Assessing self-efficacy in families of children with hearing concerns through an audiological early intervention training. Abigail Lesley, B.S., Karee Diem, B.S., and Marcy Hite, Au.D., Ph.D., Department of Audiology and Speech Pathology, College of Clinical and Rehabilitative Health Sciences, East Tennessee State University, Johnson City, TN. For children with hearing loss, spoken language outcomes are best when children have optimal auditory access through the consistent use of appropriately fitted hearing devices and are exposed to a rich linguistic environment. Parents can play a large role in facilitating their children’s use of hearing devices and supporting their language development. The purpose of this study was to improve of parent self-efficacy, increase family knowledge on language outcomes, and increase consistent use of amplification by providing an educational workshop to families with children identified with hearing loss and/or hearing concerns. The hypothesis of this study was to see an enhancement of self-efficacy skills within parent participants to empower and grow confidence in their ability to optimize their child’s amplification use and linguistic exposure. Participants were educated on the impact of hearing loss and/or hearing concerns on language development, importance of language exposure, use and care of amplification for families that utilize hearing technology, and empowerment to establish consistent device use. Assessment of self-efficacy skills in parents were measured through a pre- and post-survey distributed to participants. Survey and study were modeled after Ambrose et al., 2020 using the Scale of Parent Involvement and Self-Efficacy-Revised (SPISE-R). It queries parents about their child’s hearing device use and their perceptions of their own beliefs, knowledge, confidence, and actions pertaining to supporting their child’s auditory access and spoken language development. Ambrose et al., 2020 found the SPISE-R to be a promising tool for use in early intervention to better understand parents’ strengths and needs pertaining to supporting their young child’s auditory access and spoken language development. A total of nine parents were in attendance of the educational workshop conducted with only three participants completing both the pre- and post-survey. An analysis using a paired samples t-test revealed no statistically significant difference between the pre- and post-survey across all categories assessed within the SPISE-R apart from one question within the ‘Confidence’ category. Parents were found to have a significantly worse score between pre- and post-survey responses in the ‘Confidence’ category for the following question “If applicable, Put and keep my child’s hearing device(s) on him/her”. The overall mean significantly decreased between the pre- and post-survey, indicating less confidence with this skill. It should be noted, limited parent responses impacted the statistical analysis performed. Although the overall findings were not statistically significant, moving forward, data findings will be used to appropriately adjust the audiological early intervention training to improve self-efficacy skills of parents.

Introduction: Prediabetes is major risk factor for the development of Type 2 Diabetes Mellitus (T2DM). One-third of the population in the United States has prediabetes, but 90% remain undiagnosed because healthcare providers are not performing screenings, making this a public health challenge. The purpose of this process improvement project was to implement prediabetes screening, prediabetes identification, and a referral process to a nutritionist to prevent or delay the onset of T2DM in patients in two Federally Qualified Health Centers. Methods: This was a quality improvement project conducted over a six-week period after receiving exemption from the University’s Internal Review Board. The Knowledge to Action framework was used to guide implementation of screening, prediabetes identification, management, and referral process. The outcomes were to measure the number and percent of screenings performed after provider education on prediabetes screening, those at risk for prediabetes, and the evidence-based interventions providers chose for management. The prediabetes risk assessment tool (PRAT) was the “Are you at risk for Type 2 Diabetes?” It was administered in both English and Spanish to adults who were not pregnant and had no previous diagnosis of Type 1 Diabetes Mellitus or T2DM. The preferred interventions included referral to a nutritionist, encourage 5%-7% total body weight loss, and/or 150 minutes of exercise per week. The PRAT and interventions data were coded, extracted into SPSS Version 25, and analyzed. Descriptive statistics were used to report patient characteristics, quantity of screenings performed, evidence-based recommendations offered, and patient risk factors for prediabetes. Results: In both clinics, 41% (n=269) of patients screened were found to be at risk for prediabetes. The most self-reported risk factor for prediabetes was family history of T2DM. Healthcare providers mostly provided education on weight loss and exercise, and recommended/referred less than 20% (n=49) of patients for nutritional education. The screening rates in the clinics were 52% (n=92) at site A and 72% (n=177) in site B, falling below the goal of 100%. Conclusions: There remains a gap in provider knowledge and use of evidence-based recommendations to decrease patients’ risk for prediabetes. The authors project that implementation of the PRAT and evidence-based interventions in the electronic health record would positively impact future screening results. This project set the benchmark for future efforts to educate, encourage, and measure providers successes.

