This explanatory mixed-methods policy analysis describes how school counselors' thoughts and attitudes contribute to the implementation fidelity of the Academic and Career Plan (ACP) policy in a suburban Virginia school division. A quantitative survey investigated counselor thoughts about the policy, implementation behaviors, and counselor ideas about equity issues related to providing college and career planning services to at risk students. Counselor interviews were conducted to provide deeper insight about the street level implementation practices and beliefs of counselors. Findings reveal that counselors place substantial value in the ACP policy and think the process is useful for connecting student interests and postsecondary goals to high school programs of study. Counselors implement the ACP policy with high fidelity because the policy incorporates counselor beliefs such as integrating the career pathway model into the course selection process. Counselors report spending more time assisting higher socioeconomic groups with college planning which results in less time for supporting at risk students. Findings indicate that counselors recognize the need at risk students have for additional support during postsecondary planning but are inhibited by the demands of higher socioeconomic groups. Finally, implications for school leaders related to improving counselor services to at risk students are discussed.

Background: Many nursing home residents are at risk of developing a pressure ulcer, which is an area of localised damage to the skin and/or underlying tissue due to immobility, increasing age and co-morbidities. Whilst guidelines for the prevention of pressure ulcers exist, their implementation can be sub-optimal. Care bundles are a set of research-informed practices used to facilitate the implementation of evidence into practice and incorporating psychological theory within their development may enhance their effectiveness. I aimed to co-design and assess the feasibility of implementing a theory and research-informed pressure ulcer prevention care bundle intervention in a nursing home setting. Method: This thesis comprised four separate studies as part of an overall mixed methods research design. Firstly, I conducted a systematic review and meta-analysis to determine the effects of care bundles per se on patient outcomes. I then conducted theory-informed qualitative, semi-structured interviews with nursing home care staff and NHS community-based nurses to explore the context of, and the barriers and facilitators to, pressure ulcer prevention in nursing homes. Next I co-designed a pressure ulcer prevention care bundle with 13 healthcare workers during a four hour workshop and supplemental email consultation. Using the Nominal Group Technique, we reached a consensus about the content of the care bundle. Following the steps of the Behaviour Change Wheel, I finalised the care bundle intervention. The final study involved a before-after study design where one nursing home implemented the care bundle intervention. I collected and analysed quantitative and qualitative data to gain a more holistic understanding of the feasibility issues related to the implementation. Findings: Findings from the systematic review suggested that care bundles may reduce the risk of negative outcomes in patients. These findings were based on very low quality evidence and the original study authors rarely reported adherence to the care bundle interventions. The theoretical understanding of the complexities in the prevention of pressure ulcers in nursing homes suggested there were four barriers and six facilitators, which my final care bundle intervention addressed. The co-designed care bundle intervention comprised three elements: support surfaces, skin inspection, repositioning; alongside three intervention functions and seven behaviour change techniques. In the final feasibility study, during the baseline period, there were 462 resident bed days and 5 new pressure ulcers recorded and in the intervention phase there were 1,181 resident bed days and no new pressure ulcers. The care bundle intervention appeared to be acceptable to the nursing home care staff and we have identified specific issues relating to the feasibility of implementing the care bundle intervention. Conclusions: The current research evidence-base for care bundles is poor. However, it was possible to co-design and implement a pressure ulcer prevention care bundle intervention for a nursing home setting. Further feasibility research is necessary before we can assess whether the care bundle intervention is effective in preventing pressure ulcers in nursing homes.

Behavior during transitions in classrooms is an area in need of additional supports in order for teachers to effectively manage classrooms. Extended transition durations, particularly transition periods between one activity and another are related to problem behavior among children in educational settings. This study evaluated the use of acoustical feedback aimed to improve transition behaviors of elementary school students, using a multiple-baseline design across participants. Teachers were trained to implement the acoustical feedback procedure. Data on teacher treatment fidelity, student transition behavior (transition duration and problem behavior), generalization probes, and social validity were collected to examine the feasibility and potential efficacy of acoustical feedback. The results indicated that the participating teachers successfully implemented the acoustical feedback procedures with high levels or moderately high levels of fidelity and their implementation of the intervention was successful in reducing problem behavior and transition duration for all three participating children. Support for generalization was strong for two teachers and their students and minimal for one teacher and her student.

