The primary objective of the project was to survey recognized “experts” in the field of neurodiagnostic audiology and practicing audiologists regarding their referral criteria and referral patterns for administering an auditory brainstem response test (ABR). For purposes of this study, “expert” was defined as any recognized audiologist with at least two or more publications and/or seminars in the field of auditory evoked potentials. Responses of experts and practicing audiologists were compared and contrasted to establish: a) if there was a standard referral pattern; b) what, if any, were the apparent critical components of referral patterns; and, c) whether or not current practice reflected the utilization of such critical components. The survey was designed to establish whether the respondent was practicing, in what type of practice setting, and how often ABRs were performed. Specificity and sensitivity of ABR outcomes was also requested. The survey was administered verbally, via telephone, to 3 experts and was sent via e-mail to 178 randomly selected audiologists in the United States. Of the latter 53 returned, 38 reported conducting ABRs. Thus, data analysis was reported on 38 respondents. The survey results did not reveal a consistent standard referral pattern. Critical components for referral were hypothesized based on the “expert” majority response. These include ABR referral based on the presence of: (1) asymmetric sensorineural hearing loss; (2) unilateral tinnitus; (3) positive reflex decay; and, (4) word recognition rollover. The majority of “non-expert” practitioners surveyed reported that these symptoms warranted consideration for referral, thus reflecting utilization of apparent critical components.

We describe the mental health referral rate among youth in a correction facility, examine how sociodemographic and criminal history characteristics relate to referral, and explore how these variables and diagnostic class differ by referral source. Data were abstracted from case records. The referral rate was low (6%). Non-Latino youth, repeat offenders, and violent offenders were more likely to be referred compared to all detained youth. Referral source also varied by violent offense history and diagnosis type. Future studies examining access to mental health services should take into account a detained youth 's sociodemographic, criminal history, and clinical characteristics.

The purpose of this study was to examine differences in early intervention (EI) referral and service frequency for children with blindness or visual impairment (BVI) and gather information about the practices and experiences of vision professionals across the United States. The study focused on obtaining data from certified teachers of students with visual impairment (CTVI) and certified orientation and mobility specialists (COMS) in the United States. Information collected included descriptive statistics and professional information about EI for children with BVI, and information about the referral process and service frequency for children with BVI during EI. Thirty-three states were represented in the collected data. Of these states, 26 had responses from four or more professionals, the criteria for inclusion in the analyses. Participants provided information based on a researcher-developed survey requesting information related to the procedures used to provide EI services for children with BVI. Questions were adapted from established instruments where possible. Across states, there were some statistically significant differences in CTVIs and COMS reports of procedures regarding the role of professional collaboration, parent/caregiver participation in IFSP meetings, strengths/resources utilized by vision professionals, and challenges parents/families encountered when accessing EI services for their child with BVI. No statistically significant differences were identified across states for type of referral method, most commonly initiated by health care professionals, or method by which service frequency was determined. Results will be used to inform future research to further examine EI for children with BVI in the United States.

Employee Assistance Programme is a programme designed to assist employees who have a variety of problems affecting their productivity. It is a fact that for the programme to be effective and functional there should be enough referrals to the programme. It is without doubt that supervisors play a pivotal role in the success of the programme. However, this research focuses on explaining and understanding the perception of supervisors within the Department of Foreign Affairs (DFA) about EAP referrals. DFA is one of the Governmental departments within South Africa. Their core function is implementing the South African Foreign Policy. The mission of DFA is mainly to promote South Africa‘s national interests and values, the African Renaissance and the creation of a better world for all. To alleviate problems and enhance productivity, the Department introduced EAP system, but from statistics received from the EAP centre, it was evident that the utilisation rate is very low. It is unknown whether the low utilisation rate is due to a lack of referrals by supervisors, a lack of knowledge from both the employer and employees, or if the programme was not marketed properly. The researcher utilised a qualitative research approach because she was interested in describing and understanding the perceptions rather than explaining them. She developed a semi-structured interview schedule and the respondents were interviewed and given a chance to comment and widely define issues. It was a one-on-one interview using a semi-structured interview schedule and the respondents were free to expand on the topic. The researcher interviewed and tape recorded the responses of the respondents. The respondents were informed of the rationale for using a tape recorder and were requested to give consent in writing. The research findings revealed that the EAP within the DFA was under-utilised and not effective. Supervisors were passive role players and were not confident of their role as referral agents. The supervisors clearly highlighted that they were not trained as referral agents and were also not aware of different types of referrals. They did not know about the referral procedures and the programme was not property marketed to them. Their main concern was that the programme did not receive enough support from management hence they were not confident of the services rendered by the Programme. The researcher therefore recommended that the Department should review the policy on an ongoing basis to reach all levels of employee within the Department. A training programme to be developed and implemented, focusing on all aspect of the programme, as well as a training manual to be developed and made available to all levels of employees. The researcher further recommended that the EAP, within the DFA, be marketed, visible and accessible, with ongoing utilisation surveys to monitor the utilisation rate on an ongoing basis be conducted. / Dissertation (MSD)--University of Pretoria, 2007. / Social Work and Criminology / MSD (EAP) / Unrestricted

