Use Of Evidence-based Strategies Research Articles

SOCIALIZATION AND INCLUSION OF EDUCATIONALLY BACKWARD CHILDREN WITH DISABILITIES

In the framework of inclusive education, this study investigates the crucial aspects of socialization and inclusion for children with disabilities who are educationally disadvantaged. Taking into account the particular difficulties young kids encounter, this research looks at practical methods for promoting academic success and social growth in inclusive environments. Based on an extensive examination of the literature, the study looks at how mentoring programs, cooperative learning activities, and peer support may help people socialize. It also explores academic inclusion via the creation of Individualized Education Plans (IEPs), assistive technology, and differentiated teaching. Legislative frameworks, resource distribution, and teacher preparation are also examined in the study as essential components of fostering an inclusive atmosphere. Case studies provide insightful information on effective models, and practical recommendations are meant to help parents, legislators, and educators improve the educational experience for children with disabilities who are educationally disadvantaged. In the end, this research advances inclusive education practices by supporting a comprehensive strategy that gives equal weight to social and academic integration. The study looks at the obstacles that children with disabilities who are educationally behind the curve must overcome and suggests workable solutions. The study seeks to further the current conversation on inclusive education by integrating the available research and advocating for the use of evidence-based strategies that promote the holistic development of all children.

Is Research on Augmentative and Alternative Communication Intervention With Children With Autism Spectrum Disorder Reflected in the Clinical Practice of Speech-Language Pathologists?

Purpose: Individuals with autism spectrum disorder (ASD) who have little to no functional speech require augmentative and alternative communication (AAC). Research on AAC intervention with individuals with ASD consistently indicates that teaching requesting skills has been the primary focus, with limited guidance on teaching social communication skills, despite the critical impact of these skills on language development. Furthermore, receptive language is typically not considered when measuring responsiveness to intervention. Thus, it is unclear how individuals with severely affected receptive language respond to current intervention techniques and whether these techniques support generalization of skills. The purpose of this qualitative study was to determine if clinical practice follows the patterns observed in the research literature and to learn more about how intervention techniques are impacting individuals in this population. Method: Thirteen practicing speech-language pathologists (SLPs) were interviewed to describe AAC intervention with this population. An interpretive phenomenological approach was used to analyze qualitative data and identify unique themes. Results: Seven primary themes emerged related to intervention targets, requesting, social communication, motivation, receptive language, perceived efficacy and challenges, and communication partners. Subthemes for each primary theme are described. Conclusions: Clinical practice resembles the research literature, as SLPs emphasize requesting and report the use of evidence-based strategies. However, SLPs reported a lack of guidance for teaching social communication, limited generalization of skills, and lack of AAC uptake by communication partners. Finally, SLPs may not consider individual receptive language abilities when making clinical decisions related to AAC. This article indicates a robust need to identify more effective AAC intervention methods that promote social communication, meet the needs of children with severely affected receptive language, and include families to improve outcomes.

The Appa Health App for Youth Mental Health: Development and Usability Study.

