The purpose of this study was to explore the referrals that were generated from one hospital emergency room to a community outreach team. This study used a specific geriatric program assessment team in Winnipeg, Manitoba, Canada as the community outreach team. Malcolm Payne’s description of Task Centered Casework and Crisis Intervention and Irene Pollin’s Medical Crisis Counseling served as the theoretical structure and design to gain an understanding of the reasons geriatric patients were referred to the GPAT on discharge. This study aimed to answer three research questions: 1) What is the emergency room medical team’s main reason for referral to a geriatric outreach team? 2) Are the referrals received from the emergency room medical team clearly identifying psychosocial issues as areas for examination by an outreach team? 3) Are psychosocial issues identified only after an outreach team clinician completed a comprehensive assessment? This study revealed that out of the 209 referrals to geriatric program assessment team, the highest number of times referred was for functional decline. It revealed that the emergency room medical team saw functional decline as a valid reason to have the geriatric program assessment team assess the individual in their home settings to ensure that any functional issue be addressed and possible adaptations made in a timely manner to avoid the reverberation that one ailment can set off. The second most common reason for referring to the geriatric program assessment team was for social issues. Forty percent of the referrals identified that there were concerns in relation to social issues which clearly identifies that the emergency room medical team identified psychosocial issues as an area for further examination. And finally, the findings show psychosocial issues were not identified only after an outreach team clinician completed a comprehensive assessment, but that both appear cognizant of the interplay between medical issues and social issues.

The purpose of this study was to explore the referrals that were generated from one hospital emergency room to a community outreach team. This study used a specific geriatric program assessment team in Winnipeg, Manitoba, Canada as the community outreach team. Malcolm Payne’s description of Task Centered Casework and Crisis Intervention and Irene Pollin’s Medical Crisis Counseling served as the theoretical structure and design to gain an understanding of the reasons geriatric patients were referred to the GPAT on discharge. This study aimed to answer three research questions: 1) What is the emergency room medical team’s main reason for referral to a geriatric outreach team? 2) Are the referrals received from the emergency room medical team clearly identifying psychosocial issues as areas for examination by an outreach team? 3) Are psychosocial issues identified only after an outreach team clinician completed a comprehensive assessment? This study revealed that out of the 209 referrals to geriatric program assessment team, the highest number of times referred was for functional decline. It revealed that the emergency room medical team saw functional decline as a valid reason to have the geriatric program assessment team assess the individual in their home settings to ensure that any functional issue be addressed and possible adaptations made in a timely manner to avoid the reverberation that one ailment can set off. The second most common reason for referring to the geriatric program assessment team was for social issues. Forty percent of the referrals identified that there were concerns in relation to social issues which clearly identifies that the emergency room medical team identified psychosocial issues as an area for further examination. And finally, the findings show psychosocial issues were not identified only after an outreach team clinician completed a comprehensive assessment, but that both appear cognizant of the interplay between medical issues and social issues.

