Adverse Childhood Experiences Among Adolescents with Autism Spectrum Disorder: Implications for School-Based Interventions

An autism spectrum disorder (ASD) diagnosis in childhood comes with inherent vulnerability to adverse experiences. For some, the developmental process of adolescence overwhelms their altered neural system, exacerbating this vulnerability. Adolescence presents an opportunity to mitigate the negative effects of adverse childhood experiences (ACEs) on the developing brain. However, little is known about children who have both ASD and a history of ACEs. This study, first sought to understand the prevalence of ACEs among adolescents with ASD and whether those who have experienced ACEs are placed at further risk for other social and emotional challenges, impacting their transition into adulthood. With adolescents being highly sensitized to their environment, opportunities for intervention in their environments may mitigate the long-term consequences of ACEs. Due to adolescents spending a great deal of their time in school, developing interventions to support those with ASD that can be implemented within the school would be beneficial. Thus, the second aim of this study was to understand how schools can serve as a place for trauma-informed intervention. The Whole School, Whole Community, Whole Child (WSCC) model served as the conceptual framework for this mixed-methods study. Data from the 2020 National Survey of Children’s Health (NSCH) were examined to determine the prevalence of ACEs and further risk for social-emotional issues in adolescents with ASD. Focus groups and semi-structured interviews were conducted with school personnel in public schools to understand how they respond to typically developing and ASD students who have experienced ACEs. The findings showed that 60% of adolescents with ASD had experienced ACEs. Additionally, significant associations were found between the experience of ACEs and a diagnosis of anxiety, depression and ADHD. Furthermore, the experience of ACEs was associated with being bullied, however, no significant association was found with their ability to make friends. Great variability exists in the way schools respond to ACEs, if at all, and lack consistency and clarity in their SEL practices. Therefore, there is a need to identify the school climate components that are needed to provide trauma-informed interventions and determine how to scale these interventions. Further, with the heterogeneity of the ASD profile, identifying which factors are associated with this risk will be helpful in providing tailored interventions, specifically in the school environment

Does community health care requires different competencies from physicians and nurses?

Background: In Health Professionals Education, recently competency based approach has gained a lot of popularity. For community settings it has specific relevance as often fully functional health teams are not available to provide comprehensive care to the populations, and the health providers who work in such isolated settings need not only be competent in their own professions but also must be able to perform the roles of health team members who are not available. Utilizing an earlier published systematic review on Competencies for Community based education (CBE) as framework, this study examined the specific tasks of health providers and variations in their competencies in a context where not many health providers are available to work. Methods: In-depth Interviews of 11 Physicians’ and 6 Registered Nurses (RNs) working in community settings managed either by Government, NGO or Universities of Pakistan were conducted along with review of their job descriptions. Results: The most frequently required competency for physicians is “direct patient care” and for nurses it is either “public health” or “administration”. Location of health facility or level of care does not demand different competencies, however depending on the employer the required competencies do vary. The critical factors in determining the tasks performed by health providers were availability of a functional health team and the preparation of health providers for CBE competencies. Conclusions: The specific tasks of physicians and RNs working in community settings provide a useful framework to analyze competencies, and can help educators revisit the curricula and instructional designs. The results provide important insight into the practice of community health provision which should be utilized by educators and policy makers alike for production and deployment of appropriately competent healthcare providers. Key words: - Community Based Education - Health Professionals - Competencies - Job descriptio

Nurses

Nursing is an important part of society, as it serves the health care needs of people everywhere. Nurses may be differentiated from other health care providers by their approach to patient care, training, and scope of practice. Nurses practice in a broad diversity of practice areas with a range of practices. Nurses have influenced health care globally by actively participating in policymaking, by continuously reviewing their roles according to the health care needs of the populations they serve, and by contributing to the health care in hospitals, in rural areas, and in the community. They also make an important contribution to education, administration, and research

Does community health care require different competencies from physicians and nurses?

