Cost-Effectiveness of Comprehensive School Reform in Low Achieving Schools

We evaluated the cost-effectiveness of Struggling Schools, a user-generated approach to Comprehensive School Reform implemented in 100 low achieving schools serving disadvantaged students in a Canadian province. The results show that while Struggling Schools had a statistically significant positive effect on Grade 3 Reading achievement, d=.48 in 2005-06 and .60 in 2006-07, the program was not cost-effective when compared to two alternatives: 1. The cost of bringing one student to the provincial achievement standard was more than 25% higher in Struggling Schools than in the status quo. 2. The cost-effectiveness ratio (i.e., effect size per $1,000 of incremental cost) was lower in Struggling Schools than in Success For All. Struggling Schools would have been deemed to be cost-effective if different choices had been made, especially in (a) the calculation of costs (e.g., the inclusion of donated time), (b) the decision rules for declaring cost-effectiveness, and (c) the studies used to access comparative data.---Nous avons évalué le rapport cout-efficacité du programme Struggling Schools (écoles en difficulté), une approche générée par l'utilisateur à la réforme d'ensemble des écoles mise en œuvre dans 100 écoles peu performantes desservant des élèves défavorisés dans une province canadienne. Les résultats indiquent que si l'effet du programme Struggling Schools sur le rendement en lecture en 3e année était statistiquement significatif et positif (d= 0,48 en 2005-06 et 0,60 en 2006-07), son rapport cout-efficacité n'était pas aussi intéressant que celui des deux alternatives suivantes:1. Le cout de rehausser le rendement d'un élève pour qu'il atteigne le standard provincial était plus élevé de 25$ de cout différentiel) du programme Struggling Schools était plus bas que celui du programme Success for All.Le programme Struggling Schools aurait été jugé rentable si on avait choisi autrement, notamment par rapport (a) au calcul des couts (par ex. l'inclusion de la main d'œuvre à titre gratuit), (b) aux règlements portant sur les décisions quant aux critères de rentabilité, et (c) aux études employées pour accéder aux données de comparaison

Client-Centered Practice when Professional and Social Power are Uncoupled: The Experiences of Therapists from Marginalized Groups

Background: Client-centeredness is foundational to occupational therapy, yet virtually no research has examined this aspect of practice as experienced by therapists from marginalized groups. The discourse of client-centeredness implicitly assumes a “dominant-group” therapist. Professional power is assumed to be accompanied by social power and privilege. Here, we explore what happens when professional and social power are uncoupled. Method: In-depth interviews grounded in critical phenomenology were conducted with Canadian therapists (n = 20) who self-identified as disabled, minority sexual/gender identity (LGBTQ+), racialized, ethnic minority, and/or from working-class backgrounds. Iterative thematic analysis employed constant comparison using ATLAS.ti for team coding. Results: Clients mobilized social power conveying direct and indirect hostility toward the therapists. Clients used social power to undermine the professional credentials and competence of the therapists. In turn, the therapists strove to balance professional and social power, when possible disclosing marginalized identities only when beneficial to therapy. Strongly endorsing client-centered principles, the therapists faced considerable tension regarding how to respond to client hostility. Conclusions: The discourse of client-centeredness ignores the realities of marginalized therapists for whom professional power is not accompanied by social power. Better conceptualizing client-centeredness requires shifting the discourse to address practice dilemmas distinct to marginalized therapists working with clients who actively mobilize systemic oppression

Professional Misfits: “You’re Having to Perform . . . All Week Long”

Background: Occupational therapy professes commitment to equity and justice, and research is growing concerning the experiences of clients from marginalized groups. To date, almost no research explores the professional experiences of therapists from marginalized groups. This qualitative study explores how exclusion operates in the profession among colleagues. Method: Grounded in critical phenomenology, semi-structured in-depth interviews were conducted with 20 occupational therapists who self-identified as racialized, disabled, ethnic minority, minority sexual/gender identity (LGBTQ+), and/or from working-class backgrounds. Iterative analysis was conducted using constant comparison and employing ATLAS.ti for team coding. Results: Across identity groups, four processes of exclusion were identified: isolation, abrasion, presumptions of incompetence, and coerced assimilation. Garland-Thompson’s (2011) concept of “misfit” is employed to analyze how therapists are constructed as not-quite-fitting the professional space delimited by occupational therapy’s white, able-body-minded, Western, heterosexual, middle-class, cisgender norms. Conclusions: Misfits are constructed by contexts, by expectations and material arrangements that assume particular bodies. Misfits make visible the inequities built into business-as-usual, an illumination that comes at often-painful cost. Yet there is possibility for change toward equity and justice for therapist colleagues: we can all choose to do differently, enacting change at micro and macro levels

Routine care provided by specialists to children and adolescents in the United States (2002-2006).

