The long reach of juvenile and criminal legal debt: How monetary sanctions shape legal cynicism and adultification.

Previous research has established the deleterious long-term effects of juvenile legal system involvement such as increased risk of criminal legal system involvement as adults. This paper examines retrospective accounts of how that process occurs by exploring the following research question: how does one's involvement in the juvenile legal system, which includes monetary sanctions, shape peoples' views of law and legal institutions and with what consequences? Based on 19 interviews with adults who have legal debt from both juvenile and criminal legal systems, the paper focuses on four aspects of the long-reaching effects of juvenile legal involvement and juvenile monetary sanctions: legal socialization, adultification, legal cynicism, and future aspirations. In all these aspects, we show the organizational constraints that shape individuals' perspectives about the law and the impact of monetary sanctions on their lives. In doing so, the paper shows how monetary sanctions associated with juvenile cases add to the cumulative disadvantage of legal system involvement.

The contingent effect of incarceration on state health outcomes.

Introduction: This study examines how growth in the population of former prisoners affects rates of communicable diseases such as tuberculosis, syphilis, chlamydia, and HIV. Methods: We estimate state-level fixed effects count models showing how the former prisoner population affected communicable disease in U.S. states from 1987 to 2010, a period of dramatic growth in incarceration. Results: We find contingent effects, based on how specific diseases are recognized, tested, and treated in prisons. The rate of former prisoners increases diseases that are poorly addressed in the prison health care system (e.g., chlamydia), but decreases diseases that are routinely tested and treated (e.g., tuberculosis). For HIV, the relationship has shifted in response to specific treatment mandates and protocols. Data on prison healthcare spending tracks these contingencies. Discussion: Improving the health of prisoners can improve the health of the communities to which they return. We consider these results in light of the relative quality of detection and treatment available to underserved populations within and outside prisons.

Readiness for the aging population in private dental practices.

Background: As more adults reach advanced age with natural teeth, there is an increasing need for dental and dental hygiene practices to provide care for older adults and individuals living with dementia. Little is known about how well these populations are accommodated in private practice. Methods: Following approval from the Research Ethics Board at Mount Allison University, a survey was sent to the 517 practising dental hygienists in New Brunswick, Canada. They were asked to rate on 5-point scales their geriatric oral care knowledge, their willingness to receive more education on the topic, and how frequently they adjusted their care provision to meet the needs of older (age 70+) clients and those living with dementia. Results: A total of 121 dental hygienists responded (23.4% response rate). Overall, respondents were willing to learn more about geriatric care, but lacked knowledge about the oral health effects of certain medications frequently used by older adults, and about techniques for accessing the oral cavity of clients with dementia. Many accommodations recommended by geriatric specialists were not consistently carried out. Discussion: Given that older adults and adults with dementia make up an increasingly large part of the population in need of oral care, geriatric and dementia oral care needs should be emphasized in dental and dental hygiene practices and continuing education for dental hygienists. Conclusion: More research is required on the impact of integrating accommodations for older clients and clients with dementia into clinical practice, as well as how oral care is experienced by these populations.

