Feasibility of an intensive outpatient Perception-Action Approach intervention for children with cerebral palsy: a pilot study.

PURPOSE: The purpose of this pilot study was (1) to evaluate feasibility of attendance and parent satisfaction with an intensive outpatient physical and occupational therapy program for young children with spastic cerebral palsy (CP) and (2) to examine changes in motor function. Methods: Sixteen children with CP, age range 18-36 months (mean 24.3 ± 6.3 months), received physical and occupational therapy sessions (30 minutes each) 5 days per week for 12 weeks. Attendance rates and parent satisfaction were assessed. Change in motor function using a one-group pre-post design was evaluated using the Gross Motor Function Measure-66 (GMFM-66), Quality of Upper Extremity Skills Test, and Pediatric Evaluation of Disability Inventory. GMFM-66 outcomes were also compared with expected outcomes using previously published normative developmental trajectories of children receiving standard therapies. Results: An average of 82% of scheduled outpatient physical and occupational therapies for 16 children were completed and the 11 parents who completed the Hills and Kitchen's Physiotherapy Outpatient Satisfaction Questionnaire were satisfied with the therapies and with their child's progress. Participants showed notable, statistically significant improvement across all activity-related measures. Conclusion: An intensive protocol of outpatient therapies utilizing Perception-Action Approach was feasible for most families of young children with spastic CP to attend at the outpatient clinic location. As this was not an experimental study, no reliable conclusions related to efficacy can be made, but the promising results suggest that further research into the effectiveness of intensive protocols is worthwhile.

Kind discipline: Developing a conceptual model of a promising school discipline approach.

This formative evaluation develops a novel conceptual model for a discipline approach fostering intrinsic motivation and positive relationships in schools. We used concept mapping to elicit and integrate perspectives on kind discipline from teachers, administrators, and other school staff. Three core themes describing kind discipline emerged from 11 identified clusters: (1) proactively developing a positive school climate, (2) responding to conflict with empathy, accountability, and skill, and (3) supporting staff skills in understanding and sharing expectations. We mapped the identified components of kind discipline onto a social ecological model and found that kind discipline encompasses all levels of that model including the individual, relational, environmental/structural, and even community levels. This contrasts with the dominant individual-behavioral discipline approaches that focus on fewer levels and may not lead to sustained student and staff motivation. The findings illustrate the importance of setting and communicating clear expectations and the need for them to be collaboratively developed. Products of the analysis and synthesis reported here are operationalized materials for teachers grounded in a "be kind" culture code for classrooms.

Studying the teaching of kindness: A conceptual model for evaluating kindness education programs in schools.

Recent research suggests that school-based kindness education programs may benefit the learning and social-emotional development of youth and may improve school climate and school safety outcomes. However, how and to what extent kindness education programming influences positive outcomes in schools is poorly understood, and such programs are difficult to evaluate in the absence of a conceptual model for studying their effectiveness. In partnership with Kind Campus, a widely adopted school-based kindness education program that uses a bottom-up program framework, a methodology called concept mapping was used to develop a conceptual model for evaluating school-based kindness education programs from the input of 123 middle school students and approximately 150 educators, school professionals, and academic scholars. From the basis of this model, recommendations for processes and outcomes that would be useful to assess in evaluations of kindness education programs are made, and areas where additional instrument development may be necessary are highlighted. The utility of the concept mapping method as an initial step in evaluating other grassroots or non-traditional educational programming is also discussed.

Health insurance status, medical debt, and their impact on access to care in Arizona.

OBJECTIVES: We examined the impact of health insurance status on medical debt among Arizona residents and the impact of both of these factors on access to care. METHODS: We estimated logistic regression models for medical debt (problems paying and currently paying medical bills) and access to care (medical care and medications delayed or missed because of cost or lack of insurance). RESULTS: Insured status did not predict medical debt after control for health status, income, age, and household characteristics. Insured status (adjusted odds ratio [AOR] = 0.32), problems paying medical bills (AOR = 4.96), and currently paying off medical bills (AOR = 3.04) were all independent predictors of delayed medical care, but only problems paying (AOR = 6.16) and currently paying (AOR = 3.68) medical bills predicted delayed medications. Inconsistent coverage, however, was a strong predictor of problems paying bills, and both of these factors led to delays in medical care and medications. CONCLUSIONS: At least in Arizona, health insurance does not protect individuals from medical debt, and medical debt and lack of insurance coverage both predict reduced access to care. These results may represent a troubling message for US health care in general.

