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Drawing from collective experiences in our capacity building project: Health Equity Activation Research Team for Inclusion Health, we argue that while community-engaged partnerships tend to focus on understanding health inequities and developing solutions, they can be healing spaces for health professionals and researchers. Data were obtained from a 15-month participatory ethnography, including focus groups and interviews. Ethnographic notes and transcripts were coded and analyzed using both deductive and inductive coding. Practices of radical welcome, vulnerability, valuing the whole person, acknowledging how partnerships can cause harm, and centering lived experience expertise in knowledge creation processes were identified as key characteristics of healing spaces. Ultimately, health professionals and researchers work within the same social, political and economic contexts of populations with the worst health outcomes. Their own healing is critical for tackling larger systemic changes aimed at improving the well-being of communities harmed by legacies of exclusion. [ABSTRACT FROM AUTHOR]

Background: Precision medicine holds enormous potential to improve outcomes for cancer patients, offering improved rates of cancer control and quality of life. Not all patients who could benefit from targeted cancer therapy receive it, and some who may not benefit do receive targeted therapy. We sought to comprehensively identify determinants of targeted therapy use among community oncology programs, where most cancer patients receive their care. Methods: Guided by the Theoretical Domains Framework, we conducted semi-structured interviews with 24 community cancer care providers and mapped targeted therapy delivery across 11 cancer care delivery teams using a Rummler-Brache diagram. Transcripts were coded to the framework using template analysis, and inductive coding was used to identify key behaviors. Coding was revised until a consensus was reached. Results: Intention to deliver precision medicine was high across all participants interviewed, who also reported untenable knowledge demands. We identified distinctly different teams, processes, and determinants for (1) genomic test ordering and (2) delivery of targeted therapies. A key determinant of molecular testing was role alignment. The dominant expectation for oncologists to order and interpret genomic tests is at odds with their role as treatment decision-makers' and pathologists' typical role to stage tumors. Programs in which pathologists considered genomic test ordering as part of their staging responsibilities reported high and timely testing rates. Determinants of treatment delivery were contingent on resources and ability to offset delivery costs, which low- volume programs could not do. Rural programs faced additional treatment delivery challenges. Conclusions: We identified novel determinants of targeted therapy delivery that potentially could be addressed through role re-alignment. Standardized, pathology-initiated genomic testing may prove fruitful in ensuring patients eligible for targeted therapy are identified, even if the care they need cannot be delivered at small and rural sites which may have distinct challenges in treatment delivery. Incorporating behavior specification and Rummler-Brache process mapping with determinant analysis may extend its usefulness beyond the identification of the need for contextual adaptation. [ABSTRACT FROM AUTHOR]

Positive youth development (PYD) measurement tools are influenced by the social positionalities, ideologies, and interests of those who create them. Historically, racial, ethnic, and gender-minoritized practitioners and youth program participants have been excluded from the development and testing of PYD measures. In particular, they have been excluded from the conceptual work of defining and operationalizing central PYD constructs, from which PYD measurement and implementation are rooted. Furthermore, the existing constructs are subjective qualities, characteristics, and normative behaviors. The role and impact of power, privilege, and oppression on PYD are often missing from PYD constructs, yet they play an important role in PYD practice with racially, ethnically, and gender-diverse youth. This paper aims to center the knowledge and experiences of marginalized youth practitioners and youth in the conceptualization of PYD constructs. A multiple qualitative case study design and a purposive, convenience sampling approach were used to identify programs within a publicly funded, county-wide initiative in the pacific northwest that serves Black, Indigenous, or person of color, immigrant or refugee, and/or trans- or non-binary youth. The inductive analysis identified three key constructs: racial and social identity development, socio-emotional development, and youth-centered program environment. Participants emphasized communitarian understandings of identity development, a clear articulation of social justice principles across constructs, and emphasized relational practices and environmental factors over youth characteristics. We outline results in detail and discuss how youth and adult service providers' perspectives can help inform a more empowering and relevant model for evaluating PYD interventions. [ABSTRACT FROM AUTHOR]

Aim: To compare demographic and pain characteristics of older (≥ 65) vs younger (< 65) chronic non-cancer pain patients referred to a community pain clinic in the Greater Toronto Area (GTA), Ontario, Canada. Methods: This is a retrospective study of 644 consecutive new patients with pain seen during 2016–2017 (older group n = 126; younger group n = 518). Demographic characteristics, Brief Pain Inventory pain ratings, and diagnosis were obtained using retrospective chart review. Patients were classified into group I (pure biomedical pathology), group II (mixed biomedical causes and psychological factors) and group III (no detectable physical pathology but psychological factors were considered important). Results: Older patients comprised 19.6% of the overall population (higher than the average GTA older population). Regarding older vs younger group, male/female ratio was 1:1.3 vs 1:1.7 respectively, while 71% of the older patients were foreign born vs 37% of the younger group (p < 0.001). Low back was the most prevalent pain site for both groups; 70% of the older patients were classified as group I vs 35% of the younger patients (p < 0.0001), and only 6% as group III (vs 18% of the younger population, p < 0.05). Conclusion: The study points to considerable differences between younger and older patients with pain with the latter presenting with significant biomedical pathology but lesser psychopathology. The results are comparable to those obtained from a university pain clinic as well as a rural Northern Ontario clinic. Implications of the study for planning of pain care are discussed. [ABSTRACT FROM AUTHOR]