Contexte: Un plus grand nombre d'adultes ont toujours leurs dents naturelles lorsqu'ils atteignent un âge avancé. Il est donc de plus en plus nécessaire que les cabinets dentaires et d'hygiène dentaire fournissent des soins aux personnes plus âgées et aux personnes atteintes de démence. On ignore dans quelle mesure ces populations sont accueillies dans les cabinets privés. Méthodologie: À la suite de l'approbation du comité d'éthique de la recherche de l'Université Mount Allison, un sondage a été envoyé aux 517 hygiénistes dentaires en exercice au Nouveau-Brunswick, Canada. Ils ont été invités à évaluer, sur une échelle de 5 points, leurs connaissances en matière de soins buccodentaires gériatriques, leur intérêt à recevoir davantage de formation sur le sujet et la fréquence à laquelle ils ont adapté leur prestation de soins pour répondre aux besoins des clients plus âgés (70 ans et plus) et des personnes atteintes de démence. Résultats: En tout, 121 hygiénistes dentaires ont répondu au sondage (un taux de réponse de 23,4 %). Dans l'ensemble, les répondants voulaient en savoir davantage sur les soins gériatriques, mais ne connaissaient pas les effets sur la santé buccodentaire de certains médicaments fréquemment utilisés par les personnes âgées ni les techniques utilisées pour accéder à la cavité buccale des clients atteints de démence. De nombreux accommodements recommandés par les spécialistes en gériatrie n'ont pas été systématiquement mis en œuvre. Discussion: Les cabinets dentaires et d'hygiène dentaire et la formation continue des hygiénistes dentaires doivent souligner les besoins des adultes plus âgés et des adultes atteints de démence puisque ceux-ci représentent une part de plus en plus importante de la population nécessitant des soins buccodentaires. Conclusion: Des recherches supplémentaires sont nécessaires sur les conséquences de l'intégration des accommodements pour les clients plus âgés et les clients atteints de démence dans la pratique clinique, ainsi que sur la façon dont ces populations perçoivent les soins buccodentaires.

Felon history and change in U.S. employment rates.

In recent decades, the share of U.S. adults with felony-level criminal records has risen and the growth in the employment rate has slowed. Sociological theories of labeling and stigmatization, as well as economic theories of statistical discrimination, suggest a possible causal connection between the two phenomena. Surveys of employers have shown increasing reliance on criminal background checks, for example, and audit studies reveal explicit discrimination against people with felony-level criminal records. This paper draws on novel, state-level annual measures of individuals with felony-level records to estimate pooled cross-sectional, panel models predicting changes in aggregate employment rates. Estimates from these models indicate that a 1 percentage point increase in the share of a state's adult population with a felony history is associated with 0.3 percentage point increase in non-employment (being unemployed or not in the labor force) among those aged 18 to 54. Subgroup analysis shows that effects are stronger for women and whites. These results suggest that the stigma of a felony record may play an important part in aggregate employment rates as well as in individual hiring practices.

What Is Wrong with Monetary Sanctions? Directions for Policy, Practice, and Research.

Monetary sanctions are an integral and increasingly debated feature of the American criminal legal system. Emerging research, including that featured in this volume, offers important insight into the law governing monetary sanctions, how they are levied, and how their imposition affects inequality. Monetary sanctions are assessed for a wide range of contacts with the criminal legal system ranging from felony convictions to alleged traffic violations with important variability in law and practice across states. These differences allow for the identification of features of law, policy, and practice that differentially shape access to justice and equality before the law. Common practices undermine individuals' rights and fuel inequality in the effects of unpaid monetary sanctions. These observations lead us to offer a number of specific recommendations to improve the administration of justice, mitigate some of the most harmful effects of monetary sanctions, and advance future research.

Implementation of a COVID-19 Mass Vaccination Clinic to College Students in Montana.

We describe a large-scale collaborative intervention of practice measures and COVID-19 vaccine administration to college students in the priority 1b group, which included Black or Indigenous persons and other persons of color. In February 2021, at this decentralized vaccine distribution site at Montana State University in Bozeman, we administered 806 first doses and 776 second doses by implementing an interprofessional effort with personnel from relevant university units, including facilities management, student health, communications, administration, and academic units (e.g., nursing, medicine, medical assistant program, and engineering). (Am J Public Health. Published online ahead of print September 9, 2021:1776-1779. https://doi.org/10.2105/AJPH.2021.306435).

