Statement of the problem: Methicillin-resistant Staphyloccocus aureus (MRSA) is a pathogen of increasing concern and is associated with higher hospital readmission rates, poorer prognosis, and increased mortality resulting in increasing costs to the Canadian healthcare system.1-13 Institutions have been challenged with developing effective infection control programs to prevent the spread of MRSA. The purpose of this thesis was to examine the clinical and cost-effectiveness of a universal MRSA screening intervention within a large tertiary care facility. Methods of investigation: The retrospective population-based observational study consisted of two periods. In the first period (24 months), patients admitted to the Ottawa Hospital underwent risk factor-based screening. In the second period (20 months), universal MRSA screening was implemented in which all patients were screened for MRSA upon admission. Results: The regression analysis demonstrated that the universal MRSA screening intervention was not effective in reducing the number of nosocomial MRSA cases. The economic analysis estimated that the universal MRSA screening intervention incurred an additional cost of $1.16 million/year with an estimated additional cost per patient screened of $17.76. Conclusions: The universal MRSA screening intervention was not clinically or economically effective. Further research is required to verify/dispute these findings in other settings.

Statement of the problem: Methicillin-resistant Staphyloccocus aureus (MRSA) is a pathogen of increasing concern and is associated with higher hospital readmission rates, poorer prognosis, and increased mortality resulting in increasing costs to the Canadian healthcare system.1-13 Institutions have been challenged with developing effective infection control programs to prevent the spread of MRSA. The purpose of this thesis was to examine the clinical and cost-effectiveness of a universal MRSA screening intervention within a large tertiary care facility. Methods of investigation: The retrospective population-based observational study consisted of two periods. In the first period (24 months), patients admitted to the Ottawa Hospital underwent risk factor-based screening. In the second period (20 months), universal MRSA screening was implemented in which all patients were screened for MRSA upon admission. Results: The regression analysis demonstrated that the universal MRSA screening intervention was not effective in reducing the number of nosocomial MRSA cases. The economic analysis estimated that the universal MRSA screening intervention incurred an additional cost of $1.16 million/year with an estimated additional cost per patient screened of $17.76. Conclusions: The universal MRSA screening intervention was not clinically or economically effective. Further research is required to verify/dispute these findings in other settings.

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Excerpt: Many of my patients lead unhealthy lifestyles; they become obese and often develop hypertension, diabetes, dyslipidemia, and heart disease.

Ecomaps (drawing-based assessments of social networks) were administered to primary school-aged children in order to ascertain whether Ecomaps might be useful in universal screening. Participants included 61 children (40.9% female) aged six to ten (M = 7.39, SD = 1.19), Kindergarten through third grade students in a predominantly African American (89.5%) public charter school in New Orleans. The study hypothesis was that children who report experiencing higher levels of social support and lower levels of social stress (derived from Ecomap index of Support-Stress balance) would have better social-emotional, behavioral, and academic outcomes than children who report lower levels of support and higher levels of stress. Ecomaps were administered to all participants and correlated with school-based archival data, including results of the Behavior Assessment System for Children, 2nd Edition (BASC-2), school behavior grades, and academic records. Stress-support indices from Ecomaps were significantly correlated with social-emotional and behavioral outcomes, but correlations with academic outcomes were not significant, providing partial support for the study’s hypothesis. Based on these findings, Ecomaps might be used as self-report measures to identify children at risk for, or currently experiencing, social-emotional or behavioral problems. This measure could be helpful to school psychologists and other school-based mental health professionals who are attempting to understand and respond to the strengths and needs of the children in their care. / acase@tulane.edu

As part of a comprehensive, multi-tiered system of support for students’ emotional, academic, and behavioral success, effective universal screenings are essential to identify students who may benefit from early intervention and targeted prevention services (Strein, Kuhn-McKearin, & Finney, 2014). Although many screening procedures and methods have been developed and evaluated for general education populations, more research is needed on screening procedures designed for one traditionally underserved population in school-based mental health services—students in accelerated curricula (namely, students in Advanced Placement classes or in the International Baccalaureate program; AP/IB). When teachers are involved in universal screening procedures, regardless of student population served, training strategies to improve teacher accuracy in identifying students at-risk have resulted in gains in teacher knowledge of mental health disorders, but not improvements in accuracy (Deacon, 2015; Moor et al., 2007; Veira et al., 2014). This study examined prevalence of academic and emotional risk among 352 9th grade AP/IB students (enrolled in AP Human Geography or IB Inquiry Skills) in seven schools. Within a subgroup of 245 students (from five schools) who also participated in a teacher nomination procedure, this study also examined the accuracy of teachers (N = 6) in identifying the students who demonstrate signs of risk academically (defined by low grade in class or overall GPA) or emotionally (defined by high levels of perceived stress and low school satisfaction). Almost one in four students (24.17%) were designated as at-risk academically for either low course grades or GPA, and almost one in three students in the sample (28.88%) met at-risk criteria for emotional risk for either low school satisfaction or high perceived stress. In terms of teacher accuracy, teachers were found to have a high sensitivity and specificity identifying students with academic risk (90% sensitivity and 90.32% specificity across all 6 teachers). Mirroring previous research, teacher accuracy identifying students at-risk emotionally was lower (42.42% sensitivity and 76.14% specificity across all 6 teachers). The study also explored patterns in at-risk students missed by teachers, based on student characteristics such as gender, race, socio-economic status, risk severity, and risk type. Due to a low sample size of teachers, analyses were unable to detect differences in the rate of students missed across different student variables. Finally, the study advanced and evaluated the effects of a brief teacher training and feedback intervention intended to increase accuracy in identifying students at-risk. Low sample sizes again precluded identification of meaningful statistical differences. Although statistical findings were limited, quantitative and qualitative acceptability measures indicated high participant acceptability and feasibility for the new intervention. Conclusions from the study may be used within a population-based framework of student mental health services, to best inform early identification methods of students in accelerated curricula at-risk for diminished academic and emotional success, and working with teachers in screening efforts. Further, future research points to continued need to evaluate the brief teacher intervention with larger sample sizes to evaluate any possible intervention effects.