This study aimed to provide evidence of reliability and validity for the 42-item Perceptions of Practices Survey. The scale was designed to assess educators’ perceptions of the extent to which their schools were implementing multi-tiered system of supports (MTSS) practices. The survey was initially given as part of a larger evaluation project of a 3-year, statewide initiative designed to evaluate MTSS implementation. Elementary educators (Level-1 n = 2,109, Level-2 n = 62) completed the survey in September/October of 2007, September/October of 2008 (Level-1 n = 1,940, Level-2 n = 61), and January/February of 2010 (Level-1 n = 2,058, Level-2 n = 60). Multilevel exploratory and confirmatory factor analysis procedures were used to examine the construct validity and reliability of the instrument. Results supported a correlated four-factor model: Tiers I & II Problem Solving, Tier III Problem Identification, Tier III Problem Analysis & Intervention Procedures, and Tier III Evaluation of Response to Intervention. Composite reliability estimates for all factors across the three years approximated or exceeded .84. Additionally, relationships were found between the Perceptions of Practices Survey factors and another measure of MTSS implementation, the Tiers I & II Critical Components Checklist. Implications for future research regarding the psychometric properties of the survey and for its use in schools are discussed.

Read 180 is a research-based reading intervention program. One local district implemented the program to improve student performance on the state assessment, and after a year of implementation, nearly half of the students in the district studied still did not make adequate progress in reading. The purpose of this study was to explore teachers' perceptions of and experiences with the use of Read 180 in secondary reading classrooms. Guided by Carroll's framework on the critical aspects of implementation, the study examined teachers' perceptions of (a) availability of resources necessary to adhere to the program's design, (b) ample class time to ensure adequate dosage, (c) preparedness to deliver the curriculum, and (d) benefits for student achievement. From a list of 22 Read 180 teachers, 10 teachers were chosen through simple random sampling and invited to participate in this qualitative case study. All 10 teachers agreed to be interviewed. Triangulation of interview interpretations was accomplished using field notes and member checking. Open coding and its subsequent refinement revealed that teachers had positive perceptions about Read 180 and its potential to improve student achievement, but identified a variety of areas for improvement: access to all materials and computers, ample class time, on-going training, and appropriate placement of students in the program. These findings suggest that a more robust execution of Read 180 could lead to positive social change by improving students' literacy skills, reducing the dropout rate, and preparing students for college and careers.

This study examined factors related to the implementation of a School Wide Positive Behavioral Intervention and Support (SWPBIS) program at a large middle school in the United States. Parent Teacher Student Association volunteers at the school reported that teacher fidelity to implementation of SWPBIS activities was inconsistent, threatening the SWPBIS program's effectiveness. The purpose of this study was to identify barriers that hindered teachers' fidelity in implementing SWPBIS. Teacher resistance to change, change leadership framework, and the model for effective professional development were used in this case study to explore the perceptions of 16 participants. The research questions focused on teachers', SWPBIS coaches', and administrators' perceptions and experiences with barriers to implementing SWPBIS in the third year of implementation (2013-2014). Emergent themes derived from coding participant interviews revealed 7 major barriers to teacher implementation fidelity including confusion about priorities, peer and student influences, philosophical differences, and weaknesses in leadership and professional development. The interview data were triangulated with data from archived documents to ensure the credibility of the study. A project recommendation for 6 professional development modules was made to address study findings. Positive social change implications include the efficacy of using the project study as an example for other schools to improve teacher effectiveness by responding to teacher weaknesses and facilitating improved student outcomes.

No description available.

BACKGROUND:Integrative medicine (IM) is a patient-centered, healing-oriented clinical paradigm that explicitly includes all appropriate therapeutic approaches whether they originate in conventional or complementary medicine (CM). While there is some evidence for the clinical and cost-effectiveness of IM practice models, the existing evidence base for IM depends largely on studies of individual CM therapies. This may in part be due to the methodological challenges inherent in evaluating a complex intervention (i.e., many interacting components applied flexibly and with tailoring) such as IM.METHODS/DESIGN:This study will use a combination of observational quantitative and qualitative methods to rigorously measure the health and healthcare utilization outcomes of the University of Arizona Integrative Health Center (UAIHC), an IM adult primary care clinic in Phoenix, Arizona. There are four groups of study participants. The primary group consists of clinic patients for whom clinical and cost outcomes will be tracked indicating the impact of the UAIHC clinic (n=500). In addition to comparing outcomes pre/post clinic enrollment, where possible, these outcomes will be compared to those of two matched control groups, and for some self-report measures, to regional and national data. The second and third study groups consist of clinic patients (n=180) and clinic personnel (n=15-20) from whom fidelity data (i.e., data indicating the extent to which the IM practice model was implemented as planned) will be collected. These data will be analyzed to determine the exact nature of the intervention as implemented and to provide covariates to the outcomes analyses as the clinic evolves. The fourth group is made up of patients (n=8) whose path through the clinic will be studied in detail using qualitative (periodic semi-structured interviews) methods. These data will be used to develop hypotheses regarding how the clinic works.DISCUSSION:The US health care system needs new models of care that are more patient-centered and empower patients to make positive lifestyle changes. These models have the potential to reduce the burden of chronic disease, lower the cost of healthcare, and offer a sustainable financial paradigm for our nation. This protocol has been designed to test whether the UAIHC can achieve this potential.TRIAL REGISTRATION:Clinical Trials.gov NCT01785485.