Connecting the right to health and anti-extractivism globally / Conectando o direito à saúde e o antiextrativismo globalmente / Conectando el derecho a la salud y el anti-extractivismo a nivel mundial

ABSTRACT Natural resources are essential to health and are global commons. Recognizing the devastating damage posed by extraction to health and the environment, as well as the erosion of the sovereignty of our governments that have increasingly conceded people's health in the interest of profit and development, is important in framing our resistance. Our communities experience growing displacement, the loss of social services, of land, water and livelihood, heightened militarization, violence and repression, and increased incidence of communicable diseases and health problems resulting from exposure to toxics. All of these are linked to an extractivist project driven by global financial capital promoting an unsustainable and inequitable development model that threatens people's health and the health of the planet. Is it compatible with the right to health to finance national health systems with revenues of activities that intrinsically destroy life? The essay portrays the inconsistency of development policies that fund health/right to health with extractivism and depicts examples of resistance to extractive industries tied to the People's Health Movement (Canada,Turkey, India and Ecuador) in different types of governments. The need to strengthen the link between the right to health struggles and anti-extractive resistance is highlighted.

RESUMO Os recursos naturais são essenciais para a saúde e são bens comuns globais. Reconhecer os danos devastadores causados pelo extrativismo à saúde e ao meio ambiente, bem como a erosão da soberania de nossos governos, que cada vez mais têm subordinado a saúde das pessoas ao interesse do lucro e do desenvolvimento, é importante para enquadrar nossa resistência. Nossas comunidades sofrem deslocamentos crescentes, a perda de serviços sociais, de terra, água e meios de subsistência, militarização aumentada, violência e repressão e aumento da incidência de doenças transmissíveis e problemas de saúde resultantes da exposição a substâncias tóxicas. Tudo isso está vinculado a um projeto extrativista impulsionado pelo capital financeiro global que promove um modelo de desenvolvimento insustentável e desigual que ameaça a saúde das pessoas e a saúde do planeta. É compatível com o direito à saúde financiar sistemas nacionais de saúde com receitas de atividades que destroem intrinsecamente a vida? Este ensaio retrata a inconsistência das políticas de desenvolvimento que financiam a saúde/direito à saúde com o extrativismo e descreve exemplos de resistência às indústrias extrativas ligadas ao Movimento pela Saúde dos Povos (Canadá, Turquia, Índia e Equador) em diferentes tipos de governo. Destaca-se a necessidade de fortalecer o vínculo entre o direito à saúde e a resistência antiextrativa.

RESUMEN Los recursos naturales son bienes comunes a escala global esenciales para la salud. Reconocer la devastación que produce el extractivismo en la salud y el ambiente, así como la erosión de la soberanía de nuestros gobiernos que han cedido en favor del desarrollo y el lucro es importante para estructurar nuestras resistencias. Nuestras comunidades sufren un creciente desplazamiento, la pérdida de servicios sociales, tierras, agua, medios de subsistencia, militarización, violencia y represión. A la par vemos una mayor incidencia de enfermedades transmisibles y problemas de salud derivados de la exposición a sustancias tóxicas, todo ello vinculado a un proyecto extractivista impulsado por el capital financiero global que promueve un modelo de desarrollo insostenible e injusto, amenazando la salud de las personas y del planeta. ¿Es compatible con el derecho a la salud financiar los sistemas nacionales de salud con ingresos de actividades que destruyen la vida intrínsecamente? El ensayo reflexiona sobre la inconsistencia del modelo de desarrollo que financia el derecho a la salud con extractivismo y coloca historias de resistencia a las industrias extractivas ligadas al Movimiento para la Salud de los Pueblos (Canadá, Turquía, India, Ecuador) y en diferentes tipos de gobiernos. Destaca la necesidad de fortalecer el vínculo entre las luchas por el derecho a la salud y la resistencia contra el extractivismo.

