An Implementation Evaluation of the Comprehensive Addiction Recovery Act (CARA) Policy in New Mexico.

PURPOSE: The purpose of this field report is to describe an evaluation of the fidelity with which the comprehensive addiction and recovery act (CARA) policy has been implemented in New Mexico. DESCRIPTION: The CARA program in New Mexico focuses on providing nonpunitive supportive care for pregnant people affected by substance use and on coordinating services for parents, caregivers, and family members of newborns affected by substance exposure. The evaluation used information from program reports, a family follow-up survey, the plan of safe care database, and a data linkage between CARA participant records with Medicaid claims data. RESULTS: Follow-up survey data substantiated the program reports. Both sources showed that families were not engaged consistently in developing or receiving information about plans of safe care. The survey answers also indicated that the time-period immediately after the delivery of a baby is not the best time to communicate the contents of the plan of safe care to families. Additionally, the survey found that respondents believed that medical staff judged them for using substances during pregnancy. The Medicaid data linkage showed that 40.3% of families of infants exposed to substances in-utero did not receive a plan of safe care. Program reports revealed that limited resources existed for implementing CARA. CONCLUSION: Program funding, limited system capacity, lack of systematic screening for prenatal substance use, regional differences in access to care, and provider biases toward pregnant people using substances affected health-care workers' ability to identify at-risk families and develop plans of safe care. To support CARA implementation, healthcare systems must implement universal prenatal substance use screening, increase the level of anti-bias training pertaining to substance use, increase hospital supports, and improve data management systems.

What is already known on this subject? Stigma towards pregnant people for maternal substance use reduces access to prenatal care due to fear of involvement from child protective services. Punitive approaches to perinatal substance use result in lower healthcare utilization and opportunities to treat substance use disorder. What this study adds? This field report evaluates the implementation of a non-punitive state level policy meant to increase services for pregnant people using substances and reduce reports to child protective services for abuse neglect due to infants exposed to substances prenatally.

Signs and Behaviors to Identify Impairment and Drug Diversion.

Substance use disorder in health care professionals may adversely affect patient care. To reduce the risks of harm, raising awareness among all staff for early identification and response is a primary goal. Knowledgeable co-workers play an essential role to identify signs and behaviors indicating at-risk substance use by observed impairment or suspicion of drug diversion and report to a supervisor. Response protocol for a timely, confidential, safe and non-punitive intervention can help connect the clinician to needed assessment and treatment help and potentially save a life and provide a hopeful outcome to retain their license and career.

Is It Time for "Time-In"?: A Pilot Test of the Child-Rearing Technique.

Time-out, a mainstay of non-punitive discipline for over 60 years, has been criticized for isolating and distancing children from others. An alternative technique, one promoted by advocates of positive parenting practices, is labeled "time-in". This procedure is intended to help the child connect to the parent, communicate their feelings, and learn how to self-regulate. Although the technique has been advocated in the positive parenting literature since at least the 1990s, there are few empirical studies evaluating it. This pilot mixed-models study was designed as an initial test to determine whether mothers, following a brief training, would use the procedure over a two-week period, and how they would view it. Based on the daily reports as well as post-intervention interview of a small sample of mothers, the technique was evaluated as easy to use and effective. This study provides initial information about mothers' use of the technique and sets the stage for a comprehensive set of studies to rigorously test and evaluate the technique.

Patient Safety Culture in Primary Healthcare Centers in the Eastern Province of Saudi Arabia.

PURPOSE: This study aimed to explore health-care workers' perceptions of patient safety culture (PSC) at primary health-care centers (PHCs) in the Eastern Province of Saudi Arabia and the factors that influence them. An additional aim was to identify the challenges of adopting PSCs in the PHCs of this region. METHODS: This is a cross-sectional study that adopted a PSC questionnaire from the Agency for Healthcare Research and Quality (AHRQ). The questionnaire was administered online and onsite targeted health-care workers at private, governmental, and quasi-governmental PHCs in the Eastern Province of Saudi Arabia, with 310 participants completing the survey. RESULTS: The overall positive response rate of participants to the survey areas was 43.5% which is lower than the average for the AHRQ data in general. Teamwork scored the highest positive response (68.8%) while Number of Events and non-punitive Response to Error scored the lowest at 10.6% and 30.7%, respectively. In addition, ANOVA and t-tests were used to determine the bivariate associations for the parametric variables. The study reveals statistically significant differences between all demographic variables and overall PSC score, except by age. CONCLUSION: The findings highlight a number of areas for improvement, particularly in relation to event reporting, non-punitive responses, and openness in communication. Consequently, establishing a safety culture in health-care organizations necessitates the elimination of three crucial elements regarding errors: blame, fear, and silence. Error reporting should not just be considered a means of learning from mistakes; it should also be considered the first step towards preventing injury and improving patient safety.

