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Kim, Youngjun, and Kyungsook Kang. "Development of the Individualized Lifelong Education Plan Component for the Disabled: Individualized Education Plan and Individualized Transition Plan Linkage Based of Special Education." Journal of Humanities and Social sciences 21 11, no. 1 (February 28, 2020): 73–88. http://dx.doi.org/10.22143/hss21.11.1.6.
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Hopson, Betsy, Elizabeth N. Alford, Kathrin Zimmerman, Jeffrey P. Blount, and Brandon G. Rocque. "Development of an evidence-based individualized transition plan for spina bifida." Neurosurgical Focus 47, no. 4 (October 2019): E17. http://dx.doi.org/10.3171/2019.7.focus19425.
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OBJECTIVEIn spina bifida (SB), transition of care from the pediatric to adult healthcare settings remains an opportunity for improvement. Transition of care is necessarily multidimensional and focuses on increasing independence, autonomy, and personal responsibility for health-related tasks. While prior research has demonstrated that effective transition can improve health outcomes and quality of life while reducing healthcare utilization, little is known about the most advantageous transition program components/design. The individualized transition plan (ITP) was developed to optimize the readiness of the adolescent with SB for adult healthcare. The ITP is a set of clearly articulated, mutually developed goals that arise from best available data on successful transition and are individualized to meet the individual challenges, needs, and attributes of each patient and family.METHODSProspectively completed ITPs were retrospectively reviewed from June 2018 to May 2019. Demographic and disease characteristics were collected, and specific goals were reviewed and categorized.RESULTSThirty-two patients with an ITP were included. The cohort was 50% male and had a mean age of 16.4 years. For goal 1 (maximize education), the most common goal was to complete a career interest survey (44%), followed by researching application/admission requirements for programs of interest (25%), shadowing in and/or visiting a workplace (16%), and improving high school performance (16%). For goal 2 (bowel management), most patients (59%) had a working bowel program with few or no bowel accidents. Eight patients (25%) were having more than the desired number of bowel accidents and received formal consultation with a gastroenterologist. Five patients (16%) needed only minor adjustments to their bowel management regimen. Goal 3 (SB program coordinator goal) focused on documenting medical and/or surgical history for the majority of patients (66%). Other goals aimed to increase patient communication in healthcare settings or utilize available community resources.CONCLUSIONSThe authors developed an evidence-based ITP that focuses around 5 goals: maximizing education, bowel continence, and goals set by the SB clinic coordinator, parent/caregiver, and patient. Although developed for the authors’ SB clinic, the ITP concept is applicable to transition of care in any chronic childhood illness.
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Steere, Daniel, and Caroline DiPipi-Hoy. "Coordination in Transition Planning: The IEP/IPE Interface." Journal of Applied Rehabilitation Counseling 44, no. 1 (March 1, 2013): 4–11. http://dx.doi.org/10.1891/0047-2220.44.1.4.
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Effective planning for the transition of students with disabilities from school to adulthood requires coordination and collaboration among special education personnel, families, students, and adult service agency representatives. The state vocational rehabilitation agency is among the most important adult service entities that collaborate with schools for planning purposes. The special education and vocational rehabilitation systems, however, have different planning documents to guide service delivery. This article addresses the connection between the transition Individualized Education Program (IEP) and the Individualized Plan for Employment (IPE). The components of each planning document and how they should interfacefor students in transition are reviewed. In addition, the role of the Summary of Performance (SOP) document as a connection between the IEP and IPE is discussed. Finally, challenges to effective coordination between these planning documents are addressed.
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Perryman, Twyla, Lacey Ricks, and Labrita Cash-Baskett. "Meaningful Transitions: Enhancing Clinician Roles in Transition Planning for Adolescents With Autism Spectrum Disorders." Language, Speech, and Hearing Services in Schools 51, no. 4 (October 2, 2020): 899–913. http://dx.doi.org/10.1044/2020_lshss-19-00048.
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Purpose The purpose of this tutorial is to provide speech-language pathologists (SLPs) with foundational information that will assist them in transition planning for students with autism spectrum disorder (ASD) based on a review of current literature. SLPs must be knowledgeable of transition planning in order to assist students with ASD and their families with preparing for their future. An appreciation and awareness of pertinent assessments, functional goals, and factors associated with successful postsecondary outcomes are essential competencies that SLPs need when planning for the transition process. SLPs are ideal workforce development partners. They facilitate independence, communication, and interaction skills necessary for postsecondary and workplace success. Speech-language services are one of the most common special education services received by high school students with Individualized Education Programs. However, SLPs receive little preparation on the specifics or nuances of transition planning prior to working in the educational settings, despite the high incidence of speech-language services in secondary education. Method This tutorial reviews and synthesizes research findings related to assessment planning, goal-setting, and Individualized Education Program implementation for achieving meaningful postsecondary transitions for students with ASD. Additionally, it highlights some of the key postsecondary skillsets related to speech-language therapy services, including the development of self-determination, self-advocacy, social competence, and adaptive behaviors. Conclusion Greater focus on higher quality transition planning requires SLPs to develop high levels of knowledge and competencies in the transition planning process. This tutorial educates clinicians on the unique challenges faced by individuals with ASD and provides evidence-based strategies to help students and families successfully plan for and navigate postsecondary transitions.
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Greene, Gary. "The Emperor Has No Clothes: Improving the Quality and Compliance of ITPs." Career Development and Transition for Exceptional Individuals 41, no. 3 (June 13, 2017): 146–55. http://dx.doi.org/10.1177/2165143417707205.
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The Individuals With Disabilities Education Act of 2004 (IDEA) requires that an Individualized Education Program (IEP) for students with disabilities, age 16 years and older, include age appropriate transition assessment results aligned with measurable postsecondary goals. This section of the IEP is typically known as an Individual Transition Plan (ITP). A recent investigation found a number of ITPs did not meet the requirements of the IDEA. To support special education teachers in writing IDEA-compliant ITPs, this article presents suggestions for developing quality ITPs with specific emphasis on transition assessment. Discussion includes potential explanations for the lack of quality in presenting transition assessment results, recommendations for conducting transition assessment, transition assessment resources, and examples of quality and IDEA-compliant ITPs.
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Ryan, Catherine J., Rebecca (Schuetz) Bierle, and Karen M. Vuckovic. "The Three Rs for Preventing Heart Failure Readmission: Review, Reassess, and Reeducate." Critical Care Nurse 39, no. 2 (April 1, 2019): 85–93. http://dx.doi.org/10.4037/ccn2019345.
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Despite improvements in heart failure therapies, hospitalization readmission rates remain high. Nationally, increasing attention has been directed toward reducing readmission rates and thus identifying patients with the highest risk for readmission. This article summarizes the evidence related to decreasing readmission for patients with heart failure within 30 days after discharge, focusing on the acute setting. Each patient requires an individualized plan for successful transition from hospital to home and preventing readmission. Nurses must review the patient’s current plan of care and adherence to it and look for clues to failure of the plan that could lead to readmission to the hospital. In addition, nurses must reassess the current plan with the patient and family to ensure that the plan continues to meet the patient’s needs. Finally, nurses must continually reeducate patients about their plan of care, their plan for self-management, and strategies to prevent hospital readmission for heart failure.
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Sutherby (Bennett), Claire Michelle. "Growing a cancer survivorship care plan program." Journal of Clinical Oncology 35, no. 5_suppl (February 10, 2017): 58. http://dx.doi.org/10.1200/jco.2017.35.5_suppl.58.
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58 Background: More than 15.5 million cancer survivors live in the United States. This number is expected to be over 20 million by 2026. Cancer survivors have increased risk of morbidity; therefore, preventive and on-going medical treatment requires close monitoring and coordination. The Institute of Medicine’s (IOM) 2005 report, Cancer Patient to Cancer Survivor: Lost in Transition, recommended health providers raise awareness of cancer survivors’ needs and establish cancer survivorship as a distinct phase of care. The IOM also recommended patients who complete primary treatment are provided a comprehensive summary and plan that is effectively explained. A survivorship care plan maps out and improves care related to accessibility of past diagnosis and treatment history, surveillance guidelines, and potential long term side effects. In 2012, the Commission on Cancer (CoC) added Standard 3.3 Survivorship Care Planto the program standards. This met the IOM’s objective of addressing potential patients that get “lost” as they transition from care they received during treatment through phases of their life or disease. Methods: The Cancer Committee within a CoC certified organization developed multiple strategies to address the IOM and CoC standards. Strategies included a process to disseminate a comprehensive care summary for cancer patients who are completing primary treatment, adoption of the American Society of Clinical Oncology’s Treatment Summary and Survivorship Care Plan template, and adding a survivorship nurse navigator to the interprofessional treatment team. The survivorship nurse navigator monitors and reviews survivorship care plans with patients, advises when to seek treatment for symptoms, discusses surveillance guidelines, navigates patients through therapies, and educates on prevention and screening. Results: Evaluation for quality of life and compliance with individualized surveillance guidelines is ongoing. Conclusions: The oncology nurse navigator role is uniquely positioned to lead care coordination and improve outcomes through the continuum of care. Providing patients with a summary of their treatment and a plan moving forward may decrease stress related to the transition from active treatment to survivorship.
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Suleman, Adam, Lynda Theoret, Pierre Bourque, Elizabeth Pringle, D. William Cameron, and Juthaporn Cowan. "Evaluation of a Personalized Subcutaneous Immunoglobulin Treatment Program for Neurological Patients." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 46, no. 1 (December 3, 2018): 38–43. http://dx.doi.org/10.1017/cjn.2018.363.
