Severity Of Need Research Articles

Outcomes following suicidal crisis among hazardous and harmful alcohol users in the Crisis Resolution Team.

Despite associations between alcohol use and suicidal acts, little research measures prognoses of alcohol-using patients treated by Crisis Resolution Teams (CRTs), an intensive community-based intervention. We estimated the association of alcohol use amongst patients accepted following suicidal acts or ideation in four London-based Crisis Resolution Teams, with death-by-any-cause or recontact with crisis care. We analysed the electronic health records of 1615 CRT patients accepted following suicidal acts or ideation over 38 months, following STROBE guidelines. Using logistic regression we estimated the association of alcohol use (indicated by risk-assessment, AUDIT, or ICD-10 diagnosis) with death-or-recontact at (i) 30-days and (ii) 1-year after treatment start, adjusted for age, sex, ethnicity, psychiatric diagnosis, and severity of need. Hazardous, harmful, or dependent drinking was identified in 270 cases at baseline (16.7%); 73 (4.5%) were alcohol dependent. By 1-year, 622 patients (38.5%) had recontacted crisis care or died. After adjustment, alcohol use at a hazardous, harmful, or dependent level was not associated with increased odds of death-or-recontact at 30-days (AOR 1.17, 95%CI 0.73, 1.88) or 1-year (AOR 1.17, 95%CI 0.85, 1.60). Patients with hazardous, harmful, and dependent alcohol use are a small proportion of CRT patients, despite being more commonly encountered in emergency settings from which patients may be referred to CRTs, indicating a potential gap in provision. Those who are included in CRTs are not at increased risk of death-or-recontact within 1 year of treatment, suggesting that their inclusion can work, at least in a sample with predominantly hazardous or harmful alcohol use.

Heterogeneity in Long-Term Care for Older Adults in Europe: Between Individual and Systemic Effects

The current paper uses comparable data to present an overview of home-based long-term care (LTC) for persons over 65 years of age in Europe. It aims to provide new insights to aid discussions on LTC policy convergence in three areas: the need for services, the extent to which these needs are met and the means employed to do so. It uses data from wave 6 (2015) of the Survey of Health, Ageing and Retirement in Europe (SHARE). Four summary indicators are charted: (i) the care need: how many people need care; (ii) the care gap: the extent to which stated needs remain unmet; (iii) the care mix: how overall provision is divided into formal, informal or a mix of both; and (iv) care satisfaction based on stated preferences by recipients. Heterogeneity at individual level is explained by probit analyses, examining how individual factors (age, severity of need, gender, social networks, prosperity and others) combine with country group and country effects. Scatter plots are used to relate differences among countries to systemic variables, such as public expenditures. The key conclusions are that: (i) Once needs are defined in comparable terms, there remains a surprisingly large number of people across Europe whose needs are not addressed at all, what we call the care gap, especially among the younger group aged 65–80; this is evident everywhere and is not limited to any one type of system or group of countries; (ii) formal and informal care are both significant for the stability of an LTC provision system and for the well-being of care recipients; and (iii) recipients of care are especially sceptical about formal care, as they reward principally informal carers with whom they have personal relationships. The overwhelming finding is that the heterogeneity defies easy generalisations, whether these relate to individual characteristics or systemic effects. This (unexplained) heterogeneity is a challenge for researchers to explain, but it could also represent an untapped resource for policymakers to exploit.

Predicting drug court graduation: Examining the role of individual and programmatic characteristics

IntroductionAlthough existing research suggests drug courts reduce recidivism and substance use, a large portion of drug court participants do not graduate. According to a conceptual framework, severity of need and program intensity may help to explain variation in drug court effectiveness. Understanding variation in drug court graduation can help to identify high risk participants and effective programmatic elements. MethodsOur sample included 247 drug court participants from an adult felony-level drug court located in a large metropolitan area of the southeastern United States that either graduated (n = 113) or were terminated (n = 134) from the program. We used participant and program characteristics from drug court program records to predict drug court graduation. ResultsIn bivariate analyses, several participant and program characteristics were significantly associated with drug court graduation. In the final multivariate model, only one participant-level characteristic was significantly related to graduation: emotional/personal risk and needs (aOR: 0.56, 95% CI: 0.33, 0.93). Alternatively, three program characteristics remained statistically significant predictors of drug court graduation in the final multivariate model. Receiving more individual counseling sessions was positively associated with drug court graduation (aOR: 1.27, 95% CI: 1.14, 1.41), while jail and monetary fine sanctions were negatively associated with drug court graduation (aOR jail: 0.45, 95% CI: 0.30, 0.68; aOR fine: 0.28, 95% CI: 0.10, 0.78). ConclusionsOur findings suggest that drug court programs may benefit by tailoring services for individuals with high emotional/personal risk and participants who receive certain types of sanctions. More rigorous research should explore the causal relationship between individual counseling and drug court graduation to determine if wide-scale programmatic changes are warranted.

