Participation In Community Settings Research Articles

Awareness and Practices Regarding Leptospirosis in Andaman and Nicobar Islands, Union Territory of India.

Background Leptospirosis is a worldwide prevalent zoonotic infection and re-emerging disease caused by the bacterium of genus Leptospira transmitted by infected animals in the environment.Andaman and Nicobar Islands has one of the highest incidence rates of leptospirosis in India with a seroprevalence of 52.7%.This study examined the knowledge, attitudes, and practices (KAP) regarding leptospirosis among the urban and rural populations of the Union Territory (UT) of India. Aim and objective This study aims to assess the knowledge, attitude, and practices regarding leptospirosis in a rural and an urban community of Andaman and Nicobar Islands. Materials and methods This community-based cross-sectional study was conducted atrural and urban field practice areas under the aegis of the Department of Community Medicine, Andaman and Nicobar Islands Institute of Medical Sciences (ANIIMS), Port Blair, for a period of three months.A semi-structured interview schedule was administered to 450 participants in community settings selected from a list of households obtained from the municipal council using a systematic random sampling method. All interviews were conducted face-to-face by the investigators to collect data on the sociodemographic variables of the study participants and their knowledge, attitudes, and practices regarding the disease. The data was analyzed using Statistical Package for the Social Sciences (SPSS) version 27.0 (IBM SPSS Statistics, Armonk, NY, USA). Results The knowledge and attitude regarding leptospirosis and henceforth the likelihood of individuals using preventive practices were evaluated. The majority of respondents (97%) had previously heard about leptospirosis; however, specific knowledge regarding its risk factors, causative agent, and complications was limited among the participants. Although more than 90% of them had a favorable attitude towardseeking treatment for the disease and adopting specific preventive measures and general hygiene,they did not practice these hygiene habits nor used self-protective equipment in their day-to-day lives. Less than 50% of participants wore protective clothing, boots, and gloves while cleaning cattle sheds, and only 40% of them used rodenticides despite the presence of rodents in their houses. Most of the owners (60%) had not vaccinated their pets. We also found a significant association between the male gender and urban residence with a good knowledge score (p=0.05). Conclusion Despite having knowledge of and a positive attitude towardthe disease, the participants did not practice preventive measures. We recommend that health interventions in endemic communities should focus on the implementation of protective measures by raising awareness in the susceptible population on multiple dimensions of leptospirosis in order to attain and ensure better compliance.

745-P: The Impact of COVID-19 and the Public Health Emergency on the Medicare Diabetes Prevention Program

Background: The MDPP has been significantly affected by the COVID-19 public health emergency (PHE). Prior to the PHE, the MDPP was designed as an in-person program delivered to participants in community settings. The Centers for Medicare & Medicaid Services (CMS) moved quickly in March 2020 to waive the in-person requirement for MDPP sessions and allow classes to continue on a virtual basis. CMS also permitted beneficiaries to temporarily pause participation. Purpose: To examine the impact of the COVID-19 PHE on MDPP suppliers and on beneficiary participation, attendance, and weight loss. Methods: We analyzed data collected as part of the MDPP evaluation and Medicare claims from April 2018 to December 2021. Results: In the 6 months following the start of the PHE, new enrollment fell to 11 beneficiaries per month, a decrease of 236% from the same period in 2019. In addition, 32% of suppliers had more than half of the MDPP beneficiaries drop out, and 22% of suppliers had more than half of their MDPP beneficiaries pause for at least 30 days. In comparison, in 2019, only 2% of suppliers had more than half of their MDPP beneficiaries drop out, and 8% of suppliers had more than half of their beneficiaries pause. For participants who continued or returned after a pause, the share of virtual sessions increased from <1% prior to March 2020 to 92% in April 2020. Thereafter, the percentage of virtual sessions declined, but the overall percentage still exceeded 50% through December 2021. Among beneficiaries who started in January or February and continued in the program without dropping out or pausing, weight loss is very similar between those that participated in 2019 (6.4%; n=245) compared to those in 2020 (6.5%; n=188). Conclusions: Although the PHE altered the way MDPP sessions were delivered and substantially reduced new enrollment in the program, changes in session delivery mode (e.g., in-person to virtual) did not appear to impact overall weight loss among continuing beneficiaries. Disclosure S.Jacobs: None. T.J.Hoerger: Research Support; Gilead Sciences, Inc. B.T.Allaire: None. P.Amico: None. P.Markovich: None. M.Romaire: None. Funding Centers for Medicare & Medicaid Services (HHSM-500-2014-0037I/75FCMC18F0003)

