate documentation for level and complexity of service are extremely important components of evaluation and management services. Similarly, differentiating between a consult versus a visit is also crucial to avoid upcoding, or in a worst-case scenario, downcoding. While the history is the same for all types of visits except for the complexity for each level, four types of physical examination are available, either in a general multisystem examination or a single-system examination. However, the complexity of medical decision making is the essential factor in deciding to which level the evaluation and management belong. This review will discuss various aspects of evaluation and management guidelines in interventional practice and also guide the physician in performing these evaluations in an appropriate manner with proper documentation, thus avoiding the pitfalls of fraud and abuse.

  12. The National Status of In-Service Professional Development Systems for Early Intervention and Early Childhood Special Education Practitioners

    ERIC Educational Resources Information Center

    Bruder, Mary Beth; Mogro-Wilson, Cristina; Stayton, Vicki D.; Dietrich, Sylvia L.

    2009-01-01

    Early intervention and preschool special education coordinators in the 50 states and territories were interviewed about the current status of professional development in-service systems in their state. A definition consisting of 8 components of an in-service professional development system was used to analyze the state systems. Twenty Part C early…

  13. Implementing a Statewide Screening, Brief Intervention, and Referral to Treatment (SBIRT) Service in Rural Health Settings: New Mexico SBIRT

    ERIC Educational Resources Information Center

    Gonzales, Arturo; Westerberg, Verner S.; Peterson, Thomas R.; Moseley, Ana; Gryczynski, Jan; Mitchell, Shannon Gwin; Buff, Gary; Schwartz, Robert P.

    2012-01-01

    This is a report on the New Mexico Screening, Brief Intervention, and Referral to Treatment (SBIRT) project conducted over 5 years as part of a national initiative launched by the Substance Abuse and Mental Health Services Administration with the aim of increasing integration of substance use services and medical care. Throughout the state, 53,238…

  14. Implementing a Statewide Screening, Brief Intervention, and Referral to Treatment (SBIRT) Service in Rural Health Settings: New Mexico SBIRT

    ERIC Educational Resources Information Center

    Gonzales, Arturo; Westerberg, Verner S.; Peterson, Thomas R.; Moseley, Ana; Gryczynski, Jan; Mitchell, Shannon Gwin; Buff, Gary; Schwartz, Robert P.

    2012-01-01

    This is a report on the New Mexico Screening, Brief Intervention, and Referral to Treatment (SBIRT) project conducted over 5 years as part of a national initiative launched by the Substance Abuse and Mental Health Services Administration with the aim of increasing integration of substance use services and medical care. Throughout the state, 53,238…

  15. The National Status of In-Service Professional Development Systems for Early Intervention and Early Childhood Special Education Practitioners

    ERIC Educational Resources Information Center

    Bruder, Mary Beth; Mogro-Wilson, Cristina; Stayton, Vicki D.; Dietrich, Sylvia L.

    2009-01-01

    Early intervention and preschool special education coordinators in the 50 states and territories were interviewed about the current status of professional development in-service systems in their state. A definition consisting of 8 components of an in-service professional development system was used to analyze the state systems. Twenty Part C early…

  16. Intervention-Based School Psychology Services: Training for Child-Level Accountability; Preparing for Program-Level Accountability

    ERIC Educational Resources Information Center

    Bonner, Mike; Barnett, David W.

    2004-01-01

    This research evaluated the outcomes of a school psychology training practicum by replicating intervention-based service delivery procedures established in prior research. The key components include describing a service delivery model, teaching the model, deriving practice guidelines that fit the model, supporting trainees in carrying out the…

  17. 32 CFR Appendix E to Part 57 - DoD-CC on Early Intervention, Special Education, and Related Services

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 1 2010-07-01 2010-07-01 false DoD-CC on Early Intervention, Special Education, and Related Services E Appendix E to Part 57 National Defense Department of Defense OFFICE OF THE... SERVICES TO ELIGIBLE DOD DEPENDENTS Pt. 57, App. E Appendix E to Part 57—DoD-CC on Early...

  18. Delivering interventions to reduce the global burden of stillbirths: improving service supply and community demand

    PubMed Central

    Bhutta, Zulfiqar A; Darmstadt, Gary L; Haws, Rachel A; Yakoob, Mohammad Yawar; Lawn, Joy E

    2009-01-01

    Background Although a number of antenatal and intrapartum interventions have shown some evidence of impact on stillbirth incidence, much confusion surrounds ideal strategies for delivering these interventions within health systems, particularly in low-/middle-income countries where 98% of the world's stillbirths occur. Improving the uptake of quality antenatal and intrapartum care is critical for evidence-based interventions to generate an impact at the population level. This concluding paper of a series of papers reviewing the evidence for stillbirth interventions examines the evidence for community and health systems approaches to improve uptake and quality of antenatal and intrapartum care, and synthesises programme and policy recommendations for how best to deliver evidence-based interventions at community and facility levels, across the continuum of care, to reduce stillbirths. Methods We systematically searched PubMed and the Cochrane Library for abstracts pertaining to community-based and health-systems strategies to increase uptake and quality of antenatal and intrapartum care services. We also sought abstracts which reported impact on stillbirths or perinatal mortality. Searches used multiple combinations of broad and specific search terms and prioritised rigorous randomised controlled trials and meta-analyses where available. Wherever eligible randomised controlled trials were identified after a Cochrane review had been published, we conducted new meta-analyses based on the original Cochrane criteria. Results In low-resource settings, cost, distance and the time needed to access care are major barriers for effective uptake of antenatal and particularly intrapartum services. A number of innovative strategies to surmount cost, distance, and time barriers to accessing care were identified and evaluated; of these, community financial incentives, loan/insurance schemes, and maternity waiting homes seem promising, but few studies have reported or evaluated the

  19. Caregivers' Perspectives on the Use of Long-Term Oxygen Therapy for the Treatment of Refractory Breathlessness: A Qualitative Study.

    PubMed

    Collier, Aileen; Breaden, Katrina; Phillips, Jane L; Agar, Meera; Litster, Caroline; Currow, David C

    2017-01-01

    Despite limited clinical evidence, long-term oxygen therapy (LTOT) is used for the management of refractory breathlessness in people with life-limiting illnesses who are not necessarily hypoxemic. The aim of this study was to understand caregiver factors associated with caring for someone with LTOT from the perspectives and experiences of caregivers themselves. The qualitative study used semistructured interviews. The study was conducted in two states in Australia. Participants (n = 20) were self-nominated caregivers of people receiving LTOT for refractory breathlessness in the palliative setting. Data analyses established one overarching theme titled: "Oxygen giveth (something to help caregivers relieve breathlessness) and oxygen taketh away (from patients who lose some autonomy)." The theme captured caregivers' feelings of extreme distress in response to witnessing refractory breathlessness, and oxygen fulfilling several critical and beneficial roles in this context. In parallel, caregivers also explicitly and implicitly articulated several downsides to the use of LTOT. Caregivers find caring for someone with refractory breathlessness extremely distressing. The benefits of LTOT are often overestimated, whereas its potential harms are underestimated. As significant stakeholders of people receiving LTOT, caregivers should be provided with opportunities to collaborate with clinicians in evidence-based decision making, efforts should be made to provide them with information and education about the most effective pharmacological and nonpharmacological strategies to manage refractory breathlessness in a palliative care setting including the appropriate use of LTOT to enable them to do so. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  20. Implementing outside the box: Community-based social service provider experiences with using an alcohol screening and intervention

    PubMed Central

    Patterson Silver Wolf (Adelv unegv Waya), David A.; Ramsey, Alex T.; van den Berk-Clark, Carissa

    2014-01-01

    Objective The aim of this study is better understand perceptions of front-line social service workers who are not addiction specialists, but have to address addiction-related issues during their standard services. Method Six social service organizations implemented a validated alcohol assessment and brief education intervention. After a 3-month trial implementation period, a convenience sample of 64 front-line providers participated in six focus groups to examine barriers and facilitators to the implementation of an alcohol screening and brief intervention. Results Three themes emerged: (1) usefulness of the intervention, (2) intervention being an appropriate fit with the agency and client population, and (3) worker commitment and proper utilization during the implementation process. Conclusions A cross-cutting theme that emerged was the context in which the intervention was implemented, as this was central to each of the three primary themes identified from the focus groups (i.e., the usefulness and appropriateness of the intervention and the implementation process overall). Practitioner buy-in concerns also indicate the need for better addiction service training opportunities for those without addiction-specific educational backgrounds. Future research should assess whether targeted trainings increase addiction screening and education in social services settings. PMID:25798019

  1. A Food Service Intervention Improves Whole Grain Access at Lunch in Rural Elementary Schools

    PubMed Central

    Cohen, Juliana F. W.; Rimm, Eric B.; Austin, S. Bryn; Hyatt, Raymond R.; Kraak, Vivica I.; Economos, Christina D.

    2015-01-01

    Background Whole grain (WG) options are often limited in schools, which may impact rural, low-income students who rely on school meals for a substantial portion of their food intake. This study examined the changes in the availability and quantity of WG and refined grain foods offered in schools participating in the Creating Healthy, Active and Nurturing Growing-up Environments (CHANGE) study, a randomized, controlled intervention among rural communities (4 intervention and 4 control). Methods Foods were assessed using production records, recipes, and nutrition labels from breakfast and lunch over 1week during fall 2008 and spring 2009. Key informant interviews were conducted with school food service directors in the spring 2009. Results The CHANGE intervention schools significantly increased the average percent of school days WGs were offered (p =.047) and the amount of WGs offered/food item (ounces) at lunch compared with control schools (p = .02). There was a significant decrease in the percent of students with access to refined grains at lunch compared with control schools (p =.049), although there were no significant differences in WG availability during breakfast. Conclusions The CHANGE schools improved WG availability, enabling student's WG consumption to be closer to national recommendations. PMID:24443783

  2. Integration of Technology-based Behavioral Health Interventions in Substance Abuse and Addiction Services

    PubMed Central

    Ramsey, Alex

    2015-01-01

    The past decade has witnessed revolutionary changes to the delivery of health services, ushered in to a great extent by the introduction of electronic health record systems. More recently, a new class of technological advancements—technology-based behavioral health interventions, which involve the delivery of evidence-informed practices via computers, web-based applications, mobile phones, wearable sensors, or other technological platforms—has emerged and is primed to once again radically shift current models for behavioral healthcare. Despite the promise and potential of these new therapeutic approaches, a greater understanding of the impact of technology-based interventions on cornerstone issues of mental health and addiction services—namely access, quality, and cost—is needed. The current review highlights 1) relevant conceptual frameworks that guide this area of research, 2) key studies that inform the relevance of technology-based interventions for behavioral healthcare access, quality, and cost, 3) pressing methodological issues that require attention, 4) unresolved questions that warrant further investigation, and 5) practical implications that underscore important new directions for this emerging area of research. PMID:26161047

  3. Enhancement of Pre-Service Teachers' Teaching Interventions with the Aid of Historical Examples

    NASA Astrophysics Data System (ADS)

    Spiliotopoulou-Papantoniou, Vasiliki; Agelopoulos, Konstantinos

    2009-09-01

    This paper focuses on the attempt to include a historical perspective in a pre-service teacher education course. It is based on the design research approach and the main aim is the development of a product, a module for student-teachers’ actual involvement in the historic teaching design process. Student-teachers were presented and familiarized with the reasons for including a historical component in teaching, and with the meaning and teaching function of three historical examples. They were asked to search for historical materials on the basis of which they had to design teaching interventions justifying their choices. Total of 74 teaching interventions have been analyzed and a systemic network has been produced with the identified categories of their characteristics. Two case studies of students’ interventions with their historical materials are also discussed. Findings show that the group of student-teachers studied was able to develop a range of interesting materials. Traditional models of teaching that are held by student-teachers are obstacles for substantiating the historical perspective. Only a few student-teachers succeed in stating meaningful epistemic goals, while some others lack awareness of the potential of their own material for communicating aspects of the nature of science to students. Results appear that can lead to a future module’s revision, and further research steps.

  4. A food service intervention improves whole grain access at lunch in rural elementary schools.

    PubMed

    Cohen, Juliana F W; Rimm, Eric B; Austin, S Bryn; Hyatt, Raymond R; Kraak, Vivica I; Economos, Christina D

    2014-03-01

    Whole grain (WG) options are often limited in schools, which may impact rural, low-income students who rely on school meals for a substantial portion of their food intake. This study examined the changes in the availability and quantity of WG and refined grain foods offered in schools participating in the Creating Healthy, Active and Nurturing Growing-up Environments (CHANGE) study, a randomized, controlled intervention among rural communities (4 intervention and 4 control). Foods were assessed using production records, recipes, and nutrition labels from breakfast and lunch over 1 week during fall 2008 and spring 2009. Key informant interviews were conducted with school food service directors in the spring 2009. The CHANGE intervention schools significantly increased the average percent of school days WGs were offered (p = .047) and the amount of WGs offered/food item (ounces) at lunch compared with control schools (p = .02). There was a significant decrease in the percent of students with access to refined grains at lunch compared with control schools (p = .049), although there were no significant differences in WG availability during breakfast. The CHANGE schools improved WG availability, enabling student's WG consumption to be closer to national recommendations. © 2014, American School Health Association.

  5. TechCare: mobile assessment and therapy for psychosis – an intervention for clients in the Early Intervention Service: A feasibility study protocol

    PubMed Central

    Husain, Nusrat; Gire, Nadeem; Kelly, James; Duxbury, Joy; McKeown, Mick; Riley, Miv; Taylor, Christopher DJ; Taylor, Peter J; Emsley, Richard; Farooq, Saeed; Caton, Neil; Naeem, Farooq; Kingdon, David; Chaudhry, Imran

    2016-01-01

    Objectives: Technological advances in healthcare have shown promise when delivering interventions for mental health problems such as psychosis. The aim of this project is to develop a mobile phone intervention for people with psychosis and to conduct a feasibility study of the TechCare App. Methods: The TechCare App will assess participant’s symptoms and respond with a personalised guided self-help-based psychological intervention with the aim of exploring feasibility and acceptability. The project will recruit 16 service users and 8–10 health professionals from the Lancashire Care NHS Foundation Trust Early Intervention Service. Results: In strand 1 of the study, we will invite people to discuss their experience of psychosis and give their opinions on the existing evidence-based treatment (cognitive behavioural therapy) and how the mobile app can be developed. In strand 2, we will complete a test run with a small number of participants (n = 4) to refine the mobile intervention (TechCare). Finally, in strand 3 of the study, the TechCare App will be examined in a feasibility study with 12 participants. Conclusion: It has been suggested that there is a need for a rapid increase in the efforts to develop the evidence base for the clinical effectiveness of digital technologies, considering mHealth research can potentially be helpful in addressing the demand on mental health services globally. PMID:27790373

  6. Quality of Antenatal care services in eastern Uganda: implications for interventions

    PubMed Central

    Tetui, Moses; Ekirapa, Elizabeth Kiracho; Bua, John; Mutebi, Aloysius; Tweheyo, Raymond; Waiswa, Peter

    2012-01-01

    Introduction More efforts need to be directed to improving the quality of maternal health in developing countries if we are to keep on track with meeting the fifth millennium development goal. The World Health Organization says developing countries account for over 90% of maternal deaths of which three fifths occur in Sub-Saharan African countries like Uganda. Abortion, obstetric complications such as hemorrhage, dystocia, eclampsia, and sepsis are major causes of maternal deaths here. Good quality Antenatal Care (ANC) provides opportunity to detect and respond to risky maternal conditions. This study assessed quality of ANC services in eastern Uganda with a goal of benchmarking implications for interventions. Methods Data was collected from 15 health facilities in Eastern Uganda to establish capacity of delivering ANC services. Observation checklists were used to assess structural components and completeness of the ANC consultation process among 291 women attending it. Lastly, structured exit-interviews were conducted to assess satisfaction of patients. Data analysis was done in STATA Version 10. Results There was an overall staffing gap of over 40%, while infection control facilities, drugs and supplies were inadequate. However, there was good existence of physical infrastructure and diagnostic equipment for ANC services. It was observed that counseling for risk factors and birth preparedness was poorly done; in addition essential tests were not done for the majority of clients. Conclusion To improve the quality of ANC, interventions need to improve staffing, infection control facilities and drug-supplies. In addition to better counseling for risk factor-recognition and birth preparedness. PMID:23308332

  7. A Randomized Trial of a Tailored Barriers Intervention for Cancer Information Service (CIS) Callers in Pain

    PubMed Central

    Ward, Sandra E.; Wang, Ko Kung; Serlin, Ronald C.; Peterson, Shelly L.; Murray, Mary Ellen

    2010-01-01

    Cancer pain management can be improved by overcoming patients’ attitudinal barriers to reporting pain and using analgesics. A simple cost-effective barriers intervention designed to reach a large number of persons with cancer has not yet been tested. Such an intervention should be tested against barriers’ assessment-alone, as well as no-treatment control. The purpose of this study was to test the efficacy and the cost-effectiveness of a Tailored Barriers Intervention (TBI), an educational intervention tailored to participants’ attitudinal barriers toward reporting pain and using analgesics. This was a randomized three-group (TBI, assessment-alone, or control) trial with measures at baseline and 28 days later conducted at the NorthCentral and Heartland offices of the Cancer Information Service (CIS), an NCI program that provides information to persons seeking answers to cancer-related questions. Participants (1256 adult CIS callers diagnosed with cancer with moderate to severe pain in the past week) joined the study and were randomized. Of those participants, 970 (77.23%) provided follow up data. The TBI consisted of educational messages tailored to each participant’s attitudinal barriers, delivered orally over the telephone, followed by a printed mailed copy. The outcome measures were attitudinal barriers to pain management, as well as pain outcomes (duration, severity, and interference with life activities). At follow-up the TBI group had significantly lower attitudinal barriers scores compared to assessment-alone and control, but the groups did not differ on the pain outcome variables. TBI and assessment alone had similar cost effectiveness. The TBI needs to be strengthened to achieve reductions in pain severity. PMID:19406576

  8. Community Participation Patterns Among Preschool-Aged Children who Have Received Part C Early Intervention Services

    PubMed Central

    Khetani, Mary; Graham, James E.; Alvord, Christina

    2017-01-01

    Background We examined activity-specific patterns and child, family, and environmental correlates of participation restriction in nine community-based activities among preschoolers with disabilities who have received Part C early intervention services. Methods Data were gathered from a subsample of 1509 caregivers whose children (mean age = 67.7 months) had enrolled in the National Early Intervention Longitudinal Study (NEILS) and completed a 40-minute computerized telephone interview or 12-page mailed survey. Data were analyzed on cases with complete data on the variables of interest. Bivariate relationships were examined between variables, including patterns of co-reporting participation difficulties for pairs of community activities. Results Caregivers were more than twice as likely to report difficulty in 1 activity (20%) than difficulties in 2–3, 4–5, or 6–9 activities. Co-reporting paired difficulties was strong for activities pertaining to neighborhood outings but less conclusive for community-sponsored activities and recreation and leisure activities. Our data show strong and positive associations between child functional limitations in mobility, toileting, feeding, speech, safety awareness, and friendships and participation difficulty in 7 to 9 activities. Lower household income was associated with participation difficulty in 7 out of 9 activities and difficulty managing problematic behavior was strongly associated with participation difficulty in all 9 activities. Each of the 3 environmental variables (limited access to social support, transportation, and respite) was associated with participation restrictions in all 9 activities. Conclusion Results provide practitioners with detailed descriptive knowledge about modifiable factors related to the child, family, and environment for promoting young children’s community participation, as well information to support development of a comprehensive assessment tool for research and intervention planning

  9. Involving service users in intervention design: a participatory approach to developing a text-messaging intervention to reduce repetition of self-harm.

    PubMed

    Owens, Christabel; Farrand, Paul; Darvill, Ruth; Emmens, Tobit; Hewis, Elaine; Aitken, Peter

    2011-09-01

    OBJECTIVE To engage a group of people with relevant lived experience in the development of a text-messaging intervention to reduce repetition of self-harm. BACKGROUND Contact-based interventions, such as follow-up letters, postcards and telephone calls, have shown potential to reduce repetition of self-harm in those who present at Accident and Emergency departments. Text messaging offers a low-cost alternative that has not been tested. We set out to develop a text-based intervention. The process of intervention development is rarely reported and little is known about the impact of service user involvement on intervention design. METHOD We held a series of six participatory workshops and invited service users and clinicians to help us work out how to get the right message to the right person at the right time, and to simulate and test prototypes of an intervention. RESULTS Service users rejected both the idea of a generic, 'one size fits all' approach and that of 'audience segmentation', maintaining that text messages could be safe and effective only if individualized. This led us to abandon our original thinking and develop a way of supporting individuals to author their own self-efficacy messages and store them in a personal message bank for withdrawal at times of crisis. CONCLUSIONS This paper highlights both the challenge and the impact of involving consumers at the development stage. Working with those with lived experience requires openness, flexibility and a readiness to abandon or radically revise initial plans, and may have unexpected consequences for intervention design.

  10. Involving service users in intervention design: a participatory approach to developing a text‐messaging intervention to reduce repetition of self‐harm

    PubMed Central

    Owens, Christabel; Farrand, Paul; Darvill, Ruth; Emmens, Tobit; Hewis, Elaine; Aitken, Peter

    2010-01-01

    Abstract Objective  To engage a group of people with relevant lived experience in the development of a text‐messaging intervention to reduce repetition of self‐harm. Background  Contact‐based interventions, such as follow‐up letters, postcards and telephone calls, have shown potential to reduce repetition of self‐harm in those who present at Accident and Emergency departments. Text messaging offers a low‐cost alternative that has not been tested. We set out to develop a text‐based intervention. The process of intervention development is rarely reported and little is known about the impact of service user involvement on intervention design. Method  We held a series of six participatory workshops and invited service users and clinicians to help us work out how to get the right message to the right person at the right time, and to simulate and test prototypes of an intervention. Results  Service users rejected both the idea of a generic, ‘one size fits all’ approach and that of ‘audience segmentation’, maintaining that text messages could be safe and effective only if individualized. This led us to abandon our original thinking and develop a way of supporting individuals to author their own self‐efficacy messages and store them in a personal message bank for withdrawal at times of crisis. Conclusions  This paper highlights both the challenge and the impact of involving consumers at the development stage. Working with those with lived experience requires openness, flexibility and a readiness to abandon or radically revise initial plans, and may have unexpected consequences for intervention design. PMID:20860777

  11. Cost-effectiveness of early intervention services for psychosis and fidelity to national policy implementation guidance.

    PubMed

    Radhakrishnan, Muralikrishnan; McCrone, Paul; Lafortune, Louise; Everard, Linda; Fowler, David; Amos, Tim; Freemantle, Nick; Singh, Swaran P; Marshall, Max; Sharma, Vimal; Lavis, Anna; Jones, Peter B; Birchwood, Max

    2017-08-31

    Early intervention services (EIS) for psychosis are being implemented, internationally. It is important to learn from established examples and define the components and intensity of services that provide good value for money. This study aims to assess the cost-effectiveness of EIS according to how closely they adhered to the recommendations of the English Department of Health 2001 Policy Implementation Guide (PIG). EIS from the National Eden Study were assessed using a measure of fidelity to the PIG that rated the presence or absence of 64 recommended items relating to team structure and practice. EIS were then classified into three groups: those with fidelity of 75-80%, 81-90% and 91-95%. Patient-level resource use and outcomes were measured 1 year following inception into the service; costs were calculated and combined with quality-adjusted life years (QALYs) gained. At a threshold of £20 000 per QALY, the 81-90% fidelity group had a 56.3% likelihood of being the most cost-effective option followed by 75-80% fidelity at 35.8% and 91-95% fidelity group (7.9%). The results from England suggest that striving to maximize fidelity may not be warranted, but that dropping below a certain level of fidelity may result in inefficient use of resources. © 2017 John Wiley & Sons Australia, Ltd.