Screening, Brief Intervention, and Referral to Treatment (SBIRT) for alcohol use has been shown to reduce rates of alcohol use across multiple clinical settings, and is routinely recommended by the United States Preventative Services Task Force (USPSTF). In 2005 the National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommended implementing a single item screening question (SISQ) for this purpose. Since then the SISQ has been well validated compared to other tools, such as the Alcohol Use Disorders Identification Test (AUDIT). It has not, however, been well studied in particular populations, such as those with comorbid anxiety and/or depressive disorders. Medicare Annual Wellness Visits present a unique opportunity to study the SISQ because while they do inquire about alcohol use, they do not routinely include a SISQ. Our study seeks to investigate the efficacy of implementation of a SISQ during Medicare Annual Wellness Visits in a residency clinic population with anxiety and/or depressive disorders. Data collection is ongoing and will measure rates of referral to treatment before and after the SISQ is implemented, as well as rates of brief interventions given.

Previous research reveals the existence of social distance between the social policies that govern care work and human services that make up child welfare systems and their front-line implementation by direct service workers. The authors suggest that the nature of child welfare and human services requires discretion and flexibility that is not built into governing social policies. Our study uses qualitative ethnographic methods including participant observation, informal interviewing, and content analysis to determine the extent to which front-line barriers persist to implementing child welfare and related types of human services social policies and legal mandates. A comparison of different human services settings is presented along with a social policy analysis. A discussion of implications for front-line care work and ongoing research goals will be included.

Purpose The Johnson City Downtown Day Center (JCDDC) provides integrated inter-professional primary care, mental health, and social work case management services to homeless and under-served persons who have difficulty accessing traditional systems. Because of the exponential rise in substance abuse in the Appalachian region, the JCDDC providers and staff initiated SBIRT as recommended standard of care, as endorsed by SAMHSA, United States Public Health Services Task Force, and the National Institute on Alcohol Abuse and Alcoholism. The JCDDC has two mechanisms by which patients can choose to participate in substance abuse treatment: SMART Recovery, and psychiatric nurse practitioner (NP) referrals. The purpose of the project evaluates use of SBIRT at the JCDDC by determining process of (1) referral and (2) follow-up rates of those who received SBIRT; analyzing outcomes by measuring numbers of: (1) screens administered; (2) brief interventions; (3) positive screens; (4) referrals to either SMART Recovery or to the psychiatric NP; (5) participation in one follow-up. Review of Literature: Approximately 6.4 million people, or 2.4% of the U.S. population 12 years and older, currently misuse prescription medications. There is an undeniable and tangible correlation between the chronic disease of substance use disorder and unstable housing or homelessness (de Chesnay & Anderson, 2016). Similarly, substance use disorder was found to be much more common in people facing homelessness than in people who had stable housing (National Coalition for the Homeless, 2009). Substance Abuse and Mental Health Services Administration (SAMHSA) has been the most significant funding source for SBIRT proliferation in the United States. Despite a demonstrated need for substance abuse services among this vulnerable population, people who are homeless have substantially greater barriers to obtaining treatment and often go without. Summary of Innovation or Practice The current SBIRT process includes use of DAST-10 and AUDIT tools. Evaluating clinic processes and outcomes in vulnerable populations who have inconsistent erratic follow-up is challenging. However, new ways of understanding patterns and incremental outcomes is essential to addressing clinic practice that can impact outcomes in vulnerable groups. Implications for NPs The heterogeneity of the homeless population is often precipitated by a host of complicating factors including co-occurring mental illness, multiple chronic conditions, unstable income, and lack of transportation. Therefore, the importance of finding effective, cost-conscious processes that are population specific and patient-centered is essential for future research and policy. The inter-professional model of care also informs future practice by evaluating the feasibility of administering all of the elements of SBIRT in a single facility.

Home visits are a required training component of many Family Medicine residency programs in the United States. However, they are becoming less popular due to such factors as increasing resident responsibilities, decreasing reimbursement, and a decline in resident intention to incorporate home visits into future practice. This study’s aims are: (1) to evaluate the current practices of one Family Medicine residency training program’s time and resource expenditure to conduct home visits, and (2) to evaluate resident and faculty experiences of home visits. Residents and faculty in a Family Medicine training program were provided with a 12- question survey immediately after completing a home visit. A total of 19 surveys from residents and faculty were collected and analyzed. Average reported time spent per home visit was 90 minutes (range = 50-180 minutes), and the home visit teams included an average of 4 members (range = 2-6 members). The providers felt that they knew their patients and the patients’ circumstances better after the home visit with a score of 4.1 (on a 1-5 scale with 5 being a positively framed statement). Resident opinions were neutral (average score 3.1 on a 1-5 scale) regarding whether they found home visits to be educational to their residency training in Family Medicine. Residents also had mixed feelings (average score 2.9) regarding whether they would perform more home visits during their residency training if given the opportunity. Most faculty members (5/7) indicated they had done home visits during their residency training and all faculty (7/7) felt that home visits added value to their training in Family Medicine. Finally, qualitative recommendations were collected from respondents which may allow this training program to improve home visits in the future. Overall, significant time is currently being spent conducting home visits, with a difference in perceived efficacy between residents and faculty. Future research may include a cost analysis to quantify financial value, as well as expanding data collection to other Family Medicine residency training programs to improve generalizability.

