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The purpose of this study was to evaluate the antimicrobial efficacy of an aqueous ozone (Bio-Safe) treatment and lactic acid solutions on natural microbiota and E. coli O157:H7 and Salmonella surrogates on beef carcasses and trim in a commercial beef processing plant. For every repetition, 40 carcass and 40 trim swabs (500 cm2) were collected. Samples were taken using EZ-ReachTM swabs, and plated into aerobic plate count (APC), coliform, and E. coli PetrifilmTM for enumeration. In addition, a five-strain cocktail (MP-26) of E. coli surrogates was inoculated onto trim. For every trim surrogate repetition, 30 trim pieces were sampled after attachment and after ozone intervention. Samples were diluted and counts were determined using the TEMPO® system for E. coli enumeration. Ozone and lactic acid interventions significantly reduced (p &lt, 0.003) bacterial counts in carcasses and trim samples. Moreover, lactic acid further reduced APC and coliforms in trim samples compared to ozone intervention (p &lt, 0.009). In the surrogate trials, ozone significantly reduced (p &lt, 0.001) surrogate concentration. Historical data from the plant revealed a reduction (p &lt, 0.001) of presumptive E. coli O157:H7 in trim after a full year of ozone intervention implementation. The novel technology for ozone generation and application as an antimicrobial can become an alternative option that may also act synergistically with existing interventions, minimizing the risk of pathogens such as Salmonella and E. coli O157:H7.

For evidence-based interventions to be effective for students they must be consistently implemented, however, many teachers struggle with treatment integrity and require support. Although many implementation support strategies are research based, there is little empirical guidance about the types of treatment integrity, implementers, and contexts these strategies are best suited to address. To facilitate the data-driven identification of implementation supports, treatment integrity and the implementation context could be evaluated through an applied behavior analysis (ABA) lens. That is, teachers’ engagement in intervention implementation or competing behaviors could be considered to be occasioned by antecedents (e.g., prompts, setting) and maintained by consequences (e.g., escape intervention, access to attention). This article describes the conceptualization of treatment integrity within an antecedent-behavior-consequence framework. The current landscape and limitations of school-based treatment integrity research are reviewed and the application of ABA technology to address implementer behavior is described. Further, the article provides practical strategies for how school psychologists might apply this conceptualization to support teachers. A case study is provided to illustrate associated research-based strategies. Last, implications and limitations are described.

School psychologists are tasked with ensuring treatment integrity because the level of intervention implementation affects decisions about student progress. Treatment integrity includes multiple dimensions that may impact the effectiveness of an intervention including adherence, dosage, quality, and engagement. Unfortunately, treatment integrity is not routinely monitored in consultation. A systematic framework is needed to better prepare practitioners to assess, analyze, and intervene when there are treatment integrity failures. A framework for monitoring and improving multiple dimensions of treatment integrity in natural settings is proposed to provide guidance to practitioners through two phases. The first phase focuses on improving initial treatment integrity and the second phase outlines a problem-solving process for improving treatment integrity.

Background: There has been a considerable endeavor to understand associated challenges of caregiving for a child with Autism Spectrum Disorders (ASDs) and to develop the necessary skills and approaches to assist parents of children with ASD. Different studies have been stressed the importance and need for parental involvement in the intervention process to increase positive impacts. Methods: The process of caregiving and the associated challenges should be understood from different aspects to be able to facilitate parent involvement in intervention implementation. In a narrative literature review, ten selected reviews were considered and each review considered a special aspect of caregiving for an individual with ASD. Results: Five main different factors in the available literature and reviews were considered as different themes that needed to be reconsidered in the studies on the impacts of caregiving for an individual with ASD. Conclusions: It is concluded that to facilitate parental involvement in the intervention process, and to support caregivers of this group of individuals this review highlights the need for improved research in some proposed areas in this field and to bridge the gap between research and practice in this field.

This chapter provides a detailed account of the practical steps involved in intervention planning and delivery. A generic template for action is presented, which can be used to guide planning and implementation across a range of mental health promotion interventions and settings. This information provides a useful base for informing the more practical steps involved in successfully putting interventions into practice, including the stages of programme planning, implementation, evaluation and sustainability. Recommendations for supporting the quality of intervention implementation are outlined.

