Evaluation of care delivery by a novel multidisciplinary bone health clinic for patients at risk of glucocorticoid-induced osteoporosis.

Glucocorticoid-induced osteoporosis (GIOP) is a common condition associated with increased risk for fracture. Many patients receive suboptimal care. We created a novel GIOP clinic model which successfully fills a gap in osteoporosis care by providing multidisciplinary intervention in key components of GIOP preventive care to an underserved patient population. INTRODUCTION: This study characterizes the patient population referred to our novel glucocorticoid-induced osteoporosis (GIOP) clinic and evaluates how well the clinic performed in addressing key components of GIOP preventive care. METHODS: This population-based prospective cohort study derives data from patients reviewed at the University of Alberta Multidisciplinary Bone Health Clinic from January 2017 to September 2019. To create our clinic model, key components of GIOP preventive care were summarized based on current guidelines, and clear responsibilities were delegated to each multidisciplinary team member. A REDCap database was constructed, and each patient's multidisciplinary assessment was entered at each visit. Demographic and treatment data was extracted from our database. RESULTS: The clinic was able to achieve optimal GIOP preventive care in 60.1% of patients and in 78.7% of patients when excluding wait time. Of the 245 GIOP patients assessed, over half were females (56.7%) and the mean age was 56.7 years (range 16-95 years). Referrals were primarily made by specialists. Low-trauma fractures were reported in 24.9% of patients and 95.5% of patients had a baseline dual-energy X-ray absorptiometry (DXA). The mean current daily prednisone-equivalent dose was 14.1 mg. All patients received a recommendation for pharmacotherapy (100%) and the majority received counseling on vitamin D (98.8%), calcium (97.8%), smoking cessation (98.8%), alcohol reduction (98.4%), falls prevention (88.6%), and exercise (85.3%). CONCLUSION: Our novel GIOP clinic model successfully fills a gap in osteoporosis care by providing multidisciplinary intervention in key components of GIOP preventive care to an underserved patient population. Further studies are required to assess the real-world long-term outcomes of our model.

Immigration detention and faith-based organizations.

Immigration detention is a hot contemporary issue in the United States, with over 33,000 individuals held in detention facilities daily and reports of poor conditions and human rights abuses. Building on a growing body of theory exploring the role of faith-based organizations (FBOs) in social services provision, and seeking to address a gap in the literature concerning services provided to immigrants in detention, this qualitative study explored the responses of FBOs to immigration detainees. Twenty in-depth interviews with volunteers and staff members of FBOs as well as field notes from participant observation were analyzed using thematic coding techniques. Findings suggest that FBOs are active leaders in this area of social work practice and provide significant resources to isolated and vulnerable detained immigrants in a variety of ways. Simultaneously, they face challenges surrounding access and constricted activity. The study indicates that considerable scope exists for expanding and enhancing faith-based and other social work engagement in this crucial field.

Depression in older adults: a meta-synthesis.

Depression in older adults is often overlooked and dismissed as a part of aging. A body of knowledge-both quantitative and qualitative-has developed on the topic of depression in older adults. Meta-analyses and systematic reviews have been used to synthesize the quantitative findings of studies, and our research seeks to synthesize the qualitative studies that have been conducted on elders' experience with depression. Thirteen studies met inclusion criteria, and 4 major themes were extracted: experiences, causes, recovery, and barriers to treatment. These themes are detailed and their implications for practice are explored.

Translating evidence-based practices into policy: a case study in Texas.

Screening and brief intervention (SBI) in health care settings is an evidence-based practice for substance misuse. The Uniform Accident and Sickness Policy Provision Law (UPPL) discourages providers from carrying out SBI by allowing insurers in 26 states to refuse coverage for injuries resulting from intoxication. This project used a qualitative case study methodology to understand how policy-advocacy communication may have impacted the success of UPPL repeal efforts in Texas. Results showed bill progress could have been impeded due to less-effective communication from advocates. These findings suggest the quality of communication may influence the success of evidence-based policy-advocacy for UPPL repeal.

Back to basics: essential qualities of services for survivors of intimate partner violence.

Survivor voice is essential to effectively implement survivor-focused IPV (intimate partner violence) services. In this focus group study, domestic violence survivors (n = 30) shared detailed perspectives as service seekers and recipients, whereas national hotline advocates (n = 24) explored relationships between service providers and survivors based on their interactions with both. Four thematic categories related to enhancing IPV services emerged: providing empathy, supporting empowerment, individualizing care, and maintaining ethical boundaries. Advocates identified additional factors that interfered with quality services, including the following: inadequate organizational resources, staff burnout, lack of training, and poor integration with other community resources. Respectful, empowering relationships are the centerpiece for quality IPV services.

Sexual assault perpetrators' alcohol and drug use: the likelihood of concurrent violence and post-sexual assault outcomes for women victims.

Addressing sexual assault requires policy and practice responses that are well-informed and empirically-grounded. This study examines the impact of perpetrators' drug and alcohol use during and after sexual assault. A representative sample of women, who responded to a random digit dialing survey, and reported that they were sexually assaulted at some time in their lives were utilized. The survey questions were drawn largely from The National Violence Against Women (NVAW) Survey (Tjaden 1996), and a series of binary logistic regressions was conducted to determine the impact of perpetrators' alcohol and drug use on violence before and after the assault. Findings indicate that perpetrators' alcohol or other drug use at the time of the assault resulted in a greater likelihood of concurrent violence, including hitting, slapping, kicking, use of a weapon, threats to harm or kill, and physical injury during the assault, and as a result, assault victims experienced more time lost from work, school, home duties, and recreation. Both these impacts occurred regardless of the relationship of the perpetrator to the victim, location of the sexual assault, or the victim's ethnicity. This information assists advocates and policy makers in prevention efforts where sexual violence is more likely to emerge.

Why don't they follow through? Intimate partner survivors' challenges in accessing health and social services.

Intimate partner violence (IPV) screening and referral are routinely practiced by various healthcare providers. Although facilitators and barriers to IPV disclosure have been previously explored, healthcare providers' role in linking patients to longer-term IPV-related resources has received only superficial attention. This focus group study explored IPV survivors' service seeking experiences, using the complementary perspectives of advocates from a national domestic violence hotline (n = 24) and survivors from a domestic violence program (n = 30). Both advocates and survivors identified key service needs and access barriers. Advocates also shared successful strategies for "coaching" survivors that increased the likelihood of receiving services.

Strengths and secondary trauma in family violence work.

The strengths perspective has been a unique contribution by the field of social work to the understanding of the helper-client relationship. This article explores the utility of the strengths perspective as a conceptual framework for research in a qualitative study of secondary trauma with counselors of battered women. An emphasis on strengths allowed the researcher to identify strategies and resources that prevented symptoms of secondary trauma in the majority of counselors. These strengths include a sense of competence about their coping, maintaining an objective motivation for their work, resolving their own personal traumas, drawing on early positive role models of coping, and having buffering personal beliefs. Implications for social work practice, education, and research are discussed.