... eligible homeless veterans, such as the Health Care for Homeless Veterans (HCHV) Program, the Grant and Per... AFFAIRS 38 CFR Part 62 RIN 2900-AN53 Supportive Services for Veteran Families Program AGENCY: Department... concerning the Supportive Services for Veteran Families Program (SSVF Program) of the Department of Veterans...
..., National Center for Homelessness Among Veterans, Supportive Services for Veteran Families Program Office... services pursuant to payments from the grantee be State-licensed because ``home run daycare and other... some jurisdictions, may include home run daycares. The commenter also requested that VA consider...
Fischer, Ellen P; Sherman, Michelle D; McSweeney, Jean C; Pyne, Jeffrey M; Owen, Richard R; Dixon, Lisa B
Combat deployment and reintegration are challenging for service members and their families. Although family involvement in mental health care is increasing in the U.S. Department of Veterans Affairs (VA) system, little is known about family members' preferences for services. This study elicited the perspectives of returning Afghanistan and Iraq war veterans with posttraumatic stress disorder and their families regarding family involvement in veterans' mental health care. Semistructured qualitative interviews were conducted with 47 veterans receiving care for posttraumatic stress disorder at the Central Arkansas Veterans Healthcare System or Oklahoma City VA Medical Center and 36 veteran-designated family members. Interviews addressed perceived needs related to veterans' readjustment to civilian life, interest in family involvement in joint veteran/family programs, and desired family program content. Interview data were analyzed using content analysis and constant comparison. Both groups strongly supported inclusion of family members in programs to facilitate veterans' postdeployment readjustment and reintegration into civilian life. Both desired program content focused on information, practical skills, support, and gaining perspective on the other's experience. Although family and veteran perspectives were similar, family members placed greater emphasis on parenting-related issues and the kinds of support they and their children needed during and after deployment. To our knowledge, this is the first published report on preferences regarding VA postdeployment reintegration support that incorporates the perspectives of returning male and female veterans and those of their families. Findings will help VA and community providers working with returning veterans tailor services to the needs and preferences of this important-to-engage population. (c) 2015 APA, all rights reserved).
... Health Administration » Health Programs for Veterans Veterans Health Administration Health Programs for Veterans Beyond the doctors and ... families of patients receiving medical care at major military and VA medical centers Geriatrics & Extended Care Geriatric ...
Rush-Ossenbeck, Marilyn; West-Olatunji, Cirecie
The authors propose a CBT-based Therapeutic Community (TC) program designed to facilitate healthy relationships between military veterans and their families. In many military veteran families, there is a struggle to maintain a healthy and balanced life both outside and inside the household. This struggle affects both spouses and children and is…
Department of Veterans Affairs — If you are already enrolled in VA health care, the Choice Program allows you to receive health care within your community. Using this program does NOT impact your...
Service members and veterans face some different health issues from civilians. Their families also face some unique challenges. Families may have to cope with Separation from their loved ones Anxiety over loved ones' safety in combat ...
Ferruolo, David M
Nearly half of all combat veterans suffer from serious psychological disorders and reintegration issues. Veterans shy away from typical talk therapy and are seeking alternative treatments. Equine-facilitated mental health therapy has shown promise in treating veterans with depressive and anxiety disorders and reintegration issues. This article reports on an institutional review board-approved pilot program designed to address the mental health needs of veterans. Furthermore, this article discusses future directions for evolving development of equine treatment programming.
... housing. Only families with children under the age of 18 may receive such assistance; individuals are not... homeless persons. The Housing First approach is based on the concept that a homeless individual or...'s program concept must be generally consistent with the program concept of the grantee's current...
Manheim, Chelsea E; Haverhals, Leah M; Jones, Jacqueline; Levy, Cari R
The Medical Foster Home program is a unique long-term care program coordinated by the Veterans Health Administration. The program pairs Veterans with private, 24-hour a day community-based caregivers who often care for Veterans until the end of life. This qualitative study explored the experiences of care coordination for Medical Foster Home Veterans at the end of life with eight Veterans' family members, five Medical Foster Home caregivers, and seven Veterans Health Administration Home-Based Primary Care team members. A case study, qualitative content analysis identified these themes addressing care coordination and impact of the Medical Foster Home model on those involved: (a) Medical Foster Home program supports Veterans' families; (b) Medical Foster Home program supports the caregiver as family; (c) Veterans' needs are met socially and culturally at the end of life; and (d) the changing needs of Veterans, families, and caregivers at Veterans' end of life are addressed. Insights into how to best support Medical Foster Home caregivers caring for Veterans at the end of life were gained including the need for more and better respite options and how caregivers are compensated in the month of the Veteran's death, as well as suggestions to navigate end-of-life care coordination with multiple stakeholders involved.
Jensen, Mai Tødsø; Karmsteen, Kirstine; Jørgensen, Anne-Marie Klint
to the veteran or the mental health of the partner while relatively few publications deal with the veteran family as a whole or its members social relations outside the primary family. Furthermore, there are relatively few publications focusing on relatives to veterans deployed other places than Iraq...... and Afghanistan, publications focusing on relatives of veterans with physical injuries and few publications dealing with relatives to female veterans. The overall conclusion is that there is a potential need for addressing psychosocial functioning and health among these groups of relatives in research to provide...
Jackonis, Michael J; Deyton, Lawrence; Hess, William J
This essay discusses the challenges faced by veterans returning to society in light of the current organization and structure of the military, veterans', and overall U.S. health care systems. It also addresses the need for an integrated health care financing and delivery system to ensure a continuum of care for service members, veterans, dependents, and other family members. The health care systems of both the Department of Defense and the Department of Veterans Affairs execute their responsibilities to active duty service members, while their families and retirees/veterans are under separate legal authorities. Although they perform their mandates with extraordinary commitment and demonstrably high quality, both systems need to explore improved communication, coordination, and sharing, as well as increased collaboration with the Department of Health and Human Services programs serving the same populations, far beyond current efforts. The health care-related missions and the locus of health care delivery of each agency are admittedly unique, but their distinctions must not be permitted to impede system integration and coordination of a continuum of care provided to the men and women who serve the nation, and their families.
... delivery-related problems. For a Copy of the Application Package: Download directly from the SSVF Program... prisons, mental health institutions, hospitals); c. Residency in housing that has been condemned by... standards for the housing unit size); o. Past institutional care (prison, treatment facility, hospital); p...
Full Text Available This new generation of veterans is coming home to families, friends, employers, and communities that likely do not understand military culture, nor the effects that military service and reintegration have on a veteran’s life, leading to the next war – the Reintegration War. Military servicemembers, veterans, and their families face challenges within the Reintegration War that are different from their civilian counterparts and are complicated by military-specific circumstances. In order to more effectively and efficiently address the challenges servicemembers, veterans, and their families face, we need to work together in a comprehensive effort. Strategies are presented to help win the Reintegration War and ease the transition for servicemembers, veterans, and their families.
... Veterans' Reintegration Program AGENCY: Veterans' Employment and Training Service (VETS), Department of...: Section 2021 of Title 38 of the United States Code (U.S.C.) reauthorizes the Homeless Veterans Reintegration Program (HVRP) through fiscal year (FY) 2012 and indicates: ``the Secretary of Labor shall conduct...
to VACAA and challenges encountered during implantation of the law. Table 1 provides major highlights pertaining to the Veterans Choice Program (VCP...outpatient medical, surgical, and mental healthcare; pharmaceuticals; pregnancy and delivery services; dental care; and durable medical equipment, and
...' Employment and Training Service Veterans Workforce Investment Program AGENCY: Veterans' Employment and...' Workforce Investment Program (VWIP) for Program Year (PY) 2010, as authorized under section 168 of the Workforce Investment Act (WIA) of 1998. This Solicitation for Grant Applications (SGA) notice contains all...
Amon, Ronald D.
As a result of a review of performance reports submitted by almost 400 colleges and universities receiving Veterans Education Outreach Program (VEOP) grants, 37 exemplary programs were identified by a panel of 5 professionals in veterans' education and government administration. The exemplary programs selected showed consistency in staff efforts…
The Department of Veterans Affairs (VA) amends its medical regulations concerning eligibility for the Health Care for Homeless Veterans (HCHV) program. The HCHV program provides per diem payments to non-VA community-based facilities that provide housing, outreach services, case management services, and rehabilitative services, and may provide care and/or treatment to homeless veterans who are enrolled in or eligible for VA health care. The rule modifies VA's HCHV regulations to conform to changes enacted in the Honoring America's Veterans and Caring for Camp Lejeune Families Act of 2012. Specifically, the rule removes the requirement that homeless veterans be diagnosed with a serious mental illness or substance use disorder to qualify for the HCHV program. This change makes the program available to all homeless veterans who are enrolled in or eligible for VA health care. The rule also updates the definition of homeless to match in part the one used by the Department of Housing and Urban Development (HUD). The rule further clarifies that the services provided by the HCHV program through non-VA community-based providers must include case management services, including non-clinical case management, as appropriate.
... (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Vocational Rehabilitation and Employment Under 38 U.S.C... furnished to family members under these provisions. (c) Providing services to a veteran's family. VR&E Staff...
Taft, Casey T.; Schumm, Jeremiah A.; Panuzio, Jillian; Proctor, Susan P.
This study examined interrelationships among combat exposure, symptoms of posttraumatic stress disorder (PTSD), and family adjustment in a sample of male and female Operation Desert Storm veterans (N = 1,512). In structural equation models for both male and female veterans, higher combat exposure was associated with higher PTSD symptoms, which in…
O'Donnell, Meaghan; Varker, Tracey; Perry, Desmond; Phelps, Andrea
The Veterans and Veterans Families Counselling Service (VVCS), established by the Australian government, plays a pivotal role in providing mental health services to veterans and their families. This research explored the impact of center-based psychological counseling on depression, anxiety, stress, and alcohol use severity. A stratified sample of VVCS clients were invited to participate in this study. Data were collected on intake to the program, at the fifth counseling session, and 12 months after the commencement of counseling. Repeated-measures general linear model analyses were conducted to examine the impact of center-based counseling on depression, anxiety, stress, and alcohol severity over time. VVCS center-based counseling resulted in a significant reduction in depression, anxiety, stress, and alcohol use severity after five sessions, and these improvements were maintained over the next 12 months. Despite these improvements, however, participants continued to report moderate-to-severe levels of mental health problems. VVCS center-based counseling successfully reduced depression, anxiety, stress, and alcohol use symptom severity of veterans and their families. However, the clinical profiles of this population are often complex and challenges remain in terms of addressing the mental health needs of this group. Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.
Tsai, Jack; Rosenheck, Robert A; Kane, Vincent
As more women serve in the U.S. military, the proportion of females among homeless veterans is increasing. The current study compares the individual characteristics and 1-year outcomes of homeless female and male veterans in the Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program nationally. Administrative data on 43,853 veterans (10.69% females; 89.31% males) referred to HUD-VASH were analyzed for gender differences at baseline and over a 1-year period. Homeless female veterans were younger, had shorter homeless and incarceration histories, and were less likely to have substance use disorders than men. However, despite being less likely to report combat exposure, female veterans were more likely to have posttraumatic stress disorder. Homeless female veterans were also much more likely to have dependent children with them and to plan to live with family members in supported housing. Once admitted to HUD-VASH, there were no gender differences in attrition or main housing outcomes. Case managers were faster to admit female veterans to the program, reported better working alliances, and provided more services related to employment and income than male veterans. These findings suggest homeless female veterans may have certain strengths, including being younger, less involved in the criminal justice system, and more adept at relating to professional and natural supports; but special attention to noncombat trauma and family-oriented services may be needed.
Romero, Daniel H; Riggs, Shelley A; Ruggero, Camilo
With rising numbers of student veterans on today's college campuses, multicultural competence in college counseling centers increasingly includes an understanding of military culture and its relation to the psychological health and functioning of student veterans. Research on interpersonal and intrapersonal factors associated with college student veterans' mental health is scarce. The current study examines the contributions of coping style and family social support on symptoms of anxiety, depression, and posttraumatic stress in a student veteran sample. We also tested the moderating role of family social support in the relationship between coping style and psychological symptoms. Data from 136 student veterans were analyzed by using path analysis. Results revealed that avoidant coping and family social support significantly predicted depressive and anxiety symptoms. Avoidant coping also significantly predicted posttraumatic stress symptoms. In addition, findings indicated that family social support moderated the relationship between problem-focused coping and depression, as well as between avoidant coping and symptoms of anxiety and depression but not posttraumatic stress. Implications of results for college and university counselors are discussed. (c) 2015 APA, all rights reserved).
Cozza, Stephen J.; Lerner, Richard M.; Haskins, Ron
This "Social Policy Report" summarizes what is currently known about our nation's military children and families and presents ideas and proposals pertinent to the formulation of new programs and the policies that would create and sustain these initiatives. We emphasize the need for future rigorous developmental research about military…
Blackstock, Oni J; Haskell, Sally G; Brandt, Cynthia A; Desai, Rani A
Female Veterans comprise 12% of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans, the largest proportion of women to serve of any prior cohort. We sought to determine the sex-specific risk of using a Veterans Health Administration (VHA) homeless program among OEF/OIF Veterans and to identify factors associated with increased risk of program use for women compared with men. We included OEF/OIF Veterans with at least 1 VHA clinical visit between October 1, 2001, and September 30, 2009. The study's outcome was the time to first use of a VHA homeless program. Cox proportional-hazards regression was used to estimate the relative risk of using a homeless program by sex, adjusting for relevant sociodemographic and clinical variables. Exploratory analyses examined interactions between sex and all covariates. Of 445,319 Veterans, 7431 (1.7%) used a VHA homeless program, of which 961 were females (1.8%), and 6470 were males (1.7%) during a median follow-up period of 3.20 years. Women were as likely as men to use a homeless program (adjusted hazard ratio, 1.02; 95% confidence interval, 0.95-1.09); median time to first use was similar for female and male Veterans (1.88 vs. 1.88 y, respectively, P=0.53). In exploratory analyses, we found increased risk of program use for women compared with men for the following subgroups: ages 26-35 years, 100% service-connected disability rating, posttraumatic stress disorder diagnosis, and northeast location. Overall, there was no substantial difference in the sex-specific risk of using a VHA homeless program. In light of this finding, VHA homeless programs must be prepared to recognize and address the unique needs of female OEF/OIF Veterans.
Department of Veterans Affairs — Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a health care benefit program designed for the dependents of certain Veterans....
... consistent with the generally accepted ``disease model'' of alcoholism and drug addiction treatment, as well... burden on veterans by designing and implementing a single information technology program that agencies can use to share information about the veteran. Although we generally agree that technology increases...
Whealin, Julia M; Yoneda, Athena C; Nelson, Dawna; Hilmes, Todd S; Kawasaki, Michelle M; Yan, Oscar H
The Veterans Affairs mission to provide equitable, accessible, and patient-centered care necessitates that culturally appropriate interventions are available when cultural differences may jeopardize engagement in care. However, within the VA, wounded warriors residing in rural areas in the Pacific Islands have been offered interventions that were developed and tested using largely urban mainland populations. The objectives of this article were to (a) document the cultural adaptation of a cognitive-behavioral clinical intervention for use by rural Pacific Island veterans, and (b) report feasibility data for the intervention. The 5-stage Map of the Adaptation Process (assessment, selection, preparation, piloting, and refinement) was used to structure the work. The resultant intervention, called "Koa," is a multisession family psychoeducational program that integrates selected Pacific Islander values, beliefs, and healing traditions with an empirically based mainstream U.S. To pilot Koa, rural Pacific Island dyads (28 veterans and 28 family members) participated via video teleconference and completed pre- and post- intervention measures. Outcome data indicated that participants perceived the intervention to be highly acceptable, useful, and relevant. Relationship quality scores substantially improved postintervention as measured by the Dyadic Relationship Scale (95% CI [-10.97, -1.84], t(22) = -2.9, p = .008, d = -0.53 for veterans; 95% CI [-11.06, -2.47], t(21) = -3.28, p = .004, d = -0.68 for family members). Family caregiving burden also improved significantly. The positive results of this investigation support the development of culturally adapted mental health interventions for culturally distinct subgroups of veterans and their families. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
... of the Assistant Secretary for Veterans' Employment and Training ``Homeless Veterans' Reintegration... the Homeless Veterans' Reintegration Program (HVRP) to include the Homeless Female Veterans and... to expedite the reintegration of homeless Veterans into the labor force. In order to assist the USDOL...
Campbell, Katrina Lanelle
The purpose of this study was to conduct an analysis on ex post facto data of the federal grant supported Homeless Veterans Reintegration Program (HVRP) administered at Goodwill Industries of Lower South Carolina. Pre-existing data on variables such as performance goals, training activities, support services, and demographics from program years…
Winter, Laraine; Moriarty, Helene J
The quality of the relationship between patients with many illnesses and their family members has been shown to affect the well-being of both. Yet, relationship quality has not been studied in traumatic brain injury (TBI), and giving and receiving aspects have not been distinguished. The present study of veterans with TBI examined associations between relationship quality and caregiver burden, satisfaction with caregiving, and veterans' competence in interpersonal functioning, rated by veterans and family members. In this cross-sectional study, 83 veterans and their family members were interviewed at home. Measures of quality of relationship, veterans' interpersonal competence and sociodemographics were collected for both, caregiver burden and satisfaction for family members only. As predicted, veteran-rated Qrel/Giving was associated with family-rated Qrel/Receiving, and veteran-rated Qrel/Receiving with family-rated Qrel/Giving. Lower caregiver burden and higher caregiving satisfaction were associated with higher Qrel/Receiving scores but not with Qrel/Giving scores. Veterans' interpersonal competence was associated with total Qrel as rated by either veterans or family members. Relationship quality should be included in family research in TBI, and giving and receiving aspects should be differentiated. Findings suggest that lower caregiver burden and greater satisfaction should be more achievable by increasing caregivers' sense of benefits received from the relationship.
Nakashima, John; McGuire, Jim; Berman, Stephen; Daniels, William
Between 1992 and 2003, services for homeless veterans at the Veterans Affairs Greater Los Angeles Healthcare System went from inappropriate utilization of hospital medical and psychiatric beds, to a continuum of residential treatment, transitional housing, and employment programs through arrangements with private agencies. The authors use elements of Hasenfeld and Brock's Political Economy Model (1991) to explain this transformation in service delivery that was spearheaded by a VA social work leadership team. It is argued that three driving forces crucial to program implementation were present: technological certainty, economic stability, and concentration of power. Evidence of the implementation's impact includes creation of new homeless program beds, a reduction in use of medical/psychiatric beds, and a large number of formerly homeless veterans with housing and employment at program discharge. Study limitations and implications for future studies are discussed.
Batch, Bryan C; Goldstein, Karen; Yancy, William S; Sanders, Linda L; Danus, Susanne; Grambow, Steven C; Bosworth, Hayden B
Few evaluations of the Veterans Health Administration Motivating Overweight/Obese Veterans Everywhere (MOVE!) weight management program have assessed 6-month weight change or factors associated with weight change by gender. Analysis of administrative data from a national sample of veterans in the VA MOVE! A total of 62,882 participants were included, 14.6% were women. Compared with men, women were younger (49.6 years [standard deviation, SD, 10.8] vs. 59.3 years [SD, 9.8], p stress disorder (26.0% vs. 22.4%, p women was lower than men (5.6 [SD, 5.3] vs. 6.0 [SD, 5.9], p Women, compared with men, reported lower rates of being able to rely on family or friends (35.7% vs. 40.8%, p women was -1.5% (SD, 5.2) and for men was -1.9% (SD, 4.8, p women (body-mass index [BMI] >25 kg/m(2)) compared with men (BMI >25 kg/m(2); odds ratio, 1.05 [95% confidence interval, 0.99-1.11; p = 0.13]). Women veterans lost less weight overall compared with men. There was no difference in the odds of achieving clinically significant weight loss by gender. The majority of women and men enrolled lost <5% weight despite being enrolled in a lifestyle intervention. Future studies should focus on identifying program- and participant-level barriers to weight loss.
Hinojosa, Ramon; Hinojosa, Melanie Sberna; Högnäs, Robin S
Twenty Reserve component (Army and Marines) and Army National Guard male veterans of Operational Enduring Freedom/Operation Iraqi Freedom discuss their deployment and postdeployment family reintegration experiences. A Grounded Theory approach is used to highlight some of the ways in which family miscommunication during deployment can occur. Communication with civilian family members is affected by the needs of operational security, technical problems with communication tools, miscommunication between family members, or because veterans have "nothing new to say" to family back home. These communication difficulties may lead to an initial gulf of understanding between veterans and family members that can cause family strain during postdeployment family reintegration. We end with a discussion of veteran family reintegration difficulties.
Schaffer, Bradley J
The prominence and incidence of intimate partner violence (IPV) with male military veterans vary, but generally there is consensus that screening and intervention does help reduce IPV. Intervention is generally provided in the community via Batterer Intervention Programs. However, at the Department of Veterans Affairs (VA) intervention is provided via the Domestic Relations Clinic. Nationally the VA has limited treatment for male IPV. An aggregate sample (n = 178) of participants was assessed using the Domestic Violence/Abuse Screen to measure covariate pre-test and post-test outcomes, program failure, and recidivism. The treatment approach is psycho-educationally based to meet the challenging and unique needs of the military veteran population. The results contribute to a more comprehensive understanding of IPV and highlight the need for more intervention and prevention approaches.
The Department of Veterans Affairs (VA) is establishing a grant program (Veterans Employment Pay for Success (VEPFS)) under the authority of the U.S.C. to award grants to eligible entities to fund projects that are successful in accomplishing employment rehabilitation for Veterans with service-connected disabilities. VA will award grants on the basis of an eligible entity's proposed use of a Pay for Success (PFS) strategy to achieve goals. This interim final rule establishes regulations for awarding a VEPFS grant, including the general process for awarding the grant, criteria and parameters for evaluating grant applications, priorities related to the award of a grant, and general requirements and guidance for administering a VEPFS grant program.
Sherman, Michelle D; Fischer, Ellen P; Owen, Richard R; Lu, Liya; Han, Xiaotong
Mood disorders affect large numbers of individuals and their families; the ripple effects on relationship functioning can be great. Researchers have advocated for a relational perspective to mood disorder treatment, and several promising treatments have been developed. However, few rigorous evaluations have been conducted within the Veterans Affairs (VA) system. Multifamily group therapy, an evidence-based practice for people living with schizophrenia, has recently been adapted for other psychological disorders with promising results. This report describes the first published evaluation of this treatment modality in the VA system for veterans living with mood disorders. 101 male veterans (74 with major depression and 27 with bipolar disorder) and their family members participated in REACH (Reaching out to Educate and Assist Caring, Healthy Families), a 9-month, manualized, multi-family group treatment, intervention adapted from McFarlane's original multi-family group model. Participants completed self-report questionnaires at four time points across the course of the treatment, and service utilization data for veterans were obtained from VA databases. Both veterans and family members showed improvements in their knowledge about mood disorders, understanding of positive strategies for dealing with situations commonly confronted in mood disorders, and family coping strategies. Veterans also evidenced improvement in family communication and problem-solving behaviors, empowerment, perceived social support, psychiatric symptoms, and overall quality of life. The REACH intervention holds promise as a feasible, acceptable, and effective treatment for veterans living with mood disorders and their families. Further study is warranted.
... AFFAIRS Proposed Information Collection (VA National Veterans Sports Programs and Special Event Surveys... solicits comments on the information needed to evaluate the National Veterans Sports Programs and Special... ``OMB Control No. 2900-NEW (VA National Veterans Sports Programs and Special Event Surveys)'' in any...
Cozza, Stephen J; Holmes, Allison K; Van Ost, Susan L
The US military community includes a population of mostly young families that reside in every state and the District of Columbia. Many reside on or near military installations, while other National Guard, Reserve, and Veteran families live in civilian communities and receive care from clinicians with limited experience in the treatment of military families. Though all military families may have vulnerabilities based upon their exposure to deployment-related experiences, those affected by combat injury have unique additional risks that must be understood and effectively managed by military, Veterans Affairs, and civilian practitioners. Combat injury can weaken interpersonal relationships, disrupt day-to-day schedules and activities, undermine the parental and interpersonal functions that support children's health and well-being, and disconnect families from military resources. Treatment of combat-injured service members must therefore include a family-centered strategy that lessens risk by promoting positive family adaptation to ongoing stressors. This article reviews the nature and epidemiology of combat injury, the known impact of injury and illness on military and civilian families, and effective strategies for maintaining family health while dealing with illness and injury.
Keavney, Elaine C.
The Joining Forces Initiative challenges nursing programs throughout the country to develop curriculum that addresses the unique healthcare issues facing veterans. It is imperative that Bachelor of Science in Nursing (BSN) students acquire the knowledge that will help them to care for veterans in all areas of nursing practice. This article…
Fontana, Alan; Rosenheck, Robert; Desai, Rani
Differences in the characteristics and mental health needs of female veterans of the Iraq/Afghanistan war compared with those of veterans of other wars may have useful implications for VA program and treatment planning. Female veterans reporting service in the Iraq/Afghanistan war were compared with women reporting service in the Persian Gulf and Vietnam wars and to men reporting service in the Iraq/Afghanistan war. Subjects were drawn from VA administrative data on veterans who sought outpatient treatment from specialized posttraumatic stress disorder (PTSD) treatment programs. A series of analyses of covariance (ANCOVA) was used to control for program site and age. In general, Iraq/Afghanistan and Persian Gulf women had less severe psychopathology and more social supports than did Vietnam women. In turn, Iraq/Afghanistan women had less severe psychopathology than Persian Gulf women and were exposed to less sexual and noncombat nonsexual trauma than their Persian Gulf counterparts. Notable differences were also found between female and male veterans of the Iraq/Afghanistan war. Women had fewer interpersonal and economic supports, had greater exposure to different types of trauma, and had different levels of diverse types of pathology than their male counterparts. There appear to be sufficient differences within women reporting service in different war eras and between women and men receiving treatment in VA specialized treatment programs for PTSD that consideration should be given to program planning and design efforts that address these differences in every program treating female veterans reporting war zone service.
Trillingsgaard, Tea; Maimburg, Rikke Damkjær; Simonsen, Marianne
. However, little is known about effect of universal approaches to parenting support during the transition to parenthood. This protocol describes and experimental evaluation of group based parenting support, the Family Startup Program (FSP), currently implemented large scale in Denmark. Methods....../design: Participants will be approximately 2500 pregnant women and partners. Inclusion criteria are parental age above 18 and the mother expecting first child. Families are recruited when attending routine pregnancy scans provided as a part of the publicly available prenatal care program at Aarhus University Hospital...... and community resources. The program consists of twelve group sessions, with nine families in each group, continuing from pregnancy until the child is 15 months old. TAU is the publicly available pre- and postnatal care available to families in both conditions. Analyses will employ survey data, administrative...
Hendrix, Charles C.; Anelli, Lisa M.
