Children with disabilities are three to four times more likely to be abused than their non-disabled peers due to the impact of challenges related to behavior, cognition, language, social skills, and communication skills. In September of 2018, the Council for Exceptional Children (CEC) specifically noted the need to establish maltreatment prevention and response curricula and promote research and advocacy surrounding maltreatment of children with disabilities. One common curriculum recommended is Kidpower®. While Kidpower® shows promise in increasing people safety skills and offers some basic accommodations for use with disabled populations, a complete accommodation plan for deaf or hard of hearing students has not been developed. The purpose of this study was to explore how Kidpower® curriculum could be accommodated to meet the unique needs of deaf and hard of hearing students from the perspective of the deaf education community, including deaf adults, deaf education teachers, deaf education teacher preparation faculty, and parents with deaf or hard of hearing children. A combination of focus groups and interviews were utilized to review lessons and homework from the Kidpower® curriculum. Participants gave feedback on obstacles and ideas for accommodations and modifications that would mediate the challenges. Data were inductively coded and analyzed for themes. Findings indicated the deaf education community believes the curriculum needs media components, language modifications and teaching strategies, enhanced visual information, and representation of people and situations related to the lives of deaf and hard of hearing children to be an effective curriculum for this population.

The original publication is available at http://www.samj.org.za / The March 2011 Anti-Substance Abuse Summit in Durban continued the outdated approach to policy around illicit drugs in South Africa. It missed opportunities for discussing how to impact significantly on the health and social harms associated with problematic drug use and reduce the burden of drug-related cases in the criminal justice system. The government needs to move away from the political rhetoric of a ‘drug-free society’ and start the real work of formulating and implementing an evidence-based drug policy that learns from the experiences of other countries around decriminalising drug use; takes into account differences in the harms resulting from different classes of drugs; adopts a rights-based, public health approach to policy; and identifies a single (accountable) agency that has the authority to oversee policy implementation. In addition, consensus is needed on the short-, medium- and long-term priorities for drug policy implementation. The 17 evidence-based drug policy strategies identified by Babor et al. may serve as a useful starting point for policy development.

Thesis (DPhil (Sociology and Social Anthropology))--Stellenbosch University, 2008. / The aim of the study was to design an alcohol abuse prevention program for the workplace that was based on a sound program theory. Ultimately the study aimed to indicate an approach to the improvement of social service programs by the incorporation of program theory in the design, implementation and evaluation of social service programs. In the first phase of the study the program theory was developed. Literature studies on the prevention of alcohol abuse and on program evaluation were done. This was followed by a survey in the workplace to determine alcohol consumption and abuse, factors contributing to alcohol consumption, workplace factors contributing to abuse and attitudes towards the responsible consumption of alcohol. The survey was complemented by focus group discussions. Eight hundred and fifteen respondents completed the survey. The most important findings were that 46% of respondents indicated that they drink alcohol, nine percent could be classified as alcohol dependent according to the Michigan Alcoholism Screening Test (Selzer, 1971) and 24% of men and 15 % of women drank at risky levels. The most important factors contributing to alcohol consumption were social problems, social drinking and dependence. Workplace factors contributing to alcohol consumption were the lack of control, availability of alcohol, social pressure to drink and the quality of work. The program theory was formulated from the results of the literature study, the survey and the focus group discussions. The all-inclusive program theory was that life skills training will lead to a reduction in frustration and therefore a reduction in the abuse of alcohol, within a positive work environment. In the following phase the program was implemented and evaluated. The program consisted of life skills training, supervisor training and the revision of the alcohol policy. Quantitative and qualitative methods were used to test the program theory and evaluate the program. The life skills program was tested by means of an experimental design. The experimental groups showed an improvement in psychosocial functioning, but the differences were not statistically significant. The intervention had no significant effect on the consumption of alcohol. Respondents’ knowledge about the moderate drinking of alcohol improved significantly, but attitudes towards moderate drinking were not affected. Supervisor training was done to improve relationships at work and to lower frustration. Supervisors improved their knowledge of managing a troubled employee significantly and felt more comfortable in managing troubled employees after the training. The substance abuse policy of the workplace was revised successfully. The study contributes significantly to the methodological improvement of substance abuse prevention programs in the workplace and illustrates the importance of program theory in the design and evaluation of social programs. The study also illustrates how a process of formative evaluation can be used to improve social programs. More specifically the value of a systematic process of program development and program evaluation has been demonstrated, including that an in depth problem analysis has been done, an intensive and collaborative process of theory development has been undertaken and a rigorist evaluation design (with quantitative and qualitative components) has been applied.

