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PubMed2004

Mandated collaboration: the case of the forensic MOU.

The management and support of forensic clients is an area of interest to both clinicians and policy makers. Collaboration between hospital and community service providers is required and in some instances, mandated. This article reviews some of the literature about collaboration and examines selected experiences in the mental health field using a case study method. The case study examines the process of mandated collaboration in the development of the forensic MOU (memorandum of understanding), which involved CMHA Metro Toronto, and three general hospital ACT (assertive community treatment) teams and the Law and Mental Health Program at the Centre for Addiction Mental Health. The article offers observations on the extent to which collaboration is an emergent process that is responsive to its particular environment and explores power dynamics and how trust and flexibility affect outcomes in a positive or negative sense.

Community Mental Health Services↗

PubMed2004

Examining the presence of computer-assisted instruction in physical therapy education.

The purpose of this study was to compare computer-assisted instruction (CAI) use in physical therapist (PT) and physical therapist assistant (PTA) education programs. Secondary purposes included examining faculty attitudes toward CAI, selection criteria, and evaluation criteria. Questionnaires were mailed to 389 PT and PTA programs. The total return rate was 52% (N = 201). Frequencies, percentages, and modes of responses were calculated for each questionnaire item. Eight percent of PT and 35% of PTA programs indicated that all faculty are using CAI, whereas 3% of PT and 6% of PTA reported that no faculty are using CAI. PT program respondents indicated using nine different types of CAI, whereas PTA programs indicated using eight different types. Fifty-seven percent of PT and 33% of PTA programs provide formal computer instruction. Forty-six percent of PT and 47% of PTA programs have a computer prerequisite. Nine percent of PT and 0% of PTA programs have mandatory computer ownership or lease policies. Positive aspects reported included improved knowledge of technology and independence with information gathering. Negative aspects reported included cost and time. Respondents were unsure whether different students benefit more from CAI (high or low aptitude, learning style) Results indicated that criteria for selecting CAI material are based on cost, ease of use, and compatibility with current systems rather than instructional design, and evaluation procedures included student outcomes and course evaluations. Contextual differences between PT and PTA probably account for differences in types and uses of CAI for PT and PTA programs. Instructor feedback is important when using CAI to teach psychomotor skills. More research is needed to determine if one type of student benefits more than others. Programs should consider the instructional design of CAI materials, in addition to practical aspects such as cost, and ease of use. We need to be aware of the instructional goals, content, and learners when selecting, designing, and using CAI.

Computer-Assisted Instruction↗

PubMed2006

Residents' and program directors' attitudes toward research during anesthesiology training: a Canadian perspective.

We assessed the attitudes of residents and program directors (PD) toward research training in Canadian anesthesiology residency programs. Questionnaires were sent to all 476 anesthesiology residents in Canada and a modified questionnaire was sent to the PD of each of the 16 anesthesiology programs between November 2003 and April 2004. There was a 60% response rate to the resident questionnaire and 95% from the PDs. Eighty-one percent of programs have mandatory research activity, although only 41% of residents think research should be mandatory. A majority of residents were recently involved in a research project. There was a discrepancy between PDs' and residents' views about the availability of some resources to facilitate research. Residents regard the time needed to learn clinical anesthesia, schedule conflicts, inadequate faculty support, and a lack of protected research time as the top barriers to undertaking a research project. PDs do not consider schedule conflicts or a lack of time as important barriers for resident research. Seventy-five percent of residents would prefer to do another academic activity, such as learning transesophageal echocardiography or taking postgraduate programs in education, rather than completing a research project during their residency.

Anesthesiology↗

PubMed1993

Economic analysis of a mastitis monitoring and control program in four dairy herds.

Mastitis monitoring and control programs were instituted in 4 Illinois dairy herds for 12 months. Two herds had high mean monthly bulk tank somatic cell counts (> 490,000 cells/ml) and 2 had low mean monthly bulk tank somatic cell counts (< 260,000 cells/ml) at the start of the study. The mastitis monitoring and control programs included mandatory mastitis control measures, as well as individualized control measures that were based on results of bacterial cultures of milk, bulk tank milk analyses, milking machine and milking procedure evaluations, and environmental inspections in each herd. Changes in mastitis prevalence, clinical mastitis incidence, milk yield, and individual cow somatic cell counts were evaluated, and an economic analysis was performed for each herd. Mastitis-associated economic losses during the study period ranged from $161.79 to $344.16/lactating cow in the 4 herds. Gross economic benefits resulted when mastitis-associated losses were lower with the monitoring and control program than predicted without it. There were no gross economic benefits in the herds with low somatic cell counts, and, when the marginal costs of the programs were added, there were large net losses ($84.06 and $113.01/lactating cow) in those herds. Gross economic benefits resulted in both of the herds with high somatic cell counts. However, in 1 of the herds, the marginal costs of the program exceeded the benefits, resulting in a net loss of $12.96/lactating cow. The net loss was attributed primarily to poor producer compliance with recommendations. There was a net economic benefit of $19.11/lactating cow in the other herd with high somatic cell counts, in which producer compliance was better.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2002

Los Angeles County drug court programs: initial results.

