On-site Assistance Research Articles

An Evaluation of Arizona Cooperative Extension’s Rangeland Monitoring Program

We evaluated Arizona Cooperative Extension’s Rangeland Monitoring Program with the use of focus groups and a self- administered mail survey of grazing permittees and natural resource agency employees. Our primary objectives were to 1) determine whether Extension is reaching its target audience, 2) describe the monitoring practices and attitudes of permittees and agency staff, 3) determine whether there is a relationship between permittees’ exposure to Cooperative Extension and their monitoring and management practices, and 4) identify the monitoring information needs and preferences of permittees and natural resource agency staff. We found that Arizona’s rangeland monitoring Extension program has been effective in reaching a large part of its target audience, and a significant proportion of Arizona permittees monitor on public, private, and state- owned rangelands. However, overall monitoring adoption rates remain low. Extension contact is associated with use of monitoring and other beneficial management practices, and permittees and agency employees report that monitoring increased their knowledge and led to changes in management. Monitoring by permittees improves agency-permittee relationships in many cases. Most permittees and agency employees believe that their respective peers are the most reliable source of monitoring information and prefer to receive information from Extension through face-to-face contact at workshops or personalized on-site assistance. The evaluation revealed important social dimensions of rangeland monitoring. Extension agents play a key role in facilitating the social process of monitoring, as well as providing technical training in monitoring skills. Further study is needed to investigate whether permittee monitoring actually leads to better management, improved economic returns, or increased tenure security.

The Efficacy of an Early Literacy Tutoring Program Implemented by College Students

Absctract. This article describes a two‐year study addressing the effectiveness of a highly structured, systematic tutoring intervention implemented by minimally trained college students with two cohorts of at‐risk first‐grade readers. Participants were 61 first‐grade children in Cohort 1 and 76 first‐grade children in Cohort 2. Tutors participated in three one‐hour training sessions and received occasional on‐site assistance. Individual tutoring sessions were scheduled for three to four times each week for one school year, with each cohort receiving approximately 10–14 hours of instruction across 44 sessions. The curriculum included a game to teach phonemic awareness and letter‐sound correspondence, structured word‐study activities, reading of leveled books, and simple comprehension strategies. Significant differences were found on measures of phonemic awareness and nonsense word reading for both cohorts. For Cohort 1, but not Cohort 2, significant differences were also detected for real‐word identification. Our results support using tutors to provide additional assistance and instruction in early reading, even when tutors are not professionally trained teachers.

Put Prevention into Practice implementation model: translating practice into theory.

Put Prevention into Practice (PPIP), a national initiative promoting evidence-based clinical preventive services, was atheoretical in its approach to change. In 1994, the Texas Department of Health began demonstration projects to implement PPIP in grantee primary care sites across the state. They funded implementation and evaluation projects that resulted in eight years of experience with the process. Gathering both qualitative and quantitative data, the Texas Department of Health and the University of Texas researchers found action research essential to learning how to successfully support clinical sites in the implementation of PPIP. The researchers also found the need for on-site consultative assistance and a participatory problem-solving approach in order to produce desired systems change. A complex adaptive systems' perspective gave theoretical justification for action research, the composition of the PPIP Implementation Model, and the importance of specific adaptation by clinics. Thus, the eight-year action research project found that a state health department desiring to implement and institutionalize quality health care should focus on: (1) context-specific consultation, (2) recognition of complexity and system-level constructs, and (3) the requirement for participatory change.

Best practices: terrorism and mental health: private-sector responses and issues for policy makers.

Best practices: terrorism and mental health: private-sector responses and issues for policy makers.

A survey of managed care strategies for pregnant smokers

OBJECTIVE The purpose of this study was to measure the content and comprehensiveness of pregnancy specific smoking cessation strategies within managed care organisations (MCOs) responding affirmatively to the national 1997-98...

Can dialysis therapy be improved? A report from the ESRD Core Indicators Project.

