Organizational factors influencing implementation of evidence-based practices for integrated treatment in behavioral health agencies.

Objective. In recent years, New Mexico has prioritized integrated treatment for cooccurring mental health and substance use disorders within its public behavioral health system. This report describes factors likely to be important when implementing evidence-based practices (EBPs) in community agencies. Methods. Our mixed-method research design consisted of observations, semistructured interviews, and surveys undertaken with employees at 14 agencies at baseline and after 18 months. We developed four-agency typologies based on iterative coding and analysis of observations and interviews. We then examined survey data from employees at the four exemplar agencies to validate qualitative findings. Results. Financial resources and strong leadership impacted agency capacity to train providers and implement EBPs. Quantitative analysis of service provider survey responses from these agencies (N = 38) supported qualitative findings and demonstrated significant mean score differences in leadership, organizational climate, and attitudes toward EBPs in anticipated directions. Conclusion. The availability of strong leadership and financial resources were key components to initial implementation success in this study of community agencies in New Mexico. Reliance only on external funding poses risks for sustainment when demoralizing work climates precipitate employee turnover. Strong agency leadership does not always compensate for deficient financial resources in vulnerable communities

Race, Welfare Reform, and Nonprofit Organizations

This article presents research on the impact of welfare reform on 90 nonprofit organizations in Southeast Michigan. Utilizing a refined survey instrument, in-depth interviews and focus groups with agency executives and staff, and the analysis of agency documents, it assesses how the racial characteristics of agencies\u27 client populations affected the organizational consequences of welfare reform. The study confirmed that welfare reform has affected the ability of nonprofit organizations to meet the increased expectations generated by recent legislation. These effects have been particularly pronounced among agencies serving a high proportion of racial minority clients

Multidimensional measurement within adult protective services: design and initial testing of the tool for risk, interventions, and outcomes.

This study describes the development, field utility, reliability, and validity of the multidimensional Tool for Risk, Interventions, and Outcomes (TRIO) for use in Adult Protective Services (APS). The TRIO is designed to facilitate consistent APS practice and collect data related to multiple dimensions of typical interactions with APS clients, including the investigation and assessment of risks, the provision of APS interventions, and associated health and safety outcomes. Initial tests of the TRIO indicated high field utility, social worker "relevance and buy-in," and inter-rater reliability. TRIO concurrent validity was demonstrated via appropriate patterns of TRIO item differentiation based on the type of observed confirmed abuse or neglect; and predictive validity was demonstrated by prediction of the risk of actual APS recurrence. The TRIO is a promising new tool that can help meet the challenges of providing and documenting effective APS practices and identifying those at high risk for future APS recurrence

Thermodynamic Entropy And The Accessible States of Some Simple Systems

Comparison of the thermodynamic entropy with Boltzmann's principle shows that under conditions of constant volume the total number of arrangements in simple thermodynamic systems with temperature-independent heat capacities is TC/k. A physical interpretation of this function is given for three such systems; an ideal monatomic gas, an ideal gas of diatomic molecules with rotational motion, and a solid in the Dulong-Petit limit of high temperature. T1/2 emerges as a natural measure of the number of accessible states for a single particle in one dimension. Extension to N particles in three dimensions leads to TC/k as the total number of possible arrangements or microstates. The different microstates of the system are thus shown a posteriori to be equally probable, with probability T-C/k, which implies that for the purposes of counting states the particles of the gas are distinguishable. The most probable energy state of the system is determined by the degeneracy of the microstates.Comment: 9 pages, 1 figur

Enhancing assertive community treatment with cognitive behavioral social skills training for schizophrenia: study protocol for a randomized controlled trial.

BackgroundSchizophrenia leads to profound disability in everyday functioning (e.g., difficulty finding and maintaining employment, housing, and personal relationships). Medications can effectively reduce positive symptoms (e.g., hallucinations and delusions), but they do not meaningfully improve daily life functioning. Psychosocial evidence-based practices (EBPs) improve functioning, but these EBPs are not available to most people with schizophrenia. The field must close the research and service delivery gap by adapting EBPs for schizophrenia to facilitate widespread implementation in community settings. Our hybrid effectiveness and implementation study represents an initiative to bridge this divide. In this study we will test whether an existing EBP (i.e., Cognitive Behavioral Social Skills Training (CBSST)) modified to work in practice settings (i.e., Assertive Community Treatment (ACT) teams) commonly available to persons with schizophrenia results in better consumer outcomes. We will also identify key factors relevant to developing future CBSST implementation strategies.Methods/designFor the effectiveness study component, persons with schizophrenia will be recruited from existing publicly funded ACT teams operating in community settings. Participants will be randomized to one of the 2 treatments (ACT alone or ACT + Adapted CBSST) and followed longitudinally for 18 months with assessments every 18 weeks after baseline (5 in total). The primary outcome domain is psychosocial functioning (e.g., everyday living skills and activities related to employment, education, and housing) as measured by self-report, testing, and observation. Additional outcome domains of interest include mediators of change in functioning, symptoms, and quality of services. Primary analyses will be conducted using linear mixed-effects models for continuous data. The implementation study component consists of a structured, mixed qualitative-quantitative methodology (i.e., Concept Mapping) to characterize and assess the implementation experience from multiple stakeholder perspectives in order to inform future implementation initiatives.DiscussionAdapting CBSST to fit into the ACT service delivery context found throughout the United States creates an opportunity to substantially increase the number of persons with schizophrenia who could have access to and benefit from EBPs. As part of the implementation learning process training materials and treatment workbooks have been revised to promote easier use of CBSST in the context of brief community-based ACT visits.Trial registrationClinicalTrials.gov NCT02254733 . Date of registration: 25 April 2014

Evidence-based practice implementation: The impact of public versus private sector organization type on organizational support, provider attitudes, and adoption of evidence-based practice

<p>Abstract</p> <p>Background</p> <p>The goal of this study is to extend research on evidence-based practice (EBP) implementation by examining the impact of organizational type (public versus private) and organizational support for EBP on provider attitudes toward EBP and EBP use. Both organization theory and theory of innovation uptake and individual adoption of EBP guide the approach and analyses in this study. We anticipated that private sector organizations would provide greater levels of organizational support for EBPs leading to more positive provider attitudes towards EBPs and EBP use. We also expected attitudes toward EBPs to mediate the association of organizational support and EBP use.</p> <p>Methods</p> <p>Participants were mental health service providers from 17 communities in 16 states in the United States (n = 170). Path analyses were conducted to compare three theoretical models of the impact of organization type on organizational support for EBP and of organizational support on provider attitudes toward EBP and EBP use.</p> <p>Results</p> <p>Consistent with our predictions, private agencies provided greater support for EBP implementation, and staff working for private agencies reported more positive attitudes toward adopting EBPs. Organizational support for EBP partially mediated the association of organization type on provider attitudes toward EBP. Organizational support was significantly positively associated with attitudes toward EBP and EBP use in practice.</p> <p>Conclusion</p> <p>This study offers further support for the importance of organizational context as an influence on organizational support for EBP and provider attitudes toward adopting EBP. The study demonstrates the role organizational support in provider use of EBP in practice. This study also suggests that organizational support for innovation is a malleable factor in supporting use of EBP. Greater attention should be paid to organizational influences that can facilitate the dissemination and implementation of EBPs in community settings.</p

Unintended Consequences: The Impact of Welfare Reform in the United States on NGOs

The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 dramatically transformed the structure and goals of the public welfare system in the United States. The vast body of research and evaluation generated by the 1996 welfare reforms largely overlooked nongovernmental organizations (NGOs) despite their substantial historical and contemporary involvement in the delivery of social services to low-income populations. Therefore, this paper presents a unique assessment of PRWORA's implications based on the perspective of 90 social service NGOs operating in the Detroit metropolitan area. Examination of their services, staffing, budgets, and clients reveals many changes experienced by NGOs between 1996 and 2000 related to the welfare reforms. Overall, the findings suggest an increased role for social service NGOs in the “public” welfare system as well as concerns regarding their capacity to adequately fulfill this growing responsibility in the future.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45682/1/11266_2004_Article_471434.pd

Optimisation of the Read-out Electronics of Muon Drift-Tube Chambers for Very High Background Rates at HL-LHC and Future Colliders

In the ATLAS Muon Spectrometer, Monitored Drift Tube (MDT) chambers and sMDT chambers with half of the tube diameter of the MDTs are used for precision muon track reconstruction. The sMDT chambers are designed for operation at high counting rates due to neutron and gamma background irradiation expected for the HL-LHC and future hadron colliders. The existing MDT read-out electronics uses bipolar signal shaping which causes an undershoot of opposite polarity and same charge after a signal pulse. At high counting rates and short electronics dead time used for the sMDTs, signal pulses pile up on the undershoot of preceding background pulses leading to a reduction of the signal amplitude and a jitter in the drift time measurement and, therefore, to a degradation of drift tube efficiency and spatial resolution. In order to further increase the rate capability of sMDT tubes, baseline restoration can be used in the read-out electronics to suppress the pile-up effects. A discrete bipolar shaping circuit with baseline restoration has been developed and used for reading out sMDT tubes under irradiation with a 24 MBq 90Sr source. The measurements results show a substantial improvement of the performance of the sMDT tubes at high counting rates

Predisposing, Enabling, and Need Factors Associated with High Service Use in a Public Mental Health System

The purpose of this study was twofold: (1) To investigate the individual- and system-level characteristics associated with high utilization of acute mental health services according to a widely-used theory of service use—Andersen’s Behavioral Model of Health Service Use —in individuals enrolled in a large, public-funded mental health system; and (2) To document service utilization by high use consumers prior to a transformation of the service delivery system. We analyzed data from 10,128 individuals receiving care in a large public mental health system from fiscal years 2000–2004. Subjects with information in the database for the index year (fiscal year 2000–2001) and all of the following 3 years were included in this study. Using logistic regression, we identified predisposing, enabling, and need characteristics associated with being categorized as a single-year high use consumer (HU: >3 acute care episodes in a single year) or multiple-year HU (>3 acute care episodes in more than 1 year). Thirteen percent of the sample met the criteria for being a single-year HU and an additional 8% met the definition for multiple-year HU. Although some predisposing factors were significantly associated with an increased likelihood of being classified as a HU (younger age and female gender) relative to non-HUs, the characteristics with the strongest associations with the HU definition, when controlling for all other factors, were enabling and need factors. Homelessness was associated with 115% increase in the odds of ever being classified as a HU compared to those living independently or with family and others. Having insurance was associated with increased odds of being classified as a HU by about 19% relative to non-HUs. Attending four or more outpatient visits was an enabling factor that decreased the chances of being defined as a HU. Need factors, such as having a diagnosis of schizophrenia, bipolar disorder or other psychotic disorder or having a substance use disorder increased the likelihood of being categorized as a HU. Characteristics with the strongest association with heavy use of a public mental health system were enabling and need factors. Therefore, optimal use of public mental services may be achieved by developing and implementing interventions that address the issues of homelessness, insurance coverage, and substance use. This may be best achieved by the integration of mental health, intensive case management, and supportive housing, as well as other social services

On the exact electric and magnetic fields of an electric dipole

We derive from Jefimenko's equations a multipole expansion in order to obtain the exact expressions for the electric and magnetic fields of an electric dipole with an arbitrary time dependence. A few comments are also made about the usual expositions found in most common undergraduate and graduate textbooks as well as in the literature on this topic