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AbstractBackgroundSubcutaneous immunoglobulin (SCIg) treatment has been shown to control symptoms and improve overall satisfaction in patients with neurological disorders. However, a large injection volume can be overwhelming and a barrier to successful SCIg treatment. We established a nurse-led individualized approach program to facilitate a smooth and successful treatment transition from intravenous immunoglobulin (IVIg) to SCIg. The program involved a lead nurse to provide two or more individual educational sessions on SCIg administration, establish a written transition plan, and liaise care with physicians.ObjectivesWe aimed to evaluate the impact of our program to a successful transition defined as SCIg retention or adherence without a need to restart IVIg by six or twelve months.MethodsWe reviewed medical charts of all patients with immune-mediated neuromuscular disorders who were in our program during January 2010 to Dec 2016.ResultsNineteen patients were identified. Mean IVIg treatment duration was 31.5 months (range 4-98) before the transition. Mean steady state SCIg dosage was 26.2 g/week (SD 10.3). All patients were initially able to switch to SCIg, with a retention rate of 17/19 (89.5%) at six months and 15/19 (78.9%) at twelve months. Two patients reverted back to IVIg treatment due to worsening of their symptoms at two and three months, while two required supplemental IVIg infusions. There were no major adverse events reported during the twelve-month period, but one minor cutaneous adverse event (redness around the injection site).ConclusionsSuccessful treatment transition may be achieved with the nurse led individualized approach program.
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Iseler, Jackeline, John Fox, and Kelly Wierenga. "Performance Improvement to Decrease Readmission Rates for Patients With a Left Ventricular Assist Device." Progress in Transplantation 28, no. 2 (March 20, 2018): 184–88. http://dx.doi.org/10.1177/1526924818765820.
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Background: The 30-day readmission rate for patients with a left ventricular assist device implantation at a large, urban, Midwest hospital system (from October 2013 to September 2014) was estimated at 32.1%. Problem Statement: Readmission rates were a concern at this facility. Review of the readmissions, change in practice, and home expectations of patients and families have identified an opportunity to improve the transitions of care for this left ventricular assist device (LVAD) program. Therefore, the purpose of this project was to evaluate the effectiveness and feasibility of a transitional care model (TCM) for care of patients with left ventricular devices. Methods: Ten patients were enrolled in the pilot that was implemented in June 2015. A transitional care nurse trained to support patients with ventricular assist devices was used to facilitate patient flow. The goal was to create an individualized plan for the development or improvement of self-management skills to decrease readmission rates. The transitional care nurse collaborated with the ventricular device team. Outcomes: The 30-day readmission rate during the pilot was 14.3% compared to the previous annual overall rate of 42.6%. Implications for Practice: Based on these results, further research is recommended into interventions consistent with the TCM to advance care coordination and to facilitate care transition in the this fragile patient population.
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Gaumer Erickson, Amy S., Patricia M. Noonan, Jennifer A. Brussow, and Barb J. Gilpin. "The Impact of IDEA Indicator 13 Compliance on Postsecondary Outcomes." Career Development and Transition for Exceptional Individuals 37, no. 3 (March 22, 2013): 161–67. http://dx.doi.org/10.1177/2165143413481497.
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Since the revision of Individuals With Disabilities Education Act (IDEA) in 2004, experts and service providers have been operating on the untested assumption that State Performance Plan Indicator 13 (transition Individualized Education Program [IEP] compliance) is a precursor to Indicator 14 (student outcomes of engagement in postsecondary education, training, and employment). This study analyzed the relationship between Indicator 13 and Indicator 14 through bivariate linear regression. The sample included student-level secondary transition data from 352 local education agencies (LEAs) in Missouri. A total of 2,123 IEP files were reviewed using a validated checklist for compliance to the IDEA transition requirements, known as Indicator 13. Indicator 14 was measured via survey responses from 4,994 high school graduates with IEPs. Results revealed statistically significant linear relationships between LEAs’ Indicator 13 compliance data and the percentage of graduates with IEPs who completed a semester of college or a career training program. Findings suggest that alternate approaches and indicators may be needed to improve postsecondary outcomes for students with and without IEPs.
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Martin, James E., John H. Oliphint, and Greg R. Weisenstein. "ChoiceMaker: Transitioning Self-Determined Youth." Rural Special Education Quarterly 13, no. 1 (March 1994): 16–23. http://dx.doi.org/10.1177/875687059401300104.
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Individuals who are successful are self-determined. Unfortunately, too many youths with disabilities are not self-determined. Many individuals with disabilities exit our schools faced with a quality of life that looks quite different from their non-handicapped peers. Transition activities must be based on students' needs, preferences, and interests. School based transition planning should be directed toward employment outcomes. Students need opportunities to learn their vocational preferences, interests and skills relative to the available job market. By using a Self-Directed Employment Model, students will empower themselves to make and implement their own decisions. The Self-Directed Employment approach teaches students to choose a job that matches their interests and skills, and facilitates on-the-job self-management skills. Participating students systematically complete a three phase structured vocational curriculum as they progress through a choose, manage, evaluate, and adjust model. To help make a successful transition from school to work, the Individualized Education Plan needs to reflect student interests. The authors of this article describe the Self-Directed Employment model as a method to teach student self-determination.
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Danciu, Oana Cristina, Sushma Bharadwaj, and Kent Hoskins. "Cancer team approach for prescreening and identifying breast cancer survivors as part of survivorship care plan implementation." Journal of Clinical Oncology 33, no. 28_suppl (October 1, 2015): 107. http://dx.doi.org/10.1200/jco.2015.33.28_suppl.107.
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107 Background: Recommendations from the Institute of Medicine are that cancer patients receive individualized survivorship care plan (SCP)and treatment summary.SCP includes guidelines for monitoring and maintaining health and is a communication tool shared with families and health care providers. Offering SCP and treatment summary to cancer survivors remains challenging due to time and resource limitations, inadequate reimbursement and survivor access. Methods: Survivorship starts when completing the initial treatment (surgery, chemotherapy or radiation therapy). A team of medical oncologists, nurse practitioner and patient navigator created a process of pre-screening and identifying breast cancer (BC) survivors. SCP and treatment summary were pre-populated, individualized for each patient, then finalized and discussed with the patients during their medical oncology clinic visit.Pre intervention data was retrospectively collected, including all BC cases from March 2014 to March 2015. Post intervention data was prospectively collected over eight weeks. Pre and post intervention SCP completion rates were compared with chi square analysis. Results: A baseline one year review of 1124 encounters noted 23 of 90 (25%) BC survivors received SCP. Ninety-six encounters occurred during the 8 week pilot period. Sixteen (16.6%) cases met the definition of BC survivor. During the pilot period, 15 out of 16 (93.7%) survivors received the SCP and treatment summary (p < 0.0001). Conclusions: We successfully piloted the implementation of SCP for BC survivors. Our team found that using clinic visit screening and pre-identifying patients that transition into the survivorship program resulted in improvement of compliance with survivorship measures. We plan to open a BC survivorship clinic to address survivorship issues and to review SCP and treatment summary.
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Hébert, Johanne, and Lise Fillion. "Development and validation of an individualized survivorship care plan (ISCP) for women with endometrial cancer during the transition of the end of active treatment to the cancer survivorship." Canadian Oncology Nursing Journal 27, no. 1 (February 6, 2017): 33–42. http://dx.doi.org/10.5737/236880762713342.
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Smith, Wally R., Virginia Smith, Kamar Godder, India Sisler, Robbie Casper, Shirley Johnson, Wanda Brice, Matthew Bitsko, April Engram, and Alma Morgan. "Readiness for Transition From Pediatric Sickle Cell Care: Exploratory Analyses of Domains of Readiness and Total Scores." Blood 116, no. 21 (November 19, 2010): 2576. http://dx.doi.org/10.1182/blood.v116.21.2576.2576.
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Abstract Abstract 2576 Background: In just one generation, the average survival of patients with sickle cell anemia has increased from 14 years to nearly 50 years, necessitating transition programs from pediatric to adult care. We developed a transition program to provide continuity of care from pediatric to adult settings. In order to provide education and skills via an individualized plan for transition of care, we assessed confidence/self-efficacy, knowledge, skills, and attitudes surrounding transition of 34 African-American individuals aged 15–21 (mean 17). We hypothesized that there would be correlation between each of these domains, and that such correlation would suggest that each domain predicts initial readiness/sophistication for transition. Methods: We administered a survey battery both of items we constructed and of previously used survey items assessing medical, Educational/Vocational, Health Benefits, Social, Independent Living, Feelings, Sickle Cell Stress, and Self-Efficacy domains. We assigned/mapped these content items, using clinical judgment and consensus, to four domains of “readiness for transition”: confidence/self-efficacy, knowledge, skills, and attitudes. Readiness scores for each domain were calculated such that a summary score of 100 would indicate perfect readiness in each domain. The complete question battery is available. Results are shown in the table below. Conclusions: Attitudinal readiness, knowledge readiness, confidence readiness, and skill readiness for transition were low initially in sickle cell adolescents enrolled in a transition program. Percentage of maximum possible scores was lowest for attitude, and highest for skill. Both attitude and knowledge scores showed very high correlation with total readiness score. However, several component scores were moderately correlated with each other. Transition programs for SCD should consider assessing and enhancing not only knowledge, but also attitudes, confidence, and skill. Disclosure: No relevant conflicts of interest to declare.
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Sherpa, Dawa, and Khagendra Baraily. "Exploration of Teachers' Role in Resource Class: A Case from an Integrated School." AMC Journal 2, no. 1 (March 18, 2021): 41–55. http://dx.doi.org/10.3126/amcj.v2i1.35786.
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This study aimed at exploring the teacher’s role in resource class especially focusing on how resource teacher contributes to mainstreaming of children with disability. For this purpose, the researcher applied hermeneutics phenomenology as a research design. Five resource teachers from two integrated school from Kathmandu valley were selected as research participants by purposive sampling. The researchers adopted in depth interview and class observation to gather the rigorous information. Data analysis had been carried out along with the categorization of themes of collaboration, observation of activities of resource teachers and understanding of service delivery model. From the interview protocol the responses were transcribed and basic themes had been organized. Main themes were extracted from the basic themes. Main theme had been discussed with thematic network to draw final conclusion. The findings showed that the roles and responsibility of resource teachers are to support general teacher, to teach basic adaptive skills for children with the disability, creating collaborative environment with the parents and professionals. Therefore, the resource teacher’s roles to identification of need for children with disability, co-operation with parents and general teachers that contributes to transition planning in the individualized education plan. The findings provided implications that produced a plan to assist in the collaboration between the two educational environments.
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Corcoran, Stacie, John Russell, Andrea Smith, Bridget Kelly, Jill Clayton, Bennet Stein, Kathleen Keenan, Mark E. Robson, and Neil M. Iyengar. "The optimal living and wellness program: Piloting a novel survivorship care model." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e14003-e14003. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e14003.