We assessed the association between quality improvement interventions conducted during the End-Stage Renal Disease (ESRD) Core Indicators Project and changes in the adequacy of hemodialysis between 1993 and 1996. Improvement of hemodialysis adequacy was measured by baseline and annual urea reduction ratios (URRs) in representative samples of ESRD Network patients. Random samples of in-center hemodialysis patients aged 18 years and older who had received hemodialysis during the fourth quarters of 1993, 1994, 1995, and 1996 were used to calculate Network-specific outcomes. A mean URR was calculated for each patient using the first pretreatment and posttreatment blood urea nitrogen for October, November, and December of each study year. Both national and Network-specific interventions were used to provide feedback reports and technical assistance to treatment centers to foster improvement in hemodialysis adequacy. All Networks distributed reports on the patterns of treatment center URR levels and physician and patient educational materials to each center in the Network. Each Network selected an annual 10% sample of treatment centers in 1994 and 1995 and conducted quality improvement activities to assist the selected centers to improve dialysis adequacy. We defined Network-specific interventions by a survey of the 18 Networks conducted during 1995 to determine the characteristics of Network-specific activities used to improve adequacy of hemodialysis. The outcome of interest was the change over time in Network-specific URR value. Sustained improvement in the URR occurred within all 18 Networks between 1993 and 1996. The mean national URR increased from 62.7% in 1993 to 66. 8% in 1996. The proportion of patients with URR >/= 65% increased from 43% in 1993 to 68% in 1996. Networks reported implementing a variety of intervention strategies that included educational activities, continuous quality improvement workshops, on-site assistance, and supervision of selected treatment facilities until care improved. Network-specific interventions independently associated with an increased rate of improvement in URR included prolonged supervision of the selected facilities. We concluded that the sustained improvement in hemodialysis care that occurred after the inception of the ESRD Core Indicators Project was associated with specific ESRD Network interventions.

Can Western Quality Improvement Methods Transform the Russian Health Care System?

The Russian health care system largely remains the same system that was in place during the existence of the Soviet Union. It is almost entirely state owned and operated, although ownership and management have developed from the central government to the oblast (province). The ZdravReform (Health Reform) Program (ZRP) in Russia, which began in 1993, included the goal of improving the quality and cost-effectiveness of the health care system. Work on introducing continuous quality improvement (CQI), evidence-based practice guidelines, and indicators of quality was conducted in 1995-1996. INTRODUCING EVIDENCE-BASED MEDICINE: As a result of the poor quality of Russian-language medical journals and the inability to gain access to the knowledge available in Western medical literature, Russian medical practices have not kept up with the rapid evolution of evidence-based medical practice that has begun transforming Western medicine. A number of evidence-based clinical practice guidelines were translated and disseminated to Russian-speaking physicians working in facilities participating in ZRP in Russia and Central Asia. Given the limitations of existing measures of the quality of care, indicators were developed for participating ambulatory polyclinics in several oblasts in Siberia. Russian physicians responsible for quality of care for their respective oblasts formed a working group to develop the indicators. A clinical information system that would provide automated collection and analysis of the indicator data-as well as additional patient record information-was also developed. CQI activities, entailing a multidisciplinary, participatory team approach, were conducted in four oblasts in western Siberia. Projects addressed the management of community-acquired pneumonia and reduction of length of stay after myocardial infarction (MI). One of the oblasts provided an example of a home-grown evidence-based protocol for post-MI care, which was adopted in the other three oblasts. Evidence-based medicine is critically needed to improve the quality of research and publications, medical education, and medical practice. Physicians everywhere are data driven; they change their practices when convinced by good data. The key to successful introduction of evidence-based medicine is understanding the fundamentals of good scientific method as applied to medicine. The Russian health care system's experience in reporting to higher authorities' process and outcomes data that resemble our modern indicators can provide the basis for accurate and valid measures of quality. In contrast with American expectations that a significant cultural change in an organization could take years, even with great effort, Russian physicians and other clinicians rapidly assimilated the new concepts of QI and put them to use. More on-site assistance by international medical consultants will still be needed for several years to hasten the process of change and ensure that it does not become stalled.