Background: Population-based research and community-based interventions are integral to occupational therapy’s scope of practice, yet they are underdeveloped in actual implementation. Therefore, this paper focuses on some health challenges facing the African American population, guided by the Person-Environment-Occupation-Performance Model. Method: Using data from an observational cross-sectional nationwide telephone survey of African American adults, we examined differences between African Americans who are receiving disability payments (RDP) and those who are employed full time (FTE) on several physical health behaviors and psychosocial health indicators. We further compared the differences between African Americans RDP versus those FTE on those physical health behaviors and psychosocial health indicators across five US regions. Results: Findings suggest that African Americans RDP are engaging in fewer positive physical health behaviors and experiencing worse psychosocial health compared to their counterparts FTE. There are also nuanced regional variations in the differences between African Americans RDP and FTE in physical health behaviors and psychosocial health indicators. Conclusion: This research highlighted some health challenges of African Americans RDP and FTE using a regional lens, demonstrating the value of OT population-based research. There is a need for OT population-specific community-based practice to address the health disparities of underserved and minority populations, such as African Americans.

Abstract Background In most controlled studies of multi-component cognitive intervention, participants’ cognitive levels are homogenous, which is contrary to real-world settings. There is a lack of research studying the implementation of evidence-based cognitive intervention in communities. This study describes the implementation and preliminary effectiveness of a Multi-component Cognitive Intervention using Simulated Everyday Tasks (MCI-SET) for older adults with different cognitive levels in real-world settings. Methods Single group, pre-intervention assessment, post-intervention assessment, and 3-month follow-up research design. MCI-SET consists of 12 two-hour weekly sessions that include motor-cognitive tasks, cognitive training, and cognitive rehabilitation. One hundred and thirty participants, > = 65 and frail, dependence on > = one instrumental daily activity, or with confirmed dementia, from eight community centers were included. The primary outcome is general cognition (Montreal Cognitive Assessment-Taiwan, MoCA-T). Secondary outcomes are memory (Miami Prospective Memory Test, Digits Forward, Digits Backward), attention (Color Trail Test-Part 1), executive function (Color Trail Test-Part 2), and general function (Kihon Checklist-Taiwan). Results Pre-intervention workshop for group leaders, standardized activity protocols, on-site observation, and ten weekly conferences were conducted to ensure implementation fidelity. MCI-SET had an 85% retention rate and 96% attendance rate. The participants had a mean age of 78.26 ± 7.00 and a mean MoCA-T score of 12.55 ± 7.43. 73% were female. General cognition (Hedges’ g = 0.31), attention (Hedges’ g = 0.23), and general function (Hedges’ g = 0.31), showed significant post-intervention improvement with small effect size. Follow-ups showed maintained improvement in general cognition (Hedges’ g = 0.33), and delayed effect on attention (Hedges’ g = 0.20), short-term memory (Hedges’ g = 0.38), and executive function (Hedges’ g = 0.40). Regression analysis indicated that the intervention settings (day care centers vs neighborhood centers), the pre-intervention cognitive levels, and the pre-intervention general function of the participants were not associated with the outcomes. Conclusions MCI-SET is feasible and can improve the cognitive skills and general functions of older adults with heterogeneous cognitive skills or disabilities. It is essential to tailor programs to fit the interests of the participants and the culture of local communities. Group leaders must also have the skills to adjust the cognitive demands of the tasks to meet the heterogeneous cognitive levels of participants. Trial registration This study was retrospectively registered at clinicaltrials.gov (Identifier: NCT04615169 ).