Hospital admissions for acute myocardial infarction, angina, stroke, and asthma after implementation of Arizona's comprehensive statewide smoking ban.

OBJECTIVES: We examined the impact of Arizona's May 2007 comprehensive statewide smoking ban on hospital admissions for diagnoses for which there is evidence of a causal relationship with secondhand smoke (SHS) exposure (acute myocardial infarction [AMI], angina, stroke, and asthma). METHODS: We compared monthly hospital admissions from January 2004 through May 2008 for these primary diagnoses and 4 diagnoses not associated with SHS (appendicitis, kidney stones, acute cholecystitis, and ulcers) for Arizona counties with preexisting county or municipal smoking bans and counties with no previous bans. We attributed reductions in admissions to the statewide ban if they occurred only in diagnoses associated with SHS and if they were larger in counties with no previous bans. We analyzed the data with Poisson regressions, controlling for seasonality and admissions trends. We also estimated cost savings. RESULTS: Statistically significant reductions in hospital admissions were seen for AMI, angina, stroke, and asthma in counties with no previous bans over what was seen in counties with previous bans. No ban variable coefficients were statistically significant for diagnoses not associated with SHS. CONCLUSIONS: Arizona's statewide smoking ban decreased hospital admissions for AMI, stroke, asthma, and angina.

Mediator assessment, documentation, and disposition of child custody cases involving intimate partner abuse: a naturalistic evaluation of one county's practices.

The contentious and costly nature of the adversarial process for resolving child custody disputes has prompted scholars, practitioners, and policy makers to advocate for the development and implementation of less divisive forms of dispute resolution, notably, mediation. Mediation has been championed for its potential to resolve disputes with less acrimony among disputants, reduced economic costs, increased satisfaction with outcomes, and fewer adverse consequences for family members. Despite the increasing popularity, arguments have cautioned against the use of mandated mediation when intimate partner abuse (IPA) is alleged. This research documents a mediation screening process and models mediators' decision-making process as instantiated, naturally, in one jurisdiction.

Are cost-inclusive evaluations worth the effort?

Relative costs are as important as relative effectiveness when choosing between program alternatives or among a set of programs competing for scarce funds. Nevertheless, the number of cost-inclusive evaluations remains comparatively small. This article presents the results of three first-time cost-inclusive evaluations each performed by an experienced evaluator. Each evaluator performed a different type of cost-inclusive evaluation using different tobacco control programs as examples: "standard" cost-effectiveness analysis, threshold or break-even analysis, and a simulation model. Results are presented in terms of the challenges faced, and informational and insight benefits gained, as well as in terms of program cost-effectiveness. All three evaluators agreed that the benefits from performing cost-inclusive evaluations are well worth time and effort involved. They also found that this type of evaluation provides abundant information that can be used to improve program effectiveness and cost-effectiveness.

Unpacking cultural factors in adaptation to type 2 diabetes mellitus.

BACKGROUND: Race and ethnicity are used as predictors of outcome in health services research. Often, however, race and ethnicity serve merely as proxies for the resources, values, beliefs, and behaviors (ie, ecology and culture) that are assumed to correlate with them. "Unpacking" proxy variables-directly measuring the variables believed to underlie them-would provide a more reliable and more interpretable way of looking at group differences. OBJECTIVE: To assess the use of a measure of ecocultural domains that is correlated with ethnicity in accounting for variance in adherence, quality of life, clinical outcomes, and service utilization. DESIGN: A cross-sectional observational study. PARTICIPANTS: Twenty-six Hispanic and 29 non-Hispanic white VA primary care patients with type 2 diabetes mellitus. MEASURES: The independent variables were patient ethnicity and a summed score of ecocultural domains representing patient adaptation to illness. The outcomes were adherence to treatment, health-related quality of life, clinical indicators of disease management, and utilization of urgent health care services. RESULTS: Patient adaptation was correlated with ethnicity and accounted for more variance in all outcomes than did ethnicity. The unique variance accounted for by adaptation was small to moderate, whereas that accounted for by ethnicity was negligible. CONCLUSIONS: It is possible to identify and measure ecocultural domains that better account for variation in important health services outcomes for patients with type 2 diabetes than does ethnicity. Going beyond the study of ethnic differences alone and measuring the correlated factors that play a role in disease management can advance understanding of the phenomena involved in this variation and provide better direction for service design and delivery.