scholarly journals 2465 Enhancing outcomes for young children with behavior disorders: A model for coordinated care

2018 ◽  
Vol 2 (S1) ◽  
pp. 70-70
Author(s):  
Sufna G. John ◽  
Teresa Kramer ◽  
Nicola Edge ◽  
Michael Cucciare ◽  
Nicholas Long
Keyword(s):  
Focus Groups ◽  
Barriers And Facilitators ◽  
System Level ◽  
Second Phase ◽  
Coordinated Care ◽  
Care Model ◽  
Grand Tour ◽  
Behavior Consultation ◽  
And Behavior ◽  
Consultation Services

OBJECTIVES/SPECIFIC AIMS: (1) Identify current barriers to coordinated care between behavior consultation and PCIT services. (2) Identify current facilitators to coordinated care between behavior consultation and PCIT services. (3) Utilize this knowledge to create and pilot a coordinated care model that will enhance PCIT and behavior consultation service outcomes. METHODS/STUDY POPULATION: Objectives 1 and 2: Two focus groups consisting of 8–10 behavior consultants will be conducted to gather initial information on barriers and facilitators to coordinated care. Participants will be recruited from the state-funded behavior consultation team, to represent consultation occurring in rural and urban settings. All focus groups will be recorded and transcribed to capture questions and comments. Focus groups will be provided with an initial 10-minute overview of PCIT, including theory, prescribed strategies, and mode of intervention. A grand tour question will then be asked to elicit consultant perceptions of PCIT (e.g., “What are your thoughts on the compatibility between PCIT and behavior consultation services”), followed by probe questions deigned to elicit more detailed information about any perceived differences based on philosophical approach; differences in what is recommended in childcare settings Versus at home, etc.; and perceived barriers to coordinated care between school and outpatient services (e.g., “What factors make coordinating care with outpatient providers challenging?). Participants will be asked about their willingness to participate in a second focus group to review materials created to enhance coordinated care, based on their feedback. Objective 3. Based on feedback from the focus groups and quantitative data regarding factors associated with PCIT outcomes, we will develop an enhanced childcare component(s) for eventual implementation. To confirm our approach, we will invite the members of both focus groups back for a second session, in which we provide them with the created materials and elicit their feedback. We will start with a grand tour question (e.g., “How do you think parents and teachers would react to these materials?”) and then follow-up with probe questions related to feasibility (e.g., “How do you anticipate using these tools?”), appropriateness (e.g., “How adequately do you feel these materials address concerns with coordinated care?”), and acceptability (e.g., “How likely are you to begin using these tools within your consultation?”). Both focus groups will be recorded and transcribed to capture questions and comments. RESULTS/ANTICIPATED RESULTS: (1) Barriers and facilitators to coordinated care will include individual (e.g., acceptability of PCIT framework) and system-level factors (e.g., ease of communication between providers). (2) There will be significant overlap in coordination between the first phase of PCIT (which focuses on positive parenting strategies) and what is prescribed by behavior consultants. (3) There will be less compatibility between the second phase of PCIT (which focuses on disciplinary strategies) and what is prescribed by behavior consultants. (4) A coordinated are model will be rated as more feasible, appropriate, and acceptable to behavior consultants than PCIT services as currently prescribed. DISCUSSION/SIGNIFICANCE OF IMPACT: Childhood disruptive behaviors are among the most frequent reasons for referral to outpatient child/adolescent mental health clinics (Sukhodolsky et al., 2016). Disruptive and aggressive behaviors are problematic, not only for victims of children who are aggressive but also for aggressive children as they age. Although effective treatments exist, families are often provided with conflicting strategies for behavior management by outpatient clinicians and behavior consultants in the daycare setting, thus providing children inconsistent feedback which will delay their attainment of new skills. These data will provide the initial foundation for the development of a coordinated care model that promotes treatment efficacy by improving the compatibility between clinic-based PCIT and daycare-based behavior consultation services.