ObjectivesHaemorrhage remains the leading cause of maternal mortality in Central America. The Salud Mesoamérica Initiative aims to reduce such mortality via performance indicators. Our objective was to assess the availability and administration of oxytocin, before and after applying Salud Mesoamérica Initiative interventions in the poorest health facilities across Central America.DesignPre-post study.Setting166 basic-level and comprehensive-level health facilities in Belize, Guatemala, Honduras, Mexico, Nicaragua and Panama.ParticipantsA random sample of medical records for uncomplicated full-term deliveries (n=2470) per International Classification of Diseases coding at baseline (July 2011 to August 2013) and at first-phase follow-up (January 2014 to October 2014).InterventionsA year of intervention implementation prior to first-phase follow-up data collection focused on improving access to oxytocin by strengthening supply chains, procurement, storage practices and pharmacy inventory monitoring, using a results-based financing model.Primary and secondary outcome measuresOxytocin availability (primary outcome) and administration (secondary outcome) for postpartum haemorrhage prevention.ResultsAvailability of oxytocin increased from 82.9% to 97.6%. Oxytocin administration increased from 83.6% to 88.4%. Significant improvements were seen for availability of oxytocin (adjusted OR (aOR)=8.41, 95% CI 1.50 to 47.30). Administration of oxytocin was found to be significantly higher in Honduras (aOR=2.96; 95% CI 1.00 to 8.76) in reference to Guatemala at follow-up.ConclusionAfter interventions to increase health facility supplies, the study showed a significant improvement in availability but not administration of oxytocin in poor communities within Mesoamerica. Efforts are needed to improve the use of oxytocin.

Imitation is an important early social communicative skill that is often impaired in young children with autism. Reciprocal imitation training is an easy-to-implement intervention that targets social imitation and can be taught to parents or other caregivers to implement at home and in the community. In this study, parents of children with autism were taught to implement reciprocal imitation training. The quality of parent fidelity of intervention implementation and rates of child spontaneous imitation were examined in three phases: baseline, post-didactic training, and after the introduction of 1:1 coaching. The results suggest that coaching improved parent fidelity with all parent participants, and this correlated to an increase in spontaneous imitation with some of the child participants.

The National Comprehensive Cancer Control Program has experienced exponential growth over the past 20 years due to the coordination and collaboration of many stakeholders to sustain multisector coalitions, develop and execute data-driven plans, and successfully implement evidenced-based interventions across the United States. These stakeholders have worked tirelessly to address the burden of cancer by employing strategies that promote healthy behaviors to reduce cancer risk, facilitate screening, and address the needs of cancer survivors. The interaction between the comprehensive cancer control program and the coalitions to engage in this work has been coined the 3Ps: the partnership, the CCC plan, and CCC program interventions. This article describes the efforts to evaluate the growth of the comprehensive cancer control movement, especially as it pertains to coalition contribution, plan priority development and implementation, and intervention implementation. It describes successes and lessons learned from an evaluation whose findings can be used to bolster and sustain comprehensive cancer control programs and coalitions across the U.S.

Reports on the behavioral health workforce highlight the need to enhance evidence-based capacity; evidence-based interventions incorporated into pre-service graduate curricula (coursework and fieldwork) are needed to meet this goal. Improving educational practices across pre-service settings will require understanding of and careful attention to the contextual factors that exert pressure on curricula. The authors believe efforts to change educational practices can be enhanced by application of implementation science principles. This Open Forum delineates the key contextual factors that influence pre-service education, highlights gaps in the literature, and proposes an agenda for future research at the intersection of behavioral health workforce development and implementation science.

Increasing emphasis is being placed on providing educational interventions for children with learning and behavioral problems in the least restrictive environment (LR£). This results in greater pressure on teachers, who often have had little or no specialized training in classroom management and individualized educational needs (Peterson & Casey, 1991). Efforts to assist teachers working with students having difBculty^ usually involve teachers using a problem-solving process to develop individualized interventions. However, little applied research has been conducted to confirm the critical factors important in developing and implementing interventions to achieve positive student outcomes in school settings. Several of the factors si^ested to be critical in intervention implementation include intervention acceptability, integrity, and effectiveness. Most school-based intervention plans do not include assessment of these factors. Both intervention acceptability and integrity are hypothesized to influence intervention implementation and effectiveness. Little research has been completed to examine interventions in applied settings to determine if the hypothesized relationships between these intervention factors exists. The overall purpose of this project was to assess the relationships between intervention acceptability, intervention integrity, and the effectiveness of classroom interventions using two studies. The first study involved observing interventions as they were implemented in elementary classroom settings. The second study used a survey to ask