The role of communication environments in everyday participation is well accepted within speech-language pathology research and practice. However, the evidence base for strategies to support speech-language pathologists (SLPs) in assessing and responding to environmental and community needs are less clearly understood. This paper provides a case study to illustrate the application of ethnography of communication to understanding and responding to communication needs within a dance class for adults with intellectual disability. The case study utilised observation, participant PEERobservation, reflection, and interviews to explore the perspectives and beliefs of the dance students, dance teacher, and disability support workers. Strategies emerged for enhancing the awareness and capabilities of communication partners and addressing barriers and facilitators to inclusive social and physical environments. This study illustrates the potential of ethnography of communication as a tool to support SLPs to gain insight into everyday communication environments and the social norms that influence participation and interaction in order to enhance communication accessibility. [ABSTRACT FROM AUTHOR]

Background: Population-based research and community-based interventions are integral to occupational therapy’s scope of practice, yet they are underdeveloped in actual implementation. Therefore, this paper focuses on some health challenges facing the African American population, guided by the PersonEnvironment-Occupation-Performance Model. Method: Using data from an observational cross-sectional nationwide telephone survey of African American adults, we examined differences between African Americans who are receiving disability payments (RDP) and those who are employed full time (FTE) on several physical health behaviors and psychosocial health indicators. We further compared the differences between African Americans RDP versus those FTE on those physical health behaviors and psychosocial health indicators across five US regions. Results: Findings suggest that African Americans RDP are engaging in fewer positive physical health behaviors and experiencing worse psychosocial health compared to their counterparts FTE. There are also nuanced regional variations in the differences between African Americans RDP and FTE in physical health behaviors and psychosocial health indicators. Conclusion: This research highlighted some health challenges of African Americans RDP and FTE using a regional lens, demonstrating the value of OT population-based research. There is a need for OT population-specific community-based practice to address the health disparities of underserved and minority populations, such as African Americans. [ABSTRACT FROM AUTHOR]

Introduction: Little information exists regarding the characteristics of patients with chronic non-cancer pain (CNCP) attending Canadian pain clinics. The study describes the demographics, pain characteristics and the diagnostic classification profile of such patients attending a university-affiliated community-based pain clinic in the Greater Toronto Area. Methods: Retrospective descriptive study based on 644 unique consecutive CNCP patients assessed between January 2016 and December 2017. Results: The female/male ratio was 1.6:1; 80% were younger than 65 years; 43% held some form of employment (full-time, part-time or self employment); median pain duration was 3 years; car accidents and medical conditions accounted for 28 and 27% of pain onset, respectively; 34% had four or more distinct areas of pain; and low back pain (LBP) was the most prevalent site (66%), but was the sole site of pain in less than a third of these patients. Age was positively associated with LBP prevalence. Self-reported health service utilization (visits to the emergency room, pain physician or psychologist) increased with patient psychopathology. Cannabis was used by 15% of the cohort and opioids by 34.5%, with only one in six opioid users exceeding 90 mg of morphine equivalent dose per day. Comparison of our data to three previously published studies from other Canadian pain clinics demonstrated both similarities and substantial differences between the populations. Conclusion: Our study highlights regional differences between CNCP population phenotypes. Recognition of biomedical, psychological and socio-environmental factors affecting pain should be considered for patient stratification and rational approaches to treatment, as "one size treatment does not fit all". [ABSTRACT FROM AUTHOR]

Background: In most controlled studies of multi-component cognitive intervention, participants' cognitive levels are homogenous, which is contrary to real-world settings. There is a lack of research studying the implementation of evidence-based cognitive intervention in communities. This study describes the implementation and preliminary effectiveness of a Multi-component Cognitive Intervention using Simulated Everyday Tasks (MCI-SET) for older adults with different cognitive levels in real-world settings.Methods: Single group, pre-intervention assessment, post-intervention assessment, and 3-month follow-up research design. MCI-SET consists of 12 two-hour weekly sessions that include motor-cognitive tasks, cognitive training, and cognitive rehabilitation. One hundred and thirty participants, > = 65 and frail, dependence on > = one instrumental daily activity, or with confirmed dementia, from eight community centers were included. The primary outcome is general cognition (Montreal Cognitive Assessment-Taiwan, MoCA-T). Secondary outcomes are memory (Miami Prospective Memory Test, Digits Forward, Digits Backward), attention (Color Trail Test-Part 1), executive function (Color Trail Test-Part 2), and general function (Kihon Checklist-Taiwan).Results: Pre-intervention workshop for group leaders, standardized activity protocols, on-site observation, and ten weekly conferences were conducted to ensure implementation fidelity. MCI-SET had an 85% retention rate and 96% attendance rate. The participants had a mean age of 78.26 ± 7.00 and a mean MoCA-T score of 12.55 ± 7.43. 73% were female. General cognition (Hedges' g = 0.31), attention (Hedges' g = 0.23), and general function (Hedges' g = 0.31), showed significant post-intervention improvement with small effect size. Follow-ups showed maintained improvement in general cognition (Hedges' g = 0.33), and delayed effect on attention (Hedges' g = 0.20), short-term memory (Hedges' g = 0.38), and executive function (Hedges' g = 0.40). Regression analysis indicated that the intervention settings (day care centers vs neighborhood centers), the pre-intervention cognitive levels, and the pre-intervention general function of the participants were not associated with the outcomes.Conclusions: MCI-SET is feasible and can improve the cognitive skills and general functions of older adults with heterogeneous cognitive skills or disabilities. It is essential to tailor programs to fit the interests of the participants and the culture of local communities. Group leaders must also have the skills to adjust the cognitive demands of the tasks to meet the heterogeneous cognitive levels of participants.Trial Registration: This study was retrospectively registered at clinicaltrials.gov (Identifier: NCT04615169 ). [ABSTRACT FROM AUTHOR]

