Therapists’ Perceptions of School-based Mental Health Services: A Qualitative Evaluation of two Behavioral Health Models

Therapists’ perceptions of school-based mental health programs are considered to be an important factor in determining the effectiveness of a school based behavioral health model. This qualitative evaluation summarizes the perceptions of participant therapists on two different behavioral health models called Full Service Schools (FSS) and Full-Service Schools (FSS) Plus model that are currently being implemented in a large school district in Florida. FSS therapists provide therapy at a hub location whereas FSS Plus therapists work at one particular school. The study utilizes therapists’ views of their respective programs to compare and contrast the effectiveness of each of the behavioral health models. Five focus groups involving 24 therapists from both models were held at five separate locations. Nvivo version 10 was used to conduct a thematic analysis of collected data. Study findings revealed better results for the FSS Plus model as compared to the FSS model in terms of successful elimination of barriers such as transportation and lack of physical space to provide therapy. This study suggests that improved and effective behavioral health services can be provided to students by assigning a designated therapist at each school

The anxious wait: assessing the impact of patient accessible EHRs for breast cancer patients

<p>Abstract</p> <p>Background</p> <p>Personal health records (PHRs) provide patients with access to personal health information (PHI) and targeted education. The use of PHRs has the potential to improve a wide range of outcomes, including empowering patients to be more active participants in their care. There are a number of widespread barriers to adoption, including privacy and security considerations. In addition, there are clinical concerns that patients could become anxious or distressed when accessing complex medical information. This study assesses the implementation of a PHR, and its impact on anxiety levels and perceptions of self-efficacy in a sample of breast cancer patients.</p> <p>Methods</p> <p>A quasi-experimental pre-test/post-test design was used to collect data from participants to evaluate the use of the PHR. Study participants completed background and pre-assessment questionnaires and were then registered into the portal. By entering an activation key, participants were then able to review their lab results and diagnostic imaging reports. After six weeks, participants completed post-assessment questionnaires and usability heuristics. All data were collected using an online survey tool. Data were cleaned and analyzed using SAS v9.1.</p> <p>Results</p> <p>A total of 311 breast cancer patients completed demographic and pre-assessment questionnaires, 250 registered to use the online intervention, and 125 participants completed all required study elements. Matching the pre- and post-anxiety scores demonstrated a decrease in mean anxiety scores (-2.2, p = 0.03); the chemotherapy sub-group had a statistically insignificant mean increase (1.8, p = .14). There was no mean change in self-efficacy scores.</p> <p>Conclusions</p> <p>Participants generally found the portal easy to use; however, the perceived value of improved participation was not detected in the self-efficacy scores. Having access to personal health information did not increase anxiety levels. While these results suggest that the use of this PHR may be of benefit for informing patients, further research is required to investigate the impact on the patients experiences, their participation in their care, their relationships with the health care team, and their health outcomes.</p

The Governance of Core Competencies for Public Health: A Rapid Review of the Literature

Core competencies for public health (CCPH) define the knowledge, skills, and attitudes required of a public health workforce. Although numerous sets of CCPH have been established, few studies have systematically examined the governance of competency development, review, and monitoring, which is critical to their implementation and impact. This rapid review included 42 articles. The findings identified examples of collaboration and community engagement in governing activities (e.g., using the Delphi method to develop CCPH) and different ways of approaching CCPH review and revision (e.g., every 3 years). Insights on monitoring and resource management were scarce. Preliminary lessons emerging from the findings point towards the need for systems, structures, and processes that support ongoing reviews, revisions, and monitoring of CCPH

Is Canada ready for patient accessible electronic health records? A national scan