Connecting the right to health and anti-extractivism globally / Conectando o direito à saúde e o antiextrativismo globalmente / Conectando el derecho a la salud y el anti-extractivismo a nivel mundial

ABSTRACT Natural resources are essential to health and are global commons. Recognizing the devastating damage posed by extraction to health and the environment, as well as the erosion of the sovereignty of our governments that have increasingly conceded people's health in the interest of profit and development, is important in framing our resistance. Our communities experience growing displacement, the loss of social services, of land, water and livelihood, heightened militarization, violence and repression, and increased incidence of communicable diseases and health problems resulting from exposure to toxics. All of these are linked to an extractivist project driven by global financial capital promoting an unsustainable and inequitable development model that threatens people's health and the health of the planet. Is it compatible with the right to health to finance national health systems with revenues of activities that intrinsically destroy life? The essay portrays the inconsistency of development policies that fund health/right to health with extractivism and depicts examples of resistance to extractive industries tied to the People's Health Movement (Canada,Turkey, India and Ecuador) in different types of governments. The need to strengthen the link between the right to health struggles and anti-extractive resistance is highlighted.

RESUMO Os recursos naturais são essenciais para a saúde e são bens comuns globais. Reconhecer os danos devastadores causados pelo extrativismo à saúde e ao meio ambiente, bem como a erosão da soberania de nossos governos, que cada vez mais têm subordinado a saúde das pessoas ao interesse do lucro e do desenvolvimento, é importante para enquadrar nossa resistência. Nossas comunidades sofrem deslocamentos crescentes, a perda de serviços sociais, de terra, água e meios de subsistência, militarização aumentada, violência e repressão e aumento da incidência de doenças transmissíveis e problemas de saúde resultantes da exposição a substâncias tóxicas. Tudo isso está vinculado a um projeto extrativista impulsionado pelo capital financeiro global que promove um modelo de desenvolvimento insustentável e desigual que ameaça a saúde das pessoas e a saúde do planeta. É compatível com o direito à saúde financiar sistemas nacionais de saúde com receitas de atividades que destroem intrinsecamente a vida? Este ensaio retrata a inconsistência das políticas de desenvolvimento que financiam a saúde/direito à saúde com o extrativismo e descreve exemplos de resistência às indústrias extrativas ligadas ao Movimento pela Saúde dos Povos (Canadá, Turquia, Índia e Equador) em diferentes tipos de governo. Destaca-se a necessidade de fortalecer o vínculo entre o direito à saúde e a resistência antiextrativa.

RESUMEN Los recursos naturales son bienes comunes a escala global esenciales para la salud. Reconocer la devastación que produce el extractivismo en la salud y el ambiente, así como la erosión de la soberanía de nuestros gobiernos que han cedido en favor del desarrollo y el lucro es importante para estructurar nuestras resistencias. Nuestras comunidades sufren un creciente desplazamiento, la pérdida de servicios sociales, tierras, agua, medios de subsistencia, militarización, violencia y represión. A la par vemos una mayor incidencia de enfermedades transmisibles y problemas de salud derivados de la exposición a sustancias tóxicas, todo ello vinculado a un proyecto extractivista impulsado por el capital financiero global que promueve un modelo de desarrollo insostenible e injusto, amenazando la salud de las personas y del planeta. ¿Es compatible con el derecho a la salud financiar los sistemas nacionales de salud con ingresos de actividades que destruyen la vida intrínsecamente? El ensayo reflexiona sobre la inconsistencia del modelo de desarrollo que financia el derecho a la salud con extractivismo y coloca historias de resistencia a las industrias extractivas ligadas al Movimiento para la Salud de los Pueblos (Canadá, Turquía, India, Ecuador) y en diferentes tipos de gobiernos. Destaca la necesidad de fortalecer el vínculo entre las luchas por el derecho a la salud y la resistencia contra el extractivismo.

PROBATION AND MONETARY SANCTIONS IN GEORGIA: EVIDENCE FROM A MULTI-METHOD STUDY.