OBJECTIVE: Non-pharmacologic treatments (NPTs) are recommended for chronic pain. Information is limited on patient use or perceptions of NPTs. We examined the frequency and correlates of use and self-rated helpfulness of NPTs for chronic pain among patients who are prescribed long-term opioid therapy (LTOT). METHODS: Participants (n = 517) with musculoskeletal pain who were prescribed LTOT were recruited from two integrated health systems. They rated the frequency and utility of six clinician-directed and five self-directed NPTs for chronic pain. We categorized NPT use at four levels based on number of interventions used and frequency of use (none, low, moderate, high). Analyses examined clinical and demographic factors that differed among groups for both clinician-directed and self-directed NPTs. RESULTS: Seventy-one percent of participants reported use of any NPT for pain within the prior 6 months. NPTs were rated as being helpful by more than 50% of users for all treatments assessed (range 51–79%). High users of clinician-directed NPTs were younger than non-users or low-frequency users and had the most depressive symptoms. In both clinician-directed and self-directed categories, high NPT users had significantly higher pain disability compared to non-NPT users. No significant group differences were detected on other demographic or clinical variables. In multivariable analyses, clinician-directed NPT use was modestly associated with younger age (OR = 0.97, 95% CI = 0.96–0.98) and higher pain disability (OR = 1.01, 95% CI = 1.00–1.02). Variables associated with greater self-directed NPT use were some college education (OR = 1.80, 95% CI = 1.13–2.84), college graduate or more (OR = 2.02, 95% CI = 1.20–3.40), and higher pain disability (OR = 1.01, 95% CI = 1.01–1.02). CONCLUSIONS: NPT use was associated with higher pain disability and younger age for both clinician-directed and self-directed NPTs and higher education for self-directed NPTs. These strategies were rated as helpful by those that used them. These results can inform intervention implementation and be used to increase engagement in NPTs for chronic pain.

This article describes the use of Teacher Impression Journals during a larger study that examined the efficacy of an intervention program designed to promote kindergarteners’ positive attitudes toward peers with disabilities (i.e., the Special Friends program). The journals were designed to gather information about intervention implementation and social validity. Weekly Teacher Impression Journals were collected from 32 teachers over a 6-week period. Each week teachers responded to questions related to the implementation of two interventions: children’s behaviors related to the study’s primary focus (i.e., acceptance of individuals with disabilities) and comments from key stakeholders (i.e., parents, other school professionals). Teachers’ responses were analyzed using content analysis. Results revealed that teachers observed play interactions as evidence of children’s acceptance of peers with disabilities. Teachers also reported hearing positive comments from other stakeholders about children’s acceptance as well as about the interventions. Suggestions for research and implications for practice are discussed.

For many practitioners in schools and clinics, collecting data to show the effectiveness of an intervention is probably one of the most important yet challenging components of intervention implementation. This article provides practitioners with an example case study of how data can be organized and collected to determine the effectiveness of a social skills group intervention. Techniques to establish individual and group goals, determine a method to collect data, collect baseline data, and monitor progress are described. Challenges and practical strategies are discussed, and useful and specific suggestions are provided.

Interventional researchers face many design challenges when assessing intervention implementation in real-world settings. Intervention implementation requires holding fast on internal validity needs while incorporating external validity considerations (such as uptake by diverse subpopulations, acceptability, cost, and sustainability). Quasi-experimental designs (QEDs) are increasingly employed to achieve a balance between internal and external validity. Although these designs are often referred to and summarized in terms of logistical benefits, there is still uncertainty about (a) selecting from among various QEDs and (b) developing strategies to strengthen the internal and external validity of QEDs. We focus here on commonly used QEDs (prepost designs with nonequivalent control groups, interrupted time series, and stepped-wedge designs) and discuss several variants that maximize internal and external validity at the design, execution and implementation, and analysis stages.

Chapter 10 will focus on the implementation of evidence-based practices and principles in criminal justice and social service settings. The purpose of Chapter 3 is to examine the importance of implementation fidelity. This chapter provides an overview of the emergence and importance of implementation fidelity, adherence to fidelity in both the research process as well as during intervention implementation and delivery, measuring fidelity using valid and reliable measurement approaches, and clinical guidelines for enhancing treatment fidelity. Used more often in research studies, fidelity is often given little attention in real world criminal justice settings. Neglecting implementation fidelity has significant consequences that can negatively impact clinical and behavioral outcomes among criminal justice populations. As such, this chapter builds upon concepts discussed in Chapters 2 and 10 Chapter 17 Chapter 19 .

This article describes and comments further on the content of five articles published in School Mental Health (viz., Coles et al. 2015; Cook et al. 2015; Pas et al. 2015; Shernoff et al. 2015; Sutherland et al. 2015). Although these studies used a variety of research designs, most employed supportive coaching procedures to persuade teachers to implement evidence-based practices with high integrity. Thoughts regarding coaching and consultation as vehicles for providing support to teachers are offered, as are opinions on the value of assessing various constructs within coaching/consultation research (i.e., teachers’ beliefs, attitudes, knowledge, and/or skills in relation to enhancing intervention implementation; procedural integrity of the coaching/consultation procedure itself; and student outcomes).