Preparing On-the-Job Teachers for Urban Schools: Implications for Teacher Training

This study examines the effectiveness of a program in the preparation and retention of on-the-job teachers to serve students with mild-moderate disabilities in urban schools. Special education teachers with emergency certification participated in the two year program designed to provide: competencies specific to serving urban students with special needs; experiential and reflective experiences that linked coursework and classroom practices; and ongoing support and guidance through on-site support teachers, university supervision and cohortparticipation. Data examining teacher development, teachers'perceptions of theprogram and job experiences were collected on 35 participants. Findings from the study indicated that teachers developed competency over time and viewed seminars and on-site assistance as critical sources of support. However, despite preparation and program supports, teachers continued to experience significant challenges and stress on-the-job. Implications for the preparation and retention of urban school teachers are discussed.

Breaking New Ground: Shared Supported Housing for People with Mental Health Related Difficulties

This paper describes the establishment by a government mental health support agency of a network of rented houses in which assistance was available to tenants at key times seven days a week during its first two years of functioning. This was the first project in the mental health area in South Australia to involve ‘direct care workers’ in the provision of on-site assistance. They have proved to be an invaluable resource. For tenants it has provided an opportunity to maintain family ties while becoming independent, with some help in resolving day-to-day difficulties available as required. Areas within the scheme which need further discussion and change have been noted and are being addressed systematically by workers and tenants. Similarly, key achievements to be preserved and enhanced are outlined.

Opportunities for CD-ROM information services in Africa

In the more populous and wealthier region of Africa North Africa one library serves 26000 people while in sub-Saharan Africa this figure is 60000. Only 14% of all libraries (national libraries university libraries and special libraries) in Africa are likely users of CD-ROM technology. Most of these libraries (68%) are in North Africa. Extrapolation shows a minimum of 282 computers in North Africa and 135 computers in sub-Saharan Africa in these libraries. 65% of Africans surveyed by UNESCO in 1991 regarding their information needs have access to IBM-compatible personal computers (PCs). Indeed the number of PCs installed in Africa has grown considerably during the late 1980s. A 1990 AAAS survey showed that 16 out of 106 libraries have CD-ROM drives (9 university libraries 7 research libraries). The most frequently used CD-ROM database is MEDLINE followed by POPLINE which is produced by the Population Information Program (PIP). PIP has provided 60 CD-ROM drives to Africa where 71 POPLINE sites already exist in 27 countries. At least 200 maybe as many as 400-500 POPLINE sites exist throughout the developing world. Advantages of CD-ROM technology in Africa are: no need for telecommunication systems; limited on-site assistance needed; relatively easy to install and run; physical attributes suited for use in tropical environments; economical; and encourages end users to access information. Thus CD-ROM has the potential to solve various information problems facing Africa. Africa is a growing market for CD-ROM in Africa should be aware of several obstacles such as difficulties with indigenous human resources language barriers differing values of time nonverbal communication differences and economic constraints. In late 1992 and early 1993 several meetings on CD-ROM are scheduled in Ghana and Zimbabwe.

Self-Contained versus Team Teaching: An Analysis of a Physical Education Intervention by Classroom Teachers

A primary purpose of this study was to describe differences between self-contained and team teaching approaches when two groups of fourth- and fifth-grade classroom teachers attempted to implement a physical education curriculum during a 4-month in-service program. One school featured team teaching in pairs during physical education classes; the other used a self-contained teaching approach. The program required a minimum of three 30-min physical education classes weekly. All teachers participated in an extensive in-service training program that included weekly on-site assistance. Data collection included teachers’ lesson-completion forms, specialist’s reports, SOFIT PE class observations, teacher-completed Stages of Concern questionnaires, and teachers’ formal interviews. Results indicated that classroom teachers who used the self-contained model more consistently implemented the curriculum and more frequently expressed positive responses. Participants who used the team model for the physical education curriculum frequently strayed from the assigned pedagogical approach, ignored major portions of the program, and experienced extreme management concerns.

What Do Police Officers Really Want From the Mental Health System?

A sample of 309 police officers in Cincinnati and Hamilton County, Ohio, were interviewed about their contacts with mentally ill individuals and about their need for various kinds of information and assistance from the mental health system. During a one-month period, almost 60 percent of the officers had responded to at least one call involving a presumably mentally ill person, and 42 percent had responded to more than one such call. Twenty-two percent had dealt with a presumably mentally ill person who was also mentally retarded. Police officers indicated that they most needed access to information about an individual's past history of violence or suicide attempts, and quick on-site assistance by mental health professionals in assessing suicidal or hostile mentally ill persons.