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The purpose of this study was to examine whether removing disruptive students to a behavior support office (BSO) is an effective intervention in reducing disruptive behaviors in a school exclusively serving students diagnosed with emotional disturbance. The study also examined the effect of the BSO on academic success and school attendance. Staff attitudes toward the BSO were also examined. Finally, demographic categories were evaluated. Archival data from two school years were collected. There were 35 students during the 2007-2008 school year when the BSO was in effect, and 65 students during the 2008-2009 school year when the BSO was not in effect. There was also an evaluation of the 23 students who were present during both years. It was hypothesized that use of the behavior support office would reduce the number and intensity of behavior incidents, and ultimately, reduce the amount of time spent out of class due to those behaviors. The data, however, demonstrated that students exhibited more behavior incidents and spent more time out of the classroom due to those behaviors with the BSO in place. It is believed that this increase was most likely due to the reinforcement of escape motivated behaviors. These behaviors in the BSO were, however, of a lower intensity. This researcher further hypothesized that students would demonstrate higher grade point averages and higher rates of attendance with the behavior support office in place. There was no significant difference in GPA or attendance. School staff were administered the Intervention Rating Profile - 15 to examine levels of staff acceptance for the behavior support office. Teaching staff had the highest level of acceptance for the BSO, while administrators had a lower level of acceptance, and behavior staff had the lowest level of acceptance. The higher level of teaching staff acceptance did not appear to impact the success of the intervention. Finally, demographic information was evaluated. There were no significant effects for age or gender. However, African American students demonstrated a significantly greater decrease than Caucasian students in time out of the classroom due to behavior incidents after the Behavior Support Office was discontinued. / School Psychology

There has been little research to date specifically addressing counselors' experiences with complementary therapy. The objective of this exploratory survey was to assess counselors' professional practice, knowledge and training, and personal experience with complementary therapy. The study design was a web-based, random sample survey of American Counseling Association members. Results indicated the typical respondent was female, Caucasian, holds a Master's degree and works in a private practice/self-employed or community agency setting as an outpatient counselor. Few respondents asked about or had clients volunteer use of complementary therapy. Anxiety and depression were the most common client concerns for which respondents recommended or referred for complementary therapy. Respondents agreed that client referrals should be to licensed or certified practitioners. Respondents reported that complementary therapy provided clients with at least some positive benefits and few negative consequences. The majority of respondents included complementary therapy in counseling during the past year and thought that complementary therapy should be included in addition to counseling. Although respondents considered themselves qualified to discuss a variety of complementary therapies, few possessed licensure or certification. The majority of respondents used informal, self-study to gain knowledge of complementary therapy. Most respondents have personally experienced at least one complementary therapy, primarily "To improve overall wellness". Respondents reported they received some to large benefits from this experience. A number of respondents descriptors had moderately positive associations with client usage, recommendation and referral, inclusion, and knowledge factors. These descriptors were those respondents who worked in a private practice/self-employed setting, as an outpatient counselor, were licensed as an LPC, provided individual, family/couples, or alcohol/substance abuse counseling, and had a psychodynamic orientation. There were moderately negative associations between respondents who worked in a K-12 setting, did not possess mental health licensure and were a Master's student and client usage, recommendation and referral, and inclusion factors. The data provide support for the idea that counselors are beginning to embrace a post-modern approach, which gives consideration to complementary therapy interventions. However, the findings also suggested that the counseling profession still has a good deal of work to do before it can be considered truly holistic. / Ph. D.

Disproportionality in public school exclusionary discipline data has been documented throughout the United States, including the Commonwealth of Virginia. The literature reviewed indicates that Black male students are disproportionately excluded from school and that subjective office discipline referrals are a factor. Within subjective referrals, disruptive behaviors are the primary reasons for the referral of Black male students. The literature has investigated implicit bias as a possible cause and found that Black males were viewed as more aggressive and academically lower achieving than other subgroups. This study sought to investigate disproportionality in referrals for disruptive behavior and the possible relationships among race, gender, and academic achievement for students issued the referrals. Three years of enrollment, discipline, and academic achievement data for students in grades 3 through 8 were obtained from three Title I schools, two elementary schools and a middle school, in a high-poverty school division. A correlational, nonexperimental design was used to address two questions, was there evidence of disproportionality by race/ethnicity and/or gender in office discipline referrals for disruptive behavior? Was there a relationship among race, gender, and academic achievement for students issued those referrals? Two phases of data collection and analysis were involved, with descriptive statistics used for each phase. Results were analyzed and there were four findings: there was evidence of disproportionality by race/ethnicity, there was evidence of disproportionality by gender, there was not consistent evidence of disproportionality by race/ethnicity and gender, and there were no statistically significant relationships among race, gender, and academic achievement for students issued a referral. These findings could help researchers and educators identify and understand disproportionality in referrals for disruptive behaviors and address disproportionality in exclusionary disciplinary practices. / Doctor of Education / Disproportionality in public school exclusionary discipline data has been documented throughout the United States, including the Commonwealth of Virginia. The literature reviewed indicates that Black male students are disproportionately excluded from school and that subjective office discipline referrals are a factor. Within subjective referrals, disruptive behaviors are the primary reasons for the referral of Black male students. The literature has investigated implicit bias as a possible cause and found that Black males were viewed as more aggressive and academically lower achieving than other subgroups. This study investigated disproportionality in office discipline referrals for disruptive behavior and the relationships among the variables of race, gender, and academic achievement. A correlational, nonexperimental design was used to address two questions, was there evidence of disproportionality by race/ethnicity and/or gender in office discipline referrals for disruptive behavior? Was there a relationship among race/ethnicity, gender, and academic achievement for students issued those referrals? Three years of enrollment, discipline, and academic achievement data for students in grades 3 through 8 were obtained from three Title I schools, two elementary schools and a middle school, in a high-poverty school division. Results were analyzed and there were four findings: there was evidence of disproportionality by race/ethnicity, there was evidence of disproportionality by gender, there was not consistent evidence of disproportionality by race/ethnicity and gender, and there were no statistically significant relationships among race, gender, and academic achievement for students issued a referral.