Patient Safety Culture in a Teaching Hospital in Eastern Province of Saudi Arabia: Assessment and Opportunities for Improvement.

PURPOSE: The objective of the present study is to explore the perceptions of patient safety culture (PSC) among King Fahd University Hospital's (KFUH) employees and to develop recommendations to overcome the factors that impede the integration of PSC in the study setting. METHODS: This is a cross-sectional study that assessed the level of PSC at KFUH. This study used the Hospital Survey on Patient Safety Culture tool from all KFUH healthcare workers (n=900) in 2018. FINDINGS: The response rate of the study was 67%. Findings show that KFUH excelled in three PSC composites: continuous organizational learning, feedback and communication about error, and frequency of events reported. In contrast, staffing, teamwork within units, and non-punitive response to error yielded low composite scores. ORIGINALITY/VALUE: The strength of the present study was the use of a valid questionnaire that has been used widely in the literature with a large sample size, which yielded valid results. It is, to our knowledge, the first research study that analyzes health workers' perceptions on patient safety culture in a teaching hospital in Eastern Province in KSA and compares it with Agency for Healthcare Research and Quality (AHRQ) and Saudi Hospital Survey on Patient Safety Culture (HSPSC). Results from the study highlight the need to employ an adequate number of workers, implement continuous patient safety training programs, and adopt safety programs and policies.

ACR RADPEER Committee White Paper with 2016 Updates: Revised Scoring System, New Classifications, Self-Review, and Subspecialized Reports.

The ACR's RADPEER program is currently the leading method for peer review in the United States. To date, more than 18,000 radiologists and more than 1,100 groups participate in the program. The ABR accepted RADPEER as a practice quality improvement in 2009, which can be applied toward maintenance of certification; there are currently over 2,200 practice quality improvement participants. There have been ongoing deliberations regarding the utility of RADPEER, its goals, and its scoring system since the preceding 2009 white paper. This white paper reviews the history and evolution of RADPEER and eRADPEER, the 2016 ACR Peer Review Committee's discussions, the updated recommended scoring system and lexicon for RADPEER, and updates to eRADPEER including the study type, age, and discrepancy classifications. The central goal of RADPEER to aid in nonpunitive peer learning is discussed.

An Alternative to Residential Neighborhoods: An Exploratory Study of how Activity Spaces and Perception of Neighborhood Social Processes relate to Maladaptive Parenting.

BACKGROUND: The environments where parents spend time, such as at work, at their child's school, or with friends and family, may exert a greater influence on their parenting behaviors than the residential neighborhoods where they live. These environments, termed activity spaces, provide individualized information about the where parents go, offering a more detailed understanding of the environmental risks and resources to which parents are exposed. OBJECTIVE: This study conducts a preliminary examination of how neighborhood context, social processes, and individual activity spaces are related to a variety of parenting practices. METHODS: Data were collected from 42 parents via door-to-door surveys in one neighborhood area. Survey participants provided information about punitive and non-punitive parenting practices, the locations where they conducted daily living activities, social supports, and neighborhood social processes. OLS regression procedures were used to examine covariates related to the size of parent activity spaces. Negative binomial models assessed how activity spaces were related to four punitive and five non-punitive parenting practices. RESULTS: With regards to size of parents' activity spaces, male caregivers and those with a local (within neighborhood) primary support member had larger activity spaces. Size of a parent's activity space is negatively related to use of punitive parenting, but generally not related to non-punitive parenting behaviors. CONCLUSIONS: These findings suggest social workers should assess where parents spend their time and get socially isolated parents involved in activities that could result in less use of punitive parenting.