Individual Services Research Articles

Gender Incongruence in Danish Youth (GenDa): A Protocol for a Retrospective Cohort Study of Danish Children and Adolescents Referred to a National Gender Identity Service

Background/Objectives In recent years, the national Gender Identity Service for individuals under 18 years of age in Denmark has seen a considerable increase in referrals of youngsters during puberty. Given this development, it is important to deepen our understanding of the characteristics of contemporary youngsters seeking help for gender incongruence. This understanding can serve as the foundation for improving current treatment regimens by ensuring optimal individual assessment and care. In this study, we aim to describe the sociodemographic characteristics, health profiles, and treatment trajectories in detail, as well as any changes in these characteristics, of all transgender and gender-diverse youngsters referred to the Gender Identity Service in Denmark from 2016 through 2022. Methods: This is a retrospective observational study of a national cohort comprising all individuals under 18 years of age referred to the Danish Gender Identity Service from 1 January 2016 to 1 January 2023. We will use data from medical records obtained at routine visits from the first assessment through repeated visits. Data on demographics, physical and mental health profiles, and information regarding gender identity will be collected and analyzed. The characteristics of those individuals who progressed to hormone therapy will be compared to those who did not. Results: This study aims to enhance our understanding of the characteristics and needs of contemporary youngsters with gender identity issues. Conclusions: The scientific evidence for the assessment and treatment of gender incongruence in youngsters is limited. The characteristics of youngsters seeking healthcare for gender incongruence today may differ from earlier.

“Knowing and Working With Someone Who Has Made It Means I’m Going to Make It Too”: Experiential Knowledge as a Catalyst for Transformation in Reentry and Beyond

Of the 2.2 million adults incarcerated in the United States, between 600,000 and 700,000 return to society annually. The U.S. federal evaluations reveal over a quarter of these individuals are rearrested within 6 months, while studies in more than 40 states find that close to half are reincarcerated within 3 years. Recidivism rates reveal a pressing need to understand reentry from the perspective of those who have experienced it. This study analyzes interviews with previously incarcerated individuals, identifying four key categories of experiential knowledge: impact of clinical staff, re-entry programming staff, mentors, and founder’s experiences. Experiential knowledge, and understandings acquired through direct personal experience, emerge as pivotal in supporting successful reintegration. The discussion highlights its impact beyond reentry, aligning with individuals’ aspirations to help others. By emphasizing the significance of experiential knowledge, conclusions advocate for its integration into re-entry programs to enhance support and services for justice-involved individuals.

Diabetic Retinopathy Detection with Deep Learning Techniques on Fundus Photographs: A Review

Diabetic retinopathy (DR) is an ocular condition that can affect individuals with diabetes mellitus (DM) and may lead to reduced vision or even blindness if not detected on time. Delay in diagnosis and disagreement in interpretation of retinal images by different health experts are some of the challenges that can occur during screening for DR. Deep learning (DL) techniques are currently used for classification of images across various domains including the ophthalmic imaging field. The implementation of this cutting edge technology for detection of DR could lead to improvement of existing eye care services for diabetic individuals. This paper discussed the publicly available datasets of retinal images of diabetic individuals used for training DL models. The efficiency of several convolutional neural networks (CNNs) created for the detection of different classes of DR was also reviewed. Furthermore, the achievements and the challenges faced in the application of DL techniques for the DR detection were discussed. Finally, future works that can be performed in this research area has been suggested.

Children and Youth with Special Health Care Needs: Progress Towards More Family-Centered Systems of Care.

Children and youth with special health care needs have increasingly been included in community and society over the past 50 years. Changing definitions and programs in the education, health, and public health/Title V sectors document this greater inclusion. The most profound change was in the education system, with the passage of legislative mandates for inclusion and parental rights. Although the health system has no similar universal mandate, the sequential passage of Medicaid, Children's Health Insurance Plan, and the Patient Protection and Affordable Care Act led to expanded health care coverage with no pre-existing conditions and lifetime caps. Title V of the Social Security Act, originally passed in 1935, evolved from a focus on individual medical services to a public health systems approach focusing on building family-centered, coordinated, comprehensive care in community settings. Most of the changes in all the sectors are the result of the advocacy and engagement of parents and families; the Maternal and Child Health Bureau was a supportive and innovative leader for family-professional partnerships. Much work on understanding disparities across the sectors has led to more recent focus on equity.