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e14003 Background: Multiple national agencies define cancer survivorship as beginning at the time of cancer diagnosis. However, traditional care models deliver “survivorship care” months or years after diagnosis, which can lead to disruption in care and “transition anxiety”. We hypothesized that an approach centered around wellbeing could be applied across the cancer continuum (starting at diagnosis) and serve as a novel survivorship care model. Methods: We developed the Optimal Living and Wellness Program, a multilevel intervention with 3 key components: 1) a centralized model that provides coordinated multidisciplinary care; 2) an individualized Wellness Plan (WP); and 3) enrollment at the time of cancer diagnosis in order to mitigate the experience of post-treatment transition. Participants complete a digital wellness questionnaire (WQ) prior to the first medical oncology consult, receive a validated algorithm-based WP reviewed by a Wellness Coordinator, and meet with a Wellness Advanced Practice Provider (WAPP) via tele-medicine. The WP consists of individualized education and referrals to indicated supportive services (e.g., nutrition, exercise physiology, financial counseling, integrative medicine). The WAPP will ultimately assume care of the patient in the post-treatment (“survivorship”) phase. We piloted this approach in patients diagnosed with breast cancer beginning in November 2019. The primary outcome is feasibility defined by completion of the WQ. Secondary outcomes include participation in the WAPP visits, attendance at referral appointments, and quality of life (QOL). Results: As of January 31, 2020, a total of 39 eligible patients with newly diagnosed breast cancer were approached. Of these, 36 (92%) have completed the WQ. All 36 participants received a WP with indicated supportive referrals and educational resources. Initial WAPP tele-visits will begin in May 2020. Qualitative data regarding patient experience and QOL will be obtained via focused interviews and feedback will be categorized in thematic domains. Conclusions: In this pilot, the majority of patients with newly diagnosed breast cancer completed a WQ in advance of their initial medical oncology visit, indicating preliminary feasibility. Patient enrollment is ongoing, and updated data including additional feasibility metrics and QOL will be presented. Earlier patient engagement and incorporation of wellness and supportive services from time of diagnosis may significantly improve the transition to post-treatment care.
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Moscato, Emily, Lisa Gies, Aimee Miley, Ralph Salloum, and Shari Wade. "QOL-04. INFLUENCE OF FAMILY, SCHOOL, AND HOSPITAL SYSTEMS IN SUPPORTING SURVIVORS OF PEDIATRIC BRAIN TUMORS WITH NEUROCOGNITIVE LATE EFFECTS." Neuro-Oncology 22, Supplement_3 (December 1, 2020): iii431—iii432. http://dx.doi.org/10.1093/neuonc/noaa222.669.
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Abstract OBJECTIVE Pediatric brain tumor survivors (PBTS) are at risk for developing neurocognitive late effects that may interfere with academic and adaptive functioning. To mitigate the potential impact, some PBTS may implement strategies independently, while others may rely on system-level support from family, school, or hospital systems. Given the limited knowledge on survivor and family perspectives of these supports, we conducted a mixed-methods study involving PBTS and their caregivers to examine the influence of family, educational, and hospital supports, and identify areas of unmet need. PARTICIPANTS AND METHODS PBTS (N=56,Mage=18.12,range=10–25) completed questionnaires on academic accommodations. Medical chart reviews provided diagnosis and treatment information. A subset of families, who did not significantly differ from the larger sample on demographics, completed qualitative interviews (N=25). Three coders identified themes separately for parents and survivors and reached consensus (kappa’s > .78) using thematic content analysis. RESULTS Families emphasized the role of family support, including providing individualized help, setting up a structured learning environment, and suggesting metacognitive strategies. Parents also emphasized how they have adjusted their expectations. At school, 53% reported an individualized education plan. Formal accommodations (e.g., modified coursework, small group instruction, extra time) were helpful, yet some noted barriers, including embarrassment and lack of follow-through. Survivors emphasized the value of informal accommodations. Families described unmet needs related to connecting with other survivors, navigating community and educational resources, and transitioning to adulthood. CONCLUSIONS PBTS seem to rely on systems-level supports to mitigate neurocognitive effects. Future work should strengthen communication between systems and adult transition services.
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Basu, Rounaq, Roberto Ponce-Lopez, and Joseph Ferreira. "framework to generate virtual cities as sandboxes for land use-transport interaction models." Journal of Transport and Land Use 14, no. 1 (February 28, 2021): 303–23. http://dx.doi.org/10.5198/jtlu.2021.1791.
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One of the major critiques of land use-transport interaction (LUTI) models over the ages has been their over-dependence on individualized software and context. In an effort to address some of these concerns, this study proposes a framework to construct "virtual cities" that can act as sandboxes for testing different features of a LUTI model, as well as provide the capability to compare different LUTI models. We develop an approach to translate any prototypical transportation infrastructure network into a plausible land use zoning plan and synthetic population that are suitable for spatially detailed LUTI microsimulation of the virtual city. Disaggregate units of spatial geometry, like parcels and post codes, are generated using geospatial techniques applied to the transportation network. Households and jobs are randomly sampled from an actual city, and allocated in the virtual city based on matching density gradients. Students are matched with schools and workers are matched with jobs to complete the calibration of a synthetic population for the virtual city. Following the adjustment of behavioral models to complement the reduced scale of the virtual city, we demonstrate the integration between the land use and transportation simulation components in our LUTI model, SimMobility. The benefits of faster convergence times and shorter simulation times are clearly demonstrated through this exercise. We hope that this study, and the open-source releases of the SimMobility software with the virtual city database, can accelerate experimentation with LUTI models and aid the transition from individualized LUTI models to a common shared integrated urban modeling platform.
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Manwani, Deepa, Veronica Carullo, Michael Rinke, Steven Choi, and Catherine Driscoll. "Reducing Health Care Utilization in Sickle Cell Disease Patients By Implementation of an Individualized, Multimodal Care Plan during Hospital Admission and at Inpatient to Outpatient Discharge." Blood 124, no. 21 (December 6, 2014): 444. http://dx.doi.org/10.1182/blood.v124.21.444.444.
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Abstract Background: SickleCell Disease (SCD) is a chronic illness characterized by vaso-occlusive complications leading to unpredictable episodes of pain, cumulative organ damage and high health care utilization rates. National estimates of total hospital costs for sickle cell related hospitalizations are approximately $488 billion (Steiner 2006). 30 day readmission rates are used as a quality metric for a variety of chronic diseases: 33% of patients with SCD are readmitted within 30 days, compared to 3.4% for asthma, 12% for pneumonia, 16% for heart failure and 20% for diabetes (Brousseau 2010, Berry 2011). Multiple factors contribute to this high utilization rate and not all are modifiable. Increasing age and psychosocial comorbidities are associated with a greater length of stay (LOS). 18-30 year old patients, public insurance and admissions for pain crisis are associated with a higher 30 day readmission rate. Lack of outpatient follow up with a trained hematologist following hospital admission has been demonstrated to increase SCD readmission rates (Leschke 2012). Debaun et al have noted that written discharge management guidelines alone had low utilization rates, however when intensive ongoing patient and provider education by a nurse educator was also included, the 30 day readmission rate decreased from 28 to 11% (Frei-Jones 2009). Hydroxyurea responders have been shown to have a reduced LOS. Hypothesis: Implementation of an individualized, multimodal care plan during inpatient stay and at inpatient to outpatient discharge will reduce acute care utilization. It is likely that the implementation of the comprehensive care plan at this key transition point will be more effective due to (1) greater psychological readiness in the patient/ family to accept escalation of care soon after an acute event (2) decreased instances of “missed opportunities” in the event that the patient does not follow up with a provider with sickle cell specific expertise and (3) improvement in communication amongst inpatient providers, outpatient providers with specific hematology expertise and the multi-disciplinary team. Methods: A SCD quality improvement effort was initiated at The Children’s Hospital at Montefiore (CHAM) in July 2012 with the specific goals of reducing the 30 day readmission rates and length of stay (LOS). Secondary endpoints included admission rates, ED return rates and cost savings. Our efforts were directed at consistent and comprehensive implementation of best-practice guidelines, improved pain management strategies, a multimodal approach to patient care, andutilization of the hospital admission as an opportunity to design a comprehensive care plan. Representatives from the inpatient team, the primary hematologists, nursing, social work, psychology and pain management met weekly to create the care plan. A pre–post design was utilized, comparing data 3.5 years before to 1 year after the initiation of the transition intervention. Results: A significant reduction rate in LOS by 10% and 30 day readmission rate by 37%, with even greater gains in the 18-21 year age group was noted. This was not accompanied by an increase in ED visits (3 and 7 days) and in fact there was a significant reduction in the 3 day ED return rate in older patients. We also saw an overall reduction in the SCD inpatient admission rate by 22% and increase in hydroxyurea use. Table 1: Outcomes from the ongoing SCD Quality Improvement project Number of admissions 3 Day ED Return (%) 7 Day ED Return (%) 30 Day Readmission Rate % LOS (days) < 18 years National Average 17 4.21 Before 556 3.3 0.95 18.1 4.1 After 140 3.4 1.01 14.7 4.0 p-value 0.9 0.8 0.059 0.6 ≥ 18 years National Average 41.1 6.8 Before 1685 11.5 0.9 41.4 6.6 After 592 5 2.1 18.6 5.4 p-value 0.02 0.2 <0.0001 0.04 All Ages Before 2241 5 0.94 24 4.7 After 732 3 1.23 15 4.2 p-value 0.8 0.52 <0.001 0.018 * “Before” and “After” represent data prior to and after the implementation of the ongoing QI initiatives respectively Conclusion: We demonstrate the feasibility of reducing acute care utilization in SCD patients, with the implementation of an individualized, multimodal, comprehensive care plan during hospital admission and at discharge. Disclosures No relevant conflicts of interest to declare.
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Daeninck, Paul Joseph, Simone Stenekes, Tara Carpenter-Kellett, Jill Talylor-Brown, Mark Kristjanson, Ruth Loewen, and Joel Roger Gingerich. "Changing focus: Living with advanced cancer—Development of a palliative care transition project." Journal of Clinical Oncology 33, no. 29_suppl (October 10, 2015): 152. http://dx.doi.org/10.1200/jco.2015.33.29_suppl.152.