Surveyed Vietnam veterans' (n=131 males, 4 females) perceptions of impact of their wartime experiences on their current family life. Found direct effects of war service on psychological impact and direct effects of psychological impact on family satisfaction and functioning. Found no direct effects between war service and family satisfaction and…
Moore, Crystal Dea
A cross-sectional study of 76 family caregivers of older veterans with congestive heart failure utilized the McMaster model of family functioning to examine the impact of family functioning variables (problem solving, communication, roles, affective responsiveness, and affective involvement) on caregiver burden dimensions (relationship burden,…
Ball, Sherry L; Stevenson, Lauren D; Ladebue, Amy C; McCreight, Marina S; Lawrence, Emily C; Oestreich, Taryn; Lambert-Kerzner, Anne C
The Veterans Health Administration (VHA) is adapting to meet the changing needs of our Veterans. VHA leaders are promoting quality improvement strategies including Lean Six Sigma (LSS). This study used LSS tools to evaluate the Veterans Choice Program (VCP), a program that aims to improve access to health care services for eligible Veterans by expanding health care options to non-VHA providers. LSS was utilized to assess the current process and efficiency patterns of the VCP at 3 VHA Medical Centers. LSS techniques were used to assess data obtained through semistructured interviews with Veterans, staff, and providers to describe and evaluate the VCP process by identifying wastes and defects. The LSS methodology facilitated the process of targeting priorities for improvement and constructing suggestions to close identified gaps and inefficiencies. Identified key process wastes included inefficient exchange of clinical information between stakeholders in and outside of the VHA; poor dissemination of VCP programmatic information; shortages of VCP-participating providers; duplication of appointments; declines in care coordination; and lack of program adaptability to local processes. Recommendations for improvement were formulated using LSS. This evaluation illustrates how LSS can be utilized to assess a nationally mandated health care program. By focusing on stakeholder, staff, and Veteran perspectives, process defects in the VCP were identified and improvement recommendations were made. However, the current LSS language used is not intuitive in health care and similar applications of LSS may consider using new language and goals adapted specifically for health care.
Wenzel, S L; Bakhtiar, L; Caskey, N H; Hardie, E; Redford, C; Sadler, N; Gelberg, L
This study addresses the relationship of homeless veterans' discharge status from a domiciliary care program to biopsychosocial characteristics presented at admission into the program. Hypotheses were that younger age, less education, and substance abuse or psychiatric disorder would predict an irregular discharge. Research participants were 367 homeless male veterans who had been admitted to a domiciliary care program at the West Los Angeles Veterans Affairs Medical Center for treatment of medical, psychiatric, or substance disorders. Status of veterans' program discharge (regular or irregular) served as the outcome measure. Logistic regression analysis revealed that irregular discharge from the program was more likely among veterans who were black, who had poor employment histories, or who had problems with alcohol. Results are discussed in light of the need to maintain homeless veterans in treatment programs so that they can achieve maximum benefit from available programs.
Molinari, Victor A; Brown, Lisa M; Frahm, Kathryn A; Schinka, John A; Casey, Roger
To understand the needs and challenges encountered by older homeless veterans. We conducted six focus groups of older veterans, two focus groups, and one semi-structured interview of VA staff liaisons, and two focus groups and one semi-structured interview of housing intervention providers. Major themes for older veterans: 1) negative homelessness experience; 2) benefits of the structured transitional housing program; 3) importance of peer outreach; and 4) need for age-tailored job placement programs. Major themes for VA staff liaison/housing intervention providers: 1) belief that the transitional housing program has made a positive change; 2) need for individualized criteria to address the unique needs of veterans; 3) distinct differences between older and younger homeless veterans; 4) outreach services; 5) permanent housing issues; and 6) coordination of services. Compared with younger veterans, older veterans have less social support, greater employment and health challenges, and, perhaps greater motivation to change.
Murillo, Rose L.
Purpose: The purpose of this study was to determine how Southern California community colleges have implemented best practices based on the 8 Keys to Veterans' Success as identified by the U.S. Departments of Education, Defense, and Veterans Affairs to effectively support and retain military and veteran students in higher education programs. The…
Lutz, Barbara J; Chumbler, Neale R; Lyles, Teresa; Hoffman, Nannette; Kobb, Rita
The study purpose was to implement a stroke-specific, care coordination home telehealth (CCHT) programme for US veterans with stroke and their family caregivers. In a non-randomized open trial using a mixed methods design, we tested the utility of a stroke-specific, home telehealth programme with 18 veterans and 14 caregivers for 14 days. Programme questions assessed physical impairment, depressive symptoms, and fall prevalence among veterans, and burden level among family caregivers. Nine veterans and six caregivers completed post-programme interviews exploring their experiences with telehealth. During the 14-day trial, 55% of the veterans screened positive for depression at least once, 36% of the caregivers had clinically significant burden, half of the veterans and caregivers reported post-stroke concerns, and 90% believed post-stroke contact from a care coordinator would have been helpful. In the interviews, seven veterans indicated they had fallen or almost fallen post-stroke. Themes centred on tailoring CCHT to individual needs, coordinating with support services, identifying safety issues, and providing information about stroke prevention. Home telehealth offers innovative ways to target post-stroke rehabilitation programmes to the needs and concerns of patients and their caregivers, and should include regular real-time contact between stroke patients and their healthcare providers.
Allicock, Marlyn; Haynes-Maslow, Lindsey; Carr, Carol; Orr, Melinda; Kahwati, Leila C; Weiner, Bryan J.; Kinsinger, Linda
Introduction The Veterans Health Administration (VHA) has implemented MOVE!, a weight-management program for veterans designed to address the increasing proportion of overweight and obese veterans. The objective of our study was to determine whether peer support employing motivational interviewing (MI) could positively influence lifestyle changes, thus expanding the reach of the MOVE! program. We describe the initial evaluation of the peer training program. Methods We developed an MI peer cou...
Lu, Hien; Trancik, Emily; Bailey, F Amos; Ritchie, Christine; Rosenfeld, Kenneth; Shreve, Scott; Furman, Christian; Smith, Dawn; Wolff, Catherine; Casarett, David
The Veterans Affairs (VA) has made significant investments in care for veterans. However, it is not known whether these investments have produced improvements in end-of-life care in the VA compared to other settings. Therefore, the goal of this study was to compare families' perceptions of end-of-life care among patients who died in VA and non-VA facilities. Retrospective 32-item telephone surveys were conducted with family members of patients who died in VA and non-VA facilities. Five Veterans Affairs medical centers and their affiliated nursing homes and outpatient clinics. Patients were eligible if they received any care from a participating VA facility in the last month of life and if they died in an inpatient setting. One family member per patient completed the survey. In bivariate analysis, patients who died in VA facilities (n = 520) had higher mean satisfaction scores compared to those who died in non-VA facilities (n = 89; 59 versus 51; rank sum test p = 0.002). After adjusting for medical center, the overall score was still significantly higher for those dying in the VA (beta = 0.07; confidence interval [CI] = 0.02-0.11; p = 0.004), as was the domain measuring care around the time of death (beta = 0.11; CI = 0.04-0.17; p = 0.001). Families of patients who died in VA facilities rated care as being better than did families of those who died in non-VA facilities. These results provide preliminary evidence that the VA's investment in end-of-life care has contributed to improvements in care in VA facilities compared to non-VA facilities.
Sullivan, Connor P; Elbogen, Eric B
As a diagnosis, posttraumatic stress disorder (PTSD) has been associated with violence committed by veterans in many studies; however, a potential link to specific PTSD symptoms has received relatively less attention. This paper examines the relationship between PTSD symptoms and different types of violent behavior in Iraq and Afghanistan veterans. Participants were randomly sampled from a roster of all separated U.S. military service members or national guard/reservists who served after September 11, 2001. Data were collected at baseline and 1-year follow-up from a national sample of N = 1,090 veterans, from 50 states and all military branches. Of these veterans, 13% reported aggression toward a family member and 9% toward a stranger during the 1-year study period. Anger symptoms at baseline predicted higher odds of family violence at follow-up, both severe (OR = 1.30, CI [1.13, 1.48], p stranger violence at follow-up, both severe (OR = 1.26, CI [1.11, 1.42], p stranger violence, whereas females were more likely to endorse aggression in the family context. The results provide limited support to the hypothesis that PTSD "flashbacks" in veterans are linked to violence. The differing multivariate models illustrate distinct veteran characteristics associated with specific types of violence.
Kasprow, W J; Rosenheck, R; Frisman, L; DiLella, D
This study compared two types of residential programs that treat dually diagnosed homeless veterans. Programs specializing in the treatment of substance abuse disorders (SA) and those programs addressing both psychiatric disorders and substance abuse problems within the same setting (DDX) were compared on (1) program characteristics, (2) clients' perceived environment, and (3) outcomes of treatment. The study was based on surveys and discharge reports from residential treatment facilities that were under contract to the Department of Veterans Affairs Health Care for Homeless Veterans program, a national outreach and case management program operating at 71 sites across the nation. Program characteristics surveys were completed by program administrators, perceived environment surveys were completed by veterans in treatment, and discharge reports were completed by VA case managers. DDX programs were characterized by lower expectations for functioning, more acceptance of problem behavior, and more accommodation for choice and privacy, relative to SA programs after adjusting for baseline differences. Dually diagnosed veterans in DDX programs perceived these programs as less controlling than SA programs, but also as having lower involvement and less practical and personal problem orientations. At discharge, a lower percentage of veterans from DDX than SA programs left without staff consultation. A higher percentage of veterans from DDX than SA programs were discharged to community housing rather than to further institutional treatment. Program effects were not different for psychotic and non-psychotic veterans. Although differences were modest, integration of substance abuse and psychiatric treatment may promote a faster return to community living for dually diagnosed homeless veterans. Such integration did not differentially benefit dually diagnosed veterans whose psychiatric problems included a psychotic disorder.
O'Toole, B I; Burton, M J; Rothwell, A; Outram, S; Dadds, M; Catts, S V
To assess the association between parental post-traumatic stress disorder (PTSD) and offspring PTSD and its specificity for other disorders in a non-clinical epidemiological cohort of Australian Vietnam veterans, their partners and their sons and daughters. Veterans were interviewed twice, in 1992-1994 and 2005-2006; partners were interviewed in 2006-2007, and their offspring in 2012-2014. A total of 125 sons and 168 daughters were interviewed from 197 families, 137 of which also included partners who were the mothers of the children. Statistical analysis used multi-level modelling to compute odds ratios and 95% confidence intervals while controlling for clustering effects within families. Parent PTSD diagnoses were examined for associations with offspring trauma exposure, PTSD and other psychiatric diagnoses. Veteran PTSD increased the risk of PTSD and no other disorder in both sons and daughters; partner PTSD did not. Veteran depression was also a risk factor for sons' PTSD, and alcohol disorder was linked to alcohol dependence in sons and PTSD in daughters, but not when controlling for veteran PTSD. We conclude that PTSD in a Vietnam veteran father increases the risk specifically for PTSD in his sons and daughters. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Michaud, Ed; Jacques, Paul F; Gianola, F J; Harbert, Ken
The purpose of this study was to assess the admission policies, experiences, and attitudes of physician assistant (PA) program directors with regard to recruiting, admitting, and training veteran corpsmen and medics. A descriptive survey consisting of 18 questions was distributed to all 154 PA program directors in the United States. One hundred ten (71.4%) program directors participated in the survey. Veterans were admitted into 83.6% of programs in the years 2008-2010, and accounted for an average of 2.6% of all students. A minority of PA programs accepted college credits earned by veterans for their military training (45.3%) or for their off-duty education (28.4%). Few PA programs participated in the Yellow Ribbon Program (16%) or actively recruited veterans (16%). Over half of PA programs (56.7%) would be more likely to give special consideration to the admission of veteran corpsmen and medics if it was easier to equate their military education and experience to the program's admission prerequisites. The most frequently reported benefits for educating veteran corpsmen and medics in PA programs are their health care and life experiences, maturity, and motivation. Barriers for educating veterans include veterans' lack of academic preparedness for graduate education, a lack of time/access for recruiting, and the cost of PA school. Most PA program directors cited multiple benefits for educating veteran corpsmen and medics, but veterans face barriers for admission into PA programs. Approaches are discussed for facilitating the transition of corpsmen and medics from the military to careers as PAs.
Elnitsky, Christine A; Kilmer, Ryan P
As service members return from active duty and, in some cases, exit the military, they face a process of reintegration (also referred to as community reintegration) as they seek to resume participation in their life roles as civilians. Facilitating this dynamic process of reintegration for service members, veterans, and their families-including outlining potential strategies for supporting this return to civilian life and its demands, roles, and responsibilities-is the focus of this Special Issue. Reintegration has been framed as a national priority (U.S. Department of Veterans Affairs, 2015) and has been a point of emphasis of efforts at federal, state, and local levels. As the articles in this issue suggest, multiple public, private, and voluntary systems and the communities to which service members, veterans, and their families return can help influence their health outcomes and, ultimately, their reintegration. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Rosenheck, R; Leda, C
Demographic and clinical data are presented on 4,138 veterans assessed in the 20-site Department of Veterans Affairs (VA) Domiciliary Care for Homeless Veterans program during its first year of operation. More than two-thirds of the veterans who were screened had been hospitalized in VA medical centers during the year before assessment, and 34 percent were hospitalized at the time of assessment. Compared with veterans who were not admitted for residential treatment, veterans who were admitted were more likely to be previously involved in mental health treatment, literally homeless rather than at risk for homelessness, and without public financial support. Specialized service programs for the homeless such as the VA domiciliary care program may also be called on to play a broader role in the discharge and rehabilitative efforts of public mental health service systems.
Oliva, Elizabeth M; Nevedal, Andrea; Lewis, Eleanor T; McCaa, Matthew D; Cochran, Michael F; Konicki, P Eric; Davis, Corey S; Wilder, Christine
In an effort to prevent opioid overdose mortality among Veterans, Department of Veterans Affairs (VA) facilities began implementing opioid overdose education and naloxone distribution (OEND) in 2013 and a national program began in 2014. VA is the first national health care system to implement OEND. The goal of this study is to examine patient perceptions of OEND training and naloxone kits. Four focus groups were conducted between December 2014 and February 2015 with 21 patients trained in OEND. Participants were recruited from a VA residential facility in California with a substance use disorder treatment program (mandatory OEND training) and a homeless program (optional OEND training). Data were analyzed using matrices and open and closed coding approaches to identify participants' perspectives on OEND training including benefits, concerns, differing opinions, and suggestions for improvement. Veterans thought OEND training was interesting, novel, and empowering, and that naloxone kits will save lives. Some veterans expressed concern about using syringes in the kits. A few patients who never used opioids were not interested in receiving kits. Veterans had differing opinions about legal and liability issues, whether naloxone kits might contribute to relapse, and whether and how to involve family in training. Some veterans expressed uncertainty about the effects of naloxone. Suggested improvements included active learning approaches, enhanced training materials, and increased advertisement. OEND training was generally well received among study participants, including those with no indication for a naloxone kit. Patients described a need for OEND and believed it could save lives. Patient feedback on OEND training benefits, concerns, opinions, and suggestions provides important insights to inform future OEND training programs both within VA and in other health care settings. Training is critical to maximizing the potential for OEND to save lives, and this study
A grassroots movement of nonprofit, nongovernmental organizations is creating programs in which incarcerated individuals train rescued shelter dogs as therapeutic canines for Veterans with posttraumatic stress disorder (PTSD). Driven in part by reports of Veterans not receiving adequate treatment for PTSD, the programs are the latest iteration of prison-based animal programs and are founded on the principles of animal therapy and healing powers of animals. The far-reaching and deleterious collateral consequences of PTSD create social and economic burdens on the country; providing beneficial interventions for Veterans is a pressing social problem. Without oversight, a patchwork of agencies has developed that provides Veterans with dogs with varying levels of training and differing abilities. To best serve the needs of Veterans, the programs need regulation and standardized methods of training. [Journal of Psychosocial Nursing and Mental Health Services, 54(5), 49-57.]. Copyright 2016, SLACK Incorporated.
Nunez, Elizabeth; Gibson, Gretchen; Jones, Judith A; Schinka, John A
...) transitional housing intervention program. Our sample consisted of 9870 veterans who were admitted into a VA homeless intervention program during 2008 and 2009, 4482 of whom received dental care during treatment and 5388 of whom did...
Moriarty, Helene; Winter, Laraine; Robinson, Keith; True, Gala; Piersol, Catherine; Vause-Earland, Tracey; Iacovone, Dolores Blazer; Holbert, Laura; Newhart, Brian; Fishman, Deborah; Short, Thomas H
Community reintegration (CR) poses a major problem for military veterans who have experienced a traumatic brain injury (TBI). Factors contributing to CR after TBI are poorly understood. To address the gap in knowledge, an ecological framework was used to explore individual and family factors related to CR. Baseline data from an intervention study with 83 veterans with primarily mild to moderate TBI were analyzed. Instruments measured CR, depressive symptoms, physical health, quality of the relationship with the family member, and sociodemographics. Posttraumatic stress disorder and TBI characteristics were determined through record review. Five variables that exhibited significant bivariate relationships with CR (veteran rating of quality of relationship, physical functioning, bodily pain, posttraumatic stress disorder diagnosis, and depressive symptoms) were entered into hierarchical regression analysis. In the final analysis, the five variables together accounted for 35% of the variance, but only depression was a significant predictor of CR, with more depressed veterans exhibiting lower CR. Efforts to support CR of Veterans with TBI should carefully assess and target depression, a modifiable factor. © The Author(s) 2015.
Finlay, Andrea K; Stimmel, Matthew; Blue-Howells, Jessica; Rosenthal, Joel; McGuire, Jim; Binswanger, Ingrid; Smelson, David; Harris, Alex H S; Frayne, Susan M; Bowe, Tom; Timko, Christine
The Veterans Health Administration (VA) Health Care for Reentry Veterans (HCRV) program links veterans exiting prison with treatment. Among veterans served by HCRV, national VA clinical data were used to describe contact with VA health care, and mental health and substance use disorder diagnoses and treatment use. Of veterans seen for an HCRV outreach visit, 56 % had contact with VA health care. Prevalence of mental health disorders was 57 %; of whom 77 % entered mental health treatment within a month of diagnosis. Prevalence of substance use disorders was 49 %; of whom 37 % entered substance use disorder treatment within a month of diagnosis. For veterans exiting prison, increasing access to VA health care, especially for rural veterans, and for substance use disorder treatment, are important quality improvement targets.
OIF Operation Iraqi Freedom VA Department of Veterans Affairs VA OIG Department of Veterans Affairs Office of Inspector General VBA Veterans Benefits...reorganization into the three administrations: Veterans Health Administration (VHA), Veterans Benefits Administration ( VBA ) and National Cemetery...features. VBA also implemented a similar program in coordination with DoD called eBenefits which allows Veterans, Service Members and their families to
Seidner, Andrea L.; And Others
Gathered descriptive data on 163 telephone applicants to residential rehabilitation program for homeless veterans and compared data with general veteran and homeless populations. Found subjects to be young, educated group of homeless men with histories of relatively high, stable functioning and high rates of medical, substance abuse, psychiatric,…
Possemato, Kyle; Acosta, Michelle C; Fuentes, Juanita; Lantinga, Larry J; Marsch, Lisa A; Maisto, Stephen A; Grabinski, Michael; Rosenblum, Andrew
Combat veterans from the wars in Iraq and Afghanistan commonly experience posttraumatic stress disorder (PTSD) and substance use problems. In addition, these veterans often report significant barriers to receiving evidence-based mental health and substance use care, such as individual beliefs that treatment will be unhelpful, inconvenient, or that they should be able to handle their problems on their own. To increase access to treatment for this underserved population, a Web-based patient self-management program that teaches cognitive-behavioral therapy (CBT) skills to manage PTSD symptoms and substance misuse was developed. This paper describes and provides results from an iterative, multistage process for developing the Web-based program and seeks to inform clinicians in the field about the preferences of veterans for using a Web-based CBT program. Systematic feedback was gathered from (a) three expert clinicians in the field, (b) focus groups of combat veterans (n = 18), and (c) individual feedback sessions with combat veterans (n = 34). Clinician feedback led to the incorporation of motivational strategies to increase participant engagement and an optional module that guides written trauma exposure work. Focus group feedback guided the research team to frame the program in a strength-based approach and allows for maximum flexibility, adaptability, interactivity, and privacy for veterans. In individual feedback sessions, veterans generally found the program likable, easy to use, and relevant to their experiences; critiques of the program led to revised content meant to increase clarity and participant interest. Our findings provide specific guidance for clinicians who are interested in developing or providing technology-based treatment, including the need to gather feedback from an intervention's target audience when adapting a psychotherapeutic intervention and that the treatment must be highly interactive and private to engage clients.
health care and rehabilitation services for homeless veterans (the Health Care for Homeless Veterans and Domiciliary Care for Homeless Veterans...Health Care for Homeless Veterans ................................................................................... 19 Domiciliary Care for Homeless...for Homeless Veterans (HCHV), Domiciliary Care for Homeless Veterans (DCHV), the Compensated Work Therapy/Therapeutic Residences Program, and the
.../Veterans Benefits Administration (VA/ VBA))--Match Number 1309 AGENCY: Social Security Administration (SSA... announces a renewal of an existing computer matching program that we are currently conducting with VA/VBA... Matching Program, SSA With the Department of Veterans Affairs/Veterans Benefits Administration (VA/VBA) A...
transfer their benefits to dependents. VA – Veterans Benefit Administration ( VBA ) Spinal Cord Injury and Disorders Centers Disability; Physical...who are temporarily residing in a home owned by a family member to help adapt the home to meet his or her special needs. VA - VBA Yellow Ribbon...member and Veteran X X Allowance for Aid and Attendance for Housebound Veterans VA/ VBA Veteran X X X Appendix III
Maddox, Thomas M; Plomondon, Mary E; Petrich, Megan; Tsai, Thomas T; Gethoffer, Hans; Noonan, Gregory; Gillespie, Brian; Box, Tamara; Fihn, Stephen D; Jesse, Robert L; Rumsfeld, John S
A "learning health care system", as outlined in a recent Institute of Medicine report, harnesses real-time clinical data to continuously measure and improve clinical care. However, most current efforts to understand and improve the quality of care rely on retrospective chart abstractions complied long after the provision of clinical care. To align more closely with the goals of a learning health care system, we present the novel design and initial results of the Veterans Affairs (VA) Clinical Assessment, Reporting, and Tracking (CART) program-a national clinical quality program for VA cardiac catheterization laboratories that harnesses real-time clinical data to support clinical care and quality-monitoring efforts. Integrated within the VA electronic health record, the CART program uses a specialized software platform to collect real-time patient and procedural data for all VA patients undergoing coronary procedures in VA catheterization laboratories. The program began in 2005 and currently contains data on 434,967 catheterization laboratory procedures, including 272,097 coronary angiograms and 86,481 percutaneous coronary interventions, performed by 801 clinicians on 246,967 patients. We present the initial data from the CART program and describe 3 quality-monitoring programs that use its unique characteristics-procedural and complications feedback to individual labs, coronary device surveillance, and major adverse event peer review. The VA CART program is a novel approach to electronic health record design that supports clinical care, quality, and safety in VA catheterization laboratories. Its approach holds promise in achieving the goals of a learning health care system. Published by Elsevier Inc.
Rosenheck, R; Gallup, P; Frisman, L K
This study evaluated the impact of a Department of Veterans Affairs outreach and residential treatment program for homeless mentally ill veterans on utilization and cost of health care services provided by the VA. Veterans at nine program sites (N = 1,748) were assessed with a standard intake instrument. Services provided by the outreach program were documented in quarterly clinical reports and in residential treatment discharge summaries. Data on nonprogram VA health service utilization and health care costs were obtained from national VA data bases. Changes in use of services and cost of services from the year before initial contact with the program to the year after were analyzed by t test. Multivariate analyses were used to examine the relationship of these changes to indicators of clinical need and to participation in the outreach program. Although utilization of inpatient service did not increase after veterans' initial contact with the program, use of domiciliary and outpatient services increased substantially. Total annual costs to the VA also increased by 35 percent, from $6,414 to $8,699 per veteran per year. Both clinical need and participation in the program were associated with increased use of health services and increased cost. Veterans with concomitant psychiatric and substance abuse problems used fewer health care services than others. Specialized programs to improve the access of homeless mentally ill persons to health care services appear to be effective, but costly. Dually diagnosed persons seem especially difficult to engage in treatment.
... Grant Applications. The full announcement is posted on www.grants.gov . Funding Opportunity Number: SGA 12-02. DATES: Key Dates: The closing date for receipt of applications is June 15, 2012. Funding... complex employability problems facing eligible veterans; and (c) to increase the skills and competency...
Schinka, John A; Bossarte, Robert M; Curtiss, Glenn; Lapcevic, William A; Casey, Roger J
National Death Index data were examined to describe mortality patterns among older veterans who are homeless. Homelessness and health care records from the U.S. Department of Veterans Affairs were used to identify old (ages 55-59) and older (ages ≥60) veterans who were (N=4,475) or were not (N=20,071) homeless. Survival functions and causes of death of the two samples over an 11-year follow-up period were compared. Substantially more veterans who were homeless (34.9%) died compared with the control sample (18.2%). Veterans who were homeless were approximately 2.5 years younger at time of death compared with the control sample. Older veterans who were homeless had the lowest survival rate (58%). No disease category appeared to be critical in reducing survival time. Suicide was twice as frequent in the homeless (.4%) versus the control (.2%) sample. Older veterans who were homeless experienced excess mortality and increased suicide risk.
Taft, Casey T; Schumm, Jeremiah A; Panuzio, Jullian; Proctor, Susan P
.... When the relative impacts of separate PTSD symptom groupings were examined, those reflecting withdrawal/numbing symptoms and arousal/lack of control symptoms significantly and indirectly accounted for the negative effects of combat exposure on family adjustment.
Gao, Ni; Dolce, Joni; Rio, John; Heitzmann, Carma; Loving, Samantha
This column describes a goal-oriented, time-limited in vivo coaching/training approach for skills building among peer veterans vocational rehabilitation specialists of the Homeless Veteran Supported Employment Program (HVSEP). Planning, implementing, and evaluating the training approach for peer providers was intended, ultimately, to support veterans in their goal of returning to community competitive employment. The description draws from the training experience that aimed to improve the ability of peer providers to increase both rates of employment and wages of the homeless veterans using their services. Training peers using an in vivo training approach provided a unique opportunity for the veterans to improve their job development skills with a focus to support employment outcomes for the service users. Peers who received training also expressed that learning skills through an in vivo training approach was more engaging than typical classroom trainings. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
Allen, Patricia E; Armstrong, Myrna L; Saladiner, Jason E; Hamilton, Mary Jane; Conard, Patricia L
Capitalizing on the almost 2.2 million service members returning from Operation Iraqi Freedom and New Dawn (OIF) in Iraq, and Operation Enduring Freedom (OEF) in Afghanistan, baccalaureate educators are encouraged to create realistic, applicable nursing transitional programs for the health and health-related oriented military veterans. Opportunities, hurdles, and solutions related to the veteran's unique socio-economic circumstances of education, finances, and advisement are provided so the potential veteran student is successful within the university's milieu. Transitional nursing educational interventions related to assessment, didactic, and clinical used by two baccalaureate nursing curriculums, including the eLineMilitary* (ELM) Program, provide approaches of how to propel the veteran's journey toward graduation in a professional nursing program. These interventions include modular didactic, competency based education, as well as the concentrated, collegial time within the Faculty/Clinical Coach triad for essential role modeling, care, and skills. Copyright © 2014 Elsevier Inc. All rights reserved.
Usdansky, Margaret L.; London, Andrew S.; Wilmoth, Janet M.
