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Drug courts have become an important part of adult and juvenile corrections. Since the establishment of the first adult drug court in 1989, the therapeutic court model has developed, and can now be considered a significant component in American criminal justice. The problem is adult drug courts have faced considerable disapproval in the area of evaluation and documentation. Through the Bureau of Justice Assistance (BJA), the federal government allots millions of dollars to support drug court programs; there have been attempts to count and record the activities of these programs with little success, there is little uniform data on actual drug court success nationwide. The intent of this dissertation was to systematically and critically analyze drug court evaluations. My major goal was to demonstrate the need for uniformity in regards to assessing the impacts on outcomes. I analyzed drug court evaluations and their attempt to identify factors that contribute to graduation, in-program recidivism/ retention rates, drug treatment relapse and postprogram recidivism rates. Forty drug court evaluations were used in this examination. Further, I introduced a model that will aid in examining the impacts on outcome. My studies' unit of analysis is the evaluation report. I attempted to explain specific issues, such as how well drug courts work for different types of offenders. I was also able to generate a well founded policy recommendation for the evaluation of drug courts based on empirical data and literature. Conclusions show that Drug Courts do reduce post-program recidivism however there were certain impacts on graduation and termination rates. I also demonstrated the need for more methodologically sound and uniform evaluations in order to determine effectiveness. / Ph. D.

Family Group Conferencing (FGC) is a family led decision-making approach where practical plans are made by the family to keep children safe and improve their quality of life. FGC has attracted worldwide interest from policymakers, researchers and practitioners for its potential to: involve families in the decision-making process in child and families social work; keeping children safe within a culture of co-operation between the state and families. There is significant empirical research about the impact of the FGC process on families, and its immediate outcomes but less is known about outcomes in the longer-term. This thesis reports on the findings of a retrospective qualitative study, which sought to understand the contribution FGC makes to longer-term outcomes for looked after children at risk of being accommodated, and their families. Eleven FGC examples were studied across five local government areas in Scotland. Each example includes the perspective of different stakeholders in the process including: looked after children, their parents and extended family (n=32), and professionals (n=28) involved with them. Criteria for case selection included: the child and family had originally been referred to FGC service because the family social worker considered the child was at risk of being accommodated; the stages of FGC had been achieved and a family meeting had taken place at least one year prior to the data being collected; the age of the child who was the focus of the meeting was over eight years old wherever possible; and the core family members were prepared to be involved in the study. Individual, joint or group interviews were conducted to provide multi-dimensional perspectives of the FGC phenomena. FGC service documents (n=94) were also analysed, providing data of social activity that occurred prior to the study. This study challenges current outcome focused paradigms, arguing for a more complex and nuanced understanding of outcomes in child welfare, where the child and family,alongside professionals,are valued in the identification and measurement of outcomes. Evidence from this study highlights the need to accept two sets of outcomes when considering FGC contribution: personal and professional. The identification of outcomes in this manner supports three interconnected issues argued throughout the thesis in relation to contribution. Firstly, process matters to the service user and his/her experience of the service and opinion of outcomes. Secondly, what professionals do and how they do it is important to the outcomes of families requiring support -relationships and practice are therefore central concerns in understanding how and why families achieve (or not) longer-term outcomes. Finally, who defines outcomes and to what purpose is significant when conceptualising outcomes. The study draws on empowerment, recognition and partnership theories to better understand FGCs contribution to longer-term outcomes for children and families. The study found the FGC process contributed towards building service users' capacities to reflect on their own and acknowledge others' experiences and situations. Feelings of increased confidence, self-respect and self-esteem, derived from the FGC process, contributed towards improved social relations and a sense of control over their own lives. This increased capacity can support family members to manage future crises and conflict if they arise. FGC offers professional and service users an opportunity to reframe unhelpful attitudes towards each other. In the longer term this can contribute towards families reduced need for social work services and/or improved working relationships between social work and families. This study has significance for all professionals working with looked after children and their families; contributes to the theoretical knowledge applied in social work practice; and is applicable when considering the implementation and impact of child welfare policy in Scotland and internationally.

