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BACKGROUND: Specific stabilisation exercises (SSE) can combat the debilitating effects of chronic non-specific low back pain (CLBP), improve disability, pain and fear-avoidance beliefs (FAB). OBJECTIVE: To elicit the determinants of outcome in patients with CLBP with associated FABs after treatment with SSE. METHOD: Twenty-nine patients (20 females) with CLBP were classified using FAB questionnaire into high or low Work and Physical Activity (PA) subscales. After 4-week treatment, evaluations were done for pain, disability and lumbar spine active range of motion (AROM). Data was analysed exploratory-descriptively with a significance level set at p < 0.05. RESULTS: Participants were aged 55.24 ± 11.91 years. They scored 19 (65.5%) and 5 (17.2%) respectively on Work and PA subscales. The post-intervention evaluation showed significant differences in all outcomes, but no significant difference between patients with high or low FAB scores for both subscales. PA scores correlated significantly with pain while work scores correlated significantly with disability. Participants' gender predicted disability, pain and AROM with moderate to large effect sizes. CONCLUSION: SSE can potentially improve disability, pain and range of motion for patients with chronic low back pain regardless of FABQ status. Gender and baseline patient status are potential determinants of outcome of treatment using SSE. [ABSTRACT FROM AUTHOR]

Background: Health disparities in osteoarthritis (OA) outcomes exist both in the occurrence and treatment of functional limitation and disability for Mexican Americans. Although the effect of self-management of chronic illness is well established, studies demonstrate little attention to self-management of function or disability, despite the strong potential effect on both and, consequently, on patients' lives. Objective: The purpose of this study pilot was to develop and test key variable relationships for a measure of disability self-management among Mexican Americans. Methods: In this sequential, two-phased, mixed-methods, biobehavioral pilot study of Mexican American women and men with OA, a culturally tailored measure of disability self-management was created, and initial relationships among key variables were explored. Results: First, a qualitative study of 19 adults of Mexican American descent born in Texas (United States) or Mexico was conducted. The Mexican American Disability Self-Management Scale was created using a descriptive content analysis of interview data. The scale was tested and refined, resulting in 18 items and a descriptive frequency of therapeutic management efforts. Second, correlations between study variables were estimated: Disability and function were negatively correlated. Disability correlated positively with social support and activity effort. Disability correlated negatively with disability self-management, pain, and C-reactive protein. Function was positively correlated with age, pain, and depression. Liver enzymes (alanine transaminase) correlated positively with pain and anxiety. Discussion: This mixed-methods study indicates directions for further testing and interventions for disability outcomes among Mexican Americans. [ABSTRACT FROM AUTHOR]

BACKGROUND: The workplace accommodation process is often affected by ineffective and inefficient communications and information exchanges among disabled employees and other stakeholders. Information systems (IS) can play a key role in facilitating a more effective and efficient accommodation process since IS has been shown to facilitate business processes and effect positive organizational changes. OBJECTIVE: Since there is little to no research that exists on IS use to facilitate the workplace accommodation process, this paper, as a critical first step, examines how IS have been used in the accommodation process. METHODS: Thirty-six interviews were conducted with disabled employees from various organizations. Open, axial, and selective coding were part of the analysis. Fuzzy set qualitative comparative analysis was used to identify different levels of IS use based on participants' descriptions. RESULTS: An IS used in the workplace accommodation process consists of electronic request form, accommodation checklist, special budget, specific role, ancillary service, formal policy and procedure. There are different levels of IS use in the current accommodation process. The high-level IS use often results in a better accommodation performance than the low-level IS use, including high efficiency, high effectiveness, and low emotional tolls. Nevertheless, the high-level IS use often uses a specific, inflexible template as well as disregards human elements in the accommodation process. CONCLUSION: This work provides implications that future IS design should raise awareness of disability and accommodation, account for individual differences, involve multiple stakeholder inputs, as well as address the fundamental social issues in the accommodation process. [ABSTRACT FROM AUTHOR]

The Aid and Attendance (A&A) benefit is a cash entitlement for Veterans who served in the U.S. military to obtain personal care services. Our objective was to identify factors contributing to variation in A&A enrollment across VA Medical Centers (VAMCs). We used VA data to calculate the enrollment rate among older Veterans receiving a VA pension or compensation in 2015, then purposefully sampled social work leaders at 15 VAMCs with the highest (n = 7) and lowest (n = 8) enrollment rates for interviews. All respondents viewed A&A as an important benefit. Participants at high-enrollment sites indicated strong working relationships with Veterans Benefits Administration (VBA) and Veterans Service Organizations (VSOs) with onsite presence and education about A&A facilitate access. Participants at low-enrollment sites indicated they desired education around A&A eligibility criteria and collaboration with VBA/VSOs. VA and non-VA social workers would benefit from education about VBA's benefits, and this requires collaboration with VBA representatives. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to establish whether the Rheumatoid Arthritis Work Instability Scale (RA‐WIS), in its current form, is applicable for use with employed people with fibromyalgia (FM) to identify the risk of work disability and need for work rehabilitation. Methods: Content validity was first investigated using cognitive debriefing interviews. Participants completed a postal questionnaire. Construct validity was assessed using Rasch analysis. Concurrent validity included testing between the RA‐WIS and work (e.g., Workplace Activity Limitations Scale) and health (FM Impact Questionnaire‐Revised (FIQ‐R) scales. Two weeks later, participants were mailed a second questionnaire to measure test‐retest reliability. Results: Interviews were conducted with 13 participants with FM. All RA‐WIS items were considered very or extremely relevant by almost all participants, with only one suggesting other items (anxiety and brain fog). Questionnaire responses were analysed from 156 employed participants: 94% women; 45.71 (SD 10.05) years of age; with time since FM diagnosis 2.99 (4.17) years (symptom duration 8.36 (SD 7.16) years). The RA‐WIS mostly satisfied Rasch model requirements and a Rasch transformation scale was created. Concurrent validity was generally good (rs = 0.55–0.66) with work scales and the FIQ‐R. Internal consistency (Person Separation Index values) was consistent with group use in FM, not individual level use. Test‐retest reliability was excellent, with intraclass coefficient (2, 1) = 0.90. Discussion: The RA‐WIS is valid and reliable for group use in employed people with FM. However, further work is needed to develop a WIS for individual use in FM. [ABSTRACT FROM AUTHOR]

Comprehensive sexuality education (CSE) seeks to improve young people's knowledge, attitudes and practices in relation to sexual and reproductive health, sexual and social relationships, and dignity and rights. In Ethiopia, young people with disabilities and young women involved in sex work are particularly vulnerable to sexual violence and poor sexual health, yet face stigma and accessibility challenges that continue to exclude them from information, support and services. Because they are often out of school, these groups are also often excluded from programmes that are largely delivered in school settings. This paper explores the challenges faced by these groups of young people in accessing inclusive and age-appropriate sexual and reproductive health knowledge and services in the Ethiopian context and the implications for delivering CSE. The research included literature review, mapping analysis and interviews with young people from those two groups and with service providers and programme implementers. Our findings indicate that young people with disabilities and young women involved in sex work face myriad barriers to accessing information and services that support positive and healthy sexuality, relationships and rights. However, changes over the past decade to national and regional governance structures and a political environment in which CSE has become increasingly contested have generated siloed approaches to the provision of sexual and reproductive health information and services, and poor linkages to complementary services including violence prevention and social protection. It is vital that efforts to implement comprehensive sexuality education are informed by these challenges in the wider policy environment. [ABSTRACT FROM AUTHOR]