We used data from the Fragile Families and Child Wellbeing Study (N = 2,679 ) to examine the impact of men's past military service on the likelihood that a couple will marry within 5 years of a nonmarital birth. Logistic regression analyses showed that men's past military service increased marriage odds by 54% for couples with Black fathers even…
Liaison 64 Becoming a Family Caregiver for a Service Member/Veteran with TBI PROFESSIONAL - NAME CONTACT INFORMATION Orthopedic Specialist Physical...leave Turn off appliances when you finish using them Take out the garbage (attention, memory problems) 7. Is your front door house key color
Tejani, N; Rosenheck, R; Tsai, J; Kasprow, W; McGuire, J F
There is increasing concern that adults with a past history of incarceration are at particular disadvantage in exiting homelessness. Supported housing with case management has emerged as the leading service model for assisting homeless adults; however there has been limited examination of the success of adults with past history of incarceration in obtaining housing within this paradigm. Data were examined on 14,557 veterans who entered a national supported housing program for homeless veterans, the Housing and Urban Development-Veterans Affairs Supportive Housing program (HUD-VASH) during 2008 and 2009, to identify characteristics associated with a history of incarceration and to evaluate whether those with a history of incarceration are less likely to obtain housing and/or more likely to experience delays in the housing attainment process. Veterans who reported no past incarceration were compared with veterans with short incarceration histories (≤ 1 year) and those with long incarceration histories (>1 year). A majority of participants reported history of incarceration; 43 % reported short incarceration histories and 22 % reported long incarceration histories. After adjusting for baseline characteristics and site, history of incarceration did not appear to impede therapeutic alliance, progression through the housing process or obtaining housing. Within a national supported housing program, veterans with a history of incarceration were just as successful at obtaining housing in similar time frames when compared to veterans without any past incarceration. Supported housing programs, like HUD-VASH, appear to be able to overcome impediments faced by formerly incarcerated homeless veterans and therefore should be considered a a good model for housing assistance programs.
Nunez, Elizabeth; Gibson, Gretchen; Jones, Judith A; Schinka, John A
In this retrospective longitudinal cohort study, we examined the impact of dental care on outcomes among homeless veterans discharged from a Department of Veterans Affairs (VA) transitional housing intervention program. Our sample consisted of 9870 veterans who were admitted into a VA homeless intervention program during 2008 and 2009, 4482 of whom received dental care during treatment and 5388 of whom did not. Primary outcomes of interest were program completion, employment or stable financial status on discharge, and transition to permanent housing. We calculated descriptive statistics and compared the 2 study groups with respect to demographic characteristics, medical and psychiatric history (including alcohol and substance use), work and financial support, and treatment outcomes. Veterans who received dental care were 30% more likely than those who did not to complete the program, 14% more likely to be employed or financially stable, and 15% more likely to have obtained residential housing. Provision of dental care has a substantial positive impact on outcomes among homeless veterans participating in housing intervention programs. This suggests that homeless programs need to weigh the benefits and cost of dental care in program planning and implementation.
Kasarda, Mary; McCrery, Ennis; DePauw, Karen P.; Byrd, Carson; Mikel-Stites, Max; Ray, Victor; Pierson, Mark; Brown, Eugene; Hall, Simin; Soldan, David L.; Gruenbacher, Don; Schulz, Noel; Vogt, Blythe; Hageman, William B.; Natarajan, Rekha
This paper describes some sample best practices identified by three institutions, Virginia Tech, Kansas State University, and the University of San Diego to support the recruitment, transition, and retention of veterans in engineering degree programs. These three institutions represent a subset of the initial cadre of institutions receiving planning grants from the National Science Foundation to facilitate and support veterans in their pursuit of undergraduate and graduate engineering degrees...
Allicock, Marlyn; Haynes-Maslow, Lindsey; Carr, Carol; Orr, Melinda; Kahwati, Leila C; Weiner, Bryan J; Kinsinger, Linda
The Veterans Health Administration (VHA) has implemented MOVE!, a weight-management program for veterans designed to address the increasing proportion of overweight and obese veterans. The objective of our study was to determine whether peer support employing motivational interviewing (MI) could positively influence lifestyle changes, thus expanding the reach of the MOVE! program. We describe the initial evaluation of the peer training program. We developed an MI peer ounselor training program for volunteer veterans, the "Buddies" program, to provide one-on-one telephone support for veterans enrolled in MOVE!. Buddies were recruited at 5 VHA sites and trained to provide peer support for the 6-month MOVE! intervention. We used a DVD to teach MI skills and followed with 2 to 3 booster sessions. We observed training, conducted pre- and posttraining surveys, and debriefed focus groups to assess training feasibility. Fifty-six Buddies were trained. Results indicate positive receipt of the program (89% reported learning about peer counseling and 87% reported learning communication skills). Buddies showed a small improvement in MI self-efficacy on posttraining surveys. We also identified key challenges to learning MI and training implementation. MI training is feasible to implement and acceptable to volunteer Buddies. Trainers must assess how effectively volunteers learn MI skills in order to enhance its effective use in health promotion.
Pugh, Mary Jo; Swan, Alicia A; Carlson, Kathleen F; Jaramillo, Carlos A; Eapen, Blessen C; Dillahunt-Aspillaga, Christina; Amuan, Megan E; Delgado, Roxana E; McConnell, Kimberly; Finley, Erin P; Grafman, Jordan H
To examine the association between traumatic brain injury (TBI) severity; social, family, and community reintegration outcomes; and return to work status among post-9/11 veterans in Department of Veterans Affairs (VA) care. Retrospective observational cohort study. Mail/online survey fielded to a national sample of veterans. Sample of post-9/11 veterans with at least 3 years of VA care stratified according to TBI severity and comorbidities who completed and returned surveys (N=2023). Not applicable. Deployment Risk and Resilience Inventory-2 family functioning and social support subscales; Military to Civilian Questionnaire; and employment status. Bivariate analyses revealed that veterans with every classification of TBI severity reported significantly more difficulty on social, family, and community reintegration outcomes than those with no TBI. In the fully adjusted model, veterans with unclassified and moderate/severe TBI reported significantly more difficulty with community reintegration and were less likely to be employed relative to those with no TBI; those with unclassified TBI also reported significantly more difficulty with family functioning. Veterans with mild TBI also reported significantly more difficulty with community reintegration. This study provides insight into long-term outcomes associated with TBI in post-9/11 veterans and suggests that exposure to TBI has a negative effect on social and family functioning, community reintegration, and return to work even after controlling for comorbidity, deployment experiences, and sociodemographic characteristics. Additional research is required to explicate what appears to be complex interactions among TBI severity, psychosocial well-being, combat exposures, and socioeconomic resources in this population. Published by Elsevier Inc.
... accepted ``disease model'' of alcoholism and drug addiction treatment, as well as the modern use of medical... information technology, e.g., permitting electronic submission of responses. The proposed amendments to title... contributes to a veteran's homelessness. Substance use disorder means alcoholism or addiction to a drug that...
... programs; securing learning aids such as textbooks, computers and laboratory supplies; and obtaining... assistive technology. (3) Providing assistance to families of transitioning veterans. Examples include, but...
... homeless and at-risk Veterans and their families; and provide a supportive services program. FOR FURTHER INFORMATION CONTACT: Edward Bradley, Office of Asset Enterprise Management (044), Department of Veterans...
Mattocks, Kristin M; Kuzdeba, Judy; Baldor, Rebecca; Casares, Jose; Lombardini, Lisa; Gerber, Megan R
The purpose of this study was to develop and evaluate a comprehensive, telephonic maternity care coordination (MCC) program for all pregnant veterans enrolled for care at New England Department of Veterans Affairs (VA) facilities that comprise the Veterans Integrated Service Network 1. Telephone interviews were conducted with postpartum women veterans who had participated in the MCC program during their pregnancies. The program evaluation instrument assessed satisfaction and use of MCC services, prenatal education classes, and infant and maternal outcomes (e.g., newborn birthweight, insurance status, maternal depression) using both closed-ended and open-ended questions. A substantial majority (95%) of women enrolled in the MCC program expressed satisfaction with the services they received in the program. Women were most satisfied with help understanding VA maternity benefits and acquiring VA services and equipment, such as breast pumps and pregnancy-related medications. More than one-third of women noted their infants had experienced health problems since delivery, including neonatal intensive care unit hospitalizations. A majority of women planned to return to VA care in the future. Our findings suggest that MCC services play an important role for women veterans as they navigate both VA and non-VA care systems. MCC staff members coordinated maternity, medical, and mental health care services for women veterans. Additionally, by maintaining contact with the veteran during the postpartum period, MCC staff were able to assess the health of the mother and the infant, and refer women and their infants to medical and psychosocial services in the community as needed. Published by Elsevier Inc.
8 VBA Budget ................................................................................................................ 8... VBA Leadership and Personnel .................................................................................. 9 Employee Promotion within VBA ...14 VBA Goals and Key Programs
Finlay, Esme; Shreve, Scott; Casarett, David
The Veterans Affairs (VA) health care system has created a national initiative to measure quality of care at the end of life. This article describes the first phase of this national initiative, the Family Assessment of Treatment at End of Life (FATE), in evaluating the quality of end-of-life care for veterans dying with cancer. In the initial phase, next of kin of patients from five VA Medical Centers were contacted 6 weeks after patients' deaths and invited to participate in a telephone interview, and surrogates for 262 cancer patients completed FATE interviews. Decedents were 98% male with an average age of 72 years. There was substantial variation among sites. Higher FATE scores, consistent with family reports of higher satisfaction with care, were associated with palliative care consultation and hospice referral and having a Do Not Resuscitate order at the time of death, whereas an intensive care unit death was associated with lower scores. Early experience with FATE suggests that it will be a helpful tool to characterize end-of-life cancer care and to identify targets for quality improvement.
Orff, Henry J; Hays, Chelsea C; Twamley, Elizabeth W
Approximately 20% of current-era Veterans have sustained a traumatic brain injury (TBI), which can result in persistent postconcussive symptoms. These symptoms may disrupt family and social functioning. We explored psychiatric, postconcussive, and cognitive factors as correlates of objective functioning and subjective satisfaction in family and social relationships. At entry into a supported employment study, 50 unemployed Veterans with a history of mild to moderate TBI and current cognitive impairment were administered baseline assessments. Multivariate stepwise regressions determined that higher levels of depressive symptomatology were strongly associated with less frequent social contact, as well as lower subjective satisfaction with family and social relationships. Worse verbal fluency predicted less frequent social contact, whereas worse processing speed and switching predicted higher levels of subjective satisfaction with family relationships. The pattern of results remained similar when examining those Veterans with only mild TBI. Depressive symptoms and cognitive functioning may impact Veterans' social contact and satisfaction with family and social relationships. Evidence-based interventions addressing depression and cognition may therefore aid in improving community reintegration and satisfaction with social and family relationships.
Sarajlic Vukovic, Iris; Boricevic Maršanic, Vlatka; Aukst Margetic, Branka; Paradžik, Ljubica; Vidovic, Domagoj; Buljan Flander, Gordana
Background: Posttraumatic stress disorder (PTSD) in male veterans has been linked with impaired family relationships and psychopathology in their children. Less is known about symptoms in children of veterans with partial PTSD. Objective: To compare mental health problems, family functioning and parent-child bonding among adolescent offspring of…
... required report must include the total number of eligible veterans who participated, the associates degrees... unemployability; was not and is not enrolled in any Federal or State job training program within the previous 180... appropriate American Job Center (AJC) staff in the participant's local area enabling the AJC to offer...
Desai, Rani A; Harpaz-Rotem, Ilan; Najavits, Lisa M; Rosenheck, Robert A
Seeking Safety is a manualized cognitive-behavioral therapy intervention that is designed to treat clients with comorbid substance abuse and trauma histories. This study examined its effectiveness when used with homeless women veterans with psychiatric or substance abuse problems at 11 Department of Veterans Affairs medical centers that had Homeless Women Veterans Programs. The intervention consists of 25 sessions that cover topics to help build safety in clients' lives and is present-focused, offering psychoeducation and coping skills. A cohort of homeless women veterans (N=359) was recruited before Seeking Safety was implemented (phase I). After clinicians were trained and certified in Seeking Safety, a postimplementation cohort was recruited and offered Seeking Safety treatment (phase II, N=91). Phase I lasted from January 2000 to June 2003. Phase II lasted from June 2003 to December 2005. The intervention lasted for six months. All participants were interviewed every three months for one year and received intensive case management and other services during the study. Mixed models were used to compare one-year clinical outcomes across phases. There were few differences across groups at baseline. All women entering the Homeless Women Veterans Programs showed significant improvement on most clinical outcome measures over one year. The Seeking Safety cohort reported significantly better outcomes over one year in employment, social support, general symptoms of psychiatric distress, and symptoms of posttraumatic stress disorder, particularly in the avoidance and arousal clusters. However, the Seeking Safety cohort was significantly more likely to have used drugs in the past 30 days. Seeking Safety appears to have had a moderately beneficial impact on several clinical outcomes. Although the nonequivalent comparison groups and low follow-up rates limit the internal validity of these results, availability of Seeking Safety may be of benefit for homeless female veterans
patient facilities. e6 Points of Contact for the Exceptional Family Member Program ’ American Cleft Palate National Association for Foundation Alzheimer’s 1...area, D 0 Contact the Easter Seal Society regarding the Early Intervention Program for infants with special needs. 3 0 "!i I . . Other’Resources...800-24- CLEFT - (412) 481-1370 1-800-272-3900 -- (312) 335-8700 American Liver Foundation National Cancer Institute 1-800-223-0171) - (201) 256-2550 1
Persistence as it pertained to traditional college students had been widely researched, but little was known about persistence and the role of resilience and engagement for veteran students experiencing post-traumatic stress disorder while enrolled in online degree programs. The focus of the study was to understand the lived experiences of veteran…
Karuza, Jurgis; Gillespie, Suzanne M; Olsan, Tobie; Cai, Xeuya; Dang, Stuti; Intrator, Orna; Li, Jiejin; Gao, Shan; Kinosian, Bruce; Edes, Thomas
To describe the current structural and practice characteristics of the Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) program. We designed a national survey and surveyed HBPC program directors on-line using REDCap. We received 236 surveys from 394 identified HBPC sites (60% response rate). HBPC site characteristics were quantified using closed-ended formats. HBPC program directors were most often registered nurses, and HBPC programs primarily served veterans with complex chronic illnesses that were at high risk of hospitalization and nursing home care. Primary care was delivered using interdisciplinary teams, with nurses, social workers, and registered dietitians as team members in more than 90% of the sites. Most often, nurse practitioners were the principal primary care providers (PCPs), typically working with nurse case managers. Nearly 60% of the sites reported dual PCPs involving VA and community-based physicians. Nearly all sites provided access to a core set of comprehensive services and programs (e.g., case management, supportive home health care). At the same time, there were variations according to site (e.g., size, location (urban, rural), use of non-VA hospitals, primary care models used). HBPC sites reflected the rationale and mission of HBPC by focusing on complex chronic illness of home-based veterans and providing comprehensive primary care using interdisciplinary teams. Our next series of studies will examine how HBPC site structural characteristics and care models are related to the processes and outcomes of care to determine whether there are best practice standards that define an optimal HBPC structure and care model or whether multiple approaches to HBPC better serve the needs of veterans. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.
Schinka, John A; Casey, Roger J; Kasprow, Wesley; Rosenheck, Robert A
An important distinction in models of housing for the homeless is whether programs that require abstinence prior to program admission produce better outcomes than unrestricted programs. Data from a large transitional housing program were used to compare client characteristics of and outcomes from programs requiring abstinence at admission and programs not requiring abstinence. The U.S. Department of Veterans Affairs (VA) Northeast Program Evaluation Center provided records of individuals who were admitted into, and discharged from, the VA Grant and Per Diem program in 2003-2005. Records contained information from intake interviews, program discharge information, and descriptions of provider characteristics. Analyses were based on 3,188 veteran records, 1,250 from programs requiring sobriety at admission and 1,938 from programs without a sobriety requirement. Group differences were examined with t tests and chi square analyses; predictors of program outcome were determined with logistic regression. Individuals using drugs or alcohol at program admission had more problematic histories, as indicated by several general health and mental health variables, and shorter program stays. There were significant differences between groups in the frequency of program completion, recidivism for homelessness, and employment on program discharge, but effect sizes for these analyses were uniformly small and of questionable importance. Regression analyses did not find meaningful support for the importance of sobriety on program entry on any of the outcome measures. The results add evidence to the small body of literature supporting the position that sobriety on program entry is not a critical variable in determining outcomes for individuals in transitional housing programs.
Tsai, Jack; Kasprow, Wesley J; Rosenheck, Robert A
...) homeless service programs. We examined data from the VA's new Homeless Operations Management and Evaluation System on 120,852 veterans from 142 sites nationally in 2011 and 2012 using latent class analyses based on 9 homeless risk factors...
Scott, George A.
With the passage of the Post-9/11 Veterans Educational Assistance Act of 2008 (Post- 9/11 GI Bill), Congress created a comprehensive education benefit program for veterans, service members, and their dependents pursuing postsecondary education. Since implementation, the Department of Veterans Affairs (VA) has provided just over $5.7 billion for…
Luke OShea; Ed Watkins; Paul Farrand
Background Evidence highlights a high prevalence of common mental health disorders in armed forces veterans and their families, with depression, anxiety, alcohol misuse and anger being more common than PTSD...
Kukla, Marina; McGuire, Alan B; Salyers, Michelle P
The purpose of this mixed-methods study was to compare urban and rural supported employment programs on barriers and facilitators with employment for veterans experiencing mental illnesses. A national sample of 114 supported employment staff, supervisors, and upper level managers employed by the Veteran's Health Administration were recruited. Participants completed an online survey of work barriers and facilitators, including open-ended questions regarding additional factors that impact the work success of veterans. Survey responses were compared between participants from rural (n = 28) and urban (n = 86) programs using independent groups t tests. Open-ended questions were analyzed using content analysis. Supported employment personnel from rural programs perceived significantly more barriers to work success compared with urban personnel, particularly in the areas of access to services and a range of job-related factors, including job match and interpersonal relationships at the work site. In contrast, participants from urban programs reported greater facilitators in the domain of mental health services. Qualitative findings add depth to the quantitative findings and highlight challenges in rural supported employment programs impacting job development and job fit. Both urban and rural programs experienced unique barriers related to geography and transportation. Findings from this nationwide mixed-methods survey provide a comprehensive picture of the obstacles to employment success for veterans living with mental illnesses and receiving supported employment services in rural areas. Suggestions for changes in policy related to services and resource allocation are presented to address these unique barriers, particularly in rural areas. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
.... The Department of Veterans Affairs (VA) estimates that it has served approximately 300 returning veterans in its homeless programs and has identified over 1,000 more as being at risk of homelessness...
psychiatric disorders, including anxiety and depression, are associated with high attrition. Very little research has been conducted to determine the...condition or disease); severe asthma; diabetes; arthritis-related conditions (including arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia ...treatment prior to exiting the program. A mental health problem may include serious depression, serious anxiety , hallucinations, violent behavior or
O?Shea, Luke; WATKINS, Ed; Farrand, Paul
Background Evidence highlights a high prevalence of common mental health disorders in armed forces veterans and their families, with depression, anxiety, alcohol misuse and anger being more common than PTSD. This paper presents a protocol for a systematic review and meta-analysis to identify existing randomised controlled trial (RCT) research testing the effectiveness of psychological interventions for these difficulties in armed forces veterans and their family members. Methods Electronic da...
Ferdinand, Lisa G; Kelly, Ursula A; Skelton, Kelly; Stephens, Kisha J; Bradley, Bekh
Military sexual trauma (MST) increases the risk for Posttraumatic Stress Disorder (PTSD) and multiple other comorbidities, presenting substantial challenges for nurses and psychiatric and medical clinicians. A specialized VA Medical Center outpatient program is patterned after Herman's three-phased, empirically-supported, recovery treatments. We use a case example of a female veteran MST survivor to illustrate our treatment model. She presented to our program meeting diagnostic criteria for PTSD, Major Depressive Disorder, and a history of substance abuse. Post-treatment she demonstrated improved scores on measures of PTSD, quality of life, and socialization. This model shows promise for treatment of MST survivors with PTSD.
Beardslee, William R; Klosinski, Lee E; Saltzman, William; Mogil, Catherine; Pangelinan, Susan; McKnight, Carl P; Lester, Patricia
In response to the needs of military families confronting the challenges of prolonged war, we developed Families OverComing Under Stress (FOCUS), a multi-session intervention for families facing multiple deployments and combat stress injuries adapted from existing evidence-based family prevention interventions (Lester et al. in Mil Med 176(1): 19-25, 2011). In an implementation of this intervention contracted by the US Navy Bureau of Medicine and Surgery (BUMED), FOCUS teams were deployed to military bases in the United States and the Pacific Rim to deliver a suite of family-centered preventive services based on the FOCUS model (Beardslee et al. in Prev Sci 12(4): 339-348, 2011). Given the number of families affected by wartime service and the changing circumstances they faced in active duty and veteran settings, it rapidly became evident that adaptations of this approach for families in other contexts were needed. We identified the core elements of FOCUS that are essential across all adaptations: (1) Family Psychological Health Check-in; (2) family-specific psychoeducation; (3) family narrative timeline; and (4) family-level resilience skills (e.g., problem solving). In this report, we describe the iterative process of adapting the intervention for different groups of families: wounded, ill, and injured warriors, families with young children, couples, and parents. We also describe the process of adopting this intervention for use in different ecological contexts to serve National Guard, Reserve and veterans, and utilization of technology-enhanced platforms to reach geographically dispersed families. We highlight the lessons learned when faced with the need to rapidly deploy interventions, adapt them to the changing, growing needs of families under real-world circumstances, and conduct rigorous evaluation procedures when long-term, randomized trial designs are not feasible to meet an emergent public health need.
This final rule amends Department of Veterans Affairs (VA) regulations to establish a new program to provide grants to eligible entities to provide adaptive sports activities to disabled veterans and disabled members of the Armed Forces. This rulemaking is necessary to implement a change in the law that authorizes VA to make grants to entities other than the United States Olympic Committee for adaptive sports programs. It establishes procedures for evaluating grant applications under this grant program, and otherwise administering the grant program. This rule implements section 5 of the VA Expiring Authorities Extension Act of 2013.
This interim final rule amends Department of Veterans Affairs (VA) regulations to establish a new program to provide grants to eligible entities to provide adaptive sports activities to disabled veterans and disabled members of the Armed Forces. This rulemaking is necessary to implement a change in the law that authorizes VA to make grants to entities other than the United States Olympic Committee for adaptive sports programs. It establishes procedures for evaluating grant applications under this grant program, and otherwise administering the grant program. This rule implements section 5 of the VA Expiring Authorities Extension Act of 2013.
Prabucki, K; Wootton, E; McCormick, R; Washam, T
This study sought to evaluate the effects of a residential rehabilitation program for homeless mentally ill veterans on several measures of subjects' community adjustment. Subjects' housing status, financial and vocational status, psychological stability, utilization of coping resources, and extent of social contacts were measured at entry into the program and at follow-up six months after discharge. Data were available for 58 subjects at follow-up. Outcomes for subjects who successfully completed the program were compared with outcomes for those who did not. As a group, subjects assessed at follow-up showed significant improvement in housing, financial, and vocational status, in severity of several symptoms of psychological and emotional distress, in utilization of some types of coping resources, and in measures of social contacts and satisfaction. However, subjects who completed the program were more likely to have improved their housing, financial, and vocational situations. Comprehensive residential rehabilitation programs can help homeless veterans improve several aspects of their lives and maintain stability in those areas after discharge.
Tsai, Jack; Kasprow, Wesley J; Rosenheck, Robert A
We identified risk and need profiles of homeless veterans and examined the relation between profiles and referrals and admissions to Department of Veterans Affairs (VA) homeless service programs. We examined data from the VA's new Homeless Operations Management and Evaluation System on 120,852 veterans from 142 sites nationally in 2011 and 2012 using latent class analyses based on 9 homeless risk factors. The final 4-class solution compared both referral and admission to VA homeless services. We identified 4 latent classes: relatively few problems, dual diagnosis, poverty-substance abuse-incarceration, and disabling medical problems. Homeless veterans in the first group were more likely to be admitted to the VA's permanent supportive housing program, whereas those in the second group were more likely to be admitted to more restrictive VA residential treatment. Homeless veterans in the third group were more likely to be admitted to the VA's prisoner re-entry program, and those in the fourth group were more likely to be directed to VA medical services. The heterogeneous risk and need profiles of homeless veterans supported the diversity of VA homeless services and encouraged the development of specialized services to meet their diverse needs.
Bormann, Jill E; Hurst, Samantha; Kelly, Ann
This study describes ways in which a Mantram Repetition Program (MRP) was used for managing posttraumatic stress disorder (PTSD) symptoms in 65 outpatient Veterans with PTSD. The MRP consisted of six weekly group sessions (90 min/wk) on how to (1) choose and use a mantram, (2) slow down thoughts and behaviors, and (3) develop one-pointed attention for emotional self-regulation. Critical incident research technique interviews were conducted at 3 mo postintervention as part of a larger randomized clinical trial. The setting was an academic-affiliated Department of Veterans Affairs hospital in southern California. Categorization and comparison of the types and frequency of incidents (i.e., triggering events) were collected. Participants reported a total of 268 triggering events. Content analysis of the outcomes resulted in 12 discreet categories, including relaxing and calming down, letting go of negative feelings, thinking clearly and rationally, diverting attention away from triggering events, focusing attention, refining mantram skills, dealing with sleep disturbances, coming back from flashbacks, slowing down, communicating thoughts and feelings more effectively, feeling in touch spiritually, and letting go of physical pain. The study shows that the MRP was helpful in managing a wide range of emotional reactions in Veterans with PTSD.
Carbo, James F; Ruh, Christine A; Kurtzhalts, Kari E; Ott, Michael C; Sellick, John A; Mergenhagen, Kari A
The influence of antimicrobial stewardship programs (ASPs) on outcomes in male veterans treated for complicated urinary tract infection has not been determined. This was a retrospective cohort study encompassing the study period January 1, 2005-October 31, 2014, which was conducted at a 150-bed Veterans Affairs Healthcare System facility in Buffalo, NY. Male veterans admitted for treatment of complicated urinary tract infection were identified using ICD-9-CM codes. Outcomes before and after implementation of a patient-centered ASP, including duration of antibiotic therapy, length of hospitalization, readmission within 30 days, and Clostridium difficile infection were compared. Interventions resulting from the ASP were categorized. Of the 1,268 patients screened, 241 met criteria for inclusion in the study (n = 118 and n = 123 in the pre-ASP and ASP group, respectively). Duration of antibiotic therapy was significantly shorter in the ASP group (10.32 days vs 11.96 days; P complicated urinary tract infection. Implementation of an ASP was associated with significant decreases in duration of antibiotic therapy and length of hospitalization, without adversely affecting 30-day readmission rates. Published by Elsevier Inc.