Rehabilitation After Total Knee Arthroplasty: Do Racial Disparities Exist?

BackgroundRacial disparities in functional outcomes after total knee arthroplasty (TKA) exist. Whether differences in rehabilitation utilization contribute to these disparities remains to be investigated. MethodsAmong 8349 women enrolled in the prospective Women's Health Initiative cohort who underwent primary TKA between 2006 and 2013, rehabilitation utilization was determined through linked Medicare claims data. Postacute discharge destination (home, skilled nursing facility, and inpatient rehabilitation facility), facility length of stay, and number of home health physical therapy (HHPT) and outpatient physical therapy (OPPT) sessions were compared between racial groups. ResultsNon-Hispanic black women had worse physical function (median score, 65 vs 70) and higher likelihood of disability (13.2% vs 6.9%) than non-Hispanic white women before surgery. After TKA, black women were more likely to be discharged postacutely to an institutional facility (64.3% vs 54.5%) than white women, were more likely to receive HHPT services (52.6% vs 47.8%), and received more HHPT and OPPT sessions. After stratification by postacute discharge setting, the likelihood of receipt of HHPT or OPPT services was similar between racial groups. No significant difference in receipt of HHPT or OPPT services was found after use of propensity score weighting to balance health and medical characteristics indicating severity of need for physical therapy services. ConclusionRehabilitation utilization was generally comparable between black and white women who received TKA when accounting for need. There was no evidence of underutilization of post-TKA rehabilitation services, and thus disparities in post-TKA functional outcomes do not appear to be a result of inequitable receipt of rehabilitation care.

Right care, first time: a highly personalised and measurement-based care model to manage youth mental health.

Right care, first time: a highly personalised and measurement-based care model to manage youth mental health.

Application of System Dynamics to Inform a Model of Adolescent SBIRT Implementation in Primary Care Settings.

System dynamics (SD) modeling is used to compare and contrast strategies for effective implementation of an evidence-based adolescent behavioral health treatment in primary care settings. With qualitative and quantitative data from an on-going cluster-randomized trial in 7 federally qualified health center sites, two implementation conditions were compared: generalist vs. specialist. In the generalist approach, the primary care provider (PCP) delivered brief intervention (BI) for substance misuse (n= 4 clinics). In the specialist approach, BIs were delivered by behavioral health counselors (BHCs) (n= 3 clinics). The resultant SD model compared 'basecase' dynamics to strategic approaches to deploying continuous technical assistance (TA) and performance feedback reporting (PFR). The basecase effectively represented the SBIRT intervention, which reflected actual monthly volume of adolescent primary care visits (N= 9639), screenings (N= 5937), positive screenings (N= 246), and brief interventions (BIs; N= 50) over the 20-month implementation period. Insights gained suggest that implementation outcomes are sensitive to frequency of PFR, with bimonthly events generating the most rapid and sustained screening results. Simulated trends indicated that availability of the BHC directly impacts success of the specialist model. Similarly, understanding PCPs' perception of severity of need for intervention is key to outcomes in either condition.

The peer relations of pupils with special educational needs in mainstream primary schools: The importance of meaningful contact and interaction with peers.

Children with special educational needs (SEN) are generally less accepted by peers in school and have fewer friendships than those without SEN. However, little research has examined peer relations across multiple dimensions, relative to severity of need and in relation to classroom experiences and individual behavioural characteristics. This unique study aimed to extend understanding of the peer relations of pupils with differing levels of SEN support relative to children of differing attainment levels without a formally recognized SEN and in relation to levels of social contact in class and teacher ratings of behaviour. Three hundred and seventy-five 9- to 11-year-old children recruited from 13 classes in four mainstream primary schools in the south of England. Fifty-nine pupils had been identified as having a SEN, of which 17 had a statement of SEN. Pupil sociometric questionnaires provided a range of peer relations measures and the extent of meaningful contact with peers. Pupil behaviour was rated by teachers using the Pupil Behaviour Rating scales. Analyses examined differences in peer relations measures, pupil behaviour, and meaningful contact across different levels of educational need. Compared to pupils without SEN, pupils with a statement of SEN had lowerlevels of peer acceptance, fewer reciprocated friendships, and were lessintegrated into peer groups. While internalizing behaviours, such as social anxiousness and anxiety, and externalizing behaviours, such as aggression and hyperactivity, were related to peer relations measures, frequency of meaningful contact with peers was more predictive of peer relations measures than either SEN status or behaviour. Findings point to the crucial role of meaningful social contact in the classroom for children's relationships with peers. The study advances understanding by highlighting that greater opportunity for meaningful social contact may improve social involvement of, as well as enhance academic outcomes for, pupils with SEN educated in mainstream schools.

Current Status of Nursing Law in the United States and Implications

Methods: This systematic review was guided by a preliminary literature review that identified relevant research terms including nurse(ing) staffing, license, certification, healthcare professionals, and nursing law. An online search of the electronic bibliographic databases MEDLINE, CINAHL, OVID, Westlaw (International materials- Jurisdiction), U.S. National Conference of State Legislatures, and Google Scholar yielded journal articles, nursing acts, and websites from 2009 to 2015. Results: Most nursing laws require staffing committees in each hospital to develop staffing strategies. Staffing committees should include direct-care nurses. Illinois, Oregon, Washington, and Texas require at least 50~60% registered nurses on the committee. Nursing laws in California, New York, and Massachusetts proposed a specific nurse–patient staffing ratio in consideration of the severity of need of patients or units. Furthermore, California enacted minimum staffing ratios. California reported decreased patient mortality, decreased turnover of nursing staff, and increased satisfaction and retention of nurses. Conclusion: It is timely to have nursing laws worldwide that establish minimum numbers of nurses with professional competencies for the health and safety of global citizens.

Adopting children with high therapeutic needs: staying committed over the long haul

This research arose from concern about the prevalence of UK adoptions of children with significant levels of emotional, behavioural and/or therapeutic needs, and the fact that these are being made in a context where research into the outcomes of such placements is sparse. It focuses on adopters of children pre-identified as having high therapeutic needs and looks specifically at the factors that affect adopters’ ongoing commitment. The methodology was qualitative with findings drawn from six in-depth, semi-structured interviews with adopters, followed by focus groups comprising adopters and social workers. Levels of commitment were assessed using the conceptualisation and measures outlined in previous research involving the ‘This is My Baby Interview’ (Bates and Dozier, 1998). Contrary to initial hypotheses, levels of adopter commitment did not correlate with the severity of need or challenging behaviours in their adopted children per se. Instead, it was found to be associated with their feelings of ‘hope’ about the future, feelings that were closely linked to the level, accessibility and quality of the therapeutic and professional resources available.

Implementation of CBT for youth affected by the World Trade Center disaster: Matching need to treatment intensity and reducing trauma symptoms

An implementation study of cognitive-behavioral therapies (CBT) was conducted for traumatized youth in a postdisaster context. Headed by the New York State Office of Mental Health, the study targeted youth (N = 306) ages 5-21 affected by the World Trade Center disaster. They received either trauma-specific CBT or brief CBT skills depending upon the severity of trauma symptoms. Clinicians were trained to deliver these interventions and received monthly consultation. A regression discontinuity design was used to assess optimal strategies for matching need to service intensity. At 6-months postbaseline, both groups had improved. Rate of change was similar despite differences in severity of need. The implications for the implementation of evidence-based treatments postdisaster are discussed.

Treatment Seeking in Populations in Urban and Rural Settings on the Border

Only a small proportion of persons with alcohol or drug problems seek help in the form of treatment for these problems. To examine service disparities among Hispanics living in urban and rural border areas, an improved understanding of factors associated with service seeking is needed for this population. In-person interviews were conducted with a sample of 1,200 colonia residents and urban residents living along the Texas border with Mexico. For the present study, the dataset was limited to Hispanic respondents (85% of the sample) and those who reported any indicator of need for treatment (38% of the sample). There were 380 respondents who met these criteria. Treatment seeking was measured by any past attempt, successful or unsuccessful, to obtain treatment or by their present stated desire for treatment. Factors influencing treatment seeking were compared across 3 sites. Path analyses indicated that, after taking demographics into account, severity of need (the total number of drug-related and alcohol-related problems experienced by an individual) was a strong influence on treatment seeking, but income-related variables were more influential than severity of need in 1 site. Generation of immigration was positively related to treatment seeking in 2 sites, and in colonias, high religiosity was related to treatment seeking. In 2 sites, need severity was related to neighborhood variables. In colonias, need severity was related to low income and low religiosity. This framework for understanding treatment seeking in border communities suggests that pathways to treatment seeking vary by locality in ways that may reflect variations in local environments and service systems. Design of outreach efforts should be tailored to the unique social and service system challenges of each local community. Although service seeking is low overall, findings are suggestive of an inequitable service access structure in 1 site where need is not the predominant factor for treatment seeking.