Occupational therapists are increasingly required to work beyond traditional health-care settings in new and emerging community roles. This study explored the learning experiences of a cohort of international students studying an online post-graduate module aimed at facilitating political competence. The evaluation used an ethnographic approach and methods included online data from online communication tools: semi-structured interviews, and tutors' reflective diaries. Data were subjected to thematic analysis. Results showed shifts in students' knowledge, skills and attitudes in seeing the bigger picture; developing collaborative partnerships and navigating the politics of practice at the margins of personal, political and professional positions. Themes from learning which promoted changes were interacting with online resources, valuing and sharing experiences, a safe and supportive environment, integrated learning and assessment, critical self and peer review. Importantly the democratic approach of online learning was shown to align with the principles of political and critical occupational therapy practice. Online learning within an international community can extend opportunities for developing professional knowledge and behaviours in the politics of community-based practice. [ABSTRACT FROM AUTHOR]

Background: Service learning is used as an educational approach in many undergraduate occupational therapy programmes in South Africa and the rest of the world. Evidence for the impact of occupational therapy service learning engagements in communities, from the perspectives of community partners, is limited. Aim: The purpose of this study was to describe the perceptions of community representatives regarding the outcomes of occupational therapy service learning engagements. Methods: A descriptive qualitative enquiry design was used. In-depth interviews were conducted with eight purposively sampled community representatives and analysed using inductive qualitative content analysis. Results: This paper reports on the theme related to community outcomes of occupational therapy that emerged from the data, consisting of seven categories, namely: (1) increased knowledge and skills, (2) attitudinal change leading to practice reform, (3) increased access to resources and infrastructure, (4) enhanced community connections, (5) enhanced confidence and dignity, (6) enhanced occupational participation, and (7) non-realisation of partnership goals. Conclusion: The findings of the study demonstrated that although there were some instances in which partnership goals were not realised, occupational therapy service learning engagements contributed to occupational enablement, occupational justice, health and well-being for community members. [ABSTRACT FROM AUTHOR]

Sexual and gender minority (SGM) youth in nonmetropolitan communities face marginalization due to their SGM identities. Community support may mitigate the negative outcomes associated with marginalization. Using the strengths perspective, this study investigated the factors SGM youth identify as making their communities supportive. Interviews were conducted with SGM youth to explore their perceptions of their community, community climate, and the factors that contribute to making communities supportive to SGM youth. Findings revealed four supportive community factors: supportive people, SGM visibility, SGM resources and education, and SGM-inclusive policies. Implications include creating SGM resources and providing professional training on SGM issues. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to explore clinicians’ experiences of implementing goal setting with community dwelling clients with acquired brain injury, to develop a goal setting practice framework. Method: Grounded theory methodology was employed. Clinicians, representing six disciplines across seven services, were recruited and interviewed until theoretical saturation was achieved. A total of 22 clinicians were interviewed. Results: A theoretical framework was developed to explain how clinicians support clients to actively engage in goal setting in routine practice. The framework incorporates three phases: a needs identification phase, a goal operationalisation phase, and an intervention phase. Contextual factors, including personal and environmental influences, also affect how clinicians and clients engage in this process. Clinicians use additional strategies to support clients with impaired self-awareness. These include structured communication and metacognitive strategies to operationalise goals. For clients with emotional distress, clinicians provide additional time and intervention directed at new identity development. Conclusions: The goal setting practice framework may guide clinician’s understanding of how to engage in client-centred goal setting in brain injury rehabilitation. There is a predilection towards a client-centred goal setting approach in the community setting, however, contextual factors can inhibit implementation of this approach. Implications for Rehabilitation: The theoretical framework describes processes used to develop achievable client-centred goals with people with brain injury. Building rapport is a core strategy to engage clients with brain injury in goal setting. Clients with self-awareness impairment benefit from additional metacognitive strategies to participate in goal setting. Clients with emotional distress may need additional time for new identity development. [ABSTRACT FROM AUTHOR]

