Agency Staff Members Research Articles

The use of psychotropic medication for the management of problem behaviours in adults with intellectual disabilities living in Canada

The paper provides a Canadian perspective on the use of psychotropic medication in the management of problem behaviours in adults with intellectual disabilities in Canada. Psychotropic medication and intellectual disabilities were explored in the context of Canadian health and social services, clinical practices, medical training and factors that have shaped these over the past few decades. Informal physician intellectual disabilities networks and the newly formed Canadian Network of the National Coalition on Dual Diagnosis provided the opportunity to survey the use of psychotropic medication for problem behaviours across the country. Geographic, political, cultural and other influences on the development of health and social services are described, as well as training requirements for physicians. Survey responses were received from all provinces and represented clinicians in mental health multidisciplinary teams, health and social services ministry representatives, agency staff (up to executive director level) and family members of individuals with intellectual disabilities. Psychiatry and family medicine perspectives of the authors from working in Canada and the UK with people with intellectual disabilities presenting with problem behaviours are described. In Canada there are no national, provincial or territorial policies or guidelines on use of psychotropic medication for the management of such behaviours. There are no requirements for physicians prescribing these medications to have training in the care of people with intellectual disabilities. Services for people with intellectual disabilities and behaviour problems in Canada appear to be more crisis‐reactive than those in the UK.

Fathering Agency Staff Members’ Perspectives on Domestic Violence Perpetration

To describe the perspectives of fathering staff regarding domestic violence (DV) perpetration. A cross-sectional survey of 85 fathering staff members was conducted to identify behaviors and barriers regarding inquiry about DV perpetration. Almost half (47.1%) of the surveyed staff reported never having identified DV perpetration. Routine inquiry was less likely if staff perceived low prevalence rates among their clients (odds ratio [OR] = 0.11, p = .001), did not have standard ways of asking (OR = 0.11, p < .001), or if they had never identified family violence before (OR = 0.07, p < .001). Increased years as a provider (OR = 6.62, p = .001) and DV training (OR = 7.29, p = .003) increased rates of DV perpetration inquiry. Staff of fathering agencies do not routinely screen for DV perpetration likely due to the interplay between individual and agency-level barriers. Appropriate training interventions can address identified barriers.

Local Rural Road Safety Audit Guidelines and Case Studies

The main goal of this study was to improve the safety performance of local rural roads in South Dakota by promoting road safety audits (RSAs) and by providing a toolbox of low-cost safety improvement strategies to county highway superintendents and local highway agencies. The study conducted RSAs at 12 selected sites along county highways, city streets, and township roads. RSA projects were selected through South Dakota Local Transportation Assistance Program promotion and commitments from South Dakota local agencies. The study exposed local governments to the concept and practices of road safety analysis. The study also provided a good opportunity for local highway agency staff members to participate and gain experience by working with road safety teams. This paper reports on the procedures and the results of the rural road RSAs and identifies guidelines to conduct RSAs on local rural roads to help local agencies identify, prioritize, and implement safety improvements.

Attitudes of Community Developmental Services Agency Staff Toward Issues of Inclusion for Individuals With Intellectual Disabilities

ABSTRACTIn many countries, the shift in policy surrounding intellectual disabilities (ID) from segregation to inclusion has resulted in the closure of large‐scale institutions in favor of integrated community programs and living accommodations. Because the success of the community inclusion movement lies in the hands of the staff who implement these programs, it is important to determine the consistency of their attitudes with the philosophies that underlie policy directions. Using the Community Living Attitudes Scale‐Mental Retardation, Short Form, the current study describes the attitudes of 241 staff working in the field of ID in Ontario, Canada, and examines demographic characteristics that are related to differences in their attitudes toward inclusion. The study found that male staff members' attitudes were less supportive of inclusion than were those of female staff. Moreover, staff members with only a high school education were less likely than those with university or college training to think that individuals with ID were similar to themselves. Finally, older staff members were more likely than younger staff to think that persons with ID should be sheltered from harm. The study showed that many community agency staff members do not hold attitudes that are entirely consistent with the inclusion philosophy and that differences in attitude are associated with their demographic characteristics. This study highlights the need for education and training targeted at particular “at‐risk” staff groups in order to ensure the successful implementation of the goals of the inclusion movement.

Variability in the implementation of Team Decisionmaking (TDM): Scope and compliance with the Family to Family practice model

Team Decisionmaking (TDM) is a method of making child welfare placement decisions that draws from the perspectives of family members, community representatives and agency staff members to determine the best placement options for children. This article compares three communities which had different experiences in their implementation of TDM. During the time of this study, the first experienced uneven TDM implementation due to changes in leadership; the second had enthusiastic implementation due to strong agency support; and the third had mature implementation because of a long history of TDM use. The three communities are compared in terms of qualitative analysis of interviews with key informants and quantitative analysis of TDM statistics and foster care placement trends. The study highlights the value of examining implementation from multiple perspectives to better understand what leads to effective implementation.

State Mental Health Policy: Mental Health Transformation: Moving Toward a Public Health, Early-Intervention Approach in Texas

This column describes a mental health system transformation initiative in Texas that aims to fully integrate mental health as a component of public health and early-intervention efforts. The process has included a formal needs assessment initiative and a broad-based interagency Transformation Workgroup made up of executive-level agency staff, consumers and family members, and representatives of the legislature and governor's office. Community collaboratives have been formed to instigate transformation at the local level. Major objectives include development of consumer and family networks, workforce development and training, and an improved data and technology infrastructure.

The CATCH Project: Central Mass Access to Child Health Information*

Parents of disabled children have substantial health and social care needs and therefore, a great need for information. Access to health information for parents and health professionals has been revolutionized by the Internet [1]; however, as Blackburn and Read note, “The provision of crucial information to parents of disabled children, at the time when they need it and in a form that they can use, is an intractable problem” [2]. Relevant health information can be difficult to find and is variable in quality [3]. How can medical librarians work with community groups, public health workers, and health providers to assist parents of chronically ill children find and obtain information? The Central Mass Access to Child Health Information (CATCH) project attempted to address this problem. CATCH targeted eleven public health agencies in central Massachusetts that serve chronically ill and/or developmentally disabled children and their families. Participants varied from early intervention centers to disease-specific agencies (Table 1). CATCH provided these community-based, public health agency staff members with training to locate and effectively use quality Internet health information. CATCH developed a model for outreach and collaboration as well as established new community partnerships for the Lamar Soutter Library (LSL) of the University of Massachusetts Medical School. Table 1 Targeted agencies TARGET POPULATION AND SIGNIFICANT ISSUES Massachusetts is home to approximately 221,840 parent-reported children with special health care needs, nearly 15% of children in the state (national average 12.8%) [4]. Previous projects have explored this population's need for health information [5, 6]. The Finding Information Resources and Services through Technology (FIRST) project, funded by the Massachusetts Department of Public Health and located in the UMass Memorial Children's Medical Center (CMC), served the information needs of families with chronically ill children from 1995 to 1999. Parents participating in the FIRST project stated that they need information about their children's health conditions beyond what physicians provide. When the FIRST project ended due to state budget cuts, CATCH filled the gap. CATCH targeted public health agencies in central Massachusetts (Figure 1) that serve children with chronic physical, developmental, behavioral, or emotional disorders and their families. To establish relationships with relevant organizations, project investigators identified community-based agencies in the New England Information on Disabilities Exchange (INDEX) database that serve children in central Massachusetts and invited these agencies to participate in the project [7]. Eleven agencies responded positively. Table 1 lists these agencies and their corresponding target populations (650 staff serving 25,000 children).

The Relationship Between Technology Content in a Masters of Social Work Curriculum and Technology Use in Social Work Practice: A Qualitative Research Study

SUMMARY In the past several years, Masters of Social Work (MSW) programs around the nation (USA) have been adding technology courses to their curriculums, suggesting the need for more technology education in MSW programs. Literature reviews of attitudes of social work faculty and social workers indicate a historic trend of resistance to use of technology in the field. In order to better understand the purpose of technology content in MSW curriculums and how it relates to social workers' use of technology in the field, this research project does a qualitative study among faculty and MSW graduates working at local human service agencies to answer the following exploratory research questions: (1) What is the technology content of an MSW Curriculum? (2) What is the purpose of the technology content in an MSW Curriculum? (3) What is the amount of technology use in human service agencies by MSWs? (4) When MSWs first come to human service agencies, do they have the technological competence needed? (5) What skills are they lacking (if any?) This exploratory study used three series of interviews and a syllabi and job description review in its methodology. The first set of interviews was with human service agency administrators who hire MSWs. The second set of interviews was with human service agency staff members who graduated with an MSW degree. The third set of interviews was with select faculty members in order to find out what the technology content and purpose is for MSWs. Syllabi from technology classes were analyzed. Job application descriptions from human service offices were also analyzed. To ensure the validity of the data, interviews with all sets of interviewees were tape-recorded.

The Curious Case of Off-Label Use

In United States, new drugs and devices cannot be marketed until Food and Drug Administration finds that they are safe and effective for their intended use. To obtain FDA approval, pharmaceutical and device manufacturers must submit extensive animal, in vitro, and human study data demonstrating safety and effectiveness. Agency staff members--often joined by an external interdisciplinary advisory committee--review research reports to evaluate quality of data and make essential risk-benefit judgments that determine whether a medical product is safe and effective. Drug and device companies spend many years and millions of dollars preparing data required for FDA approval. Although agency review process is imperfect, it does ensure that a company's claims about its product are closely scrutinized by independent scientists, physicians, and patient representatives. Safety is evaluated in light of product's specific purpose: Are therapeutic benefits valuable enough and likely enough to justify known risks posed by product? Effectiveness, too, is determined in light of product's specific purpose: Does it have desired impact on enough people with condition at which it is aimed? When FDA approves a product, officials approve a specific label for product, too. That label must contain detailed scientific information about product, including approved indications, dosage and method of administration, and use in specific populations. This rigorous and fine-grained regulatory approach to product evaluation is circumscribed, however. When Congress created FDA, members said that they did not intend for agency to regulate practice of medicine. Thus, FDA oversees only product manufacturers and commercial activities. This general regulatory stance explains curious case of off-label use. After FDA approves a drug or device for its intended use, physicians and other authorized practitioners may prescribe product for uses not covered by approved label. The FDA severely restricts manufacturers' freedom to promote products for unapproved uses. Companies that want to expand formally approved uses for their products must submit safety and effectiveness data and secure FDA approval for new uses. But FDA takes a hands-off approach to clinicians prescribing products for unapproved uses. As a result, drugs and devices are prescribed in circumstances not covered by initial product evaluation. Off-label prescribing occurs not just clinicians give products to people with conditions not listed on approved label, but they depart from approved drug dosage, method of administration, or patient population. Unapproved product combinations, such as using two different drugs to treat a single condition, are another form of off-label prescribing. Surveys show that off-label prescribing occurs routinely. For example, a study published last year examined prescribing practices for 169 commonly used drugs. Researchers found that about 21 percent were prescribed to patients with diagnoses other than those included on label. Off-label prescriptions were relatively common for cardiac drugs (46 percent), anticonvulsant drugs (46 percent), and asthma medications (42 percent). Researchers also found that about 15 percent of all drugs were prescribed for off-label uses with little or no scientific support. For some types of drugs, figures were unusually high. For example, 96 percent of off-label prescriptions for psychiatric drugs and 89 percent of those for allergy drugs were based on limited or no scientific evidence. (1) The Debate over Current Policy The FDA's hands-off approach to off-label prescribing has many supporters. One is American Medical Association, which says approach respects the autonomous clinical decision-making of a physician. Off-label use is defensible, according to AMA, when such use is based upon sound scientific evidence and sound medical opinion. …

Overcoming subject recruitment challenges: Strategies for successful collaboration with novice research agencies

In most studies, the investigator reaches out to locate potential research subjects using direct strategies such as targeted radio advertising, recruitment posters, and newspaper advertisements). However, other studies may depend on indirect methods of locating potential subjects and work through intermediary contacts in clinics and hospital outpatient departments. Some agency personnel may not have had prior experience with clinical research protocols and may be unfamiliar with screening potential subjects; these personnel are likely to be employed in agencies unaffiliated with academic health sciences centers. In cases in which agency staff members are new to clinical research, special attention is required to keep agency personnel updated about the status of the research and subject recruitment efforts. This article provides an overview of practical tips designed to engage and sustain the interest of novice research agencies in subject recruitment. The article concludes with a case overview of recruitment issues that occurred during a clinical trial addressing occupational low back pain. Copyright 2003, Elsevier Science (USA). All rights reserved.

The Gazebo Café Skills Training Program — A Multi-perspective Evaluation

Interwork Limited is an open employment service that aims to maximise participation of individuals in the open labour market. As part of its services Interwork offers a Gazebo Café Program. The aim of this research project was to evaluate the impact of the participation in the Gazebo Café Program (a work preparation and skills training centre), from the perspective of key stakeholders. The rationale for this evaluation was to provide the management team of Interwork with information to inform decision-making for future directions of the Café. The project was undertaken as partial fulfilment of the requirements for the degree of Bachelor of Applied Science in Occupational Therapy with Honours. In-depth interviews were conducted with three consumers, as well as two focus groups with four employment coordinators, and two referring agency staff members respectively. Analysis of the data revealed seven themes. The results suggested that participation in the Gazebo Café Program was a positive experience. Consumers felt they developed functional skills. Employment coordinators and referring agency staff emphasised the impact of the development of social and interpersonal skills. Opportunities to experience meaningful occupation while performing the work role, all within a natural and supportive community environment were valued impacts. Issues were raised relating to finding the right composition of consumers with and without disabilities, the affordability of the services for external users, and the current unavailability of accredited training. While the findings expand upon existing literature, they describe impacts of participation in a transition program for consumers that appear to not have been described elsewhere. Information is provided to other service providers in regards to the value and impact of such a program. Implications for open employment services are discussed.

Management support organizations and university partnership in nonprofit education, training and consultation

Over the last decade there has been a tremendous growth in the nonprofit sector. Local community centers and foundations are developing Leadership Institutes to educate and assist the burgeoning nonprofit sectors needs for education and consultation. Universities and colleges are also responding to the call for nonprofit education. Since 1990 there has been a 300% growth in universities offering concentrations in nonprofit education. This paper documents how Florida Gulf Coast University, the nation’s newest university, partnered with the Center for Leadership of the local community foundation to conduct a needs assessment of demand for graduate education, training, and consultation in the area of nonprofit management. The partnership began with three focus groups of key administrative personnel from local nonprofit organizations. The survey documented a preponderance of interest in marketing, fund raising and strategic planning across all agencies, regardless of size. Smaller agencies, with budgets of less than $500,000 (52% of the sample) tended to be primarily interested in education, training, and consultation activities involving fund raising and marketing. Comparatively larger agencies tended to be interested in assistance with computer technology, legal and ethical issues, and cooperation among nonprofit organizations. The survey also indicated that that was a high interest among agency staff and board members for a nonprofit management track within an academic degree program or a graduate certificate program in nonprofit management.

The Psychology of Accountability and Political Review of Agency Rules

This article uses literature on the psychology accountability to evaluate the likely impact of the various forms of political review on the quality of agency decisionmaking. It begins by briefly reviewing the basic findings of psychological research regarding the impact of accountability on decisionmaking. It next applies those findings to three mechanisms of political review: OMB scrutiny of cost-benefit analyses that accompany rules, congressional committee oversight of rulemaking, and congressional fast-track review. Finally, it discusses the implications of those findings, in particular addressing the contention of some scholars that judicial review is unnecessary in light of political review, and opining on the desirability of each political review mechanism. The analysis of the accountability provided by these mechanisms for political review suggests that each mechanism is likely to have some unique impact on the behavior of agency staff members who formulate agency rules. Of the three mechanisms, OMB review holds the greatest promise for improving the quality of staff decisionmaking. OMB, review, however, also can induce the agency to formulate economically conservative rules rather than rules that promise uncertain but potentially large benefits at a certain and significant cost, or to accede to direct White House pressure for a particular outcome. Traditional congressional oversight is unlikely to improve the care of agency staff analyses or the propensity of the staff to use inappropriate decision rules and to succumb to heuristic biases because Congress cares almost exclusively about outcomes rather than the process that the agency uses to formulate rules. For this same reason, traditional congressional review might induce the agency staff to become defensive about its initial rule preference or it might cause the staff to formulate a rule more in line with the preferences of influential congresspersons - for example chairs of oversight committees. Fast track review is the least likely of the mechanisms canvassed in this article to encourage significant change in agency decisionmaking because the agency does not know in advance which rules will actually be subject to fast track scrutiny after they are promulgated. The article concludes that, overall, none of the mechanisms for political review are capable of replacing judicial review as a means of improving the quality of agency rulemaking.

Cognitive Loafing, Social Conformity and Judicial Review of Agency Rulemaking

Those who have recently written about the impact of judicial review on agency decisionmaking have not treated the practice kindly. Many express concern about the burdens that review places on agencies, and some even conclude that judicial review hurts the quality of the decisions the agency makes when adopting a new rule. These critics, however, treat the agency and the particular decisionmakers within it as if they react as rational maximizers of utility towards the incentives created by judicial review. At most they give some passing reference to psychological constructs of how individuals and groups make decisions. This paper takes as a major premise that psychology has much to tell us about the ways in which decisions deviate from the assumptions that public choice theorists and others who rely on economic rationality use in evaluating the workings of our governmental institutions. Individuals do not tend to optimize every decision, but instead rely on personal decision rules whose use becomes habit as well as more generally shared rules of thumb as shortcuts to making decisions. In certain situations, these shortcuts can lead to avoidable bad decisions. One mechanism for avoiding careless or improper reliance on such shortcuts is to hold the decisionmaker accountable for her choice. If structured properly, accountability can attenuate many of the systematic biases that flow from improper use of decisionmaking shortcuts. The structure of beneficial accountability corresponds closely to the nature of judicial review of agency rulemaking under current standards of arbitrary and capricious review. There is also reason to believe that agency staff members react to judicial review of a rule as they do to direct accountability for an individual decision. In addition, arbitrary and capricious review is likely to reduce any magnification of individual biases that result from the group nature of agency decisionmaking. Hence, arbitrary and capricious review provides incentives for agency staff to take appropriate care and to avoid many systematic biases when formulating rules and ushering them through the rulemaking process. This does not mean that judicial review will eliminate all decisionmaking biases. There is at least one bias ? the propensity of individuals to avoid extreme choices even when logic dictate otherwise ? that judicial review might even exacerbate. In addition, review will never prevent all biased decisionmaking; it can only encourage decisionmaking processes that reduce the probability of bias. Finally, the psychological results which I discuss come predominately from laboratory experiments, some of which involve different individuals performing different tasks than those involved in writing agency rules. Hence, the suggestion that judicial review improves the quality of agency rulemaking must be seen as just that ? a suggestion. Nonetheless, I believe there is enough evidence to warrant further consideration of the likely impact of review on the performance on agency staff, and more particularly to refute critics who, without considering this evidence, conclude that judicial review has a deleterious impact on the quality of rulemaking.

Early evaluation results of a collaborative partnership.

Early evaluation results of a collaborative partnership.

Appropriate Use of the Child Abuse Potential Inventory in a Big Brothers/Big Sisters Agency

The present study investigated the utility of the Child Abuse Potential (CAP) Inventory in screening: volunteers for Big Brothers/Big Sisters (BBDS). CAP Abuse scores effectively discriminated between volunteers who were rated excellent versus bad by BBDS agency staff members and between volunteer applicants who were accepted versus rejected by traditional BBDS agency screening method. In a second study, 21 male sexual offenders against children completed the CAP. The CAP Abuse scores for 47% of these males were elevated, suggesting that the CAP alone is insufficient for screening: this disorder. It is useful only as Dart of a multimodal assessment program. Suggestions for incorporating the CAP into the BB/BS screening program are offered.

Enhanced Quality Through Outcome-Focused Standardized Care Plans

Methods to improve the quality of care are a national issue for home healthcare agencies. In comparison with the traditional process-focused care plans, outcome-focused care plans (OCPs) resulted in significantly better quality indicator scores for clients cared for by agency staff members. Although OCPs are a valuable tool for enhancing quality, tools are only as good as the individuals who use them. Before deciding to change to an OCP format, administrators must assess all resources needed to effect the change.

Staff reaction to NSF restructuring mixed

This week shapes up as a big one for the National Science Foundation. Foundation. Its director, Walter E. Massey, is expected to issue a statement outlining his views and priorities as director, and a long-range planning process for NSF. At press time, no further details were available. However, his statement couldn't come at a better time, because as one veteran staffer puts it, Never have I seen morale so low around here. Recent organizational changes have greatly upset agency staff members. When physicist Massey took over NSF early this year, staffers breathed a collective sigh of relief. His predecessor, Erich Bloch, was a hard-driving industrialist whose main purpose, it seemed, was to agitate in favor of engineering. Hopes ran high that Massey would let the agency settle into its post-Bloch era while shifting it back to its old basic science persona. That hasn't happened. Massey, it turns out, is carrying out an even bigger organizational revolution at NSF than Bloch ever conceived. At the same ti...

Benton MacKaye: The TVA years

It seemed like a match made in planners’ heaven. In April 1934, Benton MacKaye, a pre‐eminent American planner and conservationist, came to work for the newly‐created Tennessee Valley Authority (TVA), the nation's foremost experiment in resource and regional planning. The match, however, proved much less harmonious and fruitful than initially envisioned. Within 26 months, the ties were broken and MacKaye was asked to leave the agency. By the fall of 1936, he was back in his ancestral home in Shirley Center, Massachusetts. This paper describes MacKaye's unique planning concepts and analyzes how his ideas differed from mainstream agency thinking. It examines how his influence within TVA quickly waned, except for his role as a friend and mentor for a small group of young agency staff members who shared his environmental ideals. Finally, the article will explore why MacKaye, despite his intriguing ideas (or maybe because of them) failed to have a lasting impact on agency policies.

Understanding community participation: a health programme in the Philippines

The principle of community participation is so well recognized in international health circles that no declaration about primary health care is made without it. Yet in actually planning and implementing programs it is very difficult to find clear ways of following this principle. This paper analyzes the concrete aspects of community participation in the Munoz-community based health program a small non- government health program funded by Missionary Medical Actions (MEMISA - the Netherlands) and established in Munoz Nueva Ecija the Philippines. The program started as a parish-based charity clinic with a policy of free consultations and medicines but underwent a gradual evolution towards a mother and child health (MCH) program with a growing emphasis on the participation of the pregnant mothers and community health workers (CHWs) in the villages. The sponsoring agency staff members and CHWs agreed to strive for financial independence by the year 1990- 91. This would require better cooperation with the Rural Health Unit (the government public health sector) at the program level and a higher degree of community participation at the level of the community if the MCH-program was to be maintained after the discontinuation of external financial support. An intensive debate among staff members and CHWs revealed a lack of clear understanding of the concept of community participation. Specifically the absence of an insurance to assess the process of community participation resulted in a vague and unsatisfactory analysis of the situation. Recently an analytical framework for such an analysis has been developed which focuses on participation as a process enabling an assessment of participation to go beyond the limits of a merely quantitative analysis. It appears to be a useful instrument for analyzing community participation describing what has been achieved and identifying some of the elements that influenced this process. We have applied this framework retrospectively to our program examining the organization of the communities taking a needs assessment assessing resource mobilization and investigating management involvement of the community with self-management as a goal. (authors modified)