Policy Determinants Affect Telehealth Implementation

The objective of this study is to explore the variation in the implementation of telehealth programs in the United States. In researching this topic, we assess the influence of traditional policy determinants on the extent of telehealth program implementation. The methodology used in our evaluation is cross-sectional time series regression analysis. The main dependent variable is the extent of telehealth program implementation at the state level across 29 medical specialty areas from 1995 through 2003. The results suggest that state legislative professionalism, partisanship of state legislators, government resources, and severity of need are important factors in understanding the implementation of this policy. We also find healthcare interest groups to be associated with telehealth program implementation, with nursing groups positively related to implementation, and physician networks negatively associated. In one respect, finding interest groups as significantly related to implementation is not surprising; interest groups are important to the policy landscape of the United States. On the other hand, telehealth is a procedural policy that essentially dictates how policy is to be carried out. Generally, this form of policy does not attract public interest. In this circumstance, the interest groups who mobilized are the individuals who must carry out the policy. This outcome reminds us that although the policy literature does not treat interest groups as important to execution of procedural policy, we must consider how these policies will impact those who must carry them out. As an interest group, they can either act as an impetus or barrier to implementation.

Mapping the Data Needed to Plan Integrated Services: A Case Study of Children's Services in one Locality

Children's services agencies in England are increasingly expected to work together to plan needsled interventions in their locality. Such planning requires good information on local need and service take‐up, yet this is often lacking. Connecting data from single agency, multi‐agency and community studies in one district shows how the severity of need overlaps with different service and administrative categories. The findings point to the value of such mapping exercises, while the pattern that emerges highlights the importance of planning provision for all children and of linking intervention to thresholds of severity of need. The approach will have relevance to other care groups.

Speech and language therapy services to education in England and Wales.

Services for children with speech and language needs in England and Wales are in a period of change. The context is subject to major systemic pressures deriving from government policies. These include the development of inclusive education and encouragement of multiprofessional collaboration in policy development and practice ('joined up thinking'). In addition, structures at local level are changing with the establishment of unitary authorities and the change from Health Trusts to Primary Care Trusts. Professional practice is also changing with a shift from clinical to community settings for speech and language therapists working with children. The present study reports on a survey sponsored by the Department for Education and Employment, Department of Health and the Welsh Assembly to identify the nature of speech and language therapy (SLT) services provided to education in England and Wales. The sample comprised all SLT service managers (n = 133, response rate 74%). The results indicate that services vary greatly in size and in their SLT: child ratio, with a mean of one SLT to 4257 child population. The caseload was highest for the 5-10 age group, and service delivery was targeted at these children, with low levels of work with secondary aged pupils. Most provision in educational settings was made to mainstream schools, but the provision of SLT time per child was substantially higher in specialist language resources. Apart from the preschool phase, most SLT provision was for children with statements of special educational needs. Prioritization of service delivery was usually by severity of need. The provision of bilingual SLT services was very limited, with only 14.0 full-time equivalents SLTs fluent in a community language, other than Welsh, where proportionately availability was much greater. Most LEAs funded SLT posts, although these were usually employed as part of the SLT service, with only about 10% of LEAs employing SLTs direct. However, 55.5% of SLT managers reported that recruitment and retention were problematic, resulting in gaps in the service. These findings are discussed with respect to changes driven by professional judgements on the nature of optimal service delivery, and government policy, with particular reference to inclusion and equity of service delivery.