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152 Background: The improvement in cancer screening, detection and treatment is changing the illness trajectory and experience for patients. Many cancer patients are living longer with advanced disease as treatment options have expanded. Thus, accurate prognostication is becoming challenging and referral to palliative care programs is often delayed until close to death. This has made the transition to a predominantly palliative approach to care complex to navigate for the health care team, patient and family. Methods: CancerCare Manitoba has undertaken an innovative project “Changing Focus: Living with Advanced Cancer” to enhance communication with primary health care providers (HCPs) and assist patients and caregivers in the transition to a palliative approach to care. The project includes development of an individualized patient treatment summary that provides details of the patient’s cancer treatment and symptoms, identifies the role of the HCPs involved with the patient and family, as well as the expectations for follow up care at the cancer centre and in the community. The transition appointment includes discussion around the treatment summary, standardized follow up care plan, and written information about palliative care, decision making, symptom management, unique issues for caregivers and details about local supports and resources is provided. Results: This presentation will focus on the development and implementation of this project within the cancer centre and throughout the province. Evaluation of this approach is ongoing. Family members and patients will provide feedback using a standardized questionnaire, and ongoing improvement will be built into the evolution of this program. HCPs will also be engaged in evaluation from their perspective. Conclusions: We expect this intervention will allow patients and families better quality of life and possibly improve the interval between the termination of chemotherapy and death.
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Hébert, Johanne, and Lise Fillion. "Assessment of the feasibility and acceptability, and pre-test of the utility of an individualized survivorship care plan (ISCP) for women with endometrial cancers during the transition of the end of active treatment to cancer survivorship." Canadian Oncology Nursing Journal 27, no. 2 (April 14, 2017): 153–63. http://dx.doi.org/10.5737/23688076272153163.
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Krishnan, Sudha. "The Role of Multiliteracies in Changing Learning Spaces and Promoting Self-Advocacy for Students with Complex Support Needs." Research and Practice for Persons with Severe Disabilities 46, no. 2 (April 26, 2021): 108–24. http://dx.doi.org/10.1177/15407969211010307.
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Traditional literacy practices using print-based texts exclude students with complex support needs from the full range of literacy activities provided to peers without disabilities, which may limit them to low-level literacy skills or functional skills. By contrast, by including various forms of representation and text, multiliteracies are uniquely positioned to address the literacy development of students with complex support needs. The present study aimed to investigate the changes in student engagement, teacher–student interaction, staff and parent perceptions, and self-advocacy opportunities created during the implementation of multiliteracies with students with complex support needs. In a public high school classroom in northern California with a teacher and six paraeducators, two students with complex support needs created a multimodal book to present as student input at their individualized education program meetings. The book included the students’ favorite images of family and school, videos and images of their favorite activities at home and school, an identity chart with adjectives that best described them, a description of their strengths, and a transition plan describing what they wanted to do after school. Grounded theory was used to analyze the data collected through interviews, observations, and video and audio recordings. Data suggested that multiliteracies’ pedagogy created new learning spaces, empowering teacher–student interactions, and student self-advocacy.
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Corcoran, Stacie, John Russell, Jill Clayton, Bridget Kelly, Andrea Smith, Kate Keenan, Mark E. Robson, and Neil M. Iyengar. "The optimal living and survivorship program: Piloting a novel survivorship care model." Journal of Clinical Oncology 38, no. 29_suppl (October 10, 2020): 40. http://dx.doi.org/10.1200/jco.2020.38.29_suppl.40.
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40 Background: Multiple agencies define cancer survivorship as beginning at the time of diagnosis. However, traditional care models deliver “survivorship care” months or years after diagnosis, which can cause care disruption and “transition anxiety”. We hypothesized that an approach centered around wellbeing could be applied across the cancer continuum (starting at diagnosis) and serve as a novel survivorship care model. Methods: We developed the Optimal Living and Survivorship Program with 3 key components: 1) a centralized model that provides multidisciplinary care; 2) an individualized Wellness Plan (WP); and 3) enrollment at the time of diagnosis to mitigate post-treatment transition. Participants complete a digital wellness questionnaire (WQ) prior to the 1st medical oncology consult, receive a validated algorithm-based WP, and meet with a Wellness Advanced Practice Provider (WAPP). The WP consists of individualized education and referrals (e.g., nutrition, exercise, financial counseling). The WAPP will assume post-treatment (“survivorship”) care. We piloted this approach in patients diagnosed with breast cancer beginning in 11/19. The primary outcome is feasibility defined by completion of the WQ. Secondary outcomes include participation in the WAPP visits, attendance at appointments, and quality of life (QOL). Results: Due to COVID-19, the pilot was paused in 2/20. Data collected from 11/19 through 2/20 reveal a total of 67 eligible patients with newly diagnosed breast cancer were approached, with 65 enrolled. All participants completed the WQ and all received a WP with supportive referrals and educational resources. All participants engaged with WP recommendations. Participants were screened at high risk for an average of 3.8 unmet needs, and 98% were at high risk for 2 or more needs at time of diagnosis. Exercise was the highest unmet need (83%). There was 76% adherence with referral to the program’s Exercise Physiologist. Other areas of needs were nutrition (59%) and sleep quality (51%). WAPP tele-visits began in 6/20; visit completion rates will be presented. Qualitative data regarding patient experience and QOL will be obtained via interviews and feedback will be categorized in thematic domains. Conclusions: Most patients enrolled in the program, completed a WQ and engaged with the WP. Our findings suggest that this early intro to survivorship is feasible. Earlier engagement and incorporation of wellness and supportive services from time of diagnosis may improve our ability to address multifactorial needs during and after cancer therapy.
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Bantug, Elissa Thorner, Kimberly S. Peairs, Lillie D. Shockney, Nelli Zafman, Carol D. Riley, Jennifer Barsky Reese, Claire Frances Snyder, Vered Stearns, and Antonio C. Wolff. "Making it work: Breast cancer survivorship care at Johns Hopkins." Journal of Clinical Oncology 30, no. 27_suppl (September 20, 2012): 61. http://dx.doi.org/10.1200/jco.2012.30.27_suppl.61.
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61 Background: Breast cancer survivor numbers are increasing due to population aging and improved treatment outcomes but many of their long-term health care needs are unmet. Integrated follow-up care strategies that enhance care coordination, education, and access to survivorship resources are needed to provide patients with evidence-based care that addresses medical and psychosocial needs after cancer treatment. Methods: In 2008, we established the Johns Hopkins Breast Cancer Survivorship Program with representation from the Schools of Nursing, Public Health, and Medicine to address the needs of patients completing initial cancer treatment and transitioning to long-term follow-up. Patient educational resources were created within an interactive website ( http://bit.ly/hZfzFi ) including > 35 patient/provider educational video clips, blogs and social media. Activities including provider educational events, educational folders, and trainee curriculum additions have been ongoing. Starting May 2011, Hopkins patients were offered a one-time transition visit with a nurse practitioner focusing on individualized treatment summary/survivorship care plan activities (e.g., cancer screening/surveillance, medical intervention, psychosocial support, and care coordination with non-cancer providers). Results: Our website is averaging 3,000 hits monthly. We have participated in 22 provider/trainee formal educational presentations. In the pilot phase of these transition visits (n=40), age/race breakdown of participants were representative of our breast cancer population (median age 51, range 34-69; 17% African Americans). Our post-visit survey (n=37), 97% found the survivorship visit beneficial and all reported that this one-time consultation helped with transitioning away from treatment. Conclusions: A multidisciplinary patient-centered approach to breast cancer survivorship allowed us to develop comprehensive clinical and educational service models to benefit patients and their cancer/non-cancer providers. This program aims to enhance education, overcome the fragmentation of the health care system, and improve overall health and wellness of breast cancer survivors as they transition to long-term survivorship.
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Chen, Shu-Fen, Yu-Wen Fang, Mei-Hua Wang, and Tze-Fang Wang. "Effects of an Adaptive Education Program on the Learning, Mental Health and Work Intentions of New Graduate Nurses." International Journal of Environmental Research and Public Health 18, no. 11 (May 31, 2021): 5891. http://dx.doi.org/10.3390/ijerph18115891.
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Health care workers are at a higher risk of psychological distress than ordinary people. Stress affects physical and mental health, and can even produce an intention to leave. The current training for new graduate nurses (NGNs) during this transitional period mostly focuses on the cultivation of professional ability, with less attention to mental health or emotional feelings, and thus there are insufficient structured support strategies. As such, this study explores the effects of intervention through an appropriate education program on the learning, mental health and work intentions of new recruits during the transition period. A pre-test and post-test for a single group was designed for new nursing staff in a large teaching hospital in northern Taiwan. The test period was from May 2017 to December 2018, and a total of 293 cases were accepted. A three-month adaptive education program was provided and evaluated in terms of: care for learning, care for health, improving professional ability, and individualized guidance on satisfaction, mental health disturbance and work intention. The new graduate nurses who received gentle care and counseling showed a downward trend in their BSRS-5 scores and statistical differences over time (p < 0.001). The higher the BSRS-5 score, the easier it is for new graduate nurses in acute and intensive care units. There is a tendency for turnover leave (p = 0.03). After the intervention of the overall plan, the turnover rate of new graduate nurses within three months was 12.6%, and the one-year retention rate was 87.9%. The adaptive education program uses multiple support strategies to improve learning and professional abilities, to reduce psychological emotions, and thereby to increase retention. Today will face new medical challenges; the education programs will become more important across clinical care settings, and it will be important to rigorously validate their performance in helping NGNs.
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Dougherty, David W., Julie Ann Berkhof, Cheryl Hokula, Julie Kozlowski, Jennifer Galdys, and Nicole Zimmer. "Development and implementation of competency-based orientation program for advanced practice providers at an academic cancer center." Journal of Clinical Oncology 34, no. 7_suppl (March 1, 2016): 119. http://dx.doi.org/10.1200/jco.2016.34.7_suppl.119.
