Changes In Placement Research Articles

Chronic Illness, Placement Stability, and Hospitalizations within Child Welfare: The Role of Initial Living Arrangement

Despite the high prevalence of chronic medical conditions among youth in child welfare, there is a paucity of research examining placement stability and frequency of medically-related hospitalizations for this vulnerable subpopulation. These questions are explored, with an emphasis on understanding the impact of initial living arrangement on each outcome. This study assessed 945 youth (ages 5–17) in out-of-home care within the Illinois child welfare system, using a matched sample of youth with (n = 318) and without (n = 627) a chronic medical illness. Placement stability and number of medically-related hospitalizations were compared between the two groups. Additionally, negative binomial regressions were used to assess the relationship between participant characteristics, type of living arrangement, and both placement stability and medically-related hospitalizations. Placement stability was not associated with having a chronic medical illness. However, stability was associated with initial living arrangement, with youth in kinship care having a lower likelihood of subsequent placement changes than youth in foster care or residential placements. Number of medically-related hospitalizations was significantly associated with having a chronic medical illness. Number of medically-related hospitalizations was also associated with type of initial living arrangement: kinship care showed a lower likelihood of hospitalizations than foster care or residential placements. Results provide preliminary evidence that kinship care should be prioritized for youth with a chronic medical illness over placement in foster care or residential settings, as kinship care showed higher placement stability and lower rates of medically-related hospitalizations for youth with chronic medical illness.

83.1 A Non-Hospital Continuum of Care Model for Youth in Mental Health Crisis

Mental health crises in youth often are triggered by psychosocial stress, such as conflicts with parents/caregivers and peers, school pressures, placement change, or trauma. In reaction, youth can quickly and often impulsively become suicidal/self-injurious or aggressive/destructive and engage in other risky behaviors. This often leads to psychiatric hospitalization or boarding in an emergency department (ED), with little to no form of mental health treatment. Such interventions, often far from home and with little contact with caregivers and other natural means of support, are disruptive, frightening, and stressful to the youth and family. The objective is to describe how a group of county stakeholders developed and implemented a continuum of nonhospital-based youth mental health crisis services.

Longitudinal follow-up of academic achievement in children with autism from age 2 to 18.

This study examined early predictors of and changes in school-age academic achievement and class placement in children referred for autism spectrum disorder (ASD) at age 2. Of 111 ASD referrals, 74 were diagnosed with ASD at age 18. Regression analyses were performed to identify age 3 predictors of achievement in arithmetic, passage comprehension, word reading, and spelling at ages 9 and 18. Linear Mixed Models were used to examine predictors of academic growth between ages 9 and 18. Academic skills varied widely at 9 and 18, but were mostly commensurate with or higher than expected given cognitive levels. However, 22% (age 9) and 32% (age 18) of children with average/above average IQ showed below/low average achievement in at least one academic domain. Children who remained in general education/inclusion classrooms had higher achievement than those who moved to special education classrooms. Stronger cognitive skills at age 3 and 9 predicted better academic achievement and faster academic growth from age 9 to 18. Parent participation in intervention by age 3 predicted better achievement at age 9 and 18. Many children with ASD achieve basic academic skills commensurate with or higher than their cognitive ability. However, more rigorous screening for learning difficulties may be important for those with average cognitive skills because a significant minority show relative academic delays. Interventions targeting cognitive skills and parent participation in early treatment may have cascading effects on long-term academic development.

Child strengths and placement stability among racial/ethnic minority youth in the child welfare system

While all children deserve a stable living environment, national data illustrate that many states struggle to achieve placement stability for youth in the child welfare system as a significant number of children in foster care continue to experience multiple placements while in state custody. Prior research has not considered the impact of youth protective factors or strengths on the frequency of placement changes that youth experience while in the child welfare system. This study examined the association between strengths measured at multiple levels (i.e., individual, family, and community) and placement stability among 4022 minority youth (aged 10–18) using administrative and clinical data from the Illinois child welfare system. Negative binomial regressions at the family level revealed that youth with at least one loving and supportive family member experienced 16% fewer placement changes than youth without family strengths. At the community level, youth attending schools that work to create an environment that meets its students’ needs experienced 13% fewer placement changes than youth without educational supports. These findings can inform the quality of treatment and services provided to minority youth in the child welfare system.

Reducing Radiation Exposure in an Electrophysiology Lab with Introduction of Newer Fluoroscopic Technology.

The use of fluoroscopic devices exposes patients and operators to harmful effects of ionizing radiation in an electrophysiology (EP) lab. We sought to know if the newer fluoroscopic technology (Allura Clarity) installed in a hybrid EP helps to reduce prescribed radiation dose. We performed radiation dose analysis of 90 patients who underwent various procedures in the EP lab at a community teaching hospital after the introduction of newer fluoroscopic technology in June of 2016. Watchman device insertion, radiofrequency ablation procedures, permanent pacemaker (PPM)/implantable cardioverter defibrillator (ICD) placement and battery changes were included in the study to compare radiation exposure during different procedures performed commonly in an EP lab. In all cases of watchman device placement, radiofrequency ablation procedures, PPM/ICD placement and battery changes, there was a statistically significant difference (<0.05) in radiation dose exposure. Significant reduction in radiation exposure during various procedures performed in an EP lab was achieved with aid of newer fluoroscopic technology and better image detection technology.

Experience of Self-Harm and Its Treatment in Looked-After Young People: An Interpretative Phenomenological Analysis

We report the first Interpretative Phenomenological Analysis examination of self-harm and experience of clinical services in young people in the public care system. Qualitative interviews with 24 looked-after young people were completed. Prevalent themes were 1) Changes in care placement, 2) Feelings of anger, 3) Not wanting/feeling able to talk, 4) Developing coping techniques, 5) Clinical services: A relational mixed bag (subthemes: feeling (i) patronized, not listened to, (ii) nothing being done, (iii) comfortable/able to talk). Placement change and anger were highly salient to self-harm in this group and experiences of clinical services depended on individual relationships with clinicians. Implications include increasing compassion in therapeutic relationships, recognizing and managing emotional dysregulation, and increasing support during placement changes.

Modeling Robotic Manipulators Powered by Variable Stiffness Actuators: A Graph-Theoretic and Port-Hamiltonian Formalism

This paper proposes a modeling method for generic compliant robotic manipulators. It is based on graph theory and the port-Hamiltonian formalism, which allows a modular approach to the interconnection of rigid bodies with compliant actuators by means of kinematic pairs. This modularity enables a simple and straight-forward adaption the model when a manipulator's actuator morphology is changed. An example of a spatial three degree-of-freedom manipulator shows that this modeling method is more suitable for modeling changes in actuator placement than the traditional Euler–Lagrange method.

When an object appears unexpectedly: foot placement during obstacle circumvention in children and adults with Developmental Coordination Disorder.

Adjustments to locomotion to avoid an obstacle require a change to the usual pattern of foot placement, i.e. changes to step length and/or step width. Previous studies have demonstrated a difficulty in individuals with Developmental Coordination Disorder (DCD) in controlling stability while both stepping over and while circumventing an obstacle. In a previous study, we have considered the way in which individuals with DCD prepare for the possibility of an obstacle appearing (Wilmut and Barnett in Exp Brain Res 235:1531-1340, 2017). Using a parallel data set from this same task on the same individuals, the aim of the current study was to investigate the exact nature of changes in foot placement during obstacle avoidance, as this was not clear from previous work. Children and adults aged from 7 to 34years of age took part in the study. Forty-four met the criteria for a diagnosis of DCD and there were 44 typically developing (TD) age and gender-matched controls. Participants walked at a comfortable pace down an 11m walkway; on 6 out of 36 trials a 'gate' closed across their pathway which required circumvention. These 6 'gate close' trials were analysed for this study. The number and magnitude of step length and step width adjustments were similar across the DCD and TD groups, however, the younger children (7-11years) made a greater number of early adjustments compared to the older children and adults (12-34years of age). In contrast the adults made a greater number of adjustments later in the movement compared to the children. In terms of foot placement adjustments a clear preference was seen across all participants to use adjustments which resulted in reducing step length, stepping away from the obstacle and a combination of these. Apart from subtle differences, the individuals with DCD make step placements to circumvent an obstacle in line with their peers. It is suggested that the choice of foot placement strategy in individuals with DCD, although in line with their peers, may not be optimal for their level of motor ability.

Relationship between femoral tunnel placement and serial changes in MRI of reconstructed ligament in double bundle ACLR 5 years postoperatively

Relationship between femoral tunnel placement and serial changes in MRI of reconstructed ligament in double bundle ACLR 5 years postoperatively

Were the student’s actions a manifestation of the student’s disability? The need for policy change and guidance

Under federal special education law, before a school district may discipline a student with a disability for greater than 10 days, it must first determine whether the student’s actions were a manifestation of his or her disability (IDEA, 2004). This requirement, referred to as manifestation determination review (MDR), aims to ensure that students with disabilities do not experience a significant disciplinary change in placement for actions that are caused by their disabilities. This article will discuss the evolution of the legal standard and the policy implications of a study that examined 80 MDR decisions in one large urban school district.

Anatomic Femoral and Tibial Tunnel Placement During Anterior Cruciate Ligament Reconstruction: Anteromedial Portal All-Inside and Outside-In Techniques

Tunnel malposition is one of the most common technical reasons for anterior cruciate ligament reconstruction failure. Small changes in tunnel placement can result in significant differences in outcome. More anatomic placement of the tunnels can lead to greater knee stability and a more accurate reproduction of native knee kinematics. This Technical Note describes 2 tibial tunnel–independent methods to obtain anatomic femoral tunnel placement. The all-inside anteromedial portal technique requires only minimal surgical incisions but allows precise femoral tunnel placement. However, hyperflexion of the knee is required, adequate surgical assistance is necessary, and this technique may be susceptible to graft-tunnel mismatch. The outside-in technique may be more beneficial in obese patients, skeletally immature patients, or revision cases. On the downside, it does require an additional 2-cm surgical incision. This article also provides surgical pearls to fine-tune tibial tunnel placement.

State-Level Analysis of School Punitive Discipline Practices in Florida

The purpose of this study was to identify statewide trends in school approaches to student discipline and examine the associations between punitive discipline practices and student, school, and local education agency (LEA) characteristics. In addition, we compared punitive disciplinary practices for schools and LEAs that do and do not allow corporal punishment. Publicly available data from the 2010–2011 Florida Department of Education and Common Core of Data were used to assess associations between (a) punitive discipline practices (i.e., suspensions, expulsions, restraints, corporal punishment, and changes of placement) and student characteristics (i.e., grade level, gender, and race), (b) punitive discipline practices (without corporal punishment) and school and LEA characteristics, and (c) school use of corporal punishment and school and LEA characteristics. Results of descriptive comparisons, tests of association, and multilevel regression analyses indicated that schools with higher ratios of (a) students receiving free and reduced lunch and (b) Black or African American students more frequently employed punitive discipline practices, and that punitive discipline practices were disproportionately used with males and Black or African American students. We provide additional results and implications for research, policy, and practice.

EXPERIENCE AND PRACTICE IN CARRYING A HEAVY, UNILATERAL LOAD: FOOTPRINT EVIDENCE

Although a significant amount of research has examined the biomechanical effects of carrying a load on human walking, most has focussed on fore and aft loads, or evenly balanced loads. In addition, most research on human walking no longer considers footprint analysis, despite its ease of use and its effectiveness in studies of balance. However, one project, with a small number of subjects, suggested that people carrying a heavy load in one hand (e.g., a suitcase or toolbox) make two sorts of adjustments to the placement of their feet on the substrate. The first and most obvious change is a decrease in foot angle (in-toeing) on the unloaded side. This puts the anterior part of the foot further under the center of mass when carrying a load in the contralateral hand and has been amply documented in subsequent studies. The second and more subtle change is a decrease in step width, a practice which also moves the foot on the unloaded side closer to the center of mass. However, tests subsequent to the original study did not show a consistent or significant use of this technique. This discrepancy between original and subsequent results in step width can be explained by the level of expertise which various subjects have. Experience carrying heavy loads may be required for most subjects to develop ways of accommodating loads. For this project, subjects were tested under two conditions: carrying an empty canvas bag; carrying the same bag with 21% of their body weight in it. All subjects walked on paper runners, wearing paint-soaked socks to leave footprint trails. Subjects were asked to walk once with no weights followed by three more times with weights. They were then given 10–15[Formula: see text]min of practice with the weighted bag, then asked to repeat the protocol, for a total of eight trials (two unweighted and six weighted). Foot angle and step width were measured for all trials. Results show that practice does indeed make a difference in the use of a narrower step when carrying a heavy load. Specifically, the first three weighted trials show a decrease in step width that is nonsignificant, but the last three evince a significant reduction as compared to unweighted trials. In addition, lifetime experience carrying a heavy load led to more immediate changes in foot placement. We conclude that the initial study involved subjects who already had experience carrying a unilateral heavy load and that, as with other activities, mechanically more effective movements are acquired with greater experience and practice.

On Random and Multidimensional Channel Effects in Cluttered Environments

Machine-to-machine devices have the potential to be placed in environments that are less than ideal for wireless propagation, such as factory floors or within metallic enclosures. In this letter, we illustrate that such environments not only produce the expected multipath, but can also depolarize the signal across all three spatial dimensions. Furthermore, we show that these effects are multidimensional in which they are highly sensitive to extremely small changes in user placement and frequency of operation. That is, these channels exhibit randomness based on a user's action. These effects motivate new channel characterization approaches and metrics along with the development of tripolar antenna designs. This letter concludes by presenting the efficacy of such a prototype antenna.

The Mapping-Adaptive Convolution: A Fundamental Theory for Homography or Perspective Invariant Matching Methods

If the local area of a three-dimensional object surface can be considered as a plane, the deformation between its two images captured from different camera placements is modelled by a homography. By tuning the parameters in a homographic mapping, all possible deformations caused by the change of camera placement can be simulated for the local feature matching method. Since aliasing may happen when resampling the original image to the geometry of the simulated image, an antialiasing convolution must be applied before resampling. However, the antialiasing convolution itself must also be homography-adaptive. In the scale invariant feature transform (SIFT) or affine-SIFT (ASIFT) method, the similitude or affine rectification scheme of the convolution is applied to solve this problem under similitude or affine mapping. However, these schemes will not work under homographic or perspective mapping. Although the perspective invariant matching method (perspective-SIFT or PSIFT) has been proposed in some references...

Making the McMOST out of Milestones and Objectives: Reimagining Standard Setting Using the McMaster Milestones and Objectives Stratification Technique.

As we enter the era of milestones and competency-based medical education (CBME), there is an increasing need to examine the procedures for stratifying objectives into levels of achievement. Most techniques used to date (e.g., Delphi surveys) involve some sort of consensus-based process, essentially crowd-sourcing wisdom of multiple educators to set anticipated milestones. In most graduate education settings, however, many simply use the judgment of one or two educators when setting educational objectives. Meanwhile, standard-setting procedures have been historically used in medical education for setting cut-points to determine levels of acceptable performance and do so in a more robust manner. Inspired by these standard-setting procedures, the authors sought to develop a new way to stratify objectives into three relative levels of achievement (junior [ACGME level 1], intermediate [ACGME level 2-3], senior [ACGME level 4]). The authors describe a novel, stepwise method that is composed of four steps. There are four steps to the McMOST procedure: 1) sorting objectives with a group of experienced teachers, 2) factor analysis to group preferences, 3) labeling components and reorganizing groupings, and 4) confirmation and final review by educational and content experts. Using McMOST method resulted in a change of placement for 15 of 34 (44%) of the milestones and improved agreement in two of three levels (intermediate from intraclass correlation of 0.56 to 0.80; senior from 0.69 to 0.79). The authors describe a novel protocol for stratifying objectives that may be useful to stratify and sort competencies into various levels of achievement (e.g., milestones) in this era of CBME.

Unaccompanied migrant children in the United States: Predictors of placement stability in long term foster care

Tens of thousands of unaccompanied children have migrated to the United States in recent years, particularly from Central America, but also from a range of other countries. These children are fleeing unprecedented levels of violence in their home countries, and often are seeking reunification with parents and family members (i.e., sponsors). Some children are not able to live with a sponsor, and these children are placed in federally funded foster care. Yet, virtually nothing is known about how these children fare during placement. Literature related to domestic child welfare has demonstrated the importance of placement stability to children's future well-being. Using an exploratory design, the purpose of this study is to examine the placement stability of unaccompanied youth while in long term foster care from 2012 to 2015, and how pre-migration, transit, and post-placement risk factors are each associated with placement changes for these children (n=256). Results show that experiencing violence in home countries, and significantly acting out while in care, were associated with a higher likelihood of changing placements. Migration-related trauma was not significant, but fear of returning to home countries, and suffering trauma unrelated to migration, each was associated with a lower likelihood of changing placements. Children from Northern Triangle countries (El Salvador, Guatemala, and Honduras) were more likely to have experienced a failed family reunification prior to entering foster care. These results are discussed in light of the need to adopt a global perspective in child welfare that interprets children's behavior in the larger context of pre-migration experiences and culture.

Data Sharing Between Providers and Quality Initiatives Eliminate Unnecessary Nursing Home Admissions

BackgroundThe Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) has monitored discharge disposition, after total hip and knee arthroplasties, since inception in 2012 and found the standardized risk of extended care facility (ECF) placement to be highly variable between hospitals. MethodsThe variation in standardized risks of ECF placement among MARCQI member sites was reported to the collaborative. At the May 2, 2014 quarterly meeting, a quality initiative was started, emphasizing the wide variability between hospitals, the contribution of hospital and surgeon to that variability using median odds ratios, and the need for outlier hospitals to initiate quality improvement (QI) processes. Patients from 29 hospitals that were members of MARCQI before the intervention were included in this analysis. We compared standardized risks before and after the intervention in the entire cohort, and for 3 hospitals that implemented institution-specific QI projects. We report changes in ECF placement, length of stay, emergency room visits, and readmissions over time. ResultsThis study includes 31,347 patients before and 20,879 patients after the implementation of the quality initiative. The range in standardized risk dropped from 9.4%-46.1% to 9.4%-32.4% and the average dropped from 23.0% to 19.6%. Three outlier hospitals decreased their absolute risk of ECF placement by 12.2%, 8.9%, and 12.4% after QI, without increases in adverse outcomes. ConclusionDischarge to ECF after primary hip and knee arthroplasties is highly variable and influenced by hospital and surgeon practices. Hospital-level QI measures can decrease ECF admissions.

Can Parenting Intervention Prevent Cascading Effects From Placement Instability to Insecure Attachment to Externalizing Problems in Maltreated Toddlers?

Multiple placement changes disrupt continuity in caregiving and undermine well-being in children in child welfare. This study conducted secondary data analysis of a randomized controlled trial to examine whether a relationship-based intervention, Promoting First Relationships(©) (PFR), reduced risk for a maladaptive cascade from placement instability to less secure attachment to elevated externalizing problems. Participants included caregivers (birth or foster/kin) of toddlers (10-24 months) recently transitioned to their care because of child welfare placement decisions. Although main effects of PFR on security and externalizing problems were not previously observed, this study's results revealed that PFR attenuated the association between multiple placement changes (baseline) and less security (postintervention) and that the indirect effect of placement instability on greater externalizing problems (6-month follow-up) via less security was evident only in toddlers in the comparison condition. These findings shed light on how a history of multiple caregiver changes may influence toddlers' risk for poor adjustment in subsequent placements, and the promise of supporting caregivers through a parenting intervention to prevent such risk.

Foster care placement change: The role of family dynamics and household composition

Sibling co-placement and kinship care have each been shown to protect against the occurrence of placement change for youth in substitute care. However, little is known about the effects of different combinations of sibling placement and relative caregiver status on placement change. Nor does the field fully understand how family dynamics may differ in these households. Utilizing data from the Supporting Siblings in Foster Care study, this paper examines family dynamics across four typologies of living composition, and tests the effects of living composition membership on the odds of experiencing a placement change over an 18-month period of time. Findings suggest that across living composition typologies, children who were placed separately from their siblings in non-relative care were more likely to be older, have more extensive placement histories, and experience more placement changes both prior to and during the study than were children in other living composition groups. Family living composition was found to influence the occurrence of placement change. Specifically, children co-placed in kinship care were least likely to experience movement; however, sibling co-placement in non-relative care was also protective. Results reveal the need to conduct additional research into the experiences of children in different family living arrangements, and tailor case management services and supports to children in substitute care accordingly. Implications and future directions are discussed.