<p>Abstract</p> <p>Background</p> <p>Access to personal health information through the electronic health record (EHR) is an innovative means to enable people to be active participants in their own health care. Currently this is not an available option for consumers of health. The absence of a key technology, the EHR, is a significant obstacle to providing patient accessible electronic records. To assess the readiness for the implementation and adoption of EHRs in Canada, a national scan was conducted to determine organizational readiness and willingness for patient accessible electronic records.</p> <p>Methods</p> <p>A survey was conducted of Chief Executive Officers (CEOs) of Canadian public and acute care hospitals.</p> <p>Results</p> <p>Two hundred thirteen emails were sent to CEOs of Canadian general and acute care hospitals, with a 39% response rate. Over half (54.2%) of hospitals had some sort of EHR, but few had a record that was predominately electronic. Financial resources were identified as the most important barrier to providing patients access to their EHR and there was a divergence in perceptions from healthcare providers and what they thought patients would want in terms of access to the EHR, with providers being less willing to provide access and patients desire for greater access to the full record.</p> <p>Conclusion</p> <p>As the use of EHRs becomes more commonplace, organizations should explore the possibility of responding to patient needs for clinical information by providing access to their EHR. The best way to achieve this is still being debated.</p

Human Response during the September 29, 2009, South Pacific Earthquake and Tsunami in American Samoa

Near-field tsunamis are a type of natural hazard that provide at-risk individuals with short warning periods that can severely hinder effective response. The Protection Action Decision Model (PADM) is an established theoretical framework that has been used to describe human response to natural hazards. Variables from the PADM have been used to understand individual and household responses during hazards such as hurricanes and floods but seldom for tsunamis. This study surveyed 300 adult American Samoan survivors of the September 29, 2009, Mw 8.1 South Pacific earthquake and tsunami. The primary objectives were to use variables from the PADM to: a) determine the relative importance of determinants of threat perception, b) examine tsunami survivors’ ratings of 4 social stakeholder groups regarding tsunami knowledge, trustworthiness of source of information, and protection responsibility, and c) establish whether household characteristics such as distance to shoreline, household income, and family size were situational impediments to response. Study findings showed that ground motion from the earthquake was found to be the strongest predictor of threat perception. Respondents rated themselves higher than officials and media for the 3 stakeholder characteristics. Occupational status had the most apparent effect on stakeholder perceptions. Those who reported being employed were more likely to have higher mean ratings across the social stakeholder groups for most characteristics. Respondents living closer to the shoreline and having an income of ≥ $15,000 proved to be slightly more likely to evacuate. Overall, findings suggest that the people of American Samoa displayed a remarkable response to the earthquake by evacuating upon feeling the ground shaking. Thousands of people were in the inundation zone but only 34 died, even though the first wave arrived onshore in as little as 15 minutes. The adaptive response during this event is frequently attributed to the success of recent educational outreach conducted in the months and week just prior to the event but other factors may also be important. This research represents a novel study that examines various aspects of tsunami evacuation behavior for a near-field tsunami using the PADM with a population outside of the contiguous 50 states

Does hospital ownership influence hospital referral region health rankings in the United States

Extensive evidence demonstrates that a hospital\u27s organizational ownership structure impacts its overall performance, but little is known concerning the influence of hospital structure on the health of its community. This paper explores the association between US hospital referral region (HRR) health rankings and hospital ownership and performance. Data from the 2016 Commonwealth Fund Scorecard on Local Health System Performance, the American Hospital Association dataset, and the Hospital Value-Based Purchasing dataset are utilized to conduct a cross-sectional analysis of 36 quality measures across 306 HRRs. Multivariate regression analysis was used to estimate the association among hospital ownership, system performance measures—access and affordability, prevention and treatment, avoidable hospital use and cost, and healthy lives—and performance as measured by value-based purchasing total performance scores. We found that indicators of access and affordability, as well as prevention and treatment, were significantly associated across all 3 hospitals\u27 organizational structures. Hospital referral regions with a greater number of not-for-profit hospitals demonstrated greater indications of access and affordability, as well as better prevention and treatment rankings than for-profit and government hospitals. Hospital referral regions with a greater number of government, nonfederal hospitals had worse scores for healthy lives. Furthermore, the greater the total performance scores score, the better the HRR score on prevention and treatment rankings. The greater the per capita income, the better the score across all 4 dimensions. As such, this inquiry supports the assertion that performance of a local health system is dependent on its community\u27s resources of health care delivery entities and their structure

Insight into Health Care Services: A Characterization of Emergency Room Visits and Economic Hazards in the United States