Implementasi Program Bimbingan Karir dalam Kurikulum Merdeka Belajar di SMKN 3 Madiun

Aditya Yudha Wicaksono: "Implementation of the Career Guidance Program in the Independent Learning Curriculum at SMKN 3 Madiun". Thesis. Jakarta: Guidance and Counseling Study Program, Faculty of Teacher Training and Education, University of PGRI Madiun, 2024. This study aims to find out the first, to find out the level of student career planning when the career guidance program is in the independent learning curriculum, the second is whether there is a difference after being given a career guidance program in the independent learning curriculum. This research is a descriptive qualitative research. The subjects of this study included school principals, deputy principals for curriculum, vice principals for student affairs, counseling teachers and students at SMKN 3 Madiun. Data collection methods used are observation, interviews, and documentation. From the results of this study it can be seen First; The implementation of the counseling program at SMKN 3 Madiun is quite good. Judging from the implementation of information services where the teacher always provides information about the world of work and the industrial world, the counseling teacher always provides counseling services to their students through class hours determined by the classical service method, the counseling teacher is also ready to provide individual counseling services when there are students who experience problems. . Second; The implementation of the Merdeka Curriculum at SMKN 3 Madiun was carried out well. Judging from the curriculum program that has been implemented and compiled by several teachers, it is sufficient to facilitate the implementation of learning for teachers and streamline learning or material provided to students. Supporting factors for the implementation of student career planning are categorized as quite good, schools always support the implementation of student career planning by carrying out several activities such as EduFair or JobFair to determine student career plans whether they want to continue on to higher education or the world of work.

1.O. Scientific session: Trans & Gender-Diverse Individuals’ Mental & Behavioral Health Risks & Intervention Needs

Abstract Transgender and gender-diverse (TGD) individuals are at a greater risk for various poor mental and behavioral health outcomes than cisgender individuals, including higher rates of suicide, psychiatric diagnoses, and behavioral health problems. For example, research has documented a seven-fold increased risk for lifetime suicide attempts among young TGD people, compared with the general population. Less is known about the age of onset of such mental and behavioral health disparities and how these disparities may vary across other intersectional socio-demographic variables. It has been well-documented that trans and gender-diverse individuals often encounter discrimination and transphobia across various social, educational, professional, administrative, and healthcare settings. This discrimination, as highlighted in the literature, frequently poses obstacles to accessing both general and trans-specific healthcare services due to experiences of discrimination (e.g., misgendering, refusal of care, lack of adequate services). The right and ability to self-determine and the accessibility to gender-affirming care without discrimination are key to closing the gap in TGD individuals’ mental and behavioral health outcomes, and for them to live authentically and thrive. Tailored and affirming mental and behavioral health interventions to reduce these health inequities are pivotal for TGD individuals to achieve the highest attainable standard of physical and mental health: a key fundamental human right. Considerable gaps in the literature remain concerning the onset and determinants of gender identity-based health disparities and healthcare approaches that are respectful, inclusive, non-pathologizing, and grounded in human rights principles for TGD individuals. This workshop intends to address these knowledge gaps by delving into the mental and behavioral health needs of TGD individuals. The workshop seeks to further foster dialogue on strategies to overcome resistance to implementing approaches that uphold the human rights and well-being of these communities. Dr. Richard Bränström (Karolinska Institutet) will present a study that explores the age at which gender identity-based disparities in psychiatric diagnoses and treatment can be first identified. Dr. Gonzales (Vanderbilt University) will examine disparities in mental health and social determinants of health among TGD individuals with private insurance. Dr. Moleiro (Lisbon University Institute) will review TGD persons’ ways of identifying with the choices and trajectories in social, legal, and affirmative healthcare processes in Portugal. Dr. Lelutiu-Weinberger (Columbia University School of Nursing) will present findings from a study that assessed tobacco use and cessation attitudes, facilitators, and barriers to quitting, and intervention components and delivery modality acceptability among TGD individuals, as well as sexual minority individuals, in Romania to inform a tailored and affirming smoking cessation intervention. Key messages • Transgender and gender-diverse are at increased risk for a variety of poor mental and behavioral health compared with the general public. • There is a critical need to foster healthcare services for transgender and gender-diverse individuals that are tailored and affirming.

