Prereferral Intervention Research Articles

장애위험 영유아 선별과 의뢰전 중재를 위한 교사교육이 보육교사의 민감성과 놀이교수효능감에 미치는 영향

장애위험 영유아 선별과 의뢰전 중재를 위한 교사교육이 보육교사의 민감성과 놀이교수효능감에 미치는 영향

Prereferral Intervention for English Learners: Important Considerations

Providing appropriate academic evaluation and intervention services for English learners remains a challenging goal for school support teams. Understanding English language proficiency assessment and universal screening processes can help teams make better decisions when considering possible continued intervention or referral for a comprehensive special education evaluation. This article will help school teams understand what information they should consider when determining whether to begin or continue an academic intervention or refer a student for a special education evaluation.

‘Maze’ not pathway: focus group exploration of patients’ and public experiences of the UK NHS elective total joint arthroplasty pathway

ObjectiveTo explore patient and public perceptions of planned improvements to the National Health Service (NHS) total joint arthroplasty (TJA) pathway.DesignThree qualitative focus groups undertaken March–May 2018, as part of a...

The five continuum of care criteria that should accompany rectal artesunate interventions: lessons learned from an implementation study in Malawi

BackgroundRectal artesunate (RAS) is a World Health Organization (WHO) recommended intervention that can save lives of children 6 years and younger suffering from severe malaria and living in remote areas. Access to RAS and a referral system that ensures continuity of care remains a challenge in low resource countries, raising concerns around the value of this intervention. The objective of this study was to inform RAS programming, using practical tools to enhance severe malaria continuum of care when encountered at community level.MethodsA single country two-arm-controlled study was conducted in Malawi, where pre-referral interventions are provided by community health workers (CHWs). The study populations consisted of 9 and 14 village health clinics (VHCs) respectively, including all households with children 5 years and younger. CHWs in the intervention arm were trained using a field-tested toolkit and the community had access to information, education, and communication (IEC) mounted throughout the zone. The community in the control arm had access to routine care only. Both study arms were provided with a dedicated referral booklet for danger signs, as a standard of care.ResultsThe study identified five continuum of care criteria (5 CoC Framework) to reinforce RAS programming: (1) care transitions emerged as to be dependent on a strong cue to action and proximity to an operational VHC with a resident CHWs; (2) consistency of supplies assured the population of the VHC’s functionality for severe danger signs management; (3) comprehensiveness care ensured correct assessment and dosing; (4) connectivity of care between all tiers using the referral slip was feasible and perceived positively by caregivers and CHWs and (5) communication between providers from different points of care. Compliance was high throughout but optimized when administered by a sensitized CHW. Over 93% experienced a rapid improvement in the status of their child post RAS.ConclusionRAS cannot operate within a vacuum. The impact of this lifesaving intervention can be easily lost, unless administered as part of a system-based approach. Taken together, the 5CC Framework, identified in this study, provides a structure for future RAS practice guidelines.Trial registration number and date of registration PACTR201906720882512- June 20, 2019.

특수교육지원센터에서의 다문화가정 아동 진단·평가 실태 및 지원 요구

The purpose of this study is to investigate the current status of diagnosis, evaluation process, and demands of the Special Education Support Center (SESC) for personnel who have experience in diagnosing and evaluating children from multicultural families. To this end, questionnaires were developed and distributed online to the personnel at the SESC; a total of 39 answers were collected. The results of this analysis are as follows. First, the diagnostic evaluation process has been conducted as an individual effort of the personnel without specific guidelines and standards to identify children from multicultural families. However, resources and supports were insufficient across all aspects; this included collecting various pre-referral information, supporting active parent participation, determining dominant languages, composing a multidisciplinary team, and building the personnel’s expertise in the diagnostic evaluation process. Second, the personnel had difficulties dealing with communication with multicultural families; furthermore, they pointed out a problem to refer the children from multicultural families to SESC without any efforts to implement pre-referral intervention. In addition, it was difficult to compose a multidisciplinary team including multicultural experts due to a lack of recognition regarding the importance of the team for children of multicultural families. Third, the personnel requested supports for effective communication with multicultural families; additionally, they wanted legal basis, specific guidelines, and systematic pre-referral intervention systems. The personnel requested professional development programs about children with disabilities from multicultural families; including programs that combine theoretical and practical knowledge, as well as a collaboration system between SESC and multicultural-related institutions to support reliable diagnosis and evaluation of children from multicultural families. Based on these results, practical implications and future research were discussed.

