Program Exit Research Articles

Corrigendum to: A Comparison of Two Nursing Program Exit Exams That Predict First-Time NCLEX-RN Outcome

CIN: Computers, Informatics, Nursing 36(1):p 54, January 2018. | DOI: 10.1097/01.NCN.0000527969.77275.a8

Undergraduate Performance in Solving Ill-Defined Biochemistry Problems.

With growing interest in promoting skills related to the scientific process, we studied performance in solving ill-defined problems demonstrated by graduating biochemistry majors at a public, minority-serving university. As adoption of techniques for facilitating the attainment of higher-order learning objectives broadens, so too does the need to appropriately measure and understand student performance. We extended previous validation of the Individual Problem Solving Assessment (IPSA) and administered multiple versions of the IPSA across two semesters of biochemistry courses. A final version was taken by majors just before program exit, and student responses on that version were analyzed both quantitatively and qualitatively. This mixed-methods study quantifies student performance in scientific problem solving, while probing the qualitative nature of unsatisfactory solutions. Of the five domains measured by the IPSA, we found that average graduates were only successful in two areas: evaluating given experimental data to state results and reflecting on performance after the solution to the problem was provided. The primary difficulties in each domain were quite different. The most widespread challenge for students was to design an investigation that rationally aligned with a given hypothesis. We also extend the findings into pedagogical recommendations.

A National Study of Veterans Treatment Court Participants: Who Benefits and Who Recidivates.

Although there are now over 400 veterans treatment courts (VTCs) in the country, there have been few studies on participant outcomes in functional domains. Using national data on 7931 veterans in the Veterans Affairs (VA) Veterans Justice Outreach program across 115 VA sites who entered a VTC from 2011 to 2015, we examined the housing, employment, income, and criminal justice outcomes of VTC participants; and identified veteran characteristics predictive of outcomes. VTC participants spent an average of nearly a year in the program and 14% experienced a new incarceration. From program admission to exit, 10% more participants were in their own housing, 12% more were receiving VA benefits, but only 1% more were employed. Controlling for background characteristics, a history of incarceration predicted poor criminal justice, housing, and employment outcomes. Participants with property offenses or probation/parole violations and those with substance use disorders were more likely to experience a new incarceration. Participants with more mental health problems were more likely to be receiving VA benefits and less likely to be employed at program exit. Together, these findings highlight the importance of proper substance abuse treatment as well as employment services for VTC participants so that they can benefit from the diversion process.

Predictors of CD4 health and viral suppression outcomes for formerly homeless people living with HIV/AIDS in scattered site supportive housing

ABSTRACTStable housing is key to improving health outcomes for people living with HIV/AIDS. Though many formerly homeless HIV positive individuals reside in supportive housing, little research has examined biometric HIV health outcomes for residents of these programs. Through a community-based research partnership, this study analyzed secondary data from a Shelter Plus Care supportive housing program in Cincinnati, Ohio to examine the likelihood of participants achieving a healthy CD4 count (>500 cells/mm3) and viral suppression (viral load <200 copies/mL) while in supportive housing and to identify participant characteristics associated with these outcomes. The study sample was 86 participants who entered the program between 2008 and 2016, including 50 current residents and 36 exited participants. Participants’ average length of stay in Shelter Plus Care was 35.2 months (range 3.2–108.1 months) during the study period. Bivariate analysis indicated statistically significant improvements on both outcome variables, with 45% of participants achieving a healthy CD4 count and 79% achieving viral suppression by program exit or most recent time point. Participants who had health insurance at intake and who had never been incarcerated were more likely to achieve viral suppression, and longer length of stay in the program was also positively associated with viral suppression. These results add to the literature on the relationship between housing conditions and HIV health outcomes by demonstrating that residence in supportive housing is associated with improvements in CD4 count and viral load for a sample of formerly homeless persons living with HIV/AIDS, two-thirds of whom had co-occurring physical health, mental health, or substance abuse problems. Further research collaborations should expand on these findings to examine the service packages that are associated with optimal HIV health outcomes for supportive housing residents.