JA ImpleMENTAL Implementing the Belgian Best Practice on Community Mental Health system Reform

Abstract Mental health challenges affect more than one in six people across the EU. In order to support Member States to proceed with mental health care system transformation and suicide prevention JA ImpleMENTAL, was initiated on the request of Member States, on October 2021 under the European Union 3rd Health Program. The JA consists of 39 organizations from 21 countries, more than 180 persons are working. Two advisory bodies support the consortium and provide their insights and expertise, a stakeholder forum with 10 key European Organizations in Mental Health including EUPHA Mental Health Section and WHO Europe and OECD, and the Member State Policy Committee which ensures the involvement of ministries and enables the practices to be embedded in health systems. Within the 11 countries implementing pilots under the Belgium model using a common Implementation Strategy, a total 163 activities are implemented under the 5 following key areas: 62 on structural measures needed for the establishment of local networks promoting a user’s centered, human’s right based recovery approach, 43 for the development and/or transformation of mental health services, 22 on training & capacity building in support of the reform and cultural change, 22 on continuous communication, information and awareness raising, and 13 on data collection, monitoring and evaluation. An analysis of MS pilot action plans shows that most service transformation efforts have concentrated on: defining care pathways for people at risk and for those with mild to severe mental health conditions including smooth transition from child and adolescent to Adult Mental Health services, as well as from inpatient to community services, the nomination of case managers for assisting individuals to their recovery process the development of individual service plans, the Involvement of users in various layers of service delivery including peer support and the provision of assertive treatment through mobile units.

Gambaran Kecenderungan Perilaku Self Injury pada Siswa SMP

This research is motivated by the phenomenon of junior high school students who have difficulty channeling negative emotions when facing problems. Self-injury behavior will have a negative impact on students, therefore students are expected to be able to carry out positive activities to vent their negative emotions. The objectives of this study are (1) to describe the tendency of students' self-injury behavior, (2) to describe the tendency of students' self-injury behavior from the environmental dimension, (3) to describe the tendency of students' self-injury behavior from the biological dimension, (4) to describe the tendency of students' self-injury behavior from the cognitive dimension, (5) to describe the tendency of students' self-injury behavior from the affective dimension and (6) to describe the tendency of students' self-injury behavior from the behavioral dimension. The method used is quantitative descriptive, with a sample of 49 students and the instrument used is a self-injury behavior tendency instrument with a Likert scale. The results of the study showed that: (1) the tendency of self-injury behavior in students as a whole is in the moderate category (56.44%), (2) the tendency of self-injury behavior in students from the environmental dimension is in the moderate category (55.10%), (3) the tendency of self-injury behavior in students from the biological dimension is in the moderate category (61.22%), (4) the tendency of self-injury behavior in students from the cognitive dimension is in the low category (48.98%), (5) the tendency of self-injury behavior in students from the affective dimension is in the moderate category (42.86%) and (6) the tendency of self-injury behavior in students from the behavioral dimension is in the moderate category (46.94%). Based on the results of this study, it is recommended that guidance and counseling teachers provide services to reduce the tendency of self-injury behavior in students in the form of information services, individual counseling services, group counseling services and group guidance services.

Sistem Layanan Metrologi Legal Terpusat Berbasis Web

The development of information technology, especially in data management, can have a significant impact on improving efficiency and effectiveness in legal metrology services. Technological transformation not only changes how information is obtained but also fundamentally alters service systems for the public. A centralized web-based Legal Metrology Service System is being developed to streamline administrative data management and enhance services for individuals applying for metrological calibration and re-verification. Therefore, this system is designed using the waterfall method, ensuring each development stage, from needs analysis to implementation and maintenance, is conducted in a structured and systematic manner. The primary objective of this research is to improve the quality of calibration and re-verification services in Legal Metrology at the Office of Trade and Industry in Jombang Regency. With this system in place, it is expected that administrative processes and data management in legal metrology will operate more effectively and efficiently, thereby delivering better services to the public.