La présente thèse s’inscrit dans le cadre de l’évaluation de programmes en santé publique et plus précisément sur le dépistage néonatal de la surdité. Ces programmes sont largement implémentés de par le monde et visent à diagnostiquer et prendre en charge précocement les enfants déficients auditifs, afin de leur permettre de se développer de façon optimale, notamment sur le plan du langage ou socio-émotionnel. Ce type de programme de médecine préventive a été mis en place par la Fédération Wallonie-Bruxelles (FWB), à l’échelle de la communauté, à la fin de l’année 2006. La thèse a pour objectif d’analyser la mise en place du programme de dépistage néonatal de la surdité dans la FWB, d’en évaluer les résultats et de le mettre en perspective avec les programmes de dépistage de la surdité implémentés dans les pays de l’Union Européenne. A cette fin, nous avons réalisé plusieurs études et analyses qui visaient à répondre à cinq objectifs spécifiques. Le cadre de référence utilisé pour l’évaluation était celui de la recherche évaluative. Tout d’abord, le processus de la mise à l’agenda politique du programme dans la FWB et sa mise en place ont été analysés, respectivement sur base du modèle de Kindgon et par l’application de la matrice SWOT. Ensuite, une analyse des résultats chiffrés générés par le programme a été réalisée, au moyen des indicateurs généralement utilisés pour des programmes de dépistage et les résultats pour la FWB ont été comparés à ceux d’autres programmes de dépistage néonatal de la surdité et aux critères de qualité du Joint Committee on Infant Hearing, considérés comme la référence pour l’évaluation de ces programmes. Par après, les facteurs de risque néonataux de surdité initialement élaborés pour le programme de la FWB ont été révisés, par une approche associant le niveau de preuve (échelle GRADE) et la recherche d’un consensus auprès d’experts cliniciens (méthode Delphi). Ensuite, l’âge des enfants lors de leur prise en charge a été étudié ;pour cela, les données de facturation des actes médicaux (données de l’Agence InterMutualiste) ont été exploitées afin d’objectiver si la prise en charge en Wallonie et à Bruxelles était plus précoce depuis la mise en œuvre du programme de dépistage. Enfin, le programme de la FWB a été mis en perspective avec ceux implémentés dans les pays de l’Union Européenne, sur des questions relatives à l’organisation et au design des programmes ainsi que sur la politique d’identification des facteurs de risque et la disponibilité des outcomes dans les programmes. Les résultats des analyses et évaluations réalisées dans le cadre de cette thèse ont mis en évidence que le programme de la FWB présentait des résultats favorables, mais néanmoins améliorables sur un certain nombre de points, pour lesquels nous avons formulé une série de recommandations. Ces recommandations visent à réorienter le programme de la FWB et incluent notamment le développement d’un système d’informations, la nécessité d’une plus grande intégration du concept d’« identification et de prise en charge précoces », la prise en considération du raccourcissement du séjour hospitalier ainsi que la poursuite du monitoring régulier et de l’évaluation scientifique du programme. Les recommandations formulées ont pour finalité d’augmenter la qualité du programme et de favoriser l’identification et la prise en charge précoces de l’ensemble des nouveau-nés déficients auditifs en FWB.This dissertation takes place in the field of public health program evaluation, and more precisely of newborn hearing screening programs. These programs are largely implemented across the world and aim to early diagnose and enroll hearing-impaired children in intervention programs, in order to improve their language and social-emotional development. A newborn hearing screening program has been implemented in the community (Fédération Wallonie-Bruxelles (FWB) at the end of 2006. This dissertation aims to analyze the implementation of the newborn hearing screening program in the FWB, to evaluate its results and to put it in perspective with the programs in the European Union (EU) countries. We performed several studies and analyses to encounter 5 specific goals. First, we analyzed the agenda-setting process in the FWB and the implementation of the program using the Kindgdon model and the SWOT matrix, respectively. Then, we evaluated the outcomes of the program; we compared outcomes from the FWB to those from other programs and to the Joint Committee on Infant Hearing criteria. After, we updated the initial list of neonatal risk factors for hearing loss in the FWB: we rated the level of quality evidence (using GRADE scale) and we obtained a consensus from clinicians about the updated risk factors to implement in the FWB program (Delphi method). Then, we assessed the age of children at audiological intervention: we used the Belgian healthcare billing database to analyze the evolution of the children’s age at audiological intervention in Wallonia and Brussels since the implementation of the program. Finally, we put in perspective the program in the FWB with the programs in the EU countries, about organization and design of the programs, risk factors identification and available outcomes in the programs. Results of our analyses and assessments showed positive outcomes for the program in the FWB, even if some parts of the program should be improved. We specifically made recommendations for these points. The recommendations aimed to redirect the newborn hearing screening program in the FWB: we recommend developing a health information system, integrating the “early hearing detection and intervention program” concept and the shortening of the birth length in the screening program, and performing regularly monitoring and scientific evaluation of the program. These recommendations aim to improve the quality of the program and to favor early identification and intervention among hearing-impaired children in the FWB. / Doctorat en Santé Publique / info:eu-repo/semantics/nonPublished