Effects of Family Support Program for Pre-referral Intervention of Infants at Risk of Developmental Delay on Interaction Behavior and Family Resilience

본 연구는 보육현장에서 사각지대에 놓여있는 장애위험 영아를 위한 가족지원 프로그램을 개발하는 것을 목적으로 하였다. N구에 거주하는 20-36개월 영아 중 영유아 건강검진 발달선별검사를 통해 발달지연이 확인된 14명의 영아 가족을 대상으로 가족지원 프로그램을 실시하였다. 가족지원 프로그램은 가족의 요구를 바탕으로 자녀 발달을 지원하는내용으로 구성하였으며 주 1회, 총 12회기로 진행되었다. 연구 결과, 의뢰 전 중재를 위한 장애위험 영아 가족지원 프로그램은 가족탄력성과 주양육자의 상호작용 행동 변화에 효과적이라는 것을 확인하였다. 본 연구를 통해 장애위험 영아 가족지원 프로그램은 가족의 개별적인 요구를 파악하여 가족의 어려움을 독립적으로 해결해감으로써 가족 역량을 키울 수 있다는 것을 확인하였다는 점에서 의의가 있다.

Dual discrepancy/consistency pattern of strengths and weaknesses method of specific learning disability identification: Classification accuracy when combining clinical judgment with assessment data

The Dual Discrepancy/Consistency (DD/C) pattern of strengths and weaknesses (PSW) method is the most prominent “other alternative research-based procedure” used to identify a specific learning disability (SLD). The DD/C method is intended to be used with multiple data sources, but no research has examined identification decision making using the DD/C PSW analysis of cognitive and academic achievement test scores with other assessment data (e.g., pre-referral intervention data, parent/teacher reports, observations, evaluation of exclusionary factors). This study used an experimental vignette methodology to investigate school psychologists' (N = 343) identification decision making using the DD/C method with multiple data sources. Results showed that school psychologist participants made highly accurate (97.50%) identification decisions when both cognitive and achievement test score patterns and other assessment data were clearly indicative of SLD, but that overall identification accuracy was only 65.60%. Participants made less accurate identification decisions when examining test score data that did not meet DD/C PSW criteria for SLD than when examining test score data that did. Participants made less accurate decisions when other assessment data (interpreted in conjunction with test scores) did not meet DD/C PSW criteria for SLD or were ambiguous than when they did. In addition, male school psychologists were less likely to make accurate identification decisions than female school psychologists, and participants who were Nationally Certified School Psychologists were less likely to make accurate identification decisions than those who were not. Last, more experience with DD/C resulted in less accurate identification decisions, and participants who made accurate decisions reported higher levels of confidence, although the effect size was negligible. Implications for research and practice are discussed.

Epidemiology of newborn transport in India - The reality check

Background: Transporting sick neonates from the periphery to a tertiary care unit is a challenge and transport-related factors can have a bearing on their survival. These factors influence ultimate survival in resource poor settings. Objectives: The objective is to evaluate the transport characteristics for sick newborns from peripheral centers to tertiary care referral hospital. Methods: A prospective study was done with sick newborns transported to our tertiary care teaching hospital over a period of 1 year. The transport logistics were recorded in detail and analyzed. The analyses were repeated for preterm and term babies separately. Results: There were 36.32% preterm babies in the study cohort of 961 newborns. The descriptive profile of the newborns enrolled in the study has been presented along with descriptive summary of the newborn transport logistics. Approximately 23% of babies were born to teen age mothers. Some prereferral counseling was done for only about 20% babies and <1% had vitals monitored during transport. Prereferral stabilization was scarce and around 41% babies had labored breathing or gasping at admission. As many as, 47% babies had no prereferral intervention and 31% had no referral notes; in only 3.3% instances, there was clear prior intimation to the referral unit. Conclusion: Sick newborn transport logistics are to be improved for reducing neonatal mortality in resource poor settings.

An evaluation of rectal artesunate for the pre-hospital management of severe malaria

ABSTRACT Introduction Severe falciparum malaria stills accounts for around half a million childhood deaths per year in sub-Saharan Africa. Prompt treatment of sick children close to home starting with artesunate given rectally by appropriately trained people can be lifesaving. Areas covered Rectal artesunate (RAS) has been developed for use in the WHO approved strategy of pre-referral intervention. This review covers the formulation, pharmacokinetics, safety, efficacy, and implementation of this drug. There is little RCT evidence and the only RCT has been controversial. It is unlikely that there will be further randomized studies in the field. There is a concern that the administration of a single dose of artesunate without adequate follow up therapy may encourage the emergence of artemisinin resistance. Expert opinion Artesunate is an essential drug and RAS is a very useful, potentially lifesaving formulation designed to be quickly administered in remote areas to severely unwell children by non-medical personnel. However, its use needs to be monitored and onward referral for definitive antimalarial treatment ensured.