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119 Background: Increased utilization of Advanced Practice Providers (APPs) has been identified as a means to increase oncology visit capacity and improve productivity. Many APPs have little experience in oncology or are new to the APP role. As a result, there is a need for a comprehensive, competency-based orientation and mentorship program to aid in this transition and ensure effective integration of APPs into the complex oncology environment. Methods: We developed and implemented a comprehensive, competency-based orientation and mentorship program for APPs hired into the Wilmot Cancer Institute. In addition to basic institutional orientation, APPs are assigned primary & secondary preceptors and complete a 12-week oncology-specific orientation that includes specific clinical activities relevant to their role. Oncology educational articles and lectures are provided and APPs meet weekly with preceptors to identify goals, accomplishments and improvement needs. Faculty mentors are assigned for additional oncology-specific and professional development, as well as oversight of chemotherapy ordering. If deficiencies are identified, APPs are provided an Individual Development Plan with milestones necessary for progression. Results: From January 2013 to July 2015, 16 APPs were hired and enrolled into the orientation program. 11 APPs had no prior oncology experience and 10 had no prior experience as an APP. 14 of 16 APPs (87.5%) successfully completed the orientation program. 2 APPs were placed on Individual Development Plans and subsequently did not complete the program. All 14 APPs successfully completing orientation have been retained in their position, leading to 100% retention rate for those completing the program since its inception. Conclusions: This framework for a comprehensive, competency-based orientation and mentorship program for APPs at an academic cancer center has improved our ability to successfully integrate APPs into the cancer care environment. In addition, APPs having difficulty transitioning or who are unable to complete the orientation were efficiently identified, leading to individualized improvement plans required for ongoing employment.
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Carew, Allison Payne, and Barbara Resnick. "Outcomes of the Maryland Person-Centered Hospital Discharge Program: A Pilot Targeting Decreasing Long-Term Care Use and Hospital Readmissions." Care Management Journals 16, no. 1 (March 2015): 48–58. http://dx.doi.org/10.1891/1521-0987.16.1.48.
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The Person-Centered Hospital Discharge Program (PCHDP) was offered by the Centers for Medicare and Medicaid Services as a way to improve care to Medicare and Medicaid beneficiaries in Maryland. The PCHDP used a care nurse/coordinator to facilitate the successful transition of patients at risk for becoming eligible for Medicaid. The purpose of this study was to examine the outcomes of the PCHDP pilot, explore factors that influenced hospital and long-term care admissions following hospital discharge, and obtain operational data to develop new programs with related objectives. Area Agencies on Aging were provided with a care coordinator who obtained patient data, developed an individualized care plan, and determined visit frequency and length of services. Multivariate analysis of variance was conducted to examine differences between those hospitalized or admitted to a skilled nursing facility during the follow-up period. The sample consisted of 359 at-risk patients, and the mean length of follow-up was approximately two months. Most patients did not go to the emergency room (N = 319, 88%) during the period of follow-up and were not admitted to an acute care setting (N = 301, 84%) or skilled nursing home (N = 322, 86%). Those who were rehospitalized were slightly younger and had more visits from the care coordinator. We anticipate that the care coordinators identified individuals at greatest need for follow-up and support. Future research should explore ways in which these care coordinators can intervene to prevent hospital readmission and long-term nursing home care.
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Repetto, Jeanne B., Warren J. White, and Dale T. Snauwaert. "Individualized Transition Plans (ITP): A National Perspective." Career Development for Exceptional Individuals 13, no. 2 (October 1990): 109–19. http://dx.doi.org/10.1177/088572889001300202.
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Pennarola, Brian, Patrick Demartino, Dale W. Steele, and Susan J. Duffy. "Painful Transitions—a Comparison of Acute Pain Management in Children, Adolescents and Young Adults with Sickle Cell Disease in Adjacent Pediatric and Adult Emergency Departments." Blood 132, Supplement 1 (November 29, 2018): 4700. http://dx.doi.org/10.1182/blood-2018-99-117703.
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Abstract Introduction: Qualitative research identifies delayed analgesia and under-dosing as common reasons for patient/caregiver dissatisfaction with the treatment of acute vaso-occlusive pain in sickle cell disease (SCD). Experts have identified quality measures for emergency department (ED) management of acute pain in SCD including early administration of IV analgesics (NHLBI 2014). Adolescent and young adult (AYA) patients are especially at risk for dissatisfaction, and qualitative studies identify the transition from pediatric (PED) to adult emergency department (AED) care as the most difficult site of transition. Information from empirical studies of SCD pain management in PEDs and AEDs is needed to facilitate overall improvements in care and facilitate transitions of care for AYA patients. The goal of this study was to examine differences in management of SCD pain between a PED and an AED. The primary outcome was time from triage to first opioid. Methods: We retrospectively reviewed patients with SCD and acute pain, age 3 - 27 years, seeking care from June 2015 to December 2016 in the AED and/or PED within our academic, tertiary care institution. Four visits per individual per ED were abstracted. Visits were excluded if no opioid was administered, for confounding sources of pain (e.g. post-operative), transfer from another ED or critical illness. Important encounter characteristics and outcomes were summarized by mean with standard deviation (SD) or median with interquartile range (IQR) for skewed data. We compared the difference between EDs for the primary outcome using a Cox proportional hazards model with a patient-level random effect. Results: Our initial electronic health record query yielded 353 visits by 66 patients to the PED and AED. Two patients accounted for 46% of visits (77 and 84 visits). After excluding visits by patients transferred from an outside facility (n=1), with confounding illness (n=6) or no opioid administered (n=3), we extracted data on up to 4 visits per ED per patient and analyzed 127 visits by 55 patients. Demographics, initial pain score, treatments and treatment timeline are summarized by ED (Table 1). The Kaplan-Meier plot (Figure 1) shows the proportion of patients receiving the first intravenous opioid dose, by ED, as a function of time from triage. At any given time, the probability of receiving the first opioid dose in the PED was approximately 3 times greater than in the AED (hazard ratio of 2.95 (95% CI 1.93, 4.50), p < 0.001). Patients in the AED were more likely to receive hydromorphone than morphine and adjunctive NSAIDs were rarely given. More than an hour elapsed between the 1st and 2nd opioid doses in both EDs. Intravenous hydration with normal saline boluses was common in both EDs. An individualized prescribing and monitoring protocol, written by the patient's SCD provider (pain plan) was rarely available to ED providers. Conclusions: Optimal management of acute pain in patients with SCD is difficult, a challenge exacerbated by practice and cultural differences in pediatric versus adult settings. Considering the primary outcome, the PED administered IV analgesia more quickly than the AED, although neither site provided treatment consistently within 30 minutes from triage as per the NHLBI guidelines. Much of the delay in time to first opioid in the AED (Figure 1) is explained by longer rooming times. Our data are limited in that we cannot differentiate whether the delay is due to longer overall wait times or lower prioritization of patients. Nonetheless, this difference remains a known driver of patient dissatisfaction. Our results highlight multiple opportunities in both EDs to improve care including earlier administration and individualized dosing of opioids, reducing the time interval between subsequent doses, routine administration of NSAIDs, avoidance of fluid boluses in euvolemic patients and development of patient specific pain plans. Emergency providers could benefit from education and localized practice guidelines with written protocols and electronic alerts, targeted at quality improvement. The AED could also potentially benefit from focused effort to reduce time from triage to room. Subspecialty providers could assist the ED by routinely providing pain plans; this could help achieve more uniform care across individual encounters in both EDs, particularly in the few patients accounting for a large proportion of all encounters. Disclosures No relevant conflicts of interest to declare.
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Layton, Rebekah L., V. Scott H. Solberg, Arthee E. Jahangir, Joshua D. Hall, Christine A. Ponder, Keith J. Micoli, and Nathan L. Vanderford. "Career planning courses increase career readiness of graduate and postdoctoral trainees." F1000Research 9 (October 13, 2020): 1230. http://dx.doi.org/10.12688/f1000research.26025.1.
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Background: Given national calls for intentional career development during graduate and post-graduate scientific training, this study assessed career readiness development within the context of academic career courses. The current study evaluated the effects of academic career courses offered at two institutions that were specifically designed to increase career awareness, interest, and career-related confidence among doctoral students and postdoctoral fellows. Methods: Participants enrolled in a career course at trainees’ respective academic institutions and responded to pre- and post-course surveys (n=32, n=148). The paper offers a thematic analysis of each of the two courses using an individualized learning plan career development framework and describes the results of their respective pretest-posttest evaluations which indicated increases in career readiness. Results: Though the format and content provided in each course varied, participation was associated with increases in career readiness. Participants reported increased career-awareness including a greater familiarity with different types of careers overall. Furthermore, interest in tenure track faculty careers increased in both samples, which may assuage fears that exposure to diverse career pathways could reduce interest in academic careers. Transferrable skills, including career planning and awareness also significantly increased. Course participants reported an increase in the number and type of mentors they interacted with beyond their principal faculty mentor (other faculty, professional PhDs, peers, and administrative staff). Conclusions: Findings provide supporting evidence for the benefits of implementing structured career development efforts during PhD training; even with varying content, delivery methods, and instructor type, both academic career courses led to significant gains in career awareness and readiness. Successful development and delivery of academic career courses, with a focus on career planning skills, suggest that institutions can utilize these and are an effective way to prepare PhDs for their transition from training positions into careers.
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Everson, Jane M., Dalun Zhang, and Joan D. Guillory. "A Statewide Investigation of Individualized Transition Plans in Louisiana." Career Development for Exceptional Individuals 24, no. 1 (April 2001): 37–49. http://dx.doi.org/10.1177/088572880102400104.
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Chaput, Genevieve, Maria Barrette, Vanessa DiLalla, Tristan Williams, Olivia Yu, and AndreAnne Robitaille. "Breast cancer survivors' self-reported outcomes following an end of treatment group intervention." Journal of Clinical Oncology 36, no. 7_suppl (March 1, 2018): 18. http://dx.doi.org/10.1200/jco.2018.36.7_suppl.18.