Using administrative data to explore the employment and benefit receipt outcomes of vocational rehabilitation applicants years after program exit

Using administrative data to explore the employment and benefit receipt outcomes of vocational rehabilitation applicants years after program exit

Comparing students' and managers' perceptions of essential entry-level management competencies in the hospitality industry: An empirical study

The age-old higher education concern of graduates’ industry relevancy coupled with the mounting program outcomes emphases of business schools led us to research program exit competencies. Our study determined knowledge and skills that employers most seek when hiring entry-level managers within the business discipline of hospitality management. We compared these results to student perceptions of industry-preferred managerial competencies. T-test, ANOVA, and regression analyses revealed findings suggesting that managers and students have different perceptions regarding entry-level managerial competencies. We discuss research implications, practical suggestions, and future recommendations about identifying the most essential management competencies for graduates to effect curricular changes.

Factors contributing to eviction from permanent supportive housing: Lessons from HUD-VASH

IntroductionEviction from housing is associated with several negative outcomes, further exacerbated among high-need populations requiring financial and supportive services to maintain housing stability. This study investigated risk and protective factors—both characteristics and precipitating events of tenant eviction—informing permanent supportive housing (PSH) programs’ efforts to identify tenants at risk and intervene. MethodsUsing administrative data for a cohort of 20,146 Veterans participating in PSH, this study assessed differences in Veterans who exited the program due to eviction and Veterans who exited because they accomplished their goals. A series of logistic regressions identified patterns of health services use that may signal imminent eviction. ResultsVeterans with a drug use disorder and those who received inpatient, emergency, or outpatient care related to mental/behavioral health and substance use conditions proximal to program exit had greater risk for eviction. Receipt of outpatient primary medical care and supportive services was generally protective against eviction. The likelihood of eviction was greatest for Veterans with acute care use within 30days of exit. DiscussionPSH providers may use these correlates of eviction to identify Veterans in need of an intervention to prevent eviction. Future work should focus on operationalizing these findings and identifying appropriate interventions.

The HESI Admission Assessment and Radiography Exit Examination as Predictors for Student Success

PurposeTo examine the relationship between the Health Education Systems, Inc. (HESI) Admission Assessment (A2) and specific established admission criteria in an entry-level radiologic sciences (RADS) program, and to determine any correlations between the program exit examination, the HESI radiography exit examination, and the American Registry of Radiologic Technologists (ARRT) first-time registry scores for two consecutive program cohorts. DesignA quantitative approach was used to compare students' semester grades in English (6 credit hours), anatomy and physiology (8 credit hours), and college-level mathematics (3 credit hours) to scores on comparable categories of the HESI A2. Students' scores on program exit examinations, the HESI radiography exit examination, and the ARRT first-attempt registry scores were also compared. Quantitative measurements were obtained using z scores and conducting a Pearson correlation reliability coefficient test. Results and ConclusionThere was no correlation between the HESI A2 examination and program admission criteria except when a minimum passing score of 70 was applied to the HESI A2, eliminating some students. Except for one student in each cohort, those students who would have been eliminated by the HESI also left the program, failed the ARRT registry examination, or consistently made low grades (Cs or Ds) in the program. This study showed that the HESI radiography exit examination had a high degree of correlation with the program exit examination and the ARRT registry examination. Finally, this study showed that the HESI A2 examination is a good potential additional tool to use for admission criteria when an appropriate minimum passing score is set and may help in selection of students who will be successful in the program.

A 20-Site Comparison of Transition-in-Place Versus Traditional Transitional Housing Programs.

Transition-in-Place (TIP) is a housing model being piloted in the veterans affairs transitional housing program, Grant & Per Diem (GPD). This observational 20-site study compares characteristics and outcomes of 488 clients in TIP and 10,388 clients in traditional GPD programs. TIP participants were younger, better educated, healthier, and reported higher employment income than traditional GPD participants. Adjusting for these differences, TIP participants were more likely to have their own housing and reported higher employment and public support income at program exit, although the differences were small. These results inform use of the TIP model as a public health intervention.

HOME VISIT QUALITY VARIATIONS IN TWO EARLY HEAD START PROGRAMS IN RELATION TO PARENTING AND CHILD VOCABULARY OUTCOMES.