In this era of neoliberalism, social work in the United States is arguably overly professionalized and privatized, and has almost lost its activists roots in working for social justice. Radical social work rooted in macro-level community-based practice has been in crisis over the past three decades. The rise of socially engaged art has become more prominent in the United States even as social work has strayed away from its basic tenets such as community practice, advocacy, and social action. How should the social work profession interpret the rise of socially engaged art--already a trend in the art world--whose modality and purpose resembles radical social work? By comparing and contrasting the similarities and differences between radical social work and socially engaged art, this article examines the possibility of consilience between the two and the implications for the social work profession [ABSTRACT FROM AUTHOR]

Purpose: To identify the most common and most valued outcomes of community-based rehabilitation (CBR) in Chinese communities and to map these to the CBR evaluation framework. Method: A multiple, embedded case study design was used. Four CBR programmes in China met the criteria for inclusion and participated. Data collection, via participant "story telling", followed the procedures of the most significant change technique (MSC) over a period for five months. Content analysis with thematic coding was used to detect the common significant changes described in "top-rated" stories and in the entire pool of stories. Meta-analysis using the CBR framework was carried out to enrich the understanding of programme outcomes. Results: A total of 101 stories were collected in the two rounds of story collection from the four programmes. Aggregated results demonstrated that, across all programmes, 78.21% of stories focused on changes in people with disabilities, 9.9% described aspects of programme development, 8.91% reported on outcomes related to CBR workers, and only 2.97% were focused on advocacy. When mapped against the elements of the CBR framework the MSCs among these four programmes were (1) psychosocial changes, (2) increased family participation and (3) improved physical functioning. Conclusions: CBR practice in Chinese communities remains orientated towards an approach of functional rehabilitation rather than community-based inclusive development. Community-based rehabilitation is a strategy for community-based inclusive development. Commonly reported significant outcomes of community-based rehabilitation programmes in China focus on changes in psychosocial and physical status of people with disabilities and family participation. Community-based rehabilitation in China continues to focus on traditional rehabilitation. New efforts and directions are needed to also include goals of equity and community inclusion. Further efforts to promote the use of CBR guideline with the goal of facilitating inclusion and equal participation are strongly recommended. [ABSTRACT FROM AUTHOR]

Introduction: Co-ordinated multidisciplinary primary care as a model of healthcare delivery has been utilised for over a decade in Ireland. Occupational therapists work according to this model in primary care teams throughout the country. This study aimed to examine their current practices and perceptions of practice, including perceived facilitators and barriers to practice. Method: A cross-sectional descriptive web-based survey was used to generate both quantitative and qualitative information. All occupational therapists who were members of functioning primary care teams were targeted for inclusion, and a response rate of 52.7% was achieved. Results: Primary care occupational therapists working primarily with an elderly population are experiencing high referral rates and service users are experiencing long wait times for services. The majority of their time is spent on tertiary health promotion activities such as providing enabling equipment, completing functional assessments and providing instruction in daily living tasks. These activities aim to reduce the negative impact of symptomatic disease through rehabilitation and treatment. Conclusion: Common barriers facing primary care occupational therapists include unrealistic caseloads and inadequate resources; however, support from occupational therapy colleagues and primary care team members is viewed positively. There is a need for guidelines and protocols to assist therapists with planning and delivering services in an environment with reduced resources. [ABSTRACT FROM AUTHOR]

This case study explores the opportunities for students of Industrial Design Engineering to engage with direct and indirect stakeholders by making their design process and results into open-ended designed solutions. The reported case study involved 47 students during a two-weeks intensive course on the topic of urban gardening. Observations were collected during three distinctive phases: the co-design phase, the creation of an open design, and the sharing of these design solutions on the online platform Instructables.com. The open sharing of local solutions triggered more global discussions, based on several types of feedback: from simple questions to reference to existing works and from suggestions to critiques. Also, some examples of re-appropriation of the designed solutions were reported. These feedbacks show the possibilities for students to have a global vision on their local solutions, confronting them with a wider and more diverse audience. The case study shows, on the other hand, the difficulty in keeping students engaged in this global discussion, considering how after a few weeks the online discussions dropped to an almost complete silence. It is also very difficult with such online platforms to follow the re-appropriation cycles, losing the possibility of exploring the new local context where the replication/modification of the designed product occurred. The course’s focus on open design is interesting from both the design and educational points of view. It implies a deep change in the teaching approach and learning attitude of students, allowing unknown peers to take part in the design process and fostering a global discussion starting from unique and local solutions.

This article reports an action-research focused on the improvement of a training program for professionals working with multi-challenged families with at-risk or maltreated children. The program aimed at the implementation of a multi-systemic, collaborative and strength-based family assessment and intervention model. Outcome evaluation results indicate that professionals improved their skills and achieved minimal competence. Process evaluation reveals that participating in the training has been a transformative experience and highlights facilitator and constraining conditions for participants’ learning and changing as well as suggestions for improvement of the training program. Implications for practice and future research are discussed.