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18 Background: The merit of supporting and educating breast cancer survivors (BCS) about survivorship issues such as cognitive dysfunction, body image concerns and fear of recurrence following treatment completion is well recognized. Though the majority of BCS appear to adjust fairly well in the long term, the transition from active treatments to survivorship is often described as distressing. While individualized interventions are typically not sustainable, group interventions provide an opportunity to inform BCS about potential late and long-term effects from cancer treatments in a supportive environment. BCS were offered an end of treatment educational group intervention (EOT). The EOT consists of a survivorship education session delivered by an MD and RN, a kit containing patient resources, as well as a survivorship care plan (SCP). BCS caregivers are welcomed to attend the EOT. This study aimed to assess BCS’ satisfaction, confidence level in managing their health, and intent to use the information received at the EOT. Methods: 18 EOTs have been provided to 83 BCS (group size range: 4 to 8 BCS, caregiver attendees not included). Participants completed a brief Likert-scale survey on a voluntary basis after the EOT. Variables of interest for included reported satisfaction, confidence and intent to use information received during the EOT. Descriptive statistics were utilized to analyze collected data. Results: Completed surveys were received from 69 participants (response rate 83.1%). To the survey question: “The survivorship information I received was helpful”, 72% (50) and 26% (18) responded strongly agreed and agreed, respectively. The majority of participants reported “Feeling better prepared for the next steps regarding their care” following the EOT (60% (42) strongly agreed; 33% (23) agreed). Lastly, the majority (78%) stated they were “very likely” to use the EOT information. Conclusions: Current evidence has demonstrated the feasibility and patient-related benefits of educational interventions within the field of survivorship. Our results suggest group-based interventions are efficient and effective for addressing the supportive and informational needs of BCS after treatment completion.
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Rosenberg, Carol A., Carol Flanagan, Bruce Brockstein, Jennifer Carrie Obel, Elaine Lee Wade, Teresa Murray Law, Leon Harold Dragon, Douglas E. Merkel, Janardan D. Khandekar, and Thomas A. Hensing. "Evaluation of a risk-adapted visit for post-treatment cancer survivors." Journal of Clinical Oncology 32, no. 30_suppl (October 20, 2014): 113. http://dx.doi.org/10.1200/jco.2014.32.30_suppl.113.
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113 Background: The Living in the Future (LIFE) Cancer Survivorship Program at NorthShore University HealthSystem provides a risk adapted visit (RAV) directed by a physician and facilitated by an oncology nurse during which an electronic medical record documented LIFE survivorship care plan (SCP) is provided and discussed. We evaluated the degree to which a RAV promotes individualized healthcare and self-management as survivors transition from active treatment to follow-up care. Methods: Patients anonymously complete a post-RAV evaluation on the day of their RAV and then another at least one year after their RAV. Results: 1,713 RAVS, the majority for breast cancer, occurred from 1/2007 to 3/2014.There are 1,615 complete “day of” post- RAV evaluative data with a median time from completion of last therapy of < 6 months. Respondents scaled statements as strongly agree/ agree/disagree/ strongly disagree. Combined strongly agree/agree ratings are: 94% felt more confident in their ability to communicate information about their cancer treatments to other members of their healthcare team; 90% felt more comfortable recognizing signs and symptoms to report to their healthcare provider; 98% had a better appreciation for potentially helpful community programs and services. Of the 488 respondents (RAV between 1/2007 and 12/2012 n=1,366) to a questionnaire at least one year after the RAV, nearly 100%/97%/93%/91%/85% found the SCP useful in at least 1/2/3/4/5 ways: to summarize medical information, to reinforce follow up care, to recognize symptoms to report, to identify lifestyle practices that promote health, and for assistance in identifying local resources for support. 72% discussed their SCP with their PCP or another healthcare provider, 97% stated they made at least one positive lifestyle change, 89% attended at least one LIFE health promotion seminar, and 80% continue to work on wellness goals. Conclusions: Participation in a LIFE RAV following oncology treatment helps survivors construct a useful understanding of their cancer experience to guide self-care behavior. Data demonstrate that benefits persist one year after the visit and support the feasibility of a nurse-led RAV to establish a SCP in post-treatment cancer survivors.
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MIZUTANI, Yumi, Takayuki HIRUMA, and Yuji YANAGIMOTO. "A Nationwide Investigation of Individualized Plans in Japanese Special High Schools : Implications for the Collaborative Practices of Individualized Transition Support Plans." Japanese Journal of Special Education 39, no. 6 (2002): 41–58. http://dx.doi.org/10.6033/tokkyou.39.41_2.
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Wilder, PhD, CTRS-L, Allison, Patricia J. Craig, PhD, CTRS-L, and Matthew S. Frye, MS, CTRS-L. "Therapeutic Recreation Empowering Kids: Exploring best practices in transition." American Journal of Recreation Therapy 13, no. 2 (February 12, 2017): 33. http://dx.doi.org/10.5055/ajrt.2014.0071.
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The purpose of this article is to describe the collaborative components of a school and community-based recreation therapy (RT) program designed to support the educational, developmental, and transitional needs of students with disabilities in the K-12 public school system in New Hampshire. The program, Therapeutic Recreation Empowering Kids (TREK), is one of three core service areas of the University of New Hampshire's Northeast Passage, community-based adaptive sport and RT organization. This article focuses on TREK's transition services, which align with many of the recommended best practices in transition. TREK services are delivered in school and community settings by state licensed Certified Therapeutic Recreation Specialists to students with disabilities, in accordance with their individualized education plans. Beginning as early as elementary school, through the use of purposeful RT interventions, community integration, and meaningful inclusion, the TREK therapist facilitates valued transition outcomes. In furtherance of these outcomes, the TREK therapist functions as a critical broker in establishing and maintaining mutually beneficial cross-system collaborative partnerships. The purpose of these partnerships is explored, demonstrating how the TREK program facilitates recreation therapists' ability to successfully partner with K-12 public school personnel, community providers and the families of students, all of which potentiate synergistic partnerships toward accomplishing mutual transition goals. A case example is provided to illustrate ways in which the program impacts those involved and encourages continued collaboration.
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Baggett, Kathleen M., Betsy Davis, Susan H. Landry, Edward G. Feil, Anna Whaley, Alana Schnitz, and Craig Leve. "Understanding the Steps Toward Mobile Early Intervention for Mothers and Their Infants Exiting the Neonatal Intensive Care Unit: Descriptive Examination." Journal of Medical Internet Research 22, no. 9 (September 22, 2020): e18519. http://dx.doi.org/10.2196/18519.
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Background Neonatal intensive care unit (NICU) history, combined with systemic inequities for mothers of nondominant cultures and mothers who are socioeconomically disadvantaged, places infants at an extraordinary risk for poor developmental outcomes throughout life. Although receipt of early intervention (EI) is the best single predictor of developmental outcomes among children with and at risk for early developmental delays, mothers and infants with the greatest needs are least likely to receive EI. Mobile internet-based interventions afford substantial advantages for overcoming logistical challenges that often prevent mothers who are economically disadvantaged from accessing EI. However, the bridge from the NICU to a mobile internet intervention has been virtually unexplored. Objective This study aims to examine progression flow from NICU exit referral to an early mobile internet intervention to increase EI access and promote parent mediation of infant social-emotional and communication development. Methods Three NICUs serving the urban poor in a Midwestern city were provided support in establishing an electronic NICU exit referral mechanism into a randomized controlled trial of a mobile internet intervention for mothers and their infants. Measurement domains to reflect the bridge to service included each crucial gateway required for navigating the path into Part C EI, including referral, screening, assessment, and intervention access. An iterative process was used and documented to facilitate each NICU in establishing an individualized accountability plan for sharing referral materials with mothers before their NICU exit. Subsequent to the referral, progression flow was documented on the basis of a real-time electronic recording of service receipt and contact records. Mother and infant risk characteristics were also assessed. Descriptive analyses were conducted to summarize and characterize each measurement domain. Results NICU referral rates for EI were 3 to 4 times higher for open-shared versus closed-single gatekeeper referral processes. Of 86 referred dyads, 67 (78%) were screened, and of those screened, 51 (76%) were eligible for assessment. Of the 51 assessment-eligible mothers and infants, 35 dyads (69%) completed the assessment and 31 (89%) went on to complete at least one remote coaching intervention session. The dyads who accessed and engaged in intervention were racially and ethnically diverse and experiencing substantial adversity. Conclusions The transition from the NICU to home was fraught with missed opportunities for an EI referral. Beyond the referral, the most prominent reason for not participating in screening was that mothers could not be located after exiting the NICU. Stronger NICU referral mechanisms for EI are needed. It may be essential to initiate mobile interventions before exiting the NICU for maintaining post-NICU contact with some mothers. In contrast to a closed, single point of referral gatekeeper systems in NICUs, open, shared referral gating systems may be less stymied by individual service provider biases and disruptions.
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O’Neill, Sue C., Iva Strnadová, and Therese M. Cumming. "Evidence-based transition planning practices for secondary students with disabilities: What has Australia signed up for?" Australasian Journal of Special Education 40, no. 1 (January 7, 2016): 39–58. http://dx.doi.org/10.1017/jse.2015.15.
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There are no Commonwealth or state laws in Australia that require educational authorities to provide individualised transition plans (ITPs) to secondary students with disabilities. It is argued that, in lieu of legislation, Australia's signed commitment to international treaties and national policies obliges educational jurisdictions to provide ITPs to secondary students with disabilities to improve the postschool outcomes for this vulnerable population. Document analysis methods were used to analyse these international treaties and national policies for statements aligned with evidence-based transition skills and predictors. Almost 90 transition-aligned statements were found, accounting for all evidence-based transition skill categories and most of the transition predictor categories. Implications for policymakers and educational jurisdictions are discussed.
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Snell-Rood, Claire, Lisa Ruble, Harold Kleinert, John H. McGrew, Medina Adams, Alexis Rodgers, Jaye Odom, Wing Hang Wong, and Yue Yu. "Stakeholder perspectives on transition planning, implementation, and outcomes for students with autism spectrum disorder." Autism 24, no. 5 (January 20, 2020): 1164–76. http://dx.doi.org/10.1177/1362361319894827.