Pastors are often called upon to counsel people troubled by what may be a diagnosable and treatable condition. Current research suggests that pastoral counselors (PC) are reluctant to provide a referral to a mental health professional (MHP) citing that only 10% of help seekers are referred, leaving millions of Americans to suffer with undiagnosed and untreated mental illness. The current literature indicates that PCs feel inadequately trained to counsel those with mental illnesses and the reluctance to refer is due to a distrust of MHPs. Currently, there is little qualitative research on pastors' counseling and referral experiences. In this study, social constructionism and the theory of planned behavior were used to address 3 research questions by describing PCs' experiences, describing PCs' opinions of MHPs, and examining PCs' referral decision criteria. Purposeful sampling was used to recruit 9 Southern Baptist Convention PCs from the Atlanta Metropolitan area. Giorgi's descriptive phenomenological method was used with a priori and emergent coding to analyze data collected from semistructured, face-to-face interviews. While feelings of inadequacy were confirmed by this research, it was discovered that PCs are motivated by a spiritual obligation to counsel and the reluctance to refer is not based on a distrust of MHPs, as cited by some research. Instead, PCs in this study prefer MHPs who offer Christian counseling. MHPs may want to consider incorporating spiritual sensitivity into their practice to increase PC collaboration. Increasing PC referrals may result in positive social change by decreasing the number of parishioners who suffer with undiagnosed and untreated mental illnesses.

Background. Internationally, infectious diseases remain the greatest cause of morbidity among young children. Infectious disease burden is particularly high in low-to-mid income countries (LMIC). South Africa has a high prevalence of bacterial meningitis (BM), especially in children under the age of five. BM is also one of the commonest causes of acquired hearing loss in children. Given the fluctuating and transient nature of BM-related hearing loss, there is a need for an effective audiological protocol to facilitate timeous and appropriate audiological management. There is currently no universally accepted protocol for the audiological referral and management of children diagnosed with BM. Consequently, there is a need for an evidence-based protocol that will ensure timely referral and audiological testing of all children diagnosed with BM. Early identification of BM-related hearing loss in children will allow for timeous, appropriate audiological management and associated benefits, such as an option for placement in mainstream schooling. Objectives. This study aimed to explore the audiological management of children diagnosed with BM at a tertiary hospital in the Western Cape, South Africa, with reference to: patterns of referral for audiological assessment following a diagnosis of BM; current audiological protocols for the management of children diagnosed with BM. It was anticipated that this study would generate evidence that could potentially be used to develop appropriate protocols for the audiological management of children diagnosed with BM in LMICs, specifically South Africa. Methods. A retrospective record review was conducted using patient folders of children between 0 and 6 years who were treated for BM between May 2016 and May 2018. Data collection took place at Red Cross War Memorial Children's Hospital, which has a paediatric infectious diseases unit and an audiology department. Demographic and audiological data were recorded on a self-developed data abstraction form and data were analysed descriptively. Results. A total of 291 patient folders were accessed for review in this study. Of those, 40 (13.7%) met the inclusion criteria for the study and were selected for review. The majority of excluded folders were for patients not referred for audiological testing post-BM diagnosis. For those children referred to audiology, average referral time was 15 days (SD = 24 days) and each patient attended an average of only 2 audiology appointments. Otoacoustic emissions testing and tympanometry were the most commonly performed audiological tests in all children. BM-related hearing loss developed in 2/19 of these patients. All patients who were diagnosed with BM-related hearing loss were subsequently fitted with hearing aids – one of whom was fitted unilaterally with a hearing aid and the other, a cochlear implant candidate, was lost to follow-up. Conclusions. The key challenge experienced in this study was low referral rates to audiology (16%), which was followed by poor adherence to follow-up appointments – both of which were found to impede effective audiological management. Effective management and prevention of BM-related hearing loss pose challenges in LMICs. This study highlights the need for a well-defined referral pathway and an evidence-based protocol for the audiological management of children with BM within the South African health care setting. If this could be achieved, the early identification of hearing loss in these children has the potential to provide them with developmental, scholastic, and working opportunities in line with those of children with normal hearing.

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No description available.