Barriers and Facilitators to Implementing the Uruguayan Dietary Guidelines in Everyday Life: A Citizen Perspective

2017 ◽  
Vol 45 (4) ◽  
pp. 511-523 ◽  
Author(s):  
Leandro Machín ◽  
Jessica Aschemann-Witzel ◽  
Angelina Patiño ◽  
Ximena Moratorio ◽  
Elisa Bandeira ◽  
...  
Keyword(s):  
Focus Groups ◽  
Dietary Guidelines ◽  
Barriers And Facilitators ◽  
Female Age ◽  
Cooking Skills ◽  
Daily Routines ◽  
Lack Of Control ◽  
Food Market ◽  
Household Preferences ◽  
And Behavior

An in-depth understanding of the citizen’s perception and behavior is needed for the development of targeted public policies and interventions that can successfully encourage people to shift their dietary patterns and contribute to the prevention of non-communicable diseases. The present work aimed to identify barriers and facilitators for the adoption of the new Uruguayan dietary guidelines from a citizen perspective. Twelve semistructured focus groups were conducted with a total of 91 people (81% female, age 18-64 years) from 3 Uruguayan cities. Findings identified several multifaceted barriers, including lack of value given to food, meals and cooking, taste preferences for unhealthy foods, the unsupportive social context in terms of household preferences, customs and social norms, and lack of control of the situation through insufficient food capabilities, time scarcity, and an adverse food market environment. The potential facilitators discussed in the focus groups were mainly related to policies and regulations to discourage consumption of unhealthful products and the provision of more education and information. In addition, respondents acknowledged the need for own actions in terms of seeking greater cooking skills and enjoyment, incorporating changes in their daily routines and promoting a more supportive social environment. Results suggest that supportive actions are needed to support citizen’s adoption of the new Uruguayan dietary guidelines.

Coastal monitoring and data management for restoration in Louisiana

Shore & Beach ◽  
2020 ◽  
pp. 92-101
Author(s):  
Richard Raynie ◽  
Syed Khalil ◽  
Charles Villarrubia ◽  
Ed Haywood
Keyword(s):  
Data Collection ◽  
Data Management ◽  
Management System ◽  
Monitoring Program ◽  
Document Retrieval ◽  
Information Management System ◽  
System Level ◽  
Coastal Protection ◽  
Second Phase ◽  
Coastal Louisiana

The Coastal Protection and Restoration Authority (CPRA) of Louisiana was created after the devastating hurricanes of 2005 (Katrina and Rita) and is responsible for planning and implementing projects that will either reduce storm-induced losses (protection) or restore coastal ecosystems that have been lost or are in danger of being lost (restoration). The first task of the CPRA board was to develop Louisiana’s first Coastal Master Plan (CPRA 2007), which formally integrates and guides the protection and restoration of Louisiana’s coast. The System-Wide Assessment and Monitoring Program (SWAMP) was subsequently developed as a long-term monitoring program to ensure that a comprehensive network of coastal data collection activities is in place to support the planning, development, implementation, and adaptive management of the protection and restoration program and projects within coastal Louisiana. SWAMP includes both natural-system and human-system components and also incorporates the previously-developed Coastwide Reference Monitoring System (CRMS), the Barrier Island Comprehensive Monitoring (BICM) program, and fisheries data collected by the Louisiana Department of Wildlife and Fisheries (LDWF) in addition to other aspects of system dynamics, including offshore and inland water-body boundary conditions, water quality, risk status, and protection performance, which have historically not been the subject of CPRA-coordinated monitoring. This program further facilitates the integration of project-specific data needs into a larger, system-level design framework. Monitoring and operation of restoration and protection projects will be nested within a larger hydrologic basin-wide and coast-wide SWAMP framework and will allow informed decisions to be made with an understanding of system conditions and dynamics at multiple scales. This paper also provides an update on the implementation of various components of SWAMP in Coastal Louisiana, which began as a Barataria Basin pilot implementation program in 2015. During 2017, the second phase of SWAMP was initiated in the areas east of the Mississippi River. In 2019, development of SWAMP design was completed for the remaining basins in coastal Louisiana west of Bayou Lafourche (Figure 1). Data collection is important to inform decisions, however if the data are not properly managed or are not discoverable, they are of limited use. CPRA is committed to ensuring that information is organized and publicly available to help all coastal stakeholders make informed, science-based decisions. As a part of this effort, CPRA has re-engineered its data management system to include spatial viewers, tabular download web pages, and a library/document retrieval system along with a suite of public-facing web services providing programmatic access. This system is collectively called the Coastal Information Management System (CIMS). CPRA and U.S. Geological Survey (USGS) are also developing a proposal to create an interface for CIMS data to be exported to a neutral template that could then be ingested into NOAA’s Data Integration Visualization, Exploration and Reporting (DIVER) repository, and vice versa. DIVER is the repository that the Natural Resource Damage Assessment (NRDA) program is using to manage NRDA-funded project data throughout the Gulf of Mexico. Linking CIMS and DIVER will make it easier to aggregate data across Gulf states and look at larger, ecosystem-level changes.