With the increase in survival for children with cancer, part of the focus of current research is aimed towards evaluating how these children are adapting psychosocially. Neurocognitive deficits have been well established. However, there are multiple facets encompassing quality of life, including general mental health, lifestyles and health behaviors, and academic and cognitive functioning. The relationship between neurocognitive and psychosocial functioning has yet to be thoroughly evaluated. The purpose of this study was to investigate the relationship between neurocognitive and psychosocial functioning in survivors of brain tumors and acute lymphoblastic leukemia. Data was collected from existing archival database comprised of patients of the at Cook Children's Medical Center in Texas. The sample consisted of 177 patients between the ages of 3 and 12 who were at least two years post-diagnosis. Measures used included the NEPSY and the Behavioral Assessment for Children. Statistical analyses included a several one-way analysis of variances, an independent samples t-test, a univariate analysis of variance, a hierarchical multiple regression, and odds ratio analyses. Results indicated survivors treated with neurosurgery alone appear to be less at risk for developing behavior problems than other treatment modalities. Also, brain tumor survivors demonstrate more problematic behaviors than survivors of acute lymphoblastic leukemia. Visuospatial functioning, diagnosis, and type of treatment were found to be predictive variables of behavior problems. Attention, and perhaps language, deficits may predispose children to more problems in their behavior. It is concluded that there are other factors affecting behavior in this population that were not accounted for in this analysis. It is recommended for future studies to research the individual clinical scales of the Behavior Assessment System for Children, obtain information from multiple informants, study this relationship longitudinally, and research additional factors that may be influencing the relationship between neurocognitive and psychosocial functioning. This provides evidence of risk factors that should be monitored as the child returns home and to school.

M.Ed. / Drug abuse in secondary schools appears to be a major problem. Preliminary discussions with some learners and educators triggered the researcher to attempt making a research on this matter, since enormities of this problem has a negative impact towards the process of teaching and learning. This type of practice affects the behavioural pattern of individuals within educational institutions. For example learners bring their parents’ revolvers to school to harm their classmates, in class they laugh continuously with no apparent reason, they remain behind with their school work, dress indecently, become arrogant, use vulgar language, rape girls, become disorderly, provoke other learners and start unnecessary fights. The purpose of this study was to explore and investigate whether principals, educators, parents have the necessary knowledge and skills on how to detect the learner as being a drug abuser, how intervention takes place. Further, the research study also tries to determine whether the personnel and Learner Representative Council do check on the food that the vendors are selling to ascertain whether they don’t contain any harmful substances, that can cause a barrier in the learner’s mentality, of which at the end can encourage the learner to turn to crime as a means to survival. Data was collected through a number of methods. Various community members of educational institutions like, principals parents, educators learners and the Gauteng Department of Educators official member, dealing with drugs were interviewed to inquire about their perceptions, feelings and opinions as far as it concerned about intervention strategies for drug abuse in secondary schools. What they recommend should be done to facilitate change on causes of abusing drugs by learners, which strategies to be employed to curb this problem within secondary schools. A thorough literature review was made to determine what other researchers discovered on the same phenomena. Feelings, perceptions and opinions were read throughout the interviews. The participants proved to have a minimal knowledge about the practices of drugs within their schools and the society. By means of particular programmes designed by the school and the society, they can be empowered to open up, in order to provide assistance to the troubled children. / Prof. J.R. Debeila

This dissertation includes three papers that examine the role of antipoverty policies and programs in preventing child maltreatment. Paper one examines how access to Medicaid impacts child maltreatment as characterized by Child Protective Services (CPS) reports. Paper two considers how access to Early Childhood Education and Care (ECEC) programs affects child welfare involvement. Paper three assesses the relationship between temperature and CPS reporting, looking to air conditioning and state LIHEAP cooling policies as a potential source of mitigation.