Efeito de um pacote de ensino sobre o desempenho de cuidadoras no treino de ocupações para crianças com TEA

Abstract Introduction The functional limitations observed in people with Autistic Spectrum Disorder (ASD) may prevent independent participation in community settings. Learning everyday activities can increase the inclusive participation and quality of life of these people. Teaching strategies via professionals are described in the literature, while teaching via caregivers for these skills needs to be explored and becomes essential when considering that the increase in children with ASD is not accompanied by a proportional increase in qualified professionals, in addition to the fact that the parents deal directly with teaching these activities. Objective To elaborate and evaluate the application of a training package for caregivers of children with ASD, for teaching sandwich preparation and toothbrushing. Method Four caregivers participated. The teaching package included Instructional Video Modeling, Self-Monitoring, Delayed and Immediate Feedback. A performance accuracy criterion equal to or greater than 90% was adopted for two consecutive sessions. Results All caregivers showed an increase in performance accuracy after exposure to the training package components. One caregiver reached the accuracy criterion by going through just one component or a combination of them. Three caregivers necessarily needed to go through the combination of components and the feedback phases to reach the criterion. Conclusion Corroborating other studies, there was no significant difference in the performance of caregivers when comparing the components. As with previous studies, it is shown that the feedback phases played an important role in achieving the criterion. It is attested that the training package was satisfactory in teaching the caregivers.

Community Conversations: Stakeholder-Identified Research Priorities to Foster Community Participation for Individuals With Intellectual and Developmental Disability.

To identify future research priorities and meaningful outcomes focused on community-level interventions for children and youth with intellectual and developmental disabilities and families, a group underrepresented in research, we established a diverse patient-centered outcomes research (PCOR) community. We focused on engaging regionally and nationally-diverse stakeholders—individuals, families, healthcare professionals, community, and policy experts—in research development activities that would build partnerships and research capacity. This community of stakeholders also represented the matrix of systems, services, and programs that people frequent in their communities (e.g., cultural arts, worship, sports and recreation, and transportation). We present the engagement process and methods for including individuals with intellectual and developmental disabilities as stakeholders in research planning and processes. The results of planning, completing, and evaluating three face-to-face research capacity-building meetings and their subsequent stakeholder engagement activities include: (1) individuals with intellectual and developmental disabilities and their families clearly expressed a desire to be included and to feel good about their participation in community settings, (2) many of our stakeholders wanted action and change to happen in their communities now, and often did not realize or understand that research takes time, (3) organizations expressed a need for mentoring related to best practices for access and inclusive programming. Overarching issues around societal inclusion, equal opportunities, and life chances for individuals with intellectual and developmental disabilities and their families were front and center across communities and multi-stakeholder groups, and achieving change remains valued and a high priority.