Breast cancer (BC) is the most common invasive cancer in the world. Most BC survivors (BCSs) continue working while dealing with cancer-related disabilities. BCSs' return-to-work (RTW) after cancer treatment is an important stage of their recovery and is associated with a higher survival rate. In this study, we addressed the RTW of BCSs with the intention of facilitating this process through direct action in the workplace. Thirty-two women who requested assistance from January to December 2022 were enrolled in the study. Semi-structured interviews and medical examinations were conducted by a team of three physicians. Interviews were analyzed using Thematic Analysis. Moreover, a quantitative cross-sectional study was conducted to compare the health status of BCSs with that of a control group of 160 working women, using standardized questionnaires on work ability, fatigue, sleep problems, anxiety, depression, and happiness. BCSs were also asked to rate the level of organizational justice they perceived at work prior to their illness. From the qualitative analysis emerged three facilitating/hindering themes: (1) person-related factors, (2) company-related factors, and (3) society-related factors. In the quantitative analysis, BCSs had significantly higher scores for anxiety, depression, sleep problems and fatigue, and lower levels of happiness than controls. The RTW of BCSs entails adapting working conditions and providing adequate support. The work-related analysis of each case made it possible to highlight the measures that need to be taken in the workplace to promote RTW. The treatment of cancer should be paired with advice on the best way to regain the ability to work. [ABSTRACT FROM AUTHOR]

Strategy training is an intervention that may reduce disability when delivered in inpatient rehabilitation following stroke. However, shorter lengths of stay and challenges with continuity of care following discharge results in difficulties in achieving adequate intervention dosage and carryover of training. We examined whether strategy training using a mobile health platform (iADAPT) is feasible during inpatient stroke rehabilitation and following discharge. In this RCT, participants were randomized to receive strategy training using either the iADAPT application (n = 16) or a workbook (n = 15). Participants in both groups received 7 in-person sessions during inpatient rehabilitation and 3 remote sessions following discharge. We calculated descriptive statistics to examine acceptance, attendance, and adherence, and within-group effect sizes on satisfaction and disability. Participants in the iADAPT group attended fewer total intervention sessions (n = 5.5, workbook n = 9.0) but attempted a similar number of goals (n = 7.6, workbook n = 8.2). Both groups reported similar satisfaction with in-person intervention (Treatment Expectancy: iADAPT d = 0.60, workbook d = 0.47; Patient Provider Connection: iADAPT d = 0.18, workbook d = 0.31), but the mobile health group reported greater satisfaction with remote intervention (Treatment Expectancy: iADAPT d = −0.91, workbook d = −0.97; Patient Provider Connection: iADAPT d = 0.85, workbook d = −1.80). Considering these promising feasibility metrics and the benefits of mobile health, it is worth continuing to explore the efficacy of strategy training using a mobile health platform. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore care in the context of disability as a tool to promote independence and empower disabled people. The study was based on the case of two women, Anna and Lena, who switched the roles of being either the cared-for or the one-caring. Data was collected with semi-structured interviews with the above mother and daughter. The participants discussed their experiences and feelings regarding the process of switching roles and taking responsibilities, the barriers to independence and autonomy, the implications of disability on the personal and family level, the process of adaptation to disability and their expectations for the future. It was found that switching roles had a twofold and oxymoron effect: on the one hand, a negative impact on the former one-caring's self-esteem and level of dependence was observed and, on the other, a positive impact on the disabled daughter's autonomy and independence occurred. Providing care is a moral act, which involves the one-caring and the cared-for. Caring may generate power relations and mutual dependence. In the context of impairment, sometimes need for care may be unavoidable. For this reason, dependence of some disabled people on non-disabled others may be observed. In Cyprus, caring for disabled siblings is considered as a moral duty and a virtue of females. For this reason, some women may devote themselves to caring for disabled siblings to feel valued and worthy. Switching the roles between the one-caring and the cared-for may be beneficial for the latter, because becoming the one-caring may result to feeling independent, self-confident, and free from previous control. In contrast, becoming the cared-for was related to increased stress and difficulties to adapt to impairment, since the new role was interpreted as acceptance of being depended on others and thereby unwanted loss of power. [ABSTRACT FROM AUTHOR]

This study explored children's experiences of participating in one-to-one physical training programs to identify how programs can best promote physical activity participation for children with cerebral palsy. A qualitative descriptive design with self-determination theory was used. Semistructured interviews were conducted with 6 children with cerebral palsy, age 8–14 years, who participated in a fundamental-movement-skills or lower-limb strength-training program. A hybrid approach of deductive and inductive analysis was used. Four themes developed: World around me (i.e., social/physical environments), Made for me (i.e., individualizing programs), Teach me how (i.e., teaching strategies facilitated skill learning), and I know me (i.e., sense of self). Results include recommendations for delivery of physical training programs. Using an individualized approach in a structured one-to-one program that employs skill-teaching strategies and self-reflection opportunities may provide a foundation to increase physical activity participation, related self-confidence, and desire to participate. [ABSTRACT FROM AUTHOR]

BACKGROUND: Paramedics are a high-risk occupational group for posttraumatic stress injuries (PTSI), and increasingly, evidence suggests that organizational factors play a significant role. While several resources for paramedic services to address PTSI exist, there is limited knowledge as to which PTSI-related programs and practices are implemented and how they are perceived in the workplace. OBJECTIVES: This research aimed to explore key informants' perspectives on existing and desired organizational-wide initiatives for, as well as the challenges and potential solutions to, the primary prevention, early detection and intervention, and disability management of PTSI in Canadian paramedic services. METHODS: Semi-structured interviews were conducted with 12 key informants from jurisdictions across Canada who have over five years of work experience in prehospital care. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. RESULTS: Eight recurrent organizational elements (themes) for addressing PTSI emerged: psychologically safe and healthy work culture; consistent supervisor support, mental health training and awareness, opportunities for recovery and maintaining resiliency, recognition of PTSI and its diverse risk factors, access to a variety of support initiatives for PTSI, communication during medical leave, and meaningful work accommodations. CONCLUSIONS: While organizational-wide initiatives were in place for the primary prevention, early detection and intervention, and disability management of PTSI, systemic challenges with coordination, resource allocation, and worker engagement were also identified. These challenges prevented paramedic services from optimally addressing PTSI in their workplace. Integrating considerations from the eight organizational elements to address PTSI into broader existing management systems may have merit in overcoming the systemic challenges. [ABSTRACT FROM AUTHOR]

Purpose/Objective: This work provides comprehensive analyses targeting the factor structure and dimensionality of the Disability Identity Development Scale (DIDS). In Forber-Pratt et al., 2020, disability was defined broadly to include individuals with visible or hidden disabilities across many disability groups (i.e., physical, intellectual, learning, or chronic illness). Research Method/Design: Retained items from previous exploratory factor analysis were administered to a sample of adults with disabilities (n = 1,126) ranging in age from 18-78 years. Confirmatory factor analytics (CFA) including traditional CFA, and bifactor confirmatory analyses were used to examine the dimensionality and structure of the DIDS. Results: Traditional CFA provided lack of evidence in support of the oblique four-factor structure previously reported. Bifactor confirmatory analysis revealed items on the DIDS are consistent with unidimensional, and to a lesser degree multidimensional solutions (i.e., items lacked a level of content diversity to substantiate a complex, reliable multifactor structure). Discussion/Conclusion: Analytic results on the DIDS revealed reasonable psychometric properties as a measure of disability identity. Our results support using a sum or total score of disability identity. Results of this work are an important contribution to a growing body of literature supporting, and investigating, disability identity development. Furthermore, the DIDS measure with its resulting composite score of disability identity has the potential to inform clinicians in the field of rehabilitation psychology as well as informing future targeted interventions. [ABSTRACT FROM AUTHOR]