Classroom behavior management strategies are effective in reducing impairment and improving functioning in children with or at risk of ADHD. Although these interventions are well established, there is significant concern about the integrity with which teachers implement these strategies. Possible barriers to integrity include limitations in teachers’ knowledge of ADHD and classroom management strategies, limitations in classroom management skills, and beliefs that may interfere with intervention implementation. We hypothesize that these barriers are malleable and can be targeted in school-based consultation programs. In this paper, we describe the development of a multi-component consultation package designed to address teacher knowledge, skills, and beliefs as a mechanism for enhancing intervention implementation integrity and student outcomes. Using a case study design, we examined the hypothesized relationships between the consultation strategies, intervention integrity, and student outcomes. Results provide initial support for the multi-component package and our theory of change. Limitations that will inform continued development of the package are discussed.

Background: Interventions, whether simple or complex, are increasing in health care in response to the growing complexity and acuity of patient’s conditions. Monitoring the fidelity of implementing interventions is challenging. A common method to assess and monitor fidelity of intervention implementation is through a structured, reliable and valid instrument. Purpose: The purpose of this paper is to examine existing instruments measuring fidelity of intervention implementation in order to determine aspects of fidelity that have been assessed and reported on the reliability and validity of these instruments. Design: A descriptive review was conducted. Studies were included if they described and reported on the fidelity of intervention implementation instruments, their psychometric properties were published between 1980 and 2015. Methods: Data were extracted on the study characteristics, levels and aspects of fidelity and the psychometric properties, specifically the reliability and validity of the fidelity of intervention implementation instruments. Results: In total, 21 studies were included in the review. Overall results showed that some aspects and levels of fidelity of intervention implementation are included in the instruments. At the theoretical level, fidelity of intervention implementation is not accounted for majority of the studies and few explicitly reports on the use of instruments to evaluate intervention differentiation. At the operational level, interventionists’ adherence and competence are included in the instruments; however, participants’ engagement, exposure and enactment are not. The instruments demonstrate acceptable level of validity and reliability. Conclusion: Sustained focus on developing psychometrically sound instruments that account for all levels (i.e. theoretical and operational) and aspects of fidelity of intervention implementation is imperative to strengthen the methodological literature for interventions research; and for researchers to correctly interpret research findings and to arrive at valid conclusions on the effectiveness of interventions, whether simple or complex.

Evidence indicates that restaurant-based interventions have the potential to promote healthier purchasing and improve the nutrients consumed. This study adds to this body of research by reporting the results of a trial focused on promoting the sale of healthy child menu items in independently owned restaurants. Eight pair-matched restaurants that met the eligibility criteria were randomized to a menu-only versus a menu-plus intervention condition. Both of the conditions implemented new healthy child menu items and received support for implementation for eight weeks. The menu-plus condition also conducted a marketing campaign involving employee trainings and promotional materials. Process evaluation data captured intervention implementation. Sales of new and existing child menu items were tracked for 16 weeks. Results indicated that the interventions were implemented with moderate to high fidelity depending on the component. Sales of new healthy child menu items occurred immediately, but decreased during the post-intervention period in both conditions. Sales of existing child menu items demonstrated a time by condition effect with restaurants in the menu-plus condition observing significant decreases and menu-only restaurants observing significant increases in sales of existing child menu items. Additional efforts are needed to inform sustainable methods for improving access to healthy foods and beverages in restaurants.

The incidence of skin cancer is raising in Hispanics/Latinos, which is a concern for Hispanics/Latinos living in Arizona, a state with a high amount of ultraviolet radiation exposure. There is a dearth of research on skin cancer prevention education for Hispanic/Latino adolescents in high school. Using a community-based participatory research (CBPR) framework, academic and community partners conducted a project to adapt an existing efficacious skin cancer prevention program, Project Students are Sun Safe (SASS) and the current SASS online training model, for dissemination to predominantly Hispanic/Latino students attending high schools in rural southeastern Arizona, located along the Arizona-Mexico border. We assessed the feasibility of training some of these students as peer educators (n = 16) to implement the "Border SASS" lesson to their peers in high school classrooms (n = 198). Border SASS training and the classroom lesson were feasible for, and highly acceptable to, peer educators and classroom students. These students significantly improved skin cancer prevention knowledge scores and self-reported skin cancer prevention behaviors over a 3- to 4-month period post training and the intervention implementation. Here we report on the following: (1) academic-community partnership and adaptation of the SASS training model for rural Hispanic high school students, (2) training of the high school peer educators, (3) administration of the SASS lesson by the trained peer educators to high school students, and (4) further evaluation of peer educator training and classroom student outcomes.

