The purpose of this pilot investigation was to assess the inter-rater reliability of an expert-validated pediatric feeding assessment, designed for clinician use with children who have severe disabilities. The tool would ideally allow for standardization of the clinical mealtime assessment process. A comprehensive review of available feeding instruments revealed that there is a need for an assessment tool for children with motor and developmentally based feeding problems.In response to this need, a new clinician administered instrument called the Mealtime Assessment Tool for Children (MATCH) was developed in order to guide the assessment of a child during a clinical meal. The items on the MATCH were selected based on expert validation of normal and abnormal feeding patterns that remain constant across the feeding assessments found in the literature. The tool includes a rating scale that allows for gradation of the severity of the problem. Child participants were taped while eating, and clips were rated by four SLPs using the MATCH. The resulting data was analyzed quantitatively, and it was found that across items there was a strong percentage agreement.

The purpose of this study was to determine the effects of QR code (quick reference) linked video-based instruction (VBI) on daily vocational skills for students with moderate to severe disabilities (MSD). A multiple probe across participants was used to evaluate the effectiveness of VBI accessed through scanning a QR code. During technology training a system of least prompts was used to teach students to unlock the iPod, scan the QR code, press play, and press pause between each step of the task; after reaching mastery, students entered into the intervention condition (VBI). During VBI an immediate change in level was observed across three particpants. This study found a functional relationship between VBI and the completion of vocational tasks.

Functional analyses (FAs) are a common tool used in the assessment and treatment of severe problem behaviors and often occur in the context of clinical settings with unfamiliar, trained staff. Previous research suggests that inconsistent outcomes can emerge when caregivers with an existing history of seeing their child’s challenging behavior are trained to implement the assessment in place of clinical staff. The purpose of the current study was to expand on existing literature by comparing FA implemented by clinical staff and caregivers in the context of a clinical setting. Results demonstrate that efficient identification of function and differentiated rates of problem behavior given the inclusion of caregivers during assessment may vary based on the child’s existing history of responding with those caregivers. Implications of results for researchers and practitioners are discussed.

A multi component training package (live training, video modeling, role playing, and feedback) was used to train teachers to assess and instruct students with profound multiple disabilities. Phase 1 of the study included training seven in-service teachers to conduct assessment in three areas: (a) preference assessment (i.e., potential reinforcing items), (b) controlled body movement assessment (i.e., gross and fin motor skills), and (c) access skill assessment (i.e., assessment of basic skills or prerequisite skills that are necessary for student to master before entering into further instruction). The assessment result yielded the following information for each student participant: (a) a list of three to four preferred items, (b) a list of body movements in which the study reliably uses to respond, and (c) a list of access skills that are mastered and not mastered. Four teacher/student pairs from Phase 1 participated in Phase 2, which consisted of using the multi component training package (same components as Phase 1) to train teachers to instruct students on non mastered access skills. Teachers were trained to use one of the following instructional strategies to teach non mastered access skills: least-to-most prompting, most-to-least prompting, time delay, or graduate guidance. A multiple baseline design across four teacher participants was used to determine if the instructional training was effective in increasing the percentage of correctly implemented instructional steps. Data from Phase 1 suggested that the multi component training package was effective in increasing teachers' skills in assessing students with profound multiple disabilities, as the percentage of correctly implemented assessment steps increased for all seven teacher participants from pre training to post training. Additionally, data from Phase 2 indicated that the training was effective in increasing the percentage of correctly implemented instructional steps from baseline to post training sessions, across multiple access skills. Data from student participants showed that overall, students were responsive to teachers' instruction, as the percentage of independently performed student responses also increased from baseline to post training sessions.

The following research project was a comparative study of teachers in Support Units and teachers in Special Schools. They were teachers currently involved with the implementation of the 1989 NSW Department of Education Mandatory Curriculum Change for the education of students with severe intellectual disability. The purpose of the research was to present a comparative study on teachers' responses, in both educational settings, examining their understanding of the curriculum change, the concerns of individuals and the levels of curriculum usage in relation to the factors affecting implementation. The application of the Concerns-Based Adoption Model of Change (Hall and Loucks, 1987), enabled the study to focus on the various forms of the innovation, including the innovation configuration, stages of concern, and the levels of use from the two given perspectives, teachers in Support Units and teachers in Special Schools, in relation to the major factors affecting implementation. The study findings highlighted that in both educational settings, change is accomplished by individuals and is a highly personal experience, demanding adequate support by facilitators of the change through appropriate actions, in order to assist effective and successful implementation of the change.