LUNG CANCER SCREENING PARTICIPATION IN COMMUNITY-BASED HEALTH SYSTEMS FROM THE PROSPR-LUNG CONSORTIUM

TOPIC: Imaging TYPE: Original Investigations PURPOSE: From 2013 through 2020, the US Preventive Services Task Force recommended annual lung cancer screening (LCS) via low-dose computed tomography (LDCT) for 55- to 80-year-olds with 30+ pack-years of smoking history who currently smoke or quit smoking within the last 15 years. Because the population-level impact of LCS on reducing lung cancer mortality depends on high LCS participation among eligible populations, it is important to determine LCS participation in community settings and to track participation changes over time. METHODS: Study participants were patients ages 55-80 years old who received care within the five systems in the Population-based Research to Optimize the Screening Process (PROSPR) Lung Consortium from 2014 through 2019. Data on LCS participation and patient characteristics (age, sex, race/ethnicity, and cigarette smoking history) were obtained via electronic health records (EHR). In this population, we used smoking history according to EHR data as a proxy for LCS eligibility and calculated the percent of individuals who completed LCS via LDCT by year, overall and by health system. We also evaluated differences in the percent screened by age (55-64 years old vs. 65+), sex, and race/ethnicity using chi-square tests with the significance level of < 0.05. RESULTS: The number of patients who were ages 55-80 years old with EHR documentation of 30+ pack-years of smoking and who currently smoked or had a quit date within the past 15 years ranged from 21,234 in 2013 to 39,881 in 2019. Of these, 3% completed LCS via LDCT in 2014, 7% in 2015, 12% in 2016, 17% in 2017, 21% in 2018, and 23% in 2019. Among those with 30+ pack-years in 2019 (N=51,579), 77% had current or former smoking within the past 15 years and were considered eligible for LCS in 2019. Of these individuals, 27% overall had ever received LCS, but there was variation in the percent ever screened by health system, that ranged from 16% to 45%. Among those eligible for LCS, the percent having ever received LCS LDCT also varied by age (24% of those ages 55-64 years old vs. 29% of those ages 65-80 years old; p-value < 0.01). Within each health system, the percent of eligible individuals who received LCS LDCT was not significantly different by sex or by race/ethnicity. CONCLUSIONS: Although the percent of high-risk individuals receiving LCS via LDCT increased every year from 2014 to 2019, LCS rates in community-based healthcare settings remain well below screening rates for other types of cancer. Also, there is wide variation in LCS rates by health system. CLINICAL IMPLICATIONS: To optimize the impact of LCS for reducing lung cancer mortality in the United States, health systems will need to increase LCS participation. Additional research to understand how differences in health system implementation and maintenance of LCS programs impact LCS participation is needed. DISCLOSURES: No relevant relationships by Andrea Burnett-Hartman, source=Web Response No relevant relationships by Nikki Carroll, source=Web Response Spouse, stock holder relationship with Johnson and Johnson Please note: >10 years Added 04/28/2021 by Jennifer Croswell, source=Web Response, value=Stock No relevant relationships by Robert Greenlee, source=Web Response No relevant relationships by Stacey Honda, source=Web Response No relevant relationships by Christine Neslund-Dudas, source=Web Response No relevant relationships by Katharine Rendle, source=Web Response No relevant relationships by Debra Ritzwoller, source=Web Response Grant relationship with MagArray Inc. Please note: >$100000 by Anil Vachani, source=Web Response, value=Grant/Research Support Removed 04/17/2021 by Anil Vachani, source=Web Response Grant relationship with Broncus Medical Please note: $20001 - $100000 by Anil Vachani, source=Web Response, value=Grant/Research Support Removed 04/17/2021 by Anil Vachani, source=Web Response Scientific Medical Advisor relationship with Johnson and Johnson Please note: 2020 - present Added 04/22/2021 by Anil Vachani, source=Web Response, value=Consulting fee Grant relationship with Precyte Please note: 01/2021 to present Added 04/17/2021 by Anil Vachani, source=Web Response, value=Grant/Research Removed 04/17/2021 by Anil Vachani, source=Web Response

Personalized AAC Intervention to Increase Participation and Communication for a Young Adult With Down Syndrome

Many adults with Down syndrome (DS) experience difficulty with speech production, and intelligibility challenges and communication breakdowns are common. Augmentative and alternative communication (AAC) intervention can provide important supports for persons with these complex communication needs, but must be customized to address the goals, strengths, and needs of the individual. This article provides a description of a personalized AAC intervention for a young adult with DS whose speech was frequently unintelligible. The AAC intervention made use of a video visual scene display (VSD) approach, and was investigated in two separate studies in two key community settings: An inclusive post-secondary education program (a single-case reversal ABAB design), and a community shopping activity (a non-experimental AB case study design). The participant demonstrated sharp increases in successful communication and participation in both settings following the introduction of the video VSD, and both the participant and key stakeholders viewed the intervention positively. The results provide preliminary evidence that personalized AAC intervention, including the use of a video VSD approach, can provide important supports for communication and participation in community settings for adults with DS and complex communication needs.