Background PACE-UP trial results demonstrated positive effects of a pedometer-based walking intervention on objective physical activity (PA) outcomes at 3 and 12 months in 45–75 year old primary care patients, in both postal and nurse-supported trial arms compared to controls. We explored associations between intervention implementation measures and change in PA outcomes. Methods In accordance with the MRC guidance and framework (2014), the methods were selected through a key function model. Three quantitative aspects of the process evaluation relating directly to PA outcomes at 12 months were identified to assess intervention implementation: nurse session attendance (dose); PA diary completion (fidelity); and pedometer use (fidelity). These were considered as independent variables in the multi-level models estimating the effectiveness of the intervention on PA outcomes (changes in step-counts and time in moderate-to-vigorous PA (MVPA) levels in ≥10 min bouts). Results Dose participants attending all 3 nurse sessions increased their step-count at 3 months by 961 steps more than those attending 0–2 sessions (95% CI 401–1520, p=0.001). Minutes of MVPA were also significantly increased by 64 (36, 92) at 3 months and by 28 (1, 54) at 12 months. Fidelity: both postal and nurse groups showed strong positive associations of diary return on step-count and minutes of MVPA at 3 months compared with those who didn’t return the diary: postal steps 1458 (854, 20161), nurse steps 873 (190, 1555), postal MVPA 64 (33, 94), nurse MVPA 47 (17, 75). These differences had decreased by 12 months, and only the postal group effects remained statistically significant: steps 1114 (538, 1689), MVPA 47 (17, 75). Regular pedometer use in the postal group was associated with higher step counts at 3 and 12 months: 1029 (383, 1675) and 606 (22, 1990) respectively. Regular pedometer use was not associated with PA outcomes in the nurse group. Discussion Process evaluation measures showed significant associations with most PA outcomes at 3 and 12 months. These were stronger for the postal than the nurse group for diary and pedometer use. We cannot infer causality from these results, but the strong associations between nurse appointments, diary return, pedometer use and PA outcomes suggests that they were important factors in enabling the trial changes observed. We have shown the MRC framework to be an effective tool for process evaluation of intervention implementation.

An important aspect of the COPE CT study translational design is understanding implementation processes to enable widespread adoption of COPE within the CT Home Care Program for Elders (CHCPE), and within Medicaid waiver and state-funded homecare programs elsewhere. We draw upon Normalization Process Theory (NPT) which posits specific criteria for judging implementation potential of an intervention, how practice settings may be affected by the intervention, and how the intervention can be modified to support its implementation. Focus groups designed in accordance with NPT are conducted annually in years 2–5 of the study period with CHCPE care managers and COPE interventionists. This presentation reports findings from the 6 care manager focus groups held during study years 2 and 3, with special emphasis on their experiences recruiting participants from their client caseloads, perceived COPE intervention benefits and challenges, and how well COPE services are integrated into their daily service coordination activities

Evidence-based practices are rarely translated into school settings. The literature examining the science-to-practice gap provides possible explanations, although these explanations are not supported with empirical evidence. Variables affecting behavior intervention implementation, such as lack of teacher training, lack of time, lack of resources, teacher stress level, and lack of administrative support, were examined in this preliminary study as possible explanations. Surveys were collected from 67 elementary teachers. Results regarding possible barriers to implementation indicate that the majority of respondents rated the severity of 12 of 19 barriers as extremely serious. Barriers rated as extremely serious were related to resources, training, and educator variables. In addition, significant correlations were found between job stress and the severity ratings of barriers related to lack of time, training, and support. Understanding these variables may provide important information to aid in the translat...

'Rounding' is reported to be an effective intervention to enhance patient-centred care; nurses make frequent calls on their patients to ensure their needs are met and reassure them they are the focus of their care. In our hospital, two clinical units implemented rounding as improvement projects and asked the research unit to evaluate the effectiveness of implementation. A qualitative descriptive study using focus groups and in-depth interviews revealed that although the idea of rounding was well intended, it was not as effectively implemented as it might have been. Consequently, lessons have been learnt about the difficulties of changing clinician behaviour and will inform a new attempt at implementation.