The intent of this study was to establish and validate criteria for use to assess the quality of a library and information sciences (LIS) Ph.D. program. The Ph.D. student-centric topology for quality Ph.D. programs was developed from a 2001 position statement by the American Association of Colleges of Nursing (AACN) regarding the quality indicators in research-focused doctoral programs in nursing. Topology components were tested using a survey instrument to establish their importance to the community of practice and their potential use to assess a Ph.D. program. Survey participants were asked to rank terms or concepts in a balanced incomplete block (BIB) design then rate, on a Likert-type scale, statements about the applicability of these terms or concepts to assessing a quality LIS Ph.D. program. Survey participants were from the Association for Library and Information Science Education (ALISE) Open Lib/Info Sci Education Forum jESSE Listserv. Of 225 survey participants affiliated with universities or schools from North America who submitted usable surveys, slightly less than two-thirds (64.4 %) were female while 35.5 % were male. Ninety-eight participants (43.6 %) were faculty, 114 (50.7 %) were Ph.D. students or candidates, and 13 (5.8 %) were in other roles. Statistical analysis of survey responses showed consistent results between the different demographic groups. The topology was validated by the results of the statistical analysis of the research data. Every component of the topology was acknowledged as very important to assess the quality of a LIS Ph.D. program. Faculty was the highest ranked item in the BIB analysis with a statistically significant difference (p < .0001) in the mean rank order from the next highest ranked item, Ph.D. students. The rank order from the BIB analysis was as follows: faculty, Ph.D. students, programs (courses) of study, teaching, learning environment, resources, and evaluation. Faculty was also the highest rated item in the Likert-type statement analysis.

The following study is an exercise in understanding how educators can improve their professional practice in terms of addressing the needs of Aboriginal high school students. The study was delimited to four different high schools in Northwestern Ontario in order to develop a broader understanding of best practices used by various school communities. Interviews were conducted with students and educational professionals such as teachers, administrators, guidance personnel and school board members. The study was completed over a period of one week, where one day was spent in each school completing interviews. This study is unique in two ways: it presents the voices of secondary school educators (which had scarcely been reported or heard in the academic community) outlining the direction in which Aboriginal education should go and secondly, as a researcher I attempted to use the medicine wheel as a model for completing and conducting research. There were a number of findings that appeared through the interviews. Teachers and administrators agreed that in order for Aboriginal students to succeed they needed to have involved parental support. It was important to teachers that parents take an active role in the educational life of their child. Additionally, it was acknowledged that First Nation communities were ideal settings for schooling of Aboriginal students as they were supported by family and community kinships. Yet in this study, it was also acknowledged that First Nation schools suffered financially in comparison to provincial schools. They were not able to provide programming comparable to provincial schools and iii were limited to a barebones program with compulsory courses being offered. In some cases, if students failed a course, they were not able to participate in the rest of the school program, until the course was re-taught in two years. Despite these shortcomings, students might do better in First Nation based schools if they were adequately funded with current resources and adequately compensated teachers. This study offers some suggestions on how to improve the practice of educating First Nation secondary students.

The following study is an exercise in understanding how educators can improve their professional practice in terms of addressing the needs of Aboriginal high school students. The study was delimited to four different high schools in Northwestern Ontario in order to develop a broader understanding of best practices used by various school communities. Interviews were conducted with students and educational professionals such as teachers, administrators, guidance personnel and school board members. The study was completed over a period of one week, where one day was spent in each school completing interviews. This study is unique in two ways: it presents the voices of secondary school educators (which had scarcely been reported or heard in the academic community) outlining the direction in which Aboriginal education should go and secondly, as a researcher I attempted to use the medicine wheel as a model for completing and conducting research. There were a number of findings that appeared through the interviews. Teachers and administrators agreed that in order for Aboriginal students to succeed they needed to have involved parental support. It was important to teachers that parents take an active role in the educational life of their child. Additionally, it was acknowledged that First Nation communities were ideal settings for schooling of Aboriginal students as they were supported by family and community kinships. Yet in this study, it was also acknowledged that First Nation schools suffered financially in comparison to provincial schools. They were not able to provide programming comparable to provincial schools and iii were limited to a barebones program with compulsory courses being offered. In some cases, if students failed a course, they were not able to participate in the rest of the school program, until the course was re-taught in two years. Despite these shortcomings, students might do better in First Nation based schools if they were adequately funded with current resources and adequately compensated teachers. This study offers some suggestions on how to improve the practice of educating First Nation secondary students.