Personalized paths for physical activity: developing a person-centered quantitative function to determine a customized amount of exercise and enhancing individual commitment

BackgroundNon-Communicable Diseases (NCDs) are leading causes of mortality. These conditions are also known as chronic diseases of long duration and generally slow progression. Physical activity (PA) is a main factor to delay symptoms and consequences of NCDs. In last decades, reduced physical exercise has been observed across all ages. Despite educational campaigns aimed at modifying unhealthy habits, it is difficult to promote healthy lifestyles in general population. Poor interest, lack of motivation, as well as career and family commitments hinder people’s participation in regular PA programs. In this study we propose a theoretical person-centred approach to actively involve general population in enhancing their opportunity to perform PA based on personalized needs and targets.MethodsWe defined four profiles of baseline PA levels (inactive, moderately inactive, moderately active, and active people) by referring to Metabolic equivalents (METs) based on individual answers to General Practice Physical Activity Questionnaire (GPPAQ).ResultsBased on the answers to the GPPAQ and by computing the related METs for each profile of baseline exercise levels, we developed an innovative person-centered web-based algorithm/function for enhancing and measuring PA participation in community settings. This function can compute evidence-based standardized profiles of participants, personalized goals of PA being functional to the purpose of maintaining or gaining health benefits, as well as the type and duration of PA needed to reach these goals.ConclusionIt might be speculated that this approach would be a reliable method for increasing people’s self-efficacy and population adherence to recommended levels of PA. However, this theoretical proposal requires to be implemented in further research.

Mobile Device Usage by Gender Among High-Risk HIV Individuals in a Rural, Resource-Limited Setting.

Background: Mobile health (mHealth) is a promising tool to deliver healthcare interventions to underserved populations. We characterized the use of mobile devices in rural KwaZulu-Natal, South Africa to tailor mHealth interventions for people living with HIV and at risk for acquiring HIV in the middle-income country. Methods: We surveyed participants in community settings and offered free HIV counseling and testing. Participants self-reported their gender, age, relationship, and employment status, receipt of monthly grant, condomless sex frequency, and circumcision status (if male). Outcomes included cell phone and smartphone ownership, private data access, health information seeking, and willingness to receive healthcare messages. We performed multivariable logistic regression to assess the relationship between demographic factors and outcomes. Results: Although only 10% of the 788 individuals surveyed used the phone to seek health information, 93% of cell phone owners were willing to receive healthcare messages. Being young, female, employed, and in a relationship were associated with cell phone ownership. Smartphone owners were more likely to be young, female, and employed. Participants reporting condomless sex or lack of circumcision were significantly less likely to have private data access or to purchase data. Conclusions: mHealth interventions should be feasible in rural KwaZulu-Natal, though differ by gender. As women are more likely to own smartphones, smartphone-based mHealth interventions specifically geared to prevent the acquisition of or to support the care of HIV in young women in KwaZulu-Natal may be feasible. mHealth interventions encouraging condom use and medical male circumcision should consider the use of nonsmartphone short message service and be attuned to mobile data limitations-especially when targeting men.

Literature on peer-based community physical activity programmes for mental health service users: a scoping review

ABSTRACT Physical activity is a key determinant of mental health; community programmes aim to increase health and well-being on a community wide scale with emphasis on social interaction. Regular physical activity participation in community settings yields additional social benefits, such as peer support. This scoping review aimed to explore existing literature that has included peer support as a component of community-based physical activity programmes for MHSU. Published literature was examined using electronic databases (SportDiscus, Web of Science, MEDLINE, and PsycINFO), reference lists, and hand searching of journals. Thirteen eligible articles included; adults aged 18 and over, a peer support component, physical activity and/or sport, participants with mental health diagnoses and were community-based. Research published between 2007 and 2019, peer-reviewed and written in English was included. Nine studies found a significant increase in perceived social support, seven studies reported increased mental wellbeing and five studies reported increased physical activity levels. Effectiveness of reviewed programmes were categorised as; overall improvements in physical activity levels, improvements to mental health, exercise related psychosocial benefits, knowledge relating to self-care, and improved social connections. Community-based physical activity programmes produced psychosocial benefits and positive behaviour change for MHSU, warranting greater focus towards implementing effective peer support into community programmes.

