Elevating Nebraska’s Early Childhood Workforce: Report and Recommendations of the Nebraska Early Childhood Workforce Commission

Executive Summary The science of early childhood development makes clear that the early years, from birth through age 8, are a time of unparalleled human growth and development— and that healthy development during these pivotal early years requires reliable, positive, and consistent interactions between the developing child and familiar, caring adults. Because of today’s economy, in which most parents of young children work outside the home, families often rely on early childhood professionals to provide positive interactions and experiences that young children need to thrive. Yet, despite what we know about the critical role of early childhood professionals in young children’s development, the early childhood workforce in our nation and in our state is undervalued and underpaid—which makes it difficult to retain the highly qualified professionals currently in the workforce as well as recruit those needed to meet the growing demand for early care and education. In Nebraska, 75 percent of children under the age of 6 live in homes where all adults in their family work outside the home. Increasing the number of highly qualified early childhood professionals is essential if we are to meet the growing demand across the state for learning environments where children can thrive and begin to meet their potential—and where Nebraska’s working parents can feel confident placing their children while they work and support their families. Viewed through the prism of the state’s alarming shortage of 58,000 workers, the need for high-quality early care and education takes on additional urgency. If we are to meet Nebraska’s workforce needs now and in the future, we must ensure all children and families in the state have equitable access to affordable, high-quality early care and education. In 2017, the Nebraska Early Childhood Workforce Commission came together to address how best to strengthen and expand Nebraska’s early childhood workforce. The commission was a collaborative group of more than 40 publicand private-sector leaders representing systems that influence the overall quality and delivery of early care and education—including those involved in professional preparation and learning, early care and education delivery, and policymaking, as well as local business, philanthropic, and community leaders. The commission worked for the past three years in collaboration with others from across the state to identify the strengths and challenges of Nebraska’s early childhood workforce and examine the potential of early care and education in the state

Playing well with others: a case study of collective impact in the early care and education policy arena

The quality and quantity of early childhood care and education services have risen as a key reform area for influencing educational and economic outcomes. However, changes in this policy arena are stymied by the fragmentation of this policy arena. Collaborative approaches have been proposed to create systems-level change. Collective impact is one such approach; however, few examples exist in the early childhood care and education literature, especially at the state level. This ethnographic case study conceptualizes collective impact as a policy network capable of change in a fractured policy arena and reports the results from the first year of a statewide collective impact effort examines stakeholder perceptions of mobilization and development of a common agenda, or shared understandings. The results illustrate the importance of relationship building, ongoing attention to common understandings through multiple processes and mechanisms, the importance of the backbone organization, and the need to attend to mindset shifts that accompany early collective impact work

Playing well with others: a case study of collective impact in the early care and education policy arena

The quality and quantity of early childhood care and education services have risen as a key reform area for influencing educational and economic outcomes. However, changes in this policy arena are stymied by the fragmentation of this policy arena. Collaborative approaches have been proposed to create systems-level change. Collective impact is one such approach; however, few examples exist in the early childhood care and education literature, especially at the state level. This ethnographic case study conceptualizes collective impact as a policy network capable of change in a fractured policy arena and reports the results from the first year of a statewide collective impact effort examines stakeholder perceptions of mobilization and development of a common agenda, or shared understandings. The results illustrate the importance of relationship building, ongoing attention to common understandings through multiple processes and mechanisms, the importance of the backbone organization, and the need to attend to mindset shifts that accompany early collective impact work

Reconciling healthcare professional and patient perspectives in the development of disease activity and response criteria in connective tissue disease-related interstitial lung diseases

Interstitial lung diseases (ILD), including those related to connective tissue disease (CTD), and idiopathic pulmonary fibrosis (IPF) carry high morbidity and mortality. Great efforts are under way to develop and investigate meaningful treatments in the context of clinical trials. However, efforts have been challenged by a lack of validated outcome measures and by inconsistent use of measures in clinical trials. Lack of consensus has fragmented effective use of strategies in CTD-ILD and IPF, with a history of resultant difficulties in obtaining agency approval of treatment interventions. Until recently, the patient perspective to determine domains and outcome measures in CTD-ILD and IPF had never been applied. Efforts described here demonstrate unequivocally the value and influence of patient involvement on core set development. Regarding CTD-ILD, this is the first OMERACT working group to directly address a manifestation/comorbidity of a rheumatic disease (ILD) as well as a disease not considered rheumatic (IPF). The OMERACT 11 proceedings of the CTD-ILD Working Group describe the forward and lateral process to include both the medical and patient perspectives in the urgently needed identification of a core set of preliminary domains and outcome measures in CTD-ILD and IPF

Perceptions of patients, caregivers, and healthcare providers of idiopathic inflammatory myopathies: An international OMERACT study