How do the Catholic Schools Consultants through their leadership and relationship with Principals influence the outcomes of Catholic systemic schools in New South Wales (NSW)? This research question has been of considerable interest to the professional communities of Catholic educators. Throughout NSW there are eleven diocesan Catholic school systems, each led by a Director assisted by senior field officers called Consultants, the equivalent position of Area superintendents or inspectors in other school systems. The leadership of these Consultants is considered critical for the effectiveness of the school systems especially through their influence on and with Principals. Within this survey research study, the total population of Consultants and Principals was invited to participate, and 45 Consultants (90%) and 365 Principals (76%) responded. The research study was based on the assumption that a ‘classical’ view of leadership should be augmented by a more complex, interactive view of leadership as relationship that influenced outcomes in school systems. The study was operationalized in three dimensions. Leadership was described by ten variables, derived from Sashkin’s (1998) Visionary Leadership Theory. The relationship between Consultant and Principals was posited as a composite of two variables, Interpersonal Relation and Shared Catholic Leadership Mindset, that are viewed as explanatory, mediating variables. Three selected outcome variables are posited – Educational Outcomes, School Outcomes and Spiritual Outcomes. The fifteen variables so described were developed and/or validated for this study using confirmatory factor analysis. Additionally, the impact of three demographic background factors of gender, school type, and years of networking association between Consultant and Principals on the main variables in the study was examined. A mediated – effects survey research design was used. Survey questionnaires were sent from the local Catholic Education Office to each volunteer Consultant and to her/his associated network of Principals on a confidential basis and returned directly to the researcher. At no stage did the researcher know the identity of the respondents. Data analysis methods included comparative means analysis of Consultants’ and Principals’ perceptions of the variables; multiple regression analysis and structural equation modelling to examine the associations between variables; MANOVA analysis to examine demographic background factors; and finally some descriptive analysis of survey data to provide validation or further insights. The study results showed that both Consultants and Principals agreed that the Consultants demonstrated visionary leadership as defined by Sashkin (1998) although there were significant differences on seven leadership factors. There was high level agreement that Consultants and Principals exhibited a shared mindset, described as Shared Catholic Leadership Mindset, and outstanding interpersonal relationships. Findings about the associations between variables showed different results for Principals and Consultants. The ‘Principals’ model suggested that the two relationship variables acted as mediators between some of the ten leadership variables and the three outcome variables. On the other hand, the ‘Consultants’ model suggested that neither of the two relationship variables acted as mediators, but that only two leadership variables, Capable Management and Creative Leadership, had any influence on Outcomes. There were no significant differences on results due to gender, school type or years of networking association for either Principals or Consultants. These results, supplemented by qualitative findings, led to the conclusion that there was a need for system policy makers to reconceptualise the leadership of such Consultants to emphasise the importance of the shared mindset, and the synergistic element in the relationship between Consultant and Principals. There was a recommendation that further research replicate this study with other Catholic, Government and independent education systems. The use of structural equation modelling analysis in similar future research was also recommended.

The purpose of this study was to explore the extent to which teaching strategies for theory content were utilised by nurse educators at a nursing college in Gauteng to determine whether these strategies complied with an outcomes- and problem-based nursing education programme and, if problems were identified, to make suggestions with regard to the appropriate teaching strategies. The aim of the study was to investigate what teaching strategies nurse educators utilised at a nursing college in Gauteng where an outcomes-based (OBE) and problem-based (PBL) nursing education programme was implemented. Teaching strategies used in the OBE approach are different from the traditional approach and nurse educators must master facilitation skills and guide learning of nursing students towards the attainment of outcomes, including critical cross-field outcomes such as problem-solving skills and critical thinking skills. Critical cross-field outcomes are essential life skills that learners should possess by the end of a specific course. A quantitative, non-experimental descriptive survey was used to explore the extent to which teaching strategies for theory content utilised by nurse educators at a nursing college in Gauteng, fit within an OBE and PBL nursing curriculum. Data from the study showed that educational facilities not accessible to students, were also not available to the students. These included the following: <li>Computer lab</li> <li>Internet</li> <li>Video conferences</li> <li>Teaching CD discs</li> It was also evident from the data collected that the respondents felt that library facilities were only available at another institution. From the literature studied on OBE and PBL, it became clear that, for the successful implementation thereof, students require access to computers and the Internet and these facilities should be made available to students to encourage and enhance self-directed learning, as it is an important component of PBL. The data collected clearly revealed that formal lectures were still very much utilised by nurse educators as a teaching strategy. This is a matter of great concern since formal lectures are of less importance in an OBE approach to learning. The data also indicated that nurse educators did not utilise research articles, which is again an essential part of OBE and PBL. On the other hand, the data were reassuring as it indicated that nurse educators utilised group discussions, small group activities and self-directed learning - all teaching strategies essential for OBE and PBL. Nurse educators indicated that a lack of training and in-service training were reasons why they felt only moderately competent in utilising OBE and PBL teaching strategies. Some also felt only moderately competent due to the lack of facilities, resources and support. Certain teaching strategies, such as PBL strategies, enhance critical thinking skills and assist in developing the learner’s decision-making skills. Therefore, it is important for nurse educators to make use of OBE and PBL teaching methods when facilitating learning. The South African Nursing Council [(SANC) 1993] states that “the purpose of nursing education is to develop the learner on a personal and professional level to become an independent, knowledgeable, safe practitioner with analytical and critical thinking skills”. Copyright / Dissertation (MCur)--University of Pretoria, 2009. / Nursing Science / unrestricted

