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OBJECTIVE: This study explored the likelihood of and identified the factors related to securing and sustaining jobs for people with psychiatric disabilities in New York State who received vocational services through an outcomes-based reimbursement program. METHODS: Quantitative and qualitative data were collected over two years to characterize placement and retention through the performance-based contracting demonstration. Seven social service agencies located statewide were contracted by the New York State Office of Mental Health to provide vocational services to people with mental health conditions through the performance-based contracting milestone structure, which established incremental steps toward the goal of sustained integrated competitive employment at which providers were reimbursed. Intake was continuous throughout the demonstration period, from December 2000 to December 2002. Key outcomes included placement in employment, time to placement, and job retention. RESULTS: Data were examined for the 171 participants who were still active in the demonstration at the end of the study period. A total of 108 participants (63 percent) were successful in securing jobs. Among those placed, 79 (73 percent) retained work at the end of the demonstration, a rate comparable to other best-practice models. Factors related to these outcomes included number of provider hours spent assisting consumers weekly, length of time to placement, consumer enrollment in the state's rehabilitation services program, and quality of the jobs developed. CONCLUSIONS: Outcomes funding was associated with successful employment for people with psychiatric disabilities. The performance-based funding structure may encourage providers to work more intensively with consumers early in the placement process, find jobs that consumers want to keep, and coordinate more effectively with the state rehabilitation agency. [ABSTRACT FROM AUTHOR]

Compartment syndrome is a condition where high pressure within a muscle compartment reduces capillary blood perfusion below the level necessary for tissue viability. A variety of injuries and medical conditions may initiate acute compartment syndrome, including fractures, contusions, burns, bleeding disorders, post-ischemic swelling, and gunshot wounds. Exertional compartment syndrome is a well-recognised clinical entity, which can have an acute or chronic presentation, and is associated most often with unaccustomed exercise. This case report discusses a 15-year-old girl who for two years felt transitory pain in the right peroneal compartment when she played sport. After many days of horseback riding, she sustained a sudden increase of the antero-lateral leg pain. The pressure of her lateral leg compartment rose to 100mmHg. Emergent fasciotomy of the lateral compartment of the right leg was performed, and showed partially necrotic peroneal muscles. The reported case is unusual because the pathology was localised to the peroneal compartment only and left the 3 other loges unaffected. Only two other reported cases of exertional compartment syndrome from prolonged horseback riding has been found in the medical literature. The particular mechanism of the peroneal compartment as a result of horseback riding in children is also discussed. [ABSTRACT FROM AUTHOR]