Los Angeles County established its first drug court program in 1994 in response to escalating criminal activity associated with substance abuse and overcrowded jails. This paper describes results of an evaluation of 803 drug court participants admitted to the program between 1994 and 1997. Of all drug court participants, 76% remained free of any new arrests throughout the one-year followup period, compared to 63% of participants in a drug diversion education program and 49% of the felony defendants not exposed to either program. Of offenders completing the drug court program 80% had no arrests, compared to 67% for non-completers. Drug related re-arrests were significantly lower among drug court graduates (13%) than offenders with no program participation (30%). The study results suggest that drug court participation and graduation decrease the likelihood of repeated arrests, including drug-related arrests. Drug courts represent a promising collaboration between criminal justice and public health agencies.

Adult↗

PubMedDate not supplied

Outpatient commitment: a therapeutic jurisprudence analysis.

This article analyzes the legal and therapeutic jurisprudence considerations raised by outpatient commitment. Although older forms of outpatient commitment have both legal and therapeutic advantages, preventive outpatient commitment raises serious legal problems and potential antitherapeutic consequences that may outweigh its claimed therapeutic value. As a result, alternatives are proposed, including wider availability of community treatment and outreach and case management services, assertive community treatment, police and mental health court diversion programs, and creative uses of advanced directive instruments and behavioral contracting. Proposals also are made for how preventive outpatient commitment can be applied more therapeutically, including hearings that accord patients a sense of procedural justice and techniques designed to motivate individuals facing such hearings to agree to accept treatment voluntarily.

Advance Directives↗

PubMed2002

Factors associated with completion of a drug treatment court diversion program.

Factors related to successful completion of a first offender diversion program were examined from initial data of a longitudinal study of drug treatment court outcomes in Delaware. The strongest predictors of success were factors associated with social stakeholder values, especially those involving employment. Other factors associated with program completion included race, education, and frequency of drug use. While the overall success of drug treatment courts continues to be documented, these data suggest success varies with individual characteristics. The continuing study will explore whether these characteristics are also related to subsequent outcomes, especially drug use relapse and criminal recidivism, over a 24-month post-treatment period.

Age Factors↗

PubMed1992

Reducing unnecessary psychiatric consultations for informed consent by liaison with administration.

The frequency of a psychiatric consultation being requested to assess a patients' capacity to give informed consent varies among institutions, with most recent surveys reporting a frequency of between 3% and 8% of all consultations. At Montefiore Medical Center, a hospital policy was interpreted as mandating such consultations for all patients with possible or even definite lack of decisional capacity. From 1987 to 1988, 55% of all psychiatric consultations in the institution were for consent. Only 9% of the consent patients seen had an Axis I diagnosis other than organic mental syndrome (OMS). Because many of these consultations were believed to be unnecessary, with patient clearly able or unable to give consent, the consultation service worked first with administration to modify the guidelines, and then educated the medical and nursing staff as to when consultation was indicated. With this program, the number of consent consultations fell from 958 in 1988 to 177 in 1990, representing a major saving of staff time and third-party billings. In this era of cost containment and outside review of professional practices, psychiatrists must take responsibility for identifying areas where patient services and billings for them are not justified by clinical indications.

Aged↗

PubMed1983

Ethical issues in testing for differential sensitivity to occupational hazards.

This study examines the ethical aspects of designing preventive health strategies in the workplace that rely on biochemical indexes of worker susceptibility. It analyzes the benefits and risks of this type of occupational testing, and stresses the desirability of guidelines for the use of hypersusceptibility testing in preemployment screening. The primary value of using such programs to identify previously unsuspected hazards in working environments is underscored. The report proposes elements for effective guidelines that can permit the orderly development of hypersusceptibility tests. Further study is needed to validate these technologies; to review the legal elements of consent and disclosure requirements; to assure continuation of equal employment opportunity; to provide legally enforceable protections of workers as research subjects; and to identify the extent, if any, of possible social and psychological harms imposed by such testing.