  12. Alcohol Screening and Brief Intervention in Workplace Settings and Social Services: A Comparison of Literature

    PubMed Central

    Schulte, Bernd; O’Donnell, Amy Jane; Kastner, Sinja; Schmidt, Christiane Sybille; Schäfer, Ingo; Reimer, Jens

    2014-01-01

    Background: The robust evidence base for the effectiveness of alcohol screening and brief interventions (ASBIs) in primary health care (PHC) suggests that a widespread expansion of ASBI in non-medical settings could be beneficial. Social service and criminal justice settings work frequently with persons with alcohol use disorders, and workplace settings can be an appropriate setting for the implementation of alcohol prevention programs, as a considerable part of their social interactions takes place in this context. Methods: Update of two systematic reviews on ASBI effectiveness in workplaces, social service, and criminal justice settings. Review to identify implementation barriers and facilitators and future research needs of ASBI in non-medical settings. Results: We found a limited number of randomized controlled trials in non-medical settings with an equivocal evidence of effectiveness of ASBI. In terms of barriers and facilitators to implementation, the heterogeneity of non-medical settings makes it challenging to draw overarching conclusions. In the workplace, employee concerns with regard to the consequences of self-disclosure appear to be key. For social services, the complexity of certain client needs suggest that a stepped and carefully tailored approach is likely to be required. Discussion: Compared to PHC, the reviewed settings are far more heterogeneous in terms of client groups, external conditions, and the focus on substance use disorders. Thus, future research should try to systematize these differences, and consider their implications for the deliverability, acceptance, and potential effectiveness of ASBI for different target groups, organizational frameworks, and professionals. PMID:25339914

  13. Alcohol screening and brief intervention in workplace settings and social services: a comparison of literature.

    PubMed

    Schulte, Bernd; O'Donnell, Amy Jane; Kastner, Sinja; Schmidt, Christiane Sybille; Schäfer, Ingo; Reimer, Jens

    2014-01-01

    The robust evidence base for the effectiveness of alcohol screening and brief interventions (ASBIs) in primary health care (PHC) suggests that a widespread expansion of ASBI in non-medical settings could be beneficial. Social service and criminal justice settings work frequently with persons with alcohol use disorders, and workplace settings can be an appropriate setting for the implementation of alcohol prevention programs, as a considerable part of their social interactions takes place in this context. Update of two systematic reviews on ASBI effectiveness in workplaces, social service, and criminal justice settings. Review to identify implementation barriers and facilitators and future research needs of ASBI in non-medical settings. We found a limited number of randomized controlled trials in non-medical settings with an equivocal evidence of effectiveness of ASBI. In terms of barriers and facilitators to implementation, the heterogeneity of non-medical settings makes it challenging to draw overarching conclusions. In the workplace, employee concerns with regard to the consequences of self-disclosure appear to be key. For social services, the complexity of certain client needs suggest that a stepped and carefully tailored approach is likely to be required. Compared to PHC, the reviewed settings are far more heterogeneous in terms of client groups, external conditions, and the focus on substance use disorders. Thus, future research should try to systematize these differences, and consider their implications for the deliverability, acceptance, and potential effectiveness of ASBI for different target groups, organizational frameworks, and professionals.

  14. Bridging the gap between the science and service of HIV prevention: transferring effective research-based HIV prevention interventions to community AIDS service providers.

    PubMed Central

    Kelly, J A; Somlai, A M; DiFranceisco, W J; Otto-Salaj, L L; McAuliffe, T L; Hackl, K L; Heckman, T G; Holtgrave, D R; Rompa, D

    2000-01-01

    OBJECTIVES: AIDS service organizations (ASOs) rarely have access to the information needed to implement research-based HIV prevention interventions for their clients. We compared the effectiveness of 3 dissemination strategies for transferring HIV prevention models from the research arena to community providers of HIV prevention services. METHODS: Interviews were conducted with the directors of 74 ASOs to assess current HIV prevention services. ASOs were randomized to programs that provided (1) technical assistance manuals describing how to implement research-based HIV prevention interventions, (2) manuals plus a staff training workshop on how to conduct the implementation, or (3) manuals, the training workshop, and follow-up telephone consultation calls. Follow-up interviews determined whether the intervention model had been adopted. RESULTS: The dissemination package that provided ASOs with implementation manuals, staff training workshops, and follow-up consultation resulted in more frequent adoption and use of the research-based HIV prevention intervention for gay men, women, and other client populations. CONCLUSIONS: Strategies are needed to quickly transfer research-based HIV prevention methods to community providers of HIV prevention services. Active collaboration between researchers and service agencies results in more successful program adoption than distribution of implementation packages alone. PMID:10897186

  15. The midwifery initiated oral health-dental service protocol: an intervention to improve oral health outcomes for pregnant women.

    PubMed

    Johnson, Maree; George, Ajesh; Dahlen, Hannah; Ajwani, Shilpi; Bhole, Sameer; Blinkhorn, Anthony; Ellis, Sharon; Yeo, Anthony

    2015-01-15

    Evidence is emerging that women's poor oral health and health practices during pregnancy are associated with poor oral health in their children and potentially an increased risk of pre-term or low-birth weight infants. The Midwifery Initiated Oral Health-Dental Service (MIOH-DS) trial is a three arm multicentre randomised controlled trial which will recruit women from three metropolitan hospitals aimed at improving women's oral health and service access and indirectly reducing perinatal morbidity. All three arms of the trial will deliver oral health promotion material, although a midwife oral assessment and referral to private/public/health fund dental services pathway (Intervention Group 1) and the midwife oral assessment and referral to local free public dental services pathway (Intervention Group 2) will be compared to the control group of oral health promotional material only. Midwives will undergo specific oral health education and competency testing to undertake this novel intervention. This efficacy trial will promote a new partnership between midwives and dentists focused on enhancing the oral health of women and their infants. Should the intervention be found effective, this intervention, with existing on-line educational program for midwives, can be easily transferred into practice for large metropolitan health services within and beyond Australia. Further cost-benefit analysis is proposed to inform national health policy. Australian New Zealand Clinical Trials Registry ACTRN12612001271897.

  16. Using process indicators to optimize service completion of an ED drug and alcohol brief intervention program.

    PubMed

    Akin, Joanna; Johnson, J Aaron; Seale, J Paul; Kuperminc, Gabriel P

    2015-01-01

    The strongest evidence for effectiveness of screening, brief intervention, and referral to treatment (SBIRT) programs is in primary care settings. Emergency department (ED) studies have shown mixed results. Implementation of SBIRT into ED settings is complicated by the type of patients seen and the fast-paced, high-throughput nature of the ED environment that makes it difficult to reach patients flagged for SBIRT services. This study uses data from an ED-based SBIRT program to examine the relationship between screen-positive rate, ED patient flow, and SBIRT service delivery. Data for the study (N = 67137) were derived from weekly reports extracted directly from one hospital's electronic health record. Measures included time and day of patient entry, drug/alcohol screen result (positive or negative), and whether the patient was reached by SBIRT specialists. Factorial analysis of variance compared variations in screen-positive rates by day and time and the percentage of patients reached by SBIRT specialists during these periods. Overall, 56% of screen-positive patients received SBIRT services. Only 5% of patients offered SBIRT services refused. Day and time of entry had a significant interaction effect on the reached rate (F12,14166 =3.48, P < .001). Although patient volume was lowest between 11 pm and 7 am, screen-positive rates were highest during this period, particularly on weekends; and patients were least likely to be reached during these periods. When implementing an ED-based SBIRT program, thoughtful consideration should be given to patient flow and staffing to maximize program impact and increase the likelihood of sustainability. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Specialty substance use disorder services following brief alcohol intervention: a meta-analysis of randomized controlled trials.

    PubMed

    Glass, Joseph E; Hamilton, Ashley M; Powell, Byron J; Perron, Brian E; Brown, Randall T; Ilgen, Mark A

    2015-09-01

    Brief alcohol interventions in medical settings are efficacious in improving self-reported alcohol consumption among those with low-severity alcohol problems. Screening, Brief Intervention and Referral to Treatment initiatives presume that brief interventions are efficacious in linking patients to higher levels of care, but pertinent evidence has not been evaluated. We estimated main and subgroup effects of brief alcohol interventions, regardless of their inclusion of a referral-specific component, in increasing the utilization of alcohol-related care. A systematic review of English language papers published in electronic databases to 2013. We included randomized controlled trials (RCTs) of brief alcohol interventions in general health-care settings with adult and adolescent samples. We excluded studies that lacked alcohol services utilization data. Extractions of study characteristics and outcomes were standardized and conducted independently. The primary outcome was post-treatment alcohol services utilization assessed by self-report or administrative data, which we compared across intervention and control groups. Thirteen RCTs met inclusion criteria and nine were meta-analyzed (n = 993 and n = 937 intervention and control group participants, respectively). In our main analyses the pooled risk ratio (RR) was = 1.08, 95% confidence interval (CI) = 0.92-1.28. Five studies compared referral-specific interventions with a control condition without such interventions (pooled RR = 1.08, 95% CI = 0.81-1.43). Other subgroup analyses of studies with common characteristics (e.g. age, setting, severity, risk of bias) yielded non-statistically significant results. There is a lack of evidence that brief alcohol interventions have any efficacy for increasing the receipt of alcohol-related services. © 2015 Society for the Study of Addiction.

  18. The potential benefit of a home fire safety intervention during emergency medical services calls.

    PubMed

    Pirrallo, R G; Rubin, J M; Murawsky, G A

    1998-03-01

    To determine how often house fires occur at 1- and 2-family dwellings visited previously by emergency medical services (EMS) personnel and whether these visits were missed opportunities for a point-of-contact home fire safety intervention. A retrospective, consecutive, case series analysis of all Milwaukee Fire Department alarm responses during 1994 was performed. Measurements included date of service, type of response, property type, dollar loss estimate, number of injuries and fatalities, cause of alarm, and presence of an operational smoke detector. Descriptive, chi2, and relative risk statistics were used to describe the relationship between EMS responses and fire responses at 1- and 2-family dwellings. The Milwaukee Fire Department dispatched 94,378 requests for service to 43,556 addresses. 16,150 addresses generated multiple requests; 7.2% (1,162/16,150) were for an "alarm of fire" response [relative risk 1.83 (95% CI: 1.69-1.99) for addresses with multiple requests vs those with a single request for service]. Most [62% (721/1,162)] of the addresses were visited by EMS personnel prior to the alarm; 28% (205/721) were 1- and 2-family dwellings. A mean of 1.8 (376/205) EMS responses occurred prior to the "alarm of fire" response; 121 addresses received 1 response, 46 received 2, 18 received 3, and 20 received > or = 4 responses. Of 169 addresses with complete data, there was a total fire dollar loss of $1,963,020 (1994) along with 32 injuries and 0 fatalities. While 47% (80/169) of the 1- and 2-family dwellings had a smoke detector present, only 17% (29/169) of the dwellings had an operational smoke detector. A point-of-contact home fire safety intervention appears of potential benefit for frequent users of EMS care. Determination of the presence of an operational smoke detector in 1- and 2-family dwellings may be a useful injury prevention act during such EMS calls.

  19. Communication Services and Supports for Individuals With Severe Disabilities: Guidance for Assessment and Intervention.

    PubMed

    Brady, Nancy C; Bruce, Susan; Goldman, Amy; Erickson, Karen; Mineo, Beth; Ogletree, Bill T; Paul, Diane; Romski, Mary Ann; Sevcik, Rose; Siegel, Ellin; Schoonover, Judith; Snell, Marti; Sylvester, Lorraine; Wilkinson, Krista

    2016-03-01

    The National Joint Committee for the Communication Needs of People With Severe Disabilities (NJC) reviewed literature regarding practices for people with severe disabilities in order to update guidance provided in documents originally published in 1992. Changes in laws, definitions, and policies that affect communication attainments by persons with severe disabilities are presented, along with guidance regarding assessment and intervention practices. A revised version of the Communication Bill of Rights, a powerful document that describes the communication rights of all individuals, including those with severe disabilities is included in this article. The information contained within this article is intended to be used by professionals, family members, and individuals with severe disabilities to inform and advocate for effective communication services and opportunities.

  20. Communication Services and Supports for Individuals with Severe Disabilities: Guidance for Assessment and Intervention

    PubMed Central

    Brady, Nancy C.; Bruce, Susan; Goldman, Amy; Erickson, Karen; Mineo, Beth; Ogletree, Bill T.; Paul, Diane; Romski, Mary Ann; Sevcik, Rose; Siegel, Ellin; Schoonover, Judith; Snell, Marti; Sylvester, Lorraine; Wilkinson, Krista

    2015-01-01

    The National Joint Committee for the Communication Needs of People with Severe Disabilities (NJC) reviewed literature regarding practices for people with severe disabilities in order to update guidance provided in documents originally published in 1992. Changes in laws, definitions, and policies that affect communication attainments by persons with severe disabilities are presented, along with guidance regarding assessment and intervention practices. A revised version of the Communication Bill of Rights, a powerful document that describes the communication rights of all individuals, including those with severe disabilities is included in this article. The information contained within this article is intended to be used by professionals, family members, and individuals with severe disabilities to inform and advocate for effective communication services and opportunities. PMID:26914467

  1. Consumer experience of formal crisis-response services and preferred methods of crisis intervention.

    PubMed

    Boscarato, Kara; Lee, Stuart; Kroschel, Jon; Hollander, Yitzchak; Brennan, Alice; Warren, Narelle

    2014-08-01

    The manner in which people with mental illness are supported in a crisis is crucial to their recovery. The current study explored mental health consumers' experiences with formal crisis services (i.e. police and crisis assessment and treatment (CAT) teams), preferred crisis supports, and opinions of four collaborative interagency response models. Eleven consumers completed one-on-one, semistructured interviews. The results revealed that the perceived quality of previous formal crisis interventions varied greatly. Most participants preferred family members or friends to intervene. However, where a formal response was required, general practitioners and mental health case managers were preferred; no participant wanted a police response, and only one indicated a preference for CAT team assistance. Most participants welcomed collaborative crisis interventions. Of four collaborative interagency response models currently being trialled internationally, participants most strongly supported the Ride-Along Model, which enables a police officer and a mental health clinician to jointly respond to distressed consumers in the community. The findings highlight the potential for an interagency response model to deliver a crisis response aligned with consumers' preferences.

  2. Informing alcohol interventions for student service members/veterans: Normative perceptions and coping strategies.

    PubMed

    Miller, Mary Beth; Brett, Emma I; Leavens, Eleanor L; Meier, Ellen; Borsari, Brian; Leffingwell, Thad R

    2016-06-01

    The current study aimed to inform future interventions for heavy alcohol use and problems among college students by examining the utility of normative perceptions and coping strategies in predicting alcohol use among student service members/Veterans (SSM/Vs). SSM/Vs and civilian students (N=319) at a large university in the Southern Plains completed self-report measures of demographics, alcohol use and related behaviors, and coping strategies. Both SSM/Vs and civilian students significantly overestimated the typical weekly drinking quantities and frequencies of same-sex students on campus. Among SSM/Vs, normative perceptions of typical student (not military-specific) drinking and substance-related coping strategies significantly predicted drinks consumed per week, while substance-related coping predicted alcohol-related consequences. Despite the theoretical importance of similarity to normative referents, military-specific norms did not significantly improve the prediction of SSM/Vs' personal drinking behavior. Moreover, neither typical student nor military-specific norms predicted alcohol-related consequences among SSM/Vs after accounting for substance-related coping strategies. Future research may examine the efficacy of descriptive normative feedback and the importance of military-specific norms in alcohol interventions for SSM/Vs. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Impact of a learning circle intervention across academic and service contexts on developing a learning culture.

    PubMed

    Walker, Rachel; Henderson, Amanda; Cooke, Marie; Creedy, Debra

    2011-05-01

    Partnerships between university schools of nursing and health services lead to successful learning experiences for students and staff. A purposive sample of academics and students from a university school of nursing and clinicians from three health institutions involved in clinical learning (n=73) actively participated in a learning circles intervention conducted over 5 months in south east Queensland. Learning circle discussions resulted in enhanced communication and shared understanding regarding: (1) staff attitudes towards students, expectations and student assessment; (2) strategies enhancing preparation of students, mechanisms for greater support of and recognition of clinicians; (3) challenges faced by staff in the complex processes of leadership in clinical nursing education; (4) construction of learning, ideas for improving communication, networking and sharing; and (5) questioning routine practices that may not enhance student learning. Pre-post surveys of hospital staff (n=310) revealed significant differences across three sub-scales of 'accomplishment' (t=-3.98, p<.001), 'recognition' (t=-2.22, p<.027) and 'influence' (t=-11.82, p<.001) but not 'affiliation'. Learning circles can positively enhance organisational learning culture. The intervention enabled participants to recognise mutual goals. Further investigation around staff perception of their influence on their workplace is required.

  4. Informing Alcohol Interventions for Student Service Members/Veterans: Normative Perceptions and Coping Strategies

    PubMed Central

    Miller, Mary Beth; Brett, Emma I.; Leavens, Eleanor L.; Meier, Ellen; Borsari, Brian; Leffingwell, Thad R.

    2016-01-01

    Objective The current study aimed to inform future interventions for heavy alcohol use and problems among college students by examining the utility of normative perceptions and coping strategies in predicting alcohol use among student service members/Veterans (SSM/Vs). Methods SSM/Vs and civilian students (N = 319) at a large university in the Southern Plains completed self-report measures of demographics, alcohol use and related behaviors, and coping strategies. Results Both SSM/Vs and civilian students significantly overestimated the typical weekly drinking quantities and frequencies of same-sex students on campus. Among SSM/Vs, normative perceptions of typical student (not military-specific) drinking and substance-related coping strategies significantly predicted drinks consumed per week, while substance-related coping predicted alcohol-related consequences. Conclusions Despite the theoretical importance of similarity to normative referents, military-specific norms did not significantly improve the prediction of SSM/Vs’ personal drinking behavior. Moreover, neither typical student nor military-specific norms predicted alcohol-related consequences among SSM/Vs after accounting for substance-related coping strategies. Future research may examine the efficacy of descriptive normative feedback and the importance of military-specific norms in alcohol interventions for SSM/Vs. PMID:26894552

  5. Concussion treatment after combat trauma: development of a telephone based, problem solving intervention for service members.

    PubMed

    Bell, Kathleen R; Brockway, Jo Ann; Fann, Jesse R; Cole, Wesley R; St De Lore, Jef; Bush, Nigel; Lang, Ariel J; Hart, Tessa; Warren, Michael; Dikmen, Sureyya; Temkin, Nancy; Jain, Sonia; Raman, Rema; Stein, Murray B

    2015-01-01

    Military service members (SMs) and veterans who sustain mild traumatic brain injuries (mTBI) during combat deployments often have co-morbid conditions but are reluctant to seek out therapy in medical or mental health settings. Efficacious methods of intervention that are patient-centered and adaptable to a mobile and often difficult-to-reach population would be useful in improving quality of life. This article describes a new protocol developed as part of a randomized clinical trial of a telephone-mediated program for SMs with mTBI. The 12-session program combines problem solving training (PST) with embedded modules targeting depression, anxiety, insomnia, and headache. The rationale and development of this behavioral intervention for implementation with persons with multiple co-morbidities is described along with the proposed analysis of results. In particular, we provide details regarding the creation of a treatment that is manualized yet flexible enough to address a wide variety of problems and symptoms within a standard framework. The methods involved in enrolling and retaining an often hard-to-study population are also highlighted. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. An Intervention Targeting Service Providers and Clients for Methadone Maintenance Treatment in China: A Cluster-randomized Trial

    PubMed Central

    Li, Li; Wu, Zunyou; Liang, Li-Jung; Lin, Chunqing; Zhang, Linglin; Guo, Sam; Rou, Keming; Li, Jianhua

    2012-01-01

    Aims This study examines the preliminary outcomes of an intervention targeting service providers in methadone maintenance therapy clinics in China. The intervention effects on both service providers and clients are reported. Design The MMT CARE intervention pilot was developed and implemented collaboratively with local health educators. After three group intervention sessions, trained providers in intervention clinics delivered two individual motivational interviewing sessions with their clients. Settings Six clinics in Sichuan, China, were randomized to either the MMT CARE intervention condition or a standard care condition. Participants A total of 41 providers and 179 clients were sampled from the six clinics. Measurements At baseline and 3-, 6-, and 9-month assessments, providers completed self-administrated paper/pencil questionnaires regarding provider-client interaction, methadone maintenance therapy knowledge, perceived job-related stigma, and clinic support. Clients completed a face-to-face survey about their concurrent drug use and drug avoidance self-efficacy. Mixed-effects regression models with clinic-level random effect were used to assess the intervention effects. Findings Significant intervention effects for providers were found in improved methadone maintenance therapy knowledge, provider-client interaction, and perceived clinic support. For clients, better improvements in drug avoidance self-efficacy and reduced concurrent drug use were observed for the intervention compared to the standard care group. Conclusions The methadone maintenance therapy CARE intervention targeting providers in methadone maintenance clinics can improve providers’ treatment knowledge and their interaction with clients. The intervention can also reduce clients’ drug using behavior through motivational interviewing sessions conducted by trained providers. PMID:22788780

  7. Self-reported symptoms of chronic cough and breathlessness in working-age men in the city of Izhevsk, Russia: associations with cardiovascular disease risk factors and comorbidities

    PubMed Central

    Cook, Sarah; Quint, Jennifer K; Vasiljev, Maxim; Leon, David A

    2015-01-01

    Introduction Very little is known about the prevalence of respiratory symptoms or their associations with other health conditions in Russia. Methods Between 2008 and 2010, a sample of 983 men resident in Izhevsk, Russia, took part in a cross-sectional survey. Presence of respiratory symptoms was determined from self-report of chronic productive cough and breathlessness assessed using the British Medical Research Council (MRC) breathlessness scale. Self-reported physical and mental health were measured using the 12-Item Short-Form Health Survey (SF-12). Hypertension was assessed from mean blood pressure measured at the health check and/or self-reported use of antihypertensive medication. Other comorbidities were assessed from self-report. Logistic regression models were fitted assessing the association between respiratory symptoms and comorbidities. Linear regression models were fitted to investigate the association between respiratory symptoms and self-reported health scores. All models were adjusted for age, education and smoking status. Results The age-standardised prevalence of cough and breathlessness was 20.9% (prevalence with breathlessness MRC grade 3 or above 3.7%). The majority of men with respiratory symptoms (87.3%) were current smokers. Cough and breathlessness were associated with substantially worse self-reported physical and mental health (test for trend with severity of breathlessness p<0.001). Those with chronic cough and grade 3 or above breathlessness had higher odds of having hypertension (OR 3.03; 95% CI 1.36 to 6.74), diabetes (OR 10.55; 95% CI 2.69 to 41.37), angina pectoris (OR 7.54; 95% CI 3.61 to 15.73), previous myocardial infarction (OR 7.61; 95% CI 2.10 to 27.4) and previous stroke (OR 6.61; 95% CI 1.75 to 23.34) compared with those without respiratory symptoms. Conclusions The prevalence of respiratory symptoms was high. Strong associations were found between respiratory symptoms and cardiovascular comorbidities. These are of

  8. Evaluation in the field of social services for minors: Measuring the efficacy of interventions in the Italian service for health protection and promotion.

    PubMed

    Iudici, Antonio; Gagliardo Corsi, Agnese

    2017-04-01

    This article presents the availment of a new Methodology for the efficacy evaluation of interventions in the field of social science: the Method of Computerized Textual Data Analysis (M.A.D.I.T.). In the beginning, we present some elements of the international and Italian legislation referred to the efficacy evaluation and about the child protection. Subsequently this work describes the process of efficacy evaluation of an intervention of minor protection delivered by a public Italian Service, the Minor and Family Service, MiFa. The MADIT Methodology is applied to the efficacy evaluation and it is interested in discursive repertoires, defined as "a linguistically intended mode of construction of finite reality". The aim of the research is to show, through the description of every step of the implementation of the Methodology based on text analysis, how is possible to notice if there are progress in the direction of the objective of intervention of child protection. The results describes how from a starting situation of "first appearance of psychiatric career" referred to the minor, the work of the psychologist of the Service MiFa has enabled to produce a shifting in the direction of objective of the intervention, that was "developing the competence of the minor to identify objectives". Through this work, we show how a rigorous methodology for assessing effectiveness may contribute to improve the quality of service of Minor Protection and may also be suitable for new fields of social science.

  9. Physician Perceptions of Consultant Pharmacist Services Associated with an Intervention for Adverse Drug Events in the Nursing Facility.