It is the responsibility of professions to provide evidence of the demonstrable value and quality of service delivery. Occupational therapists in mental health care settings find it difficult to produce convincing evidence of the demonstrable value and their contribution to health care. Currently no effective outcome measure for occupational therapists in mental health practices exists for the South African context . The development of an outcomes measuring system is much needed in these crucial times of cost-cutting, rendering quality of care with the minimum resources and the quest for evidence of the effect of intervention. The purpose of this study was to fill the outcome measurement gap by developing a system that is clinically tested and user-friendly for occupational therapists in mental health care settings. Such a system had to represent the outcomes in the occupational therapy programmes, meet the needs of the therapist in terms of purpose of the tool, be easily administered and be standardised. It was also important that the outcome measure was grounded in the theoretical framework that guides intervention programmes, namely Vona du Toit’s Model of Creative Ability. This theoretical framework is widely used in South African mental health care settings and was found suitable to be transformed into a rating scale for the outcome measure. A participatory approach combined with a mixed method exploratory design, specifically the instrument development model, was selected to guide the study. The development of the outcome measure happened in three phases. Domains for the outcome measure emerged after participation from occupational therapy clinicians and mental health care users in Phase 1. The operationalisation of the domains and the development of the rating scale happened during Phase 2. The third phase was the piloting of the outcome measure to identify issues to be optimised for the final implementation of the outcome measure. Eight domains with 52 representative items emerged from Phase 1. The domains were Process skills, Communication and Interaction skills, Lifeskills, Role performance, Balanced lifestyle, Motivation, Self-esteem and Affect. Clinicians were satisfied that these domains represented the service that they deliver and compared well with the mental health care users’ need for occupational therapy. The involvement of mental health care users in confirming relevant domains for the outcome measure ensured a client-centred approach in the research process. The outcome measure, named as the Activity Participation Outcome Measure (APOM), has a unique feature of generating reports and spider graphs for every mental health care user. The APOM was piloted in three mental health care settings. In spite of good intentions from clinicians to apply the measure, it was clear that measuring outcomes is neither a priority, nor a routine task in clinical settings. The preliminary investigation into the psychometric properties yielded positive results. However, the sample sizes for the validity and reliability samples were not optimal and further data collection needs to continue for confirmation. It is recommended that investigations into the psychometric properties of the instrument continue to eventually market it as a valid and reliable outcome measure for occupational therapists in mental health care settings. / Thesis (PhD)--University of Pretoria, 2010. / Occupational Therapy / unrestricted

Published Article / This article describes a process of student learning outcomes assessment for a health sciences programme in radiography at a university in South Africa. Its purpose is to demonstrate that while the process of student learning outcomes assessment is universal, it can be used both nationally and internationally. As long as underlying premises are met, assessment needs to be considered within the context of a country's unique culture, society and history. Underlying premises include understanding the institution's mission and vision, determining that the programme's mission and vision are congruent with those of the institution, and involving faculty early in the assessment process.

Data from a prospective, longitudinal study of a birth cohort of over 1000 New Zealanders was used to examine the relationships between the level of childhood physical abuse a young person is exposed to during childhood (birth to 16 years), and a range of later parenting outcomes in young adulthood. To address this issue, three questions were considered. First, the study examined risk factors that contribute to an early transition to parenthood. Second, this study investigated the current family circumstances of contemporary young parents and their families. And finally, the association between childhood physical abuse and later parenting outcomes was examined. All members of the Christchurch Health and Development Study (CHDS) who had become parents by age 25 (112 women and 55 men) were included in the study. To be eligible for inclusion cohort members had to be either biological parents or actively involved in the parenting of non-biological children on a regular basis. Exposure to childhood physical abuse (CPA) was measured at ages 18 and 21 based on cohort member's retrospective reports. At age 25, a parenting interview was conducted which included the following measures of parenting: the Conflict-Tactics Scale (CTS-PC; Straus, Hamby, Finkelhor, Moore, & Runyan, 1998), Dunn scales of positivity and negativity (Dunn, Deater-Deckard, Pickering, & Golding, 1999), the Parenting Practices Questionnaire (PPQ; Robinson, Mandleco, Olsen, & Hart, 1995), HOME ratings of responsivity and avoidance of punishment (Caldwell & Bradley, 1979), and interviewer ratings of parental warmth, sensitivity, and child management (Quinton, Rutter, & Liddle, 1984). Findings showed that parents who experienced higher levels of punishment whilst growing up were more negative and less positive towards their own children, were more accepting of the use of physical discipline, and scored lower on warmth, sensitivity and child management compared to those with lower levels of exposure to childhood physical abuse. These findings contribute to our understanding of the effects of childhood physical abuse on later parenting outcomes.