<p>During my study trip to South Africa I met a woman who held a speech. In the speech shesaid that the children in the black community don’t dream anymore, they can’t see a future.This awoke my interest for what was going to be the subject of my exam. Through myinterview with this woman, my observations during my study trip to South Africa and withhelp from relevant literature connected to the subject, I have studied how a child is affectedby growing up under such severe conditions, physical abuse and sexual assaults. I have alsostudied how I as a future educator can relate to a child who lives under these conditions.The woman in my interview told me that many of the children, in the black township I visited,are being sexually abused and she also told me how the children don’t have any grownups intheir surroundings in which they can trust. During my stay in a school in the black township Iwitnessed how the children were disciplined trough punishment, which is against the law inSouth Africa.Being abused and living under poor conditions as a child can have serious consequences.The child can become aggressive and act out on other people. They can also lose their abilityto have faith in adults and the world around them. Further when the child becomes an adultand have children on their own they can use the same behavioral pattern on their ownchildren. This can become a vicious circle, which has to be broken.How I as an educator can help and support these children is not easy and it demands biggerefforts, from social services and commitment from school and the society. You have to stayprofessional as an educator. What an educator can do is to support these children, create a safeenvironment and let the child work with their emotions.</p> / <p>Under min studieresa till Sydafrika mötte jag en kvinna som höll ett tal för oss. Talethandlade om att barnen i den svarta kåkstaden hon bodde i inte drömmer längre, de har ingaframtidsdrömmar. Detta väckte mitt intresse för vad som sen blev mitt examensarbete. Jag harmed hjälp av en intervju med denna kvinna, egna observationer under min studieresa tillSydafrika och via relevant litteratur kopplat till detta, undersökt hur man som barn kanpåverkas av att leva under svåra uppväxtvillkor, misshandel och övergrepp. Jag har ävenstuderat hur jag, som blivande pedagog, kan förhålla mig till barn som lever i kris.I intervjun berättar kvinnan hur många av barnen, i den svarta kåkstaden jag besökte, blirsexuellt utnyttjade och hur barnen inte har någon vuxen att förlita sig på. Under min vistelsedär, på en svart skola, bevittnade jag hur ett av barnen blev utsatt för barnaga, vilket ärförbjudet i Sydafrika.Att som barn bli misshandlad och leva under kris kan få allvarliga konsekvenser. Barnet kanbli aggressivt och utåtagerande samt få bristande tillit till vuxna och omvärlden. Vidare kandet leda till att barnet själv, när den är vuxen, behandlar sina barn på samma sätt. Denna ondacirkel som kan skapas när ett barn far illa måste försöka brytas.Hur man som pedagog kan hjälpa och stötta dessa barn är inte lätt utan det kräver störreinsatser, ifrån socialtjänsten samt ett engagemang från skola och samhälle. En pedagog måsteförhålla sig professionellt. Det han/ hon kan göra är att stötta barnet, skapa en trygg miljö ochlåta barnet bearbeta och förstå sina känslor.</p>

<p>The aim of this thesis was to critically examine the current use of the Camberwell Assessment of Need (CAN) in outcome assessment for service evaluation. A further aim was to propose a metric for assessing the adequacy of community mental health services in meeting ongoing needs over longer stretches of time.</p><p>We made four prospective follow-up studies of CAN assessments of patients with severe mental illness in community-based mental health care.</p><p>A factor analysis (n=741) gave support for a three-factor model, comprising only 60% of the CAN items. Need assessments (n= 92) in 1997 and 2003 were compared at both the summed total and the underlying item levels of the CAN. The mean total scores did not change, yet there were significant changes in the underlying items. Changes in mean number of needs between 1997 and 1999 were measured (n=262) with both total scores, summed over all CAN items, and with sub-total scores, summed over two sets of items reflecting the social services and the psychiatric services respectively. As indicated by the sub-total scores, all significant changes occurred within the psychiatric services, a result not possible to discern from the total scores. The Met Needs Index (MNI), defined by us as the aggregate measure of beneficial outcome, indicated that needs in general were met during 71% of the intervals between the annuals assessments from 1997 through 2004. However, the variation among particular items was large.</p><p>In conclusion, the summary scores typically used as outcome measures are likely to conceal meaningful variation at the item level. Nevertheless, sub-total scores, being more transparent, might be more useful in outcome assessment. The MNI is a continuous, normally distributed metric, estimable over any number of consecutive assessments, which seems suitable for assessing the achieved benefit of services for patients with long-term ongoing needs.</p>