This case study explores the opportunities for students of Industrial Design Engineering to engage with direct and indirect stakeholders by making their design process and results into open-ended designed solutions. The reported case study involved 47 students during a two-weeks intensive course on the topic of urban gardening. Observations were collected during three distinctive phases: the codesign phase, the creation of an open design, and the sharing of these design solutions on the online platform Instructables.com. The open sharing of local solutions triggered more global discussions, based on several types of feedback: from simple questions to reference to existing works and from suggestions to critiques. Also, some examples of re-appropriation of the designed solutions were reported. These feedbacks show the possibilities for students to have a global vision on their local solutions, confronting them with a wider and more diverse audience. The case study shows, on the other hand, the difficulty in keeping students engaged in this global discussion, considering how after a few weeks the online discussions dropped to an almost complete silence. It is also very difficult with such online platforms to follow the re-appropriation cycles, losing the possibility of exploring the new local context where the replication/modification of the designed product occurred. The course's focus on open design is interesting from both the design and educational points of view. It implies a deep change in the teaching approach and learning attitude of students, allowing unknown peers to take part in the design process and fostering a global discussion starting from unique and local solutions. [ABSTRACT FROM AUTHOR]

Externalizing behaviors are a common component of the clinical presentation of autism spectrum disorders. Although traditionally used with typically-developing children, parent-child interaction therapy (PCIT) is one behaviorally-based parent training program that has demonstrated success in increasing child compliance, reducing problem behavior, and improving parent-child communication. The study examined the efficacy of PCIT as a treatment for children with autism spectrum disorders by employing a single subject, non-concurrent multiple baseline design across three subjects. Primary findings revealed increases in child compliance, reductions in child disruptive behavior, and improved parenting skills across participants. In addition, each caregiver reported high levels of satisfaction with the intervention. Results suggested that PCIT may be a treatment option for children on the autism spectrum with co-occurring behavioral difficulties. Although the non-concurrent nature of the multiple baseline design is a limitation, this study replicates and extends previous research investigating the efficacy of PCIT with children with autism and their parents. [ABSTRACT FROM AUTHOR]

Interventional pulmonology (IP) is a field that uses minimally invasive techniques to diagnose, treat, and palliate advanced lung disease. Technology, formal training, and reimbursement for IP procedures have been slow to catch up with other interventional subspecialty areas. A byproduct of this pattern has been limited IP integration in private practice settings. We describe the key aspects and programmatic challenges of building an IP program in a community-based setting. A philosophical and financial buy-in by stakeholders and a regionalization of services, within and external to a larger practice, are crucial to success. Our experience demonstrates that a successful launch of an IP program increases overall visits as well as procedural volume without cannibalizing existing practice volume. We hope this might encourage others to provide this valuable service to their own communities. [ABSTRACT FROM AUTHOR]

The current evidence base for in-home services in child welfare is limited, with insufficient research on the use of in-home services among ethnically diverse populations. This article describes a case study examining the use of a community-defined practice and evidence approach to develop tribally based in-home service models with Alaska Native communities. The models were co-created by tribal elders, community members, and service providers, with technical assistance provided by the Western and Pacific Child Welfare Implementation Center (WPIC). Research findings suggest that this is an effective approach to developing culturally appropriate child welfare practices while also building local support and ownership. [ABSTRACT FROM AUTHOR]

Trends in policy, practice, and research point to the need for a community-engaged Scholarship of Practice (SOP) model that can be used to inform the development of occupational therapy practitioners, educators, and researchers. This article describes a community-engaged SOP model, the evidence justifying the need for such a model, and strategies to effectively create community-engaged practitioners, educators and career scientists within occupational therapy. We highlight several examples of community-based participatory research to further inform this model, and in turn, translate this knowledge back to communities for action and systems change that can affect the lives of people with disabilities and the communities in which they seek to live and participate long term. [ABSTRACT FROM AUTHOR]

Objectives To develop an assessment tool for evaluating oral health promotion practices and to evaluate community-based oral health promotion practices targeted at children and adolescents with this tool. Methods A theoretical framework about health promotion planning, implementation and evaluation was made on the basis of a literature review. Then, information about Finnish community-based oral health promotion practices ( n = 12) targeted at children and adolescents was collected using semi-structured interviews. Also, related documents, for example action plans and reports, were collected when available. Next, an assessment tool based on the theoretical framework was developed, and the recorded and transcribed interview data and other documents were evaluated with this tool. Results The assessment tool proved to be practical: it pointed out the strengths and weaknesses of the practices. The tool revealed strengths in the implementation and deficiencies in the planning and evaluation of oral health promotion practices. One-quarter of the 12 practices assessed could be considered 'good practices'. Conclusions There is a need to improve the planning and evaluation of oral health promotion practices. The assessment tool developed in this study might be useful for practitioners both in the field of oral health promotion and general health promotion. [ABSTRACT FROM AUTHOR]