Georgia leads the nation in probation supervision, which has been the subject of recent legislative reforms. Probation supervision is the primary mechanism for monitoring and collecting legal financial obligations (LFOs) from people sentenced in Georgia courts. This Article analyzes how monetary sanctions and probation supervision intersect in Georgia using quantitative data from the Department of Community Supervision as well as interviews with probationers and probation officers gathered as part of the Multi-State Study of Monetary Sanctions between 2015 and 2018. Several key findings emerge: (1) there is substantial variation between judicial districts in the amount of fines and fees ordered to felony probationers in Georgia, with fines and fees in rural areas much higher than those in urban areas; (2) probationers express fear of incarceration solely for lack of ability to pay; (3) probation officers consider collecting LFOs as a distraction from their true mission of public safety; and (4) both probationers and probation officers question the purpose, effectiveness, and fairness of monetary sanctions in Georgia. This Article concludes with a discussion of reforms to date and further options for reform based on the findings from this research.

Forensic Medical Examinations: Imagining Justice.

Depending on the type of physical contact involved during a sexual assault offense, samples collected from a suspect's body may carry greater probative value than samples collected from a victim's body. However, unlike forensic medical examinations for persons identified as victims of a sexual assault, no professional consensus exists for what constitutes a high-quality forensic medical examination standard for persons identified as suspects, or the accused. The purpose of this article is to explore underlying assumptions that may contribute to disparate practices and inequalities in the provision of forensic medical examinations for persons suspected of committing a sexual offense and persons identified as victims of a sexual offense.

"Hot Seat" Simulation Model for Conflict Resolution: A Pilot Study.

BACKGROUND: Unresolved conflicts in health care threaten both clinician morale and quality of patient care. We piloted a training model that targeted clinicians' conflict resolution skills. METHODS: Sixty clinicians from local hospitals were randomized into an intervention group (n = 30), completing a 3-hour conflict resolution training session, and a control group (n = 30) without training. The training included facilitated practice with actors, coaching, and feedback. Evaluation of 60 participants' conflict resolution skills was done in videotaped simulations with actors portraying interprofessional colleagues. Global ratings and checklist items developed for assessing clinicians' performance mirrored steps in the conflict communication model. RESULTS: The intervention group's performance exceeded the control group on global scores, 7.2 of 10 (SD = 1.6) versus 5.6 (SD = 1.5), p < .05, and checklist scores, 9.3 of 11 (SD = 2.9) versus 7.9 (SD = 1.5), p < .05. Two checklist items showed statistically significant differences: (1) subjects opened the dialogue on a neutral ground before jumping into conflict discussions (intervention: 97% and control: 73%, p < .05) and (2) subjects elicited the colleague's story before sharing their own story (intervention: 70% and control: 27%, p < .05). CONCLUSIONS: The pilot results suggest that a health care-specific approach to conflict resolution can be effectively taught through facilitated practice, coaching, and feedback.

The mobility of food retailers: How proximity to SNAP authorized food retailers changed in Atlanta during the Great Recession.

Retailer mobility, defined as the shifting geographic patterns of retail locations over time, is a significant but understudied factor shaping neighborhood food environments. Our research addresses this gap by analyzing changes in proximity to SNAP authorized chain retailers in the Atlanta urban area using yearly data from 2008 to 2013. We identify six demographically similar geographic clusters of census tracts in our study area based on race and economic variables. We use these clusters in exploratory data analysis to identify how proximity to the twenty largest retail food chains changed during this period. We then use fixed effects models to assess how changing store proximity is associated with race, income, participation in SNAP, and population density. Our results show clear differences in geographic distribution between store categories, but also notable variation within each category. Increasing SNAP enrollment predicted decreased distances to almost all small retailers but increased distances to many large retailers. Our chain-focused analysis underscores the responsiveness of small retailers to changes in neighborhood SNAP participation and the value of tracking chain expansion and contraction in markets across time. Better understanding of retailer mobility and the forces that drive it can be a productive avenue for future research.

Monetary Sanctions: Legal Financial Obligations in US Systems of Justice.