Depression occurs in approximately 20% of pregnant women, and up to 25% of them experience anxiety. Several pregnancy complications and labour and delivery outcomes have been associated with antenatal depression and anxiety, such as higher rates of nausea and vomiting, bleeding, psychosomatic complaints, preterm labour and delivery complications. Neonatal outcomes include lower Apgar scores, shorter gestation, smaller head circumference, and increased admissions to the neonatal intensive care unit. Research Questions: 1. To examine the prevalence of pregnancy complications and neonatal outcomes in this study sample. 2. To examine whether there is a difference in the association between observed pregnancy complications and neonatal outcomes and major depression, when depression is episodic compared to when the depression is continuous. 3. To examine whether there is a difference in the association between observed pregnancy complications and neonatal outcomes and mild depression, when the mild depression is episodic compared to when it is continuous. 4. To examine whether there is a difference in the association between observed pregnancy complications and neonatal outcomes and anxiety, when anxiety is episodic compared to when it is continuous. Methods: The data for this study was collected for the Feelings in Pregnancy and Motherhood Study (FIP). This population-based study interviewed 649 participants three times: in the second trimester, the third trimester, and in the early postpartum. Participants were screened for depression and anxiety with the Edinburgh Postnatal Depression Scale (EPDS), using the validated cut-off scores of >12 and >4 respectively. Sociodemographic data as well as detailed risk behaviours, and sources of stress and coping, were explored. Finally, pregnancy, labour and delivery and neonatal complications were collected. Descriptive and multivariate logistic regression analyses were completed. Results: Major depression in the second trimester was significantly associated with gestational diabetes (OR: 3.518; 95% CI 1.56, 7.93) and swelling/edema (OR: 2.099; 95% CI 1.13, 3.89). Major depression that occurred continuously throughout pregnancy was significantly associated with induced labour (2.417; 95% CI 0.99, 5.92) and antenatal bleeding/abruption (OR: 2.099; 95% CI 1.13, 3.89). Anxiety in the second trimester was significantly associated with caesarean birth (OR: 0.522; 95% CI 0.29, 0.95). Anxiety occurring continuously throughout pregnancy was significantly associated with swelling/edema (OR: 1.816; 95% CI 1.19, 2.77) and there was a significant interaction between age and anxiety that predicted epidural use during pregnancy: while age decreased in the participants who had anxiety in both trimesters, the likelihood of using an epidural increased. Finally, mild depression in the second trimester was significantly associated with antenatal bleeding/abruption (OR: 2.124; 95% CI 1.09, 4.14) and PROM (OR: 2.504; 95% CI 1.04, 6.05). Mild depression in the third trimester was associated with caesarean birth (OR: 0.298; 95% CI 0.10, 0.86). Mild depression that occurred continuously throughout pregnancy was significantly associated with the use of vacuum/forceps in delivery or an operative delivery (OR: 4.820; 95% CI 1.10, 21.16). Conclusions: These results show that episodic depression and anxiety can have a more profound impact on pregnancy complications and labour and delivery outcomes than continuous depression and anxiety. Furthermore, the results demonstrate that even mild depression can have a significant negative impact on pregnancy complications and labour and delivery outcomes. These results further highlight the imperative need for women to be screened and treated for depression and anxiety during pregnancy.

Opportunities for supporting physician continuing professional development (CPD) may exist through careful instructional design and creative use of information and communication technology. The overarching goal of this study was to explore the learning experiences and outcomes of cardiologists participating in a web conference (“webinar”) series to understand the factors that can support webinars in being an appealing and satisfying CPD medium for these learners. Acknowledging that a pedagogically-based framework for program design is a cornerstone of effective CPD (Hutchinson & Estabrooks, 2009; Inan & Lowther, 2007; Casimiro, MacDonald, Thompson, & Stodel, 2009), this study used the W(e)Learn Framework (MacDonald, Stodel, Thompson, & Casimiro, 2009) as a process guide and quality standard for program design, development and delivery. Cardiologists voluntarily participated in an educational webinar series in which they shared their observations and experiences. Informed by the results of a systematic review of physician eLearning design preferences, this dissertation serves as a mechanism to learn about how webinars can be implemented to support learning and practice change within a population of highly specialized physician learners. Methodological approaches included a systematic review of literature examining physician preferences for eLearning design, a case study of webinar implementation, and interviews with cardiologists who participated in the webinars. The findings of the systematic review, the case study and the interviews aligned to characterize key considerations in webinar implementation. Webinar designers must carefully determine program structures, content, and media to create a satisfying learning experience. Cardiologists seek a webinar experience that responds to their professional reality of competing priorities, complex patients, and ambiguous clinical questions. They seek a mix of evidence-based, authentic and challenging content, delivered by credible content experts. The study found that purposefully designed webinars can be a satisfying learning experience for cardiologists with the potential to influence changes in knowledge and practice. The use of an instructional design framework may structure and enrich webinar implementation; this dissertation encourages their use.