Severe Traumatic Brain Injury (sTBI) is a major cause of mortality and morbidity. At the Department of Neurosurgery Umeå University Hospital subjects with sTBI are treated with an intracranial pressure (ICP) guided therapy based on physiological principles, aiming to optimise the microcirculation of the brain so avoiding secondary brain injuries. The investigations in this thesis are unique in the sense that all patients with sTBI were treated according to the guidelines of an ICP targeted therapy based on the “Lund concept”. As the treatment is based on normalisation of the ICP, the accuracy and reliability of the measuring device is of outmost importance. Therefore the accuracy, drift, and complications related to the measuring device was prospectively studied (n=128). The drift was 0,9 ± 0,2 mmHg during a mean of 7,2 ± 0,4 days and the accuracy high. No clinical significant complications were noted. In 1997 uni- or bilateral decompressive hemi-craniectomy (DC) was introduced into the treatment guidelines. The effect of DC on the ICP and outcome was retrospectively analysed for subjects with sTBI treated 1998-2001. In the subjects who underwent DC the ICP was 36,4 mmHg immediately before and 12,6 mmHg immediately after the DC. The ICP then levelled out at just above 20 mmHg. The ICP was significant lower during the 72 hours following DC. The outcome did not differ between subjects who had undergone DC or not. Subclinical electroencephalographic seizures and status epilepticus have been reported to be common in subjects treated for traumatic brain injury (TBI). This can negatively influence the outcome giving rise to secondary brain injuries. The occurrence of seizures in subjects treated for TBI using continuous EEG monitoring was therefore prospectively studied. During 7334 hours of EEG recording in 47 patients no electroencephalographic seizures were observed. Theoretically, and based on animal studies, prostacyclin (PGI2) can improve the microcirculation of the brain, decreasing the risk for secondary ischaemic brain injury. PGI2 was introduced to the treatment in a prospective randomised double blinded study (epoprostenol 0,5 ng/kg/min). The effect of PGI1 pkt was analysed using the lactate/pyruvate ratio (L/P) measured by cerebral microdialysis in order to study the energy metabolism in the brain. The outcome was measured as Glasgow Outcome Scale (GOS) at 3 months follow-up. Forty-eight subjects were included. The L/P was pathological high during the first day, thereafter decreasing. There was no significant difference in L/P or outcome between the treated and non-treated group. At 3 months the mortality was 12,5% (95,8% was discharged alive from the ICU), and favourable outcome (GOS 4-5) was 52%. In the same study the brain injury biomarkers S-100B and NSE were followed twice a day for five days to evaluate brain injury and investigate the possible use of these biomarkers for outcome prediction. Initially the biomarkers were elevated to pathological levels which decreased over time. The biomarkers were significant elevated in subjects with Glasgow Coma Scale 3 (GCS) and GOS 1 compared with subjects with GCS 4-8 and GOS 2–5, respectively. A correlation to outcome was found but this correlation could not be used to predict clinical outcome. It is concluded that the ICP measurements are valid and the treatment protocol is a safe and solid protocol, yielding among the best reported results in the world, in regard to favourable outcome as well as in regard to mortality. Epoprostenol in the given dose was not shown to have any effects on the microdialysis parameters nor the clinical outcome. In sTBI L/P and brain injury biomarkers can not be used to predict the final outcome.