유치원 교사와 부모의 의뢰전 중재에 대한 인식과 요구

유치원 교사와 부모의 의뢰전 중재에 대한 인식과 요구

장애의심 유아의 진단과 의뢰 전 중재에 대한 사립 유치원 원장의 인식 분석

장애의심 유아의 진단과 의뢰 전 중재에 대한 사립 유치원 원장의 인식 분석

Cost effectiveness of pre-referral antimalarial treatment in severe malaria among children in sub-Saharan Africa

BackgroundIn 2013, 78% of malaria deaths occurred in children aged 5 years and below, in sub-Saharan Africa. Treatment of severe malaria requires a health facility with inpatient care. However, in most sub-Sahara African countries, access to health facilities is a major problem. Pre-referral antimalarial treatments aim to delay the progress of severe malaria as patients seek to access health facilities. Rectal artesunate can be administered in the community as a pre-referral treatment in rural hard-to-reach areas. In Kenya, though pre-referral rectal artesunate has been included in the National Guidelines for pre-referral treatment, it is yet to be implemented in the public healthcare system. It is important, therefore, to establish its cost-utility compared to current parenteral treatments. This study evaluated the cost-utility of provision of pre-referral treatments by community health workers compared to similar services at a primary health facility.MethodsThis was a decision model-based cost-utility analysis, comparing pre-referral antimalarial treatments provided by: community health workers (CHWs), primary health facility, direct access to a tertiary health facility and no access to treatment. A theoretical cohort, of 1000 children, who were below 5 years old; residing in rural hard-to-reach areas, was taken as the reference population. Data was collected through key informant interviews, to assess the costs, while key measures of effectiveness, were obtained from existing studies. The key measure of outcomes was Disability Adjusted Life Years (DALYS) averted. Probabilistic sensitivity analysis was carried out to assess the robustness of the model.ResultsProvision of rectal pre-referral treatment by community health workers was estimated to avert 13,276 DALYs, at a cost of $68,428 for a cohort of 1000 children. Provision of rectal pre-referral treatment at a primary health facility was estimated to avert 9993 DALYs, at a cost of $73,826 for a cohort of 1000 children, while going directly to a tertiary health facility was estimated to avert 15,801 DALYs, at a cost of $114,903 for a cohort of 1000 children. The incremental cost effectiveness ratios for provision of pre-referral treatment by community health care and primary health workers were $5.11 and $7.30 per DALYs averted respectively.ConclusionUse of CHWs was more cost effective than provision of pre-referral treatments at a primary health facility especially, with high referral compliance. Rectal artesunate can easily be administered by community health workers, unlike parenteral pre-referral interventions.

Pre-Referral Intervention in Integrated Kindergartens

Pre-Referral Intervention in Integrated Kindergartens

Exploring Relational Communication Patterns in Prereferral Intervention Teams

The purpose of this research was to understand the relational communication patterns that characterize school-based prereferral intervention teams (PITs). Fifteen PIT meetings were used as the basis for analyses, with each meeting audiotaped, transcribed, and coded using the Family Relational Communication Control Coding System (Heatherington & Friedlander, 1987). Additionally, the PIT Meeting Evaluation Coding Form was used to assess each meeting's adherence to a traditional problem-solving framework. Important results included (a) relatively consistent domineeringness (i.e., attempted influence) scores across participants, with the exception of the referring teacher; (b) relatively consistent dominance (i.e., successful influence) scores across participants; (c) significantly greater (p < .05) domineeringness displayed by the school psychologist compared with the referring teacher; and (d) no significant differences in dominance scores between the school psychologist and teacher. In sum, this study represents an important first step in understanding communication patterns found in school-based problem-solving groups.

Malaria Treatment and Prophylaxis in Endemic and Nonendemic Countries: Evidence on Strategies and Their Cost–Effectiveness