ObjectiveTo evaluate the implementation of an intensive care unit (ICU) intervention designed to establish rules for making ICU decisions about postsurgery beds.DesignPreintervention/postintervention case study using a multimethod approach, involving two phases of staff interviews, process mapping and collection of administrative data.SettingICU in a 700-bed regional tertiary care hospital in Australia.Participants31 interview participants. Phases 1 and 2 participants drawn from three groups of staff: bedside nursing staff in the ICU, ICU specialist doctors and senior management staff involved in oversight of ICU operations. Phase 2 included an additional participant group: staff from surgery and emergency departments.InterventionImplementation of an ICU escalation plan and introduction of a multidisciplinary morning meeting to determine ICU bed status in accordance with the plan.Main outcome measuresInterview data consisted of preintervention staff perceptions of ICU workplace cohesiveness with bed pressure, and postintervention staff perceptions of the escalation plan and ICU performance. Administrative data consisted of bed status (red, amber or green), monthly number of planned elective surgeries requiring an ICU bed and monthly number of elective surgeries cancelled due to unavailability of ICU beds.ResultsImproved internal communication, decision making and cohesion within the ICU and better coordination between ICU and other hospital departments. Significant reduction in elective surgeries cancelled due to unavailability of ICU beds, χ21=24.9, pConclusionsBy establishing rules for decision making around ICU bed allocation, the intervention improved internal professional relationships within the ICU as well as between the ICU and external departments and reduced the number of elective surgeries cancelled.

The public health impact of health behaviour interventions is highly dependent on large-scale implementation. Intermediaries-intervention providers-determine to a large extent whether an intervention reaches the target population, and hence its impact on public health. A cross-sectional study was performed to identify the correlates of intermediaries' intention to implement a computer-tailored physical activity intervention. According to theory, potential correlates are intervention characteristics, organisational characteristics, socio-political characteristics and intermediary characteristics. This study investigated whether intermediary characteristics mediated the association between the intervention, organisational and socio-political characteristics and intention to implement the intervention. Results showed that intervention characteristics (i.e., observability (B = 0.53; p = 0.006); relative advantage (B = 0.79; p = 0.020); complexity (B = 0.80; p < 0.001); compatibility (B = 0.70; p < 0.001)), organisational characteristics (i.e., type of organization (B = 0.38; p = 0.002); perceived task responsibility (B = 0.66; p

Objective Determine the prolonged effect of rapid response team (RRT) implementation on failure to rescue (FTR). Design Longitudinal study of institutional performance with control charts and Bayesian change point (BCP) analysis. Setting Two academic hospitals in Midwest, USA. Participants All inpatients discharged between 1 September 2005 and 31 December 2010. Intervention Implementation of an RRT serving the Mayo Clinic Rochester system was phased in for all inpatient services beginning in September 2006 and was completed in February 2008. Main Outcome Measure Modified version of the AHRQ FTR measure, which identifies hospital mortalities among medical and surgical patients with specified in-hospital complications. Results A decrease in FTR, as well as an increase in the unplanned ICU transfer rate, occurred in the second-year post-RRT implementation coinciding with an increase in RRT calls per month. No significant decreases were observed pre- and post-implementation for cardiopulmonary resuscitation events or overall mortality. A significant decrease in mortality among non-ICU discharges was identified by control charts, although this finding was not detected by BCP or pre- vs. post-analyses. Conclusions Reduction in the FTR rate was associated with a substantial increase in the number of RRT calls. Effects of RRT may not be seen until RRT calls reach a sufficient threshold. FTR rate may be better at capturing the effect of RRT implementation than the rate of cardiac arrests. These results support prior reports that short-term studies may underestimate the impact of RRT systems, and support the need for ongoing monitoring and assessment of outcomes to facilitate best resource utilization.

Reviews of treatment outcome literature indicate treatment integrity is not regularly assessed. In consultation, two levels of treatment integrity (i.e., consultant procedural integrity [CPI] and intervention treatment integrity [ITI]) provide relevant implementation data. Specifically, assessment of CPI and ITI are necessary to conclude (a) consultation is functionally related to consultee implementation behavior and (b) intervention implementation is functionally related to student outcomes. In this article, study characteristics and the presence of treatment integrity at both levels are examined in 21 studies utilizing Conjoint Behavioral Consultation, a model of consultation that includes multiple consultees. Results indicate that in approximately half of studies, CPI, ITI, or both are assessed and, when reported, treatment integrity is moderately high across both levels. However, there are distinct differences in the assessment and reporting of these levels of treatment integrity. Limitations and imp...

Despite efforts to reduce morbidity and mortality in breast cancer, Latinas continue to have lower 5-year survival rates than their non-Latina white counterparts. All along the cancer continuum from screening to follow-up of abnormal screening to diagnosis and treatment to survivorship, Latinas fare poorer than non-Latina whites. To close this gap, a number of research projects across the continuum have attempted to improve breast cancer outcomes. In this review, we examine studies that have been carried out in breast cancer along the cancer continuum. We focus not only on randomized, controlled trials, but also on quasi-experimental, and pre- and post-test studies that provided interventions for positive breast cancer outcomes. We examine not only the intervention outcomes, but also the type of intervention targets and type of intervention implementation. In future breast cancer research among Latinas, more emphasis should be placed on the steps in detection and treatment that occur after screening.