This review assesses the current state of knowledge about monetary sanctions, e.g., fines, fees, surcharges, restitution, and any other financial liability related to contact with systems of justice, which are used more widely than prison, jail, probation, or parole in the United States. The review describes the most important consequences of the punishment of monetary sanctions in the United States, which include a significant capacity for exacerbating economic inequality by race, prolonged contact and involvement with the criminal justice system, driver's license suspension, voting restrictions, damaged credit, and incarceration. Given the lack of consistent laws and policies that govern monetary sanctions, jurisdictions vary greatly in their imposition, enforcement, and collection practices of fines, fees, court costs, and restitution. A review of federally collected data on monetary sanctions reveals that a lack of consistent and exhaustive measures of monetary sanctions presents a unique problem for tracking both the prevalence and amount of legal financial obligations (LFOs) over time. We conclude with promising directions for future research and policy on monetary sanctions.

The Cost of Being Cool: How Adolescent Pseudomature Behavior Maps onto Adult Adjustment.

During adolescence, one's status among peers is a major concern. Such status is often largely a function of popularity and establishing oneself as "cool." While there are conventional avenues to achieving status among adolescents, engaging in adult-like, or pseudomature, behaviors such as substance use or sexual activity is a frequent occurrence. Although past research has examined the consequences of adolescent delinquency, what remains unclear is the long-term fate of adolescents who are both popular and antisocial. Using data from a sample of African American males (N = 339) we employ latent class analysis to examine the adult consequences of achieving popularity during adolescence by engaging in pseudomature behavior. Our results identified four classes of adolescents: the conventionals, the pseudomatures, the delinquents, and the detached. The conventionals were low on popularity, pseudomature behavior, and affiliation with deviant peers but high on academic commitment. The pseudomatures were high on popularity, adult-like behavior, and academic commitment but low on affiliation with delinquent peers. The delinquents were low on popularity and school achievement but high on pseudomature behavior and affiliations with delinquent peers. Finally, the detached were low on school commitment, popularity and pseudomature behavior but they report high involvement with a delinquent peer group. By early adulthood, the costs of adolescent adult-like behavior were evident. Early popularity and academic commitment did not portend later social competence or college completion for the pseudomatures. Instead, they frequently experienced an early transition to parenthood, a likely consequence of precocious sexual activity. These findings suggest that interventions should not focus only on the most delinquent adolescents but also need to attend to the pseudomature students who are brimming with promise but are flirting with behaviors that may subvert realization of this potential.

Self-Assessment Scores Improve After Simulation-Based Palliative Care Communication Skill Workshops.

BACKGROUND: We conducted a randomized trial of a simulation-based multisession workshop to improve palliative care communication skills (Codetalk). Standardized patient assessments demonstrated improved communication skills for trainees receiving the intervention; however, patient and family assessments failed to demonstrate improvement. This article reports findings from trainees' self-assessments. AIM: To examine whether Codetalk resulted in improved self-assessed communication competence by trainees. DESIGN: Trainees were recruited from the University of Washington and the Medical University of South Carolina. Internal medicine residents, medicine subspecialty fellows, nurse practitioner students, or community-based advanced practice nurses were randomized to Codetalk, a simulation-based workshop, or usual education. The outcome measure was self-assessed competence discussing palliative care needs with patients and was assessed at the start and end of the academic year. We used robust linear regression models to predict self-assessed competency, both as a latent construct and as individual indicators, including randomization status and baseline self-assessed competency. RESULTS: We randomized 472 trainees to the intervention (n = 232) or usual education (n = 240). The intervention was associated with an improvement in trainee's overall self-assessment of competence in communication skills ( P < .001). The intervention was also associated with an improvement in trainee self-assessments of 3 of the 4 skill-specific indicators-expressing empathy, discussing spiritual issues, and eliciting goals of care. CONCLUSION: Simulation-based communication training was associated with improved self-assessed competency in overall and specific communication skills in this randomized trial. Further research is needed to fully understand the importance and limitations of self-assessed competence in relation to other outcomes of improved communication skill.

