Within pediatric mental health, of the only 25% of children with emotional and behavioral disorders that receive mental health services many receive treatments and interventions that are not based upon evidence. The question remains how to support mental health clinicians to utilize the evidence we have regarding the treatment of pediatric mental health disorders. Research findings consistently demonstrate that there are a variety of successful interventions which can be effective in changing clinical behaviors. However, further research is required to develop and validate a coherent theoretical framework of health professional behavioral change to better inform the choice of interventions. This study applied theory-driven approaches to predict pediatric mental health clinician behavior in the utilization of evidence-based practice. A national web based survey of pediatric outpatient mental health clinicians (N=154) applying the Theory of Planned Behavior and Operant Learning Theory (Habit and Reinforcement) was conducted. The clinical behaviors of interest were: 1) Recommendation of medication consultation/prescription for the treatment of ADHD; 2) Recommendation of parent training regarding child behavior management; and 3) Utilization of evidence-based group therapy with the specific objective of reducing wait lists. Behavioral intention, a theoretically derived measure, was the main outcome measure. Habit uniquely accounted for 61%, 20% and 25% of the variance, respectively in the three behaviors of interest (parent management, medication, and group treatment for waitlist management). Attitude uniquely contributed a further 5% of the variance in intention in medication consultation/prescription while Reinforcement uniquely explained an additional 10% of the intention to use group treatment. Habit is the single greatest predictor of pediatric mental health clinician behavioral intention in the utilization of evidence-based practice. Habit describes why clinicians are engaging in a behavior (it is what they’ve always done), but the other theoretical predictors tell us something about how to change this habit.

Provision of a high standard of care in addiction treatment and prevention services is dependent upon knowledge of evidence-based practice (EBP) principles, and the skills needed to apply those principles, among the substance abuse workforce (SAW). Competency profiles for Canada’s SAW define the need for skill and knowledge of EBP. Within Canada’s SAW, persons within the Occupational Cluster Senior Management are ultimately responsible for decisions and therefore must possess a high level of proficiency in EBP. This proficiency has not been assessed in this group; the objective of this study was to conduct such an assessment on Senior Management from Nova Scotia’s Addiction Services. Eighteen Senior Managers completed semi-structured qualitative interviews. Interviews were analyzed using content analysis, five main themes emerged. It appears that Senior Management possess an understanding of the principles of EBP, but that their knowledge and use of the skills required for their application requires further development.

Serious gaps between best and actual stroke rehabilitation practices continue to exist, even with the plethora of evidence and guidelines for stroke best practice management. To address this knowledge gap with an effective knowledge translation (KT) intervention, six steps of the Knowledge to Action (KTA) Model were applied to these specific research objectives: 1) to conduct a systematic review to examine evidence on the effectiveness of single/multi-component KT interventions for improving knowledge, attitudes, and rehabilitation practice behaviors of occupational therapists (OTs) and physical therapists (PTs), in order to inform the design of a KT intervention; 2) to conduct usability testing to explore factors that facilitate or hinder OTs' and PTs' use of an evidence-based, stroke rehabilitation-specific e-learning resource (Stroke Engine; www.strokengine.ca), as a preliminary step in its potential use as a KT intervention; and, 3) to conduct a KT intervention study to determine the extent of knowledge acquired regarding stroke rehabilitation best practices by OTs and PTs while using Stroke Engine as an e-learning KT intervention for three months. A sub-objective was to identify the association between knowledge acquired and factors related to the clinician, their work environment, and adherence to the KT intervention. Main findings from this research agenda suggested that use of active, multi-component KT interventions resulted in some knowledge gains among physical therapists, but additional research was needed to understand impact of these strategies on occupational therapists. During Stroke Engine testing, factors hindering its use were identified and the website was modified to maximize its usability as an e-learning KT intervention. Clinicians were satisfied with Stroke Engine as it provided them with the latest stroke evidence in a quick, user-friendly format. Finally, significant improvements in clinicians' proportion of 'evidence-based' responses on the Stroke Rehabilitation Knowledge Questionnaire were observed between baseline and following Stroke Engine use as a KT intervention. Intensity of Stroke Engine use was the most significant predictor for clinicians' improved 'evidence-based' knowledge on the Questionnaire. It was concluded that Stroke Engine has promise as an effective e-learning KT intervention for enhancing rehabilitation clinicians' knowledge of stroke best practices.