The aim of this thesis was to critically examine the current use of the Camberwell Assessment of Need (CAN) in outcome assessment for service evaluation. A further aim was to propose a metric for assessing the adequacy of community mental health services in meeting ongoing needs over longer stretches of time. We made four prospective follow-up studies of CAN assessments of patients with severe mental illness in community-based mental health care. A factor analysis (n=741) gave support for a three-factor model, comprising only 60% of the CAN items. Need assessments (n= 92) in 1997 and 2003 were compared at both the summed total and the underlying item levels of the CAN. The mean total scores did not change, yet there were significant changes in the underlying items. Changes in mean number of needs between 1997 and 1999 were measured (n=262) with both total scores, summed over all CAN items, and with sub-total scores, summed over two sets of items reflecting the social services and the psychiatric services respectively. As indicated by the sub-total scores, all significant changes occurred within the psychiatric services, a result not possible to discern from the total scores. The Met Needs Index (MNI), defined by us as the aggregate measure of beneficial outcome, indicated that needs in general were met during 71% of the intervals between the annuals assessments from 1997 through 2004. However, the variation among particular items was large. In conclusion, the summary scores typically used as outcome measures are likely to conceal meaningful variation at the item level. Nevertheless, sub-total scores, being more transparent, might be more useful in outcome assessment. The MNI is a continuous, normally distributed metric, estimable over any number of consecutive assessments, which seems suitable for assessing the achieved benefit of services for patients with long-term ongoing needs.

During my study trip to South Africa I met a woman who held a speech. In the speech shesaid that the children in the black community don’t dream anymore, they can’t see a future.This awoke my interest for what was going to be the subject of my exam. Through myinterview with this woman, my observations during my study trip to South Africa and withhelp from relevant literature connected to the subject, I have studied how a child is affectedby growing up under such severe conditions, physical abuse and sexual assaults. I have alsostudied how I as a future educator can relate to a child who lives under these conditions.The woman in my interview told me that many of the children, in the black township I visited,are being sexually abused and she also told me how the children don’t have any grownups intheir surroundings in which they can trust. During my stay in a school in the black township Iwitnessed how the children were disciplined trough punishment, which is against the law inSouth Africa.Being abused and living under poor conditions as a child can have serious consequences.The child can become aggressive and act out on other people. They can also lose their abilityto have faith in adults and the world around them. Further when the child becomes an adultand have children on their own they can use the same behavioral pattern on their ownchildren. This can become a vicious circle, which has to be broken.How I as an educator can help and support these children is not easy and it demands biggerefforts, from social services and commitment from school and the society. You have to stayprofessional as an educator. What an educator can do is to support these children, create a safeenvironment and let the child work with their emotions. / Under min studieresa till Sydafrika mötte jag en kvinna som höll ett tal för oss. Talethandlade om att barnen i den svarta kåkstaden hon bodde i inte drömmer längre, de har ingaframtidsdrömmar. Detta väckte mitt intresse för vad som sen blev mitt examensarbete. Jag harmed hjälp av en intervju med denna kvinna, egna observationer under min studieresa tillSydafrika och via relevant litteratur kopplat till detta, undersökt hur man som barn kanpåverkas av att leva under svåra uppväxtvillkor, misshandel och övergrepp. Jag har ävenstuderat hur jag, som blivande pedagog, kan förhålla mig till barn som lever i kris.I intervjun berättar kvinnan hur många av barnen, i den svarta kåkstaden jag besökte, blirsexuellt utnyttjade och hur barnen inte har någon vuxen att förlita sig på. Under min vistelsedär, på en svart skola, bevittnade jag hur ett av barnen blev utsatt för barnaga, vilket ärförbjudet i Sydafrika.Att som barn bli misshandlad och leva under kris kan få allvarliga konsekvenser. Barnet kanbli aggressivt och utåtagerande samt få bristande tillit till vuxna och omvärlden. Vidare kandet leda till att barnet själv, när den är vuxen, behandlar sina barn på samma sätt. Denna ondacirkel som kan skapas när ett barn far illa måste försöka brytas.Hur man som pedagog kan hjälpa och stötta dessa barn är inte lätt utan det kräver störreinsatser, ifrån socialtjänsten samt ett engagemang från skola och samhälle. En pedagog måsteförhålla sig professionellt. Det han/ hon kan göra är att stötta barnet, skapa en trygg miljö ochlåta barnet bearbeta och förstå sina känslor.