The implementation of Electronic Health Records (EHR) has improved medical documentation in terms of accuracy, team communication, and ease of ordering tests and prescriptions; however, charting in an EHR strains the provider/patient relationship and contributes to physician burnout. Medical scribes are a promising potential solution to these problems. Our study aims to demonstrate that implementation of scribes into a medical residency program positively affects provider/patient satisfaction and improves quality and efficiency of EHR documentation. Our study evaluated the effectiveness and utility of scribes in a residency training program utilizing the established implementation framework “RE-AIM,” or Reach, Effectiveness, Adoption, Implementation (quality), and Maintenance. During the study’s initial “Training Phase,” 11 first and second-year Family Medicine residents conducted scribe-facilitated patient visits. Patient and provider satisfaction ratings were collected, note quality was evaluated, and time to note closure was measured. During the subsequent “Choice Phase,” residents were given the option of whether to utilize scribes, and the same data measures were collected. Resident satisfaction ratings during the Training Phase showed an average score of 6.03 (on a 1-7 scale where “7” = “strongly agree” with positive statements), and a pilot sample of 9 patients showed an average patient satisfaction rating of 4.77 (on a 1-5 scale where “5” = “strongly agree” with positive statements). Scribe-facilitated notes coded for quality had an average score of 3.375 (on a 1-5 scale where 5 is “extremely” high quality). Finally, residents’ average time to note closure was decreased by more than 8 hours in scribe-facilitated visits. During the Choice Phase, all 11 participating residents requested scribe-facilitated visits, again with very high patient satisfaction scores (4.67 on a 1-5 scale) as well as high clinician satisfaction scores (6.06 on a 1-7 scale). Choice Phase note quality and note-closure time are currently being assessed. These results demonstrate that scribes improve clinician and patient satisfaction, as well as quality and efficiency of EHR documentation. Limitations include a small sample size of clinicians and patients. Further research is needed with larger sample sizes to determine whether scribes in a medical residency program represent a sustainable and effective intervention.

Diss. (sammanfattning) Linköping : Univ., 2003. / Härtill 4 uppsatser.

Adverse Childhood Experiences (ACEs) include childhood exposure to abuse or violence, a parents' divorce, mental illness, substance use disorder, and are identified as risk factors for negative life outcomes. While ACEs screenings are commonly used in mental health and pediatric settings, screening for ACEs in primary care settings is less prevalent. The purpose of this project is to integrate screening for ACEs into a primary care setting and make appropriate referrals for follow-up, thus reducing potential negative life outcomes. The process was designed for a primary care practice located in Winston-Salem, North Carolina. Part one assessed level of awareness and screening history which determined training focus. Each provider and staff member received 30-45 minutes of training on ACEs screening algorithm, a detailed approach to guide treatment. The training was followed by question-and-answer sessions to address concerns. Part two, involved screening using the Center for Youth Wellness, Adverse Childhood Experiences Questionnaire for Children (CYW ACE-Q Child) which was initiated by the front office employee. Front office employee identified patients present for an annual well visit, briefly explained the screening tool, and handed it to the patient on a clipboard. The patient returned the completed form to the Certified Medical Assistant (CMA) when called in from the waiting room. The provider reviewed the ACEs screening and made referrals as appropriate. Part three involved data collection and analysis. Responses were collected weekly for nine weeks. The responses collected will be analyzed using quantitative statistics. The expected outcome is to note progressive increase in screening activities and when appropriate, followed by referrals to community agencies and organizations. The project educated clinicians about ACEs and created awareness among clinicians in a primary care setting to mitigate potential negative life outcomes. Barriers to integrating ACEs screening included employees' absence of training, lack of confidence in the subject matter, limited time frame to complete the screening, and fear of damaging patient-provider relationships. Barriers were mitigated through employee training, repetitive implementation of ACEs screening, and therapeutic communication with patients. The CYW ACE-Q was reserved for those arriving early or on time for their annual wellness visit to allow adequate time for completion. Recommendations include incorporating the CYW ACE-Q into all primary care visits to further intervene with referrals thereby enhancing patients' overall quality of life.