scholarly journals A75 IMPLEMENTING A CIRRHOSIS ORDER SET: A QUALITATIVE ANALYSIS OF PROVIDER-IDENTIFIED BARRIERS AND FACILITATORS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 41-42
Author(s):  
E Johnson ◽  
M Carbonneau ◽  
D Campbell-Scherer ◽  
P Tandon ◽  
A Hyde
Keyword(s):  
Focus Groups ◽  
Gastrointestinal Disease ◽  
Pragmatic Trial ◽  
Healthcare Providers ◽  
Structured Interview ◽  
Barriers And Facilitators ◽  
Care Utilization ◽  
Implementation Barriers ◽  
Mortality And Morbidity ◽  
Order Set

Abstract Background Cirrhosis is the leading cause of mortality and morbidity in individuals with gastrointestinal disease. Multiple care gaps exist for hospitalized patients with cirrhosis, resulting in high rates of re-hospitalization (e.g. 44% at 90 days in Alberta). The Cirrhosis Care Alberta (CCAB) is a 4-year multi-component pragmatic trial with an aim to reduce acute-care utilization by implementing an electronic order set and supporting education across eight hospital sites in Alberta. Aims As part of the pre-implementation evaluation, this qualitative study analyzed data from provider focus groups to identify barriers and facilitators to implementation. Methods We conducted focus groups at eight hospital sites with a total of 54 healthcare providers (3–12 per site). A semi-structured interview guide based upon constructs of the Consolidated Framework for Implementation Research (CFIR) and Normalization Process Theory (NPT) frameworks was used to guide the focus groups. Focus groups were recorded and transcribed verbatim. Data was analyzed thematically and inductively. Results Five major themes emerged across all eight sites: (i) understanding past implementation experiences, (ii) resource challenges, (iii) competing priorities among healthcare providers, (iv) system challenges, and (v) urban versus rural differences. Site-specific barriers included perceived lack of patient flow, time restraints, and concerns about the quality and quantity of past implementation interventions. Facilitators included passionate project champions, and an ample feedback process. Conclusions Focus groups were useful for identifying pre-implementation barriers and facilitators of an electronic orders set. Findings from this study are being refined to address the influence of COVID-19, and the data will be used to inform the intervention roll-out at each of the sites. Funding Agencies Alberta Innovates

scholarly journals Quality of care for people with multimorbidity: a focus group study with patients and their relatives

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e047025
Author(s):  
Nadine Janis Pohontsch ◽  
Josefine Schulze ◽  
Charlotte Hoeflich ◽  
Katharina Glassen ◽  
Amanda Breckner ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Focus Groups ◽  
Healthcare System ◽  
Qualitative Content Analysis ◽  
Coordinated Care ◽  
Treatment Standards ◽  
Focus Group Study ◽  
Treatment Regimens ◽  
Quality Aspects