The application of the International Classification of Functioning, Disability and Health (ICF) model in the field of disability has become a global trend since 2001. However, very little attention has been paid to the impact of ICF-based practices on the staff members involved in implementing them. This study develops and validates a scale with which to measure staff members' readiness to carry out ICF-based practices, as well as their competency and perceived valences in doing so. Staff members holding diverse positions in a non-governmental organisation providing disability services were recruited. An exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) were conducted to confirm the factorial structure. Data for a total of 338 participants were used in the analysis. A CFA of the data collected from the second sub-sample (n = 169) demonstrated that the goodness-of-fit indices of the five-factor model were acceptable. Those five factors are: perceived knowledge, perceived competence, intrapersonal valence, relational valence and perceived meaning. The whole scale achieved excellent reliability (Cronbach's α = 0.981). The Scale on Staff Valence under ICF-based practice (SSV-ICF) is a valid and reliable scale to measure disability personnel's perceived valences under a new ICF-based practice. The Scale on Staff Valence under ICF-based Practice (SSV-ICF) is a new scale for measuring the impact of ICF-based practices on staff and to developing evidence-based ICF-related staff training programmes. The 27-item five-factor structured SSV-ICF demonstrated acceptable psychometric properties and almost perfect internal consistency. The SSV-ICF offers a promising tool for identifying the merits of ICF-based practices and for developing evidence-based staff interventions among different disciplines. [ABSTRACT FROM AUTHOR]

Summary: This study reviews two different types of frontline social services for unaccompanied young adult refugees participating in an intensive Social Support Programme implemented in 2016–2019 by a local municipality. More specifically, the study took a phenomenological research approach to review the impact of intensive case management and specialised educational/occupational orientation services on young refugees' capabilities and agency to reach aspired life goals. The capability approach has been applied as a theoretical framework for identifying opportunities and challenges in this regard. The paper covers a mixed-method design that includes qualitative and quantitative data. The qualitative data are drawn from 42 in-depth interviews with 24 young refugees and one interview and three focus group discussions with 10 service providers. The article also includes a limited amount of longitudinal statistics on the aspirations of 31 young refugees upon entering and exiting the support programme. Findings: This article shows theoretical and empirical evidence for utilising the capability approach to review social services for young refugees. Findings suggest that social workers and refugees face intersecting structural and interpersonal tensions that counteract with the expansion of young refugees' capabilities and agency to reach their aspired life goals. Specific strategies are suggested to diminish described challenges. Applications: Social work with unaccompanied young adult refugees should shift its attention from integrating these young individuals into the dominant social order, to prioritising their human development. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to describe the experiences of Turkish nurses in the psychiatry clinics of Turkey's Mental Health and Diseases Hospital Design and Methods: This descriptive qualitative study was conducted on 20 psychiatric nurses working at a psychiatric hospital. A semi‐structured in‐person interview technique was used for data collection. Results: Six themes were defined in this study. The majority of psychiatric nurses stated that they usually faced suicidal and aggressive cases and that they used security measures, restraint and isolation, medical treatment, and emergency codes as basic interventions. Practice Implications: Psychiatry is a field of clinical practice requiring case management skills to deal with various psychiatric presentations. [ABSTRACT FROM AUTHOR]

Extant literature has demonstrated connections between workplace environment and worker stress, as well as between worker stress and direct service provision. Current research on direct service provision to people experiencing homelessness, however, has not established a clear association between the workplace environment and the quality of direct services provided to clients receiving case management. This study extends the existing research by establishing connections between all of these constructs, specifically within the context of case management services to people experiencing homelessness. For this mixed methods study, the authors sampled 16 case managers providing direct services to people experiencing homelessness in one homelessness services organization (HSO) in a large metropolitan area. Through focus group interviews and web-based surveys, the authors collected data on the workplace environment, worker stress, and direct service provision. The authors then analyzed the data using a concurrent nested approach for mixed methods analysis. The results of this study suggest that case managers in homelessness HSOs often experience a stressful workplace environment due to workplace cultural norms, inefficient processes, and high expectations placed upon them by both clients and administrators. The stressful workplace environment can interact with client trauma to produce secondary traumatic stress in direct service providers, which then influences client-case manager rapport development. Study findings point toward specific policies and practices that homelessness HSOs ought to adopt in order to mitigate case managers' workplace stress and secondary traumatic stress, and negative influences of these stressors on rapport development between case managers and clients experiencing homelessness. [ABSTRACT FROM AUTHOR]

Family caregivers play an essential role in healthcare for elderly people in primary care settings. The complexity of geriatric patients as well as the fragmentation of healthcare systems can lead to a burden for family caregivers, which can affect their physical and psychological health as well as social relationships, economic productivity and quality of caregiving. Care‐ and case‐management offers a possibility to support, empower and navigate family caregivers through healthcare systems in order to reduce their own burden. The project RubiN (Continuous care in a regional network) was developed to provide regional care‐ and case‐management for outpatient care of the elderly (age >70 years) in a primary care setting in Germany. The aim of this qualitative study was to explore experiences and attitudes of family caregivers of geriatric patients regarding the community‐based care‐ and case‐management intervention RubiN. Telephone interviews with a purposeful sample of 21 family caregivers enlisted in all RubiN networks were conducted between March and May 2020 and were followed by qualitative content analysis. The main categories, which emerged were namely: (1) current healthcare situation and (2) experiences with RubiN. Main findings suggest that participants in this study valued the provided support and experienced a sense of relief. However, some participants were disappointed with RubiN and the included support by care‐ and case‐managers. A care‐ and case‐management affected caregiving per se as well as the patient's and family caregiver's well‐being. Important aspects contributing to these findings were a continuous relationship, training and expertise of the care‐ and case‐managers. Establishing networks between the patients, family caregivers, care‐ and case‐managers and healthcare providers were key components as well as a good explanation about RubiN itself for family caregivers. Therefore, a community‐based care‐ and case‐management can play an important role in detecting, facilitating and preventing family caregiver burden. [ABSTRACT FROM AUTHOR]

Medical aid (MA) in South Korea, a national public assistance scheme, provides minimum medical security for low‐income families. The Korean government has adopted a case management (CM) programme to control MA beneficiaries' inappropriate medical use and enhance beneficiaries' quality of life. This study aimed to explore case managers' experiences of implementing CM for MA beneficiaries' potential barriers. This study employed a qualitative phenomenological tradition using focus‐group interviews. Three focus groups with 19 MA case managers were conducted (July to August 2018) using semistructured interview questions. Data were analysed through qualitative content analysis using the NVivo software programme, followed by consensus meetings between researchers. Participants perceived the structural barriers to CM implementation as a contradictory MA system, lack of communication among government departments and CM guidelines not reflecting reality. Five themes were derived as the personal barriers: burnout, the conflict between private values and CM goals, role confusion, beneficiaries' blame, and lack of acknowledgement from coworkers. To improve case managers' experiences concerning MA beneficiaries, policy solutions and a collaborative environment with beneficiaries, public nurses and social service providers are needed to ensure the workforce's sustainability. Also, it is required to develop practical guidelines that reflect the reality of implementing CM. [ABSTRACT FROM AUTHOR]

This article reports on a multidisciplinary project exploring constructions of disability in Iceland before the establishment of disability as a modern legal, bureaucratic, and administrative concept. The project's vast temporal scope spans the settlement of Iceland in the late 9th century to the early 20th century, and it combines research in the fields of Archaeology, Medieval Literature, Folklore, History, and Museology. The article outlines the project's rich and diverse source material and its data collection procedures before discussing the various methods employed across the disciplines involved. Focus simultaneously turns to the project's myriad discipline-specific findings and to the presence of ambiguity and absence, invisibility, or silence as recurring crossdisciplinary themes. [ABSTRACT FROM AUTHOR]