This study explores the impact of economic hazard areas on hospital-based emergency departments to determine whether economically hazardous environments, characterized by the change of population, income per capita, and unemployment rate, experience a higher number of emergency room visits than areas of lower rated economic hazard risk in the United States.Method A cross-sectional design was used of a nationally constructed data set of hospital-based emergency departments of over 6,000 hospitals in the United States. We identified our quality outcome measure as the emergency room visits rate within a hospital service area. We created the variable by dividing the number of emergency room visits by the population of the hospital services area in which the emergency room was located.Results Results indicate that there is a difference in the incident rate ratio of emergency room visits between environments considered to be experiencing greater amounts of hazard, compared to lower amounts of hazard.Conclusion Hospital administrators and health policy-makers need to work in conjunction to focus efforts on public safety as a key objective in the delivery of emergency medical care. One crucial effort that hospital administrators need to focus on is improving emergency room capacity and efficiency as part of the disaster preparedness plan (Disaster Med Public Health Prep. 2019;13:470-475

Hospital Partnerships in Population Health Initiatives

Hospitals are expected to fulfill a role in the communities they serve by improving the health of the population in the community as mandated in the Affordable Care Act. One way hospitals achieve this is to create partnerships with diverse organizations, such as local public health departments, state/federal agencies, and other health care organizations. The aim of this study is to examine characteristics of hospitals that developed partnerships based on improving population health. This study utilized the 2015 Population Health Survey, American Hospital Association Database, and Dartmouth Atlas of Health Care. Hospital characteristics included size, ownership status, part of a system, teaching status location, Medicare percentage, Medicaid percentage, average stay length, and inpatient days per 1000 persons. Level of partnership was measured by the hospital\u27s current working relationship with other hospitals/health care systems or local/state/other agencies. Univariate, bivariate, and multivariate regression analyses were used to analyze the relationship between hospital partnerships and organizational characteristics. Hospitals with strong relationships tend to be larger and not-for-profit hospitals, hospitals with system members and located in urban areas, and teaching-affiliated hospitals. This study also found hospital characteristics were related to hospitals\u27 partnerships. Hospitals within health care systems and with high inpatient volume were more likely to report relationships that were stronger. This study provides a systematic and updated look at hospitals\u27 partnership when looking at commitment to population health improvement and contributes to the literature by informing about the greater need to support rural and smaller hospitals with population health outreach activities

School-based nutrition and garden programs and parental dietary changes in low-income settings: a review

Income is a direct indicator of dietary health and access to food. Proper nutrition is a critical component to achieving good health. However, many children and their families do not consume the recommended amounts of fruits and vegetables. This can lead to many health disparities and contribute to the development of chronic disease. Children between the ages of 5 and 18 spend an average of 6 h a day, 180 days a year in school, which provides an opportunity for public health workers, nutritionists, and teachers to assist low-income families with nutritional education and provide access to fruits and vegetables. In-school programs have been proven to positively impact dietary choices in children, but it is unclear how such programs may impact their parents. This review examines literature on school-based nutrition and garden programs and their direct impact on the dietary practices and choices of low-income parents. The review process was conducted through an Internet search for relevant peer-reviewed journal articles on databases such as PubMed, CINAHL, and Medline. Grey literature was not included. Approximately 167 studies were generated from the literature search. After removing duplicates and those that did not meet the inclusion criteria we analysed 17 articles. Analysis of these articles provided few assessments of direct or indirect impact of nutrition and garden programs on low-income parental dietary outcomes or choices. It was discovered that passive communications and direct participation are most often used to foster parent involvement

Household evacuation characteristics in American Samoa during the 2009 Samoa Islands tsunami

Tsunamis represent significant threats to human life and development in coastal communities. This quantitative study examines the influence of household characteristics on evacuation actions taken by 211 respondents in American Samoa who were at their homes during the 29 September 2009 Mw 8.1 Samoa Islands earthquake and tsunami disaster. Multiple logistic regression analysis of survey data was used to examine the association between evacuation and various household factors. Findings show that increases in distance to shoreline were associated with a slightly decreased likelihood of evacuation, whereas households reporting higher income had an increased probability of evacuation. The response in American Samoa was an effective one, with only 34 fatalities in a tsunami that reached shore in as little as 15 minutes. Consequently, future research should implement more qualitative study designs to identify event and cultural specific determinants of household evacuation behaviour to local tsunamis