Objective. Patient-reported outcome measures (PROM) that incorporate the patient perspective have not been well established in idiopathic inflammatory myopathies (IIM). As part of our goal to develop IIM-specific PROM, the Outcome Measures in Rheumatology (OMERACT) Myositis special interest group sought to determine which aspects of disease and its effects are important to patients and healthcare providers (HCP). Methods. Based on a prior qualitative content analysis of focus groups, an initial list of 24 candidate domains was constructed. We subsequently conducted an international survey to identify the importance of each of the 24 domains to be assessed in clinical research. Patients with IIM, their caregivers, and HCP treating IIM completed the survey. Results. In this survey, a total of 638 respondents completed the survey, consisting of 510 patients, 101 HCP, and 27 caregivers from 48 countries. Overall, patients were more likely to rank “fatigue,” “cognitive impact,” and “difficulty sleeping” higher compared with HCP, who ranked “joint symptoms,” “lung symptoms,” and “dysphagia” higher. Both patients and providers rated muscle symptoms as their top domain. In general, patients from different countries were in agreement on which domains were most important. One notable exception was that patients from Sweden and the Netherlands ranked lung symptoms significantly higher compared to other countries including the United States and Australia (mean weighted rankings of 2.86 and 2.04 vs 0.76 and 0.80, respectively; p < 0.0001). Conclusion. Substantial differences exist in how IIM is perceived by patients compared to HCP, with different domains prioritized. In contrast, patients' ratings across the world were largely similar

Responsiveness and meaningful thresholds of PROMIS pain interference, fatigue, and physical function forms in adults with idiopathic inflammatory myopathies: Report from the OMERACT Myositis Working Group

Background: A series of qualitative studies conducted by the OMERACT Myositis Working Group identified pain interference, fatigue, and physical function as highly important life impact domains for adults with idiopathic inflammatory myositis (IIM). In this study, our goal was to assess the responsiveness and minimal important difference of PROMIS pain interference (6a), fatigue (7a), and physical function (8b). Methods: Adults with IIM from USA, Netherlands, Korea, Sweden, and Australia with two clinical visits were enrolled in this prospective study. Anchor questions on a Likert scale were collected at baseline, and manual muscle testing (MMT), physician and patient reported global disease activity, and PROMIS instruments were collected at both visits. Responsiveness was assessed with i) ANOVA, ii) paired t-test, effect size and standardized response mean, and iii) Pearson correlation. Minimal important difference (MID), minimal important change (MIC) and minimal detectable change (MDC) values were calculated. Results: 114 patients with IIM (median age 60, 60 % female) completed both visits. Changes in PROMIS instruments were significantly different among anchor categories. Patients who reported improvement had a significant improvement in their PROMIS scores with at least medium effect size, while patients who reported worsening and stability did not show a significant change with weak effect size. PROMIS instruments had weak to moderate correlations with MMT, patient and physician global disease activity. MID was approximately 2–3 points for Pain Interference and 3–4 points for Fatigue and Physical Functio

Myositis SIG Personal non-commercial use only

ABSTRACT. The newly formed Outcome Measures in Rheumatology (OMERACT) Myositis Special Interest Group (SIG) was established to examine patient-reported outcome measures (PROM) in myositis. At OMERACT 11, a literature review of PROM used in the idiopathic inflammatory myopathies (IIM) and other neuromuscular conditions was presented. The group examined in more detail 2 PROM more extensively evaluated in patients with IIM, the Myositis Activities Profile, and the McMaster-Toronto Arthritis Patient Preference Disability Questionnaire, through the OMERACT filter of truth, discrimination, and feasibility. Preliminary results from a qualitative study of patients with myositis regarding their symptoms were discussed that emphasized the range of symptoms experienced: pain, physical tightness/stiffness, fatigue, disease effect on emotional life and relationships, and treatment-related side effects. Following discussion of these results and following additional discussions since OMERACT 11, a research agenda was developed. The next step in evaluating PROM in IIM will require additional focus groups with a spectrum of patients with different myositis disease phenotypes and manifestations across a range of disease activity, and from multiple international settings. The group will initially focus on dermatomyositis and polymyositis in adults. Qualitative analysis will facilitate the identification of commonalities and divergent patient-relevant aspects of disease, insights that are critical given the heterogeneous manifestations of these diseases. Based on these qualitative studies, existing myositis PROM can be examined to more thoroughly assess content validity, and will be important to identify gaps in domain measurement that will be required to develop a preliminary core set of patient-relevant domains fo

Outcome measures for clinical trials in interstitial lung diseases

The chronic fibrosing idiopathic interstitial pneumonias (IIPs) are a group of heterogeneous pulmonary parenchymal disorders described by radiologic and histological patterns termed usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP). These include idiopathic pulmonary fibrosis (IPF) and those related to connective tissue disease (CTD) and are associated with substantial morbidity and mortality. Beyond the importance of establishing an appropriate diagnosis, designing optimal clinical trials for IIPs has been fraught with difficulties in consistency of clinical endpoints making power analyses, and the establishment of efficacy and interpretation of results across trials challenging. Preliminary recommendations, developed by rigorous consensus methods, proposed a minimum set of outcome measures, a ‘core set’, to be incorporated into future clinical trials (Saketkoo et al, THORAX. 2014.). This paper sets out to examine the candidate instruments for each domain (Dyspnea, Cough, Health Related Quality of Life, Imaging, Lung Physiology and Function, Mortality). Candidate measures that were not selected as well as measures that were not available for examination at the time of the consensus process will also be discussed