Beneficence↗

PubMed2004

The story behind the story of collaborative networks -- relationships do matter!

This study reports data about the real story behind the current trend of mandated interorganizational collaboration of health and human service agencies. By means of qualitative design (N-22), public health managers were interviewed about the extent and nature of their collaborative efforts in the Healthy Babies, Healthy Children (HBHC) Program in Ontario, Canada. Using a conceptual framework of resource exchange theory, this study found that relational processes specifically: (a) previous relationships with other agencies and (b) interpersonal relations namely: informality, local community, open communication and resolving conflicts were the reasons for successful collaborations. Implications are directed toward: health and social planners, administrators, board members, funding bodies and policy-makers. The study offers new knowledge about a subject which has received minimal attention in the literature.

Community-Institutional Relations↗

PubMed1984

Genetic screening: marvel or menace?

Genetic screening is a systematic search in the population for persons of certain genotypes. The usual purpose is to detect persons who themselves or whose offspring are at risk for genetic diseases or genetically determined susceptibilities to environmental agents. Is genetic screening a marvel about to free us from the scourge of genetic disease or a menace about to invade our privacy and determine who may reproduce? There are three different types of genetic screening. Newborn screening identifies serious genetic disease at birth, permitting prompt treatment to prevent mental and physical retardation. Fetal screening and prenatal diagnosis identify genetic disease in the fetus permitting selective termination of pregnancy and the opportunity to have children free of defects detectable in utero. Carrier screening identifies individuals heterozygous for a gene for a serious recessive disease who may be at risk for affected offspring. The challenge to society is to provide (by way of cost-effective programs) expert services, including genetic counseling and follow-up, to all who may benefit, to ensure confidentiality and freedom of choice, and to avoid misunderstanding and stigmatization. It is recommended that the objective of screening programs should be to maximize the options available to families at risk rather than to reduce the incidence of genetic diseases. Whenever possible, the providers of these services should be the providers of primary health care. Urgently needed are a greater awareness of avoidable genetic diseases on the part of primary care providers and efforts to familiarize the public with the basic concepts of human genetics through the public school system.

Amniocentesis↗

PubMed1990

The readiness of health profession students to comply with a hypothetical program of forced migration of a minority population.

The readiness of Jewish Israeli medical, psychology, and social work students to cooperate in a hypothetical government program involving expulsion of Arabs from Israel was explored via research scenarios that pointedly used terms reminiscent of Holocaust events. Strong moral sensitivity was expected on the part of the study subjects as both Jewish Israelis and vocationally committed to human welfare. The authors argue that the readiness of as many as one-third of the sample to "follow orders" is a disturbing sign, calling for greater vigilance in defense of human rights and values.

Attitude of Health Personnel↗

PubMed1991

A call for action. The Pepper Commission's blueprint for health care reform.

After a year of deliberation and investigation, the Pepper Commission recommended action to ensure that all Americans would have health insurance protection in an efficient, effective health care system. Because it believes that action is urgent, the commission would build universal coverage by securing, improving, and extending the combination of job-based and public coverage we now have. Reform would entail the following elements: a combination of incentives and requirements that would guarantee all workers (with their nonworking dependents) insurance coverage through their jobs; replacement of Medicaid with a new federal program that would cover all those not covered through the workplace and workers whose employers find public coverage more affordable; guaranteed affordable coverage for employers--through reform of private insurance, tax credits for small employers, and the opportunity to purchase public coverage; a minimum benefit standard for private and public plans that would cover preventive and primary services as well as catastrophic care and would include cost sharing, subject to ability to pay; and a combination of public and private sector initiatives to promote quality and contain costs.

Cost Control↗

PubMedDate not supplied

The tenuous nature of the Medicaid entitlement.

Although Medicaid is regarded as a federal entitlement program, nowhere does the Medicaid statute explicitly recognize a federal right of action to enforce recipients' rights. Arguably, the Supreme Court, rather than Congress, first recognized the right of Medicaid recipients to protection of federal law. A controversial 2001 federal court decision, however, called into question the continuing existence of federally enforceable Medicaid rights. Although this decision has been reversed, it illuminates the tenuous nature of the Medicaid entitlement, as do recent Supreme Court decisions narrowing federal rights. Congress should amend the Medicaid statute to ensure the rights of Medicaid recipients.