Background: In high-income countries, parenting programmes have been shown to be effective in reducing the risk of child maltreatment. However, there is limited evidence of their effectiveness in low- and middle-income countries. This thesis focuses on the development and pilot randomised controlled trial (RCT) of a parenting programme to reduce the risk of child maltreatment in low-income families with young children in Cape Town, South Africa. Methods: This thesis is comprised of three studies submitted as papers for publication. The first study focused on the development of an evidence-informed, locally relevant parenting programme for families with children aged three to eight years in Cape Town, South Africa. Intervention development took place over three stages: (a) identification of core intervention components common in evidence-based parenting programmes; (b) formative evaluation using qualitative in-depth interviews and semi-structured focus groups with South African practitioners and low-income parents; and (c) integration of evidence-based approaches and local contextual issues to develop the intervention structure, protocols, and manual. The second study used a pilot RCT (N = 68 parent-child dyads) to examine the evaluation feasibility and initial effects of the parenting programme developed during the first study in Cape Town - the Sinovuyo Caring Families Programme. Parents of children aged three to eight years with clinical levels of parent-reported child behaviour problems were randomly allocated to either a 12-session, group-based parenting programme or a wait-list control group. Primary outcomes included parent-report and observational assessments of positive parenting, harsh parenting, and child behaviour problems; secondary outcomes included parent-report of parent depression, parenting stress, and social support. Assessments occurred at baseline and immediate post-test (i.e., 3-months after baseline). The third study was a mixed-methods process evaluation assessing the feasibility of the parenting programme based on three theoretical dimensions: participation, implementation, and acceptability. Quantitative data included attendance registers, fidelity checklists, satisfaction surveys, and parent-report of engagement in home practice activities. Qualitative data included post-programme focus groups with community facilitators (n = 8), individual interviews with a randomly selected group of parents (n = 15), transcripts from parenting sessions, and minutes from supervision sessions with facilitators. Results: In the first study, the formative evaluation suggested that many evidence-based parenting programme components and approaches were compatible with the local cultural context. These included managing child behaviour problems, learning effective discipline strategies, building positive parent-child relationships, and reducing parenting stress. Findings also suggested that programmes may benefit from including additional content on keeping children safe in violent communities, communicating about HIV/AIDS and poverty, involving fathers and alternative caregivers, and incorporating cultural values of social responsibility and respect. The pilot RCT in the second study showed high levels of study recruitment and retention, outcome measurement reliability and response rates, and a minimal effect of clustering due to delivering the intervention in groups of parents. Analyses showed moderate intervention effects for parent-report of increased positive parenting and observations of improved child-led play. However, observational assessments also found reduced frequency of positive child behaviour in the treatment group in comparison to controls. In the third study, quantitative results showed high levels of programme acceptability, implementation, and participation. Thematic analysis of qualitative data identified seven themes related to feasibility: (a) receptivity to strengthening existing parenting practices, (b) initial resistance to new parenting skills, (c) contextualising content within a cultural framework, (d) reinforcing implementation fidelity and improving quality of delivery, (e) challenges delivering content on nonviolent discipline, (f) supporting participant involvement, and (g) engagement in a collaborative learning approach. Conclusion: This thesis is the first in sub-Saharan Africa to use a systematic approach to develop and rigorously pilot a parenting programme to reduce the risk of maltreatment against young children in low-resource settings. Initial results indicate that a parenting programme derived from evidence-based approaches is feasible, culturally acceptable, and has the potential to reduce the risk of child maltreatment by improving positive parenting behaviour. Further intervention development and testing is necessary to strengthen core programme components and determine programme effectiveness.