Objective: Occupational therapy (OT) services have been provided for people with mental health conditions since the foundation of the profession, but OT practices are not clearly outlined. This paper presents the standard OT practices performed in the mental health area. The aim of the study is to quantitatively characterize domains of OT intervention in mental health. Specifically, OT intervention in community and inpatient-based mental health settings is described, further delineated by age groups and gender. Eighteen occupational therapists (OTs), who work in the area of mental health, participated in the study. Each OT had at least two years of experience, was between the ages of 26 and 40, and documented 2-4 treatment sessions. In total, 70 treatment sessions were recorded; half were recorded in hospitals and the majority of recorded sessions involved clients diagnosed with schizophrenia ( n = 47). Significant differences were found in the intervention provided in the different settings. In addition, the intervention focus for men and women, and for age groups, was different. Despite these differences, many aspects of the intervention were similar in all contexts. The study results support previous notions that context influences intervention. [ABSTRACT FROM AUTHOR]

Abstract: Solutions are employed to support clinical research trial tasks in community-based practice settings. Using the IT Implementation Framework (ITIF), an integrative framework intended to guide the synthesis of theoretical perspectives for planning multi-level interventions to enhance IT use, we sought to understand the barriers and facilitators to clinical research in community-based practice settings preliminary to implementing new informatics solutions for improving clinical research infrastructure. The studies were conducted in practices within the Columbia University Clinical Trials Network. A mixed-method approach, including surveys, interviews, time–motion studies, and observations was used. The data collected, which incorporates predisposing, enabling, and reinforcing factors in IT use, were analyzed according to each phase of ITIF. Themes identified in the first phase of ITIF were 1) processes and tools to support clinical trial research and 2) clinical research peripheral to patient care processes. Not all of the problems under these themes were found to be amenable to IT solutions. Using the multi-level orientation of the ITIF, we set forth strategies beyond IT solutions that can have an impact on reengineering clinical research tasks in practice-based settings. Developing strategies to target enabling and reinforcing factors, which focus on organizational factors, and the motivation of the practice at large to use IT solutions to integrate clinical research tasks with patient care processes, is most challenging. The ITIF should be used to consider both IT and non-IT solutions concurrently for reengineering of clinical research in community-based practice settings. [Copyright &y& Elsevier]

An increasing number of large dam projects present a major threat to cultural heritage in much of Africa. This paper asks how such destructive projects can be held to account; not only to mitigate damage, but also to develop local heritage management structures and increase public awareness. It focuses on the situation in Lesotho, which has a history of large dam projects, but a severely under-resourced archaeological and heritage management community. The main emphasis is on a recent and ongoing project in advance of the Metolong Dam in western Lesotho that was founded with training and skills transfer as a primary aim. In addition to some practical suggestions for Lesotho that take into account its particular geopolitical context, this case study brings three broader interrelated issues into view, none of which are new, but all of which deserve fresh attention: the unsuitability of a solely commercial, contract-based response to the threat from development; the negative effects of using unskilled 'labour'; and the imperative to develop an archaeology that is relevant to and actively involves the rural African communities within which we work. [ABSTRACT FROM AUTHOR]

Background and Aims: This paper is the second in a series of two that presents and discusses an exploratory evaluation study of the ‘Motor Magic’ program conducted in Adelaide, South Australia. Methods: A realist evaluation approach was used, and two focus groups (one with parents and one with kindergarten staff) were held to identify program outcomes and to develop and refine key hypotheses about how these outcomes occurred. Results and Conclusions: Results for kindergarten staff involved in the program are presented and discussed in this paper, including improved early identification and early intervention for children with, or at risk of, fine motor developmental difficulties; increased confidence in the effectiveness of their practice with these children; improved practice of kindergarten staff with both targeted and all children; improved empathy with, and support for, parents; and increased interagency links and ongoing advocacy for further resources. These results suggest that the program provides an effective model for building the capacity of kindergarten staff to support children with, or at risk of, developmental difficulties. [ABSTRACT FROM AUTHOR]

Background and Aims: There is a lack of literature on the evaluation of programmes addressing the motor and sensory development of preschool children. This paper presents and discusses an exploratory evaluation study of the ‘Motor Magic’ programme run in Adelaide, South Australia. The purpose of this study was to identify outcomes for children, parents and kindergarten staff, as well as develop hypotheses about how these outcomes occurred and in what contexts. Methods: Using a realist approach, two focus groups were conducted, one with parents and one with kindergarten staff, to develop and refine key hypotheses. Results and Conclusion: Evaluation results for participating children and parents suggested that this programme provided a model of best practice for supporting the development of preschool-aged children, with or at risk of, developmental delay, within their family and social environments. [ABSTRACT FROM AUTHOR]

In previous hepatitis C virus (HCV) treatment studies, Black patients not only had a lower sustained viral response (SVR) rate to interferon and ribavirin (RBV) than non-Black patients but also a higher frequency of HCV genotype 1 (GT-1) infection. The aim of this community-based study was to determine whether Black patients have a lower SVR rate independent of genotype. We prospectively enrolled 785 patients (24.8% Black, 71.5% White, 3.7% others) who received interferon alpha-2b 3 MU three times weekly + RBV 1000–1200 mg/day for 24 weeks (GT-2/3) or 48 weeks (GT-1). Black patients were more commonly infected with GT-1 (86.8% vs 64.8%, P < 0.001) and less frequently had an SVR compared with non-Black patients (8.4% vs 21.6%, P < 0.001). Within GT-1, Black patients had a lower SVR rate than non-Black patients (6.1% vs 14.1%, P = 0.004) but not within GT-2/3 (50.0% vs 36.5%, P = 0.47). Black patients had lower baseline haemoglobin levels (14.8 vs 15.3 g/dL, P < 0.001) and neutrophil counts (2900 vs 4100/mm3, P < 0.001) and required more frequent dose reductions of RBV (29.8% vs 18.5%, P < 0.001) and interferon (4.7% vs 1.6%, P = 0.012). However, dose reductions were not associated with lower SVR rates while early treatment discontinuations were (2.9% vs 25.7%, P < 0.001). Independent predictors of SVR were GT-1 [odds ratio (OR) 0.33; 95% confidence interval (CI) 0.20–0.55; P < 0.001], Black race (OR 0.45; 95% CI 0.22–0.93; P = 0.030), and advanced fibrosis, stages 3 + 4 (OR 0.53; 95% CI 0.31–0.92; P = 0.023). In conclusion, Black patients infected with HCV GT-1 (but not GT-2/3) have a lower SVR rate than non-Black patients. This is not explained by their lower baseline haemoglobin levels and neutrophil counts that lead to higher rates of ribavirin and interferon dose reductions. [ABSTRACT FROM AUTHOR]

This article presents a care study focusing on surgery in the home from yesteryear. The perspectives of three key informants are presented: the patient, the patient's Scottish private-duty nurse, and the patient's sister. Their shared stories allow us to reflect on care giving in the home, as shared from the past, and to compare this to the delivery of community-based nursing care of today. [ABSTRACT FROM AUTHOR]

This article provides an orientation to increase the profession's awareness of occupational therapy's role in victim advocacy, an emerging area of community-based practice. Analysis and comparison of OT's core assumptions and values with general principles of victim advocacy and empowerment demonstrate striking similarities: Each acknowledges holism and a profound connection between the individual and society, as well as their ability to interact and influence each other. In addition, the cultures of OT and victim advocacy both value the dignity and worth of persons, self-determination, freedom and autonomy, latent capacity, human uniqueness and subjectivity, and active and mutual cooperation in restoration or recovery. The compatibility of OT and victim advocacy is further demonstrated in the context of one therapist's work with survivors of domestic and sexual violence. [ABSTRACT FROM PUBLISHER]

The Community Practice Pilot Project tested an approach for preparing students for work in organizations in which not social workers were employed. Field placement were clustered in a small geographic area. Classroom learning was linked with field instruction, advising, and Experiential Learning. Goals included integrating content on community-based practice into the foundation curriculum, exposing students to community building initiatives, and influencing the master's curriculum. The project provided some evidence that early exposure to community initiatives has positive influence on increasing student enrollment in marco concentrations and courses. Implications for social work include viewing the “environment-surrounding-the-person” as a starting point for instruction in foundation methods course. [ABSTRACT FROM PUBLISHER]

Interagency collaborations are uniquely suited to meeting the increased needs of comminutes in today's environment of reduced federal funding and devolution of services to the state and local levels (Gore, 1993). In Texas, interagency collaborations take place through Community Resource Coordination Groups (CRCGs), which were created by the Texas Legislature to coordinate local service delivery for children and their families who often “fall through the cracks” due to having multiple needs. This article present and evaluation of CRCG operations, with a focus on identified best practices, related obstacles, and suggestions for improvement. The researchers visited CRCG sites, and conducted semi-structured face-to-face interviews, as well as a mail survey, with CRCG staff. Overall, CRCGs appear to effectively enhance the delivery of coordinated services in a effort to meet the multiple needs of the children and families that they service. Recommendations for policy and practice are discussed, such as spearheading community action structures (Poole, 1997) that may help CRCGs more effectively meet the needs of their respective local communities. [ABSTRACT FROM PUBLISHER]