Civil Rights↗

PubMed1994

Screening surgeons for HIV infection: assessment of a potential public health program.

OBJECTIVE: To develop a model to assess the impact of a program of testing surgeons for human immunodeficiency virus (HIV) on the risk of HIV acquisition by their patients. DESIGN: A Monte Carlo simulation model of physician-to-patient transmission of human immunodeficiency virus (HIV) infection using three different rates of physician-to-patient transmission per percutaneous exposure event (0.15%, 0.3%, 0.6%). Data from the model were developed from a review of the medical literature and from subjective probability estimates when data were not available. We used this model to estimate on a national basis the annual number of cases of HIV transmission from surgeons to patients with and without surgeon testing and practice limitations. RESULTS: The annual number of transmitted cases would range from 0.5 (+/- 0.3), assuming a surgeon HIV prevalence of 0.1% and a surgeon-to-patient transmission rate of 0.15%, to 36.9 (+/- 11.6), assuming a surgeon HIV prevalence of 2% and a surgeon-to-patient transmission rate of 0.6%. After one screening cycle, a mandatory screening program would be expected to reduce the annual transmissions to 0.05 (+/- 0.03) and 3.1 (+/- 1.1), respectively. CONCLUSION: Patients are at low risk of acquiring HIV infection from an infected physician during an invasive procedure. The potential costs of such a program extended beyond the costs of testing and counseling. In communities with high HIV prevalence, screening surgeons and limiting their practices may decrease patient access to care. A disability insurance program also would be required to protect surgeons and trainees performing invasive procedures. Screening surgeons for HIV infection would be a costly undertaking that would reduce but not completely eliminate this risk.

AIDS Serodiagnosis↗

PubMed2005

Two brief alcohol interventions for mandated college students.

Encouraging but limited research indicates that brief motivational interventions may be an effective way to reduce heavy episodic drinking in college students. At 2 campuses, students (83% male) mandated to a substance use prevention program were randomly assigned to 1 of 2 individually administered conditions: (a) a brief motivational interview (BMI; n = 34) or (b) an alcohol education session (AE; n = 30). Students in the BMI condition reported fewer alcohol-related problems than the AE students at 3-and 6-month assessments. Trends toward reductions in number of binge drinking episodes and typical blood alcohol levels were seen in both groups. Process measures confirmed the integrity of both interventions. The findings demonstrate that mandated BMIs can reduce alcohol problems in students referred for alcohol violations.

Adult↗

PubMed2002

Iodine status and goiter prevalence in Turkey before mandatory iodization.

Endemic goiter is an important public health problem in Turkey. Legislation for mandatory iodization of household salt was passed in July 1999. Current study is aimed at ascertaining the goiter prevalence and iodine nutrition in school-age children (SAC) living in known endemic areas of Turkey. Sonographic thyroid volumes (STV) and urinary iodine concentrations (UIC) of 5,948 SAC from 20 cities were measured between 1997-1999. STV of 31.8% of the SAC examined stayed above the upper-normal limits for the same age and gender recommended by the World Health Organization (WHO). Goiter prevalence ranged between 5 to 56% and median UIC ranged between 14 to 78 microg/l, indicating severe to moderate iodine deficiency (ID) in 14 and mild ID in 6 of the cities surveyed. Neither of the cities was found to have sufficient median UIC levels. The current study shows that endemic goiter is an important public health problem and iodine nutrition is inadequate nationwide. It also provides reliable scientific evidence and shows the need for a controlled and effective iodine supplementation program nationwide. Mandatory iodization of household salt seems to be the essential measure taken for the moment, additional measures may be needed in the near future.

Child↗

PubMed2005

Partner aggressive women: characteristics and treatment attrition.

The topic of female partner aggression has been controversial for over 20 years, and yet we lack a coherent body of literature that describes the phenomenon. Furthermore, we know little about what treatment approaches effectively reduce partner aggression in women. Data for this study were derived from the initial evaluations of 107 domestically violent, heterosexual women referred to an anger management program. Descriptive statistics were used to expand our knowledge of the characteristics of this population. In addition, a number of variables were analyzed to determine their relevance to treatment dropout. Overall, women tended to be socioeconomically disadvantaged and undereducated, with histories of childhood attachment disruptions and victimization, mental health problems, and substance abuse. Participants that had been court mandated were more likely to complete treatment, while nonmandated women had fewer pretreatment arrests and were more likely to drop out after the initial intake. The implications for treatment are discussed, and suggestions for further investigation are offered.

Adolescent↗