Drug poisoning due to overdose is a major health problem in Tennessee. In TN there has been an increase of 210% in accidental overdose deaths since 1999 to 2010. About 80% of drug poisonings in Tennessee were either accidental or self-inflicted. Also as indicated by the CDC in 2010 enough drugs were prescribed to medicate every American adult around-the-clock for one month and the vast amount of drugs increases the risk of misuse. Drug Take Back Events are a useful measure for reducing the number of prescription medications kept in the households. However, the extent to which these events have affected in the reduction of drug poisoning is not well known. The objective of this study was to investigate the relation between the total number of drugs collected at Take Back Events and emergency department admissions due to overdose in three Counties in Northeast TN. In partnership with Drug Enforcement Administration and local law enforcement, drop box donations for controlled substances (CS) were analyzed for Washington, Carter and Sullivan County, Tennessee, from 2009 to 2012. Data were obtained from Tennessee Department of Health on number of emergency department (ED) admissions due to overdose based on International Classification of Diseases (ICD)-9 codes occurred between 2009 and 2012 in the above-mentioned counties. Linear forecast trend-line method was used to evaluate associations between the amount of controlled substances collected via donation boxes and number of ED visits occurred during 2009-12. Furthermore Pearson’s correlation analyses were conducted to investigate relationship between drop box donations and ED admissions due to overdose. From 2009 – 2012 the ED visits shows a significant decrease as the amount of drugs collected increases for Washington and Carter County. Also a negative correlation is seen between the ED visit and drugs collection for Washington and Carter County with R2 values of -0.96 and -0.90 respectively. However the same is not true for Sullivan County as the trend was not inversely proportional and also the correlation between ED visits and gathered drugs is low with R2 value of -0.562. These results quantify the potential impact of drug take back events on reduction in drug poisoning due to overdose in Northeast Tennessee. Further study is required to examine the effect of the events on the epidemic of prescription drug abuse and misuse.

The US Food and Drug Administration (FDA) is encouraging the innovation of long-acting opioid formulations that are manipulation-resistant. The purpose of this commentary is to assess the benefits and limitations of abuse-deterrent opioid formulations (ADFs) and discuss their role in mitigating the current opioid epidemic. ADFs have been created with chemical properties that make it difficult for people who non-medically use prescription drugs to crush and dissolve opioid tablets, as well as by combining opioids with antagonists such as naloxone or naltrexone, which are released only when the dosage form has been manipulated or the drug is taken by a non-intended route. Despite these and other technologies, consensus regarding the effectiveness of these formulations in preventing non-medical use is lacking given the difficulty in obtaining post-marketing data. Researchers also question if the creation of abuse-deterrent drugs will have a positive effect on those struggling with a severe opioid-use disorder, fearing that current opioid users will simply find a new – perhaps more dangerous – drug of choice. Abuse-deterrent opioids are still opioids, and although they may make manipulation more difficult than non-ADF formulations, they are not “abuse proof.” The introduction of ADFs could provide a false sense of security among prescribers and dispensers, and we fear that ADFs may have a minimal impact on non-medical use of prescription opioids. Further epidemiological studies will be required to determine the large-scale impact of abuse-deterrent opioids in preventing opioid use disorder and its downstream consequences.

The next presentation will examine common gray areas of community pharmacy practice. For example: under what circumstances do pharmacists fill early, transferred controlled substance prescriptions for out-of-town patients; when do pharmacists sell syringes to patients without proof of medical need; and how do pharmacists determine that a buprenorphine prescriber is acting in a patient's best interest? These and other ethical or legal dilemmas challenge pharmacists as they try to balance identifying and preventing potential drug abuse and diversion with providing evidence-based, quality patient care. Based on data from pharmacists and pharmacy students, as well as established theory, presenters will describe typical approaches to decision-making. Multiple pharmacy cases will be discussed. Participants will learn how to integrate best-practice patient care systematically into common practice scenarios.