BackgroundPrevalence of people with multimorbidity rises. Multimorbidity constitutes a challenge to the healthcare system, and treatment of patients with multimorbidity is prone to high-quality variations. Currently, no set of quality indicators (QIs) exists to assess quality of care, let alone incorporating the patient perspective. We therefore aim to identify aspects of quality of care relevant to the patients’ perspective and match them to a literature-based set of QIs.MethodsWe conducted eight focus groups with patients with multimorbidity and three focus groups with patients’ relatives using a semistructured guide. Data were analysed using Kuckartz’s qualitative content analysis. We derived deductive categories from the literature, added inductive categories (new quality aspects) and translated them into QI.ResultsWe created four new QIs based on the quality aspects relevant to patients/relatives. Two QIs (patient education/self-management, regular updates of medication plans) were consented by an expert panel, while two others were not (periodical check-ups, general practitioner-coordinated care). Half of the literature-based QIs, for example, assessment of biopsychosocial support needs, were supported by participants’ accounts, while more technical domains regarding assessment and treatment regimens were not addressed in the focus groups.ConclusionWe show that focus groups with patients and relatives adding relevant aspects in QI development should be incorporated by default in QI development processes and constitute a reasonable addition to traditional QI development. Our QI set constitutes a framework for assessing the quality of care in the German healthcare system. It will facilitate implementation of treatment standards and increase the use of existing guidelines, hereby helping to reduce overuse, underuse and misuse of healthcare resources in the treatment of patients with multimorbidity.Trial registration numberGerman clinical trials registry (DRKS00015718), Pre-Results.

Implementing early exome sequencing to shorten the diagnostic odyssey: identifying barriers and facilitators through clinician focus groups

2021 ◽  
Vol 132 ◽  
pp. S360
Author(s):  
Ann Katherine Foreman ◽  
Hannah Margaret Clare ◽  
Jeannette Bensen ◽  
Jonathan Berg ◽  
Kristen Hassmiller Lich
Keyword(s):  
Focus Groups ◽  
Exome Sequencing ◽  
Barriers And Facilitators ◽  
Diagnostic Odyssey

scholarly journals Barriers and Facilitators That Influence Providers’ Ability to Educate, Monitor, and Treat Substance Use in First-Episode Psychosis Programs Using the Theoretical Domains Framework

2021 ◽  
pp. 104973232199344
Author(s):  
Oladunni Oluwoye ◽  
Elizabeth Fraser
Keyword(s):  
Substance Use ◽  
Behavior Change ◽  
Theoretical Domains Framework ◽  
First Episode Psychosis ◽  
Barriers And Facilitators ◽  
First Episode ◽  
Evidence Based ◽  
Behavior Change Techniques ◽  
Episode Psychosis ◽  
And Behavior

In this qualitative study, we explore providers’ experiences with addressing substance use among individuals with first-episode psychosis (FEP) enrolled in coordinated specialty care (CSC) programs. Three focus groups were conducted with 24 providers from CSC programs for FEP in Washington. Questions were focused on barriers and facilitators to addressing substance use using the Theoretical Domains Framework (TDF) as a guide. Thematic analysis was used to code all transcripts. Identified TDF domains were then mapped onto the COM-B (Capability, Opportunity, Motivation, Behavior) intervention functions and behavior change techniques. Seven theoretical domains were identified as the most relevant to addressing substance use: “Knowledge,” “Skills,” “Environmental Context and Resources,” “Social Influences,” “Social and Professional Role and Identity,” “Beliefs about Capabilities,” and “Reinforcement.” The use of the TDF provides a framework to explore barriers and facilitators for targeting substance use and suggestions for behavior change techniques when considering implementation of evidence-based strategies to enhance CSC models.

scholarly journals Barriers and Facilitators to Colorectal Cancer Screening Within a Hispanic Population