Alici, Yesne; Smith, Dawn; Lu, Hien L; Bailey, Amos; Shreve, Scott; Rosenfeld, Kenneth; Ritchie, Christine; Casarett, David J
To define the frequency of post-traumatic stress disorder (PTSD)-related symptoms among veterans who are near the end of life and to describe the impact that these symptoms have on patients and their families. Patients had received inpatient or outpatient care from a participating VA facility in the last month of life, and one family member per patient was selected using predefined eligibility criteria. Family members then completed a telephone survey, The Family Assessment of Treatment at End-of-Life, which assessed their perceptions of the quality of the care that the patients and they themselves received during the patients' last month of life. Seventeen percent of patients (89 of 524) were reported to have had PTSD-related symptoms in the last month of life. PTSD-related symptoms caused discomfort less often than pain did (mean frequency score 1.79 vs. 1.93; Wilcoxon sign rank test, P<0.001) but more often than dyspnea did (mean severity score 1.79 vs. 1.73; Wilcoxon sign rank test, P<0.001). Family members of patients with PTSD-related symptoms reported less satisfaction overall with the care the patient received (mean score 48 vs. 62; rank sum test, P<0.001). Patients who received a palliative care consult (n=49) had lower ratings of discomfort attributed to PTSD-related symptoms (mean 1.55 vs. 2.07; rank sum test, P=0.007). PTSD-related symptoms may be common and severe among veterans near the end of life and may have a negative effect on families' perceptions of the quality of care that the veteran received. (c) 2010 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
McGuire, James; Rosenheck, Robert A; Kasprow, Wesley J
The U.S. Department of Veterans Affairs provides transitional residential treatment to homeless veterans through three types of programs: VA-staffed Domiciliary care, and two types of community-based treatment (one funded through locally managed contracts and the other through national grants). This study compared treatment process and outcomes in these three programs and also sought to identify differences in outcome between dually diagnosed veterans, veterans with substance abuse problems or psychiatric problems alone, and those with no psychiatric diagnoses. Altogether, 1,338 veterans admitted to the 3 types of program were recruited to participate in a prospective naturalistic study which evaluated housing, clinical and community adjustment outcomes during the year following discharge. Data on 1,003 veterans for whom psychiatric diagnostic, social climate and length of stay data were available were used to compare participants in the three program types at baseline. Regression models were used to compare outcomes across program and diagnostic types net of baseline differences between study participants, and of differences in social climate and length of stay. The overall follow-up rate across all time points was 72%. Significant differences across programs were observed on only 2 baseline measures as well as on several baseline values of the outcome measures, length of stay and a measure of social climate. Adjusting for veteran baseline differences alone there were no differences in outcomes by program after correction for multiple comparisons. Dually diagnosed veterans had poorer mental health and overall quality of life outcomes. Longer length of stay and more positive social climate were associated with superior outcomes on several measures. The adjusted mean estimate of the proportion of veterans housed at 12 months follow-up was 78%, similar to published outcomes for supported housing. Length of stay, rather than program funding configuration or
such as amnestic Mild Cognitive Impairment (aMCI). Persons with aMCI have a significantly greater risk of developing dementia than persons without...not have an available informant to document cognitive impairment and functional status E13 Did not have sufficient visual and auditory acuity to allow...AWARD NUMBER: W81XWH-12-1-0584 TITLE: A Combined Training Program for Veterans with Amnestic Mild Cognitive Impairment PRINCIPAL INVESTIGATOR
Christofferson, Dana E.; Hertzberg, Jeffrey S.; Beckham, Jean C.; Dennis, Paul A.; Hamlett-Berry, Kim
BACKGROUND SmokefreeVET is a text messaging smoking cessation program available to veterans enrolled in the Veterans Health Administration. SmokefreeVET was developed in collaboration with the National Cancer Institute as part of the SmokefreeTXT initiative. PURPOSE To evaluate the real world use of and effectiveness of the SmokefreeVET program for SmokefreeVET users who enrolled between 2013 and 2014. METHODS Demographics and smoking behavior of 1,470 SmokefreeVET users who enrolled between 2013 and 2014 were analyzed. Latent growth mixture modeling was used to identify discrete classes of SmokefreeVET users based on engagement patterns. Multi-level modeling determined class differences in abstinence. RESULTS The average age of the SmokefreeVET user was 48, 75% of users were male, and 84% were daily smokers. After five weeks, 13% of all users reported abstinence from smoking. Five statistically distinct engagement classes of SmokefreeVET users were identified. Highly engaged classes were significantly less likely to opt-out and more likely to report abstinence. Over 60% of users who were classified as high engagers throughout the program reported abstinence 5 weeks after their quit date. Users were more likely to report abstinence after two weeks if they used smoking cessation medication than those that did not use medication (OR=9.01, ptext messaging smoking cessation intervention. PMID:27318948
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Sarmiento, Kathleen; Rossettie, John; Stepnowsky, Carl; Atwood, Charles; Calvitti, Alan
The Veterans Health Administration (VHA) represents one of the largest integrated health-care systems in the country. In 2012, the Veterans Affairs Sleep Network (VASN) sought to identify available sleep resources at VA medical centers (VAMCs) across the country through a national sleep inventory. The sleep inventory was administered at the annual 2012 VA Sleep Practitioners meeting and by email to sleep contacts at each VAMC. National prosthetics contacts were used to identify personnel at VAMCs without established sleep programs. Follow-up emails and telephone calls were made through March 2013. One hundred eleven VA medical centers were included for analysis. Thirty-nine programs did not respond, and 10 were considered "satellites," referring all sleep services to a larger neighboring VAMC. Sleep programs were stratified based on extent of services offered (i.e., in-lab and home testing, sleep specialty clinics, cognitive behavioral therapy for insomnia (CBT-i)): 28 % were complex sleep programs (CSPs), 46 % were intermediate (ISPs), 9 % were standard (SSPs), and 17 % offered no formal sleep services. Overall, 138,175 clinic visits and 90,904 sleep testing encounters were provided in fiscal year 2011 by 112.1 physicians and clinical psychologists, 100.4 sleep technologists, and 115.3 respiratory therapists. More than half of all programs had home testing and CBT-i programs, and 26 % utilized sleep telehealth. The 2012 VA sleep inventory suggests considerable variability in sleep services within the VA. Demand for sleep services is high, with programs using home testing, sleep telehealth, and a growing number of mid-level providers to improve access to care.
... program for certain children of Vietnam veterans-spina bifida and covered birth defects. 21.8012 Section...-Spina Bifida and Covered Birth Defects General § 21.8012 Vocational training program for certain children of Vietnam veterans—spina bifida and covered birth defects. VA will provide an evaluation to an...
Department of Veterans Affairs — The 2010 National Survey of Veterans (NSV) is the sixth in a series of comprehensive nationwide surveys designed to help the Department of Veterans Affairs (VA) plan...
Vogt, Dawne; Smith, Brian N; Fox, Annie B; Amoroso, Timothy; Taverna, Emily; Schnurr, Paula P
Although it is well established that combat-related PTSD can lead to reduced quality of life, less is known about the relative effect of PTSD on different aspects of former service members' post-military readjustment. Moreover, research on female veterans' reintegration experiences is limited. This study aimed to document the work and family quality of life of post-9/11 male and female veterans and evaluate the gender-specific impact of PTSD on veterans' work and family outcomes. A national sample of 524 post-9/11 veterans completed mailed surveys as part of a longitudinal study. Descriptive and regression-based analyses were gender-stratified and weighted to enhance representativeness to the larger population. With a few notable exceptions, the majority of post-9/11 U.S. veterans reported high work and family quality of life. PTSD was not associated with either employment or relationship status; however, it did predict poorer work and family functioning and satisfaction for both men and women, with the most consistent negative effects on intimate relationships. Several gender differences were found, primarily with respect to work experiences. Although most post-9/11 veterans appear to be doing well in both their work and family lives, results support the need for interventions that can mitigate the negative effect of PTSD and other associated mental health conditions on several aspects of work and family quality of life. Findings contribute to research suggesting both similarities and differences in the post-military readjustment of male and female post-9/11 veterans and underscore the need for additional consideration of the unique work-related challenges women experience following military service.
Masi, Antonio; Amodeo, Salvatore; Hatzaras, Ioannis; Pinna, Antonio; Rosman, Alan S; Cohen, Steven; Saunders, John K; Berman, Russell; Newman, Elliot; Ballantyne, Garth H; Pachter, Leon H; Melis, Marcovalerio
We investigated whether the surgical Apgar score (SAS) may enhance the Veterans Affairs Surgical Quality Improvement Program (VASQIP) risk assessment for prediction of early postoperative outcomes. We retrospectively evaluated demographics, medical history, procedure, SAS, VASQIP assessment, and postoperative data for patients undergoing major/extensive intra-abdominal surgery at the Manhattan Veterans Affairs between October 2006 and September 2011. End points were overall morbidity and 30-, 60- , and 90-day mortality. Pearson's chi-square, ANOVA, and multivariate regression modeling were employed. Six hundred twenty-nine patients were included. Apgar groups did not differ in age, sex, and race. Low SASs were associated with worse functional status, increased postoperative morbidity, and 30-, 60- , and 90-day mortality rates. SAS did not significantly enhance VASQIP prediction of postoperative outcomes, although a trend was detected. Multivariate analysis confirmed SAS as an independent predictor of morbidity and mortality. SAS effectively identifies veterans at high risk for poor postoperative outcome. Additional studies are necessary to evaluate the role of SAS in enhancing VASQIP risk prediction. Published by Elsevier Inc.
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Hodgson, Michael J; Mohr, David C; Lipkowitz-Eaton, Jennifer; Rodrigues, Dianne; Moreau, Sarah; McPhaul, Kate
The federal workers' compensation program includes under a single employer five commonly encountered roles and responsibilities-injured patient, clinical provider, third-party administrator, adjudicator, and insurer. Data within the Veterans Health Administration (VHA) provide a unique opportunity to apply a simple model of health care quality improvement, exploring interactions between structures, processes, and outcomes. A facility survey identified reporting structures, levels of education and training, policies and processes, tool availability and use, and perceptions of role adherence. Administrative data included process and outcome metrics, including short-term disability, long-term disability, and lost time cases. Improved collaboration between clinical and administrative staff within VHA and with the Department of Labor was associated with improved performance. Applying a clinical quality improvement model clarifies roles, expectations, and likely relationships for improved program management.
Hodgson, Michael J; Bierenbaum, Arnold; Mather, Susan; Brown, Mark A; Beatty, John; Scott, Margie; Brewster, Peter
Despite the recognition of chemical emergencies, terrorist events, and ongoing threats, little practical guidance exists for healthcare facilities. An approach and materials developed by the Veterans Health Administration in a five-element program over the last 2 years to enhance the existing emergency management program is outlined. Nine steps to the development of a comprehensive all-hazards, emergency plan and program, with auditing and improvement tools are offered. Cognitive aids for clinical use are available on-line and in hard copy. A hazard assessment modeled patients as emission sources documenting the operations strategies under which level C personal protective equipment will protect healthcare workers. The development of this response program appears to support a broader, long-standing VHA approach to problem solving. This involves bringing together individual talented field staff, representing specific skills, geographic regions, and work styles; investing in face-to-face consensus development; and developing programs with extensive internal peer-review ("field-based," "bottom-up and top-down," and external reviews). Comprehensive and effective programs can be constructed at low cost with reasonable speed within large systems with a public mandate, leading to responsible use of public funds internally, and as models for private sector programs. It is the long-term operational cost implications, under budget constraints in health care, which often present the true challenge. Copyright 2004 Wiley-Liss, Inc.
Gabrielian, Sonya; Yuan, Anita H; Andersen, Ronald M; Rubenstein, Lisa V; Gelberg, Lillian
The US Department of Housing and Urban Development (HUD)-VA Supportive Housing (VASH) program-the VA's Housing First effort-is central to efforts to end Veteran homelessness. Yet, little is known about health care utilization patterns associated with achieving HUD-VASH housing. We compare health service utilization at the VA Greater Los Angeles among: (1) formerly homeless Veterans housed through HUD-VASH (HUD-VASH Veterans); (2) currently homeless Veterans; (3) housed, low-income Veterans not in HUD-VASH; and (4) housed, not low-income Veterans. We performed a secondary database analysis of Veterans (n=62,459) who received VA Greater Los Angeles care between October 1, 2010 and September 30, 2011. We described medical/surgical and mental health utilization [inpatient, outpatient, and emergency department (ED)]. We controlled for demographics, need, and primary care use in regression analyses of utilization data by housing and income status. HUD-VASH Veterans had more inpatient, outpatient, and ED use than currently homeless Veterans. Adjusting for demographics and need, HUD-VASH Veterans and the low-income housed Veterans had similar likelihoods of medical/surgical inpatient and outpatient utilization, compared with the housed, not low-income group. Adjusting first for demographics and need (model 1), then also for primary care use (model 2), HUD-VASH Veterans had the greatest decrease in incident rates of specialty medical/surgical, mental health, and ED care from models 1 to 2, becoming similar to the currently homeless, compared with the housed, not low-income group. Our findings suggest that currently homeless Veterans underuse health care relative to housed Veterans. HUD-VASH may address this disparity by providing housing and linkages to primary care.
O'Donnell, Lolita; Begg, Lisa; Lipson, Linda; Elvander, Erika
This article summarizes the findings from the Second Annual Trauma Spectrum Disorders Conference, which was held in December 2009 and was sponsored by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury in conjunction with the Department of Veterans Affairs and the National Institutes of Health. The conference…
Halliday, Jennifer A; Green, Julie; Mellor, David
Obesity is an emerging problem for African migrants in Australia, but few prevention programs incorporate their cultural beliefs and values. This study reports on the application of community capacity-building and empowerment principles in 4 workshops with Sudanese families in Australia. Workshop...... effects of physical activity and nutrition to improve health within communities while reducing intergenerational and gender role family conflicts....... participants prioritized health behaviors, skill and knowledge gaps, and environments for change to identify culturally centered approaches to health promotion. The workshops highlighted a need for culturally and age-appropriate interventions that build whole-of-family skills and knowledge around the positive...
Christofferson, Dana E; Hertzberg, Jeffrey S; Beckham, Jean C; Dennis, Paul A; Hamlett-Berry, Kim
SmokefreeVET is a text messaging smoking cessation program available to veterans enrolled in the Veterans Health Administration. SmokefreeVET was developed in collaboration with the National Cancer Institute as part of the SmokefreeTXT initiative. To evaluate the real world use of and effectiveness of the SmokefreeVET program for SmokefreeVET users who enrolled between 2013 and 2014. Demographics and smoking behavior of 1470 SmokefreeVET users who enrolled between 2013 and 2014 were analyzed. Latent growth mixture modeling was used to identify discrete classes of SmokefreeVET users based on engagement patterns. Multi-level modeling determined class differences in abstinence. The average age of the SmokefreeVET user was 48, 75% of users were male, and 84% were daily smokers. After five weeks, 13% of all users reported abstinence from smoking. Five statistically distinct engagement classes of SmokefreeVET users were identified. Highly engaged classes were significantly less likely to opt-out and more likely to report abstinence. Over 60% of users who were classified as high engagers throughout the program reported abstinence 5weeks after their quit date. Users were more likely to report abstinence after two weeks if they used smoking cessation medication than those that did not use medication (OR=9.01, pusers. Smoking cessation medication use was also associated with abstinence in SmokefreeVET users. Engagement appears to be a critical component when assessing the efficacy of a text messaging smoking cessation intervention. Published by Elsevier Ltd.
Moin, Tannaz; Ertl, Kristyn; Schneider, Jessica; Vasti, Elena; Makki, Fatima; Richardson, Caroline; Havens, Kathryn; Damschroder, Laura
Diabetes prevention is a national goal and particularly important in the Veterans Health Administration (VHA) where 1 in 4 veterans has diabetes. There is growing evidence to support the use of Web-based diabetes prevention program (DPP) interventions, shown to be as effective and often more feasible than in-person interventions. Our primary objective was to qualitatively explore women veterans' early experiences with a Web-based DPP intervention. Our secondary objective was to estimate weight loss, participation, and engagement to provide context for our qualitative findings. We conducted and analyzed semistructured interviews and collected data on weight change, participation, and engagement. A total of 17 women veterans with prediabetes from a Midwest VA Women's Health Clinic were eligible to participate; 15 completed interviews. Participants perceived the DPP program as an appealing way of initiating lifestyle changes and made them feel accountable in achieving their daily goals. The online program was convenient because it could be accessed at any time, and many found that it integrated well into daily life. However, some did not like the logging aspect and some found it to be too impersonal. Participants logged in a mean 76 times, posted a mean 46 group messages, and sent a mean 20.5 private messages to the health coach over 16 weeks. Participants lost 5.24% of baseline weight, and 82% (14/17) of participants completed at least 9 of 16 core modules. Women veterans' early experiences with a Web-based DPP intervention were generally positive. Accountability and convenience were key enabling factors for participation and engagement. A Web-based DPP intervention appears to be a promising means of translating the DPP for women veterans with prediabetes.
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Smith, Michael C; Boldt, Amy S; Walston, Cassandra M; Zillich, Alan J
To evaluate the effectiveness of a care management program provided by clinical pharmacists for veterans with dyslipidemia. Retrospective cohort design. Two primary care clinics at a Veterans Affairs Medical Center. An intervention (IT) cohort of 213 patients referred for management of dyslipidemia by clinical pharmacists and a control cohort of 219 patients with dyslipidemia receiving usual care (UC). Data were obtained from electronic medical records regarding drug therapy, lipid levels, and patient characteristics. Using multivariable regression models to adjust for baseline characteristics, the primary analyses compared mean final measured values of low-density lipoprotein (LDL) cholesterol, total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, and triglycerides (TGs) among the IT and UC cohorts at the final follow-up visits. Secondary analyses compared the proportion of patients achieving National Cholesterol Education Program/Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP/ATPIII) concordant LDL goals and the time to achieve LDL goals between the two groups. Compared with the UC cohort, the adjusted difference in the mean final measured LDL for the IT cohort was -10.4 mg/dl (95% confidence interval [CI] -16.1 to -4.6, p ATPIII goal LDL was met in 80.3% of patients in the IT cohort and 65.3% of patients in the UC cohort (odds ratio [OR], 2.6; 95% CI 1.6-4.3, pATPIII goal LDL, and the time to attainment of LDL goals was shorter in the pharmacist-managed cohort, supporting a continued role for pharmacy care management in the treatment of patients with dyslipidemia. © 2013 Pharmacotherapy Publications, Inc.
Vagner Ferreira do Nascimento
Full Text Available This is an observational study, which sought to reflect on the impact of television programs on family health. Thus, from February to July 2011, a Family Health Unit of Barra do Garças - Mato Grosso, the researcher observed the behavior of customers, through spontaneous expressions which referred to the materials or articles about health programs. At the end of the study, it wasfound that such programs stimulated and generated new behaviors, especially in women. But to do so, health professionals must engage with this media education and participate in the conduct of learned information in accordance with the need of the viewer.
Nyirati, Christina M; Denham, Sharon A; Raffle, Holly; Ware, Lezlee
Though recent progress in family nursing science can serve the family nurse practitioner (FNP) to intervene in the regulation of family health, whether those advances are taught to FNP students has been unclear. All 266 FNP programs in the United States were invited to participate in a survey to assess the content and clinical application of family nursing theories in the curriculum. The majority of FNP programs frame family as the context of care for the individual. Though FNP students receive a foundation in family nursing theory in core courses, they are not usually expected to use family assessment methods in clinical practicum courses or to plan interventions for the family as the unit of care. The authors challenge educators to consider family nursing science as an essential component of the FNP program as the Doctor of Nursing Practice (DNP) evolves and becomes requisite for entry into advanced practice.
Gayed, Benjamin; Black, Stephen; Daggy, Joanne; Munshi, Imtiaz A
In April 2009, an analysis of joint replacement surgical procedures at the Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, revealed that total hip and knee replacements incurred $1.4 million in non-Veterans Affairs (VA) care costs with an average length of stay of 6.1 days during fiscal year 2008. The Joint Replacement Program system redesign project was initiated following the Vision-Analysis-Team-Aim-Map-Measure-Change-Sustain (VA-TAMMCS) model to increase efficiency, decrease length of stay, and reduce non-VA care costs. To determine the effectiveness of Lean Six Sigma process improvement methods applied in a VA hospital. Perioperative processes for patients undergoing total joint replacement were redesigned following the VA-TAMMCS model--the VA's official, branded method of Lean Six Sigma process improvement. A multidisciplinary team including the orthopedic surgeons, frontline staff, and executive management identified waste in the current processes and initiated changes to reduce waste and increase efficiency. Data collection included a 1-year baseline period and a 20-month sustainment period. The primary endpoint was length of stay; a secondary analysis considered non-VA care cost reductions. Length of stay decreased 36% overall, decreasing from 5.3 days during the preproject period to 3.4 days during the 20-month sustainment period (P Six Sigma process improvement initiatives in a surgical practice, producing a 36% sustained reduction in length of stay and completely eliminating non-VA care for total hip and knee replacements while increasing total joint replacement volume at this medical center.
David E. Goodrich
Full Text Available Objectives. Persons with mental disorders experience functional impairments and premature mortality. Limited continuity of care may contribute to disparities in this group. We describe the replication of an evidence-based outreach program (Re-Engage to reconnect Veterans with mental disorders into care who have dropped out of services. Methods. Using the Enhanced Replicating Effective Programs framework, population-based registries were used to identify Veterans lost-to-care, and providers used this information to determine Veteran disposition and need for care. Providers recorded Veteran preferences, health status, and care utilization, and formative process data was collected to document implementation efforts. Results. Among Veterans who dropped out of care (n=126, the mean age was 49 years, 10% were women, and 29% were African-American. Providers determined that 39% of Veterans identified for re-engagement were deceased, hospitalized, or ineligible for care. Of the remaining 68 Veterans, outreach efforts resulted in contact with 20, with 7 returning to care. Providers averaged 14.2 hours over 4 months conducting re-engagement services and reported that gaining facility leadership support and having service agreements for referrals were essential for program implementation. Conclusions. Population-level, panel management strategies to re-engage Veterans with mental disorders are potentially feasible if practices are identified to facilitate national rollout.
Vagharseyyedin, Seyyed Abolfazl; Gholami, Mojtaba; Hajihoseini, Morteza; Esmaeili, Aliakbar
The aim of this study was to examine the effect of peer group support on family adaptation of wives of war veterans suffering from post-traumatic stress disorder (PTSD). In this randomized controlled trial, 80 wives of war veterans with PTSD were incorporated, and selected participants were randomly assigned into intervention and control groups (n = 40 per group). The intervention group was divided into four subgroups, with each participating in eight weekly based 1.5-hr peer support group sessions and the control group received no intervention. Demographics form and Family Adaptation Scale (FAS) developed by Antonovsky and Sourani (1988) were applied. The total mean scores of family adaptation increased significantly more in the intervention group than in the control group (p = .033). Furthermore, the time × group interaction effects were significant for internal family fit (p = .013) and a combination of both family fit and family community fit (p = .020) dimensions. Nonetheless family fit dimensions mean scores had no significant increase in the intervention group than the control group over time (p = .948). Peer support group can be a useful tool for health care professionals to enhance family adaptation in spouses of war veterans with PTSD. © 2017 Wiley Periodicals, Inc.
Farming offers a viable avenue for returning veterans to transition and reincorporate into society. Farming opportunities for veterans are a natural fit and capitalize on skills that made them successful in the military. However, these opportunities may be missed due to lack of targeted training pr...
The Department of Veterans Affairs (VA) adopts as a final rule, without change, the proposal to establish a pilot program known as the Rural Veterans Coordination Pilot (RVCP). The RVCP will provide grants to eligible community-based organizations and local and State government entities to be used by these organizations and entities to assist veterans and their families who are transitioning from military service to civilian life in rural or underserved communities. VA will use information obtained through the pilot program to evaluate the effectiveness of using community-based organizations and local and State government entities to improve the provision of services to transitioning veterans and their families. Five RVCP grants will be awarded for a 2-year period in discrete locations pursuant to a Notice of Funds Availability (NOFA) to be published in the Federal Register.
O'Toole, Thomas P; Johnson, Erin E; Aiello, Riccardo; Kane, Vincent; Pape, Lisa
.... We correlated site-specific health care performance data for the 3,543 homeless veterans enrolled in the program from October 2013 through March 2014, including those receiving ambulatory or acute...
Harrold, S Akeya; Libet, Julian; Pope, Charlene; Lauerer, Joy A; Johnson, Emily; Edlund, Barbara J
Individuals with severe mental illness (SMI), experience increased mortality-20 years greater disparity for men and 15 years greater disparity for women-compared to the general population (Thornicroft G. Physical health disparities and mental illness: The scandal of premature mortality. Br J Psychiatr. 2011;199:441-442). Numerous factors contribute to premature mortality in persons with SMI, including suicide and accidental death (Richardson RC, Faulkner G, McDevitt J, Skrinar GS, Hutchinson D, Piette JD. Integrating physical activity into mental health services for persons with serious mental illness. Psychiatr Serv. 2005;56(3):324-331; Thornicroft G. Physical health disparities and mental illness: The scandal of premature mortality. Br J Psychiatr. 2011;199:441-442), but research has shown that adverse health behaviors-including smoking, low rate of physical activity, poor diet, and high alcohol consumption-also significantly contribute to premature deaths (Jones J. Life expectancy in mental illness. Psychiatry Services. 2010. Retrieved from http://psychcentral.com/news/2010/07/13/life-expectancy-in-mental-illness). This quality improvement (QI) project sought to improve health and wellness for veterans in the Mental Health Intensive Case Management Program (MHICM), which is a community-based intensive program for veterans with SMI at risk for decompensation and frequent hospitalizations. At the time of this QI project, the program had 69 veterans who were assessed and treated weekly in their homes. The project introduced a pedometer steps intervention adapted from the VA MOVE! Program-a physical activity and weight management program-with the addition of personalized assistance from trained mental health professionals in the veteran's home environment. Because a large percentage of the veterans in the MHICM program had high blood pressure and increased weight, these outcomes were the focus of this project. Through mental health case management involvement and
Parsons, Elizabeth C; Mattox, Elizabeth A; Beste, Lauren A; Au, David H; Young, Bessie A; Chang, Michael F; Palen, Brian N
Primary care providers (PCPs) frequently encounter sleep complaints, especially in regions with limited specialty care access. The U.S. Department of Veterans Affairs Extension for Community Healthcare Outcomes (VA-ECHO) program (based on Project ECHO) has successfully provided rural PCP education in subspecialty areas, including hepatitis C. We describe the feasibility of an ECHO program for sleep medicine. ECHO creates a virtual learning community through video-teleconferencing, combining didactics with individualized clinical case review. We invited multidisciplinary providers to attend up to 10 stand-alone, 1-hour sessions. Invitees completed a needs assessment, which guided curriculum development. After program completion, we examined participant characteristics and self-reported changes in practice and comfort with managing sleep complaints. We surveyed participation barriers among invitees with low/no attendance. Of the 39 program participants, 38% worked in rural healthcare. Participants included nurse practitioners (26%), registered nurses (21%), and physicians (15%). Seventeen (44%) completed the summative program evaluation. Respondents anticipated practice change from the program, especially in patient education about sleep disorders (93% of respondents). Respondents reported improved comfort managing sleep complaints, especially sleep-disordered breathing, insomnia, and sleep in post-traumatic stress disorder (80% of respondents each). A follow-up survey of program invitees who attended zero to two sessions reported scheduling conflicts (62%) and lack of protected time (52%) as major participation barriers. Participants in a pilot sleep medicine VA-ECHO program report practice change and increased comfort managing common sleep complaints. Future work is needed to identify objective measures of return on investment and address participation barriers.