    PubMed

    Kane-Gill, Sandra L; Hanlon, Joseph T; Fine, Michael J; Perera, Subashan; Culley, Colleen M; Studenski, Stephanie A; Nace, Dave A; Boyce, Richard D; Castle, Nicholas G; Handler, Steven M

    2016-12-01

    To assess the importance and performance of consultant pharmacist services delivered before and after an intervention to detect and manage adverse drug events among nursing facility residents. Before and after intervention survey of physicians participating in a randomized, controlled trial. Four nonprofit, academically affiliated nursing facilities. Attending physicians providing nursing facility care who were randomized to intervention or control groups. Within the intervention arm, consultant pharmacists provided academic detailing in which trained health care professionals visit practicing physicians in their offices and present the most up-to-date clinical information. Physicians responded to alerts from a medication monitoring system, adjudicated system alerts for adverse drug events (ADEs), and provided structured recommendations about ADE management. We compared physicians' assessments of the importance and performance of consultant pharmacist services before and after the trial intervention in the intervention and control groups. In the intervention group, ratings of importance increased for all 24 survey questions, and 5 of the changes were statistically significant (P < 0.05). In the control group, ratings of importance increased for 16 questions, and none of the changes were statistically significant. In the intervention group, ratings of performance increased for all 24 questions, and 20 of the changes were statistically significant. In the control group, ratings of performance increased for 16 questions, and none of the changes was statistically significant. A multifaceted, consultant pharmacist-led intervention comprising academic detailing, computerized decision support, and structured communication framework can improve physicians' assessment of importance and performance of consultant pharmacist services. ADE = Adverse drug event, M = Statistically significant mean, RCT = Randomized controlled trial, SBAR = Situation, Background, Discussion

  10. Implementing a statewide Screening, Brief Intervention, and Referral to Treatment (SBIRT) service in rural health settings: New Mexico SBIRT.

    PubMed

    Gonzales, Arturo; Westerberg, Verner S; Peterson, Thomas R; Moseley, Ana; Gryczynski, Jan; Mitchell, Shannon Gwin; Buff, Gary; Schwartz, Robert P

    2012-01-01

    This is a report on the New Mexico Screening, Brief Intervention, and Referral to Treatment (SBIRT) project conducted over 5 years as part of a national initiative launched by the Substance Abuse and Mental Health Services Administration with the aim of increasing integration of substance use services and medical care. Throughout the state, 53,238 adults were screened for alcohol and/or drug use problems in ambulatory settings, with 12.2% screening positive. Baseline substance use behaviors among 6,360 participants eligible for brief intervention, brief treatment, or referral for treatment are examined and the process of implementation and challenges for sustainability are discussed.

  11. Information and professional support: key factors in the provision of family-centred early childhood intervention services.

    PubMed

    Fordham, L; Gibson, F; Bowes, J

    2012-09-01

    Much has been written on the principles of family-centred practice and on the service delivery methods and skills required of its practitioners. Far less has been written from the perspective of families whose children have a disability. The aims of this study were twofold: firstly to understand families' experiences of family-centred early childhood intervention services and secondly to explore other factors that might impact on these experiences. One hundred and thirty families attending two established early childhood intervention services in New South Wales, Australia completed a survey incorporating the Measure of Processes of Care-56, the Family Empowerment Scale, the Family Support Scale and the Parenting Daily Hassles Scale. Consistent with previous research using the Measure of Processes of Care-56, 'respectful and supportive care' was the domain of care families rated to occur most and 'provision of general information' was the domain they rated to occur least. Significant positive relationships existed between families' ratings of family-centred care and feelings of empowerment. Being provided with general information was strongly correlated with family empowerment. Families' social support networks played an important role but support from professionals was most strongly correlated with families' experiences of family-centred care. Finally, families whose children's early intervention services were co-ordinated by a professional experienced significantly better care. The provision of general information and professional support are key components of family-centred early childhood intervention services. © 2011 Blackwell Publishing Ltd.

  12. Acceptability and Preferences of Six Different Routes of Drug Application for Acute Breathlessness: A Comparison Study between the United Kingdom and Germany

    PubMed Central

    Niemand, Anna Maria; Benalia, Hamid; Voltz, Raymond; Higginson, Irene J.; Bausewein, Claudia

    2012-01-01

    Abstract Background Opioids are the drugs of choice for management of breathlessness in advanced disease, but acute episodic breathlessness remains difficult to manage. New routes of opioid applications with quicker onset of action seem attractive for the management of episodic breathlessness. Objective This study aimed to determine the acceptability and preference of different routes of opioid applications in patients suffering from breathlessness due to advanced disease. Design The study consisted of structured face-to-face interviews with patients suffering from breathlessness due to lung cancer (LC), chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), and motor neurone disease (MND). Images and explanation were used to illustrate six application forms (oral, inhaled, sublingual, intranasal, buccal, transmucosal). Results Participants numbered 119 (UK n=48, Germany n=71), 60% male, mean age 67.7 years (SD 9.9); 50% suffered from COPD. Inhaled was the most accepted (87%) and preferred (68%) route of application, followed by sublingual (45%/13%) and intranasal (42%/8%). The oral was least accepted (24%) and least preferred (9%) although nearly all participants had previous experiences with it (97%). Ratings were similar in both countries but different for preferences of sublingual (UK>Germany) and intranasal (Germany>UK). In general, participants from the UK rated more often “yes” for acceptability of all routes compared to Germany. Conclusion Inhaled was the most accepted and preferred route of application, but no route seemed to be acceptable to all patients. Therefore, individual patient preferences should be explored before drug prescription to enhance compliance and convenience. PMID:23094954

  13. Systematic review and narrative synthesis of the effectiveness of contraceptive service interventions for young people, delivered in health care settings.

    PubMed

    Blank, Lindsay; Baxter, Susan K; Payne, Nick; Guillaume, Louise R; Squires, Hazel

    2012-12-01

    A systematic review and narrative synthesis to determine the effectiveness of contraception service interventions for young people delivered in health care premises was undertaken. We searched 12 key health and medical databases, reference lists of included papers and systematic reviews and cited reference searches on included articles. All retrieved literature was screened at title and abstract levels, and relevant articles were taken through to full paper appraisal. Data relating to study design, outcomes and quality were extracted by one reviewer and independently checked by a second reviewer. We included interventions that consisted of contraceptive service provision for young people, and also interventions to encourage young people to use existing contraceptive services. The searches identified 23 studies that met the inclusion criteria. The papers focused on: new adolescent services, outreach to existing services, advanced provision of emergency contraception, condom/contraceptive provision and advice and repeat pregnancy prevention. The literature in general is not well developed in terms of good quality effectiveness studies and key outcome measures. However, it is possible to make recommendations in terms of outreach versus targeted young people's services in health care settings, advanced provision of emergency contraception and long-acting reversible contraception to prevent repeat adolescent pregnancy.

  14. Presenting the model of risk, disability and hard-to-reach families to inform early intervention services.

    PubMed

    Phoenix, Michelle; Rosenbaum, Peter

    2017-09-29

    Several concepts - risk, resilience, disability and hard-to-reach families in early intervention services - are talked and written about in many ways. Family Stress Theory can be usefully applied to explore these issues systematically. The relationship between risk and disability is complex, and the role of resilience is not fully understood. The idea of "hard-to-reach families" is not well defined, thus presenting challenges to service providers and policy makers. Reflection: This paper presents the Model of Risk, Disability and Hard-to-Reach Families and uses the model to: (1) define the groups of high risk families and families of children with disabilities and explore the concept of resilience within these groups; (2) describe services offered to these groups; and (3) reflect on service use and so-called "hard-to-reach families". Each section includes suggested applications for service providers that may inform the work done with young children and their families who experience risk or disability. Service providers can apply the Model of Risk, Disability and Hard-to-Reach Families to consider each family's unique strengths and challenges, and use those individual elements to influence service recommendations and anticipate service use. Implications for rehabilitation The concepts of risk, resilience, and hard-to-reach families are poorly defined in the literatures, but have important implications with respect to early childhood intervention services. Family Stress Theory can help to identify high-risk families and account for family resilience It is important for clinicians, researchers and policy makers to consider the relationship between disability and risk with respect to services offered to families and the potential barriers to service use. Clinicians and policy makers have a role in promoting accessible early childhood services.

  15. Change in coping strategies following intensive intervention for special-service military personnel as civil emergency responders.

    PubMed

    Bian, Yongqiao; Xiong, Hongyan; Zhang, Lu; Tang, Tian; Liu, Zhen; Xu, Rufu; Lin, Hui; Xu, Bing

    2011-01-01

    To evaluate the effectiveness of a coping training program for the Chinese Special-Service Military Personnel (SSMP) as civil emergency responders. A parallel control trial was carried out in four special-service units (camps) stationed in Chongqing, China from Feb. 14th to May 30th, 2009. A total of 396 subjects were recruited and were randomly divided into an intervention group (n=201) and a control group (n=195) by clustering. Over the trial, participants in the intervention group received an additional coping-training program with 14 weekly two-hour sessions while the control group continued their normal work. Of all 396 participants, 343 attended all the sessions and completed the given measures. In comparison to their own scores in coping strategies at pre-intervention, significant and positive changes were observed in the intervention group (n=176) at post-intervention. Except for the strategy of self-blaming, the coping strategies including problem-solving, help-seeking, avoidance, fantasy and rationalization were improved. The descending order of the absolute change values over the trial in 5 coping strategies was fantasy, help-seeking, avoidance, problem-solving and rationalization. In addition, most subscales of social support and self-consistency, as powerful predictors of coping strategies, changed significantly over the intervention, while these changes were not observed in the control group (n=167). With the combined use of modular contents and procedural methods, our intervention not only led to fewer choices of immature coping strategies like fantasy, escape and rationalization, but also raised the use of mature coping strategies such as problem-solving and help-seeking. Accordingly, the intervention will be very helpful for regular coping training of Special-Service Units, something which can be verified and generalized for the whole SSMP in a future study.

  16. Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Substance Use in a School-based Program: Services and Outcomes

    PubMed Central

    Mitchell, Shannon Gwin; Gryczynski, Jan; Gonzales, Arturo; Moseley, Ana; Peterson, Thomas; O’Grady, Kevin E.; Schwartz, Robert P.

    2012-01-01

    Background Despite the advantages of using high schools for conducting school-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) programs for adolescent substance misuse, there have been very few studies of brief interventions in these settings. Objectives This multi-site, repeated measures study examined outcomes of adolescents who received SBIRT services and compared the extent of change in substance use based on the intensity of intervention received. Methods Participants consisted of 629 adolescents, ages 14 to 17, who received SBIRT services across 13 participating high schools in New Mexico. The level of service received and number of sessions were collected through administrative records, while the number of self-reported days in the past month of drinking; drinking to intoxication; and drug use were gathered at baseline and 6-month follow-up. Results Brief Intervention (BI) was provided to 85.1% of adolescents, while 14.9% received brief treatment or referral-to-treatment (BT/RT). Participants receiving any intervention reported significant reductions in frequency of drinking to intoxication (p<.05) and drug use (p<.001), but not alcohol use, from baseline to 6-month follow-up. The magnitude of these reductions did not differ based on service variables. Controlling for baseline frequency of use, a BT/RT service level was associated with more days of drinking at 6 month follow-up (p<.05), but was no longer significant when controlling for number of service sessions received. Conclusions and Scientific Significance These findings support school-based SBIRT for adolescents, but more research is needed on this promising approach. PMID:23786511

  17. Introducing interventional pain services in a large african teaching hospital: challenges and opportunities.

    PubMed

    Suleiman, Zakari; Burton, Allen W

    2013-11-01

    There is a need for interventional pain management in the developing world; however, there are many barriers to the introduction of interventional pain therapies. This brief report describes one approach to the introduction of interventional pain medicine to a Nigerian teaching hospital. Although many barriers exist, interventional pain medicine can be brought to the developing world, as demonstrated in this case series.

  18. Feasibility and impact of multidisciplinary training of an evidence-based intervention within a pediatric psychiatry consultation service.

    PubMed

    Gallagher, Katherine A S; McKenna, Kristine; Ibeziako, Patricia

    2014-08-01

    To train clinicians on a multidisciplinary pediatric consultation-liaison (CL) psychiatry service to administer an evidence-based intervention, biofeedback-assisted relaxation training (BART), in the inpatient medical setting and obtain their opinions about BART's utility and feasibility in the CL setting. Attendings and trainees on a multidisciplinary pediatric CL service received 3 h of BART training and completed a 10-item questionnaire designed to assess opinions about BART at two time points: after training but prior to using the intervention with patients and again 3 months after implementing the intervention in their clinical practice. Nineteen clinicians administered BART with 28 patients across the study period, and clinicians rated BART positively after training and significantly more positively after utilizing BART in the clinical setting. From post-training to post-implementation, trainees reported significant increases in their opinions that BART increased parent and patient receptiveness to psychiatric consultation (p<0.05) and attendings reported significant increases in their opinions that BART enhanced clinical intervention (p<0.05). BART training on a multidisciplinary CL service was well received by clinicians and patients and may enhance psychiatry trainees' repertoire of cognitive-behavioral and evidence-based interventions.

  19. Impact of a community-based payment for environmental services intervention on forest use in Menabe, Madagascar.

    PubMed

    Sommerville, Matthew; Milner-Gulland, E J; Rahajaharison, Michael; Jones, Julia P G

    2010-12-01

    Despite the growing interest in conservation approaches that include payments for environmental services (PES), few evaluations of the influence of such interventions on behaviors of individuals have been conducted. We used self-reported changes in six legal and illegal forest-use behaviors to investigate the way in which a PES for biodiversity conservation intervention in Menabe, Madagascar, influenced behavior. Individuals (n =864) from eight intervention communities and five control communities answered questions on their forest-use behaviors before and after the intervention began, as well as on their reasons for changing and their attitudes to various institutions. The payments had little impact on individuals' reported decisions to change behaviors, but it had a strong impact on individuals' attitudes. Payments appeared to legitimize monitoring of behaviors by the implementing nongovernmental organization (NGO), but did not act as a behavioral driver in their own right. Although there were no clear differences between changes in behaviors in the intervention and control communities, the intervention did influence motivations for change. Fear of local forest associations and the implementing NGO were strong motivators for changing behavior in communities with the PES intervention, whereas fear of the national government was the main reason given for change in control communities. Behavioral changes were most stable where fear of local organizations motivated the change. Our results highlight the interactions between different incentives people face when making behavioral decisions and the importance of considering the full range of incentives when designing community-based PES interventions.

  20. Cost-Effectiveness of a Short Message Service Intervention to Prevent Type 2 Diabetes from Impaired Glucose Tolerance.

    PubMed

    Wong, Carlos K H; Jiao, Fang-Fang; Siu, Shing-Chung; Fung, Colman S C; Fong, Daniel Y T; Wong, Ka-Wai; Yu, Esther Y T; Lo, Yvonne Y C; Lam, Cindy L K

    2016-01-01

    Aims. To investigate the costs and cost-effectiveness of a short message service (SMS) intervention to prevent the onset of type 2 diabetes mellitus (T2DM) in subjects with impaired glucose tolerance (IGT). Methods. A Markov model was developed to simulate the cost and effectiveness outcomes of the SMS intervention and usual clinical practice from the health provider's perspective. The direct programme costs and the two-year SMS intervention costs were evaluated in subjects with IGT. All costs were expressed in 2011 US dollars. The incremental cost-effectiveness ratio was calculated as cost per T2DM onset prevented, cost per life year gained, and cost per quality adjusted life year (QALY) gained. Results. Within the two-year trial period, the net intervention cost of the SMS group was $42.03 per subject. The SMS intervention managed to reduce 5.05% onset of diabetes, resulting in saving $118.39 per subject over two years. In the lifetime model, the SMS intervention dominated the control by gaining an additional 0.071 QALY and saving $1020.35 per person. The SMS intervention remained dominant in all sensitivity analyses. Conclusions. The SMS intervention for IGT subjects had the superiority of lower monetary cost and a considerable improvement in preventing or delaying the T2DM onset. This trial is registered with ClinicalTrials.gov NCT01556880.

  1. Parents' Perceptions of Early Interventions and Related Services for Children with Autism Spectrum Disorder in Saudi Arabia

    ERIC Educational Resources Information Center

    Alotaibi, Faihan; Almalki, Nabil

    2016-01-01

    The present study sought to examine parents' perceptions of early interventions and related services for children with autism spectrum disorder (ASD) in Saudi Arabia. In this study a survey was distributed to a sample of 80 parents with children who have ASD. Parents also were asked open-ended questions to enable them to provide suggestions. The…

  2. Early Intervention Special Instructors and Service Coordinators in One State: Characteristics, Professional Development, and Needed Lines of Inquiry

    ERIC Educational Resources Information Center

    Edwards, Nicole Megan; Gallagher, Peggy A.

    2016-01-01

    The success of Early Intervention (EI) programs (Part C, IDEA [Individuals with Disabilities Education Improvement Act of 2004]) for infants and toddlers with special needs (birth to 36 months) is largely influenced by the quality of direct service providers. Little is known, however, about characteristics of providers or involvement in training…

  3. Characterizing the Use of Research-Community Partnerships in Studies of Evidence-Based Interventions in Children's Community Services

    ERIC Educational Resources Information Center

    Frazee-Brookman, Lauren; Stahmer, Aubyn; Stadnick, Nicole; Chlebowski, Colby; Herschel, Amy; Garland, Ann F.

    2015-01-01

    This study characterized the use of research community partnerships (RCPs) to tailor evidence-based intervention, training, and implementation models for delivery across different childhood problems and service contexts using a survey completed by project principal investigators and community partners. To build on previous RCP research and to…

  4. A Comparison of Speech Sound Intervention Delivered by Telepractice and Side-by-Side Service Delivery Models

    ERIC Educational Resources Information Center

    Grogan-Johnson, Sue; Schmidt, Anna Marie; Schenker, Jason; Alvares, Robin; Rowan, Lynne E.; Taylor, Jacquelyn

    2013-01-01

    Telepractice has the potential to provide greater access to speech-language intervention services for children with communication impairments. Substantiation of this delivery model is necessary for telepractice to become an accepted alternative delivery model. This study investigated the progress made by school-age children with speech sound…

  5. Translation of a Dementia Caregiver Intervention for Delivery in Homecare as a Reimbursable Medicare Service: Outcomes and Lessons Learned

    ERIC Educational Resources Information Center

    Gitlin, Laura N.; Jacobs, Mimi; Earland, Tracey Vause

    2010-01-01

    Purpose: Families of dementia patients receiving skilled homecare do not receive supportive services. We evaluated whether a proven intervention, Environmental Skill-building Program (ESP), which reduces caregiver burden and enhances skills managing patient functioning, can be integrated into homecare practices of occupational therapists (OTs) and…

  6. A Comparison of Speech Sound Intervention Delivered by Telepractice and Side-by-Side Service Delivery Models

    ERIC Educational Resources Information Center

    Grogan-Johnson, Sue; Schmidt, Anna Marie; Schenker, Jason; Alvares, Robin; Rowan, Lynne E.; Taylor, Jacquelyn

    2013-01-01

    Telepractice has the potential to provide greater access to speech-language intervention services for children with communication impairments. Substantiation of this delivery model is necessary for telepractice to become an accepted alternative delivery model. This study investigated the progress made by school-age children with speech sound…

  7. Early Intervention Services for Infants and Toddlers with Disabilities (P.L. 101-476, Part H).

    ERIC Educational Resources Information Center

    Sonnier, Catherine

    This guide to early intervention services under Part H of Public Law 101-476 (the Individuals with Disabilities Education Act) is intended to aid state legislators who have the primary responsibility to create and shape programs under this Act. Three aspects of Part H legislation are stressed: (1) requirement of unprecedented coordination among…

  8. 32 CFR Appendix A to Part 80 - Procedures for the Provision of Early Intervention Services for Infants and Toddlers With...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Families A Appendix A to Part 80 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN PROVISION OF EARLY INTERVENTION SERVICES TO ELIGIBLE INFANTS AND TODDLERS WITH DISABILITIES AND THEIR FAMILIES, AND SPECIAL EDUCATION CHILDREN WITH DISABILITIES WITHIN...

  9. 32 CFR Appendix A to Part 80 - Procedures for the Provision of Early Intervention Services for Infants and Toddlers With...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Families A Appendix A to Part 80 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN PROVISION OF EARLY INTERVENTION SERVICES TO ELIGIBLE INFANTS AND TODDLERS WITH DISABILITIES AND THEIR FAMILIES, AND SPECIAL EDUCATION CHILDREN WITH DISABILITIES WITHIN...

  10. 32 CFR Appendix A to Part 80 - Procedures for the Provision of Early Intervention Services for Infants and Toddlers With...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Families A Appendix A to Part 80 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN PROVISION OF EARLY INTERVENTION SERVICES TO ELIGIBLE INFANTS AND TODDLERS WITH DISABILITIES AND THEIR FAMILIES, AND SPECIAL EDUCATION CHILDREN WITH DISABILITIES WITHIN...

  11. 32 CFR Appendix A to Part 80 - Procedures for the Provision of Early Intervention Services for Infants and Toddlers With...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Families A Appendix A to Part 80 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN PROVISION OF EARLY INTERVENTION SERVICES TO ELIGIBLE INFANTS AND TODDLERS WITH DISABILITIES AND THEIR FAMILIES, AND SPECIAL EDUCATION CHILDREN WITH DISABILITIES WITHIN...

  12. Parent Concern and Enrollment in Intervention Services for Young Children with Developmental Delays: 2007 National Survey of Children's Health

    ERIC Educational Resources Information Center

    Marshall, Jennifer; Kirby, Russell S.; Gorski, Peter A.

    2016-01-01

    This study sought to address underenrollment and late entry to early intervention by identifying factors associated with parental concern and services for developmental delays. The authors analyzed responses from 27,566 parents of children from birth to age 5 from the 2007 National Survey of Children's Health to quantify and to identify factors…

  13. Translation of a Dementia Caregiver Intervention for Delivery in Homecare as a Reimbursable Medicare Service: Outcomes and Lessons Learned

    ERIC Educational Resources Information Center

    Gitlin, Laura N.; Jacobs, Mimi; Earland, Tracey Vause

    2010-01-01

    Purpose: Families of dementia patients receiving skilled homecare do not receive supportive services. We evaluated whether a proven intervention, Environmental Skill-building Program (ESP), which reduces caregiver burden and enhances skills managing patient functioning, can be integrated into homecare practices of occupational therapists (OTs) and…

  14. Parent Concern and Enrollment in Intervention Services for Young Children with Developmental Delays: 2007 National Survey of Children's Health

    ERIC Educational Resources Information Center

    Marshall, Jennifer; Kirby, Russell S.; Gorski, Peter A.

    2016-01-01

    This study sought to address underenrollment and late entry to early intervention by identifying factors associated with parental concern and services for developmental delays. The authors analyzed responses from 27,566 parents of children from birth to age 5 from the 2007 National Survey of Children's Health to quantify and to identify factors…

  15. Registry to Referral: A Promising Means for Identifying and Referring Infants and Toddlers for Early Intervention Services.

    ERIC Educational Resources Information Center

    Farel, Anita M.; Meyer, Robert E.; Hicken, Margaret; Edmonds, Larry

    2003-01-01

    This article proposes use of birth defects registries in facilitating early intervention. It reports results of a survey to identify state programs that are using, or planning to use, birth defects surveillance systems to identify and refer children and families for services. It provides four case examples and recommended steps to encourage use of…

  16. Systematic Review and Narrative Synthesis of the Effectiveness of Contraceptive Service Interventions for Young People, Delivered in Health Care Settings

    ERIC Educational Resources Information Center

    Blank, Lindsay; Baxter, Susan K.; Payne, Nick; Guillaume, Louise R.; Squires, Hazel

    2012-01-01

    A systematic review and narrative synthesis to determine the effectiveness of contraception service interventions for young people delivered in health care premises was undertaken. We searched 12 key health and medical databases, reference lists of included papers and systematic reviews and cited reference searches on included articles. All…

  17. Systematic Review and Narrative Synthesis of the Effectiveness of Contraceptive Service Interventions for Young People, Delivered in Health Care Settings

    ERIC Educational Resources Information Center

    Blank, Lindsay; Baxter, Susan K.; Payne, Nick; Guillaume, Louise R.; Squires, Hazel

    2012-01-01

    A systematic review and narrative synthesis to determine the effectiveness of contraception service interventions for young people delivered in health care premises was undertaken. We searched 12 key health and medical databases, reference lists of included papers and systematic reviews and cited reference searches on included articles. All…

  18. Early Intervention Special Instructors and Service Coordinators in One State: Characteristics, Professional Development, and Needed Lines of Inquiry

    ERIC Educational Resources Information Center

    Edwards, Nicole Megan; Gallagher, Peggy A.

