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At least 163 records · Page 9Linked to original sources
PubMed2001

Relationship of therapists' attitudes, children's motor ability, and parenting stress to mothers' perceptions of therapists' behaviors during early intervention.

BACKGROUND AND PURPOSE: Federal law mandates family-centered care as the service delivery model in early intervention programs for children from birth to 36 months of age. This study investigated the relationship of therapists' attitudes, children's motor ability, and parenting stress to mothers' perceptions of physical therapists' family-centered behaviors during early intervention. SUBJECTS AND METHODS: Twenty-five physical therapists and 75 mother-child dyads (3 from each therapist's caseload) participated. The mean chronological age for the children was 21.2 months (SD=7.3, range=6-35). Mothers participated in a structured interview using the Measures of Processes of Care (MPOC-56), and they completed the Parenting Stress Index-Short Form (PSI-SF) and a questionnaire. The Bayley-II Motor Scale was administered to the children. Therapists completed a modified version of the Measures of Processes of Care for Service Providers (MPOC-SP) and a questionnaire. RESULTS: Scores for mothers on the MPOC-56 and for therapists on the MPOC-SP indicated strong positive perceptions and attitudes toward family-centered behaviors. Hierarchical multiple regression analyses indicated that parenting stress explained a considerable amount of the variance in mothers' perceptions of family-centered behaviors, whereas therapists' attitudes explained a considerable amount of the variance in mothers' perceptions of respectful and supportive care. Children's motor ability was inversely related to parenting stress. DISCUSSION AND CONCLUSION: Findings suggest that mothers perceive that physical therapists are using family-centered behaviors in early intervention. Findings from the questionnaires suggest that some early intervention policies may be barriers for therapists and prevent them from actualizing attitudes toward family-centered behaviors.

Adolescent↗
PubMed2005

Hearing aid patients in private practice and public health (Veterans Affairs) clinics: are they different?

OBJECTIVE: In hearing aid research, it is commonplace to combine data across subjects whose hearing aids were provided in different service delivery models. There is reason to question whether these types of patients are always similar enough to justify this practice. To explore this matter, this investigation evaluated similarities and differences in self-report data obtained from hearing aid patients derived from public health (Veterans Affairs, VA) and private practice (PP) settings. DESIGN: The study was a multisite, cross-sectional survey in which 230 hearing aid patients from VA and PP audiology clinic settings provided self-report data on a collection of questionnaires both before and after the hearing aid fitting. Subjects were all older adults with mild to moderately severe hearing loss. About half of them had previous experience wearing hearing aids. All subjects were fitted with wide-dynamic-range-compression instruments and received similar treatment protocols. RESULTS: Numerous statistically significant differences were observed between the VA and PP subject groups. Before the fitting, VA patients reported higher expectations from the hearing aids and more severe unaided problems compared with PP patients with similar audiograms. Three wks after the fitting, VA patients reported more satisfaction with their hearing aids. On some measures VA patients reported more benefit, but different measures of benefit did not give completely consistent results. Both groups reported using the hearing aids an average of approximately 8 hrs per day. VA patients reported age-normal physical and mental health, but PP patients tended to report better than typical health for their age group. CONCLUSIONS: These data indicate that hearing aid patients seen in the VA public health hearing services are systematically different in self-report domains from those seen in private practice services. It is therefore risky to casually combine data from these two types of subjects or to generalize research results from one group to the other. Further, compared with PP patients, VA patients consistently reported more favorable hearing aid fitting outcomes. Additional study is indicated to explore the determinants of this result and its generalizability to other public health service delivery systems such as those in other countries. Moreover, efforts should be made to assess the potential for transferring positive elements from the VA system to the PP service delivery system, if possible.

Adult↗
PubMed2001

The changing attitudes of health professionals and consumers towards a coordinated care trial--SA HealthPlus.

The national coordinated care trials have been a vehicle for health reform in Australia, driven by escalating health care costs and projections of an ageing population. The first round of trials conducted between 1997 and 1999 set the trials a challenge to reduce financial and system barriers to enable health professionals in all sectors and consumers to develop service delivery models which would give better outcomes for patients within existing resources. As part of a change management strategy, the developers of the SA HealthPlus trial assessed the attitudes of health professionals and consumers involved in designing the projects which made up the larger trial, prior to trial development and twelve months later. This paper reports on the results of the survey and how initial enthusiasm gave way to appropriate anxiety as the complexities of creating a new system of care from reactive to prospective patient centred care planning, became a reality. The survey enabled trial developers to show evidence of acceptability for the new model of care and identify areas of concern and appropriate strategies for the project teams. This type of survey and the issues identified may be of benefit to the second round coordinated care trials and health regions aiming to initiate coordinated care programs.

