Consultation Program Research Articles

Incorporating evidence-based behavioral teacher training into Head Start mental health consultation: Description and initial outcomes of a large-scale program.

Development of a multicomponent mental health consultation program for a countywide Head Start program is described. The consultation program incorporates strategies from the evidence-based practice, Teacher-Child Interaction Training (TCIT). Through large group professional development trainings before the school year, comprehensive feedback reports based on observations, and in-class coaching via modeling and performance feedback on teachers' use of TCIT skills, the consultation program served 55 Head Start classrooms with 789 children. Outcome data are presented on teachers' improvement in TCIT skill use and the relative effectiveness of two coaching methods (i.e., modeling and performance feedback) used during consultation. Results from multilevel modeling analyses indicated that teachers improved in the use of multiple observed TCIT skills between the initial and midyear assessment (i.e., increased frequency of labeled praises, reflections, behavioral descriptions, and commands that were complied with; decreased frequency of commands that children did not have an opportunity to comply with). Additionally, teachers who received coaching in the form of performance feedback, in comparison to modeling, exhibited greater gains in the frequency of labeled praises and commands that resulted in compliance. Discussion focuses on implementation of evidence-based practice in large-scale preventative early interventions, study limitations, and directions for future research.

RPS launches consultant pharmacist credentialing programme

RPS launches consultant pharmacist credentialing programme

Piloting a Community of Student Data Consultants that Supports and Enhances Research Data Services

Research ecosystems within university environments are continuously evolving and requiring more resources and domain specialists to assist with the data lifecycle. Typically, academic researchers and professionals are overcommitted, making it challenging to be up-to-date on recent developments in best practices of data management, curation, transformation, analysis, and visualization. Recently, research groups, university core centers, and Libraries are revitalizing these services to fill in the gaps to aid researchers in finding new tools and approaches to make their work more impactful, sustainable, and replicable. In this paper, we report on a student consultation program built within the University Libraries, that takes an innovative, student-centered approach to meeting the research data needs in a university environment while also providing students with experiential learning opportunities. This student program, DataBridge, trains students to work in multi-disciplinary teams and as student consultants to assist faculty, staff, and students with their real-world, data-intensive research challenges. Centering DataBridge in the Libraries allows students the unique opportunity to work across all disciplines, on problems and in domains that some students may not interact with during their college careers. To encourage students from multiple disciplines to participate, we developed a scaffolded curriculum that allows students from any discipline and skill level to quickly develop the essential data science skill sets and begin contributing their own unique perspectives and specializations to the research consultations. These students, mentored by Informatics faculty in the Libraries, provide research support that can ultimately impact the entire research process. Through our pilot phase, we have found that DataBridge enhances the utilization and openness of data created through research, extends the reach and impact of the work beyond the researcher’s specialized community, and creates a network of student “data champions” across the University who see the value in working with the Library. Here, we describe the evolution of the DataBridge program and outline its unique role in both training the data stewards of the future with regard to FAIR data practices, and in contributing significant value to research projects at Virginia Tech. Ultimately, this work highlights the need for innovative, strategic programs that encourage and enable real-world experience of data curation, data analysis, and data publication for current researchers, all while training the next generation of researchers in these best practices.

How Course-Embedded Consultants and Faculty Perceive the Benefits of Course-Embedded Writing Consultant Programs

How Course-Embedded Consultants and Faculty Perceive the Benefits of Course-Embedded Writing Consultant Programs

Maximizing Expertise and Collaboration to Support Students With Brain Injury: A Case Study in Speech-Language Pathology

Purpose Through a hypothetical case study, this article aimed to describe an evidence-based approach for speech-language pathologists in managing students with moderate-to-severe traumatic brain injury (TBI), particularly within a formal statewide-supported school-based brain injury team model, such as the BrainSTEPS Brain Injury School Consulting Program operating in Pennsylvania and Colorado. Conclusion Upon transitioning from the medical setting back to school, children with TBI present with unique educational needs. Children with moderate-to-severe TBIs can demonstrate a range of strengths and deficits in speech, language, cognition, and feeding and swallowing, impacting their participation in various school activities. The specialized education, training, and insight of speech-language pathologists, in collaboration with multidisciplinary medical and educational team members, can enable the success of students with TBI when transitioning back to school postinjury ( DePompei & Blosser, 2019 ; DePompei & Tyler, 2018 ). This transition should focus on educational planning, implementation of strategies and supports, and postsecondary planning for vocations or higher education.

Consultation, Surveillance, Monitoring, and Intensive Care (COSMIC): A Novel 4-Tier Program to Identify and Monitor High-Risk Obstetric Patients From the Clinic to Critical Care

(Anesth Analg. 2019;128(6):1354–1360) The majority of obstetric patients experience good outcomes from the birthing process. However, a small group of women develop serious morbidity or even die during pregnancy, labor, or delivery. This article described the consultation, surveillance, monitoring, and intensive care (COSMIC) program that has been implemented in the authors’ institution to escalate serious obstetric patient issues to the appropriate level of medical care. The goal of the COSMIC program is to optimize available resources for high-risk obstetrical patients in the most cost effective and efficient manner.

A Scoping Review of the Evidence About the Nurses Improving Care for Healthsystem Elders (NICHE) Program.

The Nurses Improving Care for Healthsystem Elders (NICHE) is a nurse-led education and consultation program designed to help health care organizations improve the quality of care for older adults. To conduct a scoping review of the evidence associated with the NICHE program to (a) understand how it influences patient outcomes through specialized care of the older adult and (b) provide an overview of implementation of the NICHE program across organizations as well as its impact on nursing professionals and the work environment. Six databases were searched to identify NICHE-related articles between January 1992 and April 2019. After critical appraisal, 43 articles were included. Four thematic categories were identified including specialized older adult care, geriatric resource nurse (GRN) model, work environment, and NICHE program adoption and refinement. Specialized older adult care, a key feature of NICHE programs, resulted in improved quality of care, patient safety, lower complications, and decreased length of stay. The GRN model emphasizes specialized geriatric care education and consultation. Improvements in the geriatric nurse work environment as measured by perceptions of the practice environment, quality of care, and aging-sensitive care delivery have been reported. NICHE program adoption and refinement focuses on the methods used to improve care, implementation and adoption of the NICHE program, and measuring its impact. The evidence about the NICHE program in caring for older adults is promising but more studies examining patient outcomes and the impact on health care professionals are needed.

Transcultural mediation programme in a paediatric hospital in France: qualitative and quantitative study of participants’ experience and impact on hospital costs

ObjectiveIn France, immigrants with chronic diseases encounter numerous difficulties in gaining access to care and then in its initiation and organisation, difficulties only partly explained by socioeconomic factors. A transcultural...

116.8: Organ donation in the Yunnan province in China- SEUSA program.

Background: As stated by the World Health Organisation (WHO) in 2010 every country is responsible for meeting their transplantation needs and that donation from deceased donors is the primary source of organs. Self-sufficiency in organ donation (OD) is every nation’s goal. Understanding OD as every patient’s right is the first step towards achieving the goal of self-sustainability in OD. The Yunnan province in China has made efforts to reach the self-sustainability. The main barriers faced are unbalanced healthcare infrastructure and coverage, complex political policies, insufficient public awareness, low religious engagement and shortage of trained healthcare professionals (HCP). The Donation and Transplantation Institute (DTI) has been cooperating with the Organ Procurement Organisation of First People’s Hospital of Kunming City (KMOPO) over the last four years for the establishment and consolidation of a deceased OD program. The SEUSA cooperation model has been the method followed when coordinating the project. Methods: SEUSA is a consultancy program addressed to countries, regions or local institutions to ensure self-sufficient transplant programs. Its methodology is based on a comprehensive model combining the best practices of the Spanish, European and USA models and it has been designed to be tailored to the local needs. The implementation of specialised training program for the HCP based on Transplant Procurement Management (TPM) model is fundamental in the SEUSA methodology. Starting in 2014 yearly TPM trainings have been organized targeting especially physicians and nurses involved in OD process. To add a stronger layer of supports the SEUSA will introduce regular DTI experts visits to the hospitals. Prior to the visits, Organ Donation Diagnostic Surveys (ODDS) are completed to assess the OD potential in each hospital. During the visits, interviews with HCP were conducted and an alert system for donor identification was outlined. Further recommendations for the establishment of in-hospitals organ procurement units were presented. Results: A total of 193 HCP, mainly from the high potential hospitals, have been trained as Transplant Procurement Managers (TPMs). The information collected by the ODDS showed high potential donor detection. The donation rate increased from 0.3 in 2014 to1.3 donor per million population in 2018.

1280. A Pharmacist-led PrEP Program at the Epicenter of the HIV Epidemic in Atlanta; Our Experience

BackgroundAtlanta, GA ranks third in the nation for highest rates of new HIV diagnoses, disproportionally affecting Black men and women. Pre-exposure prophylaxis (PrEP) is underutilized in this population due to multiple barriers to uptake, including limited access to PrEP delivery programs. The advantages of a primary pharmacy-led PrEP program include: relatively low service fees, perform and assess point-of-care testing, and provide adherence counseling. Similar programs across the United States have been shown to effectively increase PrEP uptake and optimize retention in care. Grady Health System (GHS), the fifth largest public hospital system in the United States, is located at the epicenter of the HIV epidemic: downtown Atlanta. It encompasses 11 different primary care clinics, accounting for 850,000 outpatient visits per year. In August 2018, we launched a developmental pilot of a GHS pharmacy-based tele-PrEP program, aiming to optimize PrEP access for vulnerable populations who would otherwise not be able to obtain it. PrEP services are provided directly to the community and through a consultative support program for all clinical sites within the GHS system. The key pilot interventions included developing a user-friendly electronic medical record (EMR)-based PrEP order sets and brief provider education interventions in 6 GHS primary care clinics, to increase PrEP awareness among non-HIV clinicians.MethodsWe conducted a retrospective process evaluation of the pilot PrEP program based on the PrEP continuum of care.ResultsOver 9 months, 95 referrals were received from providers within the GHS clinics. Of the 95 patients referred, 56 (59%) started PrEP. Two patients were started on post-exposure prophylaxis prior to initiation of PrEP. Forty-five patients (81%) remain on PrEP as of April 2019. Six clients were diagnosed with 9 STIs on screening (4 syphilis, 2 gonorrhea, 2 chlamydia, 1 lymphogranuloma venereum). There have been no HIV seroconversions in patients on PrEP.ConclusionUtilizing a pharmacy-based PrEP program to train and support clinical providers in a large, hospital system can facilitate PrEP uptake and retention for patients in primary care.Disclosures All authors: No reported disclosures.

1877. Evaluation of Antibiotic Utilization After Introduction of a Dedicated Infectious Diseases-Critical Care Medicine Service in Critical Care Units

BackgroundInfection is a leading cause of admission to intensive care units (ICU), with critically ill patients often receiving a high volume of empiric broad-spectrum antibiotics. Nevertheless, a dedicated infectious diseases (ID) consultation and stewardship team is not routinely implemented. An ID-Critical Care Medicine (ID-CCM) pilot program was designed at a large tertiary hospital in which an ID attending was assigned to participate in daily rounds with the ICU team, as well as provide an ID consult on select patients. We sought to evaluate the impact of this dedicated ID consultation and stewardship program on antibiotic utilization in the ICU.MethodsThis is an IRB-approved single-site retrospective study. We analyzed antibiotic utilization in the ICU during the post-intervention period from January 1, 2017 to December 31, 2017 and compared it to antibiotic utilization in the same ICU during the pre-intervention period from January 1, 2015 to December 31, 2015. Using Poisson regression analysis, we evaluated antibiotic utilization of each agent, expressed as days of therapy (DOT) per 1,000 patient-days, between the two groups.ResultsThe six most commonly used broad-spectrum antibiotic agents were included in the final analysis. During the intervention period, statistically significant reductions were seen in cefepime (131 vs. 101 DOT per 1,000 patient-days, P = 0.01), piperacillin-tazobactam (268 vs. 251 DOT per 1,000 patient-days, P = 0.02) and vancomycin (265 vs. 228 DOT per 1,000 patient-days, P = 0.01). The utilization of other antibiotics including daptomycin, linezolid, and meropenem did not differ significantly (Figure 1).ConclusionWith this multidisciplinary intervention, we saw a decrease in the use of the most frequently administered broad-spectrum antibiotics. Our study shows that the implementation of an ID-CCM service is a feasible way to promote antibiotic stewardship in the ICU and can be used as a strategy to reduce unnecessary patient exposure to broad-spectrum agents. Disclosures All Authors: No reported Disclosures.

The "CHROME criteria": Tool to optimize and audit prescription quality of psychotropic medications in institutionalized people with dementia.

Describe and validate the CHROME (CHemical Restraints avOidance MEthodology) criteria. Observational prospective longitudinal study. Single nursing home in Las Palmas de Gran Canaria, Spain. 288 residents; mean age: 81.6 (SD 10.6). 77.4% had dementia. Multicomponent training and consultancy program to eliminate physical and chemical restraints and promote overall quality care. Clinicians were trained in stringent diagnostic criteria of neuropsychiatric syndromes and adequate psychotropic prescription. Psychotropic prescription (primary study target), neuropsychiatric syndromes, physical restraints, falls, and emergency room visits were semi-annually collected from December 2015 to December 2017. Results are presented for all residents and for those who had dementia and participated in the five study waves (completer analysis, n=107). For the study completers, atypical neuroleptic prescription dropped from 42.7% to 18.7%, long half-life benzodiazepines dropped from 25.2% to 6.5%, and hypnotic medications from 47.7% to 12.1% (p<0.0005). Any kind of fall evolved from 67.3 to 32.7 (number of falls by 100 residents per year). Physicians' diagnostic confidence increased, while the frequency of diagnoses of neuropsychiatric syndromes decreased (p<0.0005). Implementing the CHROME criteria reduced the prescription of the most dangerous medications in institutionalized people with dementia. Two independent audits found no physical or chemical restraint and confirmed prescription quality of psychotropic drugs. Adequate diagnosis and independent audits appear to be the keys to help and motivate professionals to optimize and reduce the use of psychotropic medication. The CHROME criteria unify, in a single compendium, neuropsychiatric diagnostic criteria, prescription guidelines, independent audit methodology, and minimum legal standards. These criteria can be easily adapted to other countries.

Training plus intensive consultation improves uptake and outcome expectations of prolonged exposure therapy among practitioners treating emergency service personnel with post-traumatic stress disorder

Prolonged exposure (PE) therapy is an evidence-based psychological treatment of post-traumatic stress disorder (PTSD), yet uptake amongst practitioners is less than desirable. The aim of this study was to evaluate the efficacy of a PE training workshop plus intensive consultation programme to improve practitioners' self-efficacy and outcome expectations as well as uptake of PE for emergency service patients with PTSD. Forty-five psychologists attended a PE training workshop in Sydney. Participants completed questionnaires at pre- and post-workshop and six-month follow-up. The findings suggest that participation in the programme was associated with improvements in practitioners' beliefs in their ability to deliver PE to patients, an increase in their use of a range of PE components and an increase in their use of in vivo exposure with a greater proportion of patients. Effective training approaches for evidence-based treatments of PTSD should incorporate intensive consultation following training. Future studies should consider additional strategies to encourage practitioners to deliver PE to more patients with PTSD.

Training community providers in evidence-based treatment for PTSD: Outcomes of a novel consultation program.

Extensive research supports the use of prolonged exposure (PE) and cognitive processing therapy (CPT), for posttraumatic stress disorder (PTSD) in veterans and service members. PE and CPT have been disseminated nationally across the Department of Veterans Affairs (VA) facilities. Many service members and veterans receive care outside the VA where access to these gold standard psychotherapies can be limited. This paper presents a novel program developed to train community providers in the use of PE and CPT and their application to veterans with PTSD through the use of a medium-touch approach to consultation. Four 2-day trainings (2 in PE, 2 in CPT) were delivered to a total of 170 participants over an 8-month period. A subset of approximately 10 providers per training (n = 42) received 6 months of weekly, group phone consultation following the 2-day training. All providers were assessed pre- and posttraining, as well as 3 and 6 months after their training. Outcomes for the training workshop alone and the training plus 6 months of consultation were compared. While participant knowledge, t = -22.57, p < .001 and comfort (χ² = 74.00, p < .001) with PE and CPT significantly increased immediately following the 2-day training, those who received consultation were more likely to implement (χ² = 20.88, p < .001) and either complete or be close to completing PE or CPT with patients (χ² = 20.57, p < .001) 6 months following training. Despite some limitations, these preliminary data support that consultation is an important component to include in PTSD therapy training and implementation in the community. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

P1.10-08 The Usefulness of Inpatient Smoking Cessation Program at Single Cancer Center

Smoking is a well-known risk factor for the development of several diseases including cancer, but smoking cessation is a difficult problem even in patients who need hospitalization. The purpose of the study was to investigate the usefulness of inpatient smoking cessation consultation program. This study included patients who admitted to Chonnam National University Hwasun Hospital and were requested for Inpatient smoking cessation program by doctors or nurses from January to December 2018. We assessed the cessation rate at 4 weeks and 6 months, and evaluated clinical characteristics associated with success by electronic medical record system. Enrolled patients got counseling regularly for 6 months, and the success rate was confirmed by urine cotinine and exhaled carbon monoxide level. And we analyzed the differences of clinical characteristic and survival according to the registration status in lung cancer patients. A total of 571 patients were requested and 170 (29.8%) were enrolled to this program. One hundred thirty-eight (81.2%) patients had cancer and the majority was lung cancer (42.9%) followed by gastric cancer (11.2%). One hundred eleven (65.3%) patients were enrolled during their first admission. Only 6 (3.5%) patients took smoking cessation drugs in addition to counseling. The smoking cessation rate was 78.5% at 4 weeks and 39.2% at 6 months. The 4 week-cessation rate of cancer patients was higher than non-cancer (63.8% vs. 21.9%, p=0.000) and the rate of first admission group was higher than that of re-admission group, but it was not statically significant (67.0% vs. 47.8%, p=0.098). Also, the 6 month-cessation rate of cancer group was higher than non-cancer (45.7% vs. 3.8%, p=0.000) and the rate of first admission group was higher than that of re-admission, but not statically significant (49.3% vs. 29.4%, p=0.180). And 4 week-successful cessation group showed lower nicotine dependency than failed group (66.2% vs. 33.8%, p=0.046). In 155 of lung cancer patients, 73 (47.1%) were registered and 82 (52.9%) were refused. The registration rate of early stage group was higher than advanced stage group (83.3% vs. 34.4%, p=0.011). And the registration rate of operation group was higher than non-operation (64.5% vs. 42.7%, p=0.043) but the rate of chemotherapy group was lower than non-chemotherapy (41.2% vs. 58.5%, p=0.044). And the Progression free survival and Overall survival of registration group was better than refusal group, but not statically significant (p=0.199, p=0.215). Inpatient smoking cessation program was useful with high abstinence rate. Most patients could keep cessation without medication, so the diagnosis of cancer itself might be enough motivation. And smoking cessation after cancer diagnosis could improve survival rate in lung cancer.

Surge in Suicide Prompts Call For Diagnostic Category

Surge in Suicide Prompts Call For Diagnostic Category

Assisting, Instructing, Assessing: 21st Century Student Centered Librarianship

ABSTRACTFor librarians at the University of North Florida, there was a need to move beyond information literacy instruction to one-on-one and small group research consultations to aid in student success. By staffing the research desk with staff and students, librarians were able to open their calendars to allow more time for in-person, phone, and online consultations to aid in meeting the research goals of students at the institution. After assessing the research consultation program for two years, there has been a positive correlation between research consultation usage, satisfaction in completing assignments, and student success measures throughout the university.

Consultation with child psychiatrist helps reduce overprescribing and off‐label prescribing to foster youth

It may sound surprising that children are prescribed psychotropic medications without the involvement of a child psychiatrist — and that many of these medications are off‐label or overprescribed as a result — but that's what happens to foster children and other children in the child welfare system. A promising intervention for reducing overprescribing and off‐label prescribing to youth in state welfare systems is the involvement of child psychiatrists, according to a recent study, titled “Within‐Subject Change in Psychotropic Prescribing Patterns Among Youth in Foster Care Associated With a Peer‐to‐Peer Physician Consulting Program.”

The Patient-Pathologist Consultation Program: A Mixed-Methods Study of Interest and Motivations in Cancer Patients.

There is a wide disconnect between patients and the pathologists who make their diagnoses. Recent literature highlights successful programs in which patients meet with pathologists to review their pathology reports and see their tissue under a microscope. We do not know how many patients are interested in such a service, nor do we understand what drives interested patients to want to meet with their pathologist and what specific value it may provide. To quantify patient interest in a patient-pathologist consultation program and qualitatively assess motivations for patient interest or disinterest. Subjects were recruited from an academic cancer center and a local community cancer support group to respond to a survey about their interest in a patient-pathologist consultation program. Both online forms and paper surveys were available. The online survey was promoted via social media. There was a high level of patient interest, with 75% of respondents indicating they were definitely interested in a patient-pathologist consultation program. Key themes of interest were enhanced understanding of the diagnosis and disease, an opportunity to demystify the diagnostic process, and the perception that additional knowledge would empower the patient. In a select group of cancer patients, there is a very high level of interest in a patient-pathologist consultation program. Pathologists, clinicians, and hospital leadership should work together to pilot these programs in diverse settings. Additional quantitative work to scale interventions for the interested population and qualitative work to design effective, patient-centered consultation programs and to assess value are needed.

Child psychiatrist consult reduces inappropriate prescribing

It may sound surprising that children are prescribed psychotropic medications without the involvement of a child psychiatrist — and that many of these medications are off‐label or overprescribed as a result — but that's what happens to foster children and other children in the child welfare system. A promising intervention for reducing overprescribing and off‐label prescribing to youth in state welfare systems is the involvement of child psychiatrists, according to a study, titled “Within‐Subject Change in Psychotropic Prescribing Patterns Among Youth in Foster Care Associated With a Peer‐to‐Peer Physician Consulting Program.”