Demand for adolescent mental health services has surged in the aftermath of the COVID-19 pandemic, and traditional models of care entailing in-person services with licensed mental health providers are inadequate to meet demand. However, research has shown that with proper training and supervision mentors can work with youth with mental health challenges like depression and anxiety and can even support the use of evidence-based strategies like cognitive behavioral therapy (CBT). In our increasingly connected world, youth mentors can meet with young people on a web-based platform at their convenience, reducing barriers to care. Moreover, the internet has made evidence-based CBT skills for addressing depression and anxiety more accessible than ever. As such, when trained and supervised by licensed clinicians, mentors are an untapped resource to support youth with mental health challenges. The objective of this study was to develop and assess the feasibility and acceptability of Appa Health (Appa), an evidence-based mental health mentoring program for youth experiencing symptoms of depression and anxiety. This paper describes the development, pilot testing process, and preliminary quantitative and qualitative outcomes of Appa's 12-week smartphone app program which combines web-based near-peer mentorship with short-form TikTok-style videos teaching CBT skills created by licensed mental health professionals who are also social media influencers. The development and testing processes were executed through collaboration with key stakeholders, including young people and clinical and research advisory boards. In the pilot study, young people were assessed for symptoms of depression or anxiety using standard self-report clinical measures: the Patient Health Questionnaire-8 and the Generalized Anxiety Disorder-7 scales. Teenagers endorsing symptoms of depression or anxiety (n=14) were paired with a mentor (n=10) based on preferred characteristics such as gender, race or ethnicity, and lesbian, gay, bisexual, transgender, queer (LGBTQ) status. Quantitative survey data about the teenagers' characteristics, mental health, and feasibility and acceptability were combined with qualitative data assessing youth perspectives on the program, their mentors, and the CBT content. Participants reported finding Appa helpful, with 100% (n=14) of teenagers expressing that they felt better after the 12-week program. Over 85% (n=12) said they would strongly recommend the program to a friend. The teenagers were engaged, video chatting with mentors consistently over the 12 weeks. Metrics of anxiety and depressive symptoms reduced consistently from week 1 to week 12, supporting qualitative data suggesting that mentoring combined with CBT strategies has the potential to positively impact youth mental health and warrants further study. Appa Health is a novel smartphone app aiming to improve the well-being of youth and reduce anxiety and depressive symptoms through web-based mentoring and engaging CBT video content. This formative research sets the stage for a large-scale randomized controlled trial recently funded by the National Institutes of Health Small Business Innovation Research program.

Appraisal of awareness of medical staff about preoperative patient blood management in Saudi Arabia: a questionnaire-based study

Patient blood management (PBM) is a comprehensive approach to optimizing the care of patients who might need a transfusion. It involves the use of evidence-based strategies to reduce or avoid the need for allogeneic blood transfusions while ensuring that patients receive safe and appropriate care. PBM includes strategies such as preoperative autologous donation, intraoperative cell salvage, and minimally invasive techniques to reduce bleeding. The purpose of this study is to assess the medical staff’s awareness of preoperative PBM in Saudi Arabia. Between April 2022 and July 2022, data was collected using a 10-minute online (Google Forms) self-administered, anonymous, researcherstructured questionnaire adapted from previous studies and translated into both English and Arabic. The questionnaire was divided into three sections. The first section contained sociodemographic data, while the second section was used to estimate physicians’ and nurses’ knowledge of preoperative PBM. Two questions in Part 3 of the questionnaire were used to assess doctors’ and nurses’ preoperative PBM attitudes and practices. The average relationship between patients’ blood management attitudes and levels of awareness. It was revealed that there was a positive attitude (P≤0.005) as well as a high level of awareness (P≤0.002). The effect of job, gender, or geographical distribution on PBM awareness, attitude, and practice was not significant. Despite the fact that the majority of participants have a positive attitude and good awareness of PBM, more efforts should be implemented to improve PBM awareness, which was linked to increased transfusion practices and lower product costs.

The Impact of Implicit-Bias-Oriented Diversity Training on Police Officers’ Beliefs, Motivations, and Actions

U.S. police departments have attempted to address racial inequities in policing with diversity training. However, little research has evaluated whether these trainings are effective at changing officers’ beliefs, motivations, and actions. To examine their efficacy, we tested a day-long implicit-bias-oriented diversity training designed to increase U.S. police officers’ knowledge of biases, concerns about bias, and use of evidence-based strategies to mitigate bias (total N = 3,764). The training was immediately effective at increasing knowledge about bias, concerns about bias, and intentions to address bias, relative to baseline. However, the effects were fleeting. Although the training was linked to higher knowledge for at least 1 month, it was ineffective at durably increasing concerns or strategy use. These findings suggest that diversity trainings as they are currently practiced are unlikely to change police behavior. We conclude with theorizing about what organizations and training programs could do for greater impact.