When school-based behavior problems are not solvable in short-term school counseling, referrals are often made to community therapists. The school-based referral process is described in the literature as an informal process aimed at matching clients' needs with therapist skills but the literature also suggests that the referral process is based even more so on the relationship of the school counselor to the therapist. A survey of 19 school counselors was conducted to measure the importance of six factors identified in a pilot study that are used in selecting a referral source; Therapist Accessibility, Therapist Commitment to School, Therapist Philosophy and Belief System, Therapist Reputation, and Therapist Credentials. In addition, 19 community-based therapists were surveyed to measure their ranking of these same factors. When the scores were analyzed it was found that school counselors rated two scales, Therapist Accessibility and Therapist Reputation, significantly higher than did therapists. Surprisingly, Therapist Reputation was rated least important by both groups. This research has the potential to help strengthen the engagement between the school system and the mental health system by first identifying the factors used for school-based referrals and then identifying the differences in how the two systems perceive the importance of these factors. / Master of Science

Yes / Objective To determine whether an immediate reporting service for musculoskeletal trauma reduces interpretation errors and positively impacts on patient referral pathways. Methods A pragmatic multicentre randomised controlled trial was undertaken. 1502 patients were recruited and randomly assigned to an immediate or delayed reporting arm and treated according to group assignment. Assessment was made of concordance in image interpretation between emergency department (ED) clinicians and radiology; discharge and referral pathways; and patient journey times. Results 1688 radiographic examinations were performed (1502 patients). 91 discordant interpretations were identified (n=91/1688; 5.4%) with a greater number of discordant interpretations noted in the delayed reporting arm (n=67/849, 7.9%). In the immediate reporting arm, the availability of a report reduced, but did not eliminate, discordance in interpretation (n=24/839, 2.9%). No significant difference in number of patients discharged, referred to hospital clinics or admitted was identified. However, patient ED recalls were significantly reduced (z=2.66; p=0.008) in the immediate reporting arm, as were the number of short-term inpatient bed days (5 days or less) (z=3.636; p<0.001). Patient journey time from ED arrival to discharge or admission was equivalent (z=0.79, p=0.432). Conclusion Immediate reporting significantly reduced ED interpretive errors and prevented errors that would require patient recall. However, immediate reporting did not eliminate ED interpretative errors or change the number of patients discharged, referred to hospital clinics or admitted overall. Advances in knowledge This is the first study to consider the wider impact of immediate reporting on the ED patient pathway as a whole and hospital resource usage.

Yes / Introduction: Evolution of a patient-reported symptom-based risk stratification system to redesign the suspected head and neck cancer (HNC) referral pathway (EVEREST-HN) will use a broad and open approach to the nomenclature and symptomatology. It aims to capture and utilise the patient reported symptoms in a modern way to identify patients’ clinical problems more effectively and risk stratify the patient. Method: The review followed the PRISMA checklist for scoping reviews. A search strategy was carried out using Medline, Embase and Web of Science between January 1st 2012 and October 31st 2023. All titles, abstracts and full paper were screened for eligibility, papers were assessed for inclusion using predetermined criteria. Data was extracted pertaining to the aims, type of study, cancer type, numbers of patients included and symptoms, presenting complaints or signs and symptoms. Results: There were 9,331 publications identified in the searches, following title screening 350 abstracts were reviewed for inclusion and 120 were considered for eligibility for the review. 48 publications met the eligibility criteria and were included in the final review. Data from almost 11,000 HNC patients was included. Twenty-one of the publications were from the UK, most were retrospective examination of patient records. Data was extracted and charted according to the anatomical area of the head and neck where the symptoms are subjectively and objectively found, and presented according to lay terms for symptoms, clinical terms for symptoms and the language of objective clinical findings. Discussion: Symptoms of HNC are common presenting complaints, interpreting these along with clinical history, examination and risk factors will inform a clinician’s decision to refer as suspected cancer. UK Head and Neck specialists believe a different way of triaging the referrals is needed to assess the clinical risk of an undiagnosed HNC. EVEREST-HN aims to achieve this using the patient history of their symptoms. This review has highlighted issues in terms of what is considered a symptom, a presenting complaint and a clinical finding or sign. / National Institute for Health and Care Research Programme Grant for Applied Research NIHR 202862.