Attitude to Health↗
PubMedDate not supplied

Client satisfaction: traditional care versus cluster care.

The purposes of this study were to describe and compare the level of satisfaction of clients receiving traditional care and those receiving cluster care. None of the studies reviewed described client satisfaction in the traditional and cluster care service delivery models using a reliable and valid instrument. The study sample consisted of 77 Medicaid-eligible elderly clients from three different home care agencies in an urban city. Of the 77 subjects, 37 (48 per cent) received cluster care, and 40 (52 percent) received traditional care. After receiving approval from the home health care agencies, subjects who agreed to participate in the study were asked to sign a consent form and to complete a demographic data sheet and the Gray's Home Care Satisfaction Scale (GHCSS). Internal consistency reliability for the GHCSS is 0.78, with content validity present. An independent student's t test showed a statistically significant difference in the level of satisfaction of clients receiving traditional care and cluster care (t = -5.27, P = .0005). Clients receiving traditional care had higher levels of satisfaction than clients receiving cluster care. Additional findings showed that men in both the traditional and cluster care groups were more satisfied than women (t = -3.19, P = .003 and t = -2.96, P = .007, respectively). Analysis of variance showed that blacks in both the traditional and cluster care groups had lower levels of satisfaction than either whites or Hispanics. Implications of study findings are discussed.

Aged↗
PubMed2003

Breast reconstruction following mastectomy: current status in Australia.

BACKGROUND: Although breast reconstruction provides some advantages for women following mastectomy, few Australian breast cancer patients currently receive reconstruction. In Australia, the routine provision of breast reconstruction will require the development of specific health service delivery models. The present paper reports an analysis of the provision of breast reconstruction in eight sites in Australia. METHODS: A semi-structured telephone interview was conducted with 10 surgeons offering breast reconstruction as part of their practice, including nine breast or general surgeons and one plastic surgeon. RESULTS: Surgeons reported offering breast reconstruction to all women facing mastectomy; the proportion of women deciding to have breast reconstruction varied between sites with up to 50% of women having a reconstruction at some sites. Most sites offered three types of reconstruction. Two pathways emerged: either the breast surgeon performed the breast surgery in a team with the plastic surgeon who undertook the breast reconstruction or the breast surgeon provided both the breast surgery and the reconstruction. Considerable waiting times for breast reconstruction were reported in the public sector particularly for delayed reconstruction. Surgeons reported receiving training in breast reconstruction from plastic surgeons or from a breast surgery team that performed reconstructions; a number had been trained overseas. No audits of breast reconstruction were being undertaken. CONCLUSIONS: Breast reconstruction can be offered on a routine basis in Australia in both the private and public sectors. Women may be more readily able to access breast reconstruction when it is provided by a breast surgeon alone, but the range of reconstruction options may be more limited. If access to breast reconstruction is to be increased, there will be a need to: (i) develop effective models for the rural sector taking account of the lack of plastic surgeons; (ii) address waiting times for reconstruction surgery in the public sector; (iii) review costs to women in the private sector; (iv) develop a better understanding of women's views and how best to communicate about breast reconstruction; and (v) improve training in breast reconstruction.

Australia↗
PubMed2001

Music therapy in palliative medicine.

A partnership between The Cleveland Clinic Foundation and The Cleveland Music School Settlement has resulted in music therapy becoming a standard part of the care in our palliative medicine inpatient unit. This paper describes a music therapy program and its impact on patients, their families, and staff. A service delivery model is suggested for implementation and integration of music therapy within palliative medicine. Specific music therapy interventions, evaluation and documentation techniques are also mentioned. A description of patient and family responses to music therapy, staff satisfaction, and effectiveness of interventions is presented.

Humans↗
PubMed2025

Improving Community-Based Care for Adolescents with ADHD: a Randomized Controlled Trial of Artificial Intelligence-Assisted Fidelity Supports.

Cognitive-behavioral treatments (CBTs) for adolescents with ADHD demonstrate promise of long-term effects on outcome. However, their implementation in routine care community clinics faces barriers that impact quantity, efficiency, and quality of delivery, as well as client outcomes. This study is a randomized controlled trial designed to evaluate the impact of an AI-assisted service delivery model on therapist implementation of Supporting Teens' Autonomy Daily (STAND), a CBT blended with Motivational Interviewing (MI) for adolescents with ADHD. Adolescents with ADHD (N = 51), who were clients at three community mental health agencies, received treatment from 23 therapists. There was randomization of adolescents and therapists to AI-assisted or standard implementation supports. In addition to standard supports (i.e., training, standard facilitation resources, technical assistance, case supervision), AI-assisted support package included digitized facilitation resources housed in a clinical dashboard (Care4), feedback on content fidelity, and AI-generated feedback on MI implementation quality. The AI-assisted group was associated with more efficient treatment delivery and lower number of appointments attended by the adolescent. There was also a significant decrement in MI quality over time in the AI-assisted group compared to the standard support group. Feedback in focus groups indicated that therapists perceived a task-oriented mindset to be associated with receipt of the AI-assisted support package, leading therapists to prioritize efficiency over relational aspects of therapy. Following the results of this trial, a future, larger RCT should examine the impact of the AI-assisted implementation model on mental health outcomes and cost savings to organizations, third party payers, and clients. Trial registration number: NCT05135065; https://www.clinicaltrials.gov ; Registered September 2021.