Can Primary Care Drive Tuberculosis Elimination? Increasing Latent Tuberculosis Infection Testing and Treatment Initiation at a Community Health Center with a Large Non-U.S.-born Population

Community health centers (CHC) play a key role in latent tuberculosis infection (LTBI) testing and treatment. We performed a retrospective analysis of LTBI testing and treatment among pediatric and adult patients at a CHC with a large non-U.S.-born (USB) population during a series of quality improvement (QI) interventions from 2010 to 2019. Among 124,695 patients with primary care visits, 40% of patients were tested for tuberculosis (TB) infection and among those tested, 20% tested positive, including 39% of adults aged 50–79 years. Compared to adults aged 18–49 years, children aged 6–17 had increased odds of LTBI testing and treatment initiation [odds ratio and 95% confidence interval 3.23 (3.10, 3.36) and 1.41 (1.12, 1.79), respectively], while age ≥ 65 was associated with lower odds of both testing and treatment initiation. Over the analysis period, coinciding with unfunded QI interventions intended to reduce barriers to LTBI care, there was a significant increase in the proportion of patients receiving LTBI testing for both adults (6% to 47%, p < 0.001) and children (23% to 80%, p < 0.001). During the analysis period, there was also a significant increase in the proportion of patients receiving prescriptions for LTBI treatment, as well as provider use of evidence-based strategies including rifamycin-based treatment. Our study suggests that primary care interventions can reduce barriers to LTBI treatment and drive TB elimination.

What can implementation science offer civil society in their efforts to drive rights-based health reform?

Over the years, civil society organizations (CSOs) have made tremendous efforts to ensure that state policies, programmes, and actions facilitate equitable access to healthcare. While CSOs are key actors in the realization of the right to health, a systematic understanding of how CSOs achieve policy change is lacking. Implementation science, a discipline focused on the methods and strategies facilitating the uptake of evidence-based practice and research can bring relevant, untapped methodologies to understand how CSOs drive health reforms. This article argues for the use of evidence-based strategies to enhance civil society action. We hold that implementation science can offer an actionable frame to aid CSOs in deciphering the mechanisms and conditions in which to pursue rights-based actions most effectively. More empirical studies are needed to generate evidence and CSOs have already indicated the need for more data-driven solutions to empower activists to hold policymakers to account. Although implementation science may not resolve all the challenges CSOs face, its frameworks and approaches can provide an innovative way for organizations to chart out a course for reform.

Instructional coaching actions that predict teacher classroom practices and student achievement

Although there is emerging evidence supporting the efficacy of instructional coaching models used to support teachers in schools, additional research is necessary to investigate the individual contributions of coaching actions for specific approaches. This study investigated the extent to which three coaching actions—modeling, practice, and feedback—provided during data-driven coaching predicted (a) teachers' intervention implementation fidelity, (b) teachers' use of evidence-based classroom strategies, and (c) class-wide student achievement. In addition, the study explored the potential mediating influence of teachers' intervention implementation fidelity on the relationship between coaching actions and teachers' use of evidence-based strategies. Participants included 16 instructional coaches, one from each of 16 high-poverty charter schools, and 133 coached K–12 classroom teachers assigned to 3649 students. Results from multiple regression analyses indicated that the provision of practice opportunities during coaching was a statistically significant predictor, with greater practice opportunities associated with greater teacher intervention implementation fidelity and greater class-wide student English Language Arts (ELA) and math achievement. Feedback during coaching predicted student ELA but not math achievement. Both practice and feedback opportunities predicted better teacher use of evidence-based classroom strategies. In addition, teachers' intervention implementation fidelity mediated the relationship between teacher practice opportunities and teachers' use of evidence-based classroom strategies. Modeling was not found to be a statistically significant predictor. Study limitations and implications for practice and future research are described.