There is a growing effort from a range of professionals and institutions to develop comprehensive integrated prison-to-community healthcare, discharge planning, and community re-entry support for inmates living with HIV. This paper draws from ethnographic data to explore the 'lived experience' of HIV-positive inmates in a US State prison system offering an integrated case management support programme. In the US, incarceration is critical for connecting socially marginalised people and those with health needs to certain rights and resources. We present the ways in which imprisonment enables a claims-making process against the state by allowing this group access to resources and rights connected to imprisonment, healthcare, and associated social welfare support. Offenders identified incentives underpinning their expressed desire or 'intention' to return to prison over time. Our findings suggest that this group of inmates has increased opportunity to access material, medical, and welfare resources when compared to the general inmate population and those outside the prison system. Multiple gaps remain in this group's sense of security in the community, ability to cope with the stress of everyday life, sustained support with substance dependency and, most importantly, consistent access to medical and welfare resources that enable them to live independently. Ironically, for many inmates living with HIV, incarceration offers a better chance of accessing public health services than living in the community. [ABSTRACT FROM AUTHOR]

This study reports on outcomes for 169 caregivers enrolled in the Michigan Stroke Transitions Trial (MISTT), an RCT of social work case management for stroke patients returning home. A mixed-model approach examined the mean change from 7- to 90-days post-discharge with group-by-time interactions for differences between treatment groups. Caregivers reported few life changes or depressive symptoms from caregiving. There was no significant change over time or treatment effects. Negative aspects of stroke caregiving may take longer to develop. Focused caregiver assessment at discharge and a better understanding of how caregiving develops over time may improve the type and timing of support. [ABSTRACT FROM AUTHOR]

Objective: Follow‐up after breast cancer can be divided into surveillance and aftercare. It remains unclear how follow‐up can ideally be organised from the perspective of health care professionals (HCPs). The aim of this study was to gain insight in the organisation of follow‐up in seven Dutch teaching hospitals and to identify best practices and opportunities for improvement of breast cancer (all stages) follow‐up as proposed by HCPs. Methods: Semi‐structured in‐depth group interviews were performed, one in each of the participating hospitals, with in total 16 HCPs and 2 patient advocates. To describe the organisation of follow‐up, transcripts were analysed using a deductive approach. Best practices and opportunities were derived using an inductive approach. Results: Variation was found in the organisation of aftercare, especially in timing, frequency, and disciplines of involved HCPs. Less variation was observed for surveillance, which was guided by the national guideline. Best practices focused on case management and adequate collaboration between HCPs of different disciplines. Mentioned opportunities were improving the structured monitoring of patients' needs and a comprehensive guideline for organisation and content of aftercare. Conclusions: Variation in follow‐up existed between hospitals. Shared decision‐making (SDM) about surveillance is desirable to ensure that surveillance matches the patient needs, preferences, and personal risk for recurrences. [ABSTRACT FROM AUTHOR]

Access to HIV services for HIV-positive patients in addiction care is challenging in Russia, because both care systems are organised independently from each other. Strengths-based case management is an effective strategy to connect people with HIV (PHIV) to HIV care. This mixed-methods study's objective was to investigate implementation of a case management intervention in St. Petersburg, Russia, designed to connect PHIV who inject drugs to HIV care. We analysed survey data from 118 HIV-positive patients in addiction care and conducted six focus groups (n=38). Quantitative analyses of fidelity and satisfaction outcomes and qualitative text analysis assessed intervention implementation. Participants who linked to HIV services embraced empowerment and motivation resulting from case management as supporting self-efficacy and linkage to services. Among participants who did not link to care, drug use impeded their care engagement. Main levers to implementation were empowerment to cope with challenges of a fragmented health system and persistent stigma. Those who connected to HIV services credited case managers for facilitating linkage; those who did not link attributed it to personal issues. Implementation of case management for HIV care in Russia should focus on effective substance use treatment and empowerment, motivation and support in addressing personal and system factors. [ABSTRACT FROM AUTHOR]

Background: INTEVAL_Spain was a complex workplace intervention to prevent and manage musculoskeletal pain among nursing staff. Process evaluations can be especially useful for complex and multifaceted interventions through identifying the success or failure factors of an intervention to improve the intervention implementation. Objectives: This study performed a process evaluation of INTEVAL_Spain and aimed to examine whether the intervention was conducted according to the protocol, to investigate the fulfilment of expectations and the satisfaction of workers. Methods: The intervention was a two-armed cluster randomized controlled trial and lasted 1 year. The process evaluation included quantitative and qualitative methods. Quantitative methods were used to address the indicators of Steckler and Linnan's framework. Data on recruitment was collected through a baseline questionnaire for the intervention and the control group. Reach and dose received were collected through participation sheets, dose delivered and fidelity through internal registries, and fulfilment of expectations and satisfaction were collected with two questions at 12-months follow-up. Qualitative methods were used for a content analysis of discussion groups at the end of the intervention led by an external moderator to explore satisfaction and recommendations. The general communication and activities were discussed, and final recommendations were agreed on. Data were synthesized and results were reported thematically. Results: The study was performed in two Spanish hospitals during 2016-2017 and 257 workers participated. Recruitment was 62 and 51% for the intervention and the control group, respectively. The reach of the activities ranged from 96% for participatory ergonomics to 5% for healthy diet. The number of sessions offered ranged from 60 sessions for Nordic walking to one session for healthy diet. Fidelity of workers ranged from 100% for healthy diet and 79% for participatory ergonomics, to 42 and 39% for Nordic walking and case management, respectively. Lowest fidelity of providers was 75% for case management and 82% for Nordic walking. Fulfilment of expectations and satisfaction ranged from 6.6/10 and 7.6/10, respectively, for case management to 10/10 together for the healthy diet session. Discussion groups revealed several limitations for most of the activities, mainly focused on a lack of communication between the Champion (coordinator) and the workers. Conclusions: This process evaluation showed that the implementation of INTEVAL_Spain was predominantly carried out as intended. Process indicators differed depending on the activity. Several recommendations to improve the intervention implementation process are proposed. Trial registration: ISRCTN15780649. [ABSTRACT FROM AUTHOR]

Background: Families who learn that their unborn baby has a life-limiting fetal condition are often overwhelmed by this news, alongside navigating an unfamiliar healthcare system. A skilled perinatal palliative care coordinator (PPCC) can help these families, yet little is known about their function and roles. Aims: This study sought to describe the PPCC's approach to care, their guiding principles and the roles, knowledge and skills that enable them to provide exemplary care. Methods: This qualitative descriptive study included interviews of 12 expert PPCCs. Directed content analysis was used to identify major codes. Iterative analysis led to theme identification. Findings: Findings include the PPCC's position within the healthcare system, guiding principles, goals, roles and responsibilities, and knowledge and skills. Two figures enhance the understanding of the PPCCs approach to creating a safe space for the family, supporting the interdisciplinary team and facilitating coordinated birth planning. Conclusions: Every perinatal palliative care programme should include a PPCC. Future research on clinical training could examine the effectiveness of an educational intervention, using the detailed knowledge and skills learned in this study as a curriculum. [ABSTRACT FROM AUTHOR]