Humans↗
PubMedDate not supplied

IQ variability in children with SLI: implications for use of cognitive referencing in determining SLI.

The practice of cognitive referencing assumes that IQ scores can be used as a measure of intellectual potential from which language scores may deviate. To test the validity of this assumption the WISC scores of children with specific language impairment were compared over time. The variability of WISC scores from children with SLI from their initial evaluation and from the federally-mandated three year re-evaluation was analyzed. Significant differences in the performance scale scores were found. This indicates that the IQ scores of these children are more properly interpreted as reflecting current abilities rather than potential for language learning. This further calls into question the practice of cognitive referencing as a method of determining the presence of a language impairment, eligibility for services, and the service delivery model for which a child qualifies.

Adolescent↗
PubMedDate not supplied

Nursing centers: an analysis of the anecdotal literature.

The anecdotal literature is reviewed to analyze the development and implementation of nursing centers and to make recommendations for the future. Definitions, historical developments, and services provided are reviewed and a conceptual categorization is suggested. To realize the potential of nursing centers as viable service delivery models, their leaders are urged to develop objective outcomes, test the scientific adequacy of the nursing care delivered, develop affiliations with traditional health care delivery systems, and require nursing students to rotate through these centers as part of their undergraduate and selected graduate experience.

Ambulatory Care Facilities↗
PubMed2025

Feasibility of using patient navigation to improve identification of hereditary cancer syndromes in newly diagnosed patients with colorectal cancer.

PURPOSE: Germline genetic testing to identify hereditary cancer syndromes in patients newly diagnosed with colorectal cancer (CRC) carries substantial benefits. We examined the feasibility of using patient navigation, an evidence-based approach to reduce structural barriers to recommended care, to improve test completion by increasing pretest counseling attendance. METHODS: We conducted key informant interviews with representatives from organizations providing cancer care to CRC patients. Interviews included questions derived from the Consolidated Framework for Implementation Research, which delineates barriers and facilitators to implementing evidence-based practices. We used an inductive-deductive coding approach to identify themes related to program feasibility. RESULTS: We interviewed 19 participants across 13 organizations. Key feasibility barriers included funding to implement and sustain a navigation program, staffing and supervising the navigator role, health information technology needs, gaining administrators' buy-in, and evolving genetic service delivery models. Participants suggested multiple strategies to address implementation barriers, but most would prefer other approaches to improve genetic test completion over implementing a genomics-focused patient navigation program. CONCLUSION: Stakeholders across a range of health care organizations saw limited value in improving the identification of hereditary CRC syndromes by implementing a program designed to increase pretest genetic counseling attendance. The need to scale up genetic testing has shifted interest toward delivery models better integrated in established care pathways, requiring fewer resources and providing broader reach.

Humans↗
PubMedDate not supplied

Sickle cell disease -- when opioids and physicians fail.

An interview with a 32-year-old male with sickle cell anemia and multiple sequential admissions for vaso-occlusive crises, receiving high dose narcotic analgesics, is presented. The subsequent clinical discussion outlines psychiatric, psychosocial and treatment issues. Management of acute vaso-occlusive crisis is summarized along with a discussion of the value of comprehensive care for sickle cell disease patients. This article will be useful to physicians and consultation-liaison psychiatrists treating patients with sickle cell disease as well as policy makers developing service delivery models for this population.

Adult↗
PubMed2004

Abortion law reform in Nepal: women's right to life and health.

In Nepal, the effects of the low social status of women and lack of access to health care and family planning have resulted in a maternal mortality ratio that is among the highest in South Asia. By the mid-1990s, the contribution of unsafe abortions to maternal deaths and morbidity was acknowledged by key individuals in the Ministry of Health and Department of Health Services. Advocacy for abortion law reform over several decades culminated in the passage of a new law on abortion in 2002. The parliamentary process took almost four years from the tabling of the bill. Almost two years elapsed between the passage of the bill and approval of the Procedural Order for implementing it This paper describes the development of policy and programme strategies for implementing the new law, led by the government in collaboration with NGOs, donors and other stakeholders. During that time, documents required for implementation were prepared, training of service providers was begun and a model service delivery and training site was established in Kathmandu Maternity Hospital. Simple systems to enable rapid expansion of services and a women-friendly approach were devised, promoting universal availability of affordable services provided by physicians and eventually nurses, the latter particularly in remote and rural areas, where 88% of the population live.