Kerr, Rebecca M; Leicht, Anthony S; Spinks, Warwick L
To measure the effect of a combined aerobic and resistance exercise program on key cardiovascular disease risk factors (i.e. body composition or anthropometry and cardiorespiratory function) of Australian male, Vietnam War veterans living in the tropics. Twelve-month exercise program with assessments at commencement, 3, 6 and 12 months. North Queensland regional centre. Australian male, Vietnam War veterans (n = 164) resident in north Queensland. Measurement of heart rate, blood pressure, skinfold and girth measurements, exercise heart rate response and estimated aerobic capacity to determine whether the implementation of a simple aerobic and resistance exercise program could positively change selected cardiovascular disease risk factors in Vietnam Veterans. Significant improvements were reported for systolic blood pressure (131.1 (SD 15.7) reduced to 122.7 (12.4) mmHg), diastolic blood pressure (82.7 (9.1) reduced to 76.3 (10.3) mmHg), resting heart rate (73 (11) reduced to 69 (11) bpm), sum of skinfolds (127.5 (40.3) reduced to 99.5 (32.1) mm), waist girth (103.2 (12.0) reduced to 100.5 (12.1) cm), hip girth (105.3 (9.6) reduced to 103.7 (10.4) cm) and aerobic capacity (2.17 (0.39) increased to 2.36 (0.34) L min(-1)). Participation in a combined aerobic and resistance training program elicited significant anthropometric and cardiorespiratory benefits that might lead to a decreased risk of developing cardiovascular disease for male Vietnam War veterans resident in rural and regional areas.
O'Shea, Luke; Watkins, Ed; Farrand, Paul
Evidence highlights a high prevalence of common mental health disorders in armed forces veterans and their families, with depression, anxiety, alcohol misuse and anger being more common than PTSD. This paper presents a protocol for a systematic review and meta-analysis to identify existing randomised controlled trial (RCT) research testing the effectiveness of psychological interventions for these difficulties in armed forces veterans and their family members. Electronic databases (CENTRAL, PsycInfo, MEDLINE, CINAHL, The Cochrane Register of Clinical Trials, EMBASE and ASSIA) will be searched to identify suitable studies for inclusion in the review supplemented by forward and backward reference checking, grey literature searches and contact with subject authors. Research including armed forces veterans and their family members will be included in the review with research including serving personnel or individuals under the age of 18 being excluded. Few RCTs examining the treatment of depression, anxiety, alcohol misuse or anger exist in armed forces veterans to date. The primary outcome will be symptomatic change following intervention for these difficulties. The secondary outcomes will include methodological aspects of interest such as discharge type and recruitment setting if data permits. In the event that the number of studies identified is too low to undertake a meta-analysis, a narrative review will be conducted. Quality assessment will be undertaken using the Cochrane Collaboration Tool and Cochran's Q statistic calculated to test for heterogeneity as suggested by the Cochrane handbook. The review will examine the findings of existing intervention research for depression, anxiety, alcohol misuse or anger in armed forces veterans and their families, along with any effect sizes that may exist. PROSPERO CRD42016036676.
Oliva, Elizabeth M; Christopher, Melissa L D; Wells, Daina; Bounthavong, Mark; Harvey, Michael; Himstreet, Julianne; Emmendorfer, Thomas; Valentino, Michael; Franchi, Mariano; Goodman, Francine; Trafton, Jodie A
To prevent opioid-related mortality, the Veterans Health Administration (VHA) developed a national Opioid Overdose Education and Naloxone Distribution (OEND) program. VHA's OEND program sought national implementation of OEND across all medical facilities (n = 142). This paper describes VHA's efforts to facilitate nationwide health care system-based OEND implementation, including the critical roles of VHA's national pharmacy services and academic detailing services. VHA is the first large health care system in the United States to implement OEND nationwide. Launching the national program required VHA to translate a primarily community-based public health approach to OEND into a health care system-based approach that distributed naloxone to patients with opioid use disorders as well as to patients prescribed opioid analgesics. Key innovations included developing steps to implement OEND, pharmacy developing standard naloxone rescue kits, adding those kits to the VHA National Formulary, centralizing kit distribution, developing clinical guidance for issuing naloxone kits, and supporting OEND as a focal campaign of academic detailing. Other innovations included the development of patient and provider education resources (e.g., brochures, videos, accredited training) and implementation and evaluation resources (e.g., technical assistance, clinical decision support tools). Clinical decision support tools that leverage VHA national data are available to clinical staff with appropriate permissions. These tools allow staff and leaders to evaluate OEND implementation and provide actionable next steps to help them identify patients who could benefit from OEND. Through fiscal year 2016, VHA dispensed 45,178 naloxone prescriptions written by 5693 prescribers to 39,328 patients who were primarily prescribed opioids or had opioid use disorder. As of February 2, 2016, there were 172 spontaneously reported opioid overdose reversals with the use of VHA naloxone prescriptions. VHA
... INFORMATION CONTACT: Edward Bradley, Office of Asset Enterprise Management (044), Department of Veterans... homeless Veterans and Veterans at risk of homelessness and their families; and provide a supportive...
Rugs, Deborah; Toyinbo, Peter; Patel, Nitin; Powell-Cope, Gail; Hahm, Bridget; Elnitsky, Christine; Besterman-Dahan, Karen; Campbell, Robert; Sutton, Bryce
Health care workers, such as nurses, nursing aides, orderlies, and attendants, who manually move patients, are consistently listed in the top professions for musculoskeletal injuries (MSIs) by the Bureau of Labor Statistics. These MSIs are typically caused by high-risk patient caregiving activities. In 2008, a safe patient handling (SPH) program was implemented in all 153 Veterans Administration Medical Centers (VAMCs) throughout the United States to reduce patient handling injuries. The goal of the present study is to evaluate the effects associated with the national implementation of a comprehensive SPH program. The primary objectives of the research were to determine the effectiveness of the SPH program in improving direct care nursing outcomes and to provide a context for understanding variations in program results across sites over time. Secondary objectives of the present research were to evaluate the effectiveness of the program in reducing direct and indirect costs associated with patient handling, to explore the potential mediating and moderating mechanisms, and to identify unintended consequences of implementing the program. This 3-year longitudinal study used mixed methods of data collection at 6- to 9-month intervals. The analyses will include data from surveys, administrative databases, individual and focus group interviews, and nonparticipant observations. For this study, a 3-tiered measurement plan was used. For Tier 1, the unit of analysis was the facility, the data source was the facility coordinator or administrative data, and all 153 VAMCs participated. For Tier 2, frontline caregivers and program peer leaders at 17 facilities each completed different surveys. For Tier 3, six facilities completed qualitative site visits, which included individual interviews, focus groups, and nonparticipant observations. Multiple regression models were proposed to test the effects of SPH components on nursing outcomes related to patient handling. Content analysis
Weiner, Bryan J; Haynes-Maslow, Lindsey; Kahwati, Leila C; Kinsinger, Linda S; Campbell, Marci K
One-third of US veterans receiving care at Veterans Health Administration (VHA) medical facilities are obese and, therefore, at higher risk for developing multiple chronic diseases. To address this problem, the VHA designed and nationally disseminated an evidence-based weight-management program (MOVE!). The objective of this study was to examine the organizational factors that aided or inhibited the implementation of MOVE! in 10 VHA medical facilities. Using a multiple, holistic case study design, we conducted 68 interviews with medical center program coordinators, physicians formally appointed as program champions, managers directly responsible for overseeing the program, clinicians from the program's multidisciplinary team, and primary care physicians identified by program coordinators as local opinion leaders. Qualitative data analysis involved coding, memorandum writing, and construction of data displays. Organizational readiness for change and having an innovation champion were most consistently the 2 factors associated with MOVE! implementation. Other organizational factors, such as management support and resource availability, were barriers to implementation or exerted mixed effects on implementation. Barriers did not prevent facilities from implementing MOVE! However, they were obstacles that had to be overcome, worked around, or accepted as limits on the program's scope or scale. Policy-directed implementation of clinical weight-management programs in health care facilities is challenging, especially when no new resources are available. Instituting powerful, mutually reinforcing organizational policies and practices may be necessary for consistent, high-quality implementation.
Kahn, Janet R; Collinge, William; Soltysik, Robert
Veterans with history of deployment in the Global War on Terror face significant and ongoing challenges with high prevalences of adverse psychological, physical, spiritual, and family impacts. Together, these challenges contribute to an emerging public health crisis likely to extend well into the future. Innovative approaches are needed that reach veterans and their family members with strategies they can employ over time in their daily lives to promote improved adjustment and well-being. The objective of this study was to evaluate effects of use of a Web-based, self-directed program of instruction in mind- and body-based wellness skills to be employed by Global War on Terror veterans and their significant relationship partners on mental health and wellness outcomes associated with postdeployment readjustment. We recruited 160 veteran-partner dyads in 4 regions of the United States (San Diego, CA; Dallas, TX; Fayetteville, NC; and New York, NY) through publicity by the Iraq and Afghanistan Veterans of America to its membership. Dyads were randomly allocated to 1 of 4 study arms: Mission Reconnect (MR) program alone, MR plus the Prevention and Relationship Enhancement Program (PREP) for Strong Bonds weekend program for military couples, PREP alone, and waitlist control. We administered a battery of standardized and investigator-generated instruments assessing mental health outcomes at baseline, 8 weeks, and 16 weeks. Dyads in the MR arms were provided Web-based and mobile app video and audio instruction in a set of mindfulness-related stress reduction and contemplative practices, as well as partner massage for reciprocal use. All participants provided weekly reports on frequency and duration of self-care practices for the first 8 weeks, and at 16 weeks. During the first 8-week reporting period, veterans and partners assigned to MR arms used some aspect of the program a mean of 20 times per week, totaling nearly 2.5 hours per week, with only modest declines in use at
Bakaeen, Faisal G; Reda, Domenic J; Gelijns, Annetine C; Cornwell, Lorraine; Omer, Shuab; Al Jurdi, Rayan; Kougias, Panos; Anaya, Daniel; Berger, David H; Huang, Grant D
Surgical clinical trials have played a critical role in shaping clinical practice, yet their launch and conduct remain challenging. Innovative approaches to carrying out such studies can not only help transform how trials produce definitive evidence but also move the field toward increased participation in trials. To review a recently launched pilot program aimed at enhancing patient enrollment and improving surgical trial operations at individual sites and nationally. After a solicitation to create a national network focused on making the conduct of clinical trials more efficient, 10 Department of Veterans Affairs (VA) sites were selected. These sites, collectively called the Cooperative Studies Program (CSP) Network of Dedicated Enrollment Sites (NODES), were evaluated with regard to their previous participation in CSP multisite trials, the strength of the local clinical research environment, and presentation of innovative plans to coordinate and enhance the operations of local CSP studies and share best practices with other centers. Node accountability was also emphasized and involved metrics that tracked productivity and efficiency. Building from available CSP experience in a range of clinical trials, including ones involving surgical interventions, NODES provides VA surgeons with resources for facilitating timely study initiation, determining patient availability, and addressing enrollment barriers. Such resources are particularly important for surgical studies, which often face challenges in patient recruitment and retention. In addition, NODES can maintain qualified and trained personnel at sites to support surgeons with limited time to fulfill the numerous administrative and regulatory responsibilities that often fall to the investigators. The VA's approach to enhancing trial efficiency may reinvigorate interest in surgical trials by offering a redesigned cooperative framework that builds on a core of high-yield sites and could mitigate traditional
Full Text Available ... Call see more videos from Veterans Health Administration I'm Good. But are you ready to listen? ... PSA see more videos from Veterans Health Administration I am A Veteran Family/Friend Active Duty/Reserve ...
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Thomas, Marshall W.
Given the increased educational benefits of the Post 9/11 G. I. Bill for veterans, and as the current conflicts in Iraq and Afghanistan wind down and the troops come home, the number of military veterans entering colleges and universities is expected to increase. As non-traditional students with significant life experience, often including combat,…
Stilwell Drive Fort Monroe, VA 23651 O: 1-757-788-3535 F: 1-757-788-3713 FORT MYER, VA ACS-EFMP 201 Custer Road Fort Myer, VA 22211 O: 1-703-696-8467 F...1895-61-6323 US NSGA RAF MENWITH HILL Commanding Officer US NSGA RAF Menwith Hill PSC 45 Unit 8470 APO AE 09468 O: 011-44-1423-846717 DSN: 314-262-6717...Program 151 Bernard Road Fort Monroe, VA 23651 Telephone: 757-788-3878 Army Community Service Exceptional Family Member Program Building 201, Custer
Full Text Available Abstract Background Adapting promising health care interventions to local settings is a critical component in the dissemination and implementation process. The Veterans Health Administration (VHA rural transitions nurse program (TNP is a nurse-led, Veteran-centered intervention designed to improve transitional care for rural Veterans funded by VA national offices for dissemination to other VA sites serving a predominantly rural Veteran population. Here, we describe our novel approach to the implementation and evaluation = the TNP. Methods This is a controlled before and after study that assesses both implementation and intervention outcomes. During pre-implementation, we assessed site context using a mixed method approach with data from diverse sources including facility-level quantitative data, key informant and Veteran interviews, observations of the discharge process, and a group brainstorming activity. We used the Practical Robust Implementation and Sustainability Model (PRISM to inform our inquiries, to integrate data from all sources, and to identify factors that may affect implementation. In the implementation phase, we will use internal and external facilitation, paired with audit and feedback, to encourage appropriate contextual adaptations. We will use a modified Stirman framework to document adaptations. During the evaluation phase, we will measure intervention and implementation outcomes at each site using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance. We will conduct a difference-in-differences analysis with propensity-matched Veterans and VA facilities as a control. Our primary intervention outcome is 30-day readmission and Emergency Department visit rates. We will use our findings to develop an implementation toolkit that will inform the larger scale-up of the TNP across the VA. Discussion The use of PRISM to inform pre-implementation evaluation and synthesize data from multiple sources
Leonard, Chelsea; Lawrence, Emily; McCreight, Marina; Lippmann, Brandi; Kelley, Lynette; Mayberry, Ashlea; Ladebue, Amy; Gilmartin, Heather; Côté, Murray J; Jones, Jacqueline; Rabin, Borsika A; Ho, P Michael; Burke, Robert
Adapting promising health care interventions to local settings is a critical component in the dissemination and implementation process. The Veterans Health Administration (VHA) rural transitions nurse program (TNP) is a nurse-led, Veteran-centered intervention designed to improve transitional care for rural Veterans funded by VA national offices for dissemination to other VA sites serving a predominantly rural Veteran population. Here, we describe our novel approach to the implementation and evaluation = the TNP. This is a controlled before and after study that assesses both implementation and intervention outcomes. During pre-implementation, we assessed site context using a mixed method approach with data from diverse sources including facility-level quantitative data, key informant and Veteran interviews, observations of the discharge process, and a group brainstorming activity. We used the Practical Robust Implementation and Sustainability Model (PRISM) to inform our inquiries, to integrate data from all sources, and to identify factors that may affect implementation. In the implementation phase, we will use internal and external facilitation, paired with audit and feedback, to encourage appropriate contextual adaptations. We will use a modified Stirman framework to document adaptations. During the evaluation phase, we will measure intervention and implementation outcomes at each site using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). We will conduct a difference-in-differences analysis with propensity-matched Veterans and VA facilities as a control. Our primary intervention outcome is 30-day readmission and Emergency Department visit rates. We will use our findings to develop an implementation toolkit that will inform the larger scale-up of the TNP across the VA. The use of PRISM to inform pre-implementation evaluation and synthesize data from multiple sources, coupled with internal and external facilitation, is a
... placement for homeless and/or at-risk Veterans and their families; and provide a supportive services program. FOR FURTHER INFORMATION CONTACT: Edward Bradley, Office of Asset Enterprise Management (044...
... placement for homeless and/or at-risk Veterans and their families; and provide a supportive services program. FOR FURTHER INFORMATION CONTACT: Edward Bradley, Office of Asset Enterprise Management (044...
Gabrielian, Sonya; Yuan, Anita; Andersen, Ronald M; McGuire, James; Rubenstein, Lisa; Sapir, Negar; Gelberg, Lillian
Although vulnerable populations may benefit from in-home health information technologies (HIT) that promote disease self-management, there is a "digital divide" in which these groups are often unlikely to use such programs. We describe the early phases of applying and testing an existing Veterans Affairs (VA) HIT-care management program, Care Coordination Home Telehealth (CCHT), to recently homeless Veterans in the US Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) program. Peers were used to support patient participation. CCHT uses in-home messaging devices to provide health education and daily questions about clinical indicators from chronic illness care guidelines, with patient responses reviewed by VHA nurses. Patients could also receive adjunctive peer support. We used medical record review, Veteran interviews, and staff surveys to "diagnose" barriers to CCHT use, assess program acceptability, explore the role of peer support, and inform future quality improvement. Fourteen eligible Veterans in HUD-VASH agreed to CCHT participation. Ten of these Veterans opted to have adjunctive peer support and the other 4 enrolled in CCHT usual care. Although barriers to enrollment/engagement must be addressed, this subset of Veterans in HUD-VASH was satisfied with CCHT. Most Veterans did not require support from peers to engage in CCHT but valued peer social assistance amidst the isolation felt in their scattered-site homes. HIT tools hold promise for in-home care management for recently housed Veterans. Patient-level barriers to enrollment must be addressed in the next steps of quality improvement, testing and evaluating peer-driven CCHT recruitment.
Program families can produce a (potentially huge) number of related programs from a common code base. Many such programs are safety critical. However, most verification techniques are designed to work on the level of single programs, and thus are too costly to apply to the entire program family. ...
Nace, Edgar P.; And Others
Recommends that family therapists be aware of the dynamics of the malfunctioning family which affects the process of alcoholism. Describes a family program which is part of a comprehensive alcoholism treatment program. Individual and group intervention address the family problems set in motion by alcoholism. (Author/JAC)
Haver, Mary Katherine
The promotion of library resources and services is a continuous process for all libraries, especially hospital family resource center libraries. Like public libraries, a family resource center can utilize programs as a pathway for connecting with and developing awareness of library resources and services available to patient families. This column describes the programs currently offered for All Children's Hospital Johns Hopkins Medicine patient families, marketing initiatives to promote these programs, and utilization of grant funding to supplement a program.
Suzannah K. Creech
Full Text Available Posttraumatic stress disorder (PTSD is strongly associated with exposure to war related trauma in military and veteran populations. In growing recognition that PTSD may influence and be influenced by social support and family systems, research has begun to explore the effects that war related trauma and the ensuing PTSD may have on varied aspects of close relationship and family functioning. Far less research, however, has examined the influence of war-related PTSD on parent-child functioning in this population. This paper provides a timely review of emergent literature to examine the impacts that PTSD may have on parenting behaviors and children’s outcomes with a focus on studies of military and veterans of international conflicts since post-9/11. The review sheds light on the pathways through which PTSD may impact parent-child relationships, and proposes the cognitive-behavioral interpersonal theory of PTSD as a theoretical formulation and extends this to parenting/children. The review identifies the strengths and limitations in the extant research and proposes directions for future research and methodological practice to better capture the complex interplay of PTSD and parenting in military and veteran families.
Sayers, S. L.
There is compelling evidence that mental health problems complicate the process of family reintegration of military service members after a wartime deployment. Couples in which one spouse has recently returned from military deployment in Iraq or Afghanistan and are experiencing marital problems can present a significant treatment challenge. There…
represent program families with infinite integers as so-called (finite-state) featured symbolic automata. Specifically designed model checking algorithms are then employed to verify safety of all programs from a family at once and pinpoint those programs that are unsafe (respectively, safe). We present......Program families can produce a (potentially huge) number of related programs from a common code base. Many such programs are safety critical. However, most verification techniques are designed to work on the level of single programs, and thus are too costly to apply to the entire program family....... In this paper, we propose an efficient game semantics based approach for verifying open program families, i.e. program families with free (undefined) identifiers. We use symbolic representation of algorithmic game semantics, where concrete values are replaced with symbolic ones. In this way, we can compactly...
This final rule establishes regulations for contracting with community-based treatment facilities in the Health Care for Homeless Veterans (HCHV) program of the Department of Veterans Affairs (VA). The HCHV program assists certain homeless veterans in obtaining treatment from non-VA community-based providers. The final rule formalizes VA's policies and procedures in connection with this program and clarifies that veterans with substance use disorders may qualify for the program.
Beattie, Jill; Battersby, Malcolm W; Pols, Rene G
The purpose of this study was to determine the acceptability of peer- and health-professional-led self-management education using the Stanford Program with Australian veterans and their partners. The 6-week program taught problem-solving and decision-making skills to activate healthful behaviors, including action-planning and goal-setting. The evaluation included a participant and facilitator postprogram questionnaire; group interview; and alcohol, posttraumatic stress disorder, anxiety, depression, anger, relationship, and quality-of-life measures as part of a randomized controlled study. Participants included 25 male veterans with comorbid alcohol dependency, psychiatric and medical conditions, and 18 female partners (n = 43), 61.5% of who reported a chronic condition. The primary outcome was a self-reported improvement in self-management of their conditions in 69% of participants, with another 22.2% reporting that their confidence to self-manage had improved. There was an improvement in all measures at 9 months. The program resulted in improvements in lifestyle and confidence in self-management for Vietnam veterans, a cohort difficult to engage in healthy behaviors. Most participants were also accompanied by their partners. The program is a valuable resource for providing self-management education to veterans with alcohol dependency and various chronic conditions and needs to be considered in the suite of rehabilitation programs available to Defense Force personnel, veterans, and their partners. PsycINFO Database Record (c) 2013 APA, all rights reserved.
unable to cope effectively with all role responsibilities, the health and well-being of the care recipient also may be jeopardized. Unfortunately...reported to be older, on average, than the general population of people with SCI. Research Problem: When family caregivers are unable to cope ...providing care because of declining physical or emotional health may lead to institutionalization of the care recipient. While institutionalization
A young man or woman joins the military. He or she goes to war. Soldiers are trained and expected to follow orders and support the war effort. Likewise, military families are expected to support the military and, therefore, also support the war. As C. Wright Mills put it, âIn the military world, debate is no more at a premium than persuasion: one obeys and one...
... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS... correspondence. During the comment period, comments may be viewed online through FDMS. FOR FURTHER INFORMATION... Wheelchair Games Event Application, VA Form 0925b. f. Voluntary Service Application, VA Form 0925d. g...
Bagley, Steven C.; Munjas, Brett; Shekelle, Paul
Military personnel and veterans have important suicide risk factors. After a systematic review of the literature on suicide prevention, seven (five in the U.S.) studies of military personnel were identified containing interventions that may reduce the risk of suicide. The effectiveness of the individual components was not assessed, and problems in…
Heath, Barbara; Bernhardt, Jaime; Michalski, Thomas J; Crnich, Christopher J; Moehring, Rebekah; Schmader, Kenneth E; Olds, Danielle; Higgins, Patricia A; Jump, Robin L P
We describe a course in the Veterans Affairs (VA) Employee Education System designed to engage nursing staff working in VA long-term care facilities as partners in antimicrobial stewardship. We found that the course addressed an important knowledge gap. Our outcomes suggest opportunities to engage nursing staff in advancing antimicrobial stewardship, particularly in the long-term care setting. Published by Elsevier Inc.
Rachal, James; Lacy, Timothy J.; Warner, Christopher H.; Whelchel, Jennifer
Objective: To evaluate how family practice-psychiatry residency programs meet the challenges of rigorous accreditation demands, clinical supervision, and boundaries of practice. Method: A 54-question survey of program directors of family practice-psychiatry residency programs outlining program demographic data, curricula, coordination, resident…
... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Veteran-student services.... Chapter 31 Monetary Assistance Services § 21.272 Veteran-student services. (a) Eligibility. Veterans who.... Veteran-student services may be utilized in connection with: (1) VA outreach service program as carried...
Children's social, emotional, and physical health; their developmental trajectory; and the neurocircuits that are being created and reinforced in their developing brains are all directly influenced by their relationships during early childhood. The stresses associated with contemporary American life can challenge families' abilities to promote successful developmental outcomes and emotional health for their children. Pediatricians are positioned to serve as partners with families and other community providers in supporting the well-being of children and their families. The structure and support of families involve forces that are often outside the agenda of the usual pediatric health supervision visits. Pediatricians must ensure that their medical home efforts promote a holistically healthy family environment for all children. This statement recommends opportunities for pediatricians to develop their expertise in assessing the strengths and stresses in families, in counseling families about strategies and resources, and in collaborating with others in their communities to support family relationships.
Haverhals, Leah M; Manheim, Chelsea E; Gilman, Carrie V; Jones, Jacqueline; Levy, Cari
The Veteran's Health Administration's Medical Foster Home program offers a unique long-term care option for veterans who require nursing-home- or assisted-living-level care. Veterans in a medical foster home reside with community-based caregivers who provide 24-hr-a-day care and monitoring. The veterans often remain in the medical foster home until end of life. Support and oversight is provided to the caregiver from the Veteran's Health Administration's community-based medical team. This qualitative descriptive study is based on secondary analysis of interviews with 20 medical foster home caregivers from 7 programs across the United States. The study's research aims are to describe and explain (a) the type of care backgrounds and skills these caregivers possess, (b) caregivers' primary motivations to open their homes to veterans who often have complex medical and social needs, and (c) how caregivers function in their role as primary caregiver for veterans. Findings indicated that caregivers interviewed had worked in long-term care settings and/or cared for family members. A strong desire to serve veterans was a primary motivation for caregivers, rather than financial gain. The caregivers' long-term care skills aided them in building and sustaining the unique medical foster home family-like community.
Warren, Nancy J.; And Others
Preventive educational programs are potentially useful in reducing the effects of divorce on children and families. Parenting After Divorce is an ongoing study designed to evaluate preventive programs. Divorcing families with children aged 7-12 are identified from court records and contacted to participate. Families are randomly assigned to one of…
... availability of family child care homes capable of serving children and families with disabilities affecting... 45 Public Welfare 4 2010-10-01 2010-10-01 false Family child care program option. 1306.35 Section... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES, HEAD...
Marfo, Kofi; And Others
This study examined child developmental, program, family ecological, and demographic variables from 200 families with mentally retarded or developmentally delayed toddlers, to identify predictors of child developmental progress and parental satisfaction following participation in early intervention. Child developmental progress correlated…
Head Start programs provide poor children and their families with comprehensive early education and support services. Each year, programs are required to submit a Program Information Report (PIR) to the Office of Head Start on participating children, pregnant women, and families, as well as the staff serving the Head Start population. In 2013, the…
Hughes, Robert, Jr.; Bowers, Jill R.; Mitchell, Elissa Thomann; Curtiss, Sarah; Ebata, Aaron T.