Advancing play participation for all: The challenge of addressing play diversity and inclusion in community parks and playgrounds

IntroductionOutdoor parks and playgrounds are important sites of social inclusion in many urban communities. However, these playspaces are often inaccessible and unusable for many children with disabilities. This paper presents findings from a case study of one urban municipality in Ireland. The study aimed to understand play participation in five local playgrounds by exploring the perspectives of play providers and families with diverse abilities, through the lens of universal design.MethodsMultiple qualitative methods were used, including playground audits, walk-and-talk observations, and semi-structured interviews. Four play providers, 12 children, and 10 adult users took part. Inductive analysis was conducted to understand the usability and accessibility of playgrounds from a universal design perspective.FindingsThese playgrounds provided high play value for younger children, but low play value for older children and those with disabilities, due to lack of accessibility or usability. While local authorities aimed to provide inclusive playgrounds, they lacked knowledge on universal design for playspaces.ConclusionChildren with disabilities continue to experience exclusion in community playspaces, despite a commitment to inclusion in local authorities. Play providers need support to tailor principles of universal design to playground design. Occupational therapists are ideally situated to collaborate with local authorities on universal design for enhancing children’s play participation in community settings.

1657. Notes From the Field: A Survey of Mobile Device Usage Among Individuals in KwaZulu-Natal, South Africa

BackgroundmHealth (mobile health) is a promising tool to deliver healthcare interventions to underserved populations. Across low- and middle-income countries (LMIC), the prevalence of smartphones has risen to 42%. Effective mHealth deployment in LMIC requires an understanding of how LMIC populations use mobile technology. We characterized the use of mobile devices in rural KwaZulu-Natal, South Africa to tailor mHealth interventions for people living with HIV and at risk for acquiring HIV.MethodsWe surveyed participants in community settings and offered free HIV counseling and testing. Participants self-reported their gender, age, relationship status, living distance from preferred clinic, receipt of monthly grant, condomless sex frequency, and circumcision status (if male). Outcomes included cell phone and smartphone ownership, private data access, health information seeking, and willingness to receive healthcare messages. We performed multivariable logistic regression to assess the relationship between demographic factors and outcomes.ResultsAmong 788 individuals surveyed, the median age was 28 (IQR 22–40) years, 75% were male, and 86% owned personal cell phones, of which 43% were smartphones. The majority (59%) reported having condomless sex and most (59%) males reported being circumcised. Although only 10% used the phone to seek health information, 93% of cell phone owners were willing to receive healthcare messages. Being young, female, and in a relationship were associated with cell phone ownership. Smartphone owners were more likely to be young and female, less likely to live 10–30 minutes from preferred clinic, and less likely to receive a monthly grant. Those reporting condomless sex or lack of circumcision were significantly less likely to have private data access.ConclusionMost participants were willing to receive healthcare messages via phone, indicating that mHealth interventions may be feasible in rural KwaZulu-Natal. Smartphone-based mHealth interventions specifically geared to prevent or support the care of HIV in young women in KwaZulu-Natal may be feasible. mHealth interventions encouraging condom use and medical male circumcision should consider the use of non-smartphone SMS and be attuned to mobile data limitations.Disclosures All authors: No reported disclosures.

Relationship Beliefs Patterns Among Relationship Education Participants at Different Venues

ObjectiveTo identify different patterns of relationship beliefs, and examine how those patterns vary across participants attending classes through different venues: community, reemployment services, and jails.BackgroundAlthough there have been increased efforts to provide relationship education to underprivileged and underserved populations in diverse venues, there is little research on how the relationship education needs at different venues may vary.MethodFrom the perspective of relationship lay theory, the present study used latent class analysis to identify patterns, or classes, of relationship beliefs among participants in community settings (n = 1,144), reemployment services settings (n = 423), and jails (n = 242).ResultsFive classes of relationship beliefs emerged: Low Risk, Blind Love, Sliders, Blind Love Sliders, and Control Tolerates. Differences in class membership were observed across the three venues. Being single, having a history of divorce, and no prior relationship education were associated with membership in more risky classes.ConclusionDistinct patterns of risky relationship beliefs exist among participants in different venues of relationship education. The high prevalence of the Slider class and associated beliefs indicate those beliefs may be particularly prevalent across venues.ImplicationsThe findings point to educational needs of particular groups. For example, information on the issue of sliding is needed when teaching in any setting, but information on control tolerance and blind love sliding is particularly needed when teaching in jails, and to a lesser but still elevated degree in reemployment services.