Past research has revealed that African American/Black boys are referred for special education evaluation at disproportionately higher rates than boys of other racial/ethnic groups. This correlational study used survey methodology to examine whether student and teacher demographic variables predicted how likely a teacher would refer boy students for special education evaluation. The following questions guided this research: 1) To what degree does student race/ethnicity, teacher gender, teacher race/ethnicity, and teacher attitude toward inclusion predict how likely a teacher would refer boys' to special education after controlling for teacher's years of experience in general and special education? 2) What are the differences in teacher ratings regarding the severity of classroom behaviors based on the students' race/ethnicity? Cultural theory and social exclusion theory were used to guide this research. Data were collected through the researcher developed Teacher Rating Form from 110 teachers. Results from a multiple linear regression revealed that years of teaching experience, race of teacher, race the student, and teacher attitude toward inclusion were statistically significant predictors of teacher referral to special education. However, the effect size was small. Results from the ANOVA procedure revealed no statistically significant differences in teacher ratings for severity of described classroom behaviors based on the students' race/ethnicity. Findings form this study could be used to promote social change by increasing teacher awareness of how certain teacher demographics affect teacher referral of boys to special education. Findings can be used to advocate for training and seminars that could promote cultural understanding among teachers that may lead to and reduce the number of referrals.

Thesis (M. (Nursing)) -- University of Limpopo, 2022 / Background: The referral system is an essential component of the health system. The system meant to complement the Primary Health Care (PHC) principle of treating patients close to their homes at the lowest level of care with the needed expertise. Aim of the study: The aim of the study is to develop the strategies that will facilitate the referral system of high-risk pregnant women in between public sectors in the Bojanala district, North West Province, South Africa. Objectives of the study: To explore the referral system of high-risk pregnant women between public sectors within the Bojanala District, North West Province, South Africa. To develop strategies that will facilitate the referral system of high risk pregnant women in the Bojanala District, North West Province, South Africa. Methods: The researcher first obtained permission from the University of Limpopo Turfloop Research Ethics Committee (TREC), and further requested permission from the North West Department of Health, Bojanala District to conduct the study and was granted the permission. Qualitative, exploratory and descriptive designs were used to explore the referral system of high-risk pregnant women and to describe the strategies to facilitate the referral system of high-risk pregnant women in between public sectors in the Bojanala District, North West, South Africa. Non-Probability Purposive sampling method was used to select the midwives and obstetricians to participate in the study until data saturation was reached. Data were collected through one-on-one interviews using semi structured Interview Guide. The data were analysed using Tesch‘s eight steps of data analysis. Results: The results of this study revealed that the participants are knowledgeable about the referral system though they are many challenges that they encounter when managing high-risk women and having to refer them. They are aware of the current state of referral system and made their own suggestions on how to improve the referral system. Recommendations: Recommendations were made to facilitate the referral system of high-risk pregnant women in the North West Province, Bojanala District. The Department of Health must prioritise the provision of human and material resources to the district in order to achieve a better referral system and reducing the maternal and neonatal mortality as one of the millennium developmental goals. Conclusion: The referral system of high-risk pregnant women in the Bojanala District still has some challenges that need the intervention of the North West Department of Health to provide enough material and human resources to the Maternity Section in order to improve current status and to have an effective referral system

In the last decade, the deployment of Electronic Health Records has increased tremendously in many developed countries. This increasing trend intensifies the need for developing countries like South Africa to implement electronic health record systems in state owned hospitals to facilitate e-referral processes to improve health care delivery. The aim of this research was to investigate the current process of patient record keeping, management, and the referral process of patients within the same hospital and to other hospitals and based on the findings compile an Electronic Health Record (EHR) framework to facilitate e- referral processes. This research study was based on a qualitative case study approach. A multiple data collection technique was used which included group interviews, questionnaires, document analysis and informal discussions with the hospital workers. Data were analysed by categorization and thematic approach. The findings obtained from state hospitals indicated that there is no EHR system which accommodates patient health record systems to facilitate e-referral processes. These findings led to a compilation of the Limpopo Electronic Health Record System (LEHRS) to aid e-referral processes in state hospitals. The increasing need for accurate, reliable, available and accessible EHR will be addressed by the implementation of LEHRS as information will be stored in a central database in a useable format and will be easily accessed. / Computing / M. Tech. (Information Technology)