2018 ◽  
Vol 17 (1) ◽  
pp. 23-29 ◽  
Author(s):  
Theresa L. Byrd ◽  
Jessica Calderón-Mora ◽  
Rebekah Salaiz ◽  
Navkiran K. Shokar
Keyword(s):  
Colorectal Cancer ◽  
Focus Groups ◽  
Screening Program ◽  
El Paso ◽  
Barriers And Facilitators ◽  
Hispanic Population ◽  
Community Based ◽  
Crc Screening ◽  
Predominantly Hispanic ◽  
9Th Grade

Introduction: Colorectal cancer (CRC) is the third leading cancer cause of death among US Hispanics. CRC screening among the Hispanic population is lower compared with non-Hispanic Whites. Method: The purpose of this qualitative, exploratory study was to better understand the barriers and facilitators of CRC screening and preference for stool-based testing collection methods among the predominantly Hispanic population of El Paso, Texas. Nine focus groups were conducted by a trained bilingual facilitator with a moderator guide informed by the literature. Transcripts of the focus groups were entered into qualitative analysis software and a thematic network was developed. Results: Fifty-six participants were recruited: average age was 68.5 years, 58.9% were female, 98.2% were Hispanic, 87.5% had an annual income of less than $20,000, 58.9% had 9th grade education or less, 12.5% had a discount program, and 5.4% had no insurance. Barriers to CRC screening included cost, fear, and embarrassment. Facilitators to screening included in-person health education and physician recommendation. Participants preferred the hygienic nature of a stool test collected with a brush and bottle. Conclusion: Overall, there was a lack of knowledge regarding CRC and significant barriers to CRC screening. A community-based CRC screening program was subsequently developed from our findings.

scholarly journals Barriers and Facilitators towards an Integrated Chronic Care Model as experienced by primary care health providers

2016 ◽  
Vol 16 (6) ◽  
pp. 78 ◽  
Author(s):  
Geert Goderis ◽  
Gunther D'hanis ◽  
Gert Merckx ◽  
Wim Verhoevven ◽  
Pierre Sijbers ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Care Model ◽  
Chronic Care ◽  
Barriers And Facilitators ◽  
Health Providers ◽  
Care Model ◽  
Primary Care Health ◽  
Care Health

scholarly journals Health and Access to Healthcare in Homeless People: Protocol for a Mixed-methods Study

2021 ◽  
Author(s):  
Miguel A. Bedmar Pérez ◽  
Miquel Bennasar-Veny ◽  
Berta Artigas Lelong ◽  
Francisca Salvà Mut ◽  
Joan Pou Bordoy ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Health Status ◽  
Homeless People ◽  
Premature Death ◽  
Access To Healthcare ◽  
Mixed Methods Study ◽  
Poor Health ◽  
Barriers And Facilitators ◽  
Second Phase ◽  
Structural Factors

Abstract BackgroundHomelessness is a more complex problem than the simple lack of a place to live. Homeless people (HP) often suffer from poor health and premature death due to their limited access healthcare, and are also deprived of basic human and social rights. The study protocol described here aims to evaluate the complex relationship between homelessness and health, and identify the barriers and facilitators that impact access to healthcare by HP.MethodsThis is a mixed-methods study that uses an explanatory sequential design. The first phase will consist of a cross-sectional study of 300 HP. Specific health questionnaires will be used to obtain information on health status, challenges during the COVID-19 pandemic, self-reported use of healthcare, diagnoses and pharmacologic treatments, substance abuse (DAST-10), diet quality (IASE), depression (PHQ-9), and human basic needs and social support (SSQ-6). The second phase will be a qualitative study of HP using the “life story” technique with purposive sampling. We will determine the effects of different personal, family, and structural factors on the life and health status of participants. The interviews will be structured and defined using Nussbaum's capability approach. DiscussionIt is well-known that HP experience poor health and premature death, but more information is needed about the influence of the different specific social determinants of these outcomes and about the barriers and facilitators that affect the access of HP to healthcare. The results of this mixed methods study will help to develop global health strategies that improve the health and access to healthcare in HP.

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