Clinicians and hospital administrators are increasingly challenged to achieve efficient evidence-based care. Clinical decision support (CDS) tools are being introduced into the clinical setting to facilitate the bridging of knowledge gaps at the point of care. Order sets are one of the tools used to facilitate this knowledge translation. Using the realist review methodology and a focus group of interview participants, this thesis explored retrospectively some of the causal relationships that lead to effective and successful order set adoption. Findings demonstrate the need for in-depth and regular review of context and order set adoption. Technology can offer some enhancements in the form of delivery tools, but it also introduces new and complex challenges for development and implementation. Ongoing software development is needed to improve delivery formats as well as incorporate effective tools to allow for efficient continuous quality improvement supports. / Graduate / 0769 / 0566 / hallsm.77@gmail.com

This randomized-controlled pilot study explored the impact of a pretreatment, telephone engagement intervention on adolescents’ (ages 13-19) initial mental health service attendance (i.e., the first 3 counseling sessions) and four secondary outcome variables (i.e., autonomous/ controlled treatment motivation, self-efficacy, and working alliance). Twenty-seven adolescents received the engagement intervention and completed assessments and 24 adolescents completed assessments only. Both groups completed follow-up assessments 6 weeks after study enrollment. Associations between the outcome variables and initial treatment attendance were explored. The extent to which demographic variables (i.e., age, gender, race, immigration status, and residence in low income neighbourhoods), psychological distress, and self-reported barriers (i.e., mismatched treatment expectations and external demands) were associated with treatment attendance was also explored. The primary findings from this pilot study indicated that adolescents who received the engagement intervention had greater initial treatment attendance (M=2.11, SD=1.01) than the assessment only group (M=1.54, SD=1.22), but the difference only approached significance. Moreover, no significant between-group differences in the secondary outcome variables were found. Paired samples t-tests were used to examine changes in autonomous/controlled treatment motivation and self-efficacy within groups between baseline and follow-up. The results of the paired samples t-tests indicated that that the experimental and control groups both demonstrated a significant decrease in controlled motivation at follow-up. In addition, the control group demonstrated a significant decrease in autonomous treatment motivation at follow-up. Post hoc analyses, using correlation and linear regression analyses, explored the associations between initial attendance and the secondary outcome variables, psychological distress, self-reported barriers, and demographic variables. A negative association between age, self-reported barriers and initial attendance was found. A positive association was found between working alliance and initial attendance. While the majority of adolescents who participated in this research lived in low income neighbourhoods and nearly half were second generation immigrants, these demographic variables were not associated with initial treatment attendance. Although the engagement intervention had a medium effect on initial treatment attendance, this difference was not statistically significant. Future research with a larger sample size and longer follow-up is needed to determine the effectiveness of the engagement intervention.

Aim: This paper is a report on a study that explored the professional development of intensive care unit nurses in journal clubs. Background: Evidence-based practice is important in nursing care (Krom, Batten, & Bautista, 2010). However few nurses feel comfortable using evidence to guide their practice (Pravikoff, Tanner, & Pierce, 2005). Journal clubs are a way to establish science as conversation (Wright, 2004) and foster knowledge translation for evidence-based nursing practice (Goodfellow, 2004). Methods: Monthly journal club meetings were held with the participation of a total of 71 healthcare professionals (65 nurses, 2 physicians, 2 pharmacists, 1 physiotherapist, and 1 respiratory therapist), who worked in two intensive care units of an Ontario hospital. After six months of meetings, 21 individual interviews were conducted with nurses, physicians, pharmacists, and nurse educators. Additional data collection included two focus groups, surveys, a review of staff meeting minutes, and researcher field notes. Findings: Journal clubs provided nurses with incentive to read research articles, improved nurses’ confidence in reading research, created a community of peers who worked collaboratively to improve clinical practice, provided a structure for nurses to reflect-on-practice, and led to reported changes in clinical practice. However, the data suggests that any gains in competence of nurses with the critical appraisal of research articles were probably modest. Barriers to participating in journal clubs and evidence-based practice are also identified. Conclusion: Journal clubs can foster knowledge translation and evidence-based practice through creating a community of practice and by providing nurses with motivation, structure, and confidence to read research articles. However, nurses reported a lack of critical appraisal skills and uncertainty about how to implement evidence into practice. Journal clubs may have a greater impact when implemented alongside other knowledge translation strategies such as working with clinical nurse specialists in order to enhance evidence-based practice.