Effectiveness of Goal-Directed and Outcome-Based Financial Incentives for Weight Loss in Primary Care Patients With Obesity Living in Socioeconomically Disadvantaged Neighborhoods

Financial incentives for weight management may increase use of evidence-based strategies while addressing obesity-related economic disparities in low-income populations. To examine the effects of 2 financial incentive strategies developed using behavioral economic theory when added to provision of weight management resources. Three-group, randomized clinical trial conducted from November 2017 to May 2021 at 3 hospital-based clinics in New York City, New York, and Los Angeles, California. A total of 1280 adults with obesity living in low-income neighborhoods were invited to participate, and 668 were enrolled. Participants were randomly assigned to goal-directed incentives, outcome-based incentives, or a resources-only group. The resources-only group participants were given a 1-year commercial weight-loss program membership, self-monitoring tools (digital scale, food journal, and physical activity monitor), health education, and monthly one-on-one check-in visits. The goal-directed group included resources and linked financial incentives to evidence-based weight-loss behaviors. The outcome-based arm included resources and linked financial incentives to percentage of weight loss. Participants in the incentive groups could earn up to $750. Proportion of patients achieving 5% or greater weight loss at 6 months. The mean (SD) age of the 668 participants enrolled was 47.7 (12.4) years; 541 (81.0%) were women, 485 (72.6%) were Hispanic, and 99 (14.8%) were Black. The mean (SD) weight at enrollment was 98.96 (20.54) kg, and the mean body mass index (calculated as weight in kilograms divided by height in meters squared) was 37.95 (6.55). At 6 months, the adjusted proportion of patients who lost at least 5% of baseline weight was 22.1% in the resources-only group, 39.0% in the goal-directed group, and 49.1% in the outcome-based incentive group (difference, 10.08 percentage points [95% CI, 1.31-18.85] for outcome based vs goal directed; difference, 27.03 percentage points [95% CI, 18.20-35.86] and 16.95 percentage points [95% CI, 8.18-25.72] for outcome based or goal directed vs resources only, respectively). However, mean percentage of weight loss was similar in the incentive arms. Mean earned incentives was $440.44 in the goal-directed group and $303.56 in the outcome-based group, but incentives did not improve financial well-being. In this randomized clinical trial, outcome-based and goal-directed financial incentives were similarly effective, and both strategies were more effective than providing resources only for clinically significant weight loss in low-income populations with obesity. Future studies should evaluate cost-effectiveness and long-term outcomes. ClinicalTrials.gov Identifier: NCT03157713.

The challenges of implementing evidence-based strategies to inform building and urban design decisions: a view from current practice

PurposeThis study aims to raise awareness of the key challenges, opportunities and priorities for evidence-based strategies’ application to inform building and urban design decisions.Design/methodology/approachThis study uses deductive qualitative content and manifest analysis, using semi-structured interviews undertaken with building and urban design professionals who represent a UK-based organisation.FindingsThe challenges associated with the practical implementation of frameworks, potential application areas and perceived areas of concern have been identified. These not only include the need to practically test their use, but also to identify the most appropriate forums for their use. Participant responses indicate the need to further develop engagement strategies for their practical implementation, clearly communicating the benefits and efficiencies to all stakeholders.Research limitations/implicationsImplications/ limitations of this study come with the fact that some of the respondents may possess inadequate professional experience in properly evaluating all the questions. Additionally, the information gathered is restricted to the UK geographical context, as well as coming from one organisation, because of data accessibility.Practical implicationsThe findings of the study can be adopted by designers in the strategic definition level to overcome the key challenges associated with the use of evidence-based strategies, enhancing their decision-making processes.Originality/valueAs a theoretical contribution to knowledge, this study enhances the body of knowledge by identifying the challenges associated with the practical implementation of evidence-based strategies to inform building and urban design decisions. In practice, the findings aid urban planners, designers and academics in embedding and adopting strategies that enhance decision-making processes.

The Wisconsin Alzheimer's Institute Dementia Diagnostic Clinic Network: A community of practice to improve dementia care.

