State Licensing Agencies Research Articles

Family practices in educator licensure: a content analysis of U.S. state requirements

ABSTRACT Families are critical to children’s learning and play a vital role on their children’s team. As such, preparation standards across the Division for Early Childhood, National Association for the Education of Young Children, and other key entities include family practices as part of their recommendations. This content analysis examined how states included family practices into initial licensure requirements of early childhood (ECE) and early childhood special educators (ECSE). Documents were collected electronically from state departments of education across the U.S. in 2021. This analysis determined if states required family-related practices, what was required, and what terminology and concepts were included in family-related requirements. Overall, 55% of states included family practices for ECSE while 45% of states included them for ECE. Increasing the inclusion of family practices in initial licensure requirements and building relationships across state licensing agencies and institutions of higher education may better prepare educators to partner with families.

A comparison of licensed driver counts from the Federal Highway Administration and driver licensing agencies in 11 states

Objective: Those who study motor vehicle crashes may rely on counts of licensed drivers to estimate crash, injury, or fatality rates. These counts may be obtained from the U.S. Department of Transportation Federal Highway Administration’s (FHWA) annual Highway Statistics Series or directly from state driver licensing agencies. However, previous studies have questioned the accuracy of these counts provided by the FHWA.Methods: To investigate this issue, we compared counts of licensed drivers from the FHWA and state licensing agencies in 11 states, categorized by sex and age group, from 2013 through 2017. We then assessed the impact of any potential differences by fitting two sets of Poisson regression models to estimate age- and sex-based driver fatality rate ratios. One set of models used counts from the FHWA as the offset and the other used counts from state licensing agencies.Results: Our analysis found that the differences between FHWA and state counts varied markedly. Seven states had substantial differences for at least one age group that spanned the entire study period. In several cases, these differences in license counts were large enough to produce directly contradictory driver fatality rate ratio estimates when comparing age groups.Conclusions: These findings highlight the continued concern regarding the accuracy of licensed driver counts from the FHWA and extend previous studies by illustrating the impact of using FHWA counts on statistical inference. We recommend against using these data for traffic safety research or policy evaluation. Nevertheless, we acknowledge the need for a centralized, easily accessible database for licensed driver data.

Implementing Oregon’s New Quality Measurement Program for Assisted Living Communities

Oregon legislation requires assisted living (AL) communities to report selected quality measures to the state licensing agency. The Quality Measurement Program (QMP) includes five metrics that assess different areas of resident safety and wellbeing: falls, antipsychotic medication use, staff training, staff retention, and resident satisfaction. This paper describes findings based on our 2019 survey of AL communities and offers suggestions for stakeholders interested in public reporting and quality metrics. Assisted living providers reported 28% of AL residents and 38% of memory care (MC) residents fell at least once in the prior 90 days, with 39% and 45% reporting an injury, respectively. Antipsychotic medication use was 20% among AL and 44% among MC residents. These findings and the survey methods used to collect them, combined with stakeholder and state agency staff participation, informed the current QMP approach. We describe how to collect meaningful quality metrics within the AL context.

Tobacco-free grounds implementation in California residential substance use disorder (SUD) treatment programs

Smoke-free laws and policies have contributed significantly to the decline in smoking in the U.S, but are not often applied in high-prevalence smoking populations where they are most needed. Smoking among clients in publicly funded substance use disorder (SUD) treatment is 3-4 times higher than the general population, and little is known about tobacco policies programs have adopted. To identify the prevalence of tobacco-free grounds and other smoking policies in California’s publicly funded, adult, residential SUD programs. Using a California DHCS contact list of 1,921 publicly funded, non-medical, SUD programs, 362 were eligible to participate in a brief semi-structured phone survey concerning indoor and outdoor smoking for staff and clients and other tobacco policies. Of 259 programs that completed the survey, 28 (10.8%) reported tobacco-free grounds. 91 (35.1%) expressed interest in implementing tobacco-free policies and 23 have plans to do so. Nearly all programs (n = 253, 97.7%) had some policy restricting e-cigarette use, and 110 (43.5%) of these reported a complete ban on e-cigarette use. 124 (47.9%) had policies prohibiting staff and clients smoking together. Most California residential SUD programs allow outdoor smoking for staff and clients and few have adopted tobacco-free grounds policies. Given the reported interest in adopting tobacco-free policies, the high density of smokers in the SUD population, and the association of tobacco-free policies with lower client and staff smoking rates, state licensing and regulatory agencies, as well as county health departments, should work with SUD programs to adopt tobacco-free policies.

Kuahuokalā: Reflections on Space and Transformative Education Conversations

How can a place transform a conversation? In this paper the authors discuss how meeting to develop a professional learning community in a hale, a traditional native Hawaiian building, changed the course and direction of the learning community. Too often, departments and divisions of higher education are driven by external standards imposed by state and national accrediting and licensing agencies. The conceptions of education and the way it is implemented then is more focused on meeting the standard rather than coming to a deeper understanding of what can be accomplished for our communities in the name of education and how it can be achieved. Our PLC is intended to address this shortcoming by creating space of sharing, conversation and communal action. What emerged from our work within our relationship to the hale was an expression of the values, commitments and ideals that emerged through the context of our developing relationship. With a political desire for voice, we built a community that found meaning in the process of building something greater than ourselves, yet fundamentally immersed in our everyday lives.

Outcomes, Registries and Medical Marijuana: Towards Establishing Dispensary Monitoring and Reporting Standards.

The acceptance by a large number of state governments of medical marijuana dispensaries and the regulatory framework to support their licensing has put to one side the issue of monitoring and reporting outcomes. This is a major oversight. It is an untenable situation given the limited evidence base for the clinical benefits and risks associated with dispensed botanical marijuana. The purpose of this commentary is to propose that, as a condition of licensing, marijuana dispensaries should be required to establish a registry to support ongoing monitoring of patient response associated with botanical cannabis formulations. Patients should be monitored over the course of their treatment to assess, in the case of severe non-cancer pain as an example, pain intensity and functional status by pain location. The dispensary, in meeting required audit standards, should be in a position to report on patient response over baseline to the provider who has recommended botanical cannabis. As well, registries should be in a position to report to state licensing agencies response to therapy by target patient groups. Establishing site-specific registries should go some way to meeting the present evidence deficit for botanical marijuana, reducing barriers to its acceptance by providers, patients and health agencies.

Association between Performance in a Maintenance of Certification Program and Disciplinary Actions against the Medical Licenses of Anesthesiologists.

WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: In 2000, the American Board of Anesthesiology (Raleigh, North Carolina) began issuing time-limited certificates requiring renewal every 10 yr through a maintenance of certification program. This study investigated the association between performance in this program and disciplinary actions against medical licenses. The incidence of postcertification prejudicial license actions was compared (1) between anesthesiologists certified between 1994 and 1999 (non-time-limited certificates not requiring maintenance of certification) and those certified between 2000 and 2005 (time-limited certificates requiring maintenance of certification); (2) within the non-time-limited cohort, between those who did and did not voluntarily participate in maintenance of certification; and (3) within the time-limited cohort, between those who did and did not complete maintenance of certification requirements within 10 yr. The cumulative incidence of license actions was 3.8% (587 of 15,486). The incidence did not significantly differ after time-limited certificates were introduced (hazard ratio = 1.15; 95% CI, 0.95 to 1.39; for non-time-limited cohort compared with time-limited cohort). In the non-time-limited cohort, 10% (n = 953) voluntarily participated in maintenance of certification. Maintenance of certification participation was associated with a lower incidence of license actions (hazard ratio = 0.60; 95% CI, 0.38 to 0.94). In the time-limited cohort, 90% (n = 5,329) completed maintenance of certification requirements within 10 yr of certificate issuance. Not completing maintenance of certification requirements (n = 588) was associated with a higher incidence of license actions (hazard ratio = 4.61; 95% CI, 3.27 to 6.51). These findings suggest that meeting maintenance of certification requirements is associated with a lower likelihood of being disciplined by a state licensing agency. The introduction of time-limited certificates in 2000 was not associated with a significant change in the rate of license actions.

Regulatory and Litigation Risks of Elopement

Regulatory and Litigation Risks of Elopement

P122 - Exploring the Importance of Healthfulness Among Food Truck Operators

Background (Background, Rationale, Prior Research, and/or Theory): Food trucks have become an increasingly popular part of the food scene, yet little research has investigated food truck operators or their offerings. Objective: This study examines the characteristics of food truck operators in the Metropolitan Detroit area and their attitudes toward health and nutrition of food truck menu items. Study Design, Setting, Participants, Intervention: Food truck operators were identified by searching state licensing agencies and various websites, yielding a list of 120 food trucks. Researchers conducted a cross-sectional, quantitative survey that included questions about attitudes toward healthfulness of menu items. The survey was available in both paper and web formats and delivered using a multi-modal, multi-contact approach that included paper mailings, email messages, telephone calls, and Facebook messaging. Outcome Measures and Analysis: Survey data were descriptively analyzed using one-way frequencies, measures of central tendency for continuous variables, and chi-square analysis for categorical variables. Results: Forty-seven food truck operators (39% response rate) responded to the survey, but six were excluded for lack of survey completion. Operators were 51% male, 71% white non-Hispanic, and 41% had obtained a Bachelor's degree. Average age was 39.6 years (standard deviation 9.8 years). Respondents rated taste as the most significant food success factor, with 100% rating it as very or somewhat important, whereas healthfulness was indicated as very or somewhat important by 66% of respondents. Less than a third (29%) were extremely or very familiar with the calorie content of their menu items. Only 20% reported that it is not necessary for food trucks to provide healthful offerings. Conclusions and Implications: Although food truck operators do not perceive healthfulness to be a particularly important selling feature, many are neutral or open to the importance of selling healthy food to their customers. Food trucks may be one potential unexplored avenue to increasing diet quality of consumers dining away from home. Funding: Oakland University School of Health Sciences Research Award.

The impaired and/or disabled anesthesiologist.

Impairment and/or disability resulting from any of a number of etiologies will afflict a significant number of anesthesiologists at some point during their career. The impaired anesthesiologist can be difficult to identify and challenging to manage. Questions will arise as to if, how, and when colleagues, family members, or friends should intercede if significant impairment is suspected.This review will examine the common sources of impairment among anesthesiologists and the professional implications of these conditions. We will discuss the obligations of an anesthesiologist and his/her colleagues when there is sufficient suspicion that he/she might be impaired. Substance use disorder remains one of the commonest sources of impairment among both resident and attending anesthesiologists. Other common etiologies of impairment include various physical ailments, major psychiatric disorders, especially depression and burnout, and age related dementia. Many regulatory organizations, healthcare systems, and state licensing agencies have developed programmes and protocols with which to identify and direct into treatment those suspected of significant impairment. Some degree of impairment will occur to one-third of anesthesiologists during the course of their career. It is important to understand how such impairments might impact the safe practice of anesthesiology.

When the Snake Oil Salesman Knocks on Your Door

When the Snake Oil Salesman Knocks on Your Door

An Evaluation of Early Education Based on Physical Environmental Guidelines

The integration of environmental policies with political support for action on these policies is of prime significance for mobilization and progression of improving indoor environments. However, state licensing agencies and local county ordinances for child care centers do not universally follow these policies and standards. As a result, most early childhood educational programs operate without proper indoor environments. Indoor air quality, temperature, ventilation, daylighting, and acoustics are crucial factors for educational settings in early childhood education. This study documents the physical environment in early childhood education centers in three counties in Maryland. Results indicate that building performance and indoor air quality standards vary according to the socioeconomic status of children who attend early childhood programs, and environmental factors correlate with educational achievement (as measured by kindergarten readiness scores).

Inaccuracy of Federal Highway Administration's Licensed Driver Data: Implications on Young Driver Trends

PurposeThe Federal Highway Administration (FHWA) collects and publishes annual state-based counts of licensed drivers, which have been used to estimate per-driver crash rates and document a decline in young licensed drivers. The accuracy of these data has been questioned. MethodsWe compared the number of young licensed drivers as reported by the FHWA (2006–2012) with that generated directly from New Jersey (NJ) administrative licensing data. Census data were used to estimate the proportion of NJ adolescents who were licensed. ResultsFHWA data showed a decline in the proportion of licensed 17- to 20-year olds over the 7-year period (77%–63%), whereas analysis of NJ licensing data revealed a more stable trend (75%–74%). ConclusionsWe advise against use of FHWA licensing data for research purposes and encourage FHWA to work with state licensing agencies to review and enhance data collection and quality control procedures with the goal of ensuring the accuracy of licensing data.

Randolph-Sheppard National Online Training Curriculum for Program Staff: Findings from a National Survey of Randolph-Sheppard Directors

The Randolph-Sheppard Business Enterprise Program provides employment for more than 2,300 entrepreneurs who are legally blind across the United States. Moreover, these entrepreneurs employ an additional 14,000 people, of whom almost 2,000 are visually impaired or have other disabilities (Rehabilitation Services Administration [RSA], 2010). With annual program sales of more than $800 million, the average annual income of individual entrepreneurs is approximately $60,000. Signed into law in 1936, the Randolph-Sheppard Act (20 U.S.C. [section]107 et seq) grants individuals who are legally blind the authority to operate food service facilities on federal property. With oversight from RSA, the act locates the state licensing agency for the program in the individual state vocational rehabilitation agencies across the United States. Over the years, the Randolph-Sheppard program has changed dramatically from single vendor-managed concessions and newsstands to large military food service facilities, kiosks, convenience stores, laundry facilities, restaurants, snack bars, automated vending machine operations, and other similar businesses. For a number of reasons, the Randolph-Sheppard program has seen a decline in the last two decades in the number of facilities and blind entrepreneurs. Speculations for the decline include the closing of marginal or unprofitable Randolph-Sheppard facilities by state licensing agency administrators without establishing new, more profitable locations, and the inability to find qualified candidates to replace those who retire, leave the program, or are promoted to other facilities (Schaefer, 2003). Moore (2005) suggested that the disparity among states in either having too many facilities without qualified candidates to run them or too many qualified candidates without locations to place them, coupled with the inability of blind entrepreneurs to easily transition across state programs to align these disparities, is also a contributing factor to the overall decline. In an effort to expand and improve the effectiveness of the Randolph-Sheppard program, stakeholders (for example, the National Council of State Agencies for the Blind, consumer groups, and state licensing agency administrators) in collaboration with RSA joined together in the development of five performance goals (National Council of State Agencies for the Blind, 1997). Goal 3 addressed national training initiatives including the development of training for Randolph-Sheppard staff members. More recently, the National Council of State Agencies for the Blind passed Resolution #2010-1 (2010), noting that the goals outlined in 1997 had not been accomplished, and calling upon RSA to make resources available to initiate activities in reaching those goals. Our purpose is to report research activities in support of Goal 3 that will culminate in the development of a national online training curriculum for Randolph-Sheppard staff members. The state licensing agency staff members who are specifically responsible for the state's Randolph-Sheppard program generally include a program director, who is responsible for overall program management; business consultants (counselors or specialists), who have multiple responsibilities in direct support of individual entrepreneurs; and other administrative and support staff members, who are responsible for activities related to equipment, initial and upward mobility training, accounting, payroll, contracts, and the like. The only national training package developed for program staff members was funded by RSA during the 1980s. Published in 1985 by the West Virginia Research and Training Center, the Randolph-Sheppard Management System (Minton, Spann, & Weston, 1985) is an instructional training package that includes 15 modules for self-study. The modules address different aspects of the program such as management of facilities, development of new facilities, merchandising, food safety, purchasing, working with individuals who are blind, and the Randolph-Sheppard laws. …

You've Got to Have the Right Stuff

You've Got to Have the Right Stuff

Teachers’ Oral Proficiency in the Target Language: Research on Its Role in Language Teaching and Learning

AbstractIn the past decade, the foreign language (FL) profession has established standards for beginning language teachers that are used by accrediting agencies and state licensing agencies to make decisions regarding teacher preparation program recognition and teacher certification. Among these expectations is the requirement that beginning teachers demonstrate a minimum level of Advanced‐Low on the ACTFL Proficiency Guidelines for Speaking. Consequently, the role that teachers’ oral proficiency in the target language (TL) plays in classroom instruction has become a critical issue in the field of FL education. This review presents current research related to teachers’ TL proficiency and its impact on classroom practices, teacher effectiveness, and student learning. The article raises questions that merit investigation in future research as it strives to clarify the role that teacher TL proficiency plays in classroom instruction and learning of the TL.

Core Topics in Operating Department Practice: Leadership and Management.

Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois. sjchilders@northwestern.eduCore Topics in Operating Department Practice: Leadership and Management. Edited by Brian Smith, Paul Rawling, Paul Wicker, and Chris Jones. Cambridge, United Kingdom, Cambridge University Press, 2010. Pages: 184. Price: $60.00.Core Topics in Operating Department Practice: Leadership and Management is a collection of practical topics written by experts from a variety of backgrounds. The intended audience is primarily those in managerial and leadership positions within the National Health Service (NHS) in the United Kingdom. As such, it is an excellent reference for published regulations and policies, the evolution of organizational structure and function, and corporate governance. The range of topics also includes educational offerings for those in management roles within the NHS, models for staff recruitment and retention, and specific guidelines for equipment procurement.The publication also serves as a resource and a set of references for timely topics with a much broader appeal. Several of the contributing authors offer excellent practical guides regarding leadership in the perioperative setting. The topics range from leadership styles, team dynamics, communication, and the challenges of managing change to those of promoting evidence-based practice, implementation of a quality improvement program, and maintenance of a continuous process of improvement. Each chapter is accompanied by an excellent collection of references.One chapter is dedicated to the description of the NHS initiative called “The Agenda for Change,” which is designed to “modernize pay and grading.” Tucked in the description are wonderful, albeit brief, discussions of two very important topics: How to conduct two-way feedback of personal performance, and how to organize a concise set of objectives and expectations for ongoing personal development after the review process. These are universal challenges for managers of large groups of employees, and these discussions are thoughtful and applicable in any perioperative setting.Certainly, the United Kingdom is not alone when it comes to diversity among those who work in the perioperative setting and the patients for whom they care. One of several sections devoted to managing conflict in and around the operating room focuses on managing diversity (and adversity) in a workplace in which there are staff members of different cultures, ethnicities, generations, religions, genders, sexual orientation, disabilities, and health status. Much of the discussion centers on the legislative protections and prescriptive means to accommodate everyone. One cited publication from the NHS Department of Health, “The Positively Diverse Process,” provides a fresh approach. It recommends the use of mentors to “provide a spectrum of learning and supporting behaviors” to meet “the health needs of communities through the recruitment, development and retention of a workforce that reflects the diversity of the population.”In contrast to the effective management of practices and behaviors that are apart from standard or acceptable addressed in much of this publication, “Damned if you do and damned if you don't: Whistle blowing in perioperative practice” is a fascinating chapter concerned with identifying and reporting. It is a candid look at “whistle blowing,” which implies not only going outside the primary organization to address an issue but also escalation to NHS-governing bodies or the press when going through internal channels has failed to yield results. This is likely in contrast to many institutions in the United States that have moved from turning a “blind eye” to such problems to establishing a structured process within the hospital or medical center involving “stop the line,” reporting, peer review, and/or quality oversight to manage them. Escalation to hospital-based credentialing bodies and then on to state and federal licensing agencies is the usual path when remediation fails to work. Press releases are generally not a part of the reporting process.In summary, this is an interesting look at a slice of the inner workings of the NHS, including its organization, governance, and programmatic support. The authors acknowledge that the perioperative setting is distinct from many others, even those within the healthcare system, and that effective leadership is a key ingredient. To that end, they offer this guide for successfully moving the perioperative care team along a productive path for the patients for whom they care.Sara Jean Childers, M.D.Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois. sjchilders@northwestern.eduMark A. Warner, M.D., served as Handling Editor for this book review.Michael J. Avram, Ph.D. is handing editor for this book review

Driving Fitness and Cognitive Impairment

This editorial comments on topics raised in an accompanying article (Carr and Ott, JAMA, Volume 303, Number 16) on older adult drivers with cognitive impairment. Although physicians are increasingly faced with the need to assess risk and intervene, research has yet to determine the level of cognitive impairment that constitutes an unacceptable driving risk. Many older individuals in the early stages of dementia can and do drive safely; however, at some point as the disease progresses they will need to stop driving. The authors discuss the role of the driver rehabilitation specialist (DRS), defined as a person with special training in evaluating and coordinating driving for persons with decreased functional capacities. Physicians are encouraged to refer their patients to the DRS when the physician is unsure of a patient's driving fitness. Physicians can also report patients they consider to be medically at risk to their state's licensing agency, however, the lack of guidelines and standards make this practice underutilized. Another option is the use of medical advisory boards (MABs) to advise on licensing policy and guidelines related to medical fitness to drive and/or to advise on individual cases; in most cases, MABs do only one or the other. The authors conclude by calling for a comprehensive, interdisciplinary approach to both identify cognitively-impaired drivers as well as to ensure that the resources are in place to help these drivers manage the transition to driving retirement without suffering a deterioration in their quality of life.

We Have an Obligation to Medical Insurers

We Have an Obligation to Medical Insurers

Safety and Efficacy of Office-Based Surgery with Monitored Anesthesia Care/Sedation in 4778 Consecutive Plastic Surgery Procedures

Office-based surgery has several potential benefits over hospital-based surgery, including cost containment, ease of scheduling, and convenience to both patients and surgeons. Scrutiny of office-based surgery by regulators and state-licensing agencies has increased and must be addressed by improved documentation of safety and efficacy. To evaluate the safety and efficacy of the authors' office-based plastic surgery, a review was undertaken of 3615 consecutive patients undergoing 4778 outpatient plastic surgery procedures under monitored anesthesia care/sedation in a single office. The charts of 3615 consecutive patients who had undergone office-based surgery with monitored anesthesia care/sedation between May of 1995 and May of 2000 were reviewed. In all cases, the anesthesia protocol used included sedation with midazolam, propofol, and a narcotic administered by a board-certified registered nurse anesthetist with local anesthesia provided by the surgeon. Charts were reviewed for patient profile, types of procedures, multiple procedures, duration of anesthesia, American Society of Anesthesiologists class, and complications related to anesthesia. Outcomes measured included death, airway compromise, dyspnea, hypotension, venous thrombosis, pulmonary emboli, protracted nausea and vomiting lasting more than 24 hours, and unplanned hospital admissions. Statistical analyses were performed using the Microsoft Excel program and the SAS package. Results were as follows: 92.3 percent of the patients were female and 7.7 percent were male, with a mean age of 42.7 years (range, 3 to 83 years). Patients underwent aesthetic (95.6 percent) and reconstructive (4.4 percent) plastic surgery procedures. Same-session multiple procedures occurred in 24.8 percent of patients. The vast majority of patients were healthy: 84.3 percent of patients were American Society of Anesthesiologists class I, 15.6 percent were class II, and 0.1 percent were class III. The operations required a mean of 111 minutes. There were no deaths, ventilator requirements, deep venous thromboses, or pulmonary emboli. Complications were as follows: 0.05 percent (n = 2) of patients had dyspnea that resolved, 0.2 percent (n = 6) of patients had protracted nausea and vomiting, and 0.05 percent (n = 2) of patients had unplanned hospital admissions (<24 hours). One patient had an emergent intubation. No prolonged adverse effects were noted. There was a 30-day follow-up minimum. Outpatient surgery is an important aspect of plastic surgery. It was shown that office-based surgery with intravenous sedation, performed by board-certified plastic surgeons and nurse anesthetists, is safe. Appropriate accreditation, safe anesthesia protocols, and proper patient selection constitute the basis for safe and efficacious office-based outpatient plastic surgery.