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Little is known about factors impacting poor post-school outcomes for transition-age students with autism spectrum disorder. Guided by the Exploration, Preparation, Implementation, and Sustainment implementation science framework, we sought to better understand the interdependent impacts of policy, organizational, provider, and individual factors that shape the transition planning process in schools, and the subsequent process through which transition plans are implemented as youth access services and gain employment after school. We conducted focus groups with individuals with autism spectrum disorder, parents, classroom teachers, school administrators, adult service providers, and state policymakers (10 groups, N = 40). Participants described how core tenets of the individualized education planning process were not reliably implemented: planning was characterized by inappropriate goal-setting, ineffective communication, and inadequate involvement of all decision-makers needed to inform planning. After school, youth struggled to access the services stipulated in their transition plans due to inadequate planning, overburdened services, and insufficient accountability for adult service providers. Finally, a failure to include appropriate skill-building and insufficient interagency and community relationships limited efforts to gain and maintain employment. Diverse stakeholder perspectives illuminate the need for implementation efforts to target the provider, organizational, and policy levels to improve transition outcomes for individuals with autism spectrum disorder. Lay abstract Little is known about factors impacting poor post-school outcomes for transition-age students with autism spectrum disorder. Guided by an implementation science framework that takes into account the multiple factors that influence transition outcomes, we sought to better understand the interdependent impacts of policy, organizational, provider, and individual factors that shape the transition planning process in schools, and the subsequent process through which transition plans are implemented as youth with autism spectrum disorder access services and gain employment after school. We conducted focus groups with individuals with autism spectrum disorder, parents, classroom teachers, school administrators, adult service providers, and state policymakers (10 groups, N = 40). Participants described how core tenets of the individualized education planning process were not reliably implemented: planning was described by inappropriate goal-setting, ineffective communication, and inadequate involvement of all decision-makers needed to inform planning. After school, youth struggled to access the services specified in their transition plans due to inadequate planning, overburdened services, and insufficient accountability for adult service providers. Finally, a failure to include appropriate skill-building and insufficient interagency and community relationships limited efforts to gain and maintain employment. Diverse stakeholder perspectives illuminate the need for implementation efforts to target the provider, organizational, and policy levels to improve transition outcomes for individuals with autism spectrum disorder.
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Cavendish, Wendy, and David Connor. "Toward Authentic IEPs and Transition Plans: Student, Parent, and Teacher Perspectives." Learning Disability Quarterly 41, no. 1 (January 16, 2017): 32–43. http://dx.doi.org/10.1177/0731948716684680.
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This mixed-methods study examined perspectives on factors that influence meaningful student and parent involvement in Individualized Education Program (IEP) transition planning. Survey data and open-ended qualitative interviews with urban high school students with a learning disability (LD; n = 16), their parents ( n = 9), and their teachers ( n = 17) were analyzed. A group comparison of student and teacher ratings on the Student Involvement Survey revealed no difference between students and teachers on level of school efforts to facilitate student and parent involvement. However, qualitative analysis of interview data resulted in the emergence of four primary themes related to challenges to meaningful involvement: (a) facilitation of student involvement in IEP development, (b) challenges to parent involvement in IEP development, (c) challenges and effective supports for graduation, and (d) supports needed for career and college preparation. Recommendations for school practices to support student and parent involvement in the development of authentic IEPs is provided.
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Thompson, James R., Barbara M. Fulk, and Sheryl Wernsing Piercy. "Do Individualized Transition Plans Match the Postschool Projections of Students with Learning Disabilities and Their Parents?" Career Development for Exceptional Individuals 23, no. 1 (April 2000): 3–25. http://dx.doi.org/10.1177/088572880002300102.
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Ahmed, Bilawal, Kelton R. Clements, Jonathan Heidt, Michael Trendle, and Sindhu Singh. "Optimizing the Economic Impact of Sickle Cell Hospitalization By Effective Care Plans." Blood 134, Supplement_1 (November 13, 2019): 1023. http://dx.doi.org/10.1182/blood-2019-129732.
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Background: Adults with sickle cell disease (SCD) vaso-occlusive crisis (VOC) frequently seek care in the emergency department (ED) which often results in hospital admissions. The Hematology-Oncology at Ellis Fischel Cancer Center collaborated with organization's ED to develop and implement individualized care plans for adults with SCD presenting to the ED with the goal of adequate outpatient management, reduction in hospital admissions and optimizing the economic impact of sickle cell hospitalization. Methods: Baseline data was collected from November 2014 through June 2018. Medical Director, Oncology Unit Manager, and Performance Improvement Professional (PIP) collaborated with the ED Medical Director and representatives to develop a disease-specific individualized acute care plan for our adult SCD patient population. 100% case were reviewed by PIP and bi-monthly aggregate case review were done by the Medical Director/Unit Manager. The care plan include pathways for lab collection, pain medication regimens, prescription opioid refill policies, a timeline for outpatient follow-up, and criteria for hospital admission. These care pathways were then transitioned to order sets within the organization's electronic medical record. Results: Implementation of the SCD care plans resulted in significant improvement of length of stay(LOS) index indicating better management during the hospital stay, resulting in reduction of the inpatient pharmacy cost per encounter in half as mentioned in Table 1. Admissions per patient did not change significantly, but ED visits per patient went down and clinic visits per patient went up pointing to better management outside of acute care as shown in Table 2. Last 4 quarters of this study showed marked decrease in cost per patient as indicated in Table 3. Conclusions: This study clearly demonstrates that collaboration with the ED and development of care plans can improve the overall patient care for this population resulting in better outpatient management. Implementing this protocol has not only improved the patient experience but also has decreased the financial toxicity for the patient and the institution. We would encourage other institutions to implement such protocol in the ED and in the outpatient setting to meet the patient needs. Table 3 Disclosures No relevant conflicts of interest to declare.
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Hrazdil, C., A. Datta, A. Michoulas, S. Morgan, S. Peinhof, K. Selby, L. Straatman, et al. "Utilization of transition care management plans to facilitate transition of adolescents with epilepsy into the adult healthcare system." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 42, S1 (May 2015): S23. http://dx.doi.org/10.1017/cjn.2015.116.
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Background: For adolescents with epilepsy, there is often a poor system in place to meet their individualized transition needs. Our objectives were 1) to develop epilepsy-specific transition care management plans (TCMPs) to ensure access, and attachment to adult healthcare providers, and 2) to identify strategies for providing support during the transition period, including through the development of physician and patient (or caregiver) navigated web-based tools, resources and recommendations for health system improvements. Methods: Physicians and nurses with expertise in areas including adult and pediatric epilepsy, family medicine, psychiatry, and varied allied health professionals were engaged to generate epilepsy-related TCMPs. Results: Through an iterative process spanning the course of over a year, TCMPs were developed to cover areas including: treatment responsive and resistant epilepsy, ketogenic diet, epilepsy surgery, women’s issues, mental health, and psychosocial aspects of epilepsy. The TCMPs referenced established guidelines and best practices in the literature wherever possible. Caregiver roles and responsibilities were outlined, remaining cognoscent of available provincial resources. Conclusions: Epilepsy specific TCMPs can be developed through a collaborative approach between pediatric and adult healthcare providers, easing the patient experience, creating educated accountability, and providing a forum to identify and address gaps of care in adolescents with epilepsy.
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Deardorff, Malarie E., Corey Peltier, Belkis Choiseul-Praslin, Kendra Williams-Diehm, and Melissa Wicker. "Teacher Knowledge in Transition Planning: Does Locale Matter?" Rural Special Education Quarterly 40, no. 3 (August 3, 2021): 132–42. http://dx.doi.org/10.1177/87568705211027982.
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The Individuals With Disabilities Education Act mandates transition planning to occur in conjunction with the individualized education program for secondary age students with disabilities beginning by age 16, or earlier. To fulfill this mandate, teachers must possess a depth of content and pedagogical knowledge related to the transition planning process. However, the majority of special educators do not receive coursework dedicated to transition in their undergraduate programming. Furthermore, teachers in under-resourced and underserved rural districts may have inequitable professional development opportunities to bolster their transition planning knowledge. This lack of transition-related education potentially leads to inadequate and noncompliant transition plans for students with disabilities. The current study examined differences in teachers’ knowledge based on locale: rural ( n = 75), suburban ( n = 48), and urban ( n = 64) from one southern state. Determining whether differences are identified by locale can inform the allocation of resources to provide high-quality, evidence-aligned professional development models to improve teacher knowledge in underserved and under-resourced rural locales. In addition, identifying gaps in teacher knowledge will inform pre-service and in-service teacher preparation. We provide an avenue of needed future research to improve transition-planning processes for students with disabilities.
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Ahmed, Bilawal, Tami Day, Cara Hirner, Michael Trendle, Jonathan Heidt, and Sindhu Singh. "Role of effective care plans in reducing admissions for sickle cell patients." Journal of Clinical Oncology 36, no. 30_suppl (October 20, 2018): 156. http://dx.doi.org/10.1200/jco.2018.36.30_suppl.156.
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156 Background: Adults with sickle cell disease (SCD) vaso-occlusive crisis (VOC) frequently seek care in the emergency department (ED) which often results in hospital admissions. The Hematology-Oncology at Ellis Fischel Cancer Center collaborated with organization’s ED to develop and implement individualized care plans for adults with SCD presenting to the ED with the goal of adequate outpatient management and a reduction in hospital admissions. Methods: Baseline data collected from November 2014 through December 2016 indicated that 108 SCD patients accounted for 195 inpatient hospital admissions, and 40% of all 30-day readmissions for the Hematology-Oncology service line. Further, the average length of stay for patients admitted for SCD crisis was 6.8 days per stay. Medical Director, Oncology Unit Manager, and Performance Improvement Professional collaborated with the ED Medical Director and representatives to develop a disease-specific acute care plan for our adult SCD patient population. The care plan include pathways for lab collection, pain medication regimens, prescription opioid refill policies, a timeline for outpatient follow-up, and criteria for hospital admission. These care pathways were then transitioned to order sets in within the organization’s electronic medical record. Results: Implementation of the SCD care plans resulted in significant improvement in the 30-day readmission rate among the SCD patient population, from 40% to 3%. Further, use the SCD care plans helped reduce the average length of stay for patients admitted with SCD crisis from 6.8 days to 3 days. More importantly, we have been able to sustain this improvement over time. Conclusions: This study clearly demonstrates that collaboration with the ED and development of care plans are key to reducing ED and hospital utilization among patients with SCD, and reducing the average length of stay for SCD patients who require hospitalization for disease management.