BACKGROUND: Recently competency approach in Health Professionals’ Education (HPE) has become quite popular and for an effective competency based HPE, it is important to design the curriculum around the health care needs of the population to be served and on the expected roles of the health care providers. Unfortunately, in community settings roles of health providers tend to be described less clearly, particularly at the Primary Health Care (PHC) level where a multidisciplinary and appropriately prepared health team is generally lacking. Moreover, to tailor the education on community needs there is no substantial evidence on what specific requirements the providers must be prepared for. METHODS: This study has explored specific tasks of physicians and nurses employed to work in primary or secondary health care units in a context where there is a structural scarcity of community health care providers. In-depth Interviews of 11 physicians and 06 nurses working in community settings of Pakistan were conducted along with review of their job descriptions. RESULTS: At all levels of health settings, physicians’ were mostly engaged with diagnosing and prescribing medical illness of patients coming to health center and nurses depending on their employer were either providing preventive health care activities, assisting physicians or occupied in day to day management of health center. Geographical location or level of health facility did not have major effect on the roles being expected or performed, however the factors that determined the roles performed by health providers were employer expectations, preparation of health providers for providing community based care, role clarity and availability of resources including health team at health facilities. CONCLUSIONS: Exploration of specific tasks of physicians and nurses working in community settings provide a useful framework to map competencies, and can help educators revisit the curricula and instructional designs accordingly. Furthermore, in community settings there are many synergies between the roles of physicians and nurses which could be simulated as learning activities; at the same time these two groups of health providers offer distinct sets of services, which must be harnessed to build effective, non-hierarchal, collaborative health teams

Competence, commitment and opportunity: an exploration of faculty views and perceptions on community- based education

BACKGROUND: Community-Based Education (CBE) is an instructional approach designed and carried out in a community context and environment in which not only students, but also faculty and Health Professionals’ Education (HPE) institutions must be actively engaged throughout the educational experience. Despite the growing evidence of CBE being an effective approach for contemporary HPE, doubts about its successful implementation still exist. This study has explored HPE structure, policies and curriculum from the point of view of faculty members to gain understanding about the prevailing practices and to propose recommendations that nurtures and promotes CBE. METHOD: A purposive sample was drawn from three major cities of Pakistan- Karachi, Rawalpindi and Islamabad. Out of twelve HPE institutions present in these cities we selected six, which provided a sound representation of medical and nursing colleges around the country. At each institution we had two Focus Group Discussions; in addition we interviewed registrars of medical and nursing councils and two CBE experts. RESULTS: The factors effecting implementation of CBE as perceived by study participants are categorized as: preparation of faculty members; institutional commitment and enthusiasm; curricular priorities and external milieu. Within each theme, participants recurrently described structural and curricular deficiencies, and lack of commitment and appreciation for community based teaching, service and research permeating at all levels: regulatory bodies, institutional heads and faculty members. CONCLUSIONS: The factors highlighted by our study and many others suggest that CBE could not perpetuate effectively within HPE. To enhance the effectiveness of CBE approach in a way that mutually benefits local communities as well as HPE institutions and health professionals, it is important that reforms in HPE must be strategized in a holistic fashion i.e. restructuring and aligning its polices, curriculum and research priorities

Competencies for undergraduate community-based education for the health professions - A systematic review

Background: Community-based education (CBE) along with competency approach is increasingly becoming popular. However, there appears to be lack of evidence on CBE competencies for undergraduate curriculum, therefore this systematic review attempted to identify and categorize CBE competencies to determine the ones used frequently. Aims: The systematic review aimed at identifying and categorizing CBE competencies implemented in nursing and medical schools to inform all stakeholders of health professional's education. Method: A systematic review of electronic databases including MEDLINE, CINAHL, and ERIC and manual search of four medical education journals was carried out. Search was restricted to original research, published in English language between January 2000 and December 2009. Results: Nineteen studies fulfilled the search criteria. The competencies identified were categorized under six themes: Public Health; Cultural Competence; Leadership and Management; Community Development; Research; and Generic Competencies. Moreover, a number of clinical competencies were also found to be overlapping with CBE. Conclusions: The literature on CBE competencies is limited in number and in its geographical span as most of the studies found was from developed countries; to expand the efforts to other institutions and countries, core competencies for CBE must be recognized and disseminated widely for its integration in health professionals' curriculum

Competencies for undergraduate community-based education for the health professions - A systematic review

Background: Community-based education (CBE) along with competency approach is increasingly becoming popular. However, there appears to be lack of evidence on CBE competencies for undergraduate curriculum, therefore this systematic review attempted to identify and categorize CBE competencies to determine the ones used frequently. Aims: The systematic review aimed at identifying and categorizing CBE competencies implemented in nursing and medical schools to inform all stakeholders of health professional's education. Method: A systematic review of electronic databases including MEDLINE, CINAHL, and ERIC and manual search of four medical education journals was carried out. Search was restricted to original research, published in English language between January 2000 and December 2009. Results: Nineteen studies fulfilled the search criteria. The competencies identified were categorized under six themes: Public Health; Cultural Competence; Leadership and Management; Community Development; Research; and Generic Competencies. Moreover, a number of clinical competencies were also found to be overlapping with CBE. Conclusions: The literature on CBE competencies is limited in number and in its geographical span as most of the studies found was from developed countries; to expand the efforts to other institutions and countries, core competencies for CBE must be recognized and disseminated widely for its integration in health professionals' curriculum