There is a high prevalence of chronic diseases and conditions among older, low-income individuals in the United States. It is well recognized that diet plays an important role in the management and prevention of chronic diseases. Despite this, primary-care physicians often do not provide adequate dietary counseling or appropriate nutrition referrals to this patient population. Two surveys were conducted in Southwest and the western part of Central Virginia, one with 209 family practitioners and internists and the other with 57 low-income participants in the Food Stamp Nutrition Education Program (FSNEP). The FSNEP clients were aged 40 years or older, had been enrolled in FSNEP for four months or less, and had a diet-related chronic disease or condition. Eighty-one percent of physicians reported that they provide nutrition advice to their chronic disease patients on a regular basis. Most physicians further stated that they make a limited number of referrals to registered dietitians and very few referrals to community nutrition education programs. FSNEP clients were generally dissatisfied with their primary-care physician's provision of nutrition information and indicated a desire for more dietary guidance. Results indicate a need for primary-care physician referrals to free community nutrition education services that tailor their programs to the patient's socioeconomic situation. These referrals may improve the nutrition health of older, low-income patients and help manage their chronic diseases. Informational brochures need to be developed and distributed to primary-care physicians informing them of the positive attributes of free community nutrition education programs, such as FSNEP. / Master of Science

No description available.

A large percent of high school students in New Jersey aged 12 -17 can benefit from seeing their school counselor. The problem is that without teacher referrals, many students with unidentified mental health disorders may not receive the needed early intervention services. Limited research exists as to which factors may influence a teacher to refer a student to a school counselor. Framed with cognitive behavioral theoretical foundation, a cross sectional survey design study investigated how teachers' perception of school counselors influence teachers' willingness to refer to a school counselor, as measured by the Counselor Rating Form - Short Edition. Using a stratified cluster sampling method, 55 licensed New Jersey school teachers participated in the study. To assess the relationship between the results of the Counselor-Rating Form - Short Edition, and teacher made student referrals linear regression was used. In this study, a simple correlation between the CRF-S score and the number of referrals was found to be significant, r = .338, p = 0.012. Further, the scores on the CRF-S could be a significant predictor of making a referral, F(1, 53) = 6.825, p = 0.012, R2 = 0.114. This information could be used to infuse counselor education curriculum designed to increase teacher and school counselor conversations, and ultimately provide information to school counselors that may increase the rate of teacher-made referrals of students to school counseling for mental health services.

The field of regulated financial services has been ill-served by marketing theory. As a consequence: (1) the nature of marketing in this sector has been misunderstood; (2) the key mechanism for generating new business in the field, namely, referrals, has been the subject of serious misapprehension; and, (3) the guidance offered to practitioners has been negligible. In particular, the role of the independent financial advisor (IFA) appears to have been conceptualised as a sales role, and the nature of the relationship between the IFA and the client has been addressed as though it were a straightforward buyer-seller relationship, with the IFA selling products to the client. It is unlikely that these conceptualisations were ever satisfactory and following recent regulatory changes in the sector they have become even less relevant. Since January 1st 2013 commission-based selling of financial investment products to consumers has been prohibited so that independent financial advice has become largely a fee-based service. The focus of this research is on referrals as a method of generating new business; the research context is the UK independent financial advice industry. The objectives of the study are to: (1) define and conceptualise referrals in the context of the financial advice industry; (2) develop a framework of the referral process; (3) provide practitioners with empirical evidence in connection with their embedded beliefs about referrals in this industry; (4) explore whether (as many practitioner believe) it is possible to actively manage referral generation within a financial advice business; and, (5) to investigate the importance of referrals as a means of generating new business for advisors. It was found that practitioners believe they influence referrals in four main ways: excellent service, higher qualifications, contact frequency and speed of response. However the results of this study clearly indicate that referrals are not the outcome of agency; they are a random occurrence, determined by happenstance and the result of an opportunist conversation between a prospect and a client. In turn, contrary to the advice of consultancy providers, asking for referrals was found to be ineffective and not welcomed by consumers. While word-of-mouth (WOM) often instigates referral generation, the value of WOM, needs be treated with caution, since consumers were found to have limited understanding of the service provided by independent advisors. Despite the importance consumers attribute to investment performance practitioners do not, commonly, provide investment benchmarks nor do consumers use analytical tools to assess the performance of their advisor. The absence of performance measures connects with the finding that practitioners have difficulty in describing what they do hence consumers are uncertain how to describe the service and what to say about it when asked.