BackgroundThe Wisconsin Alzheimer's Institute (WAI) Dementia Diagnostic Clinic Network is a community of practice formed in 1998 as a collaboration of community‐based clinics from various healthcare systems throughout the state. Its purpose is to promote the use of evidence‐based strategies to provide high quality care throughout Wisconsin for people with dementia. The purpose of this study is to describe the use of a community of practice to facilitate education of healthcare providers on best practices in dementia care, and the implementation of an interprofessional approach to diagnose and manage dementia and related disorders.MethodsCross‐sectional study of the members of the WAI's Dementia Diagnosis Clinic Network. Characteristics of clinics and healthcare teams, learners' participation in educational events and educational outcomes were collected from evaluation forms. Number and characteristics of patients seen in the memory clinics were collected from de‐identified data forms submitted by members to a centralized location for data analysis.ResultsThe clinic network currently has 38 clinics affiliated with 26 different healthcare systems or independent medical groups in 21 of 72 Wisconsin counties. Most (56%) are based in primary care, 15% in psychiatry, and 29% in neurology. Between 2018 and 2021, we received data on 4710 patients; 92% were ≥65 years old, 60% were female, and 92% were white. Network members meet in‐person twice a year to learn about innovations in the field of dementia care and to share best practices. Educational events associated with the network are shown to be relevant, useful, and improve knowledge and skills of participants.ConclusionCommunities of practice provide added value via shared best practices and educational resources, continuing education of the health workforce, continuous quality improvement of clinical practices, and adoption of new diagnostic and management approaches in dementia care.

Examining the Built Environment for Healthy Living via Virtual Street Audits.

During the fall 2019 and spring 2020 semesters, 156 MPH students enrolled in the Integrative Learning Experience at the University of Alabama at Birmingham School of Public Health explored concepts of the built environment and health by auditing 2500 street segments in 4 urban neighborhoods in Birmingham, Alabama. In teams of 4 to 5, in-class and online students worked collaboratively to assess 63 built environment variables related to transportation, land use, advertisement, and neighborhood physical disorder. This type of “community assessment” is the first stage of the Evidence-based Public Health Framework and consistent with the applied nature of an MPH degree. Authors conducted secondary data analysis of final team assignments to demonstrate how students translated observations and ratings into practical recommendations for neighborhood improvements to promote physical activity. Students recommended improvements in neighborhood infrastructure and services, specifically: creating exercise space, providing outdoor exercise equipment, improving neighborhood safety, and cultivating a culture of health. The Integrative Learning Experience course encouraged students to use their knowledge and skills to prioritize recommendations to improve neighborhood conditions. Variable ratings and observations increased student awareness of the built environment and its potential to impact individual and community health. Moreover, the project helped students make connections between proximal outcomes, such as improving neighborhood walkability, and distal outcomes, such as improved health outcomes among residents. Finally, this project modeled for students the use of evidence-based strategies for making data-informed decisions, which are essential skills for new and emerging public health professionals.

Combining Self-Regulation Activities and Social Skills Training to Improve Social Competence Among Children Diagnosed With Autism Spectrum Disorder

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. With the growing prevalence of children diagnosed with autism spectrum disorder (ASD), a prevailing symptom limiting their occupation is deficits in social competence. It is vital that OTs advance their use of evidence-based strategies to foster social skills development. This research examines the effectiveness of an OT group model, incorporating both self-regulation activities and social skills training to improve the social competence of children with ASD. Primary Author and Speaker: Orley Ann Templeton Additional Authors and Speakers: Lori A. Charney, Kelsey Hadsall, Randi Huffman, Robert Kennedy, Mariah Laubach, David Lutchko, Callie O'Donovan, Kristen Ritter, and Carmelina Tringali

The Role of Flexibility in the Realization of Inclusive Education

This study focused on associations between teachers’ flexibility and their use of evidence-based strategies in inclusive education in a sample of N = 119 teachers. Flexibility showed direct effects on teachers’ attitudes towards the achievement of mainstream students and students with learning difficulties, attitudes towards social benefits of inclusion for students with emotional and behavioral disturbances, and on teachers’ self-efficacy regarding the support of students’ social skills. Furthermore, indirect effects of flexibility on intentions and behavior regarding the support of social skills were found. The findings emphasize the importance of teachers’ flexibility in the realization of inclusive education.

Evidence-Based Educational Practices for Public Health: How We Teach Matters

An eight-member team of the Teaching Working Group of the Association of Schools and Programs of Public Health Scholarship of Teaching and Learning Task Force created a call to action advancing the use of evidence-based strategies for public health education. The goal of this article is threefold, to assess briefly the current status of evidence-based teaching in public health, strengthen the case for using evidence-based teaching practices in public health courses, and propose strategies for educators in public health to engage along a continuum of evidence-based teaching. In this article, we define evidence-based teaching (EBT) proposes that EBT is demonstrated by: student mastery of specific short-term learner outcomes (e.g., enhanced effectiveness such as represented by improved knowledge, skills, and/or attitudes); increases the likelihood of successfully completion of a particular public health degree or program, which represents an intermediate- or long-term outcome; and ultimately posits that effective teaching in public health aims to produce well-prepared graduates who contribute to a ready workforce (Impact 1) who are able to improve the health of the public (Impact 2), highlights effective evidence-based teaching practices that improve student learning outcomes, encourages both seasoned faculty and newcomers to the field to incorporate EBT into existing public health curricula and to begin by making small changes, and concludes with a call to action for EBT that improves student learning.

RouTEAM: Home and School Partnerships to Support Communication for Children with Complex Communication Needs

A workshop format is often the professional development (PD) model used by educators; however, research shows that workshops are often not sufficient to change educator behavior. Additionally, including caregivers in PD can promote shared decision-making and support children’s transfer of skills between home and school environments. This pilot study examined the effectiveness of a PD intervention delivered to caregiver-educator teams that included team-based coaching to target adults’ use of evidence-based strategies delivered in a planned instructional sequence (i.e., CPR - create a communication opportunity, prompt as needed, respond to child communication) designed to support reciprocal interactions with children and use of aided augmentative or alternative communication. Using a multiple baseline across five caregiver-educator-child triads, the effect of intervention on adults’ percentage of correct CPR cycles was compared to a baseline condition in which adults learned isolated strategy implementation in a workshop format. Five adults showed positive behavior changes when intervention was implemented at three different time points, demonstrating promise of the intervention; however, for reasons discussed herein, the study produced mixed results. Results are consistent with prior research, and may be useful to administrators, educators, or families interested in PD and collaboration across home and school settings.

Physicians’ Use of Evidence-Based Strategies to Increase Adult Vaccination Uptake

This study assesses the following among primary care physicians: (1) the use of evidence-based strategies to improve adult vaccination rates, (2) the number of strategies employed simultaneously, and (3) characteristics associated with assessing adult vaccinations at each visit. An internet and mail survey was administered between December 2015 and January 2016 on primary care physicians designed to be representative of the American College of Physicians and American Academy of Family Physicians memberships. Data analysis was conducted in 2019. The response rate was 66% (617 of 935); 94% reported using electronic health records. Standing orders (84%) and electronic provider reminders at a visit (61%) were the most common strategies reported for influenza vaccine. Electronic provider reminders at a visit (53%) and recording a vaccination in an immunization registry (32%) were the most common strategies reported for all noninfluenza vaccines. Most physicians reported using 2 or more strategies, although this was more common for influenza (74%) than for noninfluenza (62%) vaccines. In multivariable analysis, physicians who reported assessing adult vaccinations at every patient visit were more likely to work in practices where decisions about purchasing and handling vaccines were made at a larger system level (RR=1.20, 95% CI=1.04,1.40), and they reported using electronic provider reminders (RR=1.38, 95% CI=1.15, 1.69) and standing orders (RR=1.45, 95% CI=1.21, 1.75) for all noninfluenza adult vaccines. Several strategies are being used to increase adult vaccination, particularly for the influenza vaccine. Investment in implementing standing orders and electronic clinical decision support for all routine adult vaccinations could help facilitate assessment of adult vaccinations at each visit and potentially improve adult vaccination rates.

Sociodemographic and Job Characteristics Influence Environmental Strategies Used to Manage Workplace Sleepiness.

Suboptimal alertness and sleepiness impact work performance, health, and safety in many industries. We aimed to identify key environmental factors that workers view as supportive for reducing sleepiness and to examine the relationship between worker and job characteristics and identified sleepiness remedies. We conducted a mixed-method (qualitative and quantitative) cross-sectional study analyzing data from a representative sample of 496 workers in New York State. Changing air ventilation (29.2%), natural lighting (17.1%), and room temperature (14.9%) were the environmental strategies deemed most important for managing workplace sleepiness. Strategy selection differed by sociodemographic (income and education) and job characteristics (indoor/outdoor, sedentary/mobile, and cognitive/physical labor). Customization of workplace environmental factors in a manner cognizant of workers' needs and sociodemographic and job characteristics could increase the use of evidence-based strategies to reduce sleepiness.

Binge Drinking and Prescription Opioid Misuse in the U.S., 2012–2014

Prescription opioids were responsible for approximately 17,000 deaths in the U.S. in 2016. One in five prescription opioid deaths also involve alcohol. Drinkers who misuse prescription opioids (i.e., use without a prescription or use only for the experience or feeling it causes) are at a heightened risk of overdose. However, little is known about the relationship between drinking patterns and prescription opioid misuse. Data were analyzed from 160,812 individuals (aged ≥12 years) who responded to questions about prescription opioid misuse and alcohol consumption in the 2012, 2013, or 2014 National Survey on Drug Use and Health (analyzed in 2017-2018). The prevalence of self-reported past-30-days prescription opioid misuse was assessed by sociodemographic characteristics, other substance use (i.e., cigarettes, marijuana), and drinking patterns. Multiple logistic regression analyses were used to calculate AORs. From 2012 to 2014, 1.6% (95% CI=1.5, 1.7) of all individuals aged ≥12 years (estimated 4.2 million) and 3.5% (95% CI=3.3, 3.8) of binge drinkers (estimated 2.2 million) reported prescription opioid misuse. Prescription opioid misuse was more common among binge drinkers than among nondrinkers (AOR=1.7, 95% CI=1.5, 1.9). Overall, the prevalence of prescription opioid misuse increased significantly with binge drinking frequency (p-value<0.001). More than half of the 4.2 million people who misused prescription opioids during 2012-2014 were binge drinkers, and binge drinkers had nearly twice the odds of misusing prescription opioids, compared with nondrinkers. Widespread use of evidence-based strategies for preventing binge drinking might reduce opioid misuse and overdoses involving alcohol.

Effects of Self-Monitoring on the Praise Rates of Paraprofessionals for Students with Emotional and Behavioral Disorders

The limitations and challenges of paraprofessional training are well documented. These issues are magnified by the increasing reliance on paraprofessionals to provide vital support for students with emotional and behavioral disorders (EBD). Despite evidence supporting self-monitoring for improving teacher and paraprofessional skills, there are limited demonstrations of how paraprofessionals improve their use of evidence-based strategies through self-monitoring. This study examined the effects of self-monitoring on paraprofessionals’ total use of praise and behavior-specific praise. A first exploratory item included the extent to which any increases in praise covaried with paraprofessional use of reprimands. A second exploratory item determined whether any changes in praise covaried with the engagement and disruptive behavior of their students with EBD. Self-monitoring was associated with increased total praise, a moderately increased use of behavior-specific praise, and improvements in student engagement along with decreases in student disruptive behavior. Implications for behavioral interventions for students with EBD are discussed.