Background: Our health care is facing with the challenges of bed crunch and increasing number of patients with prolonged hospital stay. Aims: This study aimed to determine factors contributing to the prolonged hospital stay in a tertiary hospital in Singapore. Methods: A random sample of 600 medical records of patients' staying in hospital for more than 21 days was retrieved. The reasons for their prolonged hospital stay were categorized into 'medically unfit' and 'medically fit'. Results: The top three reasons for prolonged hospital stay among the 'medically unfit' group were ongoing medical treatment, surgical interventions and receiving intravenous chemotherapy/radiotherapy. The top three reasons for the 'medically fit' group were waiting for community hospital bed, waiting for a new caregiver and undecided on discharge disposition. Conclusion: The results inform health care stakeholders in planning measures to minimize the incidence of unnecessary prolonged hospitalization for optimal health care resource utilization. Implications of Nursing Management: Ineffective discharge planning can lead to serious adverse outcomes such as hospital readmission and prolonged hospital stay. Patient navigators have a crucial role in facilitating safe, smooth and timely discharge of patients from acute care hospital to community. Understanding the reasons behind extended hospitalization is essential in order to better provide support. [ABSTRACT FROM AUTHOR]

Background: The global program to eliminate lymphatic filariasis (GPELF) was started in 2003 with two strategies: the mass drug administration (MDA) to interrupt disease transmission and the morbidity management and disability prevention (MMDP) to provide the basic hygienic care to filariasis lymphedema patients. Among the two strategies, the MDA is well advanced and got the desired results, but the MMDP is lagging due to poor execution. Objectives: To assess the awareness of MMDP and ongoing morbidity management practices by lymphedema patients and to estimate the impacts of the MMDP on the prevalence and severity of lymphedema. Materials and Methods: This study was conducted among 100 lymphedema patients in 7 filariasis endemic villages of Villupuram district, Tamil Nadu, India through interviews using a structured, pretested questionnaire. The grading and adenolymphangitis (ADL) attack determination were done by a clinician. The impact was assessed in terms of changes in the lymphedema grades, frequency of ADL attacks, and changes in the burden. Results: Of the 100 patients, 70% were aware of the program and among them, only 48% were practising MMDP regularly (i.e. two times per day). The majority of them (80%) were taking treatment during ADL attacks. The overall lymphedema grades reversal and progression were observed in 13% and 52% of cases, respectively. Conclusion: This study has revealed that the second arm of the GPELF, "MMDP" has not yielded the desired results as evidenced by the incidence of frequent ADL attacks and advancement of lymphedema grades. [ABSTRACT FROM AUTHOR]

Background: Integrated community case management (CCM) has led to reductions in child mortality in Malawi resulting from illnesses such as malaria, pneumonia, and diarrhea. However, adherence to CCM guidelines is often poor, potentially leading to inappropriate clinical decisions and poor outcomes. We determined the impact of an e-CCM app on the referral, reconsultation, and hospitalization rates of children presenting to village clinics in Malawi.Objective: We determined the impact of an electronic version of a smartphone-based CCM (e-CCM) app on the referral, reconsultation, and hospitalization rates of children presenting to village clinics in Malawi.Methods: We used a stepped-wedge, cluster-randomized trial to compare paper-based CCM (control) with and without the use of an e-CCM app on smartphones from November 2016 to February 2017. A total of 102 village clinics from 2 districts in northern Malawi were assigned to 1 of 6 clusters, which were randomized on the sequencing of the crossover from the control phase to the intervention phase as well as the duration of exposure in each phase. Children aged ≥2 months to <5 years who presented with acute illness were enrolled consecutively by health surveillance assistants. The primary outcome of urgent referrals to higher-level facilities was evaluated by using multilevel mixed effects models. A logistic regression model with the random effects of the cluster and the fixed effects for each step was fitted. The adjustment for potential confounders included baseline factors, such as patient age, sex, and the geographical location of the village clinics. Calendar time was adjusted for in the analysis.Results: A total of 6965 children were recruited-49.11% (3421/6965) in the control phase and 50.88% (3544/6965) in the intervention phase. After adjusting for calendar time, children in the intervention phase were more likely to be urgently referred to a higher-level health facility than children in the control phase (odds ratio [OR] 2.02, 95% CI 1.27-3.23; P=.003). Overall, children in the intervention arm had lower odds of attending a repeat health surveillance assistant consultation (OR 0.45, 95% CI 0.34-0.59; P<.001) or being admitted to a hospital (OR 0.75, 95% CI 0.62-0.90; P=.002), but after adjusting for time, these differences were not significant (P=.07 for consultation; P=.30 for hospital admission).Conclusions: The addition of e-CCM decision support by using smartphones led to a greater proportion of children being referred to higher-level facilities, with no apparent increase in hospital admissions or repeat consultations in village clinics. Our findings provide support for the implementation of e-CCM tools in Malawi and other low- and middle-income countries with a need for ongoing assessments of effectiveness and integration with national digital health strategies.Trial Registration: ClinicalTrials.gov NCT02763345; https://clinicaltrials.gov/ct2/show/NCT02763345. [ABSTRACT FROM AUTHOR]

Though attention has been given to investigating the role of generalist case management in addressing complex needs, largely absent to date is an enquiry to develop the theory for rural community-based social work and human service case management. The purpose of this article is to describe how a two-stage exploratory mixed methods research methodology led to the formulation of a series of theoretical constructs to inform rural case management theory. This article describes Stage 2 of the study, a Delphi method with social work academics where vignettes and a rating scale were strategically combined to transform rural case management practice experience into constructs to inform rural practice theory. We conclude the article by contending that mixed method research designs hold promise for other areas of human services work, where practice theory grounded in-field experience is sought. [ABSTRACT FROM AUTHOR]

Purpose: The ageing population is a rising issue worldwide, including in Malaysia, which leads to an increase in older people compared to children. Malaysia is a relatively "younger" country compared to its Asian counterparts such as Japan and China. The demographic projections by the Department of Statistics of Malaysia state that by 2035 approximately 15% of its population would be above 60 years old. The powerful demographic trend of the ageing of the Malaysian population has consequences for the entire society and its economy. One of the biggest challenges for the Malaysian Government is to provide adequate facilities to the elderly in terms of care and support. For this purpose, around 365 registered and various unregistered centres are working throughout Malaysia, including Sabah and Sarawak. The government, non-governmental organisations, the private sector and various religious organisations run these centres. These centres provide residential and health-care services to elderlies, whereas the centre's operators face multiple challenges in the overall operation of the centre. The purpose of this study to highlight the leadership and decision making challenges among elderly care centre operators. Design/methodology/approach: The result highlights that both men and women operators face leadership and decision-making challenges for centre management. Regarding decision-making, women are experiencing more failures in proper decision-making than men. However, women operators are keen to learn from failures for appropriate decision-making. Findings: The result highlights that both men and women operators face leadership and decision-making challenges for centre management. Regarding decision-making, women are experiencing more failures in proper decision-making than men. However, women operators are keen to learn from failures for appropriate decision-making. The present study will help the new operators to persevere in their business ventures, and policymakers look into the best supports to enhance elderly care centre operator's success. Originality/value: The present study will help the new operators to persevere in their business ventures, and policymakers look into the best supports to enhance elderly care centre operator's success. [ABSTRACT FROM AUTHOR]