Australian school playgrounds have changed considerably over recent decades to reflect a climate of ‘surplus safety’. The playgrounds and policies of many Australian schools have reduced students’ opportunities for active, creative and diverse play. Significant school playground changes have included the reduction of school break time (i.e. lunch and other recess periods), removal of playground equipment, merging of school facilities which can result to crowded play spaces, and restrictive rules relating to students’ use of school playgrounds’ grounds that can lead to teachers undertaking playground policing-type roles. In Australia, there is an absence of regulations governing school playgrounds beyond the national standards for manufacturing playground equipment, and the majority primary school facilities within the state of Victoria are often over 50 years old. The most common school playground features reported have included sporting areas such as basketball courts, netball courts, sandpits, grassed play areas and football ovals. Educators plan, manage and monitor school playgrounds as they see fit. Within Australian schools, it has been revealed that all educators are allocated to undertake playground supervision during school breaks and the impact of such supervision on students’ play opportunities is little understood. It has been reported in Victoria that educators frequently report playground supervision (e.g. ‘yard duty’) as something they wish to forego. With educators across the teaching profession allocated playground supervision duties on a daily basis, it is important to provide researchers with insight into the state of school playgrounds prior to any intervention implementation.

Objectives To compare readmission rates to the intensive care unit (ICU) before and after the implementation of a rapid response team (RRT), and to identify risk factors for readmission. Design A quasi-experimental before–after study was carried out. Setting A University Hospital. Patients All patients discharged from the ICU from January to December 2008 (control group) and from January 2010 to December 2012 (intervention group). Intervention Implementation of an RRT. Main variables of interest The data included demographic parameters, diagnoses upon admission, ICU readmission, APACHE II, SOFA, and TISS 28 scores, and routine daily assessment by an RRT of patients discharged from the ICU. Results During the study interval, 380 patients were analyzed in the period prior to the implementation of the RRT and 1361 after implementation. There was a tendency toward decreased readmission rates one year after RRT implementation. The APACHE II score and SOFA score at ICU discharge were independent factors associated to readmission, as well as clinical referral to the ICU. Conclusions The RRT intervention resulted in a sustained decrease in readmission rates one year after implementation of this service. The use of a specialized team in health institutions can be recommended for ICU survivors.

Summary Low work engagement may contribute towards decreased well‐being and work performance. Evaluating, boosting and sustaining work engagement are therefore of interest to many organisations. However, the evidence on which to base interventions has not yet been synthesised. A systematic review with meta‐analysis was conducted to assess the evidence for the effectiveness of work engagement interventions. A systematic literature search identified controlled workplace interventions employing a validated measure of work engagement. Most used the Utrecht Work Engagement Scale (UWES). Studies containing the relevant quantitative data underwent random‐effects meta‐analyses. Results were assessed for homogeneity, systematic sampling error, publication bias and quality. Twenty studies met the inclusion criteria and were categorised into four types of interventions: (i) personal resource building; (ii) job resource building; (iii) leadership training; and (iv) health promotion. The overall effect on work engagement was small, but positive, k = 14, Hedges g = 0.29, 95%‐CI = 0.12–0.46. Moderator analyses revealed a significant result for intervention style, with a medium to large effect for group interventions. Heterogeneity between the studies was high, and the success of implementation varied. More studies are needed, and researchers are encouraged to collaborate closely with organisations to design interventions appropriate to individual contexts and settings, and include evaluations of intervention implementation. © 2016 The Authors. Journal of Organizational Behavior published by John Wiley & Sons, Ltd.

The purpose of this paper is to describe the process of adapting the Classroom Check-Up (CCU) coaching model to bolster teacher implementation of a universal evidence-based social–emotional and classroom management intervention, PATHS to PAX. This paper includes a description of the intervention and a rationale for supporting implementation with the CCU coaching model. Findings from a feasibility test and initial pilot study are provided. Implications for school-based intervention implementation are also discussed.