Master of Social Work / This research is about evidence based practice, which is an area of increasing interest and emphasis in social work today. Initially apparent in medical and health care settings, evidence based practice now has widened applicability to a broad range of contexts and professional disciplines. The ways in which research evidence is translated into policy and practice is itself a topic area for social work research. The study investigates evidence based practice in child welfare, specifically the out-of-home care system. Out-of-home care provides alternative placements for children and young people who cannot live with their families because of abuse and neglect, and generally consists of placement with foster carers or in a residential/group care setting. This research is an exploratory study which investigates through individual interview how nineteen out-of-home care Senior Managers and Team Leaders in the states of New South Wales, Western Australia and the Australian Capital Territory interpret and understand evidence based practice, and the degree and depth of knowledge they transfer from research awareness into out-of-home care practice and policy development. The research has three main objectives. Firstly to investigate the understanding of out-of-home care managers of evidence based practice, secondly to determine the influence of relevant research on practice and policy in out-ofhome care, and thirdly to explore potential barriers to evidence based practice. Looking After Children, a social work case management system for children and young people in out-of-home care, provides the context for this research, in which evidence based practice is critically examined. A thematic analysis of the interview data identified five major themes. These included: the benefit of broadening definitions of evidence based practice to include a wide range of influences on practice; the value and importance of 2 considering a broad range of research approaches in connecting research with policy and practice AND the potential for influencing outcomes of social work intervention via research based and influenced guided practice systems and techniques; factors which constitute barriers and also those that enhance the implementation of evidence based practice; the potential for instigating and supporting new research via the use of evidence based practice for purposes such as data aggregation, in addition to practice development and enhancement of client outcomes. Implications and conclusions are drawn from this study in relation to out-ofhome care policy and practice, with particular reference to use of the Looking After Children case management system in the Australian context. These include the potential of a consistent system such as LAC to provide common language and assessment tools and procedures in a welfare sector that is fragmented by lack of national legislation, and the potential for development of national out-of-home care research projects as a result of cross agency LAC implementation resulting in data aggregation opportunities.

abstract: Risk assessment instruments play a significant role in correctional intervention and guide decisions about supervision and treatment. Although advances have been made in risk assessment over the past 50 years, limited attention has been given to risk assessment for domestic violence offenders. This study investigates the use of the Domestic Violence Screening Inventory (DVSI) and the Offender Screening Tool (OST) with a sample of 573 offenders convicted of domestic violence offenses and sentenced to supervised probation in Maricopa County, Arizona. The study has two purposes. The first is to assess the predictive validity of the existing assessment tools with a sample of domestic violence offenders, using a number of probation outcomes. The second is to identify the most significant predictors of probation outcomes. Predictive validity is assessed using crosstabulations, bivariate correlations, and the Receiver Operating Characteristic (ROC) curve. Logistic regression is used to identify the most significant predictors of probation outcomes. The DVSI and the OST were found to be predictive of probation outcomes and were most predictive of the outcomes petition to revoke filed, petition to revoke filed for a violation of specialized domestic violence conditions, and unsuccessful probation status. Significant predictors include demographics, criminal history, current offense, victim characteristics, static factors, supervision variables and dynamic variables. The most consistent predictors were supervision variables and dynamic risk factors. The supervision variables include being supervised on a specialized domestic violence caseload and changes in supervision, either an increase or decrease, during the probation grant. The dynamic variables include employment and substance abuse. The overall findings provide support for the continued use of the DVSI and the OST and are consistent with the literature on evidence-based practices for correctional interventions. However, the predictive validity of the assessments varied across sub-groups and the instruments were less predictive for females and offenders with non-intimate partner victims. In addition, study variables only explained a small portion of the variation in the probation outcomes. Additional research is needed, expanding beyond the psychology of criminal conduct, to continue to improve existing risk assessment tools and identify more salient predictors of probation outcomes for domestic violence offenders. / Dissertation/Thesis / Ph.D. Justice Studies 2011

Bakgrund:Axelsmärta är vanligt förekommande bland idrottare och den vanligaste orsaken till detta är rotatorcuffsrelaterad smärta. Axeln är en komplex led, både anatomiskt och kinematiskt. Inom sjukvården ska man arbeta evidensbaserat och tidigare studier har gjorts i andra länder för att jämföra nuvarande praktik vid rotatorcuffsrelaterad smärta med nuvarande evidens. Ingen sådan studie har dock genomförts i Sverige.  Frågeställningar:Vilka typer av behandlingsmetoder används vid rotatorcuffsrelaterad smärta bland fysioterapeuter i Sverige? Hur ser den nuvarande evidensen ut vid behandling av rotatorcuffsrelaterad smärta? Metod:En elektronisk enkätstudie utformades och hade ett patientfall med en vanlig presentation av en patient med rotatorcuffsrelaterad smärta som grund för respondenter att grunda sina svar på. Utöver detta genomfördes också en litteraturstudie för att undersöka nuvarande evidens.  Resultat:Överlag hade fysioterapeuter grundat sin behandling på rådgivning/utbildning och träningsterapi. Även andra passiva behandlingsmetoder förekom som alternativ fysioterapeuter skulle använda sig av. Diskussion:Svenska fysioterapeuter använder sig primärt av träningsterapi vilket grundar sig på nuvarande evidens. Passiva behandlingsmetoder används trots evidens kring dess låga effekt vid rotatorcuffsrelaterad smärta och låg kostnadseffektivitet. / Background:Shoulder pain is common among athletes and the most common cause of this is rotatorcuffrelated pain. The shoulder is a complex joint, both anatomically and kinematically. In the field of health care, one should work evidence-based and previous studies have been conducted in other countries to compare current practice in rotator cuff-related pain with current evidence. However, no such study has been conducted in Sweden. Problem statments:What types of treatment methods are used in rotator cuff-related pain among physiotherapists in Sweden? What does the current evidence look like in the treatment of rotator cuff-related pain? Methods:An electronic survey was designed, which included a patient case with a typical presentation of a patient with rotator cuff-related pain as a basis for respondents to base their answers. In addition, a literature study was also conducted to investigate current evidence. Results:Overall, physiotherapists based their treatment on counseling / education and exercise therapy. Other passive treatment methods were also found that physiotherapists would use as alternative treatments. Discussion:Swedish physiotherapists primarily use exercise therapy, which is based on current evidence. Passive treatment methods are often used despite evidence of its low effect on rotator cuff-related pain and low cost effectiveness.