As a universal screening method, teacher nominations have been found to both miss and misidentify a substantial proportion of students with internalizing disorders such as anxiety and depression (Cunningham & Suldo, 2014; Gelley, 2014; Moor et al., 2007). Although some research has explored the accuracy of teacher nominations when used to identify students with anxiety and depression, no research examined the teacher characteristics that are potentially related to accuracy. The current study conducted a secondary analysis of an archival dataset (Gelley, 2014) to determine which characteristics of teachers (N= 19) are more closely related to accuracy in identifying middle school students (N = 233) with elevated levels of anxiety or depression. Teacher characteristics examined include: teacher self-efficacy beliefs in identifying students with anxiety and depression, teacher acceptance of the general method of asking teachers as a whole to identify students with anxiety and depression, teacher gender, years teaching, and subject taught. Multiple regression analyses were used to examine the relationships between the aforementioned teacher characteristics and teacher accuracy, defined by the conditional probability indices sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The combined predictors explained 38 to 69% of the variance in those indicators of accuracy. Results indicated that in predicting sensitivity, being a language arts or math teacher (as compared to being a social studies teacher), having fewer years of professional experience, and reporting greater acceptance of method may predict higher sensitivity rates. In regards to specificity, higher teacher self-efficacy, being a social studies teacher, being male, and having fewer years of professional experience predicted higher specificity rates. In terms of PPV, having higher acceptance of method and more self-efficacy may explain higher PPV rates. Finally, in terms of NPV, having fewer years of professional experience may explain higher NPV rates. Results from this study may be used to guide collaboration and consultation with teachers in universal screenings, and may inform teacher training programs aimed to increase teacher knowledge and confidence identifying students experiencing emotional distress at school.

Data derived from universal screening procedures are increasingly utilized by schools to identify and provide additional supports to students at-risk of behavioral and emotional concerns. As screening has the potential to be resource intensive, effort has been placed on the development of efficient screening procedures, namely brief behavior rating scales. This study utilized classical test theory and generalizability theory to examine the extent to which differences among students, raters, occasions, and screening measures affect the meaningfulness of data derived from universal screening procedures. Teacher pairs from three middle school classrooms completed two brief behavior rating scales during fall and spring screening administrations for all students in their respective classrooms. Correlation coefficients examining interrater reliability, test-retest reliability, and concurrent validity were generally strong. Generalizability analyses indicated that the majority of variance in teacher ratings were attributable to student differences across all score comparisons, but differences between teacher ratings for particular students accounted for relatively large percentages of error variance among student behavior ratings. Although decision studies showed that increasing the number of screening occasions resulted in more generalizable data, the impact of increasing the number of raters resulted in more efficient screening procedures.

Teachers face great demands on their time, energy, and level of commitment. Previous studies have established that high numbers of teachers leave the profession each year due to burnout. Burnout is frequently caused by difficulties with classroom management and behavior problems, as well as time pressures, and social isolation. Despite these obstacles, other teachers have been able to maintain positivity and dedication in their practice. Teachers' sense of self-efficacy has been found to be a predictor of better job satisfaction, less burnout, and more positive and productive interactions with students. The current study examined how burnout and self-efficacy may interact and how they might impact teachers' referral of at-risk students for additional school supports. Additionally, this study examined whether burnout and self-efficacy impacted teachers' identification of at-risk students using a screening measure developed to improve the school's ability to identify and start interventions for students experiencing difficulties. Results found a moderate correlation among burnout and self-efficacy, whereby teachers with higher self-efficacy experienced less burnout. Higher teacher self-efficacy was correlated with fewer referrals for students to the student support team and the identification of fewer students at-risk for emotional difficulties. Higher teacher burnout was not correlated with number of referrals but was found to be associated with the identification of more students at-risk for emotional difficulties as well as the number of total students identified as at-risk overall. Implications for practice, limitations, and future research directions are also discussed.

English Language Learners (ELLs) are considered to be at higher risk for developing emotional and behavioral difficulties due to their limited English proficiency. As a result, the present study examined the identification of emotional and behavioral risk (EBR) among ELLs and non-ELLs through the use of universal behavior screening measures. The study consisted of 395 students enrolled in kindergarten through 5th grades, ranging in age from 5 years, 6 months to 12 years, 4 months. Over half of participants (52.4%) were male and a majority (42.8%) identified as Hispanic/Latino(a). Approximately one-fifth (19.7%) of students were classified as ELLs. Teachers completed the electronic version of the BASC-2 Behavioral and Emotional Screening System-Teacher Form (BESS) for each student in their classroom. Demographic student data was provided by the school via the school’s electronic database. Results showed no relationship between ELL status and EBR. However, there was a relationship between gender and the identification of EBR among ELL students, where males demonstrated increased risk levels. In addition, students' reading ability, age, and gender predicted whether ELL and non-ELL students would be identified as at-risk for emotional and behavior problems. Although results did not show a relationship between language proficiency and EBR, ELLs remain a group vulnerable for being identified as at-risk for emotional and behavioral difficulties, due to academic and/or social-emotional problems that they may experience. In practice, schools may want to consider using an integrated approach to conducting universal screening, where schools screen for reading difficulties and behavior concerns, thus allowing them to address a broader range of concerns through early intervention programs.