    2016-01-01

    The success of Early Intervention (EI) programs (Part C, IDEA [Individuals with Disabilities Education Improvement Act of 2004]) for infants and toddlers with special needs (birth to 36 months) is largely influenced by the quality of direct service providers. Little is known, however, about characteristics of providers or involvement in training…

  19. Characterizing the Use of Research-Community Partnerships in Studies of Evidence-Based Interventions in Children's Community Services

    ERIC Educational Resources Information Center

    Frazee-Brookman, Lauren; Stahmer, Aubyn; Stadnick, Nicole; Chlebowski, Colby; Herschel, Amy; Garland, Ann F.

    2015-01-01

    This study characterized the use of research community partnerships (RCPs) to tailor evidence-based intervention, training, and implementation models for delivery across different childhood problems and service contexts using a survey completed by project principal investigators and community partners. To build on previous RCP research and to…

  20. Developing Cultural Attitudes in Teacher Candidates through a Cross-Cultural Service Learning Intervention: A Mixed Methods Study

    ERIC Educational Resources Information Center

    Valentine, Victoria L. Ringling

    2010-01-01

    The primary purpose of this study was to ascertain the impact of an intense cultural classroom experience combined with a cross-cultural service-learning intervention experience on the cultural attitudes of teacher candidates. The research focused specifically on the study of the Lakota culture both currently and in the historical context and then…

  1. Providing Effective Early Intervention Services: Why and How? Policy and Practice in Early Childhood Special Education Series.

    ERIC Educational Resources Information Center

    Salisbury, Christine L.

    This paper presents information to assist in the planning and development of policy related to the education of very young children with disabilities. The paper first considers research-supported reasons for providing early childhood intervention services based on effectiveness data from many sources. Subsequent sections examine: (1)…

  2. 32 CFR Appendix A to Part 80 - Procedures for the Provision of Early Intervention Services for Infants and Toddlers With...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Families A Appendix A to Part 80 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE... WITH DISABILITIES AND THEIR FAMILIES, AND SPECIAL EDUCATION CHILDREN WITH DISABILITIES WITHIN THE... Families A. Requirements For A System of Early Intervention Services 1. A system of...

  3. Parental Level of Satisfaction Regarding Early Intervention Services for Children Who Are Deaf or Hard of Hearing

    ERIC Educational Resources Information Center

    Ealy, Barbara Smith

    2013-01-01

    This qualitative study explores the level of satisfaction of parents regarding early identification/intervention services for children who are deaf or hard of hearing (D/HH). The purpose of this study is to compare the progress of children who are D/HH with their hearing peers on elements used to measure the readiness of students to enter the…

  4. Cultural and Linguistic Alchemy: Mining the Resources of Spanish-Speaking Children and Families Receiving Early Intervention Services

    ERIC Educational Resources Information Center

    Puig, Victoria I.

    2012-01-01

    This study was designed to gain insight into how early intervention (EI) services incorporate the cultural and linguistic resources of families and how EI professionals and families build partnerships with each other. Through observation and interview, the author looked deeply at the experiences of a small group of culturally and linguistically…

  5. Cultural and Linguistic Alchemy: Mining the Resources of Spanish-Speaking Children and Families Receiving Early Intervention Services

    ERIC Educational Resources Information Center

    Puig, Victoria I.

    2012-01-01

    This study was designed to gain insight into how early intervention (EI) services incorporate the cultural and linguistic resources of families and how EI professionals and families build partnerships with each other. Through observation and interview, the author looked deeply at the experiences of a small group of culturally and linguistically…

  6. Parental Level of Satisfaction Regarding Early Intervention Services for Children Who Are Deaf or Hard of Hearing

    ERIC Educational Resources Information Center

    Ealy, Barbara Smith

    2013-01-01

    This qualitative study explores the level of satisfaction of parents regarding early identification/intervention services for children who are deaf or hard of hearing (D/HH). The purpose of this study is to compare the progress of children who are D/HH with their hearing peers on elements used to measure the readiness of students to enter the…

  7. Driving while impaired (DWI) intervention service provider orientations: the scales of the DWI Therapeutic Educator Inventory (DTEI).

    PubMed

    DeMuro, Scott; Wanberg, Kenneth; Anderson, Rachel

    2011-10-01

    The therapeutic educator who provides services to driving while impaired (DWI) offenders is a unique professional hybrid, combining education and therapeutic service delivery. In an effort to understand and address this service provider, a 69-item DWI Therapeutic Educator Inventory (DTEI) was constructed. Using principal components and common factor analyses, 6 reliable DWI provider orientation styles were identified: judicial, disease, structure, relationship, interaction, and empathic-supportive. Second-order factoring identified 2 broad reliable dimensions: correctional and therapeutic. These findings further support the construct validity of the DTEI and raise a new question for research: do different provider orientations impact intervention outcomes, such as relapse and recidivism?

  8. Contracting and Procurement for Evidence-Based Interventions in Public-Sector Human Services: A Case Study

    PubMed Central

    Willging, Cathleen E.; Aarons, Gregory A.; Trott, Elise M.; Green, Amy E.; Finn, Natalie; Ehrhart, Mark G.; Hecht, Debra B.

    2016-01-01

    Sustainment of evidence-based interventions (EBIs) in human services depends on the inner context of community-based organizations (CBOs) that provide services and the outer context of their broader environment. Increasingly, public officials are experimenting with contracting models from for-profit industries to procure human services. In this case study, we conducted qualitative interviews with key government and CBO stakeholders to examine implementation of the Best Value-Performance Information Procurement System to contract for EBIs in a child welfare system. Findings suggest that stakeholder relationships may be compromised when procurement disregards local knowledge, communication, collaboration, and other factors supporting EBIs and public health initiatives. PMID:26386977

  9. Study design to develop and pilot-test a web intervention for partners of military service members with alcohol misuse.

    PubMed

    Osilla, Karen Chan; Pedersen, Eric R; Gore, Kristie; Trail, Thomas; Howard, Stefanie Stern

    2014-09-02

    Alcohol misuse among military service members from the recent conflicts in Iraq and Afghanistan is over two times higher compared to misuse in the civilian population. Unfortunately, in addition to experiencing personal consequences from alcohol misuse, partners and family members of alcohol-misusing service members also suffer in negative ways from their loved one's drinking. These family members represent important catalysts for helping their loved ones identify problem drinking and overcoming the barriers to seeking care. This paper describes the protocol to a pilot study evaluating a 4-session, web-based intervention (WBI) for concerned partners (CPs) of service members with alcohol misuse. The WBI will be adapted from the Community Reinforcement and Family Training (CRAFT) intervention. In the first phase, we will develop and beta-test the WBI with 15-20 CPs. In the second phase, we will randomize CPs to WBI (n = 50) or to delayed-WBI (n = 50) and evaluate the impact of the WBI on CPs' perceptions of service member help-seeking and drinking, as well as the CP's well-being and relationship satisfaction 3 months after the intervention. In the third phase, we will recruit 15-20 service members whose partners have completed the study. We will interview the service members to learn how the CP-focused WBI affected them and to assess whether they would be receptive to a follow-on WBI module to help them. This project has the potential to benefit a large population of military service members who may be disproportionately affected by recent conflicts and whose drinking misuse would otherwise go undetected and untreated. It also develops a new prevention model that does not rely on service members or partners attending a hospital or clinical facility to access care. NCT02073825.

  10. Primary care interventions to prevent tobacco use in children and adolescents: U.S. preventive services task force recommendation statement.

    PubMed

    Moyer, Virginia A

    2013-09-01

    Update of the 2003 U.S. Preventive Services Task Force (USPSTF) recommendation on primary care interventions to prevent tobacco use in children and adolescents. The USPSTF reviewed the evidence on the effectiveness of primary care interventions on the rates of initiation or cessation of tobacco use in children and adolescents and on health outcomes, such as respiratory health, dental and oral health, and adult smoking. The USPSTF also reviewed the evidence on the potential harms of these interventions. This recommendation applies to school-aged children and adolescents. The USPSTF has issued a separate recommendation statement on tobacco use counseling in adults and pregnant women. The USPSTF recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use in school-aged children and adolescents.

  11. Primary care interventions to prevent tobacco use in children and adolescents: U.S. Preventive Services Task Force recommendation statement.

    PubMed

    Moyer, Virginia A

    2013-10-15

    Update of the 2003 U.S. Preventive Services Task Force (USPSTF) recommendation on primary care interventions to prevent tobacco use in children and adolescents. The USPSTF reviewed the evidence on the effectiveness of primary care interventions on the rates of initiation or cessation of tobacco use in children and adolescents and on health outcomes, such as respiratory health, dental and oral health, and adult smoking. The USPSTF also reviewed the evidence on the potential harms of these interventions. This recommendation applies to school-aged children and adolescents. The USPSTF has issued a separate recommendation statement on tobacco use counseling in adults and pregnant women. The USPSTF recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use in school-aged children and adolescents.

  12. Maternal Depression and Early Intervention: A Call for an Integration of Services.

    PubMed

    Alvarez, Shanna L; Meltzer-Brody, Samantha; Mandel, Marcia; Beeber, Linda

    2015-01-01

    Depression is a serious disorder with severe and far-reaching consequences. Two decades of observational research have shown robust associations between maternal depression and adverse consequences on offspring (Campbell et al., 2004; Campbell, Matestic, von Stauffenberg, Mohan, & Kirchner, 2007; Campbell, Morgan-Lopez, Cox, & McLoyd, 2009; National Research Council & Institute of Medicine, 2009). Depressive symptoms may pose particular risk to infants and toddlers with neurodevelopmental disabilities, whose long-term outcomes depend heavily on the provision of Early Intervention (EI). EI is most effective with active parental engagement. Maternal depressive symptoms may reduce parental engagement, thereby limiting EI benefits to the child (Gaynes, Gavin & Meltzer -Brody, 2005; O'Hara & Swain, 1996). At present, maternal mental health is not directly addressed in EI. The purpose of this paper is to discuss the literature and significance of maternal depression and apply that evidence to mothers of children with developmental delays and disabilities. We conclude that maternal mental health and well-being is currently insufficiently addressed in the EI population. An increased integration of mental health and EI services is needed to serve the unique needs of families who face an increased risk of stress and depression while coping with their child's special needs.

  13. Maternal Depression and Early Intervention: A Call for an Integration of Services

    PubMed Central

    Alvarez, Shanna L.; Meltzer-Brody, Samantha; Mandel, Marcia; Beeber, Linda

    2014-01-01

    Depression is a serious disorder with severe and far-reaching consequences. Two decades of observational research have shown robust associations between maternal depression and adverse consequences on offspring (Campbell et al., 2004; Campbell, Matestic, von Stauffenberg, Mohan, & Kirchner, 2007; Campbell, Morgan-Lopez, Cox, & McLoyd, 2009; National Research Council & Institute of Medicine, 2009). Depressive symptoms may pose particular risk to infants and toddlers with neurodevelopmental disabilities, whose long-term outcomes depend heavily on the provision of Early Intervention (EI). EI is most effective with active parental engagement. Maternal depressive symptoms may reduce parental engagement, thereby limiting EI benefits to the child (Gaynes, Gavin & Meltzer –Brody, 2005; O’Hara & Swain, 1996). At present, maternal mental health is not directly addressed in EI. The purpose of this paper is to discuss the literature and significance of maternal depression and apply that evidence to mothers of children with developmental delays and disabilities. We conclude that maternal mental health and well-being is currently insufficiently addressed in the EI population. An increased integration of mental health and EI services is needed to serve the unique needs of families who face an increased risk of stress and depression while coping with their child’s special needs. PMID:28316368

  14. Screening, brief intervention, and referral to treatment (SBIRT) for substance use in a school-based program: services and outcomes.

    PubMed

    Mitchell, Shannon Gwin; Gryczynski, Jan; Gonzales, Arturo; Moseley, Ana; Peterson, Thomas; O'Grady, Kevin E; Schwartz, Robert P

    2012-11-01

    Despite the advantages of using high schools for conducting school-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) programs for adolescent substance misuse, there have been very few studies of Brief Interventions (BIs) in these settings. This multi-site, repeated measures study examined outcomes of adolescents who received SBIRT services and compared the extent of change in substance use based on the intensity of intervention received. Participants consisted of 629 adolescents, ages 14-17, who received SBIRT services across 13 participating high schools in New Mexico. The level of service received and number of sessions were collected through administrative records, while the number of self-reported days in the past month of drinking; drinking to intoxication; and drug use were gathered at baseline and 6-month follow-up. BI was provided to 85.1% of adolescents, while 14.9% received brief treatment or referral to treatment (BT/RT). Participants receiving any intervention reported significant reductions in frequency of drinking to intoxication (p < .05) and drug use (p < .001), but not alcohol use, from baseline to 6-month follow-up. The magnitude of these reductions did not differ based on service variables. Controlling for baseline frequency of use, a BT/RT service level was associated with more days of drinking at 6-month follow-up (p < .05), but was no longer significant when controlling for number of service sessions received. These findings support school-based SBIRT for adolescents, but more research is needed on this promising approach. Copyright © American Academy of Addiction Psychiatry.

  15. The effects of expanding outpatient and inpatient evaluation and management services in a pediatric interventional radiology practice.

    PubMed

    Edalat, Faramarz; Lindquester, Will S; Gill, Anne E; Simoneaux, Stephen F; Gaines, Jennifer; Hawkins, C Matthew

    2017-03-01

    Despite a continuing emphasis on evaluation and management clinical services in adult interventional radiology (IR) practice, the peer-reviewed literature addressing these services - and their potential economic benefits - is lacking in pediatric IR practice. To measure the effects of expanding evaluation and management (E&M) services through the establishment of a dedicated pediatric interventional radiology outpatient clinic and inpatient E&M reporting system. We collected and analyzed E&M current procedural terminology (CPT) codes from all patients seen in a pediatric interventional radiology outpatient clinic between November 2014 and August 2015. We also calculated the number of new patients seen in the clinic who had a subsequent procedure (procedural conversion rate). For comparison, we used historical data comprising pediatric patients seen in a general interventional radiology (IR) clinic for the 2 years immediately prior. An inpatient E&M reporting system was implemented and all inpatient E&M (and subsequent procedural) services between July 2015 and September 2015 were collected and analyzed. We estimated revenue for both outpatient and inpatient services using the Medicare Physician Fee Schedule global non-facility price as a surrogate. Following inception of a pediatric IR clinic, the number of new outpatients (5.5/month; +112%), procedural conversion rate (74.5%; +19%), estimated E&M revenue (+158%), and estimated procedural revenue from new outpatients (+228%) all increased. Following implementation of an inpatient clinic reporting system, there were 8.3 consults and 7.3 subsequent hospital encounters per month, with a procedural conversion rate of 88%. Growth was observed in all meaningful metrics following expansion of outpatient and inpatient pediatric IR E&M services.

  16. The relationship between services delivered and substance use outcomes in New Mexico's Screening, Brief Intervention, Referral and Treatment (SBIRT) Initiative.

    PubMed

    Gryczynski, Jan; Mitchell, Shannon Gwin; Peterson, Thomas R; Gonzales, Arturo; Moseley, Ana; Schwartz, Robert P

    2011-11-01

    Recent years have seen increased diffusion of Screening, Brief Intervention, Referral and Treatment (SBIRT) in healthcare environments. This study examined the relationship between substance use outcomes and service variables within the SBIRT model. Over 55,000 adult patients were screened for substance misuse at rural health clinics throughout New Mexico during the SBIRT Initiative. This naturalistic pre-post services study used administrative baseline, 6 month follow-up, and services data for adult participants in the New Mexico SBIRT evaluation (n=1208). Changes in self-reported frequency of illicit drug use, alcohol use, and alcohol intoxication were examined as a function of service level (brief intervention - BI vs. brief treatment/referral - BT/RT) and number of service sessions. Participants reported decreased frequency of illicit drug use, alcohol use, and alcohol intoxication 6 months after receipt of SBIRT services (p<.001 for each). Compared to those who received BI, participants who received BT/RT had sharper reductions in frequency of drinking (IRR=.78; p<.05) and alcohol intoxication (IRR=.75; p<.05). Number of service sessions was associated with reduced frequency of alcohol use (IRR=.84; p<.01) and intoxication (IRR=.82; p<.05), but only among those who received BI. Substance-using patients with disparate levels of use may benefit from SBIRT. In a real-world, multi-site rural SBIRT program, services of higher intensity and (within the BI modality) frequency were associated with greater magnitude of change in drinking behaviors. Reductions in illicit drug use, while substantial, did not differ significantly based on service variables. Future studies should identify the preferred service mix in the SBIRT model as it continues to expand. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  17. Priority interventions to reduce HIV transmission in sex work settings in sub-Saharan Africa and delivery of these services.

    PubMed

    Chersich, Matthew F; Luchters, Stanley; Ntaganira, Innocent; Gerbase, Antonio; Lo, Ying-Ru; Scorgie, Fiona; Steen, Richard

    2013-03-04

    Virtually no African country provides HIV prevention services in sex work settings with an adequate scale and intensity. Uncertainty remains about the optimal set of interventions and mode of delivery. We systematically reviewed studies reporting interventions for reducing HIV transmission among female sex workers in sub-Saharan Africa between January 2000 and July 2011. Medline (PubMed) and non-indexed journals were searched for studies with quantitative study outcomes. We located 26 studies, including seven randomized trials. Evidence supports implementation of the following interventions to reduce unprotected sex among female sex workers: peer-mediated condom promotion, risk-reduction counselling and skills-building for safer sex. One study found that interventions to counter hazardous alcohol-use lowered unprotected sex. Data also show effectiveness of screening for sexually transmitted infections (STIs) and syndromic STI treatment, but experience with periodic presumptive treatment is limited. HIV testing and counselling is essential for facilitating sex workers' access to care and antiretroviral treatment (ART), but testing models for sex workers and indeed for ART access are little studied, as are structural interventions, which create conditions conducive for risk reduction. With the exception of Senegal, persistent criminalization of sex work across Africa reduces sex workers' control over working conditions and impedes their access to health services. It also obstructs health-service provision and legal protection. There is sufficient evidence of effectiveness of targeted interventions with female sex workers in Africa to inform delivery of services for this population. With improved planning and political will, services - including peer interventions, condom promotion and STI screening - would act at multiple levels to reduce HIV exposure and transmission efficiency among sex workers. Initiatives are required to enhance access to HIV testing and ART for

  18. Development of an intervention to reduce self-stigma in outpatient mental health service users in Chile.

    PubMed

    Schilling, Sara; Bustamante, Juan Antonio; Sala, Andres; Acevedo, Claudio; Tapia, Eric; Alvarado, Ruben; Sapag, Jaime C; Yang, Lawrence Hsin; Lukens, Ellen; Mascayano, Franco; Cid, Patricia; Tapia, Thamara

    2015-01-01

    Latin America is characterized by a high prevalence of public stigma toward those with mental illness, and significant selfstigma among labeled individuals, leading to social exclusion, low treatment adherence, and diminished quality of life. However, there is no published evidence of an intervention designed to address stigma in the region. In light of this, a psychosocial intervention to reduce self-stigma among users with severe mental illness was developed and tested through an RCT in two regions of Chile. To describe the development of the psychosocial intervention, assess its feasibility and acceptability, and evaluate its preliminary impact. An intervention was designed and is being tested, with 80 users with severe mental illness attending two community mental health outpatient centers. To prepare the intervention, pertinent literature was reviewed, and experts and mental health services users were consulted. Feasibility and acceptability were assessed, and impact was analyzed, based on follow-up qualitative reports by the participants. The recovery-oriented, ten-session group intervention incorporates the Tree of Life narrative approach, along with other narrative practices, to promote a positive identity change in users, and constructivist psychoeducation, based on case studies and group discussions, to gather tools to confront self-stigma. The intervention was feasible to implement and well evaluated by participants, family members, and center professionals. Participants reported increased self-confidence, and the active use of anti-stigma strategies developed during the workshop. This group intervention promises an effective means to reduce stigma of mental illness within Chile and other Latin American countries and feasibility to scale up within mental health services.

  19. Communication Disorders and Use of Intervention Services among Children Aged 3-17 Years: United States, 2012. NCHS Data Brief. Number 205

    ERIC Educational Resources Information Center

    Black, Lindsey I.; Vahratian, Anjel; Hoffman, Howard J.

    2015-01-01

    Increasing the proportion of children with voice, swallowing, speech, or language disorders who receive intervention services is a Healthy People 2020 goal (1). Timely receipt of intervention services is shown to be effective for treatment of communication disorders (2-5). Using data from the 2012 National Health Interview Survey (NHIS), this…

  20. Model Projects for Early Intervention in the Mental Health of Young People: Reorientation of Services.

    ERIC Educational Resources Information Center

    O'Hanlon, Anne; Kosky, Robert; Martin, Graham; Dundas, Pauline; Davis, Cathy

    The Australian Early Intervention Network for Mental Health in Young People (AusEinet) was established to coordinate a national approach to early intervention for mental health in young people. The approach has three streams: (1) development and maintenance of a national early intervention network for mental health in young people; (2)…

  1. Utilisation of Evidence-Based Practices by ASD Early Intervention Service Providers

    ERIC Educational Resources Information Center

    Paynter, Jessica M.; Ferguson, Sarah; Fordyce, Kathryn; Joosten, Annette; Paku, Sofia; Stephens, Miranda; Trembath, David; Keen, Deb

    2017-01-01

    A number of autism intervention practices have been demonstrated to be effective. However, the use of unsupported practices persists in community early intervention settings. Recent research has suggested that personal, professional and workplace factors may influence intervention choices. The aim of this research was to investigate knowledge and…

  2. Utilisation of Evidence-Based Practices by ASD Early Intervention Service Providers

    ERIC Educational Resources Information Center

    Paynter, Jessica M.; Ferguson, Sarah; Fordyce, Kathryn; Joosten, Annette; Paku, Sofia; Stephens, Miranda; Trembath, David; Keen, Deb

    2017-01-01

    A number of autism intervention practices have been demonstrated to be effective. However, the use of unsupported practices persists in community early intervention settings. Recent research has suggested that personal, professional and workplace factors may influence intervention choices. The aim of this research was to investigate knowledge and…

  3. Effects of a recovery management intervention on Chinese heroin users' community recovery through the mediation effect of enhanced service utilization.

    PubMed

    Wu, F; Fu, L M; Hser, Y H

    2015-09-01

    This study investigates whether a recovery management intervention (RMI) can improve the utilization of community drug treatment and wraparound services among heroin users in China and subsequently lead to positive recovery outcomes. Secondary analysis was conducted drawing data from a randomized controlled trial; 100 heroin users with no severe mental health problems were recruited in two Shanghai districts (Hongkou and Yangpu) upon their release from compulsory rehabilitation facilities. A latent variable modeling approach was utilized to test whether the RMI influences heroin users' perceived motivation and readiness for treatment, enhances treatment and wraparound service participation, and, in turn, predicts better recovery outcomes. Enrollment in drug treatment and other social service utilization increased significantly as a result of RMI rather than an individual drug user's motivation and readiness for treatment. Increased service utilization thus led to more positive individual recovery outcomes. In addition to this mediation effect through service utilization, the RMI also improved participants' community recovery directly. Findings suggest that better drug treatment enrollment, community service utilization and recovery outcomes can be potentially achieved among heroin users in China with carefully designed case management interventions. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  4. A Randomized Clinical Trial of a Postdeployment Parenting Intervention for Service Members and Their Families With Very Young Children.

    PubMed

    DeVoe, Ellen R; Paris, Ruth; Emmert-Aronson, Ben; Ross, Abigail; Acker, Michelle

    2016-10-06

    Objective: Parenting through the deployment cycle presents unique stressors for military families. To date, few evidence-based and military-specific parenting programs are available to support parenting through cycles of deployment separation and reintegration, especially for National Guard/Reserve members. The purpose of this research was to test the efficacy of a parenting program developed specifically to support military families during reintegration. Method: Within 1 year of returning from deployment to Afghanistan or Iraq, 115 service members with very young children were randomly assigned to receive either the Strong Families Strong Forces Parenting Program at baseline or after a 12-week waiting period. Using a home-based modality, service members, at-home parents, and their young child were assessed at baseline, 3 months posttreatment/wait period, and 6 months from baseline. Results: Service member parents in Strong Families evidenced greater reductions in parenting stress and mental health distress relative to those in the waitlist comparison group. Service members with more posttraumatic stress symptoms reported higher levels of perceived parental efficacy in the intervention group than service members in the comparison group. Intervention also resulted in enhanced parental reflective capacity, including increased curiosity and interest in the young child among those in the intervention group relative to comparison. Conclusion: Service member parents and their spouses demonstrated high interest in participating in a postdeployment parenting program targeting families with very young children. Findings point to the feasibility, appeal, and efficacy of Strong Families in this initial trial and suggest promise for implementation in broader military and community service systems. (PsycINFO Database Record

  5. Preventing and controlling foodborne disease in commercial and institutional food service settings: a systematic review of published intervention studies.