Introduction. African Americans are at significantly greater risk than non-Hispanic Whites or Hispanics for cognitive impairment. This study presents an evaluation of the Alzheimer’s Association’s Healthy Brain Initiative, a culturally tailored community-level intervention to increase knowledge and awareness of brain health among African American baby boomers. Methods. The evaluation used a mixed-method design with data collection before, during, and after intervention implementation. Results. The intervention was implemented with fidelity to model design by Alzheimer’s Association chapters. Partnerships between chapters and community organizations to increase awareness of brain health among African American baby boomers were facilitated. Community members who participated in intervention workshops demonstrated increased knowledge, awareness, and intentions to engage in recommended health-protective behaviors. Conclusion. A community-level intervention can increase knowledge and awareness of brain health among African American baby boomers. In addition, such interventions can motivate participants’ intentions to engage in health-protective behaviors to maintain overall health and brain health.

Intervention integrity or adherence describes qualities of carrying out an intervention plan and in research is fundamentally linked to experimental validity questions addressed by measurement of independent and dependent variables. Integrity has been well described in conceptual writing but has been a continuing thorny subject in research and practice with some possibility of misunderstandings. In consultation practice, in contrast to research, adherence questions may be best viewed as a triage situation in that teams examine risks and costs of decisions and plan for sufficient intervention implementation checks accordingly. Furthermore, in consultation practice the measurement of intervention adherence is not necessarily needed for internal validity arguments if internal validity evidence is a key characteristic of prior research used in problem solving. However, adherence estimates remain critical for many aspects of decision making. As much thought and resources may be dedicated to the measurement of ...

Parent tutoring has been successfully used to increase children’s oral reading fluency. However, commonly used procedures pose a challenge for parents who are not proficient in reading or who speak English as a second language. A taped reading program that included listening passage preview, repeated reading, and performance feedback was developed for parental implementation during home tutoring sessions. A multiple baseline design across participants was used to evaluate the effects of parent tutoring on the oral reading fluency of two elementary-aged English language learners. Data were collected on oral reading fluency using high- and low-word overlap passages. Results revealed an immediate increase in generalized oral reading fluency for one child upon intervention implementation and continued growth for both children 2 months following termination. Findings suggest recorded readings was an effective and acceptable parent tutoring intervention for increasing reading performance for language minority families.

For more than 10 years, the Journal of Positive Behavior Interventions has published, among other types of articles, behavioral intervention outcome studies related to positive behavior support. Operationally defining interventions is important to facilitating replication studies and adoption of intervention in applied settings. Furthermore, treatment integrity data are necessary to make valid claims that changes in outcomes resulted from intervention implementation and are thus essential to the internal validity of intervention outcome research. Reviews of treatment outcome research in related fields (e.g., applied behavior analysis) indicate that although many researchers operationally define interventions, a majority of researchers fail to report treatment integrity data. The purpose of this study was to review the treatment integrity data reported in all experimental intervention studies published in the Journal of Positive Behavior Interventions between 1999 and 2009. Results indicate that in recent years, a majority of published studies include a definition of the independent variable but do not provide quantitative treatment integrity data.

Sing & Grow is a 10-week group music therapy intervention to promote positive parenting and child development for marginalized parents of birth to 3-year-old children. This paper examined whether changes from pre to post intervention varied according to implementation site, when the intervention was taken to scale nationally. Outcomes for 850 participants were compared for the site where the program was first established against three new locations; one site where implementation processes were more favorable relative to the other two sites. Overall, the findings provided only limited support for differential outcomes by site of implementation. Participants showed significant improvements in parent-reported parenting and child outcomes from pre to post that were similar across all sites. For clinician-reported outcomes, improvements over time were generally greater in the original site and the well-supported site compared to the sites where there were more implementation difficulties. These differences were partly accounted for by differences in the characteristics of participants receiving programs in different sites and differences in the clinicians’ ratings of program quality and the levels of support and training provided. However, confounding by the source of measurement requires cautious interpretation of clinician data. This study further highlights the potential for music therapy as an early parenting intervention, and the need for more rigorous evaluations in this field.

Early childhood intervention and habilitation services for children with disabilities operate on an interdisciplinary basis. It requires a common language between professionals, and a shared framework for intervention goals and intervention implementation. The International Classification of Functioning, Disability and Health (ICF) and the version for children and youth (ICF-CY) may serve as this common framework and language. This overview of studies implemented by our research group is based on three research questions: Do the ICF-CY conceptual model have a valid content and is it logically coherent when investigated empirically? Is the ICF-CY classification useful for documenting child characteristics in services? What difficulties and benefits are related to using ICF-CY model as a basis for intervention when it is implemented in services? A series of studies, undertaken by the CHILD researchers are analysed. The analysis is based on data sets from published studies or master theses. Results and conclusion show that the ICF-CY has a useful content and is logically coherent on model level. Professionals find it useful for documenting children's body functions and activities. Guidelines for separating activity and participation are needed. ICF-CY is a complex classification, implementing it in services is a long-term project.