Are psychiatric illnesses adequately considered in distribution of nursing care levels according to the nursing care insurance law? Evaluation using a new scale for evaluating need for nursing care by senior citizens

The object of our study is the evaluation of care needs of senior citizens and the adjustment of certain stage of care according to the German Health Care Act ("Pflegeversicherungsgesetz"). For assessment of care needs we developed a new rating scale (BPS). Factor analysis of the rating scale showed 5 dimensions: (1) "Psychoorganic Syndrome" (Dementia), (2) "Physical Care Needs", (3) "Lack of Social Skills", (4) "Aggressiveness" and (5) "Depression". The sample size is N = 1739, mean age 82.5 years. A statistically significant partial correlation of the extent of care needs as indicated by the stage of care described by BPS dimensions was found only for dimension (2) "Physical Care Needs" (r = 0.50). Cluster analysis resulted in distribution of the whole sample into 6 discriminable groups, according to their syndrome specificity (BPS profiles). Additionally clusters are different regarding the severity of need for care. It is obvious, analyzing the adjustment of stages of care within clusters, that psychiatric relevant disturbances contribute substantially to this adjustment. Nevertheless this finding is valid only for aged people, who receive regular care by ambulant or home services, and can not be transferred to senior citizens cared by their families.

Patients' perceptions of need for primary health care services: useful for priority setting?

To assess the feasibility of using patients' perceptions of need for primary health care services to develop priorities. A postal survey of a random sample of 3478 patients registered with five general practices. Lothian, Scotland. Comparison of rankings of 36 different kinds of help or advice according to (a) popularity in the sample size as a whole and in healthy and unhealthy subgroups and (b) health status (severity of need) of potential service users. Popularity rankings differed between the healthy and unhealthy subgroups and the whole sample. Popularity rankings were almost the inverse of rankings based on health status. The analysis identified two areas of substantial need both in terms of popularity and severity: pain management and advice about welfare benefits. Methodological efforts to ensure equal participation in the processes of assessing health needs and of priority setting do not in themselves promote equity. To promote equity some opinions may need to be given greater weight.

An ‘Ordinary’ Life for People with Learning Disability and Severe Sensory Impairment?

While life in small, ordinary type homes in the community is seen as desirable for the majority of people with learning disability, it may not serve the special needs of people with more complex impairment, such as those with additional severe sensory impairment. The case is made for retention and development of specialised residential provision for this group of people and for specialised service centres. This is on the condition that, firstly, such services see their function as the provision of intensive specialist help which equips people to make use of community services, as well as that of providing more permanent care for those whose severity of need requires it. Secondly, that they act as resource centres of ideas and practice which provide training for staff who work in a wide variety of situations with people with sensory impairment. Parallels are drawn between meeting children's special educational needs and the special needs of adults with learning disability. A flexible continuum of provision is seen as desirable to meet the diversity of need.

Allocating scarce resources: A contingency model of distributive justice

Two experiments tested predictions derived from a contingency model of distributive justice that identifies four interrelated categories of determinants of people's allocation decisions: (1) abstract distributive norms; (2) perceived attributes of claimants; (3) resource constraints; and (4) attributes of judges. The model posits that allocations of public resources (e.g., health care or welfare) engage in two types of appraisal: one focused on the adequacy of the resource pool, and the other on the causes of claimants' needs. When resources are inadequate, attributional analysis assumes central importance, and need and efficiency emerge as key distributive values. If claims arise from internal-controllable causes, allocators experience anger toward claimants, devalue their deservingness, and withhold resources. If claims arise from other causes, distributive norms become direct predictors of deservingness and allocation. The experiments manipulated the causes of need, the severity of need, and the likelihood of effective assistance under low and high scarcity (Study I) and no scarcity (Study II). Under scarcity, allocators were much more likely to deny aid to claimants who were responsible for their predicament. Need and efficiency emerged as joint predictors of allocating aid to claimants who were not responsible for their predicament. Politically conservative allocators withheld resources from those personally responsible for their needs regardless of both severity of need and likelihood of effective helping, even when there were sufficient resources to satisfy all claimants, whereas liberals tended to provide resources to all claimants.

Severity of Need and Educational Excellence: Public School Reform and Students with Disabilities

Severity of Need and Educational Excellence: Public School Reform and Students with Disabilities

A Branch and Bound Algorithm for Optimum Allocation of Float Nurses

This paper discusses a methodology developed for allocation of float nurses in short-term general hospitals. The severity of need for nursing care on a unit is measured from the perceptions of head nurses of the unit. A multivariate regression model is used to predict head nurses perceptions at the beginning of a shift from certain auditable variables. The multivariate regressions are used as an objective function in a branch and bound allocation model designed to allocate float nurses before the start of a shift. The model is tested in five nursing units of a study hospital, and results are presented.