Home-visiting programs aiming to improve early child development have demonstrated positive outcomes, but processes within home visits to individual families are rarely documented. We examined family-level variations in the home-visiting process (N = 71) from extant video recordings of home visits in two Early Head Start programs, using an observational measure of research-based quality indicators of home-visiting practices and family engagement, the Home Visit Rating Scales (HOVRS). HOVRS scores, showing good interrater agreement and internal consistency, were significantly associated with parent- and staff-reported positive characteristics of home visiting as well as with parenting and child language outcomes tested at program exit. When home-visiting processes were higher quality during the program, home visit content was more focused on child development, families were more involved in the overall program, and most important, scores on measures of the parenting environment and children's vocabulary were higher at the end of the program. Results showed that home visit quality was indirectly associated with child language outcomes through parenting outcomes. Observation ratings of home visit quality could be useful for guiding program improvement, supporting professional development, and increasing our understanding of the links between home-visiting processes and outcomes.

The First Dedicated Cardiac Rehabilitation Program for Patients With Spontaneous Coronary Artery Dissection: Description and Initial Results

BackgroundSpontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction in women, but the role of rehabilitation after SCAD is unclear. MethodsWe designed a dedicated SCAD cardiac rehabilitation (SCAD-CR) program for our SCAD survivors at Vancouver General Hospital. This program encompasses a multidisciplinary approach including exercise rehabilitation, psychosocial counselling, dietary and cardiovascular disease education, and peer group support. Exercise and educational classes were scheduled weekly with a targeted participation of 6 months. Psychosocial counselling, mindful living sessions, social worker and psychiatry evaluations, and peer-group support were offered. ResultsWe report our first consecutive cohort of 70 SCAD women who joined SCAD-CR from November 2011 to April 2015. The average age was 52.3 ± 8.4 years. Mean participation duration was 12.4 ± 10.5 weeks; 28 completed 6 months, 48 completed ≥ 1 month. At entry, 44 (62.9%) had recurrent chest pains and average metabolic equivalents on exercise treadmill test was 10.1 ± 3.3. At program exit, the proportion with recurrent chest pains was lower (37.1%) and average metabolic equivalents was higher 11.5 ± 3.5 (both P < 0.001). There was a significant improvement in the STOP-D depression questionnaire, with mean scores of 13.0 ± 1.4 before and 8.0 ± 1.7 after the SCAD-CR (P = 0.046). Twenty (28.6%) social worker referrals and 19 (27.1%) psychiatry referrals were made. Mean follow-up was 3.8 ± 2.9 years from the presenting SCAD event, and the major cardiac adverse event rate was 4.3%, lower than our non-SCAD-CR cohort (n = 145; 26.2%; P < 0.001). ConclusionsThis is the first dedicated SCAD-CR program to address the unique exercise and psychosocial needs of SCAD survivors. Our program appears safe and beneficial in improving chest pain, exercise capacity, psychosocial well-being and cardiovascular events.

Moving to Opportunity or Isolation? Network Effects of a Randomized Housing Lottery in Urban India

A housing lottery in an Indian city provided winning slum dwellers the opportunity to move into improved housing on the city’s periphery. Fourteen years later, relative to lottery losers, winners report improved housing farther from the city center, but no change in family income or human capital. Winners also report increased isolation from family and caste networks and lower access to informal insurance. We observe significant program exit: 34% of winners never moved into the subsidized housing and 32% eventually exited. Our results point to the importance of considering social networks when designing housing programs for the poor.Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.

Moving to Opportunity or Isolation? Network Effects of a Randomized Housing Lottery in Urban India

A housing lottery in an Indian city provided winning slum dwellers the opportunity to move into improved housing on the city's periphery. Fourteen years later, winners report improved housing but no change in tenure security, family income, or human capital. Winners also report increased isolation from family and caste networks and reduced informal insurance. We observe significant program exit: 34 percent of winners never took up subsidized housing and 32 percent eventually exited. Our results suggest negligible long-run economic value of this expensive public program and point to the importance of considering social networks in housing programs for the poor. (JEL I38, O15, O18, R23, R31, R38, Z13)

Prioritization of resources for participants in a peer counseling breastfeeding support program.