    PubMed

    Viator, Catherine; Blitstein, Jonathan; Brophy, Jenna E; Fraser, Angela

    2015-02-01

    This study reviews the current literature on behavioral and environmental food safety interventions conducted in commercial and institutional food service settings. A systematic search of the published literature yielded 268 candidate articles, from which a set of 23 articles reporting intervention outcomes was retained for evaluation. A categorization of measured outcomes is reported; studies addressed multiple outcomes ranging from knowledge, attitudes, and behavior of personal hygiene and food safety to management practices and disease rates and outbreaks. This study also investigates the quality of reported research methods used to evaluate the effectiveness of the interventions, using a nine-point quality index adapted by the authors. The observed scores suggest that there are opportunities to improve the design and reporting of research in the field of foodborne disease prevention as it applies to food safety interventions that target the food service industry. The aim is to aid researchers in this area to design higher quality studies and to produce clearer and more useful reports of their research. In turn, this can help to create a more complete evidence base that can be used to continually improve interventions in this domain.

  6. Introduction to the theme--state intervention and the social wage: the politics of social services expansion.

    PubMed

    Friedland, R

    1979-01-01

    State intervention in the consumption process has become increasingly critical to economic growth on the one hand and to real family income on the other. The social wage thus tends to become a conflictual political issue. As a result, the articulation of state intervention with the changing requirements of economic growth is subject to continuous political challenge. This special issue examines the problematic relationship between state intervention in social services and the organization of the capitalist economy. Some contributors study the ways in which state inter ventions are structured so as to be consonant with the requirements of economic growth and profitability, as well as the difficulties such structures pose. Feshbach's analysis of the Hill-Burton Hospital Construction Program and Mollenkopf's study of San Francisco's public transit system both reflect this concern. Other contributors study the ways in which the organization of the economy constrains the development of democratically responsive social services. Sbragia's study of the capital market and public housing in Italy and Taylor's study of free medical clinics in the U.S. both reflect this concern. Finally, contributors study macroscopic transformations in the relationship between state intervention and the organization of the capitalist economy. Esping-Andersen's study of the political logic of increasing state intervention in production and Hirschhorn's analysis of the defunctionalization of social services attendent upon the disaccumulative tendencies in capitalism both reflect this concern. This introductory paper reviews four theories which attempt to explain how state intervention is insulated from democratic controls. For each theory, the mechanisms specified to perform this function are subject to weaknesses. An attempt is made to position the contributions to this volume with respect to these theoretical traditions.

  7. Parents seek early intervention services for a two-year-old without autism.

    PubMed

    Reddy, Arathi; Graves, Crista; Augustyn, Marilyn

    2011-10-01

    increasingly challenging because he does not like the sensation of soap and the water temperature must be "just right." You refer the child to a Developmental and Behavioral Pediatrician for evaluation and at 28 months he is seen. During his testing visit, he had decreased eye contact and followed his own agenda but improved significantly as testing progressed. As he got more comfortable, he began making good eye contact, social referenced, and exhibited joint attention with his parents and the examiner. He did not meet criteria for an autism spectrum disorder or specifically pervasive developmental disorder-not otherwise specified (PDD-NOS). He was given a diagnosis of mixed receptive and expressive language delay and disruptive behavior disorder with sensory processing problems.The parents come to you a month after their evaluation visit asking you to give him a "listed diagnosis of PDD-NOS" that could be removed when he turns 3 years so that he may qualify for increased hours of services-up to 15 hours per week-as well as applied behavioral analysis therapy. A behavioral therapist through early intervention has told the family that he would benefit from this increased intervention, specifically applied behavioral analysis but the only way he can receive it is with a "medical diagnosis" on the autism spectrum. What do you do next?

  8. Retrospective chart review for obesity and associated interventions among rural Mexican-American adolescents accessing healthcare services.

    PubMed

    Champion, Jane Dimmitt; Collins, Jennifer L

    2013-11-01

    To report a retrospective analysis of data routinely collected in the course of healthcare services at a rural health clinic and to assess obesity incidence and associated interventions among rural Mexican-American adolescents. Two hundred and twelve charts reviewed; 98 (46.2%) males and 114 (53.8%) females. Data extracted included Medicaid exams conducted at the clinic within 5 years. Equal overweight or obese (n = 105, 49.5%), versus normal BMI categorizations (n = 107, 50.5%) documented overall and by gender. Female obesity higher (25.4%) than national norms (17.4%); male rates (25.5%) were within national norm. Interventions provided by nurse practitioners (94%) for 34.8%-80% of overweight/obese had limited follow-up (4%). Obesity incidence markedly increased between 13 and 18 years of age without associated interventions; 51.4%-75.6% without interventions. Obesity is a healthcare problem among rural Mexican-American adolescents accessing care at the rural health clinic. Obesity intervention and follow-up was suboptimal within this setting. Rural and ethnic minority adolescents experience health disparities concerning obesity prevalence and remote healthcare access. Obesity prevention and treatment during adolescence is a national health priority given physiologic and psychological tolls on health and potential for obesity into adulthood. Obesity assessment and translation of evidence-based interventions for rural Mexican-American adolescents at rural health clinics is implicated. ©2013 The Author(s) ©2013 American Association of Nurse Practitioners.

  9. Infant Mental Health Assessment and Intervention Guidance for Service Providers and Families of Young Children. Service Guideline 4.

    ERIC Educational Resources Information Center

    Connecticut Birth to Three System, Hartford.

    This guide offers assessment and intervention guidelines for the Connecticut Birth to Three system concerning the emotional and psychological well-being of infants and toddlers in the system. Emphasis is on infants and toddlers who exhibit symptoms of traumatic stress disorder, depression or other affective disorders, regulatory disorders, sleep…

  10. Applying a Total Market Lens: Increased IUD Service Delivery Through Complementary Public- and Private-Sector Interventions in 4 Countries.

    PubMed

    White, Julia N; Corker, Jamaica

    2016-08-11

    Increasing access to the intrauterine device (IUD), as part of a comprehensive method mix, is a key strategy for reducing unintended pregnancy and maternal mortality in low-income countries. To expand access to IUDs within the framework of informed choice, Population Services International (PSI) has historically supported increased IUD service delivery through private providers. In applying a total market lens to better understand the family planning market and address major market gaps, PSI identified a lack of high-quality public provision of IUDs. In 2013, PSI started a pilot in 4 countries (Guatemala, Laos, Mali, and Uganda) to grow public-provider IUD service delivery through increased public-sector engagement while maintaining its ongoing focus on private providers. In collaboration with country governments, PSI affiliates carried out family planning market analyses in the 4 pilot countries to identify gaps in IUD service delivery and create sustainable strategies for scaling up IUD services in the public sector. Country-specific interventions to increase service delivery were implemented across all levels of the public health system, including targeted advocacy at the national level to promote government ownership and program sustainability. Mechanisms to ensure government ownership were built into the program design, including a proof-of-concept approach to convince governments of the feasibility and value of taking over and scaling up interventions. In the first 2 years of the pilot (2013-2014), 102,055 IUD services were provided to women at 417 targeted public-sector facilities. These preliminary results suggest that there is untapped demand for IUD service delivery in the public sector that can be met in part through greater participation of the public sector in family planning and IUD provision. © White et al.

  11. Applying a Total Market Lens: Increased IUD Service Delivery Through Complementary Public- and Private-Sector Interventions in 4 Countries

    PubMed Central

    White, Julia N; Corker, Jamaica

    2016-01-01

    ABSTRACT Increasing access to the intrauterine device (IUD), as part of a comprehensive method mix, is a key strategy for reducing unintended pregnancy and maternal mortality in low-income countries. To expand access to IUDs within the framework of informed choice, Population Services International (PSI) has historically supported increased IUD service delivery through private providers. In applying a total market lens to better understand the family planning market and address major market gaps, PSI identified a lack of high-quality public provision of IUDs. In 2013, PSI started a pilot in 4 countries (Guatemala, Laos, Mali, and Uganda) to grow public-provider IUD service delivery through increased public-sector engagement while maintaining its ongoing focus on private providers. In collaboration with country governments, PSI affiliates carried out family planning market analyses in the 4 pilot countries to identify gaps in IUD service delivery and create sustainable strategies for scaling up IUD services in the public sector. Country-specific interventions to increase service delivery were implemented across all levels of the public health system, including targeted advocacy at the national level to promote government ownership and program sustainability. Mechanisms to ensure government ownership were built into the program design, including a proof-of-concept approach to convince governments of the feasibility and value of taking over and scaling up interventions. In the first 2 years of the pilot (2013–2014), 102,055 IUD services were provided to women at 417 targeted public-sector facilities. These preliminary results suggest that there is untapped demand for IUD service delivery in the public sector that can be met in part through greater participation of the public sector in family planning and IUD provision. PMID:27540122

  12. Factors influencing the implementation of a brief alcohol screening and educational intervention in social settings not specializing in addiction services

    PubMed Central

    Silver Wolf (Adelv unegv Waya), David A. Patterson

    2015-01-01

    Although alcohol use continues to be a major problem, when high-risk users enter social services, they are not provided with empirically supported treatments (ESTs). This study investigates predictors of successful implementation in agencies not specializing in addiction services. Fifty-four frontline workers in six organizations were enrolled in the study. After completing self-administered surveys of organizational culture and climate and attitudes toward ESTs, workers were trained to implement a brief intervention. The results indicate that organizational factors and attitudes may not be related to implementation. Although high implementers had similar traits, further research is needed to characterize successful EST implementers. PMID:25905766

  13. The steps to recovery program: Evaluation of a group-based intervention for older individuals receiving mental health services.

    PubMed

    Flaherty-Jones, Graeme M; Carne, Alexandra S; Dexter-Smith, Sarah

    2016-03-01

    This study reports on the evaluation of a group-based intervention for older individuals receiving mental health services. A prospective cohort repeated-measure design was used for 48 participants who accessed secondary care mental health services for older people. Changes on the Recovery Assessment Scale (RAS), the Warwick-Edinburgh Mental Well-Being Scale (WEMWEBS), and a postevaluation questionnaire were analyzed. A paired sample t test examined changes in participant's scores on the WEMWEBS and RAS from baseline to postintervention. Participants qualitatively evaluated the Steps to Recovery group as having a positive effect on their recovery. Following involvement in this group intervention, participants reported improved mental well-being and recovery from mental health difficulty. These results suggest that the program has the potential to provide an accessible framework for developing recovery-orientated approaches in mental health care that can be delivered by care staff at all levels. (c) 2016 APA, all rights reserved).

  14. Developing a checklist for research proposals to help describe health service interventions in UK research programmes: a mixed methods study.

    PubMed

    Dorling, Hannah; White, Donna; Turner, Sheila; Campbell, Kevin; Lamont, Tara

    2014-03-04

    One of the most common reasons for rejecting research proposals in the National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) Programme is the failure to adequately specify the intervention or context in research proposals. Examples of failed research proposals include projects to assess integrated care models, use of generic caseworkers, or new specialist nurse services. These are all important service developments which need evaluation, but the lack of clarity about the intervention and context prevented these research proposals from obtaining funding. The purpose of the research presented herein was to develop a checklist, with key service intervention and contextual features, for use by applicants to the NIHR HS&DR Programme to potentially enhance the quality of research proposals. The study used mixed methods to identify the need for and develop and test a checklist. Firstly, this included assessing existing checklists in peer-reviewed literature relevant to organisational health research. Building on existing work, a new checklist was piloted. Two reviewers used a small sample (n = 16) of research proposals to independently assess the relevance of the checklist to the proposal and the degree of overlap or gaps between the constructs. The next two stages externally validated the revised checklist by collecting qualitative feedback from researchers and experts in the field. The initial checklist was developed from existing checklists which included domains of intervention and context. The constructs and background to each were developed through review of existing literature. Eight researchers provided feedback on the checklist, which was generally positive. This iterative process resulted in changes to the checklist, collapsing two constructs and providing more prompts for others; the final checklist includes six constructs. Features relating to intervention and context should be well described to increase the quality of

  15. The Impact of a Telenovela Intervention on Use of Home Health Care Services and Mexican American Elder and Caregiver Outcomes

    PubMed Central

    Pasvogel, Alice; Hepworth, Joseph T.; Koerner, Kari

    2015-01-01

    A two-group randomized controlled trial tested a telenovela intervention (a culturally congruent videotaped dramatization with guided dialogue) to increase Mexican American elders’ and family caregivers’ awareness of and confidence in home health care services (HHCS), thereby increasing use of HHCS and improving elders’ and caregivers’ outcomes. Both groups had significant increases in awareness of and confidence in HHCS. The intervention group used HHCS more than the control group (91.1% versus 71.2% of total visits authorized) although this was not a statistically significant difference (p=.18). Use of HHCS was associated with increased elders’ and caregivers’ mutuality (the quality of the elder-caregiver relationship), and decreased caregiving burden and caregiver depression. The predictive role and measurement of awareness and ways to improve the intervention are discussed. Findings are especially important with today’s focus on transitional care to keep elders at home and prevent unnecessary readmissions. PMID:25594360

  16. Impact of water management interventions on hydrology and ecosystem services in Garhkundar-Dabar watershed of Bundelkhand region, Central India

    NASA Astrophysics Data System (ADS)

    Singh, Ramesh; Garg, Kaushal K.; Wani, Suhas P.; Tewari, R. K.; Dhyani, S. K.

    2014-02-01

    Bundelkhand region of Central India is a hot spot of water scarcity, land degradation, poverty and poor socio-economic status. Impacts of integrated watershed development (IWD) interventions on water balance and different ecosystem services are analyzed in one of the selected watershed of 850 ha in Bundelkhand region. Improved soil, water and crop management interventions in Garhkundar-Dabar (GKD) watershed of Bundelkhand region in India enhanced ET to 64% as compared to 58% in untreated (control) watershed receiving 815 mm annual average rainfall. Reduced storm flow (21% vs. 34%) along with increased base flow (4.5% vs. 1.2%) and groundwater recharge (11% vs. 7%) of total rainfall received were recorded in treated watershed as compared to untreated control watershed. Economic Water productivity and total income increased from 2.5 to 5.0 INR m-3 and 11,500 to 27,500 INR ha-1 yr-1 after implementing integrated watershed development interventions in GKD watershed, respectively. Moreover IWD interventions helped in reducing soil loss more than 50% compared to control watershed. The results demonstrated that integrated watershed management practices addressed issues of poverty in GKD watershed. Benefit to cost ratio of project interventions was found three and pay back period within four years suggest economic feasibility to scale-up IWD interventions in Bundelkhend region. Scaling-up of integrated watershed management in drought prone rainfed areas with enabling policy and institutional support is expected to promote equity and livelihood along with strengthening various ecosystem services, however, region-specific analysis is needed to assess trade-offs for downstream areas along with onsite impact.

  17. An Educational and Administrative Intervention to Promote Rational Laboratory Test Ordering on an Academic General Medicine Service.

    PubMed

    Wertheim, Bradley M; Aguirre, Andrew J; Bhattacharyya, Roby P; Chorba, John; Jadhav, Ashutosh P; Kerry, Vanessa B; Macklin, Eric A; Motyckova, Gabriela; Raju, Shveta; Lewandrowski, Kent; Hunt, Daniel P; Wright, Douglas E

    2017-01-01

    Overuse of clinical laboratory testing in the inpatient setting is a common problem. The objective of this project was to develop an inexpensive and easily implemented intervention to promote rational laboratory use without compromising resident education or patient care. The study comprised of a cluster-randomized, controlled trial to assess the impact of a multifaceted intervention of education, guideline development, elimination of recurring laboratory orders, unbundling of laboratory panels, and redesign of the daily progress note on laboratory test ordering. The population included all patients hospitalized "general medicine" was duplicated during 2 consecutive months on a general medicine teaching service within a 999-bed tertiary care hospital in Boston, Massachusetts. The primary outcome was the total number of commonly used laboratory tests per patient day during 2 months in 2008. Secondary outcomes included a subgroup analysis of each individual test per patient day, adverse events, and resident and nursing satisfaction. A total of 5392 patient days were captured. The intervention produced a 9% decrease in aggregate laboratory use (rate ratio, 0.91; P = .021; 95% confidence interval, 0.84-0.98). Six instances of delayed diagnosis of acute kidney injury and 11 near misses were reported in the intervention arm. A bundled educational and administrative intervention promoting rational ordering of laboratory tests on a single academic general medicine service led to a modest but significant decrease in laboratory use. To our knowledge, this was the first study to examine the daily progress note as a tool to limit excessive test ordering. Unadjudicated near misses and possible harm were reported with this intervention. This finding warrants further study. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Early intervention, IDEA Part C services, and the medical home: collaboration for best practice and best outcomes.

    PubMed

    Adams, Richard C; Tapia, Carl

    2013-10-01

    The medical home and the Individuals With Disabilities Education Act Part C Early Intervention Program share many common purposes for infants and children ages 0 to 3 years, not the least of which is a family-centered focus. Professionals in pediatric medical home practices see substantial numbers of infants and toddlers with developmental delays and/or complex chronic conditions. Economic, health, and family-focused data each underscore the critical role of timely referral for relationship-based, individualized, accessible early intervention services and the need for collaborative partnerships in care. The medical home process and Individuals With Disabilities Education Act Part C policy both support nurturing relationships and family-centered care; both offer clear value in terms of economic and health outcomes. Best practice models for early intervention services incorporate learning in the natural environment and coaching models. Proactive medical homes provide strategies for effective developmental surveillance, family-centered resources, and tools to support high-risk groups, and comanagement of infants with special health care needs, including the monitoring of services provided and outcomes achieved.

  19. Developing an intervention to prevent acute kidney injury: using the Plan, Do, Study, Act (PDSA) service improvement approach.

    PubMed

    Byrne, Jo; Xu, Gang; Carr, Sue

    2015-03-01

    In the UK, recent National Institute for Health and Care Excellence guidelines for acute kidney injury point to the need for interventions to help prevent this condition. Effective medicines management is of prime importance in reducing the risk of AKI. Part of this challenge is to increase patients' awareness of their medicines and the possible need to temporarily withhold certain medications when acutely unwell. The objectives were to use a service improvement approach (the Plan, Do, Study, Act cycle) to develop an intervention and to evaluate current delivery of acute kidney injury management and to test and generate new ideas relating to patients' needs. A postal feedback form sent to a random sample of over 200 patients with chronic kidney disease. The feedback form collected information on: what patients know about acute kidney injury and managing medicines; where patients get their information from; whether patients want more information and where from; and what patients feel about self-managing their medicines. Completed feedback forms were received from 113 participants. Of these, 92% said they had received no advice, 77% of respondents wanted more advice but only 17% said they would feel comfortable to stop their own medication without medical consent. The PDSA cycle offered a very useful framework to evaluate the current service delivery and to test and generate new ideas for the development of an AKI intervention. Our findings highlighted that the current service is limited and more robust research is needed. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.

  20. Behavioral Counseling Interventions Expert Forum: Overview and Primer on U.S. Preventive Services Task Force Methods.

    PubMed

    Curry, Susan J; Whitlock, Evelyn P

    2015-09-01

    The importance of behavioral counseling as a clinical preventive service derives from the social and economic burden of preventable disease in the U.S., the central role behavioral risk factors play as leading causes of premature morbidity and mortality, and the promise of the healthcare visit as a teachable moment for behavioral counseling support. In November 2013, the U.S. Preventive Services Task Force convened an expert forum on behavioral counseling interventions. The forum brought together NIH, CDC, and Agency for Healthcare Research and Quality leaders, leading behavioral counseling researchers, and members of the U.S. Preventive Services Task Force to discuss issues related to optimizing evidence-based behavioral counseling recommendations. This paper provides an overview of the methods used by the Task Force to develop counseling recommendations. Special focus is on the development and evaluation of evidence from systematic reviews. Assessment of the net benefit of a behavioral counseling intervention, based on the evidence review, determines the recommendation statement and accompanying letter grade. A recent Task Force recommendation on screening and behavioral counseling interventions in primary care to reduce alcohol misuse provides a brief example.

  1. "A Person to Talk to Who Really Cared": High-Risk Mothers' Evaluations of Services in an Intensive Intervention Research Program.

    ERIC Educational Resources Information Center

    Pharis, Mary E.; Levin, Victoria S.

    1991-01-01

    Discusses the Clinical Infant Development Program, an intervention project for mothers at extremely high risk of dysfunctional parent-infant interactions. A survey of services staff and clients showed that the staff found that provision of concrete services formed a bridge to abstract services, which the clients ranked as the most helpful…

  2. The Relationship between State Lead Agency and Enrollment into Early Intervention Services

    ERIC Educational Resources Information Center

    Twardzik, Erica; MacDonald, Megan; Dixon-Ibarra, Alicia

    2017-01-01

    Services offered through Part C of the Individuals With Disabilities Education Improvement Act improve cognitive, behavioral, and physical skills for children less than 3 years old at risk for or with a disability. However, there are low enrollment rates into services. Various Lead Agencies oversee services through Part C, and states determine…

  3. Developmental Status and Early Intervention Service Needs of Maltreated Children. Final Report

    ERIC Educational Resources Information Center

    Barth, Richard P.; Scarborough, Anita A.; Lloyd, E. Christopher; Losby, Jan L.; Casanueva, Cecilia; Mann, Tammy

    2008-01-01

    This report describes the extent to which maltreated children have developmental problems or are subject to factors associated with poor developmental outcomes, what services these children might be eligible to receive, what factors influence service receipt, and what solutions have been devised to address barriers to service provision. This final…

  4. Use of Psychosocial Services Increases after a Social Worker-Mediated Intervention in Gynecology Oncology Patients

    ERIC Educational Resources Information Center

    Abbott, Yuko; Shah, Nina R.; Ward, Kristy K.; McHale, Michael T.; Alvarez, Edwin A.; Saenz, Cheryl C.; Plaxe, Steven C.

    2013-01-01

    The purpose of this study was to determine whether the introduction of psychosocial services to gynecologic oncology outpatients by a social worker increases service use. During the initial six weeks (phase I), patients were referred for psychosocial services by clinic staff. During the second six weeks (phase II), a nurse introduced available…

  5. Use of Psychosocial Services Increases after a Social Worker-Mediated Intervention in Gynecology Oncology Patients

    ERIC Educational Resources Information Center

    Abbott, Yuko; Shah, Nina R.; Ward, Kristy K.; McHale, Michael T.; Alvarez, Edwin A.; Saenz, Cheryl C.; Plaxe, Steven C.

    2013-01-01

    The purpose of this study was to determine whether the introduction of psychosocial services to gynecologic oncology outpatients by a social worker increases service use. During the initial six weeks (phase I), patients were referred for psychosocial services by clinic staff. During the second six weeks (phase II), a nurse introduced available…

  6. Quality Services Management: A Consumer-Oriented Model for Systems Audit and Strategic Intervention.

    ERIC Educational Resources Information Center

    Baker, Pamela C.

    The paper describes Quality Service Management (QSM) as applied to the provision of services to disabled and other special needs persons. QSM is defined as a systems approach to consumer relations based on the belief that quality care may be achieved only within the context of overall services management. Differences among "quality…

  7. The Use of Sensory Integration Therapy by Intervention Service Providers in Malaysia

    ERIC Educational Resources Information Center

    Leong, Han Ming; Stephenson, Jennifer; Carter, Mark

    2011-01-01

    Sensory integration (SI) therapy is a controversial intervention used in intervention for children with disabilities that is popular in the United States. Little is known about the use of SI therapy for children with disabilities in educational centres in developing nations such as Malaysia. Supervisors and teachers from seven educational…

  8. Early Intervention and Treatment Acceptability: Multiple Perspectives for Improving Service Delivery in Home Settings.

    ERIC Educational Resources Information Center

    Paget, Kathleen D.

    1991-01-01

    This article examines issues related to treatment acceptability in early intervention programs, by applying concepts pertaining to collaboration, cultural difference, compliance and freedom of choice, family life cycles, and systems theory. A paradigm for designing home-based intervention plans with families of preschoolers with behavior disorders…

  9. Enrolling and Engaging High-Risk Youths and Families in Community-Based, Brief Intervention Services

    ERIC Educational Resources Information Center

    Dembo, Richard; Gulledge, Laura; Robinson, Rhissa Briones; Winters, Ken C.