This study was designed to examine the relationship between teacher referral and the underrepresentation of CLD students in gifted education and to identify the factors that influenced teachers' decisions to refer CLD students to gifted services. Studies on the issue of disproportionality in gifted education in the United States have indicated teacher referrals can be a pivotal instrument in the identification of culturally and linguistically diverse (CLD) gifted students. However, previous research has shown teacher referrals of CLD students to gifted services may be influenced by the teacher's own explicit or implicit stereotypes or beliefs of their students' cultural or linguistic backgrounds. District level data from the 2021 school year were examined through a Pearson's correlation coefficient test and a survey was administered to teachers in three different grade levels to determine whether factors such as assessment scores, parent referral, student behavior, and teachers' prior experience with CLD predicted their decision to refer CLD students for gifted services. The survey included two open-ended questions that provided qualitative data on the traits that teachers most associated with giftedness in CLD students, as well as information on school division resources that teachers find to be most effective in supporting their referral of CLD students. The findings of this study revealed there was a relationship between teacher referral and the underrepresentation of CLD students in gifted education. No significant relationship was found between the factors listed in the survey and the teachers' decision to refer CLD students to gifted services. However, the frequency of teachers' responses to the Likert-scale questions in the survey indicated the teachers' strong consideration of assessment scores and prior experience with CLD students when recommending CLD students for gifted education. The implications of the study emphasized the need for structures that support the analysis of data on the role teachers play in the underrepresentation of CLD students in gifted education, the assessments used to identify gifted students, and the need for intentional professional development that equips teachers with the skills to recognized exceptionality in CLD students. / Doctor of Education / This study was designed to examine the relationship between teacher referral and the underrepresentation of CLD students in gifted education and to identify the factors that influenced teachers' decisions to refer CLD students to gifted services. The disproportionate representation of these students in gifted education has been considered one the most pressing current issues in educational equity. Studies on the underrepresentation of CLD students in gifted education have identified that teachers are the first step in the gifted screening process. However, previous research has shown teacher referrals of CLD students to gifted services may be influenced by the teacher's own explicit or implicit stereotypes or beliefs of their students' cultural or linguistic backgrounds. This study examined talented and gifted district level referral data from the 2021 school year. This data consisted of the number of referrals by teachers, parents, and administration to the gifted education program. A point biserial correlation was used to determine if a relationship existed between total teacher referrals and the ethnicity of the students in the reported data. A survey consisting of demographic questions, Likert scale questions, and two open-ended questions was administered to teachers in nine elementary schools to determine whether factors such as assessment scores, parent referral, student behavior, and teachers' prior experience with CLD predicted their decision to refer CLD students for gifted services. The survey included two open-ended questions that provided qualitative data on the traits that teachers most associated with giftedness in CLD students, as well as information on school division resources that teachers find to be most effective in supporting their referral of CLD students. The findings of this correlational study revealed there was a significant negative relationship between teacher referral and the representation of CLD students in gifted education, indicating that moving from the non-CLD student category to the CLD student category of student ethnicity, there was a medium decrease in total teacher referrals. No significant relationship was found between the factors listed in the survey and the teachers' decision to refer CLD students to gifted services. However, the frequency of teachers' responses to the Likert-scale questions in the survey indicated the teachers' strong consideration of assessment scores and prior experience with CLD students when recommending CLD students for gifted education. The implications of the study emphasized the need for structures that support the analysis of data on the identification instruments used in the gifted education process, the assessments used to identify CLD gifted students, and the need for targeted professional development that equips teachers with the skills to recognized exceptionality in CLD students.

Yes / Background: In older people living with frailty, polypharmacy can lead to preventable harm like adverse drug reactions and hospitalisation. Deprescribing is a strategy to reduce problematic polypharmacy. All stakeholders should be actively involved in developing a person-centred deprescribing process that involves shared decision-making. Objective: To co-design an intervention, supported by a logic model, to increase the engagement of older people living with frailty in the process of deprescribing. Design: Experience-based co-design is an approach to service improvement, which uses service users and providers to identify problems and design solutions. This was used to create a person-centred intervention with the potential to improve the quality and outcomes of the deprescribing process. A ‘trigger film’ showing older people talking about their healthcare experiences was created and facilitated discussions about current problems in the deprescribing process. Problems were then prioritised and appropriate solutions were developed. Review located the solutions in the context of current processes and procedures. An ideal care pathway and a complex intervention to deliver better care were developed. Setting and participants: Older people living with frailty, their informal carers and professionals living and/or working in West Yorkshire, England, UK. Deprescribing was considered in the context of primary care. Results: The current deprescribing process differed from an ideal pathway. A complex intervention containing seven elements was required to move towards the ideal pathway. Three of these elements were prototyped and four still need development. The complex intervention responded to priorities about (a) clarity for older people about what was happening at all stages in the deprescribing process and (b) the quality of one-to-one consultations. Conclusions: Priorities for improving the current deprescribing process were successfully identified. Solutions were developed and structured as a complex intervention. Further work is underway to (a) complete the prototyping of the intervention and (b) conduct feasibility testing. / National Institute for Health and Care Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC)