Structured Treatment Program Research Articles

A Structured Social-Media Health Support intervention Program after Bariatric Surgery.

Social media networks have been found to provide emotional, instrumental, and social support, which may contribute to improved adherence to post-bariatric surgery care recommendations. To evaluate the impact of an online social media-based, healthcare professional-led, educational and support program on patients' long-term engagement with and adherence to follow-up guidelines, self-care recommendations, and weight management after bariatric surgery. An observational cohort study, employing mixed methods, accompanied a 12-week interactive, structured, social-media psychoeducational intervention program delivered on Facebook. Program participants, who had undergone one bariatric surgery within the past 1-7 years and were at least 18 years old at the time of surgery, were invited to join the program via posts online. Interested individuals were provided information about the program and the accompanying evaluation study, and those who met requirements completed study questionnaires before and after the program. Questionnaires included demographic and anthropometric information; postoperative recommendations received and their clarity and implementation; attitudes towards recommendation adherence; and well-being. Daily system data on program engagement were collected from the Facebook website. Of the 214 participants enrolled in the program, 101 (80.2% female, mean age 43.8±9.1 years and mean BMI 30.2±6.8 kg/m2, 1-7 years after bariatric surgery) completed both baseline and end-of-program questionnaires and were included in the analysis. Following the program, improvements were observed in most aspects of participants' adherence to postoperative recommendations and well-being. Close to half of the participants (44.6%) reported reaching their postoperative target weight at the end of the program or maintaining it throughout the program. Video posts drew higher participant engagement than other media, and content about proteins received the highest number of reactions. However, participants' active engagement gradually declined over time. Interactive health support on social media can positively enhance patient engagement, adherence to treatment recommendations, health outcomes, and overall well-being.

Programmes Addressed to Informal Caregivers' Needs: A Systematic Literature Review.

Addressing informal caregivers' needs is essential for ensuring quality healthcare and promoting citizen-centred care. This systematic review assessed current knowledge about programmes aimed at meeting the needs of informal caregivers of adults who are dependent on others for daily life activities. Following the PRISMA guidelines, the electronic databases EBSCOhost Research Platform, MEDLINE, CINAHL, Scopus, Web of Science and The Virtual Health Library were searched for randomized experimental studies published between 2012 and 2022 that implemented programmes addressing informal caregivers' needs to improve their experiences, health, and well-being. Quality was assessed using the standardized critical evaluation tools from the Joanna Briggs Institute. Two independent investigators performed the eligibility assessment and data extraction. Quantitative data on the effectiveness of interventions were collected, and the content of each intervention was synthesized and aggregated into categories, through narrative synthesis. The majority of the included studies (n = 16) were conducted in European countries and implemented a structured intervention programme compared to the provision of usual care. The studies were of fair to high methodological quality, with a higher risk of bias related to blinding. The results supported the achievement of favourable health outcomes among informal caregivers, namely improvements in mental health (n = 3) and quality of life (n = 3) and a decrease in psychological symptomatology (n = 5) and burden (n = 3). None of the interventions reported adverse outcomes; however, five studies did not describe significant differences in the outcomes assessed after the implementation of the programmes. Interventions focusing on training and educating caregivers (n = 14) and cognitive-behavioural strategies (n = 7) were the most common, while programmes focusing on emotional and psychological support as a resource to improve caregivers' psychological outcomes were scarce. This systematic review adds to the growing body of evidence and insight showing that programmes that address informal caregivers' needs seem to contribute to better physical and psychological health outcomes through the promotion of caregivers' educational support and the implementation of cognitive-behavioural strategies. Future research should implement methodologically robust cross-country programmes tailored to informal caregivers' physical, emotional, psychosocial, societal, and educational needs throughout the care trajectory.

Efficacy of Learning Disorder Treatment for Reading or Mathematics Disorders: An Open Study.

This study aimed to identify the effectiveness of treatment programs for children with reading (RD) or mathematics disorders (MD). Structured treatment programs were developed to improve phonological awareness and number sense among children and adolescents with RD or MD, respectively, and the effectiveness of the learning disorder treatment programs were evaluated. We used standardized, objective diagnostic, and evaluation tools not only to recruit participants with RD, MD, or comorbid attention deficit and hyperactivity disorder, but also to assess the effectiveness of the treatments regarding both improved core neurocognitive deficits of RD or MD and academic achievement. Forty children with RD or MD received one-on-one treatments from therapists. In the RD group, treatment effects were observed in all subtests. In the word and paragraph reading tests, the accuracy rates and fluency improved. The results of the phonological working memory test, word-sound correspondence test, and rapid automatic naming tests also improved. In the MD group, the accuracy rate and fluency on the arithmetic test improved. An increase in the accuracy rate in the size and distance comparison tests and a decrease in the error rate in the estimation test were also observed. However, there were no improvements in reaction time in these subtests. Learning disorder treatment programs that focus on improving phonological awareness or number sense in children with RD or MD improved achievement, phonological awareness, and number sense.

“The Heart Chakra as a Gateway to Self-awareness in Young Adulthood: a Pretest-posttest Study”

The research titled "The Heart Chakra as a Gateway to Self-Awareness in Young Adulthood: A Pretest-Posttest Study “explores the role of the heart chakra in developing self-awareness among young adults. Drawing upon principles of eastern philosophy and modern psychology, this study examines the role of heart-centered practices in enhancing self-awareness. Utilizing a pretest-posttest design, young adult participants in a structured intervention program aimed at activating and balancing the heart chakra. Qualitative data was collected from 15 participant age range 18-22 years, to assess changes in self-awareness before and after the intervention. Findings suggest a significant improvement in participants self-awareness levels post-intervention, indicating the potential of heart-centered practices i.e. using solfeggio frequencies of 639 Hz, which benefit in activating heart chakra as per research, facilitating introspection and personal growth during the pivotal stage of young adulthood.

Blueprint for medication management with added benefits

What connects the selective contractual care offer eLiSa (1) of AOK Nordost and the innovation fund projects AdAM (2), TOP (3), eRIKA (4) of BARMER and AOK Nordost with the DMP requirements guideline for requirements for structured treatment programmes for patients with type 1 diabetes mellitus and the medication management including medication plan planned with the ePA (5) from 2025? The problem with the latter two: It is not defined how medication management and the medication plan should be implemented. Both the G-BA in its DMP-A guideline (6) and the legislator in the definition of the medication plan (7) leave this completely open. Although the legislator stipulates that dosage and intake instructions should be ‚clearly and comprehensibly documented‘, nothing more than documentation has been specified to date. The situation is different with the AOK Nordost ‚electronic Life Saver‘ (eLiSa for short) and BARMER‘s ‚AdAM‘, which were jointly awarded the first prize for patient safety by the Patient Safety Action Alliance and the first prize of the MSD Health Prize 2023, and the expansion stage planned this year can certainly be regarded as a blueprint for medication management, especially for DMPs and ePAs.

The Father's Part: A Pilot Evaluation of a Father-Centered Family Intervention Group in Child and Adolescent Psychiatry.

Changes in parental roles have renewed the focus on a father's involvement in an offspring's psychological development. However, fathers are still under-represented in family research. There are only a few structured father-centered intervention programs in child and adolescent psychiatry. In a German population sample, a pilot father-centered family intervention program with n = 16 participants, conducted in person (n = 8) and online (n = 8), in a child and adolescent psychiatry inpatient/day clinic setting was evaluated by comparing paternal stress, PSE, and child-rated paternal competence in a pre-post design. Participating fathers showed significant decreases in child-related parenting stress (presence: p = 0.042, online: p = 0.047) and significant increases in PSE (p = 0.006/0.012). Parent-related stress and child-rated paternal competence were unaffected (p = 0.108/0.171; p = 0.167/0.101), while small-to-medium effect size measures pointed in the direction of our hypothesis (d = 0.48/0.36; d = 0.37/0.50). Participant satisfaction was higher in person than online (p = 0.008). As social and biological fathers have important influences on child and adolescent well-being and development, they should be included more frequently in prevention and intervention programs. Fathers seem to benefit from gender-specific intervention programs with regard to stress reduction, as well as experiencing competence- and PSE-increasing effects.

Effect of Self-Esteem Enhancement Program on level of self-esteem among School Children: A Pre Experimental Study

An experimental study was conducted to assess the effect of self-esteem enhancement programme on the selfesteemof school going adolescents in selected schools of Kottayam district. The research design used was onegroup pretest, post test design. The study was conducted among 8th standard Malayalam medium students of aselected school in Kottayam district of Kerala State. The sample consisted of 62 students, recruited using purposivesampling. The data were collected, using self report questionnaire- Socio demographic data and Self-esteeminventory (Thomas 1984). Structured intervention programme comprised of 10 sessions and each session was for45 minutes. Post assessment was done one week after the structured intervention programme, using the sametool. Data were analyzed using descriptive and inferential statistics. The study findings revealed that majority ofthe study group were having average self – esteem, there was significant improvement in the mean self- esteemof sample in the post assessment. There was no significant relationship between adolescent’s self-esteem anddemographic variables. Based on the findings of study it is important to focus on primary prevention, andprogrammes to enhance self-esteem of adolescents should be formulated and implemented.

Using an intervention programme to empower intellectually disabled learners to use WhatsApp in a special needs unit in Cape Town, South Africa

Although WhatsApp has become so ubiquitous and widespread across the globe, it poses a risk of abuse and cyberbullying to vulnerable groups of people like intellectually disabled learners. This study explores intellectually disabled learners’ experiences of using WhatsApp during an intervention programme in a special needs unit at a school in Cape Town. The study was conducted using a qualitative case study within an interpretive paradigm. Nineteen participants who include intellectually disabled learners, parents/guardians and staff members were purposively selected to participate in the study. Data was collected using observations and interviews. It was found that all learners who participated in the programme were empowered to use the social media effectively and to become responsible digital citizens. The study concluded that a structured intervention programme provides a milestone of achievement in terms of preparing intellectually disabled learners to become digitally competent and to be able to use social media independently.

Lifestyle habits among Najran University students, Najran, Saudi Arabia.

BackgroundUnhealthy lifestyles have been linked to increased cardiovascular disease, diabetes, and other non-communicable diseases. University students have been reported to adopt unhealthy lifestyles and undesirable eating choices.ObjectivesThe study aimed to estimate the prevalence of healthy eating habits; determine the prevalence of physical activity habits; to estimate the smoking habits among male health sciences college students at Najran University, Najran, Saudi Arabia.MethodsThe present questionnaire-based descriptive cross-sectional study (convenient sample) was carried out among undergraduate male students enrolled in the health sciences colleges at Najran University, Najran, Saudi Arabia, from 1st May to 31st May, 2019. Around 500 students were recruited and were requested to answer a self-administered questionnaire about eating habits, physical activity, and tobacco smoking habits. Descriptive results were summarized in percentage and frequency. Cross tabulation using chi-square test was performed to measure the impact of demographic variable on eating pattern, physical activity and smoking behavior. Pearson's correlation was done using two tailed tests to determine the type of relationship between different variables. The SPSS (version 26) was used to perform statistical analysis.ResultsA total of 454 complete responses from the male students from Najran University were obtained. The majority (74%) were aged 21 years and above, unmarried (94.9%), had healthy BMI (47.4%), and suffered mild (41.4%) to moderate (32.4%) levels of stress during the previous month. The study findings showed a low daily frequency of consumption of vegetables and fruits. There was a low prevalence of daily consumption of vegetables (16%) and fruits (9%). More than 10% of all students reported no consumption of fruits and vegetables. Students who felt severely stressed during the previous month were significantly not eating any vegetables (p = 0.022) and fruits (p < 0.001), and had high salt intake (p = 0.045). Married participants had a significantly (p = 0.03) higher servings of vegetables per day. Furthermore, 32.15% of participants were not practicing 30 min of physical activity 5 days per week. The study showed a low prevalence (47.57%) of physical activity among the participants. However, none of the participants' variables were significantly associated with routine physical activity. In addition, the study showed a relatively high prevalence of smoking (25.77%) among Najran university male students. The participants' age (p 0.01), overall health (p = 0.02) and level of stress (p = 0.001) experienced during the last month were significantly associated with the length of exposure to secondhand smoke. Whereas, smoking any kind of tobacco daily (25.77%) was significantly (p = 0.005) related to the age of participants. A high number of participants aged 21 years and above (52.72%) were significantly (p = 0.019) exposed to secondhand smoke.ConclusionTo conclude, the study findings showed a low daily frequency of consumption of vegetables and fruits, a relatively high prevalence of smoking and a low level of awareness regarding the health risks of smoking; and a large number of participants were physically inactive among male university students. Intervention programs in university students should concentrate on improving nutrition attitudes and knowledge toward good diet, tobacco-smoking cessation strategies, and structured intervention programs to encourage physical activity. However, these interventions should be pilot-tested for feasibility and acceptability before implementation.

How can counselling by family physicians on nutrition and physical activity be improved: trends from a survey in Germany

PurposeCancer and its therapy causes severe symptoms, most of which are amendable to nutrition and physical activity (PA). Counselling on nutrition and PA empowers patients to take part more actively in their treatment. Many cancer patients are yet in need of information on these topics. In this study, we investigate the perception of family physicians (FP) on nutrition and PA in cancer patient care and assess barriers and steps to improve their involvement in counselling on these topics.MethodsBased on qualitative content analysis of 5 semi-structured interviews with FP, a questionnaire was developed and completed by 61 German FP.ResultsMost of the FP acknowledged the importance of nutrition and PA during (91.4%) and after (100%) cancer therapy. While many participants were involved in cancer patient care, 65.6% of FP viewed themselves as primary reference person to address these topics. However, a third (32.8%) of FP were unfamiliar with information thereof. Some were unsatisfied regarding timely updates on their patient’s treatment course via discharge letters (25.0%) or phone calls (36.2%). FP would like to dedicate more consultation time addressing nutrition and PA than they currently do (p < 0.001).ConclusionCommunication btween healthcare practitioners about mutual cancer patient’s treatment must be improved, e.g. utilising electronic communication to quicken correspondence. Acquisition of information on nutrition and PA in cancer patient care needs to be facilitated for FP, approachable by compiling reliable information and their sources. Involvement of FP in structured treatment programs could benefit cancer patient care.Trial registration number(May 7, 2021): 2021–2149-Bef.

Where Exactly Is the Therapist in Virtual Reality and Game-Based Rehabilitation Applications? A Randomized Controlled Trial in Children with Specific Learning Disability

Objective: Children with specific learning disability (SLD) experience problems in visual perception that influence academical skills and activities of daily living. Virtual reality and game-based rehabilitation applications are becoming increasingly popular in rehabilitation, including visual perception rehabilitation. However, the usage of commercially available and easily accessible games as intervention tools raises the question whether rehabilitation conducted with these games is really rehabilitation, or just casual gameplay. Therefore, we aimed to investigate the effects of a nonactively supervised (game-based intervention program [GIP]) and an actively supervised (therapist guided game-based intervention program [TGGIP]) on the visual perception skills of children with SLD. Materials and Methods: This study was designed as a single-blind randomized, controlled trial of a TGGIP on visual perception skills in children with SLD compared with the self-oriented, nonsupervised program (GIP). A total of 138 children with SLD participated in the study and were randomly divided into two groups (TGGIP and GIP). Children's visual perception skills were assessed with Motor-Free Visual Perception Test-3. Results: Both groups showed significant improvements in visual perception after the intervention programs (P < 0.05). However, the TGGIP (a supervised and structured intervention program) was significantly more effective in improving the visual perception skills compared with the GIP (a standard, nonsupervised, and unstructured intervention program) (P < 0.05). Conclusion: We think that the TGGIP methodology that we designed acts as a facilitator for therapists in using trademarked, commercially available, and easily accessible games for structured and supervised virtual reality and game-based rehabilitation applications.

Obesity - a chronic disease requiring treatment

The globally increasing prevalence of obesity represents a key medical and socioeconomic challenge. Due to related comorbidities and complications such as arterial hypertension, diabetes mellitus, fatty liver disease, and arteriosclerosis, obesity leads to a significant statistical reduction in lifespan. Currently, bariatric surgery is the most effective approach to manage body weight and comorbidities while lifestyle intervention as basic obesity therapy and medical treatment often do not lead to sufficient and sustainable weight loss. However, recent medical approaches show now promising effects on weight control and might close the gap towards bariatric surgical procedures. For instance, semaglutide has been approved by EMA in January 2022 for medical treatment of obesity concomitant to basic lifestyle therapy in adults with a BMI of ≥ 30 kg/m2 or ≥ 27 kg/m2 and weight-related comorbidity. Apart from weight control, improvement in cardiometabolic risk factors can be achieved with this treatment. Moreover, other drugs, mostly based on incretin mono- or multiagonism, are currently developed and may open further effective treatment options for obesity and its complications in the near future.On a health political level, first steps for the development of a structured treatment program (DMP) for obesity are in progress to enable early guideline-based and structured treatment of obesity, and to prevent the obesity associated complications.

An integrated early intervention approach for children with cerebral visual impairment - A case report

A 2-year-old child with cerebral visual impairment (CVI) was brought by the mother to the pediatric ophthalmology clinic. She underwent a detailed functional vision and developmental assessment that revealed impairments in visual developmental skills, sensory, motor, and social skills. She was admitted into an integrated, parent-centered, structured early intervention program specifically designed for her for 3-months after which there were improvements noticed in visual developmental skills such as visual fixation, attention, and tracking; sensory skills such as tactile, olfactory, and gustatory; motor skills, including neck control and fine motor grasping; and age-appropriate social and communication skills. Through this case report, we aim to bring out the benefits of an evidence-based systematic early intervention approach in a child with CVI.

Gender, metacognitive intervention, and dialogic interaction: EFL multimedia listening

This study investigated the combined effect of gender, metacognitive intervention, and dialogic interaction on Iranian EFL learners' multimedia listening comprehension and their metacognitive awareness. The data were collected through 1080 male and female Iranian advanced learners, ranging from 18 to 24 years of age, in four experimental and two control groups. Two of the experimental groups of male and female students (N = 360) received metacognitive intervention through dialogic interaction (MIDI), two of the experimental groups of male and female students (N = 360) received metacognitive intervention only (MI), and the two control groups of male and female students (N = 360) were trained through regular classroom listening activities without receiving the structured intervention program. Multimedia listening tests and the Metacognitive Awareness Listening Questionnaire (MALQ) were used to track the advanced learners’ multimedia listening comprehension and metacognitive awareness. The results showed that female EFL learners in both experimental groups outperformed their male counterparts in multimedia listening comprehension and metacognitive awareness in listening. The results also revealed that the EFL learners in experimental group one (MIDI) outperformed their peers in experimental group two (MI) in both multimedia listening and metacognitive awareness. Therefore, the effectiveness of gender and dialogic interaction can be deemed as two major contributions of this study.

Proposition d’un modèle descriptif et thérapeutique du rapport au travail : le modèle AIRE

Mental-health professionals are increasingly solicited for work-related suffering problems. If considered alone, the difficulty of the tasks in the workplace cannot explain the phenomena of exhaustion and suffering, and the increase in the impact of these troubles requires the use of functional and descriptive models. Various ones have been suggested and are utilized: Seyle's general adaptation syndrome model; Lazarus and Folkman's stress adaptation model, which focuses on the transactions between the subject and their environment and the strategies (coping) used to adapt; Karasek's model, confronting the pressure of demands with the self-sufficiency abilities and the social support; Siegrist's model, assessing the scale between the efforts demanded to the subject and all the reinforcements drawn from work; Finally, Demerouti's model, for whom there are two essential dimensions: the demands, and the resources, source of engagement and achievement. Starting from Albert Bandura's works, we suggest describing the relationship to work through the feeling of the self-efficacy perceived (or not) by a subject in their professional activity. The feeling of efficacy is a subjective perception, linked to one particular activity (for example, a sport), different from self-esteem or self-confidence, and supposedly constitutes the main source of motivation and dedication for this activity. It interacts with the expectations from the environment perceived by the subject for the given activity. The interaction between a strong feeling of efficacy and perceptions of high expectations supposedly leads to a proper commitment and a feeling of satisfaction. Hence a fulfilling relationship to work is seemingly based on an adequate feeling of efficacy and suitable for the professional activity, interacting accordingly with actual but not excessively high expectations. To complete the description of the relationship to work, we suggest adding two parameters: the commitment of the subject in the professional activity and the reinforcements received through this activity. It really is a matter of cognitive notions, corresponding to the subject's vision and perception in each area. This description is schematized by four parameters as follows Expectations – Commitment – Reinforcements – Efficiency, represented by a quadrilateral, with these 4 parameters as vertexes. The relationship to work is represented by each one of the sides: The EC segment Expectations – Commitment refers to the subject's desire and initial willpower for his work; The CR segment Commitment – expected Reinforcements represents the persistence and motivational aspect: rewards are implicitly expected depending on the provided commitment. The segment RE perceived Reinforcements–feeling of Efficiency represents the most intimate aspect experienced by the subject in their work time and one's attachment to a professional environment. The EE segment (Expectations–feeling of Efficiency) refers to the way the subject approaches the task to do. In a balanced relationship to work, the quadrilateral is regular, rectangular or square, with an “average” surface area. On the contrary, imbalances are represented by an irregular quadrilateral, and/or a too small or big surface area. Some of the typical clinical pictures (Burn-Out, Bore-Out, impostor syndrome, etc.) will lead to easily identifiable cases: thus the Burn-Out is characterized by expectations perceived as high, an initially conserved commitment which then collapses (linked to cynicism), reinforcements perceived as insufficient and a low feeling of efficiency. During a consultation with a patient, it is particularly useful for them to establish their own representation of their relationship to work and to share it with the therapist. If suffering is experienced, the goal is to get balance back, firstly by talking about the rationality of their perception of in each of these dimensions, on a standard model of cognitive therapy, then in a more behavioral approach, by leading to the required practical modifications, when it is possible, in each dimension. The perception of one's relationship to work is indeed targeted, aiming at a short therapy, and not a global psycho-therapeutic effort on personality aspects. In this experience, this model facilitates the usual collaborative link in behavioral therapy, and the implementation of changes. In order to try out the validity of this model, it would be interesting to evaluate the reproducibility of its usage among several therapists, and to suggest a structured treatment program by assessing the results.

73 THE NEW CHRONIC DISEASE MANAGEMENT PROGRAMME FOR GENERAL PRACTITIONERS: MAKING THE CASE FOR ITS REVISION TO INCLUDE DEMENTIA

Abstract Background A significant component of the new contract for general practitioners is the chronic disease management programme (CDMP for GPs). Although dementia can be framed as a chronic disease, it was not included in this programme. Its exclusion raises a number of questions including: Should dementia be framed as a chronic disease? Is it feasible to include dementia in a future revised CDMP for GPs? What are the likely benefits and potential risks? Methods This presentation focuses on two elements of a larger mixed-methods study, namely: (i) in-depth analysis of the CDMP for GPs, involving a review of the programme’s three main components to test the feasibility of extending it to incorporate dementia; and (ii) qualitative content analysis of data from semi-structured interviews with 12 stakeholders whose expertise is in dementia, chronic disease or both. Both elements were informed by a literature review. Results No consensus was found about whether dementia should be framed as a chronic disease. Results showed that it is feasible to extend the annual preventative programme of the CDMP for GPs to include additional modifiable dementia risk factors. While opportunistic case finding for identifying undiagnosed dementia cannot be recommended, a tool is available that would enable GPs identify people with dementia for enrolment on the structured treatment programme. Expected benefits from including dementia in the CDMP for GPs include integrated care pathways, better GP access and record-keeping and greater emphasis on primary and secondary prevention. Expected risks include excessive costs, caregiver burden, increased GP workload and sub-optimal care due to lack of specialist dementia training. Conclusion There is a compelling case to support dementia risk reduction in the CDMP for GPs. However, the programme’s current emphasis on self-management and rigidly planned visits could prove problematic for people with dementia and would need substantial revision.

55.3 PEDIATRIC CHRONIC PAIN: INFRASTRUCTURES AND LEVELS OF CARE

Objectives: Successful management of chronic pain requires addressing physical symptoms and comorbid mental health conditions. Pharmacological and nonpharmacological interventions can be successfully provided by a multidisciplinary approach that is both effective and safe. This model can be delivered in different settings, including outpatient, intensive outpatient, and inpatient. In this module, we focus on assessing the patient’s presentation, establishing the appropriate level of care, detecting the need to transition or modify settings, and understanding the prevalent challenges due to the COVID-19 pandemic. Methods: Souraya Torbey, MD, will: 1) highlight the distinction between outpatient clinic program and intensive day treatment, with an emphasis on the advantages and challenges of each model;2) clarify the intensive day treatment programs, their types, and structures;3) discuss medical decisions in the appropriate level of care;4) review the referral processes;and 5) discuss treatment modalities in the setting of COVID-19, including telehealth. Results: Outpatient pain treatment programs allow the child to stay at home in a familiar environment. However, such arrangements may lack the intensity, consistency, and integration necessary to make progress. Intensive day treatment or partial hospitalization programs are a midway between inpatient and outpatient. They provide a smooth transition from inpatient to outpatient through the support of a structured treatment program. The COVID-19 pandemic has resulted in an increase in pediatric chronic pain and mental health issues, concomitant with a decrease in availability of in-person psychiatric and rehabilitation services. The development of telehealth/hybrid models arose to respond to these needs and to increase access for those who might not be close to big centers. We discuss the implementation of these virtual platforms in the outpatient treatment models of chronic pain. Conclusions: This presentation aims to explore the distinction between outpatient clinic and intensive day treatment, highlighting the advantages and challenges of each model respectively, including the effect of the COVID-19 pandemic. Attendees will also be equipped with the necessary tools to implement alternate multimodal approaches in communities where such multidisciplinary programs are scarce. MDM, PAH, TVM

Improving higher-order comprehension skills of Grade 3 learners in a second language at a quintile 2 school, in Cape Town, South Africa

Background: Developing higher-order comprehension skills of learners in primary schools is a challenge that faces many countries. South Africa is no exception. Primary school learners in South Africa have particularly low literacy and comprehension skills: many learners struggle to read for understanding. There is little published scholarship that focuses on developing the comprehension skills of Grade 3 learners in a second language. A lack of practical classroom knowledge in this area is what this article seeks to address.Objectives: To improve the higher-order comprehension skills of Grade 3 learners in a second language.Method: A qualitative approach, using a case study design, within an interpretivist paradigm was devised and deployed. Five struggling Grade 3 learners were purposively selected to participate in an intervention programme. Their parents or guardians and two current Grade 3 teachers were interviewed. Data were collected over a 10-week intervention programme. The first and last weeks were devoted to pre-testing and post-testing. The entire intervention lasted for 10 weeks.Results: All the five Grade 3 learners showed significant improvements in their comprehension skills when comparing their pre-test and post-test scores.Conclusion: The post-test scores revealed the importance of a structured intervention programme for improving the four comprehension skills highlighted. Mediation and scaffolding in the Zone of Proximal Development were employed while concurrently developing their cognitive, social and language skills.

Perceived Effectiveness of Parent Representation Social Workers by Legal Professionals Involved with Indigent Defendants

The total number of children in the U.S. foster care system exceeds 428,000. Previous research indicates that when social workers and legal professionals work together, children and their families benefit significantly. Parents who effectively engage in the child welfare system are more likely to benefit from services and reunify with their children. The present study employed a phenomenological approach to explore how a parent representation pilot, which paired social workers with public defenders to better represent the needs of families in the child welfare system, was experienced by legal professionals. Judges and family court attorneys (n = 9) found the program to be helpful in reunifying families. Public defenders were able to leverage the social worker’s skills and experience to facilitate more positive outcomes, while reducing case burden. Challenges were also identified and included a lack of interdisciplinary training, potential overlap in ethical responsibilities, and role confusion. Structured intervention programs that encourage collaboration between social workers and legal professionals may improve case outcomes for indigent families involved in the child welfare system. It is advised that social work undertake a formal multidisciplinary approach in support of public defenders, which may serve to encourage positive case outcomes.

Exercise prescription improves exercise tolerance in young children with CHD: a randomised clinical trial

ObjectiveThe main objective of this study was to ascertain if a structured intervention programme can improve the biophysical health of young children with congenital heart disease (CHD). The primary end...