Peer counseling (PC) breastfeeding support programs have proven effective in increasing breastfeeding duration in low-income women. This study aimed to describe program participants and breastfeeding duration in a PC program according to (1) timing of enrollment (prenatal vs postnatal) and (2) breastfeeding status at program exit (discontinued breastfeeding, exited program while breastfeeding, and completed 1 year program) to improve understanding of how these groups differ and how services might be optimized when resources are limited. This study is a secondary analysis of data from low-income women enrolled in a PC breastfeeding support program. Participant characteristics and breastfeeding duration were described using chi-square tests, analyses of variance, and logistic regression. Postnatal enrollees had longer breastfeeding duration than prenatal enrollees (F < .001) and were more likely to be older, to be married, to be more educated, and to have prior breastfeeding experience (each variable P < .01). Women who withdrew from the program while breastfeeding were more demographically similar to those who discontinued breastfeeding prior to 1 year than to those who continued in the program breastfeeding for 1 year, although they breastfed for significantly longer at exit (mean ± SD = 27.8 ± 14.8 weeks) compared to women who discontinued breastfeeding while in the program (15.7 ± 13.3 weeks) (P < .001). It may be advantageous for peer counselors to direct fewer resources to later postnatal enrollees and more to prenatal or early postnatal enrollees. It may also be advantageous to focus on supporting women at high risk of discontinuation rather than on retaining women who choose to withdraw from the program while breastfeeding.

Intervention with substance-abusing mothers: Are there rural-urban differences?

The purpose of this study was to examine rural-urban differences among substance-abusing mothers enrolled in the Parent-Child Assistance Program (PCAP) from 1998 to 2008 in Washington State. This was a longitudinal study utilizing PCAP data reports of 773 women enrolled from 1998 to 2008. Differences across urban-rural PCAP participants were examined. Rural participants were more likely to report alcohol use and binge drinking at program intake and at the 3-year program exit. In addition, throughout the program, rural women were less likely to complete outpatient substance abuse treatment compared to urban participants. Rural women also used less services during the last year including alcohol/drug support and mental health provider services. Findings are troubling when we consider that at program exit, rural participants also reported higher use of alcohol and more suicidal thoughts than those residing in urban areas. Data presented indicate there are important differences between urban and rural residing participants. Findings highlight the importance of considering the barriers that rural or remote locations might create. Identifying community-specific needs of substance abusing pregnant or parenting women in both rural and urban settings is crucial for the successful development and improvement of treatment and intervention programs for this vulnerable population of women. (Am J Addict 2014;XX:1-9).

Examining Writing Performance and Self-Perception for Low Socioeconomic Young Adolescents

The present case study investigated the impact of a short-term summer literacy approach on writing performance and self-perception of writing for young adolescents of low-income families residing in urban housing projects. The approach offered intensive literacy engagement to offset summer achievement loss; assisted ethnic-minority, low socioeconomic youth achieve state benchmarks in the English language arts; and pioneered research on writer self-perception for this population. Findings from pre/post use of a normed writer self-perception scale, Chi-square analysis of a camp experience survey, participant interviews and a program exit survey revealed that the 250 youth entering grades five through seven and engaged in extensive writing prompted by reading, discussion, and use of graphic organizers believed their progress and ability to write positively improved. Progress in writing was objectively measured by pre/post writing accounts of a favorite experience evaluated by calibrated raters using the state rubric system. The results of a dependent t-test evidenced a significant increase in writing performance with 157 participants increasing, 56 decreasing, and 37 achieving the same score between pre/post evaluation. A bivariate correlation comparing postwriting scores with postresults of four self-perception subscales revealed significant correlations at the .01 level.