Die vorliegende Arbeit ist Teil eines Lehrerfortbildungsprogramms zur Förderung von Selbstwirksamkeit und Selbstbestimmung bei Schülern. Im Fokus dieser Arbeit steht die Untersuchung der Wirksamkeit eines Teilmoduls dieses Projekts, das auf die Förderung sozialer Kompetenzen und des Klassenklimas abzielte. Als zentrale Interventionsstrategien wurden kooperatives Lernen sowie Maßnahmen der Klimaförderung (soziale Regeln, Klimadiagnose) im Rahmen von Workshops an Lehrerkollegien vermittelt. Über einen Zeitraum von drei Jahren setzten die Lehrkräfte diese Maßnahmen in ihrem regulären Unterricht um und dokumentierten ihre Aktivitäten in Logbüchern. Zur Untersuchung der Wirksamkeit der Intervention wurden in der vorliegenden Arbeit 364 Schüler aus acht Interventionsschulen und 198 Schüler aus fünf Kontrollschulen über drei Messzeitpunkte im Hinblick auf die Entwicklung sozialer Kompetenzen und Kompetenzüberzeugungen sowie auf das Klimaerleben untersucht. Der Vergleich der Schülergruppen zeigte in der Interventionsgruppe eine weniger starke Verschlechterung in der Lehrer-Schüler-Beziehung als ein Merkmal des Klassenklimas. Unter Berücksichtigung des von den Lehrern dokumentierten Implementationsausmaßes wurden weitere Effekte der Intervention deutlich. Ein verstärkter Einsatz der Maßnahmen ging mit günstigeren Entwicklungen der sozialen Kompetenzüberzeugungen, der Schüler-Schüler-Beziehungen sowie der Lehrer-Schüler-Beziehungen einher. Die Befunde zeigen die Wichtigkeit der Erfassung von Informationen zur Implementation im Rahmen von Interventionsstudien auf, da Analysen ohne die Berücksichtigung von Implementationsinformationen zu ungenauen Schlussfolgerungen über die Wirksamkeit der Intervention führen können. Gleichzeitig machen die Befunde deutlich, wie anspruchsvoll eine zuverlässige Erfassung der Implementation im Hinblick auf die Konzeption und Umsetzung ist. Zukünftige Forschung sollte auf diesen Aspekt der Evaluation besonderes Augenmerk legen. / A teacher training program was developed to improve students’ self efficacy and self determination that consists out of three units. In this work one of the units concerning social competence and the classroom climate is focused. The core intervention strategies of this unit were cooperative learning as well as strategies to improve the classroom climate (e.g. social rules, climate diagnostics). These strategies were taught in workshops attended by the teacher stuff of the participating schools. The teachers implemented the strategies in their regular classrooms and documented the implementation fidelity by a logbook. The intervention as well as the implementation was evaluated over a period of three years. The treatment efficacy was tested in a longitudinal study (3 assessment points) at 364 students from 8 schools with intervention and 198 students from 5 schools without intervention serving as control group. The targeted criteria in this evaluation were the development of social competence, social competence beliefs and class climate. Comparing the two groups the teacher-student-relationship decreased less drastically in the schools with intervention compared to the control group. Taking the teachers’ documentation of the implementation fidelity into account results indicate that more frequent implementations of the strategies led to better development of the students’ social competence, the teacher-student-relationship as well as student-student-relationship. Therefore, the results impressively demonstrate the relevance to assess the implementation fidelity in intervention trials. Data on implementation fidelity (exposure, adherence) enables more valid conclusions on the intervention’s effectiveness. However, the project revealed difficulties to develop and to apply instruments to assess implementation fidelity, Therefore, in future research instruments for the evaluation of the implementation process have to be focused as well.

No description available.