    2011-01-01

    Increasing interest has been shown in brief interventions for troubled persons, including those with substance abuse problems. Most of the published literature on this topic has focused on adults, and on the efficacy of these interventions. Few of these studies have examined the critical issues of enrollment and engagement in brief intervention…

  10. What's Possible for First-Grade At-Risk Literacy Learners Receiving Early Intervention Services

    ERIC Educational Resources Information Center

    Bufalino, Janet; Wang, Chuang; Gomez-Bellenge, Francisco X.; Zalud, Garreth

    2010-01-01

    This paper summarizes a study that was conducted on data from children who received a one-on-one intervention called Reading Recovery[R] during the first half of their first-grade year in school. The purpose was to investigate the relationship between accelerated progress children made during and after receiving a Reading Recovery intervention,…

  11. Enrolling and Engaging High-Risk Youths and Families in Community-Based, Brief Intervention Services

    ERIC Educational Resources Information Center

    Dembo, Richard; Gulledge, Laura; Robinson, Rhissa Briones; Winters, Ken C.

    2011-01-01

    Increasing interest has been shown in brief interventions for troubled persons, including those with substance abuse problems. Most of the published literature on this topic has focused on adults, and on the efficacy of these interventions. Few of these studies have examined the critical issues of enrollment and engagement in brief intervention…

  12. A study of the effectiveness of a workplace violence intervention for small retail and service establishments.

    PubMed

    Casteel, Carri; Peek-Asa, Corinne; Greenland, Sander; Chu, Lawrence D; Kraus, Jess F

    2008-12-01

    Examine the effectiveness of a robbery and violence prevention program in small businesses in Los Angeles. Gas/convenience, liquor and grocery stores, bars/restaurants, and motels were enrolled between 1997 and 2000. Intervention businesses (n = 305) were provided training, program implementation materials, and recommendations for a comprehensive security program. Control businesses (n = 96) received neither training nor program materials. Rate ratios comparing intervention to control businesses were 0.90 for violent crime (95% confidence limits [CL] = 0.53, 1.53) and 0.81 for robbery (95% CL = 0.38, 1.73). The reduction in violent crime was concentrated in high-compliance intervention businesses (risk ratio = 0.74, 95% CL = 0.40, 1.36). Low-compliance intervention businesses had practically the same postintervention crime as the control businesses. Our results suggest that the workplace violence intervention may reduce violent crime among high-risk businesses, especially those with high program compliance.

  13. Making the journey with me: a qualitative study of experiences of a bespoke mental health smoking cessation intervention for service users with serious mental illness.

    PubMed

    Knowles, Sarah; Planner, Claire; Bradshaw, Tim; Peckham, Emily; Man, Mei-See; Gilbody, Simon

    2016-06-08

    Smoking is one of the major modifiable risk factors contributing to early mortality for people with serious mental illness. However, only a minority of service users access smoking cessation interventions and there are concerns about the appropriateness of generic stop-smoking services for this group. The SCIMITAR (Smoking Cessation Intervention for Severe Mental Ill-Health Trial) feasibility study explored the effectiveness of a bespoke smoking cessation intervention delivered by mental health workers. This paper reports on the nested qualitative study within the trial. Qualitative semi-structured interviews were conducted with 13 service users receiving the intervention and 3 of the MHSCPs (mental health smoking cessation practitioners) delivering the intervention. Topic guides explored the perceived acceptability of the intervention particularly in contrast to generic stop-smoking services, and perceptions of the implementation of the intervention in practice. Transcripts were analysed using the Constant Comparative Method. Generic services were reported to be inappropriate for this group, due to concerns over stigma and a lack of support from health professionals. The bespoke intervention was perceived positively, with both practitioners and service users emphasising the benefits of flexibility and personalisation in delivery. The mental health background of the practitioners was considered valuable not only due to their increased understanding of the service users' illness but also due to the more collaborative relationship style they employed. Challenges involved delays in liaising with general practitioners and patient struggles with organisation and motivation, however the MHSCP was considered to be well placed to address these problems. The bespoke smoking cessation intervention was acceptable to service users and the both service users and practitioners reported the value of a protected mental health worker role for delivering smoking cessation to this

  14. Effects of individual and neighborhood characteristics on the timeliness of provider designation for early intervention services in New York City.

    PubMed

    Kim, Claire; Disare, Katherine; Pfeiffer, Melissa; Kerker, Bonnie D; McVeigh, Katharine H

    2009-02-01

    The Early Intervention (EI) Program of the New York City (NYC) Department of Health and Mental Hygiene provides therapeutic services to children under 3 years of age with developmental delays or disabilities. Although the EI Program targets delivery of services within 21 days of the meeting at which the Individualized Family Service Plan (IFSP) is developed, the designation of a service provider alone often takes longer than that. This study examined associations between individual and neighborhood characteristics and timeliness of provider designation in NYC. Multivariable logistic regression analyses were performed for 14,623 children who had their initial IFSPs developed in Fiscal Year 2004. Provider designation was delayed 13.4% of the time for speech therapy, 10.0% of the time for special instruction, 8.2% of the time for occupational therapy, and 4.2% of the time for physical therapy. Individual characteristics independently associated with provider designation delay were: being older than 24 months, having the IFSP meeting between July and December, having an adaptive delay, and having speech therapy or special instruction in the IFSP. Neighborhood characteristics independently associated with provider designation delay included living in a low-income neighborhood and living in a heavily Spanish-speaking neighborhood. Delayed provider designation occurs because of both individual and neighborhood factors. Interventions are needed to address shortages of providers in certain neighborhoods or with specific skills, and to address surges in administrative program functions at certain times of the year.

  15. Hospital Organization and Importance of an Interventional Radiology Inpatient Admitting Service: Italian Single-Center 3-Year Experience

    SciTech Connect

    Simonetti, Giovanni; Bollero, Enrico; Ciarrapico, Anna Micaela; Gandini, Roberto; Konda, Daniel Bartolucci, Alberto; Di Primio, Massimiliano; Mammucari, Matteo; Chiocchi, Marcello; D'Alba, Fabrizio; Masala, Salvatore

    2009-03-15

    In June 2005 a Complex Operating Unit of Interventional Radiology (COUIR), consisting of an outpatient visit service, an inpatient admitting service with four beds, and a day-hospital service with four beds was installed at our department. Between June 2005 and May 2008, 1772 and 861 well-screened elective patients were admitted to the inpatient ward of the COUIR and to the Internal Medicine Unit (IMU) or Surgery Unit (SU) of our hospital, respectively, and treated with IR procedures. For elective patients admitted to the COUIR's inpatient ward, hospital stays were significantly shorter and differences between reimbursements and costs were significantly higher for almost all IR procedures compared to those for patients admitted to the IMU and SU (Student's t-test for unpaired data, p < 0.05). The results of the 3-year activity show that the activation of a COUIR with an inpatient admitting service, and the better organization of the patient pathway that came with it, evidenced more efficient use of resources, with the possibility for the hospital to save money and obtain positive margins (differences between reimbursements and costs). During 3 years of activity, the inpatient admitting service of our COUIR yielded a positive difference between reimbursements and effective costs of Euro 1,009,095.35. The creation of an inpatient IR service and the admission of well-screened elective patients allowed short hospitalization times, reduction of waiting lists, and a positive economic outcome.

  16. Hospital organization and importance of an interventional radiology inpatient admitting service: Italian single-center 3-year experience.

    PubMed

    Simonetti, Giovanni; Bollero, Enrico; Ciarrapico, Anna Micaela; Gandini, Roberto; Konda, Daniel; Bartolucci, Alberto; Di Primio, Massimiliano; Mammucari, Matteo; Chiocchi, Marcello; D'Alba, Fabrizio; Masala, Salvatore

    2009-03-01

    In June 2005 a Complex Operating Unit of Interventional Radiology (COUIR), consisting of an outpatient visit service, an inpatient admitting service with four beds, and a day-hospital service with four beds was installed at our department. Between June 2005 and May 2008, 1772 and 861 well-screened elective patients were admitted to the inpatient ward of the COUIR and to the Internal Medicine Unit (IMU) or Surgery Unit (SU) of our hospital, respectively, and treated with IR procedures. For elective patients admitted to the COUIR's inpatient ward, hospital stays were significantly shorter and differences between reimbursements and costs were significantly higher for almost all IR procedures compared to those for patients admitted to the IMU and SU (Student's t-test for unpaired data, p < 0.05). The results of the 3-year activity show that the activation of a COUIR with an inpatient admitting service, and the better organization of the patient pathway that came with it, evidenced more efficient use of resources, with the possibility for the hospital to save money and obtain positive margins (differences between reimbursements and costs). During 3 years of activity, the inpatient admitting service of our COUIR yielded a positive difference between reimbursements and effective costs of 1,009,095.35 euros. The creation of an inpatient IR service and the admission of well-screened elective patients allowed short hospitalization times, reduction of waiting lists, and a positive economic outcome.

  17. Impact of Brief Intervention Services on Drug Using Truant Youth Arrest Charges over Time

    PubMed Central

    Dembo, Richard; Briones-Robinson, Rhissa; Wareham, Jennifer; Schmeidler, James; Winters, Ken C.; Barrett, Kimberly; Ungaro, Rocio; Karas, Lora M.; Belenko, Steven

    2012-01-01

    School truancy is a serious concern in the U.S., with far-reaching negative consequences. Truancy has been positively associated with substance use and delinquent behavior; however, research is limited. Consequently, the Truancy Brief Intervention Project was established to treat and prevent substance use and other risky behaviors among truants. This article examines whether the Brief Intervention program is more effective in preventing future delinquency over a 12-month follow-up period, than the standard truancy program. Results indicate the Brief Intervention was marginally significant in effecting future delinquency among truants, compared to the standard truancy program. Future implications of this study are discussed. PMID:25382960

  18. A Systematic Review of the Effect of Early Interventions for Psychosis on the Usage of Inpatient Services

    PubMed Central

    Randall, Jason R.; Vokey, Sherri; Loewen, Hal; Martens, Patricia J.; Brownell, Marni; Katz, Alan; Nickel, Nathan C.; Burland, Elaine; Chateau, Dan

    2015-01-01

    Objectives: To review and synthesize the currently available research on whether early intervention for psychosis programs reduce the use of inpatient services. Methods: A systematic review was conducted using keywords searches on PubMed, Embase (Ovid), PsycINFO (ProQuest), Scopus, CINAHL (EBSCO), Social Work Abstracts (EBSCO), Social Science Citations Index (Web of Science), Sociological Abstracts (ProQuest), and Child Development & Adolescent Studies (EBSCO). To be included, studies had to be peer-reviewed publications in English, examining early intervention programs using a variant of assertive community treatment, with a control/comparison group, and reporting inpatient service use outcomes. The primary outcome extracted number hospitalized and total N. Secondary outcome extracted means and standard deviations. Data were pooled using random effects models. Primary outcome was the occurrence of any hospitalization during treatment. A secondary outcome was the average bed-days used during treatment period. Results: Fifteen projects were identified and included in the study. Results of meta-analysis supported the occurrence of a positive effect for intervention for both outcome measures (any hospitalization OR: 0.33; 95% CI 0.18–0.63, bed-days usage SMD: −0.38, 95% CI −0.53 to −0.24). There was significant heterogeneity of effect across the studies. This heterogeneity is due to a handful of studies with unusually positive responses. Conclusion: These results suggest that early intervention programs are superior to standard of care, with respect to reducing inpatient service usage. Wider use of these programs may prevent the occurrence of admission for patients experiencing the onset of psychotic symptoms. PMID:25745034

  19. A Systematic Review of the Effect of Early Interventions for Psychosis on the Usage of Inpatient Services.

    PubMed

    Randall, Jason R; Vokey, Sherri; Loewen, Hal; Martens, Patricia J; Brownell, Marni; Katz, Alan; Nickel, Nathan C; Burland, Elaine; Chateau, Dan

    2015-11-01

    To review and synthesize the currently available research on whether early intervention for psychosis programs reduce the use of inpatient services. A systematic review was conducted using keywords searches on PubMed, Embase (Ovid), PsycINFO (ProQuest), Scopus, CINAHL (EBSCO), Social Work Abstracts (EBSCO), Social Science Citations Index (Web of Science), Sociological Abstracts (ProQuest), and Child Development & Adolescent Studies (EBSCO). To be included, studies had to be peer-reviewed publications in English, examining early intervention programs using a variant of assertive community treatment, with a control/comparison group, and reporting inpatient service use outcomes. The primary outcome extracted number hospitalized and total N. Secondary outcome extracted means and standard deviations. Data were pooled using random effects models. Primary outcome was the occurrence of any hospitalization during treatment. A secondary outcome was the average bed-days used during treatment period. Fifteen projects were identified and included in the study. Results of meta-analysis supported the occurrence of a positive effect for intervention for both outcome measures (any hospitalization OR: 0.33; 95% CI 0.18-0.63, bed-days usage SMD: -0.38, 95% CI -0.53 to -0.24). There was significant heterogeneity of effect across the studies. This heterogeneity is due to a handful of studies with unusually positive responses. These results suggest that early intervention programs are superior to standard of care, with respect to reducing inpatient service usage. Wider use of these programs may prevent the occurrence of admission for patients experiencing the onset of psychotic symptoms. © The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.

  20. The existing therapeutic interventions for orgasmic disorders: recommendations for culturally competent services, narrative review

    PubMed Central

    Salmani, Zahra; Zargham-Boroujeni, Ali; Salehi, Mehrdad; K.Killeen, Therese; Merghati-Khoei, Effat

    2015-01-01

    Background: In recent years, a growing number of interventions for treatment of female orgasmic problems (FODs) have emerged. Whereas orgasm is a extra biologically and learnable experience, there is a need for practitioners that to be able to select which therapy is the most appropriate to their context. Objective: In this critical literature review, we aimed to assess areas of controversy in the existing therapeutic interventions in FOD with taking into accounted the Iranian cultural models. Materials and Methods: For the present study, we conducted an extensive search of electronic databases using a comprehensive search strategy from 1970 till 2014. This strategy was using Google Scholar search, “pearl-growing” techniques and by hand-searching key guidelines, to identify distinct interventions to women's orgasmic problem therapy. We utilized various key combinations of words such as:" orgasm" OR "orgasmic "," female orgasmic dysfunction" OR Female anorgasmia OR Female Orgasmic Disorder ", orgasmic dysfunction AND treatment, “orgasm AND intervention”. Selection criteria in order to be included in this review, studies were required to: 1 employ clinical-based interventions, 2 focus on FOD. Results: The majority of interventions (90%) related to non-pharmacological and other were about pharmacological interventions. Self-direct masturbation is suggested as the most privilege treatment in FOD. Reviewing all therapies indicates couple therapy, sexual skill training and sex therapy seem to be more appropriate to be applied in Iranian clinical settings. Conclusion: Since many therapeutic interventions are introduced to inform sexually-related practices, it is important to select an intervention that will be culturally appropriate and sensitive to norms and values. Professionals working in the fields of health and sexuality need to be sensitive and apply culturally appropriate therapies for Iranian population. We further suggest community well defined protocols

  1. Efficacy of a Process Improvement Intervention on Inmate Awareness of HIV Services: A Multi-Site Trial.

    PubMed

    Swan, Holly; Hiller, Matthew L; Albizu-García, Carmen E; Pich, Michele; Patterson, Yvonne; O'Connell, Daniel J

    2015-06-01

    The prevalence of HIV among U.S. inmates is much greater than in the general population, creating public health concerns and cost issues for the criminal justice system. The HIV Services and Treatment Implementation in Corrections protocol of the NIDA funded Criminal Justice Drug Abuse Treatment Studies cooperative tested the efficacy of an organizational process improvement strategy on improving HIV services in correctional facilities. For this paper, we analyzed efficacy of this strategy on improving inmate awareness and perceptions of HIV services. The study used a multi-site (n=28) clustered randomized trial approach. Facilities randomized to the experimental condition used a coach-driven local change team approach to improve HIV services at their facility. Facilities in the control condition were given a directive to improve HIV services on their own. Surveys about awareness and perceptions of HIV services were administered anonymously to inmates who were incarcerated in study facilities at baseline (n=1253) and follow-up (n=1048). A series of one-way ANOVAs were run to test whether there were differences between inmates in the experimental and control facilities at baseline and follow-up. Differences were observed at baseline, with the experimental group having significantly lower scores than the control group on key variables. But, at post-test, following the intervention, these differences were no longer significant. Taken in context of the findings from the main study, these results suggest that the change team approach to improving HIV services in correctional facilities is efficacious for improving inmates' awareness and perceptions of HIV services.

  2. Prospects of using community directed intervention strategy in delivering health services among Fulani Nomads in Enugu State, Nigeria

    PubMed Central

    2013-01-01

    Background The Community Directed Interventions (CDI) strategy has proven effective in increasing access to health services in sedentary populations. It remains to be seen if CDI strategy is feasible among nomads given the dearth of demographic and medical data on the nomads. This study thus characterized the nomadic populations in Enugu State, Nigeria and outlined the potentials of implementing CDI among nomads. Study design and methods This exploratory study adopted qualitative methods. Forty focus group discussions (FGD) were held with members of 10 nomadic camps in 2 LGAs in Enugu State, as well as their host communities. Thirty in-depth interviews (IDIs) were held with leaders of nomadic camps and sedentary populations. Ten IDIs with traditional healers in the nomadic camps and 14 key informant interviews with health workers and programme officers were also conducted. Documents and maps were reviewed to ascertain the grazing routes of the nomads as well as existing health interventions in the area. Results Like sedentary populations, nomads have definable community structures with leaders and followers, which is amenable to implementation of CDI. Nomads move their cattle, in a definite pattern, in search of grass and water. In this movement, the old and vulnerable are left in the camps. The nomads suffer from immunization preventable health problems as their host communities. The priority health problems in relation to CDI include malaria, measles, anemia, and other vaccine preventable infections. However, unlike the sedentary populations, the nomads lack access to health interventions, due to the mutual avoidance between the nomads and the sedentary populations in terms of health services. The later consider the services as mainly theirs. The nomads, however, are desirous of the modern health services and often task themselves to access these modern health services in private for profit health facilities when the need arises. Conclusion Given the definable

  3. Caregiver Factors Predicting Service Utilization among Youth Participating in a School-Based Mental Health Intervention

    ERIC Educational Resources Information Center

    Burnett-Zeigler, Inger; Lyons, John S.

    2010-01-01

    Large numbers of children and adolescents experience diagnosable psychiatric disturbances; however, the majority of those with need do not utilize mental health services. Characteristics of caregivers are important predictors of which youth will access and continue to use services over time. In recent years school-based mental health intervention…

  4. The Components of Early Intervention Services for Families Living in Poverty: A Review of the Literature

    ERIC Educational Resources Information Center

    Corr, Catherine; Santos, Rosa Milagros; Fowler, Susan A.

    2016-01-01

    The Individuals With Disabilities Education Act mandates that very young children with disabilities be served through Part C services. Families of young children with disabilities who are also living in poverty are often the primary recipients of these services. To better understand the experiences of families, particularly those living in…

  5. Caregiver Factors Predicting Service Utilization among Youth Participating in a School-Based Mental Health Intervention

    ERIC Educational Resources Information Center

    Burnett-Zeigler, Inger; Lyons, John S.

    2010-01-01

    Large numbers of children and adolescents experience diagnosable psychiatric disturbances; however, the majority of those with need do not utilize mental health services. Characteristics of caregivers are important predictors of which youth will access and continue to use services over time. In recent years school-based mental health intervention…

  6. The Components of Early Intervention Services for Families Living in Poverty: A Review of the Literature

    ERIC Educational Resources Information Center

    Corr, Catherine; Santos, Rosa Milagros; Fowler, Susan A.

    2016-01-01

    The Individuals With Disabilities Education Act mandates that very young children with disabilities be served through Part C services. Families of young children with disabilities who are also living in poverty are often the primary recipients of these services. To better understand the experiences of families, particularly those living in…

  7. Service Providers? Perceptions of Universal Newborn Hearing Screening and Intervention Training Needs

    ERIC Educational Resources Information Center

    Malone, Delia G.; Easterbrooks, Susan; Gallagher, Peggy A.

    2005-01-01

    Following the initial implementation of universal newborn hearing screening initiatives currently required by law in most states, there is a need to move beyond the hospital follow-up to the delivery of services and support for children identified with hearing loss. A cadre of trained providers is needed to deliver these services. In order to…

  8. Translating a health service intervention into a rural setting: lessons learned.

    PubMed

    Dent, Elsa; Hoon, Elizabeth; Kitson, Alison; Karnon, Jonathan; Newbury, Jonathan; Harvey, Gillian; Gill, Tiffany K; Gillis, Lauren; Beilby, Justin

    2016-02-18

    Limited research exists on the process of applying knowledge translation (KT) methodology to a rural-based population health intervention. This study reports on the implementation and translational stages of a previously described Co-creating KT (Co-KT) framework in the rural town of Port Lincoln, South Australia (population: 14,000). The Co-KT framework involves five steps: (i) collecting local data; (ii) building stakeholder relationships; (iii) designing an evidence-based intervention incorporating local knowledge; (iv) implementation and evaluation of the intervention; and (v) translating the research into policy and practice. Barriers and enablers to the overall Co-KT implementation process were identified. Our intervention focused on musculoskeletal (MSK) conditions. Although the Co-KT framework was valuable in engaging with the community, translating the final intervention into daily clinical practice was prevented by a lack of an accessible policy or financial framework to anchor the appropriate intervention, a lack of continued engagement with stakeholders, access problems to general practitioners (GPs) and Allied Health Professionals; and the paucity of referrals from GPs to Allied Health Professionals. Consequently, while many aspects of the intervention were successful, including the improvement of both function and pain in study participants, the full implementation of the Co-KT framework was not possible. This study implemented and evaluated a Co-KT framework for a population with MSK conditions, linking locally generated health care system knowledge with academic input. Further policy, health system changes, and on-the-ground support are needed to overcome the identified implementation challenges in order to create sustainable and effective system change.

  9. A systematic review of interventions to improve prevention of mother-to-child HIV transmission service delivery and promote retention.