Artemisinin combination treatment is currently the preferred treatment strategy to combat malaria. However, the drug costs are considerably higher than for previously used therapies. This review discusses the cost-effectiveness of current malaria treatment and prophylaxis in endemic and nonendemic countries. For endemic countries, a systematic search for economic evaluations (i.e., cost-effectiveness, cost-utility and cost-benefit analyses) was conducted, looking at the use of Artemisinin combination treatments in children, pregnant women and other adults. In total, 24 studies were identified investigating the cost-effectiveness of malaria treatments with the focus on uncomplicated malaria, severe or prereferral treatment, all in combination with adequate diagnosis, and malaria prevention by intermittent preventive treatment, respectively. In areas with both Plasmodium falciparum and Plasmodium vivax transmission, artemether-lumefantrine and dihydroartemisinin-piperaquine, respectively, are currently the most cost-effective treatment options. Treatment of severe malaria with artesunate is more cost effective compared with treatment with quinine. For patients that live more than 6 h away from an appropriate healthcare facility, prereferral treatment proved to be more cost-effective compared with no prereferral intervention. Cost-effectiveness of intermittent preventive treatment in pregnant women (IPTp) was dependent an clinical attendance. IPT in infants with sulphadoxine-pyrimethamine (SP) is cost effective in sites with high malaria transmission. IPT in children with artesunate (AS + SP), amodiaquine (AQ) + SPQ or SP alone is a cost effective and safe intervention for reducing the burden of malaria in children in areas with markedly seasonal malaria transmission. Although there is a need for it, little is known about the cost-effectiveness of current approaches to malaria therapy in nonendemic countries and the cost-effectiveness of antimalarial chemoprophylaxis.

A Multiple Method Longitudinal Investigation of Pre-Referral Intervention Team Functioning: Four Years in Rural Schools

Qualitative and quantitative methods were used to examine a four year program designed to improve the effectiveness of prereferral intervention teams in rural schools. Quantitative data (basic descriptives) were collected regarding referrals, recommendations, and outcomes. Team meetings were audiotaped and coded to yield qualitative data about the problem-solving processes used and the ecological focus of the statements. Results suggested that the program yielded positive effects, such as a shift from teachers selecting outside interventions to implementing within-classroom interventions, increased follow-up, and increased utilization of objective evaluation methods. Qualitative results suggested that teams focused on a variety of factors and used problem-solving processes. This study provides an example of an effective way to collaborate with schools to improve the functioning of prereferral teams. Teams are most likely to be successful when they invest in training, have administrative support, operate with multidisciplinary membership, and adhere to a consultative model with a structured problem-solving process.

Assessing the Acceptability of Problem-Solving Procedures by School Teams: Preliminary Development of the Pre-Referral Intervention Team Inventory

The responses of 472 educators were used to develop the Pre-Referral Intervention Team Inventory (PRITI), a 24-item Likert scale. Principal axis analyses resulted in a one-dimensional structure with high internal consistency that explained 57% of the total variance. Acceptability of team procedures was strongly and positively correlated with a measure of team members' interaction practices and negatively related to professional stress. These results suggest that (a) pending further analyses and development, the PRITI may prove useful for assessing school staff acceptability perceptions of pre-referral team consultation procedures and (b) team process variables are important predictors of the acceptability of pre-referral team consultation procedures to educators. Directions for future research are proposed.

Parental Involvement in the Prereferral Process

Little is known about parental involvement in the prereferral intervention team (PIT) process. To shed light on the role of parental involvement in PIT meetings and referred student outcomes, this study used a stratified sample of 88 PIT student records from 14 elementary schools within one district. The records were randomly selected and reliably coded. Analyses revealed that greater parental involvement, measured in two ways—parent presence at PIT meetings and parent implementation of PIT interventions—was associated with an indicator of the quality of the PIT process. Parent presence at PIT meetings was also linked with a student outcome. When parents attended more PIT meetings, there was a decreased likelihood of referral for special education evaluation. Practical implications about why and how parents may influence the PIT process and student outcomes are offered.

Training Elementary School General Educators to Implement Function-Based Support

Function-based support (FBS) is an intervention strategy aimed at decreasing problem behaviors and increasing replacement behaviors via functional behavioral assessment and behavioral intervention planning. Although FBS is considered best practice for behavioral interventions in school settings, it is not mandated for students without disabilities and students with unidentified disabilities exhibiting problem behavior. Thus, many of these students receive inadequate interventions or none at all. Considering this context, this study investigated the effects of training elementary school general educators to independently implement FBS as a prereferral intervention. Results from four participating teachers and students suggest this may be a pragmatic and moderately effective practice. Confounds and limitations, as well as future directions for research and practice, are explored herein.

Educational Experiences of Children in Foster Care

The educational achievements of children in foster care have been determined to be below average in individual studies. In the present investigation, 31 studies were examined via four meta-analyses to answer questions regarding the educational status of children in out-of-home placements in multiple countries. Data analysis encompassed the following variables: special education eligibility rates, grade retention rates and disciplinary rates. Exploratory meta-analyses uncovered conclusive results in this project, illuminating common educational challenges faced by children living in foster care across countries. Students living in out-of-home care are disproportionately represented in special education. They are prevented from moving to advanced grade levels at alarming rates. In addition, these students are disciplined frequently in the school setting. Implications for serving fostered youth include promoting pre-referral interventions and positive behavioural supports.