Students are often referred for special education evaluations following teacher generated referrals. These referrals indicate observable poor academic progress, although often there is no indication of the cause of the poor performance as well as no indication of remediation attempts prior to a special education referral. Students who demonstrate reading difficulties struggle in nearly all areas due to the dependence on reading that permeates all academic classes. Poor reading abilities are a prominent concern in schools and one of the primary reasons for special education referrals (NAEP, 2007). The purpose of this study was to determine whether effectively implementing a reading fluency intervention prior to referring a student for a special education evaluation led to fewer overall special education referrals as well as more accurate special education referrals. Results of this study indicated that the implementation of a reading intervention did significantly decrease the number of overall special education referrals that were made. The students who were referred for special education following participation in the intervention program were also more likely to qualify for special education services compared to students who had not participated in the intervention program. Additional student characteristics that were explored included sex, work habits, attendance rates and socioeconomic status (SES). Results indicated that work habits and sex did not significantly affect the rate of teacher referral for special education evaluations. Poor attendance did have a significant relationship on special education referral rates, indicating that students with poor attendance were more likely to be considered in need of special education support. SES was found to have a significant relationship to special education referrals over the length of the study as well as during the pre-intervention period, but did not have a significant impact on special education referrals during the intervention period.

Much of the practice is clinical neuropsychology is performed in the role of consultant and although the neuropsychologist is dependent upon referrals made from outside sources, relatively little attention has been devoted to the investigation of the referral process. Surveys of clinicians and referral sources have reported breakdowns of referral sources by discipline and general topics of referral questions based on recollection, but direct analysis of referral patterns across the same period has not been undertaken. The purpose of the study is to document the advancement of neuropsychology from providing psychological testing to establishing itself as a multifaceted discipline with a significant diagnostic purview that is regularly relied upon to contribute to important decisions in the lives of patients. By examining the referral questions rather than neuropsychologists' or referral sources' recollection of referrals, this study expands what is known about referral content and patterns. In an effort to explain question content without relying upon recollection, a coding rubric was designed to capture the breadth of presenting problems and requests seen in the original referral questions. Two-thousand-six-hundred referral questions were selected from the odd year over the 25 year period from 1983 to 2007, yielding a total of 2600 referral questions. Cochran's Kappa was used to conduct interrater reliability analyses in three stages across the entire rating process. Content analysis showed that 79.1% of all questions had at more than minimal content. The most common request was for assistance with diagnostic considerations, which was present in 66.4% of all cases. Assistance with differential diagnoses was requested in 27.4% of all cases with the majority of these composed of requests for assistance in differentiating between psychiatric and neurological or other medical considerations. There was evidence for a trend over time in the gradual decline of requests for assistance with psychiatric differential diagnosis and requests for the MMPI from 1993 to the present. Memory problems and dementia are the most common presenting problems, although there is evidence of a slight decline in these evaluations beginning in 1997. Requests for specific recommendations, particularly those related to making recommendations regarding treatment planning were found to steadily increase across the sampling period. Limitations and implications for practice were discussed.