Background: The Australian Nurse Family Partnership Program (ANFPP) is an evidence-based, home visiting program that offers health education, guidance, social and emotional support to first-time mothers having Aboriginal and/or Torres Strait Islander (First Nations) babies. The community-controlled sector identified the need for specialised support for first time mothers due to the inequalities in birthing and early childhood outcomes between First Nations' and other babies in Australia. The program is based on the United States' Nurse Family Partnership program which has improved long-term health outcomes and life trajectories for mothers and children. International implementation of the Nurse Family Partnership program has identified interagency service integration as key to program recruitment, retention, and efficacy. How the ANFPP integrates with other services in an Australian urban setting and how to improve this is not yet known. Our research explores the barriers and enablers to interagency service integration for the Australian Nurse Family Partnership Program ANFPP in an urban setting. Methods: A qualitative study using individual and group interviews. Purposive and snowball sampling was used to recruit clients, staff (internal and external to the program), Elders and family members. Interviews were conducted using a culturally appropriate 'yarning' method with clients, families and Elders and semi-structured interview guide for staff. Interviews were audio-recorded and transcribed prior to reflexive thematic analysis. Results: Seventy-six participants were interviewed: 26 clients, 47 staff and 3 Elders/family members. Three themes were identified as barriers and three as enablers. Barriers: 1) confusion around program scope, 2) duplication of care, and 3) tensions over 'ownership' of clients. Enablers (existing and potential): 1) knowledge and promotion of the program; 2) cultural safety; and 3) case coordination, co-location and partnership forums. Conclusion: Effective service integration is essential to maximise access and acceptability of the ANFPP; we provide practical recommendations to improve service integration in this context. [ABSTRACT FROM AUTHOR]

Introduction: Canadian occupational therapists are employed as case managers on assertive community treatment (ACT) teams to support community living for individuals with severe and persistent mental illnesses. In this position, occupational therapists act primarily as generalists, typically attending appointments with clients, supervising medication adherence, supporting basic living needs, and managing client crises. Occupational therapists may also provide psychotherapy and coping skill groups, as well as profession-specific practices, such as skills training. Exploring how ACT occupational therapists describe their perceived ideal practice may support transformation in long-standing, occupational therapy practices on ACT teams. Method: This qualitative, interpretive description study involved 11 Canadian ACT team occupational therapists in one individual, semi-structured in-depth interview using an interview guide containing open-ended questions. Interview transcripts were analyzed to identify themes pertaining to therapists' descriptions of their perceived ideal occupational therapy practice on ACT teams. Results: Three themes emerged: (a) Engaging in practice "with intention"; (b) Finding the space for occupational therapy practice; and (c) Supporting clients in their recovery to find their best occupational self. Conclusions: The findings highlight practice possibilities for occupational therapist working on ACT teams and provide a foundation for advocating for better use of specific occupational therapy practices within community mental health settings. [ABSTRACT FROM AUTHOR]

Purpose There is an absence of evidence-based guidance to support workplace stakeholders in the effective delivery of return-to-work (RTW) messages. Our study examines the specific RTW communication practices and their impact on the management of work disability. Methods Within two large and complex healthcare organizations, semi-structured interviews were conducted with workplace stakeholders (e.g., supervisors, union representatives, disability management professionals and workers' compensation representatives) and workers who had previously experienced sickness absence related to an occupational injury or illness. For workplace stakeholders interview questions asked about their roles and responsibilities in the RTW process, and specific communication strategies and messages that were used at different phases of the RTW process. For worker participants, interview questions explored RTW experiences and the impact of communication on work re-integration. An interpretative descriptive approach was used to inductively examine themes from interviews to create ways of understanding phenomena that yielded applied findings. Results Forty participants were interviewed including workplace stakeholders and workers. Participants frequently described effective RTW communication as messages that were delivered by a workplace stakeholder that included the content required by an injured worker to navigate the organizational disability management process and utilized specific strategies to address the perceived attitudes and perceptions held by an injured worker regarding work re-integration. Workplace stakeholders described five specific communication strategies including relaying messages of support, optimizing the timing of communication, careful word choice, framing messages, and tailoring communication to the injured worker. Conclusion RTW communication is an active process that requires a strategic approach. Effective communication practices represent an important strategy for workplace stakeholders to address the barriers held by injured workers and foster early and sustained RTW. [ABSTRACT FROM AUTHOR]

Context The Canadian reality of dementia care may be complicated by the cultural diversity of patients and their informal caregivers. Objectives To what extent do needs differ between Canadian- and foreign-born patients and caregivers? What are their experiences with the illness in primary care case management? Methods Mixed methods, sequential explanatory design (a cross-sectional study, followed by a qualitative descriptive study), involving 15 pairs of patients and caregivers. Results Foreign-born patients had more needs compared to their Canadian-born counterparts. Foreign-born caregivers reported more stress, more problems, and increased need for services. However, the reported experiences of Canadian- vs. foreign-born individuals were similar. Conclusion The results remain hypothesis-generating. The present pilot illustrated the suitability of mixed methods to this area of study, which deserves further investigation to better serve all members of a population already vulnerable by age and disease. [ABSTRACT FROM AUTHOR]

This article explores the experiences of social workers at a non-governmental organisation (NGO) involved in disaster responses to COVID-19 in a rural and resource-challenged region of Cambodia. The views of Khmer and international social workers in the NGO were gathered through an internal auditing process utilising survey and structured conversation methods. Key themes related to the importance of prioritising the safety of staff and clients, effective communication methods, responsiveness of case management systems, public health responses and adapting to emerging needs. To ensure responsiveness to future disaster events consideration should be given in strengthening partnerships, ensuring case management systems are effective for current use but able to be adapted in new circumstances, and that preparation incorporates a focus on diversified funding streams and open communication channels between staff and management. These elements will enable social workers to continue their practice, reassured and with the flexibility required in the post-disaster context. [ABSTRACT FROM AUTHOR]

Purpose: This case study is the introspective account of the evaluation process of Functional Family Therapy (FFT) as implemented in Middlesex County in New Jersey between 2005 and 2011. The study presents challenges and issues in evaluation falling into three main categories. Methods: The case study is based on the recollections and documented experiences of the author who was responsible for all major aspects of the evaluation including designing the study, collecting the data, and handling daily evaluation activities. Results: The author differentiated among three main categories of challenges. In respect to research design, the relative merits of experimental versus nonexperimental designs and quantitative versus qualitative research methods are discussed. The second set of issues involves developing and exercising the social competence skills necessary to form working partnerships with service providers. The third set encompasses logistical barriers encountered during daily evaluation activities. Conclusions: The challenges and lessons learned from conducting the outcome evaluation of FFT are situated within scholarly debates on evaluation research, with the goal of providing further insights into the on-the-ground implementation and process of program evaluations. The experiences, recollections and processes illustrate challenges and solutions applicable to evaluations of other family-based violence prevention interventions. [ABSTRACT FROM AUTHOR]

There is worldwide recognition of the need to redesign health service delivery with a focus on strengthening primary health care and aligning health and social care through integrated models. A defining feature of integrated models is improved patient and carer experience of care. This study explored the experiences of older people and their carers enrolled in a unique model of integrated care that provides a specialist geriatric intervention in the primary care setting for older adults with complex needs in Far North Queensland. A qualitative exploratory descriptive design using semistructured interviews was used to address the study aims. Seventeen older people and nine carers took part in the study. Data were analysed inductively, guided by the principles of thematic analysis. Three themes emerged: getting by; achieving positive change; and improving and maintaining the OPEN ARCH (Older Persons ENablement And Rehabilitation for Complex Health conditions) approach. The findings indicate that enablement models of integration can be successful in activating positive change towards independence for the older person with complex needs. Understanding patients' and carers' experiences is essential to comprehensive service evaluation. [ABSTRACT FROM AUTHOR]