Abortion, Induced↗
PubMed2003

Ethical and legal issues related to telepractice.

The subject of speech-language pathologists providing services over a distance via telepractice is attracting the attention of the profession. The new service delivery model will challenge us to exploit its potential without violating legal constraints or compromising our affirmative ethical responsibilities. This article provides an overview of the implications of current state licensure laws on telepractice and a look at the issues of competence, standard of care, privacy, informed consent, and the use of support personnel. Several principles are offered to guide the practitioner and additional resources are suggested.

Allied Health Personnel↗
PubMed2005

Quality of life for people with intellectual disabilities in China: a cross-culture perspectives study.

BACKGROUND: The concept of quality of life (QOL) is explained on the basis of traditional Chinese culture and contemporary social and cultural trends. METHOD: The importance of internationally recognized QOL domains and indicators was determined for three respondent groups: consumers, parents of the consumers, and teachers and rehabilitation professionals working with the clients. RESULTS: Principal component analysis confirmed seven factors influencing QOL for people with intellectual disabilities (ID) in China. These seven components are conceptually equivalent to the eight domains found in the international QOL literature. CONCLUSION: The concept of QOL has become one of the most sensitive issues in present Chinese society and peoples' lives, and an important theoretical framework for the education and rehabilitation for people with ID in several ways: curriculum development, service delivery models, education and rehabilitation practices, and employment models.

Adult↗
PubMedDate not supplied

Teachers with learning disabilities: a view from both sides of the desk.

The purpose of this qualitative multicase study was to explore the perceptions of individuals who could speak from both sides of the special education desk--as students and as teachers. The three participants for this study each received special education services for learning disabilities while in school and were currently teaching students with learning disabilities. Specifically the study focused on how participants' past experiences with receiving special education services influenced their current practice as special education teachers. Participants' views on service delivery models, the importance of teacher expectations, and the value of conceiving a learning disability as a tool rather than a deficit are discussed.

Adolescent↗
PubMedDate not supplied

Learning disabilities existing concomitantly with communication disorder.

This article describes the characteristics of language disorders that occur with learning disabilities. In this context, formal and naturalistic language, including specific standardized test batteries and curriculum-based language assessment, portfolio assessment, and others, are discussed. In addition, service delivery models and interventions that focus on the enhancement of semantic, syntactic, and pragmatic development are presented. Finally, future directions for research in the area of learning disabilities and secondary language disorders are suggested. Intervention strategies, including supportive scaffolding, whole language, and collaborative consultation, are reviewed; and implications for language assessment, intervention, and future research are discussed.

Environment↗
PubMedDate not supplied

Co-teaching experiences: the benefits and problems that teachers and principals report over time.

This report describes a 3-year study of 18 elementary and 7 middle school teams involved in the development and implementation of building-level programs designed to support students with disabilities in mainstream classrooms. All of the teams used co-teaching as an integral part of their service delivery models. During the investigation, 119 teachers and 24 administrators participated in 1 or more years of data collection. The emerging benefits and persistent problems that participants identified in the development of their models are described.

Administrative Personnel↗
PubMed2006

Sensorimotor training in a virtual reality environment: does it improve functional recovery poststroke?

OBJECTIVE: To investigate the effectiveness of computerized virtual reality (VR) training of the hemiparetic hand of patients poststroke using a system that provides repetitive motor reeducation and skill reacquisition. METHODS: Eight subjects in the chronic phase poststroke participated in a 3-week program using their hemiparetic hand in a series of interactive computer games for 13 days of training, weekend breaks, and pretests and posttests. Each subject trained for about 2 to 2.5 h per day. Outcome measures consisted of changes in the computerized measures of thumb and finger range of motion, thumb and finger velocity, fractionation (the ability to move fingers independently), thumb and finger strength, the Jebsen Test of Hand Function, and a Kinematic reach to grasp test. RESULTS: Subjects as a group improved in fractionation of the fingers, thumb and finger range of motion, and thumb and finger speed, retaining those gains at the 1-week retention test. Transfer of these improvements was demonstrated through changes in the Jebsen Test of Hand Function and a decrease after the therapy in the overall time from hand peak velocity to the moment when an object was lifted from the table. CONCLUSIONS: It is difficult in current service delivery models to provide the intensity of practice that appears to be needed to effect neural reorganization and functional changes poststroke. Computerized exercise systems may be a way to maximize both the patients' and the clinicians' time. The data in this study add support to the proposal to explore novel technologies for incorporation into current practice.

Aged↗