Utilization of a large, diverse sample provided a rare opportunity to advance our understanding of gender, race, and socioeconomic differences in school-based problem behavior. Yearly assessment of discipline referrals and suspensions received within the school context from 5th- through 11th-grade, as well as assessment of school dropout, provided an opportunity to examine these issues through an extended prospective longitudinal design. Results highlight the middle school transition as a time when discipline referrals and suspensions increase markedly, while student reports of connections to others, motivation, and optimism decline sharply. Results indicate that boys, African-American students, and students from low socioeconomic status backgrounds report lower levels of connections to others, motivation, and optimism in 5th-grade. Boys, African-American students, and students from low socioeconomic status backgrounds also receive more discipline referrals and suspensions from 5th-grade onward and are more likely to experience dropout. However, regardless of demographic group membership, students who report stronger connections to others, motivation, and optimism in 5th-grade receive fewer referrals and suspensions from 5th- through 11th grade, and are much less likely to dropout of school than are students who report lower levels of connections, motivation, and optimism in 5th-grade. These results highlight the need to address students' sharp declines in functioning across the middle school transition through both ecological and person-centered prevention and school restructuring efforts. Results also highlight the utility of movement away from a static, demographic based understanding of problem behavior toward a clearer understanding of person and environment factors that may underlie both between and within demographic group differences in outcomes. Placing emphasis upon factors that are potentially amenable through school based prevention efforts considerably increases the likelihood that all of our nation's children are provided with equal opportunity to achieve their fullest potential.

The purpose of the study was to identify the reasons stated by ACT primary school teachers for referral of students for specialist assistance, and the type of specialist assistance given to referred students. The study also compared student referrals in Resource Teacher and Non-Resource Teacher Schools, and examined what patterns were reflected in this sample of primary school student referrals. This study had two sections; an examination of: 1) primary school student referrals and 2) primary school teacher attitudes towards learning difficulties and behavioural difficulties children. The identification of courses undertaken by teachers which were helpful in teaching students with learning and behavioural difficulties were also compared to teacher attitudes. These results were compared with those of Bourke (1985), a previous study of ACT teacher attitudes towards learning difficulties students. The study confirmed findings within the literature review that classroom teachers were the major source of student referrals for specialist services and that two important student variables impacted upon referral. The student variables, student gender and behaviour were found to have a significant effect upon referral. Boys were referred more often in both samples of schools with girls more likely to be referred in Resource Teacher Schools. Referred students were more likely to have no reported behaviour problems in Resource Teacher Schools. There were differences in the patterns of referral in Resource and Non-Resource Teacher Schools, ie service response to referral, parents' role and attitudes of teachers.

The purpose of this study was to examine the feasibility of a behavioral health referral protocol and barriers to behavioral health care in a pediatric epilepsy clinic. A sample of 93 youth with epilepsy ages 10–17 and caregivers completed behavioral health and seizure severity measures during a routine epilepsy clinic visit. Key findings are that 47 (50.5%) of the youth screened positive for a behavioral health referral, and 35 of these youth were referred for behavioral health services. However, only 20% made and presented for the behavioral health appointment. The most commonly cited barrier for accessing and utilizing behavioral health care was stigma related- a mental health label for the child. The significance of this study lies in the revelation that solely screening for and educating caregivers about behavioral health symptoms and providing behavioral health referral information is not an ideal model. Instead, stigma related barriers point to the necessity of continued integrated physical and behavioral health care within the pediatric epilepsy visit.

Title: Improving Diabetes Self-Management Education and Support (DSMES) Referrals in the Primary Care Setting Authors: Stephanie Sossong and Dr. Jean Hemphill, College of Nursing, East Tennessee State University, Johnson City, TN. Purpose: The purpose of this quality improvement project is to implement a standardized referral process to DSMES in primary care. DSMES decreases complications from T2DM and reduces healthcare costs. However, patients diagnosed with T2DM are referred <7% of the time. Aim: To assure that patients diagnosed with T2DM receive referrals to an accredited DSMES program. Processes: Baseline data of the number of patients with T2DM referred to DSMES was collected from a primary care clinic for 4 weeks. An educational in-service highlighting the benefits of DSMES, guidelines for referrals, and the process improvement was presented to providers and medical assistants. Data regarding referrals to DSMES after the process implementation will be collected for 4 weeks, numbers will be compared to pre-implementation data and reported using percent frequency. The IRB determined that the activities of this project are not defined as research involving human subjects. Results: The results of this project have not been determined yet, however; the expected outcome is an increased number of referrals to DSMES. Limitations: The limitations of this project include a small sample size and a short length of study. Conclusions: Implementing a standardized referral process in primary care increases referral rates to DSMES. This is important because DSMES has been proven to reduce diabetes related complications, healthcare spending, and prevalence of other comorbidities.