Exploring the impact of population agglomeration on ecosystem services: an empirical study based on Fenhe River Basin

Abstract Since the 21st century, cities have experienced rapid expansion, posing serious threats to the health of non-urban ecosystems. It is generally believed that continued urbanization will put increasing pressure on ecosystems. However, in recent decades, the degree of population agglomeration and ecological environment have simultaneously increased in China. This paper takes Fenhe River Basin as the study area, measures the spatial Gini coefficient of population distribution (Gini) and ecosystem services in 165 sub-basins from 2000 to 2020, and adopts two-way fixed effects model to study the impacts of population agglomeration on ecosystem services and its mechanism. The results show that population agglomeration is positively correlated with the overall benefit (OB) of ecosystem services, and the effect is moderated by vegetation coverage, slope and distance from market centre, only when the values are greater than 0.198, less than 6.62° and 17.90 km, respectively, will the positive effects become apparent. The phenomenon of ‘people withdrawing and vegetation entering’ makes population agglomeration have significant impacts on individual ecosystem services and trade-offs and synergies. In order to give better play to the positive effect, the population needs to migrate from areas with worse geographical conditions and farther away from market centres to better places, and the return of farmland to forests should be accelerated in areas with population concentration. Following the laws of nature to promote population agglomeration and vegetation restoration, so as to achieve a ‘win–win’ situation between economic development and ecological civilization construction through the optimization of resource allocation.

Predictors of Outpatient and Inpatient Service Utilization Among Publicly-Insured Youth With Eating Disorders.

Although eating disorders (EDs) affect youth from all socioeconomic backgrounds, little is known about the treatment experiences of under-resourced youth with EDs. To address this gap, we examined patterns of outpatient and inpatient service utilization among publicly-insured youth with EDs in California and potential disparities for youth with additional marginalized identities. Participants were identified from the full sample of California Medicaid/Medi-Cal beneficiaries aged 7-18 with ≥ 1 service episode between January 1, 2014 and December 31, 2016. Claims data were extracted for youth with a full year of claims after the first known ED diagnosis (N = 3311) to analyze outpatient mental health, outpatient medical/physical, inpatient mental health, and inpatient medical/physical service use across ED diagnosis and demographic characteristics (sex, age, race/ethnicity, and preferred language). Outpatient individual and family therapy service utilization was low across ED diagnoses (4-7 individual therapy sessions and ≈5 family therapy sessions annually). Conversely, hospitalization rates were high, particularly among youth with anorexia nervosa (27.8%) and bulimia nervosa (30.0%). Youth with other specified feeding or ED had high medical service utilization, with more days of outpatient medical care and greater odds of medical hospitalization than youth with all other diagnoses. Latinx youth, Black youth, and boys tended to receive fewer services after accounting for diagnosis, with disparities particularly pronounced for Latinx youth. Publicly-insured youth with EDs in California experience high hospitalization rates but receive limited outpatient therapy. Additional research is needed to identify possible unmet needs and factors contributing to treatment disparities among these youth.

Organizational Strategies for Providing Foreign Language Education Services to Adults Over 45: International Practices and Approaches