Satisfaction, safety, and supports: Comparing people with disabilities’ insider experiences about participation in institutional and community living

BackgroundLegislation and court decisions in the United States mandate the right to least restrictive community living and participation for people with disabilities, yet little research has examined differences in participation across institutional and community settings, or over time in the community post-transition. ObjectiveAs part of a multi-site participatory action research project examining participation, we examined the differences in quality of life in institutional and community living environments among people with disabilities. MethodsWe conducted surveys with adults with disabilities between 18 and 65 years-old that transitioned from institutions to the community in the United States within the last five years. This paper reports on findings for a diverse sample of 150 participants. ResultsWe found significant differences between ratings of institutional and community experiences, with increased reports of satisfaction, personal safety, service access, and participation in community settings. We also found significant improvements in community integration and inclusion after transition to community living, although barriers to transportation and activity access often remained. ConclusionsThis study of insider experiences of previously institutionalized people with disabilities illuminates important understandings of community participation, integration, and quality of life for the disability community in the United States.

A survey of patients’ experience of pain and other symptoms while receiving care from palliative care services

ContextIn Australia, patients at the end of life with complex symptoms and needs are often referred to palliative care services (PCSs), but little is known about the symptoms of patients...

Initial findings from the implementation of a community-based sentinel surveillance system to assess the health effects of climate change in Alaska

BackgroundThis report describes the results of a study to determine whether a community-based sentinel surveillance system can be developed and implemented to assess the health effects of climate change, and to contribute to local discussions to mitigate these health effects. The purpose of this report is to describe the process and outcomes of this innovative approach to identifying priority areas for adaptation investment. This report can be used to assist local, state and federal governments in determining how to develop actions and policies to promote adaptation to climate change.ObjectiveTo evaluate the health effects of climate change in rural Alaska.DesignWe conducted an iterative and participatory process to develop metrics, an instrument and a protocol to collect sentinel surveillance data on the health effects of climate change in 3 ecologically distinct regions of the state.ResultsWe collected surveillance data from 91 study participants over the course of 12 months. These data were analyzed and categorized by frequency and association between specific health outcomes or health-related factors (such as food security) and reported exposure to environmental effects of climate change. We found significant associations between several health outcomes and health outcome mediators and reported exposures. We presented these data to study participants in community settings and moderated discussions of likely causal factors for these measured associations, and helped community residents to identify specific adaption measures to mitigate those health effects.ConclusionsWe conclude that community-based sentinel surveillance is an effective method for assessing health outcomes from exposure to environmental effects of climate change, and informing climate change health adaptation planning in Alaskan communities. We contend that it would be effective in other regions of the nation as well.

Efficacy of a Peer‐Guided Exercise Programme for Adolescents with Intellectual Disability

Peer support is strongly associated with physical activity of adolescents. This study examined the efficacy of a YMCA-based, peer-guided exercise training programme for increasing health-related physical fitness among adolescents with intellectual disabilities. Adolescents with intellectual disabilities and typically developing peer partners provided reciprocal support during 1-h exercise sessions that included aerobic exercise, weight training and stretching activities. The programme was conducted 2 days/week for 15 weeks and pre- and post-test fitness testing was conducted. Participants demonstrated significant improvements in curl-ups, 6-min walk and BMI. Exercise session attendance was high and participants typically completed all of the prescribed aerobic and stretching exercises, whereas weight training exercises were completed less consistently. This peer-guided model integrates social and instructional support for adolescents with intellectual disabilities and may encourage exercise participation in community settings.

Evaluating community participation as prevention: life narratives of youth

AbstractCommunity‐based prevention programs strive to foster the composition of positive life stories, in part, by promoting active participation in community settings. This article used life narratives of youth to explore the experience of community participation and showed how such participation influenced their lives. Youth aged 18–19 years who participated in Better Beginning, Better Futures (n=62), a community‐based prevention program, when they were aged 4–8 years, recounted stories of their lives that showed significantly higher levels of participation in community programs and greater personal impacts of that involvement compared with youth who were not involved in Better Beginnings (n=34). Qualitative analysis of a subsample of these youth (n=34) revealed individual and community characteristics that were instrumental in fostering positive outcomes of community participation. The findings indicated both the utility of using a narrative approach to evaluate community‐based prevention programs and the value of community participation for children and youth. © 2010 Wiley Periodicals, Inc.