The Growth, Scope, and Spatial Distribution of People With Felony Records in the United States, 1948-2010.

The steep rise in U.S. criminal punishment in recent decades has spurred scholarship on the collateral consequences of imprisonment for individuals, families, and communities. Several excellent studies have estimated the number of people who have been incarcerated and the collateral consequences they face, but far less is known about the size and scope of the total U.S. population with felony convictions beyond prison walls, including those who serve their sentences on probation or in jail. This article develops state-level estimates based on demographic life tables and extends previous national estimates of the number of people with felony convictions to 2010. We estimate that 3 % of the total U.S. adult population and 15 % of the African American adult male population has ever been to prison; people with felony convictions account for 8 % of all adults and 33 % of the African American adult male population. We discuss the far-reaching consequences of the spatial concentration and immense growth of these groups since 1980.

Implementing an error disclosure coaching model: A multicenter case study.

National guidelines call for health care organizations to provide around-the-clock coaching for medical error disclosure. However, frontline clinicians may not always seek risk managers for coaching. As part of a demonstration project designed to improve patient safety and reduce malpractice liability, we trained multidisciplinary disclosure coaches at 8 health care organizations in Washington State. The training was highly rated by participants, although not all emerged confident in their coaching skill. This multisite intervention can serve as a model for other organizations looking to enhance existing disclosure capabilities. Success likely requires cultural change and repeated practice opportunities for coaches.

Interprofessional Error Disclosure Training for Medical, Nursing, Pharmacy, Dental, and Physician Assistant Students.

INTRODUCTION: Errors that harm patients often have many contributing factors and ideally should be disclosed by a team rather than an individual provider. However, most health professions students learn about errors and error disclosure in a single-profession class. METHODS: We developed a 2-hour small-group session in which our students practice discussing and disclosing a medical error that involves several professions, following a communication map. As they practice, students gain an understanding of the roles, skills, and perspectives of the other professions represented in the group. RESULTS: Over the last 5 years, student evaluations have been very positive. In 2016, our students strongly agreed that "The small group skills practice was a useful and interesting learning opportunity," "Learning with other professional students was valuable," and "Thinking about error disclosure from a team perspective was helpful." Student comments consistently indicated that they learned both about disclosing medical errors as well as other professionals' roles and perspectives. DISCUSSION: This activity has met both of our major goals. The first was to bring health professions students together to learn with, from, and about each other. The second was to practice a critical and challenging communication skill. This activity has been successfully implemented at other institutions, and can be adapted to fit other groups of students.

A Quality Improvement Project to Identify Patients With Advanced Heart Failure for Potential Palliative Care Referral in Telemetry and Cardiac Intensive Care Units.

Background: Although national guidelines recommend timely initiation of palliative care for hospitalized patients with advanced heart failure (AHF), providers may not recognize which patients who have heart failure are most in need of consultation. Measures: A tool was developed and pilot-tested to screen patients admitted to a cardiology inpatient service with a left ventricular ejection fraction (LVEF) of 50% or less for potential triggers signifying palliative care needs in the telemetry or cardiac intensive care unit (CICU). Intervention: The tool was completed during cardiology rounds. Outcomes: Of the 21 patients evaluated, the median LVEF was lower in the telemetry group (22%) than in the CICU group (28%). Trigger patients in the telemetry unit were less adherent to medical management (χ2 = 6.034, p = .014) and had greater psychosocial and spiritual needs (χ2 = 3.956, p = .047) than those in the CICU. Conclusion: We describe a feasible palliative care screening tool for patients with AHF hospitalized in a telemetry unit or CICU that may identify opportunities for early palliative care referrals. Additional study is needed to determine whether this tool can be used to improve patient care or patient outcomes.