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Lee, Sarah, Benjamin Switzer, Mohammad Khan, Pramod Pinnamaneni, Joseph Hooley, Girish Chandra Kunapareddy, Ruth Lagman, Christa Poole, and Alberto J. Montero. "Implementing individualized care plans in high-risk oncology patients: A team-based model to increase hospice utilization." Journal of Clinical Oncology 37, no. 27_suppl (September 20, 2019): 64. http://dx.doi.org/10.1200/jco.2019.37.27_suppl.64.
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64 Background: In the era of increasing therapeutic options and complexity of disease, some cancer patients (pts) continue aggressive treatment even within days of death. Previous studies report 30-66% of pts do not receive hospice or palliative services in the last month of life and many are enrolled in hospice < 3 days before death. Quality measures are endorsed by ASCO, National Quality Forum, and Oncology Care Model to increase hospice utilization. It is shown that pts enrolled in hospice have increased survival time with reduced in-hospital resources. These benefits increase the longer pts are in hospice. We hypothesize early identification of high risk pts by a multidisciplinary group and formulation of a care plan will prompt early discussion for hospice eligibility, increasing referrals to hospice and the number of days spent in hospice. Methods: As reported (ASCO 2018, Abst 6547), an Interdisciplinary Care Team (ICT) was created with palliative medicine and oncology physicians, nurses, and social workers. Twice monthly pts with high utilization over a 60-day period were identified. Care plans (CP) were created using a team based approach with parallel input from outpatient teams. CP was communicated back to the primary team. Results: 112 pts were discussed over 24 months; 39 pts died with a solid tumor malignancy and this was our study cohort. 85% pts (33/39) were referred to or had a hospice discussion and 82% pts (27/33) enrolled. 6 pts declined and 6 acutely died. Of the 27 pts that entered hospice 78% (21/27) were enrolled > 3 days and 22 % (6/27) < 3 days. Average number days in hospice was 19.7 (median 11) for all who entered hospice. In the subgroup that were enrolled for > 3 days, average number days was 25 (median 21). 62% pts (17/27) entered hospice within 60 days of ICT meeting and CP. Conclusions: Early identification of high-utilizing cancer patients along with review by ICT may correlate with early recognition of hospice eligibility, enrollment, and therefore greater number days spent in hospice. This increases hospice utilization allowing patients and families to experience the full benefit of hospice-directed care. Further interventions should be explored in optimizing transitions of care.
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Bullis, Michael, and Maurine Otos. "Characteristics of Programs for Children with Deaf-Blindness: Results of a National Survey." Journal of the Association for Persons with Severe Handicaps 13, no. 2 (June 1988): 110–15. http://dx.doi.org/10.1177/154079698801300207.
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Specialized service programs for children and youth (ages 0 to 21) with deaf-blindness have received federal support since 1968. Currently, a combination of single state and multistate/regional programs serve students with dual sensory impairments. A national survey of program coordinators was conducted to provide a description of services. Respondents completed a 57-item questionnaire about their program's administrative structure, teacher certification requirements, technical assistance, eligibility determination, educational placement, curricula/instructional settings, transition, and unmet educational needs. Thirty-two surveys (a response rate of 59%) were returned and analyzed. Most coordinators indicated that they work only part time in the position and that technical assistance to practitioners and families constitutes a major part of their responsibilities. Educational placements for students with deaf-blindness include classrooms for persons with severe handicaps/sensory impairments, residential programs, and vocational programs. The majority of respondents noted that transition programs are in place in their service areas, but that individualized transition plans (ITPs) are not mandated. Services to families of preschool and elementary students were identified as an area needing further attention, and the lack of appropriate curricula materials was identified as a problem across age groups.
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Bruce, Susan M., Susan M. Bashinski, Andrea J. Covelli, Veronika Bernstein, Mary C. Zatta, and Stevi Briggs. "Positive Behavior Supports for Individuals who Are Deafblind with Charge Syndrome." Journal of Visual Impairment & Blindness 112, no. 5 (September 2018): 497–560. http://dx.doi.org/10.1177/0145482x1811200507.
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Introduction The purpose of this study was to identify effective individualized positive behavior support strategies and cognitive behavior therapy strategies for young adults who are deafblind. It discusses findings specific to four young adult students with CHARGE syndrome. Methods This collaborative action research study employed collective case study design and elements of grounded theory analysis. Principles of positive behavior support and modified cognitive behavior therapy supported the identification and implementation of individualized behavioral interventions that addressed environment arrangement, sensory needs and sensitivities, and how adults communicated with the students. Results Eight themes were identified as being important to each of the students, although to varying degrees. These were: provide structure, establish and maintain a positive climate, address students’ sensory needs and sensitivities, support on-task behavior, support transitions between activities and environments, support mature behavior, support students in coping with anxiety, and use adult language supports. Each theme included multiple strategies. Discussion Proactive and reactive strategies must be individualized even when children share an etiology. Educational team members must know each student's preferences, likes, dislikes, reinforcers, and unique communication needs in order to identify and effectively implement behavioral supports. Modified cognitive behavior therapy may be helpful in addressing the anxiety experienced by individuals with CHARGE syndrome. Teams require time to collaborate on behavioral assessment, the identification of individualized behavioral strategies, and the effectiveness of behavioral plans. Implications for practitioners Providing well-structured environments and teaching rules and routines can reduce anxiety because students know what to expect. Educational team members should prevent sensory overload, provide structured desensitization opportunities, and teach relaxation techniques to these students. Adult communication must be positive, clarify what will happen next, and redirect behaviors when needed.
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Sample, Pat L. "Postschool Outcomes for Students with Significant Emotional Disturbance following Best-Practice Transition Services." Behavioral Disorders 23, no. 4 (August 1998): 231–42. http://dx.doi.org/10.1177/019874299802300405.
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Six best practices—vocational intervention, paid work experience, social skills curriculum, interagency collaboration, parent involvement, and individualized plans/planning—were linked to postschool outcomes of employment and community adjustment for students with significant emotional disturbance (SED). Telephone and in-person interviews were conducted with 30 (57%) of 53 former students who had participated in supported employment and entrepreneurial education transition grant projects between 1989 and 1994. The former students answered questions about their employment, residential situations, community involvement, recreational pursuits, and citizenship activities 6 months, 12 months, and 24 months after leaving school. Univariate analyses of individual interventions and student outcomes showed that students out of school for 6 months who had been employed for long periods of time while in school had higher rates of employment than those who had not worked. Students out of school for 7 year whose parents were actively involved in their educational programs were more likely than their peers with uninvolved parents to have a successful community adjustment. Recommendations for further study include pursuing the development of appropriate definitions and assessment of transition services and interventions and exploring further interventions over which educators have direct control.
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Page, Margaretta S., and Susan M. Chang. "Creating a caregiver program in neuro-oncology." Neuro-Oncology Practice 4, no. 2 (August 26, 2016): 116–22. http://dx.doi.org/10.1093/nop/npw019.
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Abstract Background. Neuro-oncology caregivers face unique challenges. Caring for a patient who has a catastrophic, life-threatening diagnosis combined with progressive neurological decline can produce great distress. Experts agree that a formalized plan of care to address the needs of the neuro-oncology caregiver is needed. Methods. In 2013, the Division of Neuro-Oncology at the University of California, San Francisco initiated a program designed to provide additional services to address the needs of the neuro-oncology caregiver. Records have been kept outlining program development, the caregivers seen, their identified needs, and services provided. Results. From October 2013 through August 2015 staff met with 334 “new to clinic” caregivers, 90 of whom were caring for patients with newly diagnosed glioblastoma. One hundred ninety-eight caregivers were deemed at high risk for distress due to transitions in patient care that were occurring. One hundred forty-nine caregivers of former patients received bereavement services for up to 6 months. The areas of highest need were emotional support and advocacy issues. The number of caregiver needs increased as patients moved along the disease trajectory. The program was able to identify resources that were lacking. Dedicated staff allowed for improvement in the kinds of caregiver-specific support services offered. Conclusion. Dedicated caregiver staff allows for developing relationships with caregivers across the disease trajectory and appears to be important in being able to offer individualized assessments and tailored care plans. Evaluation of caregiver and patient outcomes is the next step in understanding program effectiveness.
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Deol, Raman, Matthew C. Cheung, Elisabeth M. Del Giudice, Angela Boudreau, Debbie Miller, and Simron Singh. "Transition care clinic: Evidence-based survivorship care." Journal of Clinical Oncology 31, no. 31_suppl (November 1, 2013): 141. http://dx.doi.org/10.1200/jco.2013.31.31_suppl.141.
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141 Background: The Odette Cancer Centre (OCC) is the sixth largest comprehensive cancer centre in North America. In 2012/2013 fiscal year it is projected there will be 19,633 new cases and 82,293 follow-up visits, of which 16% of new and 24% of follow-ups will be for gastrointestinal (GI) and hematology disease sites. Current specialty cancer clinics are not well equipped to provide evidence-based survivorship care. Methods: The Transition Care Clinic (TCC) was developed for colorectal cancer and lymphoma patients transitioning from acute care at OCC back to their primary care provider (PCP) for follow-up, assessment, and surveillance after completion of active treatment. Patients are seen by a family medicine physician and advanced practice nurse and receive comprehensive survivorship care, individualized treatment summaries, and post-treatment care plans. An accompanying web resource continues to connect patients to OCC after discharge and provides survivorship specific information. Results: An eight month pilot resulted in 66 visits and 28 discharges, of which 53% of visits and 93% of discharges were for GI patients and 47% and 7% respectively for hematology. The 28 discharges resulted in resource utilization savings of 122 OCC clinic visits and 118 hospital CT scans. Symptom screening results across the domains of anxiety, depression, pain, and tiredness were on par with other cancer patients, dispelling concern that these patients experience different/more symptoms after treatment and during transition. Finally, patient feedback indicated that those that found it difficult to attend OCC appointments appreciated knowing guidelines were available and were comfortable with PCP follow-up, while others whose PCP missed initial presenting symptoms preferred cancer centre “specialists” and were not comfortable. Conclusions: There is need for inter-disciplinary development of survivorship and transition programs with buy-in from disease sites, multimodality consensus, revision of eligibility criteria for lymphoma, and efficiencies to complete comprehensive treatment summaries. Short and long-term outcomes to be measured include recurrences and secondary cancers, adherence to guidelines, patient quality of life, and satisfaction.