Although numerous online family life education programs have been developed over the past few years, there has been little discussion about best practices in the development of these programs. This article presents a framework to assist family life educators in the development and improvement of online programs from the initial problem analysis…
Parenting Tools (ADAPT) is a family resilience program which helps parents to be their children’s best teachers by providing them with effective...Lane County, Oregon. Families are immigrant families ; we will assess 120 Latino students, about 210 Latino parents, and about 50 teachers and...Contribution: Collaboration and networking, facilities, marketing consultation and product Organization: Fort Bragg, Family Advocacy Program and USASOC
Wharton, Tracy C; Nnodim, Joseph; Hogikyan, Robert; Mody, Lona; James, Mary; Montagnini, Marcos; Fries, Brant E
Comprehensive health care for older adults is complex, involving multiple comorbidities and functional impairments of varying degrees and numbers. In response to this complexity and associated barriers to care, home-based care models have become prevalent. The home-based primary care (HBPC) model, based at a Michigan Department of Veterans Affairs Medical Center, and the Michigan Waiver Program (MWP) that includes home-based care are 2 of these. Although both models are formatted to address barriers to effective and efficient health care, there are differences in disease prevalence and functional performance between groups. The objective of this study was to explore the differences between the 2 groups, to shed some light on potential trends that could suggest areas for resource allocation by service providers. Using a retrospective analysis of data collected using the interRAI-home care, we examined a cross-sectional representation of clients enrolled in HBPC and MWP in 2008. The HBPC sample had 89 participants. The MWP database contained 9324 participants from across the State of Michigan and were weighted to be comparable to the HBPC population in sex and age, and to simulate the HBPC sample size. Veterans were more independent in basic activities of daily living performance, but there was no difference in the rate of reported falls between the 2 groups. Veterans had more pain and a higher prevalence of coronary artery disease (z = 7.0; P Affairs Medical Center were more burdened by chronic disease and had higher degrees of loneliness than their MWP counterparts- factors, which may increase their likelihood of hospitalizations. MWP participants had more cases of cerebrovascular accident (z = 2.1; P = .039), as well as a higher rate of diagnosed dementias (z = 2.7; P = .006). Though not different, stress among caregivers in both groups, and depression in clients of both groups were substantial. Overall, sleep, pain, coronary artery disease, chronic obstructive
Preliminary Data from the Caring for Older Adults and Caregivers at Home (COACH) Program: A Care Coordination Program for Home-Based Dementia Care and Caregiver Support in a Veterans Affairs Medical Center.
D'Souza, Maria F; Davagnino, Judith; Hastings, S Nicole; Sloane, Richard; Kamholz, Barbara; Twersky, Jack
Caring for Older Adults and Caregivers at Home (COACH) is an innovative care coordination program of the Durham Veteran's Affairs Medical Center in Durham, North Carolina, that provides home-based dementia care and caregiver support for individuals with dementia and their family caregivers, including attention to behavioral symptoms, functional impairment, and home safety, on a consultation basis. The objectives of this study were to describe the COACH program in its first 2 years of operation, assess alignment of program components with quality measures, report characteristics of program participants, and compare rates of placement outside the home with those of a nontreatment comparison group using a retrospective cohort design. Participants were community-dwelling individuals with dementia aged 65 and older who received primary care in the medical center's outpatient clinics and their family caregivers, who were enrolled as dyads (n = 133), and a control group of dyads who were referred to the program and met clinical eligibility criteria but did not enroll (n = 29). Measures included alignment with Dementia Management Quality Measures and time to placement outside the home during 12 months of follow-up after referral to COACH. Results of the evaluation demonstrated that COACH aligns with nine of 10 clinical process measures identified using quality measures and that COACH delivers several other valuable services to enhance care. Mean time to placement outside the home was 29.6 ± 14.3 weeks for both groups (P = .99). The present study demonstrates the successful implementation of a home-based care coordination intervention for persons with dementia and their family caregivers that is strongly aligned with quality measures. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.
Facebook page as well as the weekly newsletter distributed to staff. We continued our recruitment efforts to those veterans outside of the VA health... Depressive Disorder, determined by the Mini International Neuropsychiatric Interview (MINI). E02 Diagnosis of dementia, CDR > 0.5; modified...available through the Alzheimer’s Association (www.alz.org). Information regarding the study has been placed on the VA Palo Alto’s Facebook page as well
Goodrich, David E; Klingaman, Elizabeth A; Verchinina, Lilia; Goldberg, Richard W; Littman, Alyson J; Janney, Carol A; Kim, Hyungjin Myra; Maguen, Shira; Hoerster, Katherine D; Owen, Richard R; Holleman, Robert G; Roman, Pia; Lai, Zongshan; Bowersox, Nicholas W
Obesity disproportionately burdens individuals with serious mental illness (SMI), especially women. This observational study investigated whether there were sex differences in weight loss and program participation among veterans with SMI enrolled in the Veterans Health Administration's (VHA) MOVE! weight management program. Participants were identified from a national cohort of 148,254 veterans enrolled in MOVE! during fiscal years 2008 through 2012 who attended two or more sessions within 12 months of enrollment. The cohort included those with International Classification of Disease, 9th Edition, Clinical Modification (ICD-9-CM) diagnoses for SMI, age less than 70 years, and weight data at baseline and one or more follow-up timepoints within approximately 1 year of enrollment (n = 8,943 men; n = 2,245 women). Linear mixed models assessed associations of sex with 6- and 12-month weight change from baseline, adjusting for demographic- and site-level variables. Both sexes averaged 6.4 (standard deviation, 4.6) sessions within 12 months; however, women with and without SMI participated at rates double their respective proportion rates among all VHA users. Participants averaged statistically significant weight loss at 6 months (men, -2.5 lb [95% CI, -2.8 to -2.1]; women, -2.4 lb [95% CI, -3.1 to -1.7]) and 12 months (men, -2.5 lb [95% CI, -2.8 to -2.2]; women, -2.9 lb [95% CI, -3.6 to -2.2]), but no sex-based difference in absolute weight loss at either timepoint. Slightly more women achieved 5% or greater (clinically significant) weight loss at the 12-month follow-up than did men (25.7% vs. 23.0%; p Women with SMI participated in MOVE! at rates equivalent to or greater than men with SMI, with comparable weight loss. More women were Black, single, had bipolar and posttraumatic stress disorder, and higher service-connected disability, suggesting areas for program customization. Published by Elsevier Inc.
Knowles, Ginny A.; Tripple, Patricia A.
Describes a model program to address the problems of pregnant teens. Services include education, health care assistance, economic self-support assistance, prevention of child abuse, family preservation, coordination of helping programs, and counseling on options. (CH)
Rishel, Carrie W.; Hartnett, Helen P.
The prevalence of mental health disorders constitutes a nationwide public health crisis. Estimates suggest that more than 90 million people live in areas designated mental health professional shortage areas, with almost 6,000 additional practitioners needed to meet the service needs in these areas. Military personnel and veterans have greater…
Mediation of smoking-associated postoperative mortality by perioperative complications in veterans undergoing elective surgery: data from Veterans Affairs Surgical Quality Improvement Program (VASQIP)?a cohort study
Singh, Jasvinder A; Hawn, Mary; Campagna, Elizabeth J; Henderson, William G; Richman, Joshua; Houston, Thomas K
Objective To assess the mediation of smoking-associated postoperative mortality by postoperative complications. Design Observational cohort study. Setting Using data from the Veterans Affairs (VA) Surgical Quality Improvement Programme, a quality assurance programme for major surgical procedures in the VA healthcare system, we assessed the association of current smoking at the time of the surgery with 6-month and 1-year mortality. Primary and secondary outcome measures Using mediation analyse...
Rait, Douglas Samuel
Objective: This study describes the current state of family therapy training in a sample of child and adolescent psychiatry fellowship programs. Method: Child and adolescent psychiatry fellows (N = 66) from seven training programs completed a questionnaire assessing demographics, family therapy training experiences, common models of treatment and…
Bauer, Sarah M; McGuire, Alan B; Kukla, Marina; McGuire, Shannon; Bair, Matthew J; Matthias, Marianne S
Goal setting is a common element of self-management support programs; however, little is known about the nature of patients' goals or how goals change during pain self-management. The purpose of the current study is to explore how patients' goals and views of goal setting change over the course of a peer-led pain self-management program. Veterans (n=16) completing a 4-month peer-led pain self-management program completed semi-structured interviews at baseline and follow-up regarding their goals for their pain. Interviews were analyzed using immersion/crystallization. Analyses revealed six themes: motivation to do something for their pain, more goal-oriented, actually setting goals, clarity of goal importance, more specific/measurable goal criteria, and more specific/measurable strategies. The current analyses illustrate how participants' goals can evolve over the course of a peer-led pain self-management program. Specifically, increased motivation, more openness to using goals, greater clarity of goal importance, more specific and measurable goals and strategies, and the influence of the peer coach relationship were described by participants. Pain self-management interventions should emphasize goal setting, and development of specific, measurable goals and plans. Trainings for providers should address the potential for the provider-patient relationship, particularly peer providers, to facilitate motivation and goal setting. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Bauer, Sarah M.; McGuire, Alan B.; Kukla, Marina; McGuire, Shannon; Bair, Matthew J.; Matthias, Marianne S.
Objective Goal setting is a common element of self-management support programs; however, little is known about the nature of patients' goals or how goals change during pain self-management. The purpose of the current study is to explore how patients' goals and views of goal setting change over the course of a peer-led pain self-management program. Methods Veterans (n = 16) completing a 4-month peer-led pain self-management program completed semi-structured interviews at baseline and follow-up regarding their goals for their pain. Interviews were analyzed using immersion/crystallization. Results Analyses revealed six themes: motivation to do something for their pain, more goal-oriented, actually setting goals, clarity of goal importance, more specific/measurable goal criteria, and more specific/measurable strategies. Conclusion The current analyses illustrate how participants' goals can evolve over the course of a peer-led pain self-management program. Specifically, increased motivation, more openness to using goals, greater clarity of goal importance, more specific and measurable goals and strategies, and the influence of the peer coach relationship were described by participants. Practice implications Pain self-management interventions should emphasize goal setting, and development of specific, measurable goals and plans. Trainings for providers should address the potential for the provider-patient relationship, particularly peer providers, to facilitate motivation and goal setting. PMID:27516437
Reese, Robert J; Slone, Norah C; Soares, Neelkamal; Sprang, Rob
Families with a child diagnosed with attention-deficit hyperactivity disorder completed an 8-session parenting program, the Group Triple P Positive Parenting Program, provided by videoconferencing technology. Families reported improved child behavior (effect size of d = -1.23) and decreased parent distress (d = -0.34). Parent training implemented with videoconferencing technology can be an effective way of delivering evidence-based services to families with specialized needs. (c) 2012 APA, all rights reserved.
Herrmann, Douglas; Raybeck, Douglas; Wilson, Roland
Last summer Congress passed the new GI Bill, and the president signed it into law. Americans can take great pride in such a program, one that helps veterans attend college after they return home. However, few are aware that many of those veterans will also encounter a variety of non-financial problems that require substantial adjustment as they…
Office has four primary missions. First, it provides family support policies and programs in such areas as family center operations, child care...deployment family- centered – children need to be assessed, monitored, and treated in the context of their family and its support structure...because installation facilities serve only half of military school children, services must also be provided in daycare and other facilities 9
Joe, J. Richelle; Harris, Pamela N.
School counselors are expected to form collaborative relationships with the families of students. Yet, school counselors have limited knowledge about families to form these partnerships, as a descriptive content analysis of the family coursework requirements in CACREP-accredited school counseling programs in the southern region revealed that most…
O'Donnell, Julie; Kirkner, Sandra L.
Latino families highly value education and are committed to their children's educational success; however, Latino students often experience educational challenges. Well-designed family involvement programs can encourage Latino families, especially new immigrants or monolingual Spanish-speakers, to increase their involvement resulting in positive…
Singh, Sunita; Sylvia, Monica R.; Ridzi, Frank
This ethnographic study presents findings of the literacy practices of Burmese refugee families and their interaction with a book distribution program paired with an intergenerational family literacy program. The project was organized at the level of Bronfenbrenner's exosystem (in "Ecology of human development". Cambridge, Harvard…
Ahern, Aaron; Foster, Michael; Head, Darlene
This chapter outlines the birth and growth of a veterans' program in Salt Lake City, Utah, and discusses next steps in spurring additional innovations and advancements to improve service for student veterans in community colleges.
Moreau, Katherine A; Cousins, J Bradley
This study explored ways in which program evaluation activities in pediatric rehabilitation settings can become congruent with family-centered service (FCS) philosophy. Two Canadian pediatric rehabilitation centers participated in this study, which included focus groups with staff members and interviews with parents. Participants identified seven ways in which program evaluation practices could be made congruent with FCS. Suggestions included: (a) the inclusion of a diverse group of program recipients, (b) the use of processes that facilitate family involvement, (c) the recruitment of family champions, (d) the involvement of families in program development, (e) the establishment of evaluations that are relevant to families (f) the development of center-wide statements about family involvement in evaluation and (g) the compensation of families for their active participation in evaluation. For program evaluation practices to be useful and relevant, they should be improved and made consistent with FCS philosophy. Those evaluating pediatric rehabilitation programs need to use approaches and activities that respect the needs, characteristics, cultures and diversity of the program recipients. Such actions will help to improve the quality of care provided, the nature of program evaluation activities, as well as the overall level of FCS in pediatric rehabilitation settings.
This paper describes the Portage County, Ohio community hospice program, emphasizing the linkages between family life specialists, health professionals, volunteers, and students. Hospice service is defined as a specialized, home-based program for the management of pain and other symptoms of terminal illness, with the family as the unit of care.…
Population Survey (CPS), the difference between veteran and non-veteran youth unemployment increased substantially between 2008 and 2011, but then...the veteran youth unemployment rate averaged 10.7 percent compared to 8.0 percent among non-veteran youth . But the unemployment rates of older...Labor NLSY97 1997 National Longitudinal Survey of Youth PaYS U.S. Army Partnership for Youth Success TAP Transition Assistance Program UCX Unemployment
Keller, Deborah S; Kroll, Donald; Papaconstantinou, Harry T; Ellis, C Neal
To identify patients with a high risk of 30-day mortality after elective surgery, who may benefit from referral for tertiary care, an institution-specific process using the Veterans Affairs Surgical Quality Improvement Program (VASQIP) Risk Calculator was developed. The goal was to develop and validate the methodology. Our hypothesis was that the process could optimize referrals and reduce mortality. A VASQIP risk score was calculated for all patients undergoing elective noncardiac surgery at a single Veterans Affairs (VA) facility. After statistical analysis, a VASQIP risk score of 3.3% predicted mortality was selected as the institutional threshold for referral to a tertiary care center. The model predicted that 16% of patients would require referral, and 30-day mortality would be reduced by 73% at the referring institution. The main outcomes measures were the actual vs predicted referrals and mortality rates at the referring and receiving facilities. The validation included 565 patients; 90 (16%) had VASQIP risk scores greater than 3.3% and were identified for referral; 60 consented. In these patients, there were 16 (27%) predicted mortalities, but only 4 actual deaths (p = 0.007) at the receiving institution. When referral was not indicated, the model predicted 4 mortalities (1%), but no actual deaths (p = 0.1241). These data validate this methodology to identify patients for referral to a higher level of care, reducing mortality at the referring institutions and significantly improving patient outcomes. This methodology can help guide decisions on referrals and optimize patient care. Further application and studies are warranted. Copyright © 2017 American College of Surgeons. All rights reserved.
... AFFAIRS Proposed Information Collection (Operation Enduring Freedom/ Operation Iraqi Freedom Veterans... facilities for returning Operation Enduring Freedom/ Operation Iraqi Freedom veterans and their families.... Title: Operation Enduring Freedom/Operation Iraqi Freedom Veterans Health Needs Assessment, VA Form 10...
Estrada, Carlos A; Dolansky, Mary A; Singh, Mamta K; Oliver, Brant J; Callaway-Lane, Carol; Splaine, Mark; Gilman, Stuart; Patrician, Patricia A
Healthcare professionals need a new skill set to ensure the success of quality improvement in healthcare. The Department of Veterans Affairs (VA) initiated the VA National Quality Scholars fellowship in 1998; its mission is to improve the quality of care, ensure safety, accelerate healthcare re-design, and advance the improvement science by educating the next generation of leaders in quality and safety. We describe the critical need for leadership in quality and safety and interprofessional education, illustrate the curriculum, provide lessons learned by fellows, summarize key lessons learned from the implementation of an interprofessional education approach, and present most recent accomplishments. Narrative review. As of 2011, 106 program alumni are embedded in the health care delivery system across the United States. Since 2009, when nurse fellows joined the program, of the first nine graduating interdisciplinary fellows, the tailored curriculum has resulted in five advanced academic degrees, 42 projects, 29 teaching activities, 44 presentations, 36 publications, six grants funded or submitted, and two awards. The VA National Quality Scholars program continues to nurture and develop leaders for the new millennium focusing on interprofessional education. The nations' health care systems need strong interdisciplinary leaders in advanced quality improvement science who are dedicated to improving the overall quality of health and health care. Published 2012. This article is a U.S. Government work and is in the public domain in the USA.
Full Text Available Background: Evaluation of psychological problems in children of war veterans with PTSD can be the first step in improving the war – related trauma and interrupting the known phenomenon of transgeneration transmission of this trauma. Methods: Using three self – administered questionnaires, this study was carried out to compare aggression, anxiety, and social development (as some of the most expected mental health problems in this group according to literature in adolescent children of war veterans and those of non-veterans. The two groups were matched regarding sex, academic achievement, stage of education, and economic status of the family. Results: After controlling the level of parental education (as a confounding variable, a higher rate of aggression and anxiety was found in adolescent children of war veterans with PTSD but the two groups showed no significant difference in social development. Conclusion: The higher rate of anxiety and aggression among children of war veterans with PTSD along with many other factors such as low socioeconomic status in this group signifies the importance of mental health screening programs and appropriate interventions in this group. Keywords: Aggression, Social Development, Anxiety, War Veterans, PTSD, Adolescent.
Saltzman, William R
This article describes the core principles and components of the FOCUS Program, a brief intervention for families contending with single or multiple trauma or loss events. It has been administered nationally to thousands of military family members since 2008 and has been implemented in a wide range of civilian community, medical, clinical, and school settings. Developed by a team from the UCLA and Harvard Medical Schools, the FOCUS Program provides a structured approach for joining with traditional and nontraditional families, crafting shared goals, and then working with parents, children, and the entire family to build communication, make meaning out of traumatic experiences, and practice specific skills that support family resilience. Through a narrative sharing process, each family member tells his or her story and constructs a timeline that graphically captures the experience and provides a platform for family discussions on points of convergence and divergence. This narrative sharing process is first done with the parents and then the children and then the family as a whole. The aim is to build perspective-taking skills and mutual understanding, to reduce distortions and misattributions, and to bridge estrangement between family members. Previous studies have confirmed that families participating in this brief program report reductions in distress and symptomatic behaviors for both parents and children and increases in child pro-social behaviors and family resilient processes. © 2016 Family Process Institute.
Sørensen, Birgitte Refslund
social identity and find a meaningful life in the civilian world. When doing so, they need to navigate an ambiguous political environment and emergent public imaginaries of the veteran while also wrestling with their own military socialization and personal experiences of war. The certainty previously...... experiences, present conditions, and future ambitions are embedded in webs of concealment, disclosure, exposure, deception, lying, silence, and so forth, only partially controlled by the veterans themselves. The intricacies and anxieties associated with secrecy work are discussed in relation to three veteran...
Schulz-Heik, R Jay; Meyer, Hilary; Mahoney, Louise; Stanton, Michael V; Cho, Rachael H; Moore-Downing, Danae P; Avery, Timothy J; Lazzeroni, Laura C; Varni, Joanne M; Collery, Linda Martin; Bayley, Peter J
Yoga is increasingly popular, though little data regarding its implementation in healthcare settings is available. Similarly, telehealth is being utilized more frequently to increase access to healthcare; however we know of no research on the acceptability or effectiveness of yoga delivered through telehealth. Therefore, we evaluated the feasibility, acceptability, and patient-reported effectiveness of a clinical yoga program at a Veterans Affairs Medical Center and assessed whether these outcomes differed between those participating in-person and those participating via telehealth. Veterans who attended a yoga class at the VA Palo Alto Health Care System were invited to complete an anonymous program evaluation survey. 64 Veterans completed the survey. Participants reported high satisfaction with the classes and the instructors. More than 80% of participants who endorsed a problem with pain, energy level, depression, or anxiety reported improvement in these symptoms. Those who participated via telehealth did not differ from those who participated in-person in any measure of satisfaction, overall improvement (p = .40), or improvement in any of 16 specific health problems. Delivering yoga to a wide range of patients within a healthcare setting appears to be feasible and acceptable, both when delivered in-person and via telehealth. Patients in this clinical yoga program reported high levels of satisfaction and improvement in multiple problem areas. This preliminary evidence for the effectiveness of a clinical yoga program complements prior evidence for the efficacy of yoga and supports the use of yoga in healthcare settings.
Full Text Available Shelley B Bhattacharya,1–3 Michelle I Rossi,1,2 Jennifer M Mentz11Geriatric Research Education and Clinical Center (GRECC, Veteran's Affairs Pittsburgh Healthcare System, 2University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 3Albert Schweitzer Fellowship Program, Pittsburgh, PA, USAIntroduction: Interprofessional patient care is a well-recognized path that health care systems are striving toward. The Veteran's Affairs (VA system initiated interprofessional practice (IPP models with their Geriatric Evaluation and Management (GEM programs. GEM programs incorporate a range of specialties, including but not limited to, medicine, nursing, social work, physical therapy and pharmacy, to collaboratively evaluate veterans. Despite being a valuable resource, they are now faced with significant cut-backs, including closures. The primary goal of this project was to assess how the GEM model could be optimized at the Pittsburgh, Pennsylvania VA to allow for the sustainability of this important IPP assessment. Part 1 of the study evaluated the IPP process using program, patient, and family surveys. Part 2 examined how well the geriatrician matched patients to specialists in the GEM model. This paper describes Part 1 of our study.Methods: Three strategies were used: 1 a national GEM program survey; 2 a veteran/family satisfaction survey; and 3 an absentee assessment.Results: Twenty-six of 92 programs responded to the GEM IPP survey. Six strategies were shared to optimize IPP models throughout the country. Of the 34 satisfaction surveys, 80% stated the GEM clinic was beneficial, 79% stated their concerns were addressed, and 100% would recommend GEM to their friends. Of the 24 absentee assessments, the top three reasons for missing the appointments were transportation, medical illnesses, and not knowing/remembering about the appointment. Absentee rate diminished from 41% to 19% after instituting a reminder phone call policy.Discussion: Maintaining the
Tsai, Jack; O'Connell, Maria; Kasprow, Wesley J; Rosenheck, Robert A
The Housing and Urban Development-Department of Veterans Affairs Supportive Housing (HUD-VASH) program is the largest supported housing program in the country for homeless veterans who are seeking rapid entry into permanent independent housing. This study examined factors related to how rapidly clients were housed in the early years of the program and how long they stayed in the program. Mental health, substance abuse, work/income, criminal history, and site were examined as predictors of process times. Regression analyses based on 627 HUD-VASH clients who entered the program between 1992 and 2003 showed that client characteristics were not rate-limiting factors for obtaining HUD-VASH housing; i.e., clients who had greater substance abuse problems or more extensive criminal histories did not take longer to obtain housing. The large differences associated with site of entry partly reflected a curvilinear relationship between the duration of operation of the HUD-VASH program and process times; i.e., at relatively younger and older programs, clients entered housing slightly faster than at programs in the middle range. Lastly, HUD-VASH clients whose case managers reported good therapeutic alliances stayed in the program longer. These findings have implications for the continued expansion of the HUD-VASH program.
Ceylony, Manju; Porhomayon, Jahan; Pourafkari, Leili; Nader, Nader D
Internal Medicine residents must develop competency as Primary Care Providers, but a gap exists in their curriculum and training with regard to women's reproductive health. With increasing need in VA due to new influx of women veterans it poses problems in recruitment of competent physicians trained in Women's health. An intensive, one-month women's reproductive health curriculum with hands on experience for Internal Medicine residents was provided. Curriculum was taught to the residents who rotated at the Women's Health Clinic for one month. Pre-test and post-test exams were administered. Increase in knowledge of residents in providing gender specific evaluations and management was objectively assessed by changes in post-test scores. Data were analyzed for statistically significant improvement in written tests scores. Total of 47 Internal Medicine residents rotated through Women's Health Center during the evaluation period. All residents completed both pre-test and post-test exams. The average time to complete the pre-test was 20.5 ± 5.4 min and 19.5 ± 4.8 min for post-test. There was no correlation between the time to complete the pre-test exam and the post-test exam. The total score was significantly improved from 8.5 ± 1.6 to 13.2 ± 1.8 (p training with information on women's health that enables them to provide safe and gender appropriate care in primary care settings. This practice will reduce the need for frequent referrals for specialized care and thus provide cost saving for patient and health care on the whole.
Devine, Sharon Mayne; Daly, Kerry; Lero, Donna; MacMartin, Clare
Family Relations and Applied Nutrition, which is offered at the University of Guelph, is an interdisciplinary department that previously offered three undergraduate majors: child, youth, and family; applied human nutrition; and gerontology; as well as graduate programs at the master's and doctoral levels. Several factors have precipitated a review…
Santiago, Anthony; Franz, Nancy; Christoffel, Rebecca; Cooper, Kristi; Schmitt, Brenda
Since its inception, Extension has focused on helping individuals, families, and communities change economic, environmental, and social conditions. Over the organization's history, environmental condition change programming has been mostly the purview of natural resource educators and less often conducted by family and consumer science…
Much attention is given today to the importance of forging family, school, and community partnerships. Growing numbers of schools, many of them with afterschool programs, are dedicating resources to support and sustain relationships with families and community-based organizations. And, among government agencies and the philanthropic sector, there…
Golden, Adam G; Antoni, Charles; Gammonley, Denise
We describe the development and implementation of a home-based palliative care consult service for Veterans with advanced illness. A retrospective chart review was performed on 73 Veterans who received a home-based palliative care consult. Nearly one-third were 80 years of age or older, and nearly one-third had a palliative diagnosis of cancer. The most common interventions of the consult team included discussion of advance directives, completion of a "do not resuscitate" form, reduction/stoppage of at least 1 medication, explanation of diagnosis, referral to home-based primary care program, referral to hospice, and assessment/support for caregiver stress. The home-based consult service was therefore able to address clinical and psychosocial issues that can demonstrate a direct benefit to Veterans, families, and referring clinicians. © The Author(s) 2015.
concurrent logic programming can be found in . Procs pipes: linear press networks The following program is a parallel implementation of the Sieve of... Eratosthenes . It consists of a process generating all integers in the desired range, and a set of filter proceses, one per prime number found...computation terminates or deadlocks. To improve upon this the guard sake~o(L) can be added to the other clauses of the meta-interpreter. This ensures that
Department of Veterans Affairs — This report summarizes the history of women Veterans in the military and as Veterans. It profiles the characteristics of women Veterans in 2015, and illustrates how...
... code here VA » Veterans Health Administration Veterans Health Administration Veterans – Here's how to Avoid Getting the Flu ... Read more » VA Medical Centers The Veterans Health Administration is home to the United States’ largest integrated ...
