Abuse Referrals Research Articles

Academic achievement among youth in foster care

This disproportionate rate of academic achievement among youth in foster care raises significant concerns given the social and economic benefits that earning a high school diploma provides over the course of an individual’s life. This study examines the relationship between a youth’s foster care experience (removal reason, number of placements, total number of days in foster care, connection to adult mentor, substance abuse, and dual-system involvement) and academic achievement across gender, race, ethnicity, and disabilities using the Adoption and Foster Care Analysis and Reporting (AFCARS) data and the National Youth in Transition Database (NYTD). This study found that several factors including gender, race, ethnicity, disability, connection to adult mentor, substance abuse referral, and dual-system involvement (incarceration) were associated with academic achievement. It is clear from the data that youth involved in the foster care system need increased support during their educational tenure. Low academic achievement rates among youth in foster care need to be addressed with more effectual, balanced, deliberate supportive resources, such as special education/disability services, mentoring programs, and independent living services (ILS) that connect youth in foster care to supports that will help them earn a high school diploma and increased the likelihood that they would go on to postsecondary education opportunity.

Independent living skills program use and outcomes of youth in and aging out of foster care in Florida

ABSTRACT Independent living (IL) skills can assist youth in and aging out of foster care transition to adulthood. Research consistently documents that youth aging out of foster care are resilient, yet often face challenges developing self-sufficiency. Using National Youth Transition Database (NYTD) data for Florida, this study examined receipt of IL services and outcomes for youth at ages 17 and 19. Results showed most youth did not receive IL services across several domains. Many youth experienced homelessness, incarceration, and substance abuse referrals after leaving care. Findings suggest that child welfare professionals should ensure that youth receive IL services while in foster care.

Abstract LB553: Empowering tobacco using cancer patient initiation of tobacco cessation by a personal pathway to success program during preoperative patient counseling: A feasibility study

Abstract Background: Cancer patients who use tobacco often decline to participate in structured tobacco cessation programs. and personal barriers and priorities vary. To overcome barriers and improve pt engagement, we constructed a Personal Pathway to Success (PPS) program which enabled patients to choose cessation components they could effectively use. Methods: City of Hope (COH) constructed a comprehensive list of cessation tools. Patients completed tobacco use and Lifestress social domain stress assessments. PPS was then proposed to patients who selected tools they would initially use in quit attempts. Pts could add or delete tools at any time but were encouraged to add likely effective tools. Since tobacco use is associated with adverse surgical outcomes, the PPS program was pilot tested at the preoperative anesthesia testing clinic (PATC). Patients were evaluated for acceptance of cessation and follow through with counseling. Results were compared by Chi square statistic to pt cessation results before PPS program implementation. Study data collection was 9/11/21 to 1/3/22.Results: The tools in PPS were Individual cessation counseling, nicotine replacement and cessation medications, signed personal commitment agreement, cessation support group, choosing a buddy partner (family, friends or support group), lung cancer screening, letter to primary care physicians requesting assistance for non-responding patients, SmokeFree Text support, Kick It California or Asian Quitline support, rapid action plan for relapses, 5Ds cessation and 7 self-care skills, COH relaxation and/or hypnosis videos, guidance for cinnamon stick/bubble blowing, stress management and smoking cessation apps, cessation videos and audios, educational brochures, advice on vaping, assistance with internet and digital devices, family education and support, and psycho-social or substance abuse referrals. At PATC 36 evaluable patients were offered the PPS program, counseling and/or video education. Nineteen patients (53%) agreed to cessation, 14 (74%) scheduled a definite date for counseling. 42% completed the counseling. Video education was watched by 6 (32%) patients. Thirty two % had future appointments, but 26% had not yet scheduled. Three patients (8%) desired more time to evaluate cessation. Fourteen patients did not respond despite 3 attempts and were referred back to their attending physician. Compared to results pre-PPS, patient initiation was increased from 8.7% to 53% (p<.001). Conclusions: The Personal Pathway to Success program empowered patients to select among different cessation tools and increased pt acceptance of cessation. Offering comprehensive tobacco cessation during cancer surgery pre-anesthesia visits represents a teachable moment when patients are more motivated to accept behavioral interventions and tobacco cessation. Further research will develop additional methods to further increase engagement of hard to reach patients, family and caregivers. Citation Format: Cary A. Presant, Kimlin Ashing, Sophia Yeung, Jonjon Macalintal, Brenda Gascon, Argelia Sandoval, Brian Tiep, Mary Cianfrocca, Ravi Salgia, Dan Raz, Loretta Erhunmwunsee, Yuman Fong, Steven Rosen. Empowering tobacco using cancer patient initiation of tobacco cessation by a personal pathway to success program during preoperative patient counseling: A feasibility study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr LB553.