Trajectories of Symptom Reduction and Engagement During Treatment for Childhood Behavior Disorders: Differences Across Settings

In this study, we examined trajectories of symptom reduction and family engagement during the modular treatment phase of a clinical trial for early-onset disruptive behavior disorders that was applied either in community settings or a clinic. Participants (N=139) were 6-11 year-old children with diagnoses of Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD). Symptoms of ODD/CD and level of engagement were assessed at every session during the course of treatment. Overall, symptom reduction was characterized by a gradual decline in symptoms over the first 11 sessions followed by a flatter slope beginning with session 12. Clinic participants evidenced a greater decline in symptoms after session 11 compared to participants in community settings. Overall, engagement remained stable during the course of treatment. However, clinic participants had higher levels of engagement throughout treatment compared to participants in the community settings. These setting differences in level of engagement did not account for the differences in trajectories of symptom reduction across the treatment settings.

Researching Men's Sheds in Community Contexts in Australia: What Does it Suggest about Adult Education for Older Men?

This paper reports on research into community-based men's sheds in Australia, focusing on how regular activity in these sheds impacts on the informal learning experiences of the mainly older men who use them. It leads to an exploration and reflection on how men's learning experiences in such sheds might inform adult and vocational education in community contexts for older men in other national and cultural contexts. Shed-based activity in community settings is found to provide a critically important, positive and therapeutic, male-positive context that satisfies a wide range of needs not currently available to older men in more formal education settings or in typical adult learning providers. Men's sheds in community contexts provide an important and voluntary social and community outlet for older retired men, particularly for workin- class men who are less likely than other men and particularly women to participate in adult and community education. The research identifies the likely fruitfulness of more closely examining the role of informal learning in enhancing wellbeing through voluntary participation in community settings in other cultural and national contexts.

Response to Review of Youth Participatory Evaluation: A Field in the Making

Children, Youth and Environments. Vol 14, No.2 (2004) ISSN 1546-2250 Response to Review of Youth Participatory Evaluation: A Field in the Making Kim Sabo Kim Sabo Consulting Citation: Sabo, Kim. “Response to Review of Youth Participatory Evaluation: A Field in the Making.” Children, Youth and Environments 14(2), 2004. I want to start by thanking the reviewer for describing the book Youth Participatory Evaluation: A Field in the Making as “powerful.” I am especially appreciative of her comments regarding the significance of Lev Vygotsky’s contribution to the field of youth development, and in my understanding, to the field of Youth Participatory Evaluation (YPE). I think it is important to note that while I used Vygotsky’s theories to frame the conversation regarding YPE, many of the authors would not consider themselves Vygotskians. Contributors to this book had a variety of different backgrounds and perspectives ranging from youth development, to environmental psychology, to community development, to health and prevention, to participatory action research, to human/child rights. Within each of the chapters, authors brought their own unique theoretical perspectives to bear on the subject of youth participatory evaluation. Just a few points of correction; first, most of the people who contributed to the volume were not part of the meeting entitled Children’s Participation in Community Settings, sponsored by Child watch International Research Network and the Growing Up in Cities project of the MOST program of UNESCO but many were part of subsequent meetings and continue to do terrific work growing the field of YPE. Those who were involved in the meeting influence my thinking 357 greatly and I wish to thank them for their seminal thoughts on the matter. Further, I wish to credit Roger Hart, my dissertation advisor, with discovering the need for research in this area. Lois Holzman, my undergraduate mentor, remains a close colleague and great influence on thinking. Kim Sabo holds a Doctorate in Psychology from the City University of New York Graduate School and has worked in the areas of youth development and participatory evaluation for the past decade. As a consultant to the United Nations Drug Control Program, UNICEF, The U.S. Diana Princess of Wales’ Fund, and The Robert Bowne Foundation, she has worked to develop and evaluate children and youth programs both nationally and internationally. Dr. Sabo has also conducted numerous long- and short-term evaluation training institutes for non-profit organizations. Dr. Sabo has a strong commitment to engaging children and youth in the process of research and evaluation and has recently published a volume for Jossey Bass’ New Directions for Evaluation entitled Youth Participatory Evaluation. Address: Kim Sabo Consulting/ 424 West 49th Street #4A/ New York, NY/ 10019 ...