    PubMed

    Ambia, Julie; Mandala, Justin

    2016-01-01

    The success of prevention of mother-to-child transmission of HIV (PMTCT) is dependent upon high retention of mother-infant pairs within these programmes. This is a systematic review to evaluate the effectiveness of interventions that aim to improve PMTCT service delivery and promote retention throughout the PMTCT steps. Selected databases were searched for studies published in English (up to September 2015). Outcomes of interest included antiretroviral (ARV) drugs or antiretroviral therapy (ART) initiation among HIV-positive pregnant and/or breastfeeding women and their infants, retention into PMTCT programs, the uptake of early infant diagnosis (EID) of HIV and infant HIV status. Risk ratios and random-effect meta-analysis were used in the analysis. Interventions assessed in the 34 identified studies included male partner involvement in PMTCT, peer mentoring, the use of community health workers (CHWs), mobile phone-based reminders, conditional cash transfer, training of midwives, integration of PMTCT services and enhanced referral. Five studies (two randomized) that evaluated mobile phone-based interventions showed a statistically significant increase (pooled RR 1.18; 95% CI 1.05 to 1.32, I(2)=83%) in uptake of EID of HIV at around six weeks postpartum. Male partner involvement in PMTCT was associated with reductions in infant HIV transmission (pooled RR 0.61; 95% CI 0.39 to 0.94, I(2)=0%) in four studies (one randomized). Four studies (three randomized) that were grounded on psychological interventions reported non-significant results (pooled RR 1.01; 95% CI 0.93 to 1.09, I(2)=69%) in increasing ARV/ART uptake among HIV-positive pregnant and/or breastfeeding women and infant HIV testing (pooled RR 1.00; 95% CI 0.94 to 1.07, I(2)=45%). The effect of the other interventions on the effectiveness of improving PMTCT uptake was unclear. Heterogeneity of interventions limits these findings. Our findings indicate that mobile phone-based reminders may increase the uptake

  10. A systematic review of interventions to improve prevention of mother-to-child HIV transmission service delivery and promote retention

    PubMed Central

    Ambia, Julie; Mandala, Justin

    2016-01-01

    Introduction The success of prevention of mother-to-child transmission of HIV (PMTCT) is dependent upon high retention of mother-infant pairs within these programmes. This is a systematic review to evaluate the effectiveness of interventions that aim to improve PMTCT service delivery and promote retention throughout the PMTCT steps. Methods Selected databases were searched for studies published in English (up to September 2015). Outcomes of interest included antiretroviral (ARV) drugs or antiretroviral therapy (ART) initiation among HIV-positive pregnant and/or breastfeeding women and their infants, retention into PMTCT programs, the uptake of early infant diagnosis (EID) of HIV and infant HIV status. Risk ratios and random-effect meta-analysis were used in the analysis. Results Interventions assessed in the 34 identified studies included male partner involvement in PMTCT, peer mentoring, the use of community health workers (CHWs), mobile phone-based reminders, conditional cash transfer, training of midwives, integration of PMTCT services and enhanced referral. Five studies (two randomized) that evaluated mobile phone-based interventions showed a statistically significant increase (pooled RR 1.18; 95% CI 1.05 to 1.32, I2=83%) in uptake of EID of HIV at around six weeks postpartum. Male partner involvement in PMTCT was associated with reductions in infant HIV transmission (pooled RR 0.61; 95% CI 0.39 to 0.94, I2=0%) in four studies (one randomized). Four studies (three randomized) that were grounded on psychological interventions reported non-significant results (pooled RR 1.01; 95% CI 0.93 to 1.09, I2=69%) in increasing ARV/ART uptake among HIV-positive pregnant and/or breastfeeding women and infant HIV testing (pooled RR 1.00; 95% CI 0.94 to 1.07, I2=45%). The effect of the other interventions on the effectiveness of improving PMTCT uptake was unclear. Heterogeneity of interventions limits these findings. Conclusions Our findings indicate that mobile phone

  11. Survey of otolaryngology services in Central America: need for a comprehensive intervention.

    PubMed

    Wagner, Richard; Fagan, Johan

    2013-11-01

    In the developing world, there exists a scarcity of services and training in otolaryngology, audiology, and speech therapy, which is reflected by the gap between health care delivery in high-income countries and low-income countries. We surveyed, by questionnaire, the countries of Central America, except for Belize, because of the lack of otolaryngology services, on the following issues: availability of otolaryngology, audiology, and speech therapy services and equipment; otolaryngologist, audiologist, and speech therapist training; and availability of services in rural areas. Surveys were distributed via email and by hand at the 2011 Central American Congress of Otolaryngology, in San Salvador, El Salvador, to otolaryngologists, audiologists, and speech therapists. Not to our surprise, there is a shortfall in services and training in all three professions. The data collected and presented in this commentary will provide a basis by which change might take place.

  12. Battered Women’s Profiles Associated with Service Help-Seeking Efforts: Illuminating Opportunities for Intervention

    PubMed Central

    Macy, Rebecca J.; Nurius, Paula S.; Kernic, Mary A.; Holt, Victoria L.

    2015-01-01

    Knowledge about where battered women present for services and the violence, biopsychosocial, and demographic factors associated with their help seeking can provide social workers with guidance in anticipating needs among this portion of their clientele. The authors examined the service contact patterns of a sample of battered women (N = 448) following an incident of partner violence that triggered legal involvement. Significant group differences, tested with t tests and chi squares, between women who sought compared with those who did not seek services were found on partner violence exposure and biopsychosocial factors. Correlations and regression analyses of relationships among partner violence and biopsychosocial and demographic factors with help-seeking indices show how battered women’s needs differentially relate across a range of service types. Results show distinctive profiles of needs and resources among battered women who seek violence, legal, health, economic, substance abuse, and religious helping services. PMID:25705104

  13. Early psychosis intervention outpatient service of the 1st Psychiatric University Clinic in Athens: 3 Years of experience.

    PubMed

    Kollias, Constantinos; Xenaki, Lida-Alkisti; Dimitrakopoulos, Stefanos; Kosteletos, Ioannis; Kontaxakis, Vassilis; Stefanis, Nikos; Papageorgiou, Charalampos

    2016-11-09

    To present the 3-year experience of the early intervention in psychosis (EIP) service implementation of the 1st Psychiatric University Clinic in Athens. An overview of: (1) the purpose of our service, (2) the referral network, (3) the selection criteria, (4) the diagnostic procedures, (5) the therapeutic interventions and (6) the research activities. The service was established in 2012 and developed gradually aiming to provide information, early detection, treatment and support to people aged 15 to 40 years with psychotic manifestations, who are either at increased risk of developing psychosis (at-risk mental state [ARMS]) or with first episode psychosis (FEP). In order to assess individuals with ARMS, we used the comprehensive assessment of at-risk mental states interview and the Social and Occupational Functioning Assessment Scale The duration of untreated psychosis was estimated by using the Nottingham Onset Schedule. So far we have had 65 referrals, of which 26 were ARMS and 17 FEP. Based on the individual needs, they were offered psychotherapeutic and/or pharmacological treatment. After 3 years, the rate of transition to psychosis was 19.2% and the rate of psychosis relapse was 11.7%. The implementation of our service has had positive results, enabling young people with early psychosis to receive prompt and effective care. The rates of transition to psychosis are the first to be published from a Greek EIP service. Further development of our referral network and inter-hospital collaboration will allow us to address the needs of a wider part of the population. © 2016 John Wiley & Sons Australia, Ltd.

  14. Evaluating an early intervention in psychosis service for 'high-risk' adolescents: symptomatic and social recovery outcomes.

    PubMed

    Lower, Rebecca; Wilson, Jonathan; Medin, Evelina; Corlett, Emma; Turner, Ruth; Wheeler, Karen; Fowler, David

    2015-06-01

    This study presents client characteristics and treatment outcomes for a group of young people seen by Central Norfolk Early Intervention Team (CNEIT). The team offers an intensive outreach model of treatment to young people with complex co-morbid emotional, behavioural and social problems, as well as the presence of psychotic symptoms. Outcomes include both client self-report and clinician-rated measures. Data are routinely collected at acceptance into service, after 12 months of service and at point of discharge. Data show that clients seen by the CNEIT youth team are a group of young people at high risk of developing long-term mental illness and social disability. Outcomes show significant reductions in not only psychotic symptomatology, but also co-morbid anxiety and depression, as well as improvements in social recovery. At the end of their time with the service, the majority of clients are discharged back to the care of their general practitioner, which indicates that the team successfully managed to reduce the complexity of needs and difficulties associated with this client group. Outcomes support the use of an intensive outreach approach for young people at high risk of developing psychotic disorders. It has been suggested that this model may be successfully broadened to young people with other emerging, potentially severe or complex mental disorders. Norfolk and Suffolk NHS Foundation Trust has built on the success of its youth early intervention team and innovatively redesigned its services in line with this model by developing a specific youth mental health service. © 2014 Wiley Publishing Asia Pty Ltd.

  15. Early Hearing Detection and Intervention-Pediatric Audiology Links to Services EHDI-PALS: Building a National Facility Database

    PubMed Central

    Chung, Winnie; Beauchaine, Kathryn L.; Hoffman, Jeff; Coverstone, Kirsten R.; Oyler, Anne; Mason, Craig

    2017-01-01

    Objectives To create a searchable web-based national audiology facility directory using a standardized survey, so parents and providers could identify which facilities had capacity to provide appropriate services based on child’s age. Design An Early Hearing Detection and Intervention-Pediatric Audiology Links to Services expert panel was convened to create a survey to collect audiology facility information. Professional practice documents were reviewed, a survey was designed to collect pertinent test protocols of each audiology facility, and a standard of care template was created to cross-check survey answers. Audiology facility information across the United States was collected and compiled into a directory structured and displayed in an interactive website, ehdipals.org. Results Since November 7, 2012, to May 21, 2016, over 1000 facilities have completed the survey and become listed in the Early Hearing Detection and Intervention-Pediatric Audiology Links to Services directory. The site has registered 10,759 unique visitors, 151,981 page views, and 9134 unique searches from consumers. User feedback has been positive overall. Conclusion A searchable, web-based facility directory has proven useful to consumers as a tool to help them differentiate whether a facility was set up to test newborns versus young children. Use of a preprogrammed standard of practice template to cross-check survey answers was also shown to be a practical aid. PMID:28353523

  16. Early Hearing Detection and Intervention-Pediatric Audiology Links to Services EHDI-PALS: Building a National Facility Database.

    PubMed

    Chung, Winnie; Beauchaine, Kathryn L; Hoffman, Jeff; Coverstone, Kirsten R; Oyler, Anne; Mason, Craig

    To create a searchable web-based national audiology facility directory using a standardized survey, so parents and providers could identify which facilities had capacity to provide appropriate services based on child's age. An Early Hearing Detection and Intervention-Pediatric Audiology Links to Services expert panel was convened to create a survey to collect audiology facility information. Professional practice documents were reviewed, a survey was designed to collect pertinent test protocols of each audiology facility, and a standard of care template was created to cross-check survey answers. Audiology facility information across the United States was collected and compiled into a directory structured and displayed in an interactive website, ehdipals.org. Since November 7, 2012, to May 21, 2016, over 1000 facilities have completed the survey and become listed in the Early Hearing Detection and Intervention-Pediatric Audiology Links to Services directory. The site has registered 10,759 unique visitors, 151,981 page views, and 9134 unique searches from consumers. User feedback has been positive overall. A searchable, web-based facility directory has proven useful to consumers as a tool to help them differentiate whether a facility was set up to test newborns versus young children. Use of a preprogrammed standard of practice template to cross-check survey answers was also shown to be a practical aid.

  17. Supporting students with brain tumors in obtaining school intervention services: the clinician's role from an educator's perspective.

    PubMed

    Grandinette, Sharon

    2014-01-01

    With an increase in the number of pediatric patients surviving the diagnosis and treatment of brain tumors, many children are returning to school with an alteration in their physical, cognitive, and social-emotional functioning and thus requiring school intervention or services. Physicians and clinicians in hospital and rehabilitation settings serving this population can play a key role in communicating the medical and functional needs these children present as a result of diagnosis and treatment as they transition to an educational setting. Medical and allied health personnel can best support successful school transition when they are aware of the information schools require in order to open the door for students to easily access the interventions, supports, and services available through 504 Accommodation Plans and special education supports and services under the Individuals with Disabilities Education Act. Clear communication between medical and school personnel is vital in improving educational, social, and vocational outcomes for students with brain tumors. A streamlined approach to accomplish this task is offered for consideration.

  18. Developing Targeted Health Service Interventions Using the PRECEDE-PROCEED Model: Two Australian Case Studies.

    PubMed

    Phillips, Jane L; Rolley, John X; Davidson, Patricia M

    2012-01-01

    Aims and Objectives. This paper provides an overview of the applicability of the PRECEDE-PROCEED Model to the development of targeted nursing led chronic illness interventions. Background. Changing health care practice is a complex and dynamic process that requires consideration of social, political, economic, and organisational factors. An understanding of the characteristics of the target population, health professionals, and organizations plus identification of the determinants for change are also required. Synthesizing this data to guide the development of an effective intervention is a challenging process. The PRECEDE-PROCEED Model has been used in global health care settings to guide the identification, planning, implementation, and evaluation of various health improvement initiatives. Design. Using a reflective case study approach, this paper examines the applicability of the PRECEDE-PROCEED Model to the development of targeted chronic care improvement interventions for two distinct Australian populations: a rapidly expanding and aging rural population with unmet palliative care needs and a disadvantaged urban community at higher risk of cardiovascular disease. Results. The PRECEDE-PROCEED Model approach demonstrated utility across diverse health settings in a systematic planning process. In environments characterized by increasing health care needs, limited resources, and growing community expectations, adopting planning tools such as PRECEDE-PROCEED Model at a local level can facilitate the development of the most effective interventions. Relevance to Clinical Practice. The PRECEDE-PROCEED Model is a strong theoretical model that guides the development of realistic nursing led interventions with the best chance of being successful in existing health care environments.

  19. Short message service (SMS)-based intervention targeting alcohol consumption among university students: study protocol of a randomized controlled trial.

    PubMed

    Thomas, Kristin; Bendtsen, Marcus; Linderoth, Catharina; Karlsson, Nadine; Bendtsen, Preben; Müssener, Ulrika

    2017-04-04

    Despite significant health risks, heavy drinking of alcohol among university students is a widespread problem; excessive drinking is part of the social norm. A growing number of studies indicate that short message service (SMS)-based interventions are cost-effective, accessible, require limited effort by users, and can enable continuous, real-time, brief support in real-world settings. Although there is emerging evidence for the effect of SMS-based interventions in reducing alcohol consumption, more research is needed. This study aims to test the effectiveness of a newly developed SMS-based intervention targeting excessive alcohol consumption among university and college students in Sweden. The study is a two-arm randomized controlled trial with an intervention (SMS programme) and a control (treatment as usual) group. Outcome measures will be investigated at baseline and at 3-month follow up. The primary outcome is total weekly alcohol consumption. Secondary outcomes are frequency of heavy episodic drinking, highest estimated blood alcohol concentration and number of negative consequences due to excessive drinking. This study contributes knowledge on the effect of automatized SMS support to reduce excessive drinking among students compared with existing support such as Student Health Centres. ISRCTN.com, ISRCTN95054707 . Registered on 31 August 2016.

  20. Multidimensional Measurement Within Adult Protective Services: Design and Initial Testing of the Tool for Risk, Interventions, and Outcomes

    PubMed Central

    Sommerfeld, David H.; Henderson, Linda B.; Snider, Marcy A.; Aarons, Gregory A.

    2014-01-01

    This study describes the development, field utility, reliability, and validity of the multidimensional Tool for Risk, Interventions, and Outcomes (TRIO) for use in Adult Protective Services (APS). The TRIO is designed to facilitate consistent APS practice and collect data related to multiple dimensions of typical interactions with APS clients, including the investigation and assessment of risks, the provision of APS interventions, and associated health and safety outcomes. Initial tests of the TRIO indicated high field utility, social worker “relevance and buy-in,” and inter-rater reliability. TRIO concurrent validity was demonstrated via appropriate patterns of TRIO item differentiation based on the type of observed confirmed abuse or neglect; and predictive validity was demonstrated by prediction of the risk of actual APS recurrence. The TRIO is a promising new tool that can help meet the challenges of providing and documenting effective APS practices and identifying those at high risk for future APS recurrence. PMID:24848994

  1. Efficacy of a Web-based Intervention for Concerned Spouses of Service Members and Veterans with Alcohol Misuse.

    PubMed

    Osilla, Karen Chan; Trail, Thomas E; Pedersen, Eric R; Gore, Kristie L; Tolpadi, Anagha; Rodriguez, Lindsey M

    2017-10-03

    Concerned partners (CPs) of service members and veterans who misuse alcohol face help-seeking barriers and mental health problems. We used multiple regression to evaluate the efficacy of Partners Connect, a four-session web-based intervention (WBI) to address military CPs' mental health and communication. We randomized 312 CPs to the WBI or a control group. Five months later, WBI CPs reported significant reductions in their anxiety and increases in their social support compared to control CPs. Intervention dose was also associated with improved WBI CP outcomes. Partners Connect appears to fill a need for families who face help-seeking barriers and provides an alternative to traditional care for those who may not otherwise seek help. © 2017 American Association for Marriage and Family Therapy.

  2. Dietary, food service, and mealtime interventions to promote food intake in acute care adult patients.

    PubMed

    Cheung, Grace; Pizzola, Lisa; Keller, Heather

    2013-01-01

    Malnutrition is common in acute care hospitals. During hospitalization, poor appetite, medical interventions, and food access issues can impair food intake leading to iatrogenic malnutrition. Nutritional support is a common intervention with demonstrated effectiveness. "Food first" approaches have also been developed and evaluated. This scoping review identified and summarized 35 studies (41 citations) that described and/or evaluated dietary, foodservice, or mealtime interventions with a food first focus. There were few randomized control trials. Individualized dietary treatment leads to improved food intake and other positive outcomes. Foodservices that promote point-of-care food selection are promising, but further research with food intake and nutritional outcomes is needed. Protected mealtimes have had insufficient implementation, leading to mixed results, while mealtime assistance, particularly provided by volunteers or dietary staff, appears to promote food intake. A few innovative strategies were identified but further research to develop and evaluate food first approaches is needed.

  3. Speech-language pathologists' practices regarding assessment, analysis, target selection, intervention, and service delivery for children with speech sound disorders.

    PubMed

    Mcleod, Sharynne; Baker, Elise

    2014-01-01

    A survey of 231 Australian speech-language pathologists (SLPs) was undertaken to describe practices regarding assessment, analysis, target selection, intervention, and service delivery for children with speech sound disorders (SSD). The participants typically worked in private practice, education, or community health settings and 67.6% had a waiting list for services. For each child, most of the SLPs spent 10-40 min in pre-assessment activities, 30-60 min undertaking face-to-face assessments, and 30-60 min completing paperwork after assessments. During an assessment SLPs typically conducted a parent interview, single-word speech sampling, collected a connected speech sample, and used informal tests. They also determined children's stimulability and estimated intelligibility. With multilingual children, informal assessment procedures and English-only tests were commonly used and SLPs relied on family members or interpreters to assist. Common analysis techniques included determination of phonological processes, substitutions-omissions-distortions-additions (SODA), and phonetic inventory. Participants placed high priority on selecting target sounds that were stimulable, early developing, and in error across all word positions and 60.3% felt very confident or confident selecting an appropriate intervention approach. Eight intervention approaches were frequently used: auditory discrimination, minimal pairs, cued articulation, phonological awareness, traditional articulation therapy, auditory bombardment, Nuffield Centre Dyspraxia Programme, and core vocabulary. Children typically received individual therapy with an SLP in a clinic setting. Parents often observed and participated in sessions and SLPs typically included siblings and grandparents in intervention sessions. Parent training and home programs were more frequently used than the group therapy. Two-thirds kept up-to-date by reading journal articles monthly or every 6 months. There were many similarities with

  4. Service Engagement in Interventions for Street-Connected Children and Young People: A Summary of Evidence Supplementing a Recent Cochrane-Campbell Review

    ERIC Educational Resources Information Center

    Hossain, Rosa; Coren, Esther

    2015-01-01

    Background: This paper builds on a Cochrane-Campbell systematic review of interventions that reduce harms and promote reintegration in street-connected children and young people focusing on intervention outcomes. The aim of the present analysis is to explore questions raised in the systematic review over the potential role of service engagement in…

  5. Service Engagement in Interventions for Street-Connected Children and Young People: A Summary of Evidence Supplementing a Recent Cochrane-Campbell Review

    ERIC Educational Resources Information Center

    Hossain, Rosa; Coren, Esther

    2015-01-01

    Background: This paper builds on a Cochrane-Campbell systematic review of interventions that reduce harms and promote reintegration in street-connected children and young people focusing on intervention outcomes. The aim of the present analysis is to explore questions raised in the systematic review over the potential role of service engagement in…

  6. Impact of crime victimization on initial presentation to an early intervention for psychosis service and 18-month outcomes.

    PubMed

    Fisher, Helen L; Roberts, Anna; Day, Fern; Reynolds, Nicky; Iacoponi, Eduardo; Garety, Philippa A; Craig, Thomas K J; McGuire, Philip; Valmaggia, Lucia; Power, Paddy

    2017-04-01

    To investigate the clinical and social correlates of a lifetime history of crime victimization among first-episode psychosis patients at entry to an Early Intervention Service and following 18 months of specialist care. Face-to-face interviews were conducted with 149 individuals who presented to an Early Intervention Service for the first time with psychosis in the London borough of Lambeth, UK. A range of demographic and clinical measures were completed including self-reported history of victimization along with the type of crime and its subjective effect on the patient. Clinical and functional outcomes at 18-month follow up were ascertained from clinical case notes by a psychiatrist. A large proportion of patients (n = 64, 43%) reported a history of crime victimization. This was associated with significantly higher levels of depression and substance misuse at initial presentation. Being a victim of a crime was not significantly associated with poorer clinical or functional outcomes after 18 months of specialist care. However, non-significant differences were found for those who reported crime victimization in terms of their increased use of illegal substances or having assaulted someone else during the follow-up period. Past experience of being a victim of crime appears to be common in patients presenting for the first time with psychosis and is associated with increased likelihood of comorbidity. Thus, Early Intervention Services should consider screening for past victimization and be prepared to deal with comorbid problems. The impact of crime victimization on clinical and functional outcomes requires investigation over a longer period of time. © 2015 Wiley Publishing Asia Pty Ltd.

  7. Bystander Intervention Prior to The Arrival of Emergency Medical Services: Comparing Assistance across Types of Medical Emergencies.

    PubMed

    Faul, Mark; Aikman, Shelley N; Sasser, Scott M

    2016-01-01

    To determine the situational circumstances associated with bystander interventions to render aid during a medical emergency. This study examined 16.2 million Emergency Medical Service (EMS) events contained within the National Emergency Medical Services Information System. The records of patients following a 9-1-1 call for emergency medical assistance were analyzed using logistic regression to determine what factors influenced bystander interventions. The dependent variable of the model was whether or not a bystander intervened. EMS providers recorded bystander assistance 11% of the time. The logistic regression model correctly predicted bystander intervention occurrence 71.4% of the time. Bystanders were more likely to intervene when the patient was male (aOR = 1.12, 95% CI = 1.12-1.3) and if the patient was older (progressive aOR = 1.10, 1.46 age group 20-29 through age group 60-99). Bystanders were less likely to intervene in rural areas compared to urban areas (aOR = 0.58, 95% CI = 0.58-0.59). The highest likelihood of bystander intervention occurred in a residential institution (aOR = 1.86, 95% CI = 1.85-1.86) and the lowest occurred on a street or a highway (aOR = 0.96, 95% CI = 0.95-0.96). Using death as a reference group, bystanders were most likely to intervene when the patient had cardiac distress/chest pain (aOR = 11.38, 95% CI = 10.93-11.86), followed by allergic reaction (aOR = 7.63, 95% CI = 7.30-7.99), smoke inhalation (aOR = 6.65, 95% CI = 5.98-7.39), and respiration arrest/distress (aOR = 6.43, 95% CI = 6.17-6.70). A traumatic injury was the most commonly recorded known event, and it was also associated with a relatively high level of bystander intervention (aOR = 5.81, 95% CI = 5.58-6.05). The type of injury/illness that prompted the lowest likelihood of bystander assistance was Sexual Assault/Rape (aOR = 1.57, 95% CI = 1.32-1.84) followed by behavioral/psychiatric disorder (aOR = 1.64, 95% CI = 1.57-1.71). Bystander intervention varies greatly on

  8. Evaluating Crisis Intervention Services for Youth within an Emergency Department: A View from within

    ERIC Educational Resources Information Center

    Dion, Jacinthe; Kennedy, Allison; Cloutier, Paula; Gray, Clare

    2010-01-01

    An innovative crisis intervention programme was created at the Children's Hospital of Eastern Ontario in Canada in order to provide emergency assessments for youth presenting with mental health crises. The current investigation presents an overview of the programme and examines the emergency staff's perception and satisfaction with it.…

  9. Psychological Intervention: Case Studies in School Psychological Services. Volume 2, 1978.

    ERIC Educational Resources Information Center

    Grimes, Jeff, Ed.

    The 16 case studies illustrate the nature and scope of psychological intervention with emotionally disturbed and otherwise handicapped students. Included are papers with the following titles and authors: "Reducing Math Anxiety while Increasing Independent Work Habits in a Learning Disabled Elementary School Boy" (K. Hoogeveen); "Coping with…

  10. Evidence Based Interventions: An Examination of Pre-Service Training, Professional Development, and Classroom Implementation

    ERIC Educational Resources Information Center

    Hoover, Kristin Nicole

    2013-01-01

    The purpose of the study was to examine the relationship between EBI training for special education teachers and their practice of classroom interventions for children with an autism spectrum disorder (ASD). Evaluating the usage of EBIs in the classroom is imperative because of the many obligations educators have to uphold federal compliances…

  11. Psychological Intervention: Case Studies in School Psychological Services, Volume 3, 1979.

    ERIC Educational Resources Information Center

    Iowa State Dept. of Public Instruction, Des Moines. Div. of Pupil Personnel Services.