Mayberry, Lindsay Satterwhite; Shinn, Marybeth; Benton, Jessica Gibbons; Wise, Jasmine
Maintenance of family processes can protect parents, children, and families from the detrimental effects of extreme stressors, such as homelessness. When families cannot maintain routines and rituals, the stressors of poverty and homelessness can be compounded for both caregivers and children. However, characteristics of living situations common among families experiencing homelessness present barriers to the maintenance of family routines and rituals. We analyzed 80 in-depth interviews with parents who were experiencing or had recently experienced an instance of homelessness. We compared their assessments of challenges to family schedules, routines, and rituals across various living situations, including shelter, transitional housing programs, doubled-up (i.e., living temporarily with family or friends), and independent housing. Rules common across shelters and transitional housing programs impeded family processes, and parents felt surveilled and threatened with child protective service involvement in these settings. In doubled-up living situations, parents reported adapting their routines to those of the household and having parenting interrupted by opinions of friends and family members. Families used several strategies to maintain family routines and rituals in these living situations and ensure consistency and stability for their children during an otherwise unstable time. (c) 2014 APA, all rights reserved.
Chumbler, Neale R; Kobb, Rita; Harris, Linda; Richardson, Lisa C; Darkins, Adam; Sberna, Melanie; Dixit, Neha; Ryan, Patricia; Donaldson, Molla; Kreps, Gary L
The 2001 Institute of Medicine report indicted that the US healthcare system fails to provide high-quality care, and offered 6 aims of improvement that would redesign the delivery of care for the 21st century. This study compared the use of Department of Veterans Affairs (VA) inpatient and outpatient services of cancer patients enrolled in a Cancer Care Coordination/Home-Telehealth (CCHT) program that involved remote management of symptoms (eg, emotional distress, pain) via home-telehealth technologies to a control group of cancer patients receiving standard VA care. Using a matched case-control design, 2 control patients per case were selected, matched by tumor type and cancer stage. There were 43 Cancer CCHT patients and 82 control group patients. Based on a medical record review of each patient, the total number of cancer-related services (defined as visits that were expected given the patients' cancer diagnosis and treatment protocol) and preventable services (defined as visits needed outside of those expected given the cancer diagnosis and planned treatment) were calculated over a 6-month period. Poisson multivariate regression models were used to estimate the adjusted relative risks (RRs) for the effects of the Cancer CCHT program on the service use outcomes. Cancer CCHT patients had significantly fewer preventable services (clinic visits: RR = 0.03, 95% confidence interval [CI] = 0.00-0.24; bed days of care (BDOC) for hospitalization [all-cause]: RR = 0.50, 95% CI = 0.37-0.67; hospitalizations [chemotherapy related]: RR = 0.43, 95% CI = 0.21-0.91; and BDOC for hospitalizations [chemotherapy related]: RR = 0.49, 95% CI = 0.34-0.71) than the control group. This study offered some preliminary evidence that patients enrolled in a Cancer CCHT program can successfully manage multiple complex symptoms without utilizing inpatient and outpatient services.
McDowell, Teresa; Fang, Shi-Ruei; Kosutic, Iva; Griggs, Julie
In this article, we report the results of a survey that accessed the perceptions of family studies and family therapy international master's and doctoral students across the United States. Our goals included giving collective voice to the experience of international students and gathering their suggestions for improving programs. Themes that…
Al, C.M.W.; Stams, G.J.J.M.; Bek, M.S.; Damen, E.M.; Asscher, J.J.; van der Laan, P.H.
The aims of the present study were, first, to establish the effect of brief, in-home intensive family preservation programs on prevention of out-of-home placement, family functioning, child behavior problems and social support and, second, to study moderators of these effects. The results of this
Northouse, Laurel L; Walker, Julie; Schafenacker, Ann; Mood, Darlene; Mellon, Suzanne; Galvin, Elizabeth; Harden, Janet; Freeman-Gibb, Laurie
To evaluate the FOCUS Program (family involvement, optimistic attitude, coping effectiveness, uncertainty reduction, and symptom management), a family-based program of care for women with recurrent breast cancer and their family caregivers. Randomized clinical trial. Midwest region of the United States. The family-based program of care consisted of five components: family involvement, optimistic attitude, coping effectiveness, uncertainty reduction, and symptom management. The program was delivered in three home visits and two follow-up phone calls over a five-month period of time. Patients with recurrent breast cancer and their family members reported high satisfaction with the FOCUS Program. Although the FOCUS Program had a number of strengths, limitations of the program also were identified that need to be addressed in future family-based interventions. A need exists for family-based programs of care that enable both patients and their family members to manage the multiple demands associated with recurrent breast cancer.
... Veteran Program, the Women Veterans Health Committee, the Women's Health Collaborative Workgroup, trauma recovery, domiciliary care, mental health, and military sexual trauma treatment. The Committee will also...
.... One commenter stated that the ``inclusion of the State Veterans Home as Federal VA land in all maps... of the NHV (i.e., the Pacific Branch of the National Home for Disabled Volunteer Soldiers) in the...
Kuncharapu, Indumathi; Cass, Alvah R.; Carlson, Carol A.; Scott, Jack R.
Morning Report (MR) is a frequently held case conference in most Family Medicine (FM) residency programs among medical learners who discuss recent inpatient admissions before the day's care of patients. This study conducted a national survey of FM residency program directors to describe the roles of faculty and residents in facilitating MR.…
Mohan, Anitha; Walker, Christina
Since 1965, the Head Start program has served low-income 3- and 4-year-old children and their families with comprehensive early education and support services. Programs provide services focused on the "whole child," including early education addressing cognitive, developmental, and socio-emotional needs; medical and dental screenings and…
Since 1965, the Head Start program has served low-income 3- and 4-year-old children and their families with comprehensive early education and support services. Programs provide services focused on the "whole child," including early education addressing cognitive, developmental, and socio-emotional needs; medical and dental screenings and…
Kring, Thomas C.
Describes the Adolescent Family Life Program, which develops and tests approaches that encourage adoption as an alternative to abortion for pregnant teens. Notes that both abortion and adoption rates have dropped since the program was instituted in 1981; maintains that additional research is needed into factors associated with adoption. Discusses…
Hastings, S Nicole; Sloane, Richard; Morey, Miriam C; Pavon, Juliessa M; Hoenig, Helen
An important contributor to hospital-associated disability is immobility during hospitalization. Preliminary results from STRIDE, a clinical demonstration program of supervised walking for older adults admitted to the hospital with medical illness, are reported. The STRIDE program consisted of a targeted gait and balance assessment by a physical therapist, followed by daily walks supervised by a recreation therapy assistant for the duration of the hospital stay. To examine program effectiveness, STRIDE participants (n = 92) were compared with individuals referred but not enrolled (because of refusal or because program was at capacity, n = 35). Median length of stay was 4.7 days for STRIDE participants and 5.7 days for individuals receiving usual care (P = .31). There was one inpatient fall in each group (not associated with a STRIDE walk). Overall, 92% of STRIDE participants were discharged to home (rather than a skilled nursing facility (SNF)) compared to 74% of individuals receiving usual care (P = .007). Thirty-day emergency department visit rates and readmission rates were not significantly different between the two groups. STRIDE, a supervised walking program for hospitalized older adults, was feasible and safe, and program participants were less likely to be discharged to a SNF than a demographically similar comparison group. STRIDE is a promising interdisciplinary approach to promoting mobility and improving outcomes in hospitalized older adults. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.
...-sufficiency. FOR FURTHER INFORMATION CONTACT: Edward Bradley, Office of Asset Enterprise Management (044... priority placement for homeless Veterans and Veterans at risk of homelessness and their families; and...
Silvana Aparecida Mariano
Full Text Available The Brazilian social assistance policy is guided by the perspective of poverty fight efforts, which prioritize the conditioned income transfer. These programs privilege the income transfer to women and involve them in a net of obligations and conditions, as it is done in the Family Donation Program. The practice within Family Donation Program highlights some contradictions between the State actions and the feminist demands, especially those concerning the motherhood problem. This is thus a core question for the dialogue between the feminism and the social policies sponsored by the State.
Bademli, Kerime; Duman, Zekiye Çetinkaya
"Family to Family Support Program" is a significant intervention program to assist families by informing them about treatment procedures and coping strategies, increasing their functionality, helping them to overcome the challenges of the disease. This study was particularly designed to investigate the emotions, thoughts, and experiences of caregivers of schizophrenia patients who participated in "Family to Family Support Program." The study was conducted with one of the qualitative research methods, phenomenological method. The study sample included caregivers who care for schizophrenia patients and participated in the "Family to Family Support Program". Twenty caregivers were included in the sample. The study was carried out in İzmir Schizophrenia Support Association. The study data were collected with four open ended questions. The average age of the participants was 56,77 ± 72,89, 10 male caregivers and 10 female caregivers, 9 caregivers were fathers, 6 caregivers were mothers, and 5 of them were siblings. The thematic analysis indicated that the emotions, thoughts and experiences of caregivers can be categorized in four groups: "I learned to deal with my problems", "I am conscious in my interaction with the patient and I know and I am not alone", "I feel much better", and "Schizophrenia is not the end of the road, knowledge sorts things out." Caregivers who participated in "Family to Family Support Program" expressed their satisfaction that they were benefited from the program, their coping skills were improved, they experienced less challenges when providing care, they understood the disease better, and it felt comfortable. Copyright © 2015 Elsevier Inc. All rights reserved.
Ellis, Niki; Mackenzie, Alison; Mobbs, Robyn
In Australia greater attention is being given to health determinants, and the dominance of treatment in health policy and budgets is giving away some ground to prevention, health promotion, rehabilitation and disability management. This creates a dilemma for compensation systems: should the inclusion criteria be broadened to match the new thinking or should a narrower definition of "disease, injury or death" be retained? This issue is explored in the context of war syndromes among veterans. While veterans experience symptoms more frequently and more severely than military and community controls, their patterns of symptoms are not unique. Current compensation and benefit programs can create iatrogenic effects. It is concluded that compensation systems should be kept as safety nets while resources are provided to improve the capacity of primary health care caregivers, community organisations and veterans with war syndromes and their families to better deal with these problems. Adapting compensation systems to promote wellness through self-management health partnerships is one way of directing resources to individuals and their families. Action research at the community level with veterans, their families, their organisations, primary health care organisations, policy makers and researchers would allow this sector to work out the best way to apply existing efficacious tools to these modern health problems.
Speiser, Bernadette; Dutra-Brice, Cynthia
Aortic valve disease, especially aortic stenosis, becomes progressively debilitating and carries a high mortality risk if it is categorized as severe and symptomatic (J Thorac Cardiovas Surg. 2012;144(3):e29-e84). In the past, the only treatment for aortic stenosis was surgical aortic valve replacement. Surgical treatment may require several hours of cardioplegia, and if the patient has comorbidities, such as renal failure or chronic obstructive pulmonary disease, their operative mortality percentage increases.In 2011, the US Food and Drug Administration approved the use of a transcatheter aortic valve replacement (TAVR) procedure for patients who were deemed high risk or inoperative for the routine surgical aortic valve replacement surgery. More than 20, 000 TAVRs have been performed in patients worldwide since 2002 when Dr Alain Cribier performed the first-in-man TAVR (Arch Cardiovasc Dis. 2012;105(3):145-152). The Edwards Lifesciences SAPIEN XT valve and the Medtronic CoreValve are commercially available.The clinical findings and economic statistic have supported the expansion of the TAVR procedure. However, there has been considerable controversy over where the procedure is to occur and who is directly responsible for directing the TAVR care. This debate has identified barriers to the implementation of a TAVR program. The operating rooms and a cardiac catheterization laboratory are underprepared for the hybrid valve replacement therapy. Because of the barriers identified, the Department of Veterans Affairs determined a need for a systematic approach to review the programs that applied for this structural heart disease program. A centralized team was developed to ensure room readiness and staff competency. The use of the Health Failure Mode and Effects Analysis can define high-risk clinical processes and conduct a hazard analysis. Worksheets can show potential failure modes and their probabilities, along with actions and outcome measures, team collaboration
Tolmie, Rhiannon S.; Bruck, Susan; Kerslake, Rachel
A child's diagnosis with autism spectrum disorder (ASD) can be an extremely stressful time for families. Researchers suggest that the period immediately following ASD diagnosis is a key time for professionals to guide families by providing appropriate information about support options. This article describes a family support program, developed by…
Lacasse, Miriam; Ratnapalan, Savithiri
ABSTRACT OBJECTIVE To review the literature on teaching-skills training programs for family medicine residents and to identify formats and content of these programs and their effects. DATA SOURCES Ovid MEDLINE (1950 to mid-July 2008) and the Education Resources Information Center database (pre-1966 to mid-July 2008) were searched using and combining the MeSH terms teaching, internship and residency, and family practice; and teaching, graduate medical education, and family practice. STUDY SELECTION The initial MEDLINE and Education Resources Information Center database searches identified 362 and 33 references, respectively. Titles and abstracts were reviewed and studies were included if they described the format or content of a teaching-skills program or if they were primary studies of the effects of a teaching-skills program for family medicine residents or family medicine and other specialty trainees. The bibliographies of those articles were reviewed for unidentified studies. A total of 8 articles were identified for systematic review. Selection was limited to articles published in English. SYNTHESIS Teaching-skills training programs for family medicine residents vary from half-day curricula to a few months of training. Their content includes leadership skills, effective clinical teaching skills, technical teaching skills, as well as feedback and evaluation skills. Evaluations mainly assessed the programs’ effects on teaching behaviour, which was generally found to improve following participation in the programs. Evaluations of learner reactions and learning outcomes also suggested that the programs have positive effects. CONCLUSION Family medicine residency training programs differ from all other residency training programs in their shorter duration, usually 2 years, and the broader scope of learning within those 2 years. Few studies on teaching-skills training, however, were designed specifically for family medicine residents. Further studies assessing the
Full Text Available Background: Upon successful experiences of family physician program in the rural regions, Iranian Ministry of Health and Medical Education (MOHME made a decision to expand this program to urban areas. For this reason a pilot program were designated and some cities have been selected to determine dos and don′ts of performing family physician program in the cities. Various studies were published during this period demonstrating the advantages and disadvantages of family physicians′ care in these cities. After this process in 2012 and 2013 MOHME announced implementation of family physician program in Tehran. Our study investigated public attitudes, knowledge and practice about the newly introduced program. Methods: This cross-sectional study was performed in Tehran during November to December 2012. A telephone survey was carried out using the Random Digit Dialing (RDD method and data was gathered by a researcher designed questionnaire. A total of 386 residents aged 18 years and over participated in the study. To compare the differences between various groups′ knowledge scores data were analyzed performing Chi-square test, t-test, ANOVA, and logistic regression by SPSS software version 17, to find factors that affected individuals′ agreement with the program. Results: Among all samples 214(57.4% knew about the program and almost 120(85.1% of these aware people were planning to participate in the program. Television and Radio were the major information resources. After adjusting for Educational status, Access to Internet and Socio Economic Status(SES those people who didn′t have any kind of health coverage systems(Health insurance were most likely to accept the program and agree with that[OR= 2.38(1.05-5.38 ]. Conclusions: The fact that despite low levels of information, most of aware people intend to enroll in the new program reveals that expanding informative programs would bring more participation and involvement among community.
... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS AFFAIRS Notice of Funds Availability Inviting Applications for Grants for Transportation of Veterans in... Wallace, National Coordinator, Highly Rural Transportation Grants, Veterans Transportation Program, Chief...
Mallon, Timothy M; Grizzell, Tifani L; Hodgson, Michael J
The objective of this article is to introduce the reader to this special supplement to the Journal of Occupational and Environmental Medicine regarding Federal Workers' Compensation Programs. The short history of both the VHA and DoD Federal Workers' Compensation Programs are provided and a short synopsis of each author's article is provided. The lessons learned from the articles in the supplement are summarized in this article and 6 key findings are highlighted. Cooperation between human resources workers' compensation personnel, safety and occupational health personnel is a must for successful management of the WC program. Information and data sharing are critical for root cause and injury prevention, case management, and cost containment efforts. Enhancing efforts in these areas will save an estimated $100 million through cost avoidance efforts.
Byrnes, Hilary F; Miller, Brenda A; Aalborg, Annette E; Plasencia, Ana V; Keagy, Carolyn D
Reliability and validity of intervention studies are impossible without adequate program fidelity, as it ensures that the intervention was implemented as designed and allows for accurate conclusions about effectiveness (Bellg AJ, Borrelli B, Resnick B et al. Enhancing treatment fidelity in health behavior change studies: best practices and recommendations from the NIH behavior change consortium. Health Psychol 2004; 23: 443-51). This study examines the relation between program fidelity with family engagement (i.e. satisfaction and participation) in family-based prevention programs for adolescent alcohol, tobacco or other drug use. Families (n = 381) were those with an 11- to 12-year-old child enrolled in Kaiser Permanente in the San Francisco area. Families participated in one of two programs: Strengthening Families Program: For Parents and Youth 10-14 (SFP) (Spoth R, Redmond C, Lepper H. Alcohol initiation outcomes of universal family-focused preventive interventions: one- and two-year follow-ups of a controlled study. J Stud Alcohol Suppl 1999; 13: 103-11) or Family Matters (FM) (Bauman KE, Ennett ST. On the importance of peer influence for adolescent drug use: commonly neglected considerations. Addiction 1996; 91: 185-98). Fidelity was assessed by: (i) adherence to the program manual and (ii) quality of implementation. No relationships were found for FM, a self-directed program. For SFP, higher quality scores were related to higher parent satisfaction. Higher adherence scores were related to higher satisfaction for youth, yet surprisingly to lower satisfaction for parents. Parent sessions involve much discussion, and to obtain high adherence scores, health educators were often required to limit this to implement all program activities. Findings highlight a delivery challenge in covering all activities while allowing parents to engage in mutually supportive behavior.
... who in the first year of postsecondary education placed into college-level math and English without.... There are three types of grants under the UB Program: Regular UB grants, UB Math and Science (UBMS... if current per participant cost levels are at or below $2,250. For example, an applicant that is...
... unanticipated delays, computer service outages, or other delivery-related problems. For a Copy of the... from an institution in which the person has been a resident for more than 180 days (including prisons... standards for the housing unit size); o. Past institutional care (prison, treatment facility, hospital); p...
Tsai, Jack; Rosenheck, Robert A
Although criminal justice involvement and incarceration are common problems for homeless veterans, few studies have examined childhood risk factors for criminal justice involvement among veterans. This study examined the association between three types of childhood problems, family instability, conduct disorder behaviors, and childhood abuse, and criminal justice involvement and incarceration in adulthood. Data from 1,161 homeless veterans across 19 sites participating in the Housing and Urban Development-Veterans Affairs Supportive Housing program were examined. After controlling for sociodemographics and mental health diagnoses, veterans who reported more conduct disorder behaviors during childhood tended to report more criminal charges of all types, more convictions, and longer periods of incarceration during adulthood. However, the variance explained in criminal behavior by childhood was not large, suggesting that there are other factors that affect the trajectory by which homeless veterans become involved in the criminal justice system. Further research is needed to intervene in the pathway to the criminal justice system and guide efforts to prevent incarceration among veterans. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.
... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Child adopted out of family. 3.58 Section 3.58 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS... out of family. A child of a veteran adopted out of the family of the veteran either prior or...
Pugno, Perry A; McGaha, Amy L; Schmittling, Gordon T; DeVilbiss, Ashley D; Ostergaard, Daniel J
The results of the 2009 National Resident Matching Program (NRMP) reflect a persistently low level of student interest in family medicine residency training in the United States. Compared with the 2008 Match, 70 fewer positions (with 89 fewer US seniors) were filled in family medicine residency programs through the NRMP in 2009, at the same time that 18 fewer positions were filled in primary care internal medicine (11 fewer US seniors), one more position was filled in pediatrics-primary care (three more US seniors), and 13 more positions were filled in internal medicine-pediatrics programs (but with seven fewer US seniors). Multiple forces, including student perspectives of the demands, rewards and prestige of the specialty, the turbulence and uncertainty of the health care and economic environments, lifestyle issues, the advice of deans, and the impact of faculty role models, continue to influence medical student career choices. A total of 152 more positions (28 fewer US seniors) were filled in categorical internal medicine. Thirty-one more positions (72 more US seniors) were filled in categorical pediatrics programs. The 2009 NRMP results suggest that while interest in family medicine experienced a slight increase in the number of students choosing the specialty last year, overall interest in primary care careers continues to decline. With the nation continuing to call for the roles and services of family physicians, family medicine still matched too few graduates through the 2009 NRMP to effectively address the nation's needs for primary care physicians.
Pugno, Perry A; McGaha, Amy L; Schmittling, Gordon T; DeVilbiss, Ashley D; Ostergaard, Daniel J
The results of the 2008 National Resident Matching Program (NRMP) reflect a currently stable level of student interest in family medicine residency training in the United States. Compared with the 2007 Match, 91 more positions (with 65 more US seniors) were filled in family medicine residency programs through the NRMP in 2008, at the same time as 10 fewer (one fewer US senior) in primary care internal medicine, eight fewer positions were filled in pediatrics-primary care (10 fewer US seniors), and 19 fewer (27 fewer US seniors) in internal medicine-pediatrics programs. Multiple forces, including student perspectives of the demands, rewards, and prestige of the specialty, the turbulence and uncertainty of the health care environment, lifestyle issues, and the impact of faculty role models, continue to influence medical student career choices. Thirty-one more positions (20 fewer US seniors) were filled in categorical internal medicine. Thirty more positions (84 fewer US seniors) were filled in categorical pediatrics programs. The 2008 NRMP results suggest that while interest in family medicine experienced a slight increase in the number of students choosing the specialty, interest in other primary care careers continues to decline. With the needs of the nation calling for the roles and services of family physicians, family medicine still matched too few graduates through the 2008 NRMP to meet the nation's needs for primary care physicians.
Ottomanelli, Lisa; Barnett, Scott D; Goetz, Lance L
To investigate impact of participation in a supported employment program and impact of employment itself on health-related quality of life (HRQOL), disability, and handicap among Veterans with spinal cord injury (SCI). We used a prospective, randomized, controlled, multi-site trial of supported employment (SE) versus treatment as usual (TAU) for vocational issues. Subjects were 157 Veterans with SCI who received either SE or TAU for vocational issues. Outcomes were examined in terms of type of vocational treatment received and whether competitive employment was obtained. Outcomes investigated were HRQOL as measured by the Veterans RAND 36-item health survey (VR-36), handicap as measured by the Craig Handicap Assessment and Reporting Technique (CHART), and disability as measured by the functional independence measure (FIM). Subjects were assessed at baseline and at 3, 6, 9, and 12 months. There were no significant differences between Veterans who participated in SE compared to those who received TAU in study measures. Participants obtaining competitive employment demonstrated significantly higher scores on the Social Integration, Mobility, and Occupation dimensions of the CHART. There were no observed differences in VR-36 scores or FIM scores for those obtaining competitive employment. This study suggests that employment has a positive effect on an individual's ability to participate in social relationships, move about their home and community, and spend time in productive and usual roles. Inability to detect differences across other domains of handicap or any changes in HRQOL may have been due to several factors including level and intensity of employment, insufficient follow-up period, or measurement limitations.
Peterson, Jane; Brommelsiek, Margaret; Amelung, Sarah Knopf
Background/Objective: The number of veterans and their families seeking healthcare and support within civilian communities is increasing worldwide. There is a need for healthcare providers to provide sensitive, comprehensive care for veterans with both physical and behavioral health conditions. Many civilian providers are unfamiliar with veterans'…
Halliday, Jennifer A; Green, Julie; Mellor, David; Mutowo, Mutsa P; de Courten, Maximilian; Renzaho, André M N
Obesity is an emerging problem for African migrants in Australia, but few prevention programs incorporate their cultural beliefs and values. This study reports on the application of community capacity-building and empowerment principles in 4 workshops with Sudanese families in Australia. Workshop participants prioritized health behaviors, skill and knowledge gaps, and environments for change to identify culturally centered approaches to health promotion. The workshops highlighted a need for culturally and age-appropriate interventions that build whole-of-family skills and knowledge around the positive effects of physical activity and nutrition to improve health within communities while reducing intergenerational and gender role family conflicts.
Mileski, Michael; Scott Kruse, Clemens; Brooks, Matthew; Haynes, Christine; Collingwood, Ying; Rodriguez, Rachel
Military veterans diagnosed with dementia compose a large portion of our population. Often ignored are their caregivers and their plight as well as the availability, quality, and accessibility of health care for this demographic. The purpose of this systematic literature review is three fold: to identify opportunities available to increase public awareness on the subject; to identify areas of improvement in the level of care and quality of life for our nation's veterans; and to identify if adequate resources are available to veterans with dementia and their caregivers. The authors conducted systematic searches of three databases: PubMed via The National Center for Biotechnology Information, the Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete via Ebson B. Stephens Company (EBSCO Host), and Google. Data were collected regarding providing care to veterans who are suffering from dementia or Alzheimer's disease and their caregivers between 2008 and June 2016. Search results were filtered by date range, full text, English language, Boolean operators, and academic journals (n = 14). The review confirmed there are many facilitators and barriers in the coordination of care offered to veterans with dementia. Facilitators of quality care include veteran's expectations, family support, program development, and the availability of services. These positive aspects are aided by several community-based support services, new technology, and preventative care. Barriers are caregiver expectations, coordination of care, providers, and informal and formal costs. These negative facets are due to lack of educational resources, an increased veteran population diagnosed with dementia, limited knowledge of resources, and limited medical service in rural areas. Overall, there are a number of community programs that want to, and can, help veterans with dementia. There are also a number of ways to help veterans with dementia cope with their issues, which include
Washington, Donna L; Yano, Elizabeth M; McGuire, James; Hines, Vivian; Lee, Martin; Gelberg, Lillian
Women veterans are three to four times more likely than non-veteran women to become homeless. However, their risk factors for homelessness have not been defined. Case-control study of non-institutionalized homeless women veterans (n533) and age-matched housed women veterans (n=165). Health, health care, and factors associated with homelessness were assessed using multiple logistic regression with a Monte Carlo algorithm to estimate exact standard errors of the model coefficients and p-values. Characteristics associated with homelessness were sexual assault during military service, being unemployed, being disabled, having worse overall health, and screening positive for an anxiety disorder or post-traumatic stress disorder. Protective factors were being a college graduate or married. Efforts to assess housed women veterans' risk factors for homelessness should be integrated into clinical care programs within and outside the Veterans Administration. Programs that work to ameliorate risk factors may prevent these women's living situations from deteriorating over time.
Webber, Elaine; Serowoky, Mary
Health care provider support is essential for breastfeeding success. Family Nurse Practitioners (FNP) are in a unique position to promote and manage breastfeeding. There is a gap in the literature regarding the amount and type of breastfeeding curricular content in FNP programs. An online survey of FNP programs was conducted. Data collection included program descriptors, didactic breastfeeding coursework, and clinical breastfeeding opportunities available to students. No programs offered courses specific to breastfeeding: 82% of programs devoted 1 to 2 hours of didactic lactation content. More than three quarters of the programs offered students breastfeeding counseling opportunities; no programs, however, identified specific breastfeeding clinical competencies. FNPs can play an integral role in breastfeeding promotion and counseling. There appears to be a lack of education provided to FNPs regarding breastfeeding management. Creative approaches that incorporate lactation education into FNP programs may increase FNPs' breastfeeding knowledge and enhance their ability to provide support to breastfeeding families. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.
Continental Illinois National Bank and Trust Co., Chicago.