Improving pregnancy outcomes among high-risk mothers who abuse alcohol and drugs: Factors associated with subsequent exposed births

Parental alcohol and drug abuse is a factor in approximately 15% of the cases investigated by the child welfare system and in approximately one quarter of cases with substantiated maltreatment. While substance abuse treatment is generally an essential component of child welfare family plans, a relatively low proportion of substance abusing mothers involved in the child welfare system complete treatment, which typically results in placement of their children in substitute care and the beginning of a new generation of adaptive problems. This longitudinal study explores whether loss of an index child due to substance abuse is associated with risk of a subsequent alcohol/drug-exposed birth in a sample of 795 substance-abusing mothers enrolled in the Washington State Parent–Child Assistance Program (PCAP). Results indicate that at program exit, over one-fifth of these women had a subsequent birth (SB) after the birth of their index child. Among these women, over half (i.e., 56.3% or 12.3% of the entire sample) used alcohol and/or drugs during the subsequent pregnancy. Consistent with our main hypothesis, the adjusted odds of having a SB were increased nearly two-fold for women who had the index child removed from their care. Furthermore, among mothers with subsequent births, the adjusted odds of having an exposed SB were increased three-fold if the index child had been removed from the mother's care. We discuss implications of our findings for child welfare policy and practices.

A comparison of two nursing program exit exams that predict first-time NCLEX-RN outcome.

This retrospective descriptive correlational study compared the predictive accuracy of the Health Education Systems, Inc, Exit Exam (Elsevier) and Assessment Technologies Institute's RN Comprehensive Predictor, both of which were administered to nursing students in an upper-division baccalaureate nursing program during their final semester of study. Using logistic regression analyses, it was determined that the two examinations were statistically significant but weak predictors of success on the RN licensure examination. The RN Comprehensive Predictor had a slightly better odds ratio; however, both examinations had similar sensitivity, specificity, and overall accuracy. Because the RN Comprehensive Predictor was included in the Assessment Technologies Institute's Comprehensive Assessment and Review Program already being used by the BSN program, based on the results of this study, the nursing faculty decided to use only the RN Comprehensive Predictor during its NCLEX-RN preparation course.

Policy Traps: Consumer Subsidies in Post-Crisis Argentina

Developing countries devote significant resources to lowering consumer prices for basic goods and services such as food and electricity. Theories of the welfare state only partially elucidate why consumer subsidy regimes grow so large and become entrenched. While the welfare state literature stresses how concentrated, organized beneficiary groups push for the expansion and protection of well-known programs such as pensions, the developing world’s consumers are atomized, and subsidies themselves are of low visibility. The size and durability of consumer subsidy regimes stem primarily from political uncertainty and price shocks that provide politicians with strong incentives to avoid blame for repeal. Over time, environmental pressures and fears of political backlash against repeal reinforce one another, increasing the fiscal burden subsidies impose and dramatically raising the political cost of program exit. In this sense, consumer subsidy programs come to form “policy traps”—initially modest policies that quickly grow and become entrenched, thereby greatly reducing politicians’ maneuvering room. We utilize this framework to analyze the meteoric growth and entrenchment of utility subsidies in post-crisis Argentina. In Argentina, subsidies grew despite the private provision of subsidized services—making it difficult for the government to claim credit—even in sectors with weakly organized interests.

Description of an Intensive Residential Aphasia Treatment Program: Rationale, Clinical Processes, and Outcomes

The purpose of this article is to describe the rationale, clinical processes, and outcomes of an intensive comprehensive aphasia program (ICAP). Seventy-three community-dwelling adults with aphasia completed a residentially based ICAP. Participants received 5 hr of daily 1:1 evidence-based cognitive-linguistically oriented aphasia therapy, supplemented with weekly socially oriented and therapeutic group activities over a 23-day treatment course. Standardized measures of aphasia severity and communicative functioning were obtained at baseline, program entry, program exit, and follow-up. Results were analyzed using a Bayesian latent growth curve model with 2 factors representing (a) the initial level and (b) change over time, respectively, for each outcome measure. Model parameter estimates showed reliable improvement on all outcome measures between the initial and final assessments. Improvement during the treatment interval was greater than change observed across the baseline interval, and gains were maintained at follow-up on all measures. The rationale, clinical processes, and outcomes of a residentially based ICAP have been described. ICAPs differ with respect to treatments delivered, dosing parameters, and outcomes measured. Specifying the defining components of complex interventions, establishing their feasibility, and describing their outcomes are necessary to guide the development of controlled clinical trials.