The recognition of disability as a social construct has aided in providing better access to the built environment for disabled people, through the implementation of accessible spaces. However, access to them is not straightforward for disabled people who do not match stereotypical representations of disability. Drawing on empirical data collected from semi structured interviews and photo elicitation exercises, conducted with people with dwarfism living in the UK, this paper shows how they are often challenged or denied access to accessible spaces, creating a hierarchy of impairments. Building on the notion of 'statuarized spaces' the paper demonstrates how access to accessible spaces is influenced by their representation, which differs from representations of dwarfism, leading to incongruous encounters. These incongruous encounters affect the spatial practices of people with dwarfism. A more varied representation of disability is required in order to provide people with dwarfism straightforward access to accessible spaces. The ideas explored in this paper are based upon research carried out with people with dwarfism living in the UK. Shows how people with dwarfism are told off or challenged by other people when they want to access to accessible spaces. The paper shows some of the ways people with dwarfism gain access to accessible spaces. The paper argues for a broader representation of disability in order for people with dwarfism to be recognised as disabled. [ABSTRACT FROM AUTHOR]

Insurance company case managers can play a critical role in the rehabilitation process of people with musculoskeletal disorders sustained following minor motor vehicle crash injury due to their interaction with multiple stakeholders and their role in approving various services. This study aimed to identify factors that case managers perceive as predictive of recovery in people with musculoskeletal disorders after minor motor vehicle crash injury. To explore the perspectives of cases managers in Australia and the United States, semi-structured interviews explored factors that case managers thought provided an early indication of likely recovery outcomes in people with musculoskeletal disorders after minor motor vehicle crash injury. A framework analysis was applied and factors were displayed within the ICF-framework. Case managers (n = 40) demonstrated a broad, detailed understanding of biopsychosocial and contextual issues influencing recovery. They emphasized the importance of the injured worker's expressed affect and motivation, style of communication, the role of lawyers, the worker's family and friends, as well as cultural and geographic influences. The overarching themes perceived as having a major influence on recovery outcomes were general health, pain processing and response, work situation, and compensation entitlement. Case managers' broad and detailed perceptions about recovery may provide additional, valuable perspectives for professionals involved in the rehabilitation process of people with musculoskeletal disorders after minor motor vehicle crash injury. Further research needs to be conducted to explore the effects of case manager involvement in the process of recovery. Insurance Case Managers identified multiple factors including affect and motivation, style of communication, the role of lawyers, family and friends, cultural and geographic variation provide opportunities for more effective treatment of people with musculoskeletal disorders related to minor motor vehicle collisions. These managers' perceptions about recovery may be informative to and provide opportunities for health professionals involved in the rehabilitation of people with musculoskeletal disorders related to minor motor vehicle collisions. While the Insurance Case Managers involved in this research did not use formalized assessment techniques, tools and assessment protocols could be developed jointly between for the needs of Insurance Case Managers and other stakeholders to tackle recovery of people with musculoskeletal disorders related to minor motor vehicle collision. [ABSTRACT FROM AUTHOR]

mHealth can be a valuable means of monitoring symptoms and supporting care for rural patients, but barriers to implementation remain. This study aimed to examine care manager perspectives on the adoption, use and impact of an mHealth system deployed within a pragmatic Collaborative Care trial for rural patients with PTSD and/or Bipolar Disorder. Sixteen care managers at 12 Federally Qualified Health Centers in 3 states participated in semi-structured interviews. Interviews were transcribed, coded, and thematically analyzed using the Unified Theory of Adoption and Use of Technology as a conceptual framework. App metadata was used to assess the frequency of a care manager reported phenomenon, clinically disengaged app use. 4 themes were identified: infrastructural limitations; redundant and incompatible clinical and mHealth workflows; cross platform and web access; and patient engagement and clinically disengaged app use. Most users had a period of consistently submitting symptom measures via the app while disengaged from care for >4 weeks. [ABSTRACT FROM AUTHOR]

Background: Chronic migraine is a primary headache disorder affecting approximately 3-7 million individuals in the United States. This condition is associated with significant individual and societal consequences, causing impaired function and high levels of health care utilization. Purpose: The aim of this quasi-experimental single cohort study was to determine if an 8-week outpatient selfmanagement program for chronic migraine would decrease migraine disability and enhance self-efficacy. Methods: This was a prospective, single cohort, pre- and postintervention pilot study. Fifteen adults aged 18-65 years who met the criteria for diagnosis of chronic migraine were enrolled in the study through convenience sampling. Participants participated in an evidence-based self-management program with multimodal formats including verbal, written, video, and online materials. Outcome measures included migraine disability (using Migraine Disability Assessment tool [MIDAS]), headache self-efficacy (using Headache Management Self-Efficacy Scale [HMSE]), acute medication use, and migraine frequency. Participants also completed a postintervention survey to assess satisfaction. Results: Findings showed a reduction in MIDAS scores, acute medication use, and frequency of migraine. Outcomes also included an increase in HMSE scores and a trend of improved health behaviors. Acute medication use decreased by more than 50%, and frequency of migraine and headache days reduced by close to 40%. [ABSTRACT FROM AUTHOR]

Continuous Ambulatory Peritoneal Dialysis (CAPD) is one of kidney replacement therapy with advantage of home therapy and much cheaper than hemodialysis. Nevertheless, CAPD patients need integrated health care by primary care health facilities to maintain CAPD effectiveness of which has never been assessed and improved. Therefore, this study aims to assess the effect of modified CAPD patient's handling process among nurses at the primary care level. This quasi-experimental study, 47 nurses in sub-district health promoting hospitals (HPHs) of Nan general hospital renal node which completed the standard protocol were assigned to an experimental group, which received the modified-continuous ambulatory peritoneal dialysis (CAPD) patient's handling process intervention. The intervention covered both a case management (CM) and a CAPD web-based program. The comparative groups were 45 nurses in sub-district health promoting hospitals of Pua Crown Prince Hospital renal node. The main outcomes were improvement in knowledge, perceived benefits and CAPD patients care performances of which assessed by t-test, and ANCOVA. There were significant higher scores of knowledge, perceived benefits and performances of nurses in the experimental group applying the "Modified CAPD patient's handling process" than those of the comparative group. Therefore, this intervention should be implemented in other primary care facilities to improve qualities of care for CAPD patients. [ABSTRACT FROM AUTHOR]

Background and Objectives: Adults experiencing homelessness with opioid use disorder (OUD) utilize buprenorphine (BUP), a first-line medication for OUD, at very low rates. Innovative and tailored approaches are needed to reduce barriers to treatment and increase utilization of BUP in this population. This study describes a pilot Mobile Community-based Access Team (M-CAT) that used mobile technology and FaceTime in addition to existing community-based case management programs to provide BUP treatment for veterans with OUD experiencing homelessness who had difficulties engaging in the regular BUP clinic.Methods: We conducted a retrospective chart review of veterans enrolled in M-CAT or the usual BUP clinic between January 2015 and December 2017 (N = 36). We abstracted demographic, medical, substance use, prescription, health care utilization, and drug use data from medical records.Results: Twelve veterans were enrolled in M-CAT and 24 were enrolled in BUP clinic. Mean retention in treatment was 19.2 months (standard deviation [SD] = 10.2) in M-CAT and 36 months (SD = 27.6) in BUP clinic. At the endpoint, 66.7% (n = 8) in M-CAT and 100% (n = 24) in BUP clinic remained on BUP.Discussion and Conclusion: M-CAT is an innovative and tailored pilot project that successfully integrated specific OUD medication treatment into existing case management programs for veterans experiencing homelessness using mobile technology and Facetime. M-CAT can potentially increase utilization of BUP for OUD among high-risk population of veterans experiencing homelessness who are otherwise not engaged in treatment.Scientific Significance: Integrating telemedicine, BUP treatment, and community-based case management to treat OUD among veterans experiencing homelessness is feasible with high treatment retention. (Am J Addict 2020;29:485-491). [ABSTRACT FROM AUTHOR]

Summary: An initial validation of the Child Welfare Provider Stigma Inventory is reported. The Child Welfare Provider Stigma Inventory assesses stigmas held by child welfare professionals toward clients on three domains: Attitudes, Behavior, and Coworker Influence. Methods: Initial validation of the Child Welfare Provider Stigma Inventory was conducted with a sample of 360 child welfare professionals in Florida. Scale conceptualization and development, content validation, and construct validation measures are discussed. Findings: Preliminary psychometrics indicated good model fit for a three factor multidimensional scale. Racial differences emerged and subgroup models were also validated. Reliabilities were moderate to strong; the global stratified α was.89. Evidence of construct validity supported hypotheses about the accuracy of underlying constructs. Conclusions: The Child Welfare Provider Stigma Inventory appears to be a reliable and valid measure of provider stigma. Applications: The Child Welfare Provider Stigma Inventory may be useful for agency climate assessment and quality improvement initiatives, as well as for in-service training and social work education. [ABSTRACT FROM AUTHOR]

Chronic diseases impact 117 million adults in the United States and account for $3.3 trillion in health care spending. This qualitative study investigated experiences with reimbursement structure for non-face-to-face (NFF) chronic care management (CCM) through diverse health system approaches in primary care settings in Southeastern Louisiana. In-depth interviews were conducted with 16 purposively selected key informants, and reflexive thematic analysis was utilized to explore findings. Variation in health system approaches for implementing and quality of NFF CCM programs were identified. Results included differences in health system motivation and methods for financial structuring and quality of third-party vendor and alternative models. [ABSTRACT FROM AUTHOR]

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Objectives: With funding from the Pregnancy Assistance Fund, the Maternal, Child, and Adolescent Health Division (MCAH) of California redesigned its existing Adolescent Family Life Program (AFLP) for expectant and parenting young women into a more intensive and structured intervention, AFLP with positive youth development (PYD). This paper presents key findings from a federally funded, rigorous implementation study of the two programs. Methods: This implementation study collected data from 13 agencies from January 2016 through December 2017, including interviews with 69 case managers and 18 supervisors; focus groups with 130 program participants; surveys of 66 case managers and 1330 young women; and observations of 42 visits with program participants. The study combined qualitative and quantitative analysis methods. Results: As designed, PYD was a much more structured and intensive program than AFLP. Case managers and supervisors saw value in the PYD model and new approach but needed more support and guidance than expected in order to deliver it with fidelity. MCAH provided additional trainings and technical assistance to address challenges. In practice, although staff noted differences in approach and content, the youth experience with the two programs was similar. Conclusions for Practice: Integrating the PYD framework into case management systems may foster youth self-sufficiency and resiliency. However, the rigid structure of the program was often challenging to implement in practice. Organizations interested in implementing prescribed case management approaches should consider allowing opportunities for flexibility in implementation and providing more detailed preservice training to prepare staff for real-world implementation. [ABSTRACT FROM AUTHOR]

Accessible Summary: Pharmacists are an important source of support for people with learning disabilities, healthcare professionals and carers.Pharmacists can support carers and healthcare professionals to manage medicines in line with stopping over‐medication of people with a learning disability, autism or both principles.Healthcare staff and carers were interviewed to see how they felt about working with a pharmacist and how this helped them to look after people with learning disabilities.Healthcare professionals and carers felt that the pharmacist was very helpful and listened to them. Background: The issues surrounding the prescribing and monitoring of medications for people with learning disabilities and behaviours deemed to be challenging, and are complex in their management for patients, healthcare professionals and carers. The aim of the study was to explore the impact of the pharmacist independent prescriber on a medication clinic for people with learning disabilities and challenging behaviours from the perspectives of healthcare professionals and carers in a UK mental health Trust setting. Materials and Methods: Qualitative methods were used to provide an understanding of the participants' interactions with the pharmacist in the context of the medication clinic. Individual, semi‐structured interviews were carried out with staff and carers, audio‐recorded and transcribed verbatim. A thematic analysis was carried out to identify themes which illuminated the participants' experiences. Recruitment took place December 2017–August 2018. Results: Nine participants took part (six staff and three full‐time carers). Eight themes were constructed from the data: five from staff and three from the carer cohort: being open to innovation and change in collaborative practice, challenging traditional norms in collaborative approaches to person‐centred care, proactive empowerment via maximisation of expertise and resources, supporting and empowering informed decision‐making, encouraging collaborative debate around medication, establishing authentic and interactive dialogue, gaining trust of the pharmacist independent prescriber's role in the management of patients and feeling empowered to challenge ambiguity and inconsistency in prescribing practice. Conclusion: The pharmacist independent prescriber is a valued asset, with high levels of interaction between all staff, carers and an integral aspect of services provided. [ABSTRACT FROM AUTHOR]

Purpose: An evaluation of a disability equality training (DET) programme, based on the social model of disability, was conducted to explore the changes in the participants' attitudes and behaviours in Ulaanbaatar, Mongolia. Methods: This study is composed of two parts. First, the participants' attitude changes during DET sessions were examined through a descriptive quantitative and qualitative analysis of questionnaires and related documents. Second, the behavioural changes at the organisational and individual levels, the impact on society, and related factors were explored by quantitative and qualitative analysis of good practice cases: 39 participants were selected through purposive sampling and semi-structured interviews were conducted. Results: It was found that most participants adopted the social model perspective within these sessions. A qualitative content analysis of the good practice cases also found that the majority of participants attempted to change their social environments after the sessions. Thematic analysis identified promotional factors, such as within-organisation dynamics and compatibility and barriers at the individual and organisational levels, which were associated with participants' behaviours after DET sessions. Conclusion: The implications of these findings are discussed in connection with the strategic implementation of DET to promote disability-inclusive development. Future studies should examine the effectiveness of a strategy by considering the factors identified in this study and by using a reliable sample in various settings where DET sessions are conducted. [ABSTRACT FROM AUTHOR]

Introduction: Employment of occupational therapists in generic roles in public mental health services (PMHSs) constrains capacity to undertake discipline‐specific activity meaning consumers may be unable to access valuable occupational therapy assessments and interventions that could promote recovery. Establishing a dedicated occupational therapy clinic has been identified as one way of improving care provided and outcomes for organisations, therapists, and consumers. To inform such developments, this paper reports evaluation of feasibility, acceptability, and sustainability of a pilot clinic established within a PMHS. Methods: An observational evaluation was used combining quantitative and qualitative data collected from service documents, clinic records, and in semi‐structured interviews with 42 stakeholders. Quantitative data were used to describe referrals and flow through the clinic. Framework analysis of qualitative data examined the process and outcomes of referrals and enabled understanding of acceptability, perceived impact and areas for improvement. Results: Substantial ground work, particularly stakeholder engagement, and redistribution of resources enabled establishment and successful operation of an assessment clinic for 12 months. Assessments were completed for 68% of the 100 accepted referrals, with the remainder in process or unable to be completed. Stakeholders agreed that the clinic enabled clinicians' timely access to specialist assessment, improving care for consumers. Occupational therapists valued the opportunity to deploy and develop discipline‐specific skills and when there was some impact on work flow of occupational therapists' 'home teams', team managers judged the investment worthwhile. Strong leadership by the discipline lead and support from team managers who enabled allocation of occupational therapists to the clinic were critical to success. Conclusion: An occupational therapy assessment clinic can be established and operate successfully within a public mental health setting. Redistribution of resources supported increased efficiency and consumer access to specialist interventions that support their recovery. [ABSTRACT FROM AUTHOR]