The teacher's guide is for a high school unit on personal income management, part of a family financial education program which also includes a unit on accepting credit responsibility. It can be used by teachers of any subject attempting to develop in students habits and attitudes in the area of earning, saving, and spending. The unit is based on…
Mohan, Anitha; Walker, Christina
In 1994, the federal Early Head Start (EHS) program was created to address the comprehensive needs of low-income pregnant women and children under age 3. EHS was launched almost 30 years after Head Start was established in 1965 to serve low-income 3- and 4-year-old children and their families with comprehensive early education and support…
Khelifa, Maher; Sonleitner, Nancy; Wooldridge, Deborah; Mayers, Gloysis
The authors report the outcomes of introducing undergraduate research to family science majors at Zayed University, United Arab Emirates. The program has enriched students' educational experiences and has had tangible benefits. In addition to acquiring research skills, students improved in critical analysis, originality, independent learning,…
... efficiency in managing the SFHGLP. The proposed changes are in accordance with the recommendations of the... Housing Service proposes two changes to its Single Family Housing Guaranteed Loan Program (SFHGLP...-quarter of 1 percent. The first proposed rule change would eliminate the lender's published VA rate for...
Geiger, Brian F.
Passport in Time (PIT), a volunteer program of the United States Department of Agriculture Forest Service, is an excellent recreational learning experience. Families work side-by-side with professional archaeologists and historians to excavate, record, and restore historic and prehistoric sites across the United States. In addition, families…
Full Text Available Information about medicinal plants that is available in text documents is generally quite easy to access, however, one needs some efforts to use it. This research was aimed at utilizing crucial information taken from a text document to identify the family of several species of medicinal plants using a heuristic approach, i.e. genetic programming. Each of the species has its unique features. The genetic program puts the characteristics or special features of each family into a tree form. There are a number of processes involved in the investigated method, i.e. data acquisition, booleanization, grouping of training and test data, evaluation, and analysis. The genetic program uses a training process to select the best individual, initializes a generate-rule process to create several individuals and then executes a fitness evaluation. The next procedure is a genetic operation process, which consists of tournament selection to choose the best individual based on a fitness value, the crossover operation and the mutation operation. These operations have the purpose of complementing the individual. The best individual acquired is the expected solution, which is a rule for classifying medicinal plants. This process produced three rules, one for each plant family, displaying a feature structure that distinguishes each of the families from each other. The genetic program then used these rules to identify the medicinal plants, achieving an average accuracy of 86.47%.
Hardy, James M.
A document intended to provide program planning guidelines for Young Men's Christian Associations (YMCAs) desirous of working with families, recommends adherence to eight principles and following of five steps. The principles involve planning before action, fact finding and analysis, clear delineation of operational objectives, planning at all…
Pugno, Perry A; McGaha, Amy L; Schmittling, Gordon T; DeVilbiss Bieck, Ashley D; Crosley, Philip W; Ostergaard, Daniel J
The results of the 2010 National Resident Matching Program (NRMP) reflect a small but promising increased level of student interest in family medicine residency training in the United States. Compared with the 2009 Match, 75 more positions (with 101 more US seniors) were filled in family medicine residency programs through the NRMP in 2010, at the same time that seven more positions were filled in primary care internal medicine (one more US senior), 14 fewer positions were filled in pediatrics-primary care (16 fewer US seniors), and 16 more positions were filled in internal medicine-pediatrics programs (58 more US seniors). Multiple forces including student perspectives of the demands, rewards, and prestige of the specialty; national dialogue about health care reform; turbulence in the economic environment; lifestyle issues; the advice of deans; and the impact of faculty role models continue to influence medical student career choices. Ninety-four more positions (90 more US seniors) were filled in categorical internal medicine. Fifty-seven more positions (29 more US seniors) were filled in categorical pediatrics programs. The 2010 NRMP results suggest that there is a small increase in primary care careers; however, students continue to show an overall preference for subspecialty careers. Despite matching the highest number of US seniors into family medicine residencies since 2004, in 2010 the production of family physicians remains insufficient to meet the current and anticipated need to support the nation's primary care infrastructure.
In Japan, the condom is the method of choice of 82% of all contraceptive users. The Japan Family Planning Association covers about 3% of the total condom market through a well-organized social marketing scheme. Mobile guidance teams, equipped with a vehicle, supply contraceptives to health centers, independent midwives, and maternity hospitals in 17 prefectures and collect payment for condoms distributed after their previous visit. As an incentive, organizations and health institutions receive a commission for the condoms they supply. Japan's largest condom manufacturer provides supplies to the Family Planning Association at a very low price. The contraceptive social marketing program pays for its own promotion, and the Family Planning Association is able to support its other activities from the income it earns. The program was designed to complement rather than compete with commercial marketing channels such as pharmacies, which supply 60% of the 660 million condoms purchased in Japan each year.
Johnson, Erin E.; Aiello, Riccardo; Kane, Vincent; Pape, Lisa
Introduction Although the clinical consequences of homelessness are well described, less is known about the role for health care systems in improving clinical and social outcomes for the homeless. We described the national implementation of a “homeless medical home” initiative in the Veterans Health Administration (VHA) and correlated patient health outcomes with characteristics of high-performing sites. Methods We conducted an observational study of 33 VHA facilities with homeless medical homes and patient- aligned care teams that served more than 14,000 patients. We correlated site-specific health care performance data for the 3,543 homeless veterans enrolled in the program from October 2013 through March 2014, including those receiving ambulatory or acute health care services during the 6 months prior to enrollment in our study and 6 months post-enrollment with corresponding survey data on the Homeless Patient Aligned Care Team (H-PACT) program implementation. We defined high performance as high rates of ambulatory care and reduced use of acute care services. Results More than 96% of VHA patients enrolled in these programs were concurrently receiving VHA homeless services. Of the 33 sites studied, 82% provided hygiene care (on-site showers, hygiene kits, and laundry), 76% provided transportation, and 55% had an on-site clothes pantry; 42% had a food pantry and provided on-site meals or other food assistance. Six-month patterns of acute-care use pre-enrollment and post-enrollment for 3,543 consecutively enrolled patients showed a 19.0% reduction in emergency department use and a 34.7% reduction in hospitalizations. Three features were significantly associated with high performance: 1) higher staffing ratios than other sites, 1) integration of social supports and social services into clinical care, and 3) outreach to and integration with community agencies. Conclusion Integrating social determinants of health into clinical care can be effective for high
O'Toole, Thomas P; Johnson, Erin E; Aiello, Riccardo; Kane, Vincent; Pape, Lisa
Although the clinical consequences of homelessness are well described, less is known about the role for health care systems in improving clinical and social outcomes for the homeless. We described the national implementation of a "homeless medical home" initiative in the Veterans Health Administration (VHA) and correlated patient health outcomes with characteristics of high-performing sites. We conducted an observational study of 33 VHA facilities with homeless medical homes and patient- aligned care teams that served more than 14,000 patients. We correlated site-specific health care performance data for the 3,543 homeless veterans enrolled in the program from October 2013 through March 2014, including those receiving ambulatory or acute health care services during the 6 months prior to enrollment in our study and 6 months post-enrollment with corresponding survey data on the Homeless Patient Aligned Care Team (H-PACT) program implementation. We defined high performance as high rates of ambulatory care and reduced use of acute care services. More than 96% of VHA patients enrolled in these programs were concurrently receiving VHA homeless services. Of the 33 sites studied, 82% provided hygiene care (on-site showers, hygiene kits, and laundry), 76% provided transportation, and 55% had an on-site clothes pantry; 42% had a food pantry and provided on-site meals or other food assistance. Six-month patterns of acute-care use pre-enrollment and post-enrollment for 3,543 consecutively enrolled patients showed a 19.0% reduction in emergency department use and a 34.7% reduction in hospitalizations. Three features were significantly associated with high performance: 1) higher staffing ratios than other sites, 1) integration of social supports and social services into clinical care, and 3) outreach to and integration with community agencies. Integrating social determinants of health into clinical care can be effective for high-risk homeless veterans.
Award Number: W81XWH-12-1-0385 TITLE: Evaluating a Novel Sleep-Focused Mind -Body Rehabilitative Program for Veterans with mTBI and Other...3. DATES COVERED 31Aug 2014 - 30 Aug 2015 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER W81XWH-12-1-0385 Evaluating a Novel Sleep-Focused Mind -Body...study is still ongoing. There is no finding to report from the study as of 30/09/2015. 15. SUBJECT TERMS mind -body intervention, awareness training
Shepherd-Banigan, Megan; Kelley, Michelle L; Katon, Jodie G; Curry, John F; Goldstein, Karen M; Brancu, Mira; Wagner, H Ryan; Fecteau, Teresa E; Van Houtven, Courtney H
This study examined the association between parent and family reported history of non-PTSD mental illness (MI), PTSD specifically, and substance use problems, and participant clinical diagnosis of PTSD. Participants were drawn from the US Department of Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC) Post-Deployment Mental Health (PDMH) study (n = 3191), an ongoing multi-site cohort study of US Afghanistan and Iraq conflict era veterans. Participants who recalled a father history of PTSD had a 26-percentage point higher likelihood of meeting criteria for PTSD; while participants reporting any family history of PTSD had a 15-percentage point higher probability of endorsing symptoms consistent with PTSD. Mother history of substance use problems was associated with Veteran current PTSD, but results were sensitive to model specification. Current PTSD was not associated with family/parent history of non-PTSD mental illness, mother history of PTSD, or family/father history of substance use problems. Family history of PTSD may increase PTSD risk among veterans exposed to trauma, particularly when a father history is reported. Knowledge of family history could improve clinical decision-making for trauma-exposed individuals and allow for more effective targeting of programs and clinical services. Published by Elsevier B.V.
Department of Veterans Affairs — The caring responders at the Veterans Crisis Line are specially trained and experienced in helping Veterans of all ages and circumstances. Some of the responders are...
Ortega, Enrique; Giannotta, Fabrizia; Latina, Delia; Ciairano, Silvia
Background: The family context has proven to be a useful target in which to apply prevention efforts aimed at child and adolescent health risk behaviors. There are currently a variety of cultural adaptation models that serve to guide the international adaptation of intervention programs. Objective: The cultural adaptation process and program…
Jor'dan, Jamilah R.; Wolf, Kathy Goetz; Douglass, Anne
Strengthening Families is a relationship-based child abuse and neglect prevention initiative started nationally in 2001 through a partnership between the Doris Duke Charitable Foundation and the Center for the Study of Social Policy (CSSP) in Washington, DC. Thirty-five states and several thousand early childhood programs nationwide implement…
Biggs, Wendy S; Bieck, Ashley D; Pugno, Perry A; Crosley, Philip W
The results of the 2011 National Resident Matching Program (NRMP) reflect another small but promising increased level of student interest in family medicine residency training in the United States. Compared with the 2010 Match, family medicine residency programs filled 172 more positions (with 133 more US seniors) through the NRMP in 2011. In other primary care fields, 26 more primary care internal medicine positions filled (10 more US seniors), one more position in pediatrics-primary care (two fewer US seniors), and seven more positions in internal medicine-pediatrics programs (10 more US seniors). The 2011 NRMP results suggest a small increase in choosing primary care careers for the second year in a row; however, students continue to show an overall preference for subspecialty careers. Multiple forces continue to influence medical student career choices. Despite matching the highest number of US seniors into family medicine residencies since 2002, the production of family physicians remains insufficient to meet the current and anticipated need to support the nation's primary care infrastructure.
... AFFAIRS Agency Information Collection Activity (Veteran Suicide Prevention Online Quantitative Surveys.... Veterans Online Survey, VA Form 10-0513. b. Veterans Family Online Survey, VA Form 10-0513a. c. Veterans Primary Care Provider Online Survey, VA Form 10-0513b. OMB Control Number: 2900-New (VA Form 10-0513...
... AFFAIRS Proposed Information Collection (Veteran Suicide Prevention Online Quantitative Surveys) Activity.... Veterans Online Survey, VA Form 10-0513: b. Veterans Family Online Survey, VA Form 10-0513a. c. Veterans Primary Care Provider Online Survey, VA Form 10-0513b. OMB Control Number: 2900-New (VA Form 10-0513...
functioning and satisfaction . 3. Objective 3.1.1 Given the presence of one or more positive responses to PTSD screening questions, the nurse selects...evaluation at an eating disorder clinic. b. Individual psychotherapy at the mental health clinic. c. Marital counseling at the family services center...and depression, stating, Its nothing I can t handle . The nurse puts her pen down and talks directly to Jeff, expressing empathy for how
Azad Aminjan, Maboud; Moaddab, Seyyed Reza; Hosseini Ravandi, Mohammad; Kazemi Haki, Behzad
Nowadays in the world, tuberculosis is the second largest killer of adults after HIV. Due to the location of presidios that is mostly located in hazardous zones soldiers and army personnel are considered high risk, therefore we decided to determine the prevalence of tuberculosis status in this group of people. This was a cross-sectional descriptive research that studied the prevalence of pulmonary tuberculosis in soldiers and military personnel in the last 15 years in tuberculosis and lung disease research center at Tabriz University of Medical Sciences. The statistical population consisted of all the soldiers and military personnel. The detection method in this study was based on microscopic examination following Ziehl-Neelsen Stain and in Leuven Stein Johnson culturing. Descriptive statistics was used for statistical analysis and statistical values less than 0.05 were considered significant. By review information in this center since the 1988-2013 with 72 military personnel suffering from tuberculosis, it was revealed that among them 30 women, 42 men, 14 soldiers, 29 family members, and 29 military personnel are pointed. A significant correlation was found between TB rates among military personnel and their families. Although in recent years, the national statistics indicate a decline of tuberculosis, but the results of our study showed that TB is still a serious disease that must comply with the first symptoms of tuberculosis in military personnel and their families that should be diagnosed as soon as possible.
Maboud Azad Aminjan
Full Text Available Nowadays in the world, tuberculosis is the second largest killer of adults after HIV. Due to the location of presidios that is mostly located in hazardous zones soldiers and army personnel are considered high risk, therefore we decided to determine the prevalence of tuberculosis status in this group of people. This was a cross-sectional descriptive research that studied the prevalence of pulmonary tuberculosis in soldiers and military personnel in the last 15 years in tuberculosis and lung disease research center at Tabriz University of Medical Sciences. The statistical population consisted of all the soldiers and military personnel. The detection method in this study was based on microscopic examination following Ziehl-Neelsen Stain and in Leuven Stein Johnson culturing. Descriptive statistics was used for statistical analysis and statistical values less than 0.05 were considered significant. By review information in this center since the 1988-2013 with 72 military personnel suffering from tuberculosis, it was revealed that among them 30 women, 42 men, 14 soldiers, 29 family members, and 29 military personnel are pointed. A significant correlation was found between TB rates among military personnel and their families. Although in recent years, the national statistics indicate a decline of tuberculosis, but the results of our study showed that TB is still a serious disease that must comply with the first symptoms of tuberculosis in military personnel and their families that should be diagnosed as soon as possible.
Pavao, Joanne; Turchik, Jessica A; Hyun, Jenny K; Karpenko, Julie; Saweikis, Meghan; McCutcheon, Susan; Kane, Vincent; Kimerling, Rachel
programs in providing mental health care to homeless Veterans.
Afghanistan Veterans of America (IAVA); Brian Hawthorne, legisla- tive director of the Student Veterans of America ( SVA ); Derek Blumke, president of SVA ...Veterans of America ( SVA ), a national student veterans’ organization; the National Association of Veterans’ Program Administrators (NAVPA), a
Handheld computers are valuable practice tools. It is important for residency programs to introduce their trainees and faculty to this technology. This article describes a formal strategy to introduce handheld computing to a family practice residency program. Objectives were selected for the handheld computer training program that reflected skills physicians would find useful in practice. TRGpro handheld computers preloaded with a suite of medical reference programs, a medical calculator, and a database program were supplied to participants. Training consisted of four 1-hour modules each with a written evaluation quiz. Participants completed a self-assessment questionnaire after the program to determine their ability to meet each objective. Sixty of the 62 participants successfully completed the training program. The mean composite score on quizzes was 36 of 40 (90%), with no significant differences by level of residency training. The mean self-ratings of participants across all objectives was 3.31 of 4.00. Third-year residents had higher mean self-ratings than others (mean of group, 3.62). Participants were very comfortable with practical skills, such as using drug reference software, and less comfortable with theory, such as knowing the different types of handheld computers available. Structured training is a successful strategy for introducing handheld computing to a residency program.
Marcelle Aparecida de Barros
Full Text Available ABSTRACT: Epidemiological studies on drugs use point towards this phenomenon as a public health problem. Nowadays, the Family Health Program (FHP is presented by the Health Ministry as a model to restructure primary health care and aims to offer family-centered care, permeated by integrality, problem solving and community bonds. This article aims to discuss action possibilities of Family Health Care professionals involving drugs patients. It is evident that, as opposed to other actions already developed by FHP professionals in other health care areas, which has appeared clearly and objectively. This fact is observed in the daily activities of FHP professionals, which give little attention to drugs-related problems. However, research emphasizes that there exists a broad range of action possibilities for FHP professionals. Although other studies evidence this team’s fragilities in terms of care for drugs users, these can be overcome by investing in the training and valuation of these professionals. KEY WORDS: Family Health Program; Street drugs; Health Knowledge, Attitudes, Practice.
Bolles, Elliot; Patrizio, Kami
This study investigates the leadership tenets informing veterans' work as school leaders. Drawing on 15 interviews and surveys with military veterans working as educational leaders, the study relies on Stake's (2006) case study method to substantiate assertions that veterans: 1) come into education without the support of a transitional program, 2)…
For military veterans suffering from the long-term trauma of warfare, arts and crafts become much more than the fabrication of relics; they can literally save the spirit. Dialogue and interaction between the veterans, volunteers, and staff are crucial to the success of veterans' arts and crafts program. The purpose of this research was threefold.…
Robertson, Heather C.; Brott, Pamelia E.
Many military veterans face the challenging transition to civilian employment. Military veteran members of a national program, Troops to Teachers, were surveyed regarding life satisfaction and related internal/external career transition variables. Participants included military veterans who were currently or had previously transitioned to K-12…
The Program of Information, Education, and Services for Basic Family Health Care in Magdalena Medio and Bajo was designed to increase knowledge and use of contraception and to improve basic health practices and nutrition in the region, which includes municipios belonging to 9 different departments and a total population of 1,720,000. Poverty levels in the area are high. During the 1st year of the project, which was underway from February 1988-May 1991, home visits were made to inform each family about basic family health, to weigh and measure children under 5 not receiving health care elsewhere, and to refer families to the nearest health services. Talks were presented to small groups on family planning, intestinal parasites, sexually transmitted diseases, nutrition, vaccination, cancer prevention, malaria, acute diarrhea, and acute respiratory infection. Community workshops were presented in the 2nd year. Community distribution posts were created for contraceptive and other health product distribution. Information and communication materials from PROFAMILIA were used, and other materials were specially designed for the project by the Foundation for Development of Health Education in Colombia. PROFAMILIA's system of service statistics was used for quantitative evaluation of the information and education activities and sales of contraceptives, antiparasitics, and oral rehydration packets of each instructor. In the 3 years of the program, 89.086 cycles of pills, 398,772 condoms, 29,080 vaginal tablets, 209.791 antiparasitics, and 49,305 oral rehydration packets were sold. 9295 talks were presented to 143,227 residents of the region. 22,000 children were enrolled in the growth monitoring program, and almost 40,000 women were referred for prenatal care and cytology. The instructors gave 900 talks to distributors of contraceptives, antiparasitics, and oral rehydration packets. Surveys of women aged 15-49 residing in the municipios covered by the project were conducted
Sullivan, Jennifer L; Adjognon, Omonyêlé L; Engle, Ryann L; Shin, Marlena H; Afable, Melissa K; Rudin, Whitney; White, Bert; Shay, Kenneth; Lukas, Carol VanDeusen
From 2010 to 2013, the Department of Veterans Affairs (VA) funded a large pilot initiative to implement noninstitutional long-term services and supports (LTSS) programs to support aging Veterans. Our team evaluated implementation of 59 VA noninstitutional LTSS programs. The specific objectives of this study are to (a) examine the challenges influencing program implementation comparing active sites that remained open and inactive sites that closed during the funding period and (b) identify ways that active sites overcame the challenges they experienced. Key informant semistructured interviews occurred between 2011 and 2013. We conducted 217 telephone interviews over four time points. Content analysis was used to identify emergent themes. The study team met regularly to define each challenge, review all codes, and discuss discrepancies. For each follow-up interview with the sites, the list of established challenges was used as a priori themes. Emergent data were also coded. The challenges affecting implementation included human resources and staffing issues, infrastructure, resources allocation and geography, referrals and marketing, leadership support, and team dynamics and processes. Programs were able to overcome challenges by communicating with team members and other areas in the organization, utilizing information technology solutions, creative use of staff and flexible schedules, and obtaining additional resources. This study highlights several common challenges programs can address during the program implementation. The most often mentioned strategy was effective communication. Strategies also targeted several components of the organization including organizational functions and processes (e.g., importance of coordination within a team and across disciplines to provide good care), infrastructure (e.g., information technology and human resources), and program fit with priorities in the organization (e.g., leadership support). Anticipating potential pitfalls of
... various organizations and individuals are doing to challenge perceptions about women Veterans. Learn more » #VeteranOfTheDay - Nominate a Veteran Today! Veteran of the Day has been a tradition on VA’s social media pages for more than two years now. This ...
Pletsch, Pamela K; Morgan, Sarah
Tobacco use during pregnancy continues to cause health problems for women and children. Nurses can facilitate smoking cessation during pregnancy through the use of tobacco control guidelines and counseling tailored to pregnant women. In this article, the Treating Tobacco Use and Dependence: Clinical Practice Guideline is reviewed; the Smoke Free Families program, which is tailored for pregnancy, stage matched, and includes second-hand smoke control assistance, is described; and two models for integrating smoking cessation counseling into prenatal services are offered.
Youth for Astronomy and Engineering (YAE) is a program in the Space Telescope Science Institute's Office of Communication and Public Outreach designed to engage the local community in science, technology, engineering, and mathematics (STEM). This is accomplished through a series of yearly events such as astronomy and engineering clubs for students, family nights, and star parties. These events leverage our mission science to expose participants to the latest science discoveries (Hubble), new developments in space technology (James Webb), STEM career information, and activities that are representative of the work done by individuals in the astronomical and engineering fields. The YAE program helps provide a progression of opportunities for audiences by attracting and identifying highly-engaged individuals for participation in more intensive experiences. It also helps increase our impact by creating a network for piloting educational outreach initiatives at the local level before nationwide release. This poster will highlight the YAE program.
Collinge, William; Kahn, Janet; Soltysik, Robert
This article reports pilot data from phase I of a project to develop and evaluate a self-directed program of integrative therapies for National Guard personnel and significant relationship partners to support reintegration and resilience after return from Iraq or Afghanistan. Data are reported on 43 dyads. Intervention was an integrated multimedia package of guided meditative, contemplative, and relaxation exercises (CD) and instruction in simple massage techniques (DVD) to promote stress reduction and interpersonal connectedness. A repeated measures design with standardized instruments was used to establish stability of baseline levels of relevant mental health domains (day 1, day 30), followed by the intervention and assessments 4 and 8 weeks later. Significant improvements in standardized measures for post-traumatic stress disorder, depression, and self-compassion were seen in both veterans and partners; and in stress for partners. Weekly online reporting tracked utilization of guided exercises and massage. Veterans reported significant reductions in ratings of physical pain, physical tension, irritability, anxiety/worry, and depression after massage, and longitudinal analysis suggested declining baseline levels of tension and irritability. Qualitative data from focus groups and implications for continued development and a phase II trial are discussed. PMID:23397692
Nauta, Marrit J.
The Child and Family Resource Program (CFRP) is a family-oriented child development program initiated by the Administration for Children, Youth and Families to provide support services to low-income families and their children. This report summarizes preliminary findings based on the first year and a half of CFRP evalution. Following the brief…
Department of Veterans Affairs — The 2007 Veterans Employability Research Survey (VERS) was conducted to determine the factors that impact veterans' employability resulting from participation in the...
... AFFAIRS Veterans' Rural Health Advisory Committee, Notice of Meeting The Department of Veterans Affairs... Affairs on health care issues affecting enrolled Veterans residing in rural areas. The Committee examines programs and policies that impact the provision of VA health care to enrolled Veterans residing in rural...
... AFFAIRS Veterans' Rural Health Advisory Committee; Notice of Meeting The Department of Veterans Affairs... health care issues affecting enrolled Veterans residing in rural areas. The Committee examines programs and policies that impact the provision of VA health care to enrolled Veterans residing in rural areas...
Full Text Available This paper proposes several mixed integer programming models which incorporate optimal sequence properties into the models, to solve single machine family scheduling problems. The objectives are total weighted completion time and maximum lateness, respectively. Experiment results indicate that there are remarkable improvements in computational efficiency when optimal sequence properties are included in the models. For the total weighted completion time problems, the best model solves all of the problems up to 30-jobs within 5 s, all 50-job problems within 4 min and about 1/3 of the 75-job to 100-job problems within 1 h. For maximum lateness problems, the best model solves almost all the problems up to 30-jobs within 11 min and around half of the 50-job to 100-job problems within 1 h. Keywords: Family scheduling, Sequence independent setup, Total weighted completion time, Maximum lateness
Kumpfer, Karol L.; Xie, Jing; O'Driscoll, Robert
Background: Evidence-based programs (EBPs) targeting effective family skills are the most cost effective for improving adolescent behavioural health. Cochrane Reviews have found the "Strengthening Families Program" (SFP) to be the most effective substance abuse prevention intervention. Standardized cultural adaptation processes resulted…
Home Visiting Campaign, 2015
The federally funded, locally administered Maternal, Infant, and Early Childhood Home Visiting Program sponsors family support programs that are often called "home visiting" because they take place in the homes of at-risk families. These families often lack support, experience, and knowledge of basic parenting skills. Because children…
Fontana, Alan; Rosenheck, Robert
Differences in the characteristics and mental health needs of veterans of the Iraq/Afghanistan war when compared with those of veterans who served in the Persian Gulf war and in the Vietnam war may have important implications for Veterans Affairs (VA) program and treatment planning. Subjects were drawn from administrative data bases of veterans who sought treatment from specialized VA programs for treatment of posttraumatic stress disorder (PTSD). Current Iraq/Afghanistan veterans were compared with 4 samples of outpatient and inpatient Persian Gulf and Vietnam veterans whose admission to treatment was either contemporaneous or noncontemporaneous with their admission. A series of analyses of covariance was used hierachically to control for program site and age. In analyses of contemporaneous veterans uncontrolled for age, Iraq/Afghanistan veterans differed most notably from Vietnam veterans by being younger, more likely to be female, less likely to be either married or separated/divorced, more often working, less likely to have ever been incarcerated, and less likely to report exposure to atrocities in the military. Regarding clinical status, Iraq/Afghanistan veterans were less often diagnosed with substance abuse disorders, manifested more violent behavior, and had lower rates of VA disability compensation because of PTSD. Differences are more muted in comparisons with Persian Gulf veterans, particularly in those involving noncontemporaneous samples, or those that controlled for age differences. Among recent war veterans with PTSD, social functioning has largely been left intact. There is a window of opportunity, therefore, for developