Perspectives on Care Coordination for Youth with TBI: Moving Forward to Provide Better Care

BACKGROUND: Care coordination aligns services and optimizes outcomes for children with traumatic brain injury (TBI), yet numerous obstacles can impede effective care coordination following a TBI. OBJECTIVE: The goal of this work is to identify barriers and facilitators to care coordination from the perspective of individuals who care for young people impacted by TBI. METHODS: Twenty-one care providers participated in semi-structured interviews to gather their perspectives on systems of care coordination for youth with TBI and potential areas for improvement. Using reflexive thematic analysis, researchers identified key themes across interviews. RESULTS: Three themes were identified: 1) gaps in knowledge; 2) poor collaboration and communication between systems and care providers; and 3) inadequate legislative and policy frameworks that fund and support pediatric TBI. Across themes, participants shared their experiences and ideas to improve each of these areas. CONCLUSIONS: A structured, consistent, and coordinated system of care for pediatric TBI is critical to ensure optimal outcomes. Protocols that emphasize intentional and productive collaboration between healthcare settings and schools and education for all care providers are cornerstones in improving outcomes for children. Top-down action that develops policy and funding initiatives is needed to ensure equitable, consistent access to appropriate healthcare and educational supports

Care Coordination for Children with Special Health Care Needs: A Scoping Review to Inform Strategies for Students with Traumatic Brain Injuries

BACKGROUND: Chronic and complex medical issues, including traumatic brain injuries (TBIs), have significant educational implications. The purpose of this study was to identify and summarize the literature on care coordination strategies among health care professionals, educators, and caregivers for children with special health care needs (CSHCN). Clarifying factors that influence care coordination for CSHCN can inform future studies on care coordination for students with TBI. Improved understanding of these factors may lead to better communication, reduction of unmet needs, more efficient service access, and improved long-term outcomes for children. METHODS A scoping review was conducted, guided by PRISMA-ScR methodology. Five databases (CINAHL, PSYCINFO, EMBASE, ERIC, PubMed) were searched to identify relevant studies that focused on care coordination and educational settings. RESULTS Twelve articles met inclusion criteria. Care coordination interventions for CSHCN used in educational settings focused on relationship-building strategies, clear procedures and roles, and education of members of the school community. CONCLUSIONS Findings highlight strategies to coordinate care for CSHCN and factors that may moderate effects of these interventions. Key stakeholders should now study these strategies specifically in children with TBI

A scoping review to inform care coordination strategies for youth with traumatic brain injuries: Care coordination tools

BACKGROUND: Children with traumatic brain injury (TBI) report unmet needs several years after their injury and may require long-term care. However, this chronic health condition is often only treated and monitored in the short-term. Care for young persons with TBI often relies on parents to manage their child’s complex care network. Effective care coordination can close these gaps and facilitate continuity of care for children with TBI. The purpose of this scoping review was to develop a better understanding of tools that improve care coordination for Children with Special Health Care Needs (CSHCN). This, in turn, can inform care for children with TBI. METHODS: A scoping review was conducted following the PRISMA framework and methodology. OVID/Medline, CINAHL, PsycINFO, EMBASE, and ERIC databases were searched for articles relevant to care coordination tools used with CSHCN. RESULTS: 21 articles met the criteria for inclusion in the review, and 6 major categories of care coordination tools were identified: telehealth, online health records and tools, care plans, inpatient discharge protocols, family training, and reminders. DISCUSSION: Studies examining telehealth, online tools, care plans, and family training care coordination interventions for CSHCN have shown positive outcomes and would be relevant strategies to improve the care of children with TBI. Future prospective research should investigate these tools to explore whether they might improve communication, reduce unmet needs, increase service access, and improve long-term outcomes for children with TBI

A scoping review to inform care coordination strategies for youth with traumatic brain injuries: Care coordination personnel

Introduction & Importance: Effective, patient-centered care coordination has been shown to improve outcomes for children with special healthcare needs (CSHCN), who often have complex, long-term involvement with multiple service providers. Traumatic brain injury (TBI) can result in long-term physical, intellectual, social, and emotional disabilities that persist long after acute treatment. Yet, even though it is a chronic condition, TBI remains an area with scarce standardization and research surrounding the complex, long-term care coordination need in this population. The purpose of this scoping review is to summarize current research on outcomes in CSHCN after implementation of care coordinators, whether individual or teams, to inform future research for youth with TBI. Methods: OVID/Medline, CINAHL, PsycINFO, EMBASE, and ERIC databases were searched for articles relevant to care coordination and CSHCN. Results: 31 articles met inclusion criteria. Outcomes for children and families were grouped into 5 major categories: healthcare utilization, cost of care, disease status, parent and child quality of life, and healthcare satisfaction and perception of care. Discussion: Implementation of care coordinators, whether in the form of individuals, dyads, or teams, resulted in overall positive outcomes for CSHCN and their families across all 5 major outcome domains. Future research should be focused on the efficacy of care coordinators differing in profession, qualifications, and educational attainment specifically for the unique needs of children with TBI. Additionally, the application of care coordination within medical homes should be further investigated to increase proactive, preventative care of children with TBI and further reduce reactive, need-based treatment only

Brain Injury Is Treatable

Children with traumatic brain injury (TBI) are under-identified and under-served by healthcare and educational professionals. Factors such as lack of understanding regarding long-term needs following TBI, limited awareness and training in emerging evidence-based practices and inefficient care coordination (Haarbauer-Krupa et al., 2017) impede effective clinical management. Despite these considerable challenges, childhood brain injury is treatable. Families, schools, and healthcare systems are integral to that treatment. Where a child lives and learns can also greatly influence long-term outcomes. Children from home environments with supportive caregivers have more positive outcomes (Wade et al., 2016). Closer proximity to medical care and providers who streamline postacute care, rehabilitation, and community services also positively affect recovery (Buzza et al., 2011). Schools with educators who are trained to understand the unique needs of students with TBI are better situated to ensure that needed services and accommodations are received upon a child’s return to school (Davies, 2016)

Before and After the Clean Water Act: How Science, Law, and Public Aspirations Drove Seven Decades of Progress in Maine Water Quality

In the 1950s, Maine established a water quality classification system creating the conceptual scaffolding of a tiered system of management. Passage of the federal Clean Water Act in 1972 drove dramatic advances in science, technology, and policy leading to systematic improvement for the next five decades. Today’s tiered classification system provides a range of management goals from natural to various allowable uses. The state assigns uses and standards for each classification, incorporating physical, chemical, and biological indicators. This system has brought steady improvement in water quality, ecological condition, and overall value for human use. Visible evidence of improvement and adoption of these management alternatives have inspired a re-imagining of how Maine’s waters can benefit clean water-based businesses, recreation, and amenity development

TB208: Biological Water Quality Standards to Achieve Biological Condition Goals in Maine Rivers and Streams: Science and Policy

This publication describes the philosophy, history, methodology, and management applications of numeric biological criteria in water quality standards in Maine. The presentation describes the decision-making process used by the Maine Department of Environmental Protection (MDEP) for assessing attainment of aquatic life uses in water quality standards using benthic macroinvertebrates in Maine streams and rivers including eight case studies of management applications and the improved environmental outcomes that have resulted. The MDEP, University of Maine, and business and nonprofit stakeholders participated in the development and testing of Maine’s numeric biological criteria. This publication further discusses the broader relevance of numeric biological criteria in water quality management at both the state and federal levels and considers parallels and differences between Maine’s biological criteria and other biological assessment methods in the United States and the European Union.https://digitalcommons.library.umaine.edu/aes_techbulletin/1205/thumbnail.jp

Integrated farm management for sustainable agriculture:lessons for knowledge exchange and policy

As a response to the environmentally and socially destructive practices of post-war mechanization and intensification, the concept of sustainable agriculture has become prominent in research, policy, and practice. Sustainable agriculture aims to balance the economic, environmental, and social aspects of farming, creating a resilient farming system in the long-term. Over the last few decades, various concepts have been used in research and policy to encourage the adoption of sustainable practices. Within such a congested space, this paper assesses the value of ‘integrated farm management’ as a concept for the promotion of sustainable agriculture. The concept is the subject of renewed policy interest in England and Wales and it is also being promoted in Europe. Previous research, however, has suggested that integrated farm management may not be well understood or widely practised. There are also criticisms that it can be impractical and poorly differentiated from similar ideas. As such, renewed insights are required into how useful the concept might be for encouraging sustainable agriculture. Using a mixed methods approach, we gathered the views of farmers, farm advisors, and industry representatives about integrated farm management in England and Wales, and interpreted these through a theoretical framework to judge the strength of the concept. Overall, the general principles of Integrated Farm Management were found to be coherent and familiar to most of our respondents. However, the concept performed poorly in terms of its resonance, simplicity of message, differentiation from other similar terms and theoretical utility. We reflect on our findings in the context of other ways to promote sustainable agriculture, drawing out messages for policy and knowledge exchange in England and Wales, as well as elsewhere.This research was funded as part of Defra's Sustainable Intensification Platform (Project Code LM0201). In addition, WJS was funded by Arcadia, LVD was funded by the UK Natural Environment Research Council partly under the Biodiversity and Ecosystem Service Sustainability (BESS) programme, grant codes NE/K015419/1 and NE/N014472/1

An implementation research agenda.

In October 2006, the Chief Medical Officer (CMO) of England asked Professor Sir John Tooke to chair a High Level Group on Clinical Effectiveness in response to the chapter 'Waste not, want not' in the CMOs 2005 annual report 'On the State of the Public Health'. The high level group made recommendations to the CMO to address possible ways forward to improve clinical effectiveness in the UK National Health Service (NHS) and promote clinical engagement to deliver this. The report contained a short section on research needs that emerged from the process of writing the report, but in order to more fully identify the relevant research agenda Professor Sir John Tooke asked Professor Martin Eccles to convene an expert group - the Clinical Effectiveness Research Agenda Group (CERAG) - to define the research agenda. The CERAG's terms of reference were 'to further elaborate the research agenda in relation to pursuing clinically effective practice within the (UK) National Health Service'. This editorial presents the summary of the CERAG report and recommendations