BACKGROUND: Hysterectomies are one of the most frequently performed surgical procedures in the United States. There are a wide variety of diagnoses that require a patient to obtain this procedure, but the majority of hysterectomies are performed for benign indications. Currently, gynecologists do not follow a standardized protocol surrounding postoperative laboratory ordering, and healthcare professionals can order a wide range of tests as often as they choose. Extraneous laboratory orders are disruptive to the patients’ well-being and risk their health following surgery. These orders are costly for hospital systems, take up precious time of hospital employees, and influence the course of patient treatment only in extremely rare circumstances. There are few studies that develop exclusion criteria for patients who may not require a laboratory test following surgery. Though systems to predict postoperative hematocrit have been created, they are complicated and difficult to use. The few studies that were performed are yet to be accepted by the medical community, in part because of their limited scope. This study will be the first to incorporate the results of robotic surgery in the analysis. OBJECTIVE: The purpose of this study is to determine concrete parameters to indicate that a patient is in need of postoperative laboratory work and at risk for anemia or transfusion. We aim to develop two comprehensive models that guide surgical practitioners to identify the cases which do not require laboratory data. METHODS: A total of 1027 gynecologic surgeries were performed at Saint Francis Hospital and Medical Center between April 1, 2014 and May 31, 2016. This retrospective study extracted data from EPIC EMR according to 42 variables preconceived to be the leading indicators of postoperative hematocrit and overall healing. Five healthcare professionals were surveyed to identify the variables that influence their postsurgical patient assessments and their decisions to order blood testing. This information was developed into score sheets with differing levels of stringency. Correlation highlighted 14 of the initial 42 variables as contributors to postoperative hematocrit and an equation model was built. Stepwise linear regression was used for univariate and multivariate analyses, from which we created our equation to predict all patients’ postoperative hematocrit. RESULTS: Out of the 1027 initial cases, a total of 602 cases were identified as hysterectomies for benign indications. Survey data gave the highest value to urine output and heart rate as key indicators of postoperative anemia. From the survey data, two clinical scoring sheets with differing stringency were created to guide practitioner laboratory ordering. These sheets gave parameters of heart rate and urine output the largest correlative weight in determining postoperative hematocrit. However, based on regression analysis, parameters of age (AGE), body mass index (BMI), preoperative platelet count (PPC), estimated blood loss during surgery (IO EBL), preoperative hematocrit (PHCT) and postoperative fluid bolus orders (POSTOP FB) proved to be the key variables impacting postoperative hematocrit (POSTOP HCT). These items were translated into the equation: POSTOP HCT = 22.51 – 0.40*POSTOP FB – 0.01*IO EBL + 0.25 PHCT + 0.09*BMI + 0.06*AGE – 0.01*PPC (R-squared = 0.310). CONCLUSIONS: This study aims to decrease superfluous laboratory testing, as well as to contribute to a larger conversation considering the potential merits of clinical judgement in a data-driven healthcare system. We have created a number of comparable strategies in order to reduce the number of unnecessary blood draws: two clinical scoring sheets and an equation. The score sheets indicate when to order additional testing. These sheets are representative of a range of surgical practitioners’ conventional clinical judgement. The equation serves as an evidence-based guide for determining postoperative hematocrit following benign gynecologic surgery. These predictive mechanisms will be validated and a superior method determined as our research continues with prospective application. We eventually expect to use the most accurate mechanism to reduce postoperative blood testing following all surgeries.