A Legacy of Reform and Innovation: Celebrating the Children\u27s Bureau Centennial

Guest Editors Nancy Claiborne and Katharine Briar-Lawson introduce the latest issue of Journal of Family Strengths, celebrating the centennial of the Children\u27s Bureau

Recent trauma and acute infection as risk factors for childhood arterial ischemic stroke.

ObjectiveTrauma and acute infection have been associated with stroke in adults, and are prevalent exposures in children. We hypothesized that these environmental factors are independently associated with childhood arterial ischemic stroke (AIS).MethodsIn a case-control study nested within a cohort of 2.5 million children (≤19 years old) enrolled in an integrated health care plan (1993-2007), childhood AIS cases (n = 126) were identified from electronic records and confirmed through chart review. Age- and facility-matched controls (n = 378) were randomly selected from the cohort. Exposures were determined from review of medical records prior to the stroke diagnosis, or the same date for the paired controls; time windows were defined a priori.ResultsA medical encounter for head or neck trauma within the prior 12 weeks was an independent risk factor for childhood AIS (odds ratio [OR], 7.5; 95% confidence interval [CI], 2.9-19.3), present in 12% of cases (1.6% of controls). Median time from trauma to stroke was 0.5 days (interquartile range, 0-2 days); post hoc redefinition of trauma exposure (prior 1 week) was more strongly associated with AIS: OR, 39; 95% CI, 5.1-298. A medical encounter for a minor acute infection (prior 4 weeks) was also an independent risk factor (OR, 4.6; 95% CI, 2.6-8.2), present in 33% of cases (13% of controls). No single infection type predominated. Only 2 cases had exposure to trauma and infection.InterpretationTrauma and acute infection are common independent risk factors for childhood AIS, and may be targets for stroke prevention strategies

Societal Factors Impacting Child Welfare: Validating the Perceptions of Child Welfare Scale

Objective: This research examines the psychometric properties of the Perceptions of Child Welfare Scale (PCWS). This instrument is designed to assess child welfare workers ’ understanding of how society views their role and their work. Methods: Confirmatory factor analysis (CFA) was utilized to analyze data on 538 child welfare workers. Results: The final model consisted of three latent variables with 14 indicators related to stigma, value, and respect (w2 362.33, p .00; root mean square error of approximation [RMSEA] .09; 90 % confidence interval [CI]: [.08,.09]; comparative fit index [CFI] .96; Tucker–Lewis Index [TLI] .95). Discussion: The way in which workers believe others view their work suggests an increasingly complex prototype for understanding workforce issues. Those wishing to examine societal factors related to child welfare workforce issues could use this validated instrument

Design Teams as an Organizational Intervention to Improve Job Satisfaction and Worker Turnover in Public Child Welfare

This study focuses on the field test of a design team intervention in two rural and one urban site experiencing high workforce turnover. Hypothesis 1: Job satisfaction is significantly improved among public child welfare workers participating in the Design Team intervention. Hypothesis 2: Job satisfaction is significantly related to lower turnover in public child welfare workers participating in the Design Team intervention. The Design Team is an externally facilitated intervention in which team members consist of caseworkers and supervisors representing all services provided by the agency. The facilitator uses a formal logic model and team building expertise to guide the team. A pre-post design and structural equation modeling findings indicate a positive impact to overall worker job satisfaction and satisfaction with the nature of their work, and has strong potential to reduce turnover

Duration of hospital participation in a nationwide stroke registry is associated with improved quality of care

BACKGROUND: There are several proven therapies for patients with ischemic stroke or transient ischemic attack (TIA), including prophylaxis of deep venous thrombosis (DVT) and initiation of antithrombotic medications within 48 h and at discharge. Stroke registries have been promoted as a means of increasing use of such interventions, which are currently underutilized. METHODS: From 1999 through 2003, 86 U.S. hospitals participated in Ethos, a voluntary web-based acute stroke treatment registry. Detailed data were collected on all patients admitted with a diagnosis of TIA or ischemic stroke. Rates of optimal treatment (defined as either receipt or a valid contraindication) were examined within each hospital as a function of its length of time in registry. Generalized estimating equations were used to adjust for patient and hospital characteristics. RESULTS: A total of 16,301 patients were discharged with a diagnosis of stroke or TIA from 50 hospitals that participated for more than 1 year. Rates of optimal treatment during the first 3 months of participation were as follows: 92.5% for antithrombotic medication within 48 h, 84.6% for antithrombotic medications at discharge, and 77.1% for DVT prophylaxis. Rates for all treatments improved with duration of participation in the registry (p < 0.05), with the most dramatic improvements in the first year. CONCLUSION: In a large cohort of patients with stroke or TIA, three targeted quality-improvement measures improved among hospitals participating in a disease-specific registry. Although the changes could be attributed to interventions other than the registry, these findings demonstrate the potential for hospital-level interventions to improve care for patients with stroke and TIA

How Can Social Workers Improve Outcomes and Costs in Disease Management?

Disease management relies on a team approach to chronic diseases for which good treatment regimens are known and national data are available. Limitations of and opportunities for disease management programs are explored and a case is presented that the inclusion of social work can enhance the performance, outcomes, and cost-benefits of disease management teams. Social workers can attend to depression, other mental health issues, resources, family support, and communication, when other team members may be less able to do so. Social workers are particularly well suited to help patients have voice in their treatment, and to participate actively as decision makers in their own care. Preliminary data show that inclusion of social workers in disease management programs enhances patient outcomes and cost benefits.Disease-management-programmes

Introducing Habits of Critical Inquiry Across Academic Disciplines

First-year college students are introduced to habits and practices of academic inquiry that are novel to them but expected throughout their college experience. Though the forms of academic inquiry are rarely made explicit, introductory courses are tasked not only with teaching disciplinary knowledge, but also the basic character of intellectual life that is shared across disciplines. Our lesson study project was designed to help students identify and articulate the forms of inquiry through annotated readings and guided discussion. We will share our lesson plan; the results of our study employed in anthropology, philosophy and geology first-year writing seminars; and the challenges and possibilities we six instructors discovered through this multidisciplinary SoTL project. Participants will discuss the practices of academic inquiry in their classrooms, contribute to a shared list of its characteristics and obstacles, and develop strategies to modify our lesson plan for their own classrooms