Organizing educational services for people over the age of 45 is essential for their personal development, economic participation, social inclusion, and mental well-being. International and local legislation supports these initiatives, aiming to provide equitable and inclusive educational opportunities for all ages and to use the benefits of these people being fruitfully involved in the economic and social life of a country. The article aims to examine the strategies for providing educational services to adult learners (citizens over the age of 45) in different countries (European countries, the USA, Australia, China, Ukraine, Brazil, and Japan), with a focus on whether this process is integrated into social services and formal and informal education systems within the framework of the concept of lifelong learning. The methods included literature review on databases such as Google Scholar, JSTOR, and ERIC; comparative analysis of educational policy documents; case studies and reports from different nations; meta-analysis; field observations; and others typical to the field of comparative education and general education. They were utilized to provide a comprehensive and well-rounded analysis of how different countries organize and implement foreign language education services for adults over the age of 45. The findings reveal that the approaches to providing foreign language education for adults over 45 varies widely across different countries, reflecting each nation's unique historical traditions, cultural values, and current societal needs. This diversity in practice can be categorized into four main groups: services provided by social services; formal education systems; informal education systems; and self-organized services to present the prevailing approach to providing foreign language education for individuals over 45 in each country. The study concludes that the provision of foreign language learning services for individuals over 45 varies significantly across countries, reflecting diverse historical traditions, cultural attitudes, and current needs. Whether through social services, formal education systems, informal educational channels, or self-organization, each country’s approach highlights the importance of adapting educational services to meet the needs of an adult population seeking continued personal and professional growth.

Needs Companion: A Novel Approach to Continuous User Needs Sensing Using Virtual Agents and Large Language Models

In today’s world, services are essential in daily life, and identifying each person’s unique needs is key to creating a human-centered society. Traditional research has used machine learning to recommend services based on user behavior logs without directly detecting individual needs. This study introduces a system called Needs Companion, which automatically detects individual service needs, laying the groundwork for accurate needs sensing. The system defines a needs data model based on the 6W1H framework, uses virtual agents for needs elicitation, and applies large language models (LLMs) to analyze and automatically extract needs. Experiments showed that the system could detect needs accurately and quickly. This research provides interpretable data for personalized services and contributes to fields like machine learning, human-centered design, and requirements engineering.

Quality of life and mental health due to COVID-related lifestyle changes and sociodemographic characteristics among Asian Indians

PurposeTo examine quality of life (QoL) and mental health among Asian Indians in Southwest and Central-west Florida by COVID-related lifestyle changes, and demographic characteristics.MethodsQoL was assessed using SF-12 questionnaire while mental health/healthcare was assessed using the household pulse survey. Face-to-face interviews and self-administered online surveys were conducted among 151 participants in 2021–22. F and Chi-square statistics were used to examine the differences in QoL scores and mental health/mental healthcare by sociodemographic factors and COVID-related lifestyle changes.ResultsMental Component Summary (MCS) scores were lower for those who experienced changes in work expectations (p 0.041), sleep (p 0.002), exercise (p < 0.001), meditation (p.004) and connecting with family (p 0.007) and among those with family testing COVID positive (p.012). Mean Physical Component Summary (PCS) scores were lower for caregivers (p .008). PCS scores were lower for certain income groups (p 0.006), retired (p 0.004), older age groups (p 0.002). Lower MCS scores with college education (p .005), those who were students (p <0 .001), younger age groups (p < 0.001). Those who helped with homeschooling felt anxious (p 0.049), couldn’t stop worrying (p 0.046) and took medications (p < 0.001). Participants’ families who tested COVID positive were anxious (p = 0.019) and worried (p = 0.015). Those with greater work expectations sought counseling (p = 0.009) and those who connected more with their family were anxious (p = 0.008).ConclusionThe pandemic affected QoL, especially the mental component and increased anxiety and worrying. Mental health services for younger individuals, those with caregiving responsibilities and facing increased job demands must be prioritized.

Peer navigation intervention for individuals with serious mental illness reentering the community after jail incarceration: a qualitative case study

BackgroundCriminal legal system-involved individuals with serious mental illness (SMI) experience more challenges accessing mental health and other community services than those without a history of criminal legal system involvement. A formative qualitative study was conducted to explore feasibility and acceptability and inform the adaptation of a mental health peer navigation intervention for individuals with SMI reentering the community after jail incarceration.MethodsIn-depth qualitative interviews and focus-group discussions were conducted with mental health peer navigators (i.e., certified mental health peer support specialists, peer recovery coaches) and individuals with lived experience of SMI and criminal legal system involvement (N = 20 total). Data were analyzed using applied thematic analysis.ResultsFour major themes emerged: (1) Feasibility and acceptability of peer-provided services: all participants reported that peer navigation services would be feasible and acceptable for individuals with SMI reentering the community after jail incarceration; (2) roles of peer navigators in addressing barriers to care: peers can address barriers to care experienced during community reentry and contribute towards service linkage/engagement; (3) shared identity and combating stigma: having a shared identity with peer navigators may minimize the impact of stigma and make it easier for clients with multiple marginalized identities to seek support; and (4) peer navigator skills and recommendations for the planned program: essential peer navigation skills include authenticity, reliability, active listening, advocacy, trauma-informed care, motivational interviewing, and empathy. Recommendations for the planned program include initiating services while clients are in custody, emphasizing the voluntary nature of peer support, knowing the limits of a peer navigation intervention, and offering support for peer navigators while on the job.ConclusionParticipants saw peer navigation services for individuals with SMI with criminal legal system involvement as potentially feasible and acceptable. Such programs may enhance their impact by offering supportive supervision, emphasizing the voluntary nature of the service, and acknowledging recovery as a self-directed endeavor.

Study on the Value of Ecosystem Services and Land Use Change in the Area North of the Tianshan Mountains from 2000 to 2020

The northern Tianshans region in the arid zone of northwestern China plays a key role in promoting high-quality development of the ecological environment. In recent years, ecological environmental protection in this region has encountered major challenges due to the dual impacts of human activities and natural changes. In order to accurately assess the current status of the ecological environment in the northern Tianshans, this study analyzed the spatial and temporal changes in land use and ecological and environmental effects using land use data from 2000 to 2020 and explored the current status of land use, land use dynamic process, and ecosystem service value (ESV) in the region. Two-factor spatial autocorrelation analysis revealed the spatio-temporal characteristics of the value changes over the 20-year period as well as their spatial heterogeneity. The results show that: (1) land use changes are dominated by increases in cultivated land, forest land, watershed, and wetland, and decreases in grassland, glacier snow, and bare land. Of these changes, the expansion of cultivated land area is the most significant, showing a total increase of 1136.13 × 103 hm2. (2) The ESV increased and then decreased, reaching the highest value in 2005 and the lowest in 2020. The value of individual ecosystem services is dominated by regulating services, accounting for about 67% of the total value. (3) The overall regional balance of ecological environment quality and the contribution rate of the conversion from bare land to other land types is as high as 82.7986%, constituting the main factor in regional ecological environment improvement. The spatial distribution pattern exhibits the characteristic of “high in the northeast and low in the southwest”. (4) There is a positive correlation between the ESV, the Normalized Difference Vegetation Index (NDVI), and the Anthropogenic Impact Composite Index, with the NDVI being the main cause of spatial heterogeneity in the ESV. The research results provide a scientific basis for ecological protection, land management, and policy formulation in the northern foothills of the Tianshan Mountains and are of great significance for promoting regional sustainable development.

Цифровизация закупочного процесса как элемент управления медицинской организации

In modern conditions, digital technologies are penetrating into all spheres of life, and the healthcare industry is no exception. It is not individual medical services that compete in the market, but financial models. Therefore, those medical institutions that are able to quickly search, test and implement appropriate changes win. Digitalization tools and approaches help you learn to speak the language of value that is created for different target audiences, and regularly update the financial model of a medical institution. A significant stage in the activities of a public health institution is the procurement process. The purpose of the study is to identify the main aspects of building the procurement process of a public health institution through the prism of digitalization of this process within a medical institution. Materials and methods. The study includes the identification of factors that must be taken into account when forming a model of the procurement process; the stages of creating a digital model of the procurement process; the principles of implementing the procurement process project; substantiation of design decisions on information and software for the procurement process of a public health institution; the stages of developing an information system. Methods of structural, functional, information process, causal analysis and modeling are used. Results. The paper identified the main problems associated with the procurement process in medical institutions, including shortcomings in the regulatory framework, the lack of a clear distribution of responsibility between the participants in the process and the inefficiency of management decisions. To improve procurement monitoring and management, a proposal has been developed to optimize the procurement process through the use of digital technologies. Conclusions. The conducted research made it possible to identify the optimization of the procurement process in public medical institutions, which is associated with the use of a digital model of the procurement process. The scope of the results. The results of the work can be used in public medical institutions of various levels to develop and implement a system of digitalization of procurement activities within a medical organization. And also, when optimizing the procurement process in public medical institutions, when using a digital financial model of the procurement process, which has a number of beneficial advantages.

Dukungan Sosial Guru Bimbingan Konseling terhadap Kematangan Karir Siswa di Sekolah Menengah Atas

The aim of this research is to determine the social support provided by Guidance Counseling Teachers (BK) on the Career Maturity of High School Students or equivalent. The method in this research is library research which uses 9 scientific articles related to social support, guidance and counseling teachers, and career maturity of high school students. The results of this research show that BK teachers provide information services to students who really need services so that they can maximize their learning process and be enthusiastic about achieving their dreams or desired careers. Through career guidance, it can be a bridge for students to get closer and get to know the world of work and the things that must be prepared so that students are able to plan the careers needed in the era of society 5.0. The BK Teacher's efforts include providing individual counseling services, developing group guidance, providing support to students, completing facilities, providing systematic and sustainable training that suits the potential needs of students at school. Additionally, before deciding on an academic or non-academic career path, it is important for students to complete an interest test. The conclusion of this research is that social support from guidance and counseling teachers can support the career maturity of high school students. The implication of this research is that students can use the services of guidance and counseling teachers to support career maturity for the students' future

Increasing expenditures on home- and community-based services: Do home care workers benefit?

To examine the association of Medicaid home- and community-based services (HCBS) expenditures on the home care workforce. We use two national, secondary data sources from 2008 to 2019: state-level Medicaid HCBS expenditures and the American Community Survey, in which we identify direct care workers in the home (i.e., home care workers), defined as nursing, psychiatric, and home health aides or personal care aides working in home health care services, individual and family services, and private households. Our key explanatory variable is HCBS expenditures per state per year. To estimate the association between changes in Medicaid HCBS expenditures and the workforce size, hourly wages and hours worked, we use negative binomial, linear, and generalized ordered logit regression, respectively. All models include demographic and socioeconomic characteristics, the number of potential HCBS beneficiaries (individuals with a disability and income under the federal maximum income eligibility limits), indicators for minimum wage and/or overtime protections for direct care workers, wage pass-through policies, and state and year fixed effects. We exclude states with incomplete reporting of expenditures. States' HCBS expenditures increased between 2008 and 2019 after adjusting for inflation and the number of potential HCBS beneficiaries. Yet, home care workers' wages remained stagnant at $11-12/h. We find no association between changes in Medicaid HCBS expenditures and wages. For every additional $1 million in Medicaid HCBS expenditures, the expected number of workers increases by 1.2 and the probability of working overtime increased (0.0015% points; p < 0.05). Results are largely robust under multiple sensitivity analyses. We find no evidence of a statistically significant relationship between changes in state-level changes in Medicaid HCBS expenditures and worker wages but do find a significant, but small, association with hours worked and workforce size.

Assessing teachers' beliefs and practices regarding vocational rehabilitation services for individuals with intellectual disabilities.

This study investigates UAE teachers' beliefs and practices regarding vocational rehabilitation (VR) services for individuals with intellectual disabilities. The study used a descriptive survey methodology with a 30-item Likert scale questionnaire. The sample size consisted of 121 VR teachers in the Emirate of Abu Dhabi. The data was analyzed using Fisher's exact test and the Chi-square test. Male teachers (P<0.0063) and diploma in special education holders (P<0.0272) were significantly good at career counseling, while female teachers and bachelor's in education degree holders were good at vocational training (P<0.0039 and P<0.0001, respectively) and placement (P<0.0006 and P<0.001). Educators with 1-5 and 6-10 years of experience had more positive beliefs and practices than their more experienced counterparts in terms of VR services. VR instructors have an important role in improving the results and opportunities for people with intellectual disabilities, and their empowerment and professional development should be endorsed.