BACKGROUND: Specialist physicians provide a large share of outpatient health care for children and adolescents in the United States, but little is known about the nature and content of these services in the ambulatory setting. Our objective was to quantify and characterize routine and co-managed pediatric healthcare as provided by specialists in community settings. METHODS: Nationally representative data were obtained from the National Ambulatory Medical Care Survey for the years 2002-2006. We included office based physicians (excluding family physicians, general internists and general pediatricians), and a representative sample of their patients aged 18 or less. Visits were classified into mutually exclusive categories based on the major reason for the visit, previous knowledge of the health problem, and whether the visit was the result of a referral. Primary diagnoses were classified using Expanded Diagnostic Clusters. Physician report of sharing care for the patient with another physician and frequency of reappointments were also collected. RESULTS: Overall, 41.3% out of about 174 million visits were for routine follow up and preventive care of patients already known to the specialist. Psychiatry, immunology and allergy, and dermatology accounted for 54.5% of all routine and preventive care visits. Attention deficit disorder, allergic rhinitis and disorders of the sebaceous glands accounted for about a third of these visits. Overall, 73.2% of all visits resulted in a return appointment with the same physician, in half of all cases as a result of a routine or preventive care visit. CONCLUSION: Ambulatory office-based pediatric care provided by specialists includes a large share of non referred routine and preventive care for common problems for patients already known to the physician. It is likely that many of these services could be managed in primary care settings, lessening demand for specialists and improving coordination of care.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Factors Impacting Primary Care Engagement in a New Approach to Integrating Care in Ontario, Canada.

INTRODUCTION: In 2019, Ontario\u27s Ministry of Health (the Ministry) introduced Ontario Health Teams (OHTs) to provide population-based integrated healthcare. Primary care was foundational to this approach. We sought to identify factors that impacted primary care engagement during OHT formation from different perspectives. METHODS: Interviews with 111 participants (administrators n = 80; primary care providers n = 17; patient family advisors = 14) from 11 OHTs were conducted following a semi-structured guide. Interviews were transcribed, coded, and thematically analyzed. RESULTS: Participants felt that primary care engagement was an ongoing, continuous cycle. Four themes were identified: 1) \u27A low rules environment\u27: limited direction from the Ministry (system-level), 2) \u27They\u27re at different starting points\u27: impact of local context (initiative-level); 3) \u27We want primary care to be actively involved\u27: engagement efforts made by OHTs (initiative-level); 4) \u27Waiting to hear a little bit more\u27: primary care concerns about the OHT approach (sector-level). Thirteen factors impacting primary care engagement were identified across the four themes. DISCUSSION AND CONCLUSION: The 13 factors influencing primary care engagement were interconnected and operated at health system, integrated care initiative, and sector levels. Future research should focus on integrated care initiatives as they mature, to address potential gaps in the involvement of primary care physicians

The Portrayal of Complementary and Alternative Medicine in Mass Print Magazines Since 1980

Objectives: The objectives of this study were to examine and describe the portrayal of complementary and alternative medicine (CAM) in mass print media magazines. Design: The sample included all 37 articles found in magazines with circulation rates of greater than 1 million published in the United States and Canada from 1980 to 2005. The analysis was quantitative and qualitative and included investigation of both manifest and latent magazine story messages. Results: Manifest analysis noted that CAM was largely represented as a treatment for a patient with a medically diagnosed illness or specific symptoms. Discussions used biomedical terms such as patient rather than consumer and disease rather than wellness. Latent analysis revealed three themes: (1) CAMs were described as good but not good enough; (2) individualism and consumerism were venerated; and (3) questions of costs were raised in the context of confusion and ambivalence

A survey of primary and specialised health care provision to prisons in England and Wales

Background Prison health care in England, including primary care, is now incorporated into the National Health Service; the impetus for the change is in part due to concern about standards of health care within prisons. The demographic characteristics and health status of patients within prisons are relatively well understood, as are the problems faced by health care professionals. Less is known about current health care provision. Aims To describe the organisation of primary health care and specialised services in prisons and compare services available to different types of prison. Method A piloted questionnaire was sent to the governors of all prisons in England and Wales for completion by the health care manager. Findings Completed questionnaires were received from 122 (89%) of 138 prisons. The survey showed a low use of information technology (IT). Problems were reported with the recruitment and retention of general nurses in more than 50% of prisons. Prisoners in category A/B (higher security) prisons had available to them a greater range of health care services compared with those in other prisons. The results suggest that provision of services for chronic diseases and improvements in IT are needed. Problems with the recruitment and retention of general nurses need addressing. The reasons why lower-security prisoners are receiving a narrower range of specialised health care services compared with higher-security prisoners need justifying

Implementation of outpatient total joint arthroplasty in canada: Where we are and where we need to go

© 2020 Zomar et al. Total joint arthroplasties (TJA) are successful procedures for the treatment of end-stage hip and knee arthritis. Length of stay in hospitals after these procedures has been steadily decreasing over time, with outpatient procedures (discharge on the same day as surgery) introduced in the US within the last 20 years. Reducing length of stay after TJA can provide cost savings. Centres in Canada have started to utilize outpatient TJA procedures, but we have identified some barriers that may have limited their implementation. We have summarized the current literature for outpatient TJA and discussed potential solutions for the current barriers