579 Outcomes of an Independent Burn Advanced Practice Provider Peer Review Process

IntroductionBurn peer review (PR) is an important process for quality assurance and process improvement. Our division consists of five burn surgeons, seven advanced practice providers (APPs) and four night house officer (NHO) APPs. As the APPs are intimately integrated within the burn service - both on the inpatient (IP) and outpatient (OP) settings, a subsequent need to create an independent peer review process for the APPs was identified. We describe our process and evaluate the results after two years of a monthly APP PR meeting.MethodsAll data is entered into a quality management software. Triggers for APP PR include complex discharge, inappropriate OP referral, delay in treatment, OP treatment greater than three weeks without surgical intervention, pressure wound, patient discharge with greater than 30 morphine equivalent dose (MED) of narcotic, readmission or unexpected admission from OP clinic, substance abuse, and self referral. Cases with individual improvement opportunities result in real time direct feedback from the director, lead APP, and peers. These may be escalated to the provider’s ongoing professional performance evaluation (OPPE) or trigger a focused professional performance evaluation (FPPE). Systemic issues identified are referred for multidisciplinary discussion in our Performance Improvement/Quality Assurance (PI/QA) process. Complicated issues involving multiple disciplines may trigger a root cause analysis. If an individual or system issue is not identified, a group discussion about process improvement and standardization of practice ensues.ResultsFrom initiation of the Burn APP PR process in May of 2019, to September 2021, there were 37 cases reviewed. Twelve were for indicated triggers and 25 for self-referrals. Breakdown of these cases is as follows: outpatient treatment greater than three weeks without surgical intervention (3), readmission or unexpected admission from outpatient clinic (4), delay in treatment impacting clinic course (5). Self referred cases included graft loss (8), cellulitis (3), venous thromboembolic event (2), and wound dressing discussion (2). There were three cases where clinical issues were identified of which one was referred for root cause analysis, and the other two led to real-time education and feedback from the director.ConclusionsPR is important to ensure that high quality patient care standards are met. Autonomous APP practice is important for the function of a team, quality of care delivered, professional satisfaction of the APP, and enables financial optimization for burn centers. Creating an independent burn APP peer review process allows for time-sensitive feedback to patient care related events, improves collaboration and practice standardization, and provides an important educational opportunity for the team.

Police referrals for domestic abuse before and during the first COVID-19 lockdown: An analysis of routine data from one specialist service in South Wales.

BackgroundCOVID-19 lockdown measures may have led to more, and increasingly severe, domestic abuse. This study examines police referrals to a specialist domestic abuse service in Wales, UK before and during the first lockdown.MethodsRoutine data relating to 2292 police referrals for female adult victim-survivors from December 2019 until July 2020 were analysed and presented in the form of descriptive statistics to monitor changes in referral rates and the profile of those referrals.ResultsThere was little increase in the overall volume of police referrals during lockdown, but the proportion assessed as high risk increased, and children became the primary source of third-party referrals, with a higher proportion of reports made by other third parties as restrictions eased. Police reports for cases of Child/Adolescent to Parent Violence (C/APV) occurred almost exclusively during lockdown.ConclusionsThe increase in risk level despite less clear increase in volume may suggest unmet need, with victims less likely to seek help during lockdown other than for more severe instances. Increased reports by children suggest increased exposure of children to domestic abuse during school closure. Unmet need for women and children may have been made visible to services, and acquaintances, as measures began to ease.

Postoperative Opioid Pain Medication Usage Following Adult Tonsillectomy.

The purpose of this study was to determine if short-term, high-quantity opioid use following adult tonsillectomy in active duty military members results in opioid misuse, using a proxy measure of referrals to substance abuse rehabilitation programs. An Institutional Review Board-approved retrospective chart review was performed of 741 active duty patients who underwent tonsillectomy between 2012 and 2017. Data collection included preoperative medications within 60 days of surgery, all postoperative opioid prescriptions up to 12 months following surgery, and referrals to substance abuse rehabilitation within a year of surgery. Out of 741 patients, 658 met inclusion criteria. Fifty-one percent were women and the average age was 26 years. Fifty-nine percent of patients received 5 mg/325 mg oxycodone/acetaminophen as their initial postoperative pain medication. The average number of opioid tablets prescribed was 70 ± 18. Ninety three percent of patients received at least 60 tabs. The refill rate within 30 days of tonsillectomy was 38.6%. In the year following surgery, 25.4% of patients received additional doses of outpatient opioids for other indications. Nineteen patients (2.9%) were referred for substance abuse treatment within 1 year of tonsillectomy: seventeen for alcohol abuse, one for marijuana, and one for alcohol/marijuana. There were no referrals for opiate misuse or abuse. Short-term, high-quantity opioid treatment of post-tonsillectomy pain in active duty adults does not result in long-term opioid misuse, as measured by substance abuse treatment program referrals within a year after surgery. This finding supports the appropriateness of adequate short-term narcotic medication treatment. The long-term readiness of these patients appears unaffected by long-term opioid misuse or abuse. Even with this finding, there is an institutional shift to multi-modality pain management and appropriate opioid reduction to further mitigate the risk of opioid misuse. Extrapolation of these findings to all adult tonsillectomy patients should be done with caution, as there are several protective factors in the active duty population such as stable full-time employment with mandatory random drug screening.

Medical Marijuana Dispensaries and Referrals for Child Maltreatment Investigations.

The changing legal status of marijuana in the United States has increased access to the drug through medical marijuana dispensaries. Limited research exists that examines the effects of these dispensaries on social problems including child maltreatment. The current study examines how medical marijuana dispensaries may affect referrals for child abuse and neglect investigations. Data are analyzed from 2,342 Census tracts in Los Angeles County, California. Locations of medical marijuana dispensaries were obtained through Weedmaps.com. Using conditionally autoregressive models, local and spatially lagged dispensaries show a positive relationship to rates of referrals in the unadjusted models. However, when we adjust for alcohol outlet density and measures of social disorganization, this relationship is no longer significant. Although this study does not find a relationship between medical marijuana dispensaries and referrals for investigations of child maltreatment, it should not be considered a definitive finding of this relationship. The increasing number of states that are allowing marijuana to be used for medical and recreational purposes is resulting in more people using the drug and the effects on parenting are still unknown.

101 Predicting and Estimating Burn Outcomes: A Single Institution Analysis of over 4000 Cases

Abstract Introduction Advances in burn care have improved patient outcomes, and independently validated indices, scores, and predictors of burn outcomes warrant re-evaluation. The purpose of this study is to consolidate predictors of burn outcomes and determine the factors that significantly contribute to length-of-stay (LOS) and mortality. Methods A retrospective review of all burn patients (n = 5778) admitted to a quaternary provincial burn unit from 1973 to 2017, was conducted. Removal of blank and pediatric entries yielded 4622 independent cases. Goodness-of-fit models and multivariate logistic regression was performed. Burn predictors included %TBSA, Baux (classic, revised) index, Abbreviated Burn Severity Index, and Ryan score. Primary outcomes were mortality and LOS. Variables considered in the multivariate logistic regression included: diabetes, hypertension, smoking, obesity, alcohol use, drug abuse, full-thickness burn, ventilator support, and ICU referral. Results Multivariate logistic regression for mortality showed the classic Baux index to be a significant predictor for mortality (OR = 1.118, p < 0.001). Other predictors included male sex, ICU referral, diabetes, smoking, and alcoholism (OR = 1.96, 4.97, 2.38, 1.63, 1.98, all p < 0.05). Interestingly, hypertension had a protective effect (OR = 0.24, p < 0.013). Linear regression for LOS found %TBSA, ICU referral, alcoholism, age, male sex, significant. The area under the ROC curve for Baux index was 0.945. Conclusions The regressions show that burn mortality and LOS are best predicted with the Baux index. Hypertension may have a protective effect on burn outcomes and may be attributed to increased perfusion to the periphery. Goodness-of-fit models, although variable, tended to show tighter grouping in patients with TBSA >20%. LOS ratios prove to be useful benchmarks for burn units with TBSA >20%. Similar findings are preliminary found in the NBR, national burn repository, database. Applicability of Research to Practice LOS ratios and burn index scores prove to be valuable markers to predict burn outcomes. The results of this study will directly help the clinician make decisions and communicate clinical severity to patient and family members.

The functional patterns of adolescent mothers leaving foster care: Results from a cluster analysis

AbstractFew studies have explored the outcomes of adolescent mothers leaving foster care, especially using person‐oriented methods. The current study employed a cluster analysis to identify unique patterns of functioning among adolescent mothers aged 19 (n = 777). Data from the National Youth in Transition Database and the Adoption and Foster Care Analysis and Reporting System were utilized. Findings revealed five subpopulations characterized by distinct constellations of outcomes at age 19. The largest group (43%) exhibited competent functioning across all the domains studied—its members were connected to school and/or employment and did not experience homelessness, substance abuse referrals, or incarceration during the past 2 years (i.e., “resilient”). A relatively small group (12%) exhibited challenges across all the above‐referenced domains, whereas the remaining groups presented challenges in some domains, but not in others. Follow‐up analyses revealed that adolescent mothers classified as resilient at age 19 had the lowest rates of congregate care placements and the highest rates of nonrelative foster care placements at age 17. Moreover, they had lower placement instability and higher rates of extended foster care as compared with members of the other clusters. Implications for practice, policy, and research are discussed.

Assessment of Rates of Child Maltreatment in States With Medicaid Expansion vs States Without Medicaid Expansion

Physical abuse and neglect affect a significant number of children in the United States. The 2014 Medicaid expansion, in which several states opted to expand their Medicaid programs, is associated with parental financial stability and access to mental health care. To determine whether Medicaid expansion is associated with changes in physical abuse and neglect rates. This ecological study used state-level National Child Abuse and Neglect Data Systems (NCANDS) data from January 1, 2010, through December 31, 2016, to compare the change in physical abuse and neglect rates in states that chose to expand Medicaid vs those that did not. All cases of physical abuse and neglect of children younger than 6 years during the study period that were referred to state-level Child Protective Services and screened in for further intervention after having met a maltreatment risk threshold were included. Cases with only documented sexual or emotional abuse were excluded. A difference-in-difference analysis was conducted from April 12, 2018, through March 26, 2019. State-level Medicaid expansion status. Incidence rate of screened-in referrals for physical abuse or neglect per 100 000 children younger than 6 years per year by state. Data were analyzed for 31 states and the District of Columbia that expanded Medicaid and 19 states that did not during the study period, with baseline neglect counts of 646 463 and 388 265, respectively. After Medicaid expansion, 422 fewer cases of neglect per 100 000 children younger than 6 years (95% CI, -753 to -91) were reported each year after adjusting for confounders for comparison of postexpansion and preexpansion rates in states that expanded Medicaid contrasting with the change during that time in nonexpansion states. From 2013 to 2016, Medicaid coverage for adults with dependent children increased a median 1.9% (interquartile range, 0.4% to 4.3%) in the states that did not expand Medicaid and 4.2% (interquartile range, 0.9% to 6.0%) in the states that did. No associations were found between Medicaid coverage or Medicaid eligibility criteria and physical abuse or neglect rates. Medicaid expansion was associated with a reduction in the reported child neglect rate, but not the physical abuse rate. These findings suggest that expanding Medicaid may help prevent child neglect.

85 Patterns of Child Maltreatment Referrals in Immigrant Populations

Children from immigrant families are at risk for decreased visibility, social isolation, language barriers, cultural differences, and financial hardship, which are risk factors associated with child maltreatment. To date, these are the first published Canadian data on this subject. To identify incidence patterns of child maltreatment in immigrant populations in comparison with non-immigrant populations. This study is a 3-year (2014 – 2016) retrospective chart review of child maltreatment referrals at our tertiary institution. Immigrant families were identified with the “English as a Second Language” field on the intake questionnaire, as a proxy for semi-acculturation. Chi-squared or ANOVA tests were used for categorical statistical analysis. Of a total 764 new referrals, 139 (18%) were from immigrant families and 625 (82%) were from non-immigrant families. Physical abuse referrals occurred at higher frequency than sexual abuse referrals in the immigrant group (63% and 24%, respectively) compared to the non-immigrant group (44% and 32%, respectively) (p < 0.01). Referrals for children 10 years of age or older occurred at higher frequency in the immigrant group (21%) compared to the non-immigrant group (12%) (p < 0.01), for which subgroup analysis showed a similar pattern in physical abuse referrals but not sexual abuse referrals (p < 0.01). Only 7 of 67 (10%) physical abuse referrals had claims of discipline based on different cultural values. A majority (54%) of immigrant referrals were assessed by a physician prior to referral, most commonly an emergency physician (74%), which was higher than disclosures to teachers (5%). Major risk factors affecting immigrant families include needing an interpreter (37%), the child being invisible in the community (34%), previous child protection agency involvement (21%), domestic violence (17%), financial stress (17%), and the family being socially isolated (16%). Ninety-six of 129 (74%) immigrant referrals were from postal codes with child poverty rates higher than the metropolitan average. Immigrant populations in this study have a different pattern of child maltreatment referrals, which may be attributable to a higher proportion of physical abuse referrals in older school-aged children. Physicians are an important gateway for detection of possible child maltreatment. Addressing common risk factors, such as language and visibility, may be useful in future screening and prevention efforts.

The impact of early childbirth on socioeconomic outcomes and risk indicators of females transitioning out of foster care

Few studies have documented the relationship between early childbirth and the adjustment of females transitioning out of foster care. In this study, data from the National Youth in Transition Database were used to evaluate the associations between childbirth at three time points (prior to age 17, ages 17–19, and ages 19–21) and females’ socioeconomic outcomes and risk indicators at age 21 (n=3173). Findings revealed that over 40% of females had given birth at least once by age 21, with a substantial increase in birth rates from adolescence to early adulthood. Multivariate analyses showed that childbirth between ages 17 and 19 and between ages 19 and 21 was associated with decreased likelihood of obtaining a high school diploma/GED or higher. However, only most recent childbirth (between ages 19 and 21) was associated with decreased likelihood of employment and increased likelihood of receiving public assistance. Contrary to the hypothesis, childbirth was unrelated to homelessness, substance abuse referrals and incarceration at age 21, once earlier presence of such risks was taken into account. Overall, while childbirth between ages 19 and 21 was linked to negative socioeconomic outcomes as females entered young adulthood, earlier births did not appear to confer a unique, prospective risk for the majority of the variables studied. These findings underscore the importance of expanding specialized services designed to promote educational and vocational opportunities for young mothers transitioning out of foster care, especially in the first years following childbirth. The importance of targeting foster youth for pregnancy prevention programs will also be discussed.

Protecting children in research: Safer ways to research with children who may be experiencing violence or abuse.

Children participating in research, like other children, may be being maltreated. There is also potential for exposure to abuse during research. Research training, practices and protocols to respond to disclosure and discovery of abuse to protect both researchers and children may not be sufficiently robust. Our aim was to compare and contrast research practices reported in the literature related to protecting children and to recommend safer ways to conduct research. The simultaneous increase in research with children, along with an increased willingness to listen to child victims of abuse, means that researchers must consider the protection of children in the research setting. Twenty-three papers were identified in a literature review. These studies reported a wide variation of ethical considerations, methods, methodology and came from different disciplines. From the 23 papers, two overarching themes were identified: social justice and research and safer research. To make research safer teams should consider training, safety protocols and support for child protection, which includes support to report safeguarding concerns to social care. Further work is required to ensure that training, protocols and support are effective in facilitating researchers to identify and make appropriate child abuse referrals. Ethics practices in abuse research need further debate.

Referrals to the police of vulnerable adult abuse

Purpose – The purpose of this paper is to examine the outcome of referrals made to one police force in England by three local authorities between March 2010 and April 2011, in order to identify and understand the barriers to prosecuting suspects of abuse or harm against vulnerable adults, and improve inter-agency co-operation. Design/methodology/approach – All referrals to this police force are given a crime number when they are recorded on the Criminal Justice System database together with a vulnerable adult flag and a status code which indicates the outcome following a police investigation. A search of the database using the vulnerable adult flag identifies the total number of referrals and outcomes for the selected period. This can then be imported into a Microsoft Excel spreadsheet to allow further analysis to take place. Findings – Over 87 per cent of all referrals of alleged abuse to vulnerable adults made to this police force did not establish that a crime had been committed. Of those that did only 1 per cent resulted in either a caution or court proceedings. Research limitations/implications – This is a small sample from one, predominantly rural, police force. Originality/value – The benefit of this research is that it contributes to a greater knowledge of the outcomes of adult safeguarding referrals made, primarily, by local authorities to the police and how police disclosures, on Disclosure and Barring Service checks, are being used as a means of providing employers of regulated activities with information on individuals who have been suspected of abusing vulnerable adults.

Functioning patterns among older adolescents in foster care: Results from a cluster analysis

Older adolescents in foster care represent a heterogeneous population, though such heterogeneity is often underemphasized in research and practice. This study employed a cluster analysis to identify subpopulations in a large, national sample of 17-year-old youth based on the following indicators: educational attainment, connection to a supportive adult, adolescent parenthood, homelessness, substance abuse referral and incarceration. Data from the National Youth in Transition Database (NYTD) and Adoption and Foster Care Analysis and Reporting System (AFCARS) were used in the analysis. Results revealed five subpopulations defined by specific strengths, vulnerabilities and child welfare experiences. The largest group identified (39%) functioned successfully in all domains, whereas an additional group (15%) exhibited consistent maladaptation. The remaining groups evidenced variable adaptation patterns, with strengths in some domains and challenges in others. Entry to foster care for reasons other than child's problem behaviors, and placement in stable, family-based settings were associated with belonging to the most adaptive group. Findings emphasize heterogeneity among older adolescents in foster care, and call for better design and targeting of child welfare services and programs as appropriate to the needs of specific subgroups.

A qualitative study of referring agents' perceptions of access barriers to inpatient substance abuse treatment centres in the Western Cape.

BackgroundDespite empirical support for the individual and public health benefits of treating substance use disorders (SUDs) , access to these services is impeded by several barriers. Although many studies on access barriers have been put forward in the literature, few have explored the barriers to accessing state-funded inpatient substance abuse treatment or the views of referral agents.MethodsA qualitative study was conducted to explore referring agents’ perceptions of the barriers to accessing state-funded inpatient substance abuse treatment centres in the Western Cape Province of South Africa. Six individual in-depth interviews were conducted and analysed using theoretical thematic analysis.ResultsThe key barriers to emerge from the analysis pertained to referring agents’ perceptions of the following: service users, the substance abuse referral and treatment system and community dynamics.ConclusionsRecommendations are made for interventions to address the identified barriers.

Correlates of Child Maltreatment Among Adolescent Mothers With Young Children

Child maltreatment and teen pregnancy are serious social problems facing America today. In 2010, 3.3 million referrals of child abuse and neglect resulted in approximately 461,297 confirmed victims. Teen pregnancy has similarly been a cause of serious political and social concern. Although the teen birth rate has declined overall during the last half century, the United States still has a higher teen birth rate than other industrialized countries. Young maternal age is generally considered a risk factor for child maltreatment. What is not known is what separates adolescent mothers who maltreat their children and those who do not. This study compares the ecological correlates of adolescent mothers who maltreat their children to adolescent mothers who do not maltreat. Implications for practice and future research are discussed.

Adolescent Parents in the First Wave of the National Youth in Transition Database

Adolescent parenthood occurs with relative frequency among youth in the foster care system. Few studies describe the characteristics of adolescent parents in foster care, or compare male and female parents, particularly using large, national samples. The present study used data from the National Youth in Transition Database (NYTD; N = 15,601) to document the number of foster youth who had children at age 17 years, the factors associated with adolescent parenthood, and the differences between male and female parents on general functioning indicators and use of Chafee services. Results revealed that 4% of males and 10% of females in the NYTD sample had children. Multivariate analyses indicated that for males and females alike, non-White race and Hispanic ethnicity were associated with increased likelihood of childbirth. Among males, the multivariate odds of being a parent increased substantially if they had a history of homelessness, substance abuse referral, or incarceration. Among females, only a history of incarceration was significantly associated with parenthood. Receiving Chafee-funded services was not related to either male or female parenthood. These findings highlight the high rates of adolescent parenthood among youth in foster care, particularly if other risk factors are also present. Practice implications and future research directions are discussed.

Collaborating across health and social care: joint funding an adult protection Coordinator post in Caerphilly, UK

Purpose – The purpose of the paper is to improve the consistency and quality of the response to vulnerable adults who experience abuse and neglect within NHS, independent healthcare and social care settings is noted by practitioners, agencies and patients. Health and social care policy frameworks promote principles of service improvement and consistency, along with a focus on outcomes and resource effectiveness and interagency collaboration. The Protection of Vulnerable Adults (POVA) coordinator role carries the responsibility of coordinating a response to individual referrals of abuse and neglect as described as part of the Designated Lead Manager role in the Wales Interim POVA Policy and Procedures for the POVA from abuse (Wales Adult Protection Coordinators Group, 2013). Design/methodology/approach – This paper will explore the benefits realised through a registered nurse being seconded from the Aneurin Bevan University Health Board into a newly created joint adult protection Health Coordinator post within the Caerphilly County Borough Council social services department POVA team. Findings – This is the first example of such partnership working in adult protection in Wales and has provided a number of benefits in relation to: providing adult protection advice; coordinating the response to referrals of vulnerable adult abuse and neglect within health and social care settings; carrying out or buddying others to complete adult protection investigations; facilitating the two day non-criminal POVA investigation training course and, awareness raising within the local Health Board. The development of a student nurse placement in the social services POVA team cements the multiagency collaborative approach that this development sought to achieve. Originality/value – The need to improve the consistency and quality of the response to vulnerable adults who experience abuse and neglect within NHS, independent healthcare and social care settings is noted by practitioners, agencies and patients.

Who Uses a Prescription Drug Monitoring Program and How? Insights From a Statewide Survey of Oregon Clinicians

Prescription drug monitoring programs (PDMPs) are relatively new but potentially useful tools to enhance prudent prescribing of controlled substances. However, little is known about the types of clinicians who make the most use of PDMPs, how these programs are incorporated into clinicians' work flow, or how clinicians and patients respond to the information. We therefore surveyed a random sample of Oregon providers, with 1,065 respondents. Clinicians in emergency medicine, primary care, and pain and addiction specialties were the largest number of registrants, but many frequent prescribers of controlled substances were not registered to use the PDMP. Among users, 95% reported accessing the PDMP when they suspected a patient of abuse or diversion, but fewer than half would check it for every new patient or every time they prescribe a controlled drug. Nearly all PDMP users reported that they discuss worrisome PDMP data with patients; 54% reported making mental health or substance abuse referrals, and 36% reported sometimes discharging patients from the practice. Clinicians reported frequent patient denial or anger and only occasional requests for help with drug dependence. More research is needed to optimize how clinicians use PDMPs across settings and how clinicians and patients respond to the data. PerspectiveThis study examined differences between PDMP users and nonusers and how clinicians in various specialties use PDMPs in practice. A better understanding of effective PDMP use will facilitate access to treatment for patients with pain while curbing the prescription drug epidemic and may ultimately reduce abuse, misuse, and overdose death.