    The book presents 27 case studies illustrating psychological interventions with behavior problem school children. Studies ususally introduce the target population, describe the method of psychological evaluation, report the results of treatment, and discuss the case's implications. Among cases reported are investigations of stimulant medication on…

  12. Birth-Related Posttraumatic Stress Disorder: Implications for Early Intervention Services

    ERIC Educational Resources Information Center

    Pizur-Barnekow, Kris; Doering, Jennifer J.; Willett, Marjorie; Ruminski, Christine; Spring, Molly

    2014-01-01

    The positive impact of healthy relationships on child development is widely accepted. A healthy relationship between mother and child is at risk when a mother experiences symptoms of birth-related posttraumatic stress disorder (PTSD). Mothers of children with special needs are at high risk for this disorder and early intervention (EI)…

  13. Birth-Related Posttraumatic Stress Disorder: Implications for Early Intervention Services

    ERIC Educational Resources Information Center

    Pizur-Barnekow, Kris; Doering, Jennifer J.; Willett, Marjorie; Ruminski, Christine; Spring, Molly

    2014-01-01

    The positive impact of healthy relationships on child development is widely accepted. A healthy relationship between mother and child is at risk when a mother experiences symptoms of birth-related posttraumatic stress disorder (PTSD). Mothers of children with special needs are at high risk for this disorder and early intervention (EI)…

  14. Providing Services for Students with Gifts and Talents within a Response-to-Intervention Framework

    ERIC Educational Resources Information Center

    Johnsen, Susan K.; Parker, Sonia L.; Farah, Yara N.

    2015-01-01

    Response to intervention (RTI) was included in the 2004 reauthorization of the Individuals With Disabilities Education Act (IDEA), specifically as part of an assessment process to determine if a child has a disability. Although IDEA's focus is on students with disabilities, 10 states have developed policies that attend to students with gifts and…

  15. Psychological Intervention: Case Studies in School Psychological Services. Volume 1, 1977.

    ERIC Educational Resources Information Center

    Grimes, Jeff, Ed.

    The case studies presented by seven school psychologists illustrate the nature and scope of psychological intervention with emotionally disturbed and otherwise handicapped students. Included are papers with the following titles and authors: "Desensitization--An Approach to the Elimination of Phobic Behavior" (E. Asmus); "Reduction of Classroom…

  16. Poverty and Schools: Intervention and Resource Building through School-Linked Services.

    ERIC Educational Resources Information Center

    Jozefowicz-Simbeni, Debra M. H.; Allen-Meares, Paula

    2002-01-01

    Article focuses on the devastating consequences of poverty on the educational outcomes of school children and micro-, exo-, and mesosystems as their home, school, and community. An ecological systems perspective is offered to identify interventions and change the quality of interactions and processes among these systems in ways that improve…

  17. Intensive Behavioural Intervention for Young Children with Autism: A Research-Based Service Model

    ERIC Educational Resources Information Center

    Hayward, Diane W.; Gale, Catherine M.; Eikeseth, Svein

    2009-01-01

    Outcome research has shown that early and intensive behavioural intervention (ABA) may improve intellectual, language and adaptive functioning in children with autism. However, research has also indicated that not all ABA provisions are equally effective. Therefore, it may be beneficial to describe the key variables that are common to programmes…

  18. Evaluating Crisis Intervention Services for Youth within an Emergency Department: A View from within

    ERIC Educational Resources Information Center

    Dion, Jacinthe; Kennedy, Allison; Cloutier, Paula; Gray, Clare

    2010-01-01

    An innovative crisis intervention programme was created at the Children's Hospital of Eastern Ontario in Canada in order to provide emergency assessments for youth presenting with mental health crises. The current investigation presents an overview of the programme and examines the emergency staff's perception and satisfaction with it.…

  19. Student Placement Service: An Exploratory Investigation of Employer Retention and a "Priority Partner" Intervention

    ERIC Educational Resources Information Center

    Walsh, Francis D.; Byrne, Sean

    2013-01-01

    Purpose: The purpose of this paper is to investigate the factors relating to retention of employers on an undergraduate work placement programme in a third level institution. Design/methodology/approach: An action research methodology involving problem diagnosis, intervention planning, action and evaluation is employed. The diagnosis involved a…

  20. Evidence Based Interventions: An Examination of Pre-Service Training, Professional Development, and Classroom Implementation

    ERIC Educational Resources Information Center

    Hoover, Kristin Nicole

    2013-01-01

    The purpose of the study was to examine the relationship between EBI training for special education teachers and their practice of classroom interventions for children with an autism spectrum disorder (ASD). Evaluating the usage of EBIs in the classroom is imperative because of the many obligations educators have to uphold federal compliances…

  1. Adapting Effective Narrative-based HIV Prevention Interventions to Increase Minorities’ Engagement in HIV/AIDS Services

    PubMed Central

    Berkley-Patton, Jannette; Goggin, Kathy; Liston, Robin; Bradley-Ewing, Andrea; Neville, Sally

    2009-01-01

    Disparities related to barriers to care for HIV-positive and at-risk minorities continue to be a major public health problem. Adaptation of efficacious HIV prevention interventions for use as health communication innovations is a promising approach for increasing minorities’ utilization of HIV health and ancillary services. Role model stories, a widely-used, HIV prevention strategy, employ culturally tailored narratives to depict experiences of an individual modeling health risk reduction behaviors. This paper describes the careful development of a contextually appropriate role model story focused on increasing minorities’ engagement in HIV/AIDS health and related services. Findings from interviews with community members and focus groups with HIV-positive minorities indicated several barriers and facilitators related to engagement in HIV healthcare and disease management (e.g., patient/provider relationships) and guided the development of role model story narratives. PMID:19415552

  2. Breathlessness and new de-saturation in a patient with congenital heart disease: a time to thrombolyse or to seek specialist help?

    PubMed Central

    Orchard, Elizabeth A; Picault, Nathalie; Tsang, Victor; Walker, Fiona

    2012-01-01

    A patient with known repaired complex congenital heart disease was referred as an emergency with increasing breathlessness on exertion. He was not short of breath at rest and had a saturation of 85% in air. A CT pulmonary angiography demonstrated decreased flow from his right ventricle to pulmonary artery, which was thought to be due to  pulmonary embolism. We reviewed the CT with a knowledge and understanding of his anatomy and found that he had developed a false aneurysm of his right ventricular outflow tract, which required surgical treatment. PMID:22669868

  3. An intervention to increase fruit and vegetable consumption using audio communications: in-store public service announcements and audiotapes.

    PubMed

    Connell, D; Goldberg, J P; Folta, S C

    2001-01-01

    Consumers make an estimated 70% of their food purchase decisions as they shop. Effective presentation of information about healthier food selections at the point-of-purchase should have an impact on their decisions. This study was designed to evaluate the effectiveness of two audio formats on knowledge, attitudes, and beliefs about fruits and vegetables and on intake of these foods. Participants identified as "regular shoppers" (n = 374) in three intervention stores were recruited as they entered. They provided baseline demographic data, answered questions about their knowledge and beliefs about fruits and vegetables, and completed a checklist to assess fruit and vegetable intake. They were given two one-hour audiotapes and asked to play them within the next four weeks. In-store public service announcements (PSAs) with information about fruits and vegetables were rotated every 30 minutes for four weeks. A control group (n = 378), recruited in three other stores matched by demographic characteristics, provided the same information. They received an audiotape with stress reduction information. At posttest, the original series of questionnaires were readministered in telephone interviews with 87.7% of the original intervention group and 93.7% of the original control group. Knowledge scores in the intervention group increased significantly over baseline and as compared with the control group. Self-reported fruit and vegetable intake increased significantly in both groups, perhaps in part because of a seasonal effect. The increase from baseline was significantly higher in the intervention group and compared with controls. These findings support the further exploration of the use of audiotapes in nutrition education interventions.

  4. Use of Health Services by Maltreated Children in Two Different Sociocultural Contexts: Where Can Doors for Interventions Be Opened?

    PubMed

    Suglia, Shakira F; Shen, Sa; Cohall, Alwyn; Bird, Hector; Canino, Glorisa; Brown, Jocelyn; Duarte, Cristiane S

    2016-07-31

    Among maltreated children, elevated use of non-routine (for illness or injury) services may coexist with underutilization of preventive services. Besides physical health problems, lack of contact with primary care may preclude the identification and delivery of appropriate interventions. We examined health service utilization in the longitudinal Boricua Youth Study of Puerto Rican children residing in the South Bronx (SBx), New York City (n = 901), and San Juan metropolitan area, Puerto Rico (n = 1,163). Parents and children (Mage = 9 years) reported on child physical abuse, sexual abuse, and neglect. Parents reported if their child had been to illness, injury, and well-child visits in the past year. In the SBx site, caretakers were more likely to report the children seeing a doctor for a well-child visit (90%) compared with children in Puerto Rico (71%). Children in Puerto Rico were more likely to visit a doctor for an injury in the past year compared with children in the SBx (39% vs. 24%). Twenty-one percent of children in the SBx reported maltreatment versus 16% in Puerto Rico. Adjusting for sociodemographic factors, compared with non-maltreated children, those who experienced two or more types of maltreatment were more likely to have an illness visit in Puerto Rico (prevalence ratio [PR] = 1.5, 95% confidence interval [CI] = [1.1, 2.2]) and the SBx (PR = 1.8, 95% CI = [1.1, 3.0]), or an injury visit (PR = 4.1, 95% CI = [1.9, 8.9]) in Puerto Rico only. Children in the SBx who reported only one type of maltreatment were less likely to use services for injuries than non-maltreated children (PR = 0.42, 95% CI = [0.2, 0.9]). No relation between maltreatment and well-child visits was noted. Children who experience maltreatment may frequently come in contact with health care providers, presenting opportunities for intervention and the prevention of further maltreatment.

  5. Respiratory symptom perception differs in obese women with strong or mild breathlessness during constant-load exercise.

    PubMed

    Bernhardt, Vipa; Babb, Tony G

    2014-02-01

    During constant-load exercise, some otherwise healthy obese women report substantially more dyspnea on exertion (DOE) than do others. The objective of this study was to investigate whether qualitative differences exist between the sensations of dyspnea felt by these women. Seventy-eight women were categorized based on their ratings of perceived breathlessness (RPBs) (Borg 0-10 scale) after 6 min of 60-W cycling. Thirty-four women rated RPB ≥ 4 (+DOE) (34 ± 7 years, 36 ± 5 kg/m² BMI), and 22 women rated RPB ≤ 2 (-DOE) (32 ± 7 years, 37 ± 4 kg/m² BMI). Twenty-two women rated RPB as 3 (RPB = 3) (34 ± 7 years, 34 ± 4 kg/m² BMI) and were grouped separately to allow for a better delineation of the +DOE and the -DOE groups. After the exercise test, subjects were asked to pick three of 15 statements that best described their respiratory sensations. The +DOE and the -DOE groups were characterized differentially (P < .05) by the respiratory clusters "Breathing more" (82% of -DOE vs 41% of +DOE), "Shallow" (36% vs 6%), and "Heavy" (14% vs 53%). All four descriptors in the cluster "Work/Effort" were chosen more frequently by women in the +DOE group than by women in the -DOE group. Although relative exercise intensity was higher in the +DOE women (75% ± 13% vs 67% ± 10% of oxygen uptake at peak exercise, 41 ± 10 L/min vs 31 ± 8 L/min as % maximal voluntary ventilation, 83% ± 7% vs 76% ± 7% of peak heart rate), none of these variables was significantly associated with RPB. Not only is the intensity of dyspnea significantly different between the +DOE and the -DOE groups, but so are the self-reported qualitative aspects of their dyspnea. Women in the +DOE group reported an increased sensation of the work of breathing relative to women in the -DOE group, which may be associated with the elevated RPB.

  6. Respiratory Symptom Perception Differs in Obese Women With Strong or Mild Breathlessness During Constant-Load Exercise

    PubMed Central

    Bernhardt, Vipa

    2014-01-01

    Background: During constant-load exercise, some otherwise healthy obese women report substantially more dyspnea on exertion (DOE) than do others. The objective of this study was to investigate whether qualitative differences exist between the sensations of dyspnea felt by these women. Methods: Seventy-eight women were categorized based on their ratings of perceived breathlessness (RPBs) (Borg 0-10 scale) after 6 min of 60-W cycling. Thirty-four women rated RPB ≥ 4 (+DOE) (34 ± 7 years, 36 ± 5 kg/m2 BMI), and 22 women rated RPB ≤ 2 (−DOE) (32 ± 7 years, 37 ± 4 kg/m2 BMI). Twenty-two women rated RPB as 3 (RPB = 3) (34 ± 7 years, 34 ± 4 kg/m2 BMI) and were grouped separately to allow for a better delineation of the +DOE and the −DOE groups. After the exercise test, subjects were asked to pick three of 15 statements that best described their respiratory sensations. Results: The +DOE and the −DOE groups were characterized differentially (P < .05) by the respiratory clusters “Breathing more” (82% of −DOE vs 41% of +DOE), “Shallow” (36% vs 6%), and “Heavy” (14% vs 53%). All four descriptors in the cluster “Work/Effort” were chosen more frequently by women in the +DOE group than by women in the −DOE group. Although relative exercise intensity was higher in the +DOE women (75% ± 13% vs 67% ± 10% of oxygen uptake at peak exercise, 41 ± 10 L/min vs 31 ± 8 L/min as % maximal voluntary ventilation, 83% ± 7% vs 76% ± 7% of peak heart rate), none of these variables was significantly associated with RPB. Conclusions: Not only is the intensity of dyspnea significantly different between the +DOE and the −DOE groups, but so are the self-reported qualitative aspects of their dyspnea. Women in the +DOE group reported an increased sensation of the work of breathing relative to women in the −DOE group, which may be associated with the elevated RPB. PMID:23989732

  7. A Brief Intervention to Reduce Suicide Risk in Military Service Members and Veterans

    DTIC Science & Technology

    2014-12-01

    months following the index ED visit, as well as attendance at an outpatient mental health or substance abuse treatment appointment within 30 days post...of outpatient mental health and substance abuse interventions, and suicide- related coping for veterans at high suicide risk in emergency department...as well as attendance at an outpatient mental health or substance abuse treatment appointment within 30 days post the index ED visit. If the safety

  8. A Brief Intervention to Reduce Suicide Risk in Military Service Members and Veterans

    DTIC Science & Technology

    2011-10-01

    to the general population. There are limited evidence-based suicide prevention interventions that have been developed for military personnel and...veteran populations in three ways by: (1) evaluating suicide risk using a structured assessment measure; (2) enhancing suicide-related coping strategies ...Institutional Review Board Processes The PIs and SAFEMIL project team members participated in face-to-face, phone, and/or email communication to determine the

  9. Improving Science and Literacy Learning for English Language Learners: Evidence from a Pre-service Teacher Preparation Intervention

    NASA Astrophysics Data System (ADS)

    Shaw, Jerome M.; Lyon, Edward G.; Stoddart, Trish; Mosqueda, Eduardo; Menon, Preetha

    2014-08-01

    This paper present findings from a pre-service teacher development project that prepared novice teachers to promote English language and literacy development with inquiry-based science through a modified elementary science methods course and professional development for cooperating teachers. To study the project's impact on student learning, we administered a pre and post assessment to students (N = 191) of nine first year elementary teachers (grades 3 through 6) who experienced the intervention and who taught a common science unit. Preliminary results indicate that (1) student learning improved across all categories (science concepts, writing, and vocabulary)—although the effect varied by category, and (2) English Language Learner (ELL) learning gains were on par with non-ELLs, with differences across proficiency levels for vocabulary gain scores. These results warrant further analyses to understand the extent to which the intervention improved teacher practice and student learning. This study confirms the findings of previous research that the integration of science language and literacy practices can improve ELL achievement in science concepts, writing and vocabulary. In addition, the study indicates that it is possible to begin to link the practices taught in pre-service teacher preparation to novice teacher practice and student learning outcomes.

  10. Automated personnel-assets-consumables-drug tracking in ambulance services for more effective and efficient medical emergency interventions.

    PubMed

    Utku, Semih; Özcanhan, Mehmet Hilal; Unluturk, Mehmet Suleyman

    2016-04-01

    Patient delivery time is no longer considered as the only critical factor, in ambulatory services. Presently, five clinical performance indicators are used to decide patient satisfaction. Unfortunately, the emergency ambulance services in rapidly growing metropolitan areas do not meet current satisfaction expectations; because of human errors in the management of the objects onboard the ambulances. But, human involvement in the information management of emergency interventions can be reduced by electronic tracking of personnel, assets, consumables and drugs (PACD) carried in the ambulances. Electronic tracking needs the support of automation software, which should be integrated to the overall hospital information system. Our work presents a complete solution based on a centralized database supported by radio frequency identification (RFID) and bluetooth low energy (BLE) identification and tracking technologies. Each object in an ambulance is identified and tracked by the best suited technology. The automated identification and tracking reduces manual paper documentation and frees the personnel to better focus on medical activities. The presence and amounts of the PACD are automatically monitored, warning about their depletion, non-presence or maintenance dates. The computerized two way hospital-ambulance communication link provides information sharing and instantaneous feedback for better and faster diagnosis decisions. A fully implemented system is presented, with detailed hardware and software descriptions. The benefits and the clinical outcomes of the proposed system are discussed, which lead to improved personnel efficiency and more effective interventions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. Interventions in Organizational and Community Context: A Framework for Building Evidence on Dissemination and Implementation in Health Services Research

    PubMed Central

    Mendel, Peter; Meredith, Lisa S.; Schoenbaum, Michael; Sherbourne, Cathy D.; Wells, Kenneth B.

    2013-01-01

    The effective dissemination and implementation of evidence-based health interventions within community settings is an important cornerstone to expanding the availability of quality health and mental health services. Yet it has proven a challenging task for both research and community stakeholders. This paper presents the current framework developed by the UCLA/RAND NIMH Center to address this research-to-practice gap by: 1) providing a theoretically-grounded understanding of the multi-layered nature of community and healthcare contexts and the mechanisms by which new practices and programs diffuse within these settings; 2) distinguishing among key components of the diffusion process—including contextual factors, adoption, implementation, and sustainment of interventions—showing how evaluation of each is necessary to explain the course of dissemination and outcomes for individual and organizational stakeholders; 3) facilitating the identification of new strategies for adapting, disseminating, and implementing relatively complex, evidence-based healthcare and improvement interventions, particularly using a community-based, participatory approach; and 4) enhancing the ability to meaningfully generalize findings across varied interventions and settings to build an evidence base on successful dissemination and implementation strategies. PMID:17990095

  12. Assessing the effects of regional payment for watershed services program on water quality using an intervention analysis model.

    PubMed

    Lu, Yan; He, Tian

    2014-09-15

    Much attention has been recently paid to ex-post assessments of socioeconomic and environmental benefits of payment for ecosystem services (PES) programs on poverty reduction, water quality, and forest protection. To evaluate the effects of a regional PES program on water quality, we selected chemical oxygen demand (COD) and ammonia-nitrogen (NH3-N) as indicators of water quality. Statistical methods and an intervention analysis model were employed to assess whether the PES program produced substantial changes in water quality at 10 water-quality sampling stations in the Shaying River watershed, China during 2006-2011. Statistical results from paired-sample t-tests and box plots of COD and NH3-N concentrations at the 10 stations showed that the PES program has played a positive role in improving water quality and reducing trans-boundary water pollution in the Shaying River watershed. Using the intervention analysis model, we quantitatively evaluated the effects of the intervention policy, i.e., the watershed PES program, on water quality at the 10 stations. The results suggest that this method could be used to assess the environmental benefits of watershed or water-related PES programs, such as improvements in water quality, seasonal flow regulation, erosion and sedimentation, and aquatic habitat. Copyright © 2014 Elsevier B.V. All rights reserved.

  13. Involving service users in the development of the Support at Home: Interventions to Enhance Life in Dementia Carer Supporter Programme for family carers of people with dementia.

    PubMed

    Burnell, Karen J; Selwood, Amber; Sullivan, Theresa; Charlesworth, Georgina M; Poland, Fiona; Orrell, Martin

    2015-02-01

    Involving service users in research can be an effective way of improving the practicalities and acceptability of interventions for target end users. The current paper presented two consensus methods, not commonly used in consultation with service users, to develop a peer support intervention for family carers of people with dementia (SHIELD Carer Supporter Programme). Study 1 was a modified Delphi process combined with a consensus conference to explore details of the intervention from the carer and volunteer perspective. Study 2 was an anonymous reader consultation to develop informed consent documents for the intervention trial. Median scores were used to measure and establish consensus. Open-ended responses were thematically analysed. Study 1: twenty-five delegates participated (eight were current/former carers) in the first round Delphi questionnaire, with 21 attending the conference. Five completed the Round 2 questionnaire. Study 2: six family carers and 11 people with dementia took part in the consultation. Study 1: the role of the peer supporters was developed in terms of relational and practical aspects of the intervention. Study 2: changes were made to the documents, reflecting service user input, but the effectiveness of this less discursive type of service user involvement was unclear. Study 1 methods allowed for service users to contribute significantly and meaningfully, but maybe limiting some design innovation. Study 2 took a more traditional and less collaborative approach. This has implications for balancing the needs of the research with meaningful service user involvement in research. © 2012 John Wiley & Sons Ltd.

  14. Funding and Rationale for Early Intervention Services in Nebraska's "Early Development Network" in 2004: An Evaluation Study for the Nebraska Departments of Education and Health and Human Services. Final Report

    ERIC Educational Resources Information Center

    Marvin, Chris; Nugent, Gwen; Doll, Beth

    2006-01-01

    Anecdotal information has recently suggested that families of infants and toddlers with disabilities in Nebraska were seeking early intervention services from providers not affiliated with the free, state-sanctioned "Early Development Network" and children's "Individualized Family Service Plans" (IFSPs). The purpose of this…

  15. Informing Sexual Health Intervention Development in India: Perspectives of Daughters, Mothers, and Service Providers in Mumbai

    ERIC Educational Resources Information Center

    Adelson, Emiliya; Maitra, Shubhada; Nastasi, Bonnie K.

    2017-01-01

    In India, girls face many challenges that pose a threat to their sexual health and psychological well-being. The authors explore sexual health from the perspectives of adolescent girls, mothers of adolescent girls, and service providers. Focus groups and interview data were analyzed to understand the unique and shared perspectives of stakeholders.…

  16. An Integrated Parent-Teacher-Related Service Team Approach to Communication Intervention. Final Report.

    ERIC Educational Resources Information Center

    Stremel, Kathleen; Wilson, Rebecca

    This final report describes a federally funded 3-year project for integrating related services within educational objectives for children (ages 3-10) with dual vision and hearing impairments. A Training-Utilization model of inservice training and technical assistance was developed, implemented, and evaluated to address the communication needs of…

  17. Service-learners at dementia care programs:an intervention for improving contact, comfort, and attitudes.

    PubMed

    Fruhauf, Christine A; Jarrott, Shannon E; Lambert-Shute, Jennifer J

    2004-01-01

    Service-Learning can be a rewarding and challenging experience for students. One of the rewards for students can be the connection between their course work and real life experience. However, students interacting with populations with which they have limited prior experience face unique challenges. We developed a training program designed to facilitate comfort with older adults who have dementia for service-learners in a gerontology course who were serving at an Adult Day Services (ADS) program. Students in the course completed pre- and post-surveys assessing level of contact with older adults and attitudes on aging. Service-learners serving at the ADS comprised the treatment group (n = 5) while those serving at other S-L sites made up the control group (n = 11). Independent and paired sample t-tests indicated that the training program contributed to intra-individual and group differences in comfort working with older adults and with adults who are cognitively impaired. Differences in attitudes about older adults were also identified. Implications for adult development courses involving S-L at dementia care programs are discussed.

  18. Eligibility Characteristics of Infants and Toddlers Entering Early Intervention Services in the United States

    ERIC Educational Resources Information Center

    Scarborough, Anita A.; Hebbeler, Kathleen M.; Spiker, Donna

    2006-01-01

    In the United States, legislation originally enacted in 1986 provided grants to states to build interagency service systems for children from birth to 3 years of age with developmental delays and disabilities. This legislation now renamed the Individuals with Disabilities Education Act (IDEA) was intended to facilitate the development of a…

  19. Korean American Parents' Communication with European American Therapist during Behavioral Intervention Services

    ERIC Educational Resources Information Center

    Park, Sungho

    2012-01-01

    Qualitative research method was employed in order to explore how Korean American parents of children with severe developmental disabilities and problem behaviors collaborate with European American service providers. Ten Korean American parents who received behavioral therapy from European American therapists participated in this study. Results of…

  20. Transition: From Home or Early Intervention Services to Preschool Special Needs

    ERIC Educational Resources Information Center

    Arizona Department of Education, 2007

    2007-01-01

    Transition is movement or change without interruption. It should be a smooth flow from one place or condition to another. While the transition plan for a student receiving special education services is designed to prepare him or her for life after high school, transition can start when a child enters preschool. The first of six distinct stages of…