Background: Individuals with intellectual and/or developmental disabilities (IDD) are experiencing longer life expectancies with the majority requiring the ongoing support of family caregivers into adulthood. Medicaid is the primary funding source for supports and services for adults with IDD. Growing Medicaid expenditures and goals to improve quality of care are driving more states to move their Medicaid fee-for-service programs into a managed care model. The stated goals of Medicaid managed long-term services and supports (MLTSS) are to improve care coordination and access to care while controlling costs, but the evidence regarding these outcomes is limited and mixed. Given the level of uncertainty about MLTSS for adults with IDD and their family caregivers, best practices recommendations have been produced by the federal government and advocacy agencies to help guide future MLTSS implementation efforts. These best practice recommendations combined with the continued expansion of MLTSS in the states, provided an opportunity to further explore implementation of MLTSS to inform both policy and practice. One state which recently reformed their Medicaid program to MLTSS and which has been referred to as a bellwether state is Kansas. The MLTSS program in Kansas, titled “KanCare”, is the first for adults with IDD to integrate across health, behavioral health, and LTSS while also contracting through three private-for-profit managed care organizations (MCOs). Aims: The objective of this study was to describe the current implementation of MLTSS for adults with IDD and their family caregivers in one state, Kansas. Study aims were as follows: 1) To understand the rationale behind and what actually happened with MLTSS implementation for adults with IDD in Kansas; 2) To understand how service coordination providers and family caregivers perceived care coordination and access to services for adults with IDD in MLTSS; 3) To understand how family caregivers and their roles were recognized in MLTSS for adults with IDD. Methods: A single case embedded design case study approach was used with in-depth semi-structured interviews completed with state/regional level representatives (N=13), MLTSS service coordination providers (N=7), and family caregivers of adults with IDD (N=11). Data collection and analysis were guided by the unified theory of family quality of life (FQOL) and Bronfenbrenner’s ecological model. The framework method was used to structure the data analysis process. Member checking was completed to ensure accuracy of results. Findings: Regarding aim one, respondents identified reducing costs and improving care quality as the rationale behind MLTSS, but these were outcomes not yet realized given the early stages of implementation. At the time of this study, the Managed Care Organizations (MCOs) were continuing to work on expanding provider networks and to provide additional services to address health disparities amongst individuals with IDD. Study participants identified the importance of adequate planning and stakeholder engagement to reduce confusion and fear when transitioning into MLTSS. Addressing aim two, timely and accessible consumer education, clear care coordination processes, and provider network adequacy were identified as important to influence the challenges experienced to date in care coordination and access to services. Regarding aim three, participants acknowledged the important role of family caregivers. At the current stage of the KanCare implementation, participants reported lack of formal processes for family caregiver assessment and a need for more proactive family support services planning. Conclusion: Lessons learned from this implementation experience include the importance of having long planning timelines and including stakeholder feedback into the design of MLTSS programs. Care coordination holds promise to better integrate care, but more research is needed to understand best practices for the provision of care coordination in MLTSS. In order to address access to services, MLTSS programs will need to work and build provider capacity and provider networks. MLTSS programs will also need to formally recognize the role of family caregivers by incorporating the use of family caregiver assessments to proactively plan for support needs.

Recreational organizations that deliver activities to youth within their communities can provide an effective setting for positive youth development (PYD) endeavours due to being fun, engaging, and an environment where skill-building is inherent. However, not all recreational organizations offering PYD aimed programs are successful and many are cancelled after a short amount of time. A framework or guide for (1) promoting PYD through community recreation and (2) evaluating and identifying PYD outcomes does not yet exist. This research seeks to develop a model to inform recreational program design to bring about positive developmental outcomes in youth participants using empirical data collected from three successful organizations. Both one-on-one interviews and a focus group with youth participants and adult staff were utilized following a qualitative multiple case study approach. Data collected was concerned with the positive developmental outcomes experienced by youth participants in the organizations and mechanisms used to realize these outcomes. The key themes, derived through inductive and deductive analyses, are presented as a five-step logic model. These themes help identify the intended results of programs along with the resources and processes needed to achieve these results, thus making this study’s findings easy to integrate into recreational programming. The model’s process factors included a series of inputs (i.e., contextual factors and external assets) and activities (i.e., direct and indirect strategies). Findings identified as intended PYD outcomes included outputs (i.e., objective measurable indicators), short-term outcomes (i.e., life skills), and long-term impacts (i.e., the four Cs including life skill transfer and contribution). This study elaborates on concepts identified in previous research that are conducive to PYD while bringing them together into a framework for designing recreational programs with the goal of promoting positive developmental outcomes in youth. However, further testing through quantitative, longitudinal, and intervention research may be needed.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / The department with the greatest economic dependence on the fruit is Ancash, and the Province of Casma is most important in production, as it only produces mango; however, at the productivity level, is a marked difference of 8.2 t/ha compared to the highest worldwide producer, Mexico. Taking this data into consideration, an analysis of the MSEs producing mango in Casma was conducted and problems were seen in the management of resources and processes, both at the levels of planning and control. Considering the problems of MSEs from Casma, a basic Production Planning and Control model was designed based on Process Management and agricultural best practices. The model consists of applying process management tools, such as the flow diagram, the SIPOC turtle, data sheet indicators, procedures, and formats for each sub-process, all with the aim of better understanding the proposal’s development and increasing the productivity of MSEs.

Introduction: The rapid growth of social media provides new opportunities for non-profit organizations to network and influence the public. Rural non-profit organizations can expand organizational capacity and reach, engage more stakeholders, and acquire new donors at a relatively low cost by using social media effectively. Despite the obvious benefits of social media, many rural non-profits underutilize this technology due to social drivers in the community and lack of organizational capacity. This is particularly salient in rural Appalachia where inequities persist in access to broadband and wireless mobile services. Eliciting insights from the experts - rural nonprofit leaders – is critical in identifying strategies to help nonprofit organizations level up social media use. There is a paucity of research on social media use among nonprofit organizations in rural Appalachia. The present study fills this important knowledge gap in the literature. Methodology: This qualitative study used purposive sampling techniques to recruit representatives from nonprofit organizations located in an 8-county region of Appalachian Tennessee. Semi-structured phone interviews were conducted in 2018 with nonprofit representatives (n=21). Nonprofit representatives were asked questions pertaining to social media use, effective communication strategies, and best practices. Probing questions were used to explore topics further. The audio recordings of the interviews were transcribed verbatim. Braun and Clarke’s thematic analysis procedures were used to conduct an in-depth descriptive analysis of participants’ responses and develop themes. Result: Four best practice strategies were identified: 1) “Know your people”—relationships matter: It is important to develop strong ties within the community; 2) “We had to come up with something fast”—resourcefulness matters: Nonprofit organizations should practice resourcefulness and adaptability in program development and outreach, 3) “Catch their attention”—the message matters: Messaging should be brief and positive in nature, and 4) “A lot of nonprofits come and go…”—the nonprofit matters: Nonprofit organizations should implement sound business practices. These themes highlight practical steps nonprofit organizations can take to enhance their social media communication strategies. Conclusion: With the emergence of sophisticated, easily accessible social media platforms like Facebook, YouTube, and Twitter, there is an urgent need to identify simple strategies rural nonprofits can employ to use social media more effectively. Our research addresses this need by summarizing the best practices in social media practices for nonprofit organizations in rural Appalachia. Nonprofit organizations in rural Appalachia can use these best practices to enhance communication strategies, expand their reach, and strengthen relationships within the communities they serve.

This research is designed to distinguish and describe or explain incubator practices that affect the performance of incubator clients of university technology incubator programs. The research focuses on understanding which practices significantly contribute to increasing job creation for the firms located in university based technology incubators. An increasing number of communities are embracing economic development strategies that target the high tech sector with high wage, high value jobs as a way to diversify their economies and boost local and regional economies. New economic development strategies include the notion of a creation strategy or "growing your own" instead of relying on recruiting of existing companies from other regions. In 1999-2000 (according to the most recent data), small businesses created three-quarters of U.S. net new jobs (2.5 million of the 3.4 million total). The small business percentage varies from year to year and reflects economic trends. Over the decade of the 1990s, small business net job creation fluctuated between 60 and 80 percent. Moreover, according to a Bureau of the Census working paper, start-ups in the first two years of operation accounted for virtually all of the net new jobs in the economy. The study is broken into three parts: (1) a review of the literature on incubation, focusing on its history, best practices, technology incubation, networking theory, and previous empirical studies (2) a review of previous data collected in a recent national survey and (3) case studies of the top performing incubators in the country based on employment growth of client firms contracted with case studies from non-top ten programs. The literature suggests that the study of incubation must be considered in the context of a larger enterprise development system of which the incubator will fill gaps in the larger regional enterprise development system. This notion is explored. In general, there is a great need for more empirical research into best practice of incubation. It is a non trivial task however as the nature of the industry limits the ability to obtain traditional, statistically defendable, measures.

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Yes / Purpose Pharmaceuticals are a key input into healthcare operations and so their effective management is vital. This issue is of key importance in Thailand and is aligned with the Thailand’s 2nd National Logistics and Supply Chain Research Strategies (2012-2016) focusing on healthcare green logistics. Pharmaceuticals in hospitals account for more than 50% of the total hospital purchasing budget. Moreover, the overuse of medicine was generally found to be prevalent in Thai hospitals despite serious financial concerns. The aim of this study was twofold: Phase (i) to investigate the movement and lifecycle of pharmaceuticals within Thai hospital sites and Phase (ii) identify the GL practices that effectively control/minimize the use of pharmaceuticals. Research Approach Using a case research method six hospitals were examined, to give coverage of the different types/sizes, locations and a range of environmental performance issues. Hospital visits were undertaken during January to July 2014, to obtain data by using a multi-method approach: interviews, documentation reviews and in situ observation. Purposive respondent sampling was undertaken to ensure that data was collected from staff with experience of pharmaceutical management and a bespoke form of content analysis used for the data review before further cross-case analysis. Findings and Originality The result of Phase (i) revealed that pharmaceutical flows appeared to be sophisticated and problematic, caused by issues such as limited budget allocation, ineffective governmental processes, and the over-prescribing of medicine for chronic patients. The findings also identified effective GL practices such as: (i) prescribing medicines for only 1-2 months for some patient conditions/drug types and increasing the frequency of follow-up reviews, (ii) conducting a medicines return programme and (iii) having a clearly defined system of pharmaceutical product review. The outcomes of the study proposed key practices to support a Sustainable Health System at both policy and hospital levels. Within this were: (i) a representation of stakeholder views, (ii) the provision of healthcare education and communication, (iii) addressing self-health management issues and (iv) planned system review and improvement. The design and execution of such a system should be grounded in Thailand’s Sufficiency Economy Philosophy (SEP) concept. Research Impacts In the GL research paradigm public healthcare, developing nations, human elements and life-cycle products have received limited attention; this study therefore contributes to the reduction of these gaps. The SEP concept was highly recommended by the United Nations, instead of Sustainable Development, in addressing GL practices in Thai culture to promote sustainable health standards and this underpins the focus and the originality/impact of this study. Practical Impacts This study recommends that staff in Thai hospitals focus on effective pharmaceutical management to contribute to the sustainability of good GL practices (as identified) and to the design and delivery of a Sustainable Health System in Thailand. The study presents guidance and support to do this.

This study assesses the influence of writing center tutorials on student writing and presents tutoring best practices. Writing center scholars have emphasized the need for evidence-based studies to understand how one-on-one tutorials influence student writing practices. After examining twenty tutorial recordings along with their pre-and post-intervention drafts in two state universities (ten in each university), the author traced the influence of writing center tutorials on students' post-session revisions and identified tutoring best practices. The findings show that all the twenty students included in the study followed up on the issues addressed in their tutorials, in some form or the other, in their post-session drafts. In terms of tutoring strategies, the findings revealed that although most of the tutors in the study could identify and speak about global concerns (i.e. development, structure, purpose, audience), many lacked specific strategies to address these concerns effectively. To address this concern, this study identifies tutoring best practices related to global concerns. Furthermore, the findings also revealed that the tutors faced challenges navigating the directive/non-directive continuum of tutoring. To address this concern, this study presents tutoring best practices to demonstrate how tutors can shift flexible between directive and non-directive strategies during a session. / Ph. D. / Writing center scholars have emphasized the need for evidence-based studies to develop a deeper understanding of how one-on-one writing center tutorials influence student writing practices. My aim in this study was to examine how writing center tutorials influence student writing and to identify tutoring best practices. To assess how writing center tutorials influence student writing practices, I asked this question: Do students carry over what is discussed in their writing center sessions into their post-session drafts? To assess tutoring best practices, I asked: What tutoring strategies influenced students to revise their drafts? To examine these two questions, I recorded twenty writing center tutorials in two state universities (ten in each university) and collected the drafts that students brought to their tutorials (i.e. the pre-intervention drafts) as well as the drafts that students revised after their tutorials (i.e. the post-intervention drafts). By comparing the pre-and post-intervention drafts and listening to the tutorial recordings, I was able to determine not just what issues were discussed in each of the twenty tutorials, but also how much of this discussion was carried over by students in their post-intervention drafts. As a result, I was able to demonstrate how students make use of their writing center instruction after attending a writing center session. In other words, I was able to show what aspects of a session students’ carried over into their post-intervention draft. My analysis revealed that all the twenty students included in my study incorporated their tutors’ suggestions, in some form or the other, in their post-intervention drafts. Thus, I was able to show the various ways in which a writing center tutorial can influence student revisions. I also used my data to identify tutoring best practices. For instance, my data revealed that although most of the tutors in the study could identify and speak about global concerns in a student’s paper (i.e. development, structure, purpose, audience), many lacked specific strategies to address these concerns effectively. To address this need, I examined the tutoring strategies used by the tutors in my study to address such global concerns and identified best practices related to such interventions. I also analyzed my data to examine how tutors use directive (i.e. providing direct instructions or suggestions) and nondirective (i.e. engaging students by soliciting their views) methods of tutoring. Although many writing center scholars and practitioners recommend using a flexible approach to alternate between these two methods depending on the nature of each session, tutors often find it challenging to do so in actual practice. Through my analysis, I identified best practices to demonstrate how tutors can adopt a flexible approach between directive and non-directive tutoring strategies. Such tutoring best practices can be a useful resource for tutor training programs and contribute to the overall development of writing center pedagogy.

This qualitative study aimed to examine the challenges surrounding the non-exit of first grade students from mathematics intervention programs, particularly focusing on Atlantic Elementary School within the Gulf County Public School District. Against the backdrop of declining mathematics proficiency, exacerbated by the COVID-19 pandemic, this study investigates the effectiveness of mathematics intervention and its alignment with best practices in mathematics instruction. While mathematics intervention aims to support students needing additional support with mathematical concepts, there exists a notable gap in understanding why many primary students do not transition successfully from mathematics intervention on grade level prior to advancing to the subsequent grade level. The research questions driving this study center on comparing the tasks and instructional approaches during mathematics intervention against established best practices and examining the impact of teachers' beliefs on mathematics intervention instruction. The data for this study was collected through surveys, observations, semi-structured interviews, and abstracts with three first grade teachers. The finding revealed instances where tasks lacked complexity and failed to promote mathematical conceptual understanding among students, indicating a misalignment with the Mathematics Teaching Practices. In contrast, some instruction during mathematics intervention demonstrated effective use of tasks that encouraged reasoning and problem-solving, aligning closely with the Mathematics Teaching Practices. Also, teachers who held positive beliefs about the effectiveness of interventions were more likely to implement tasks aligned with best practices and provide meaningful mathematics instruction. Conversely, teachers who expressed uncertainty about interventions tended to adopt less effective instructional approaches. The analysis highlighted the importance of aligning Tier 2 interventions with Mathematics Teaching Practices in mathematics iii instruction and recognizing the role of teacher beliefs in shaping instructional practices. These findings should encourage stakeholders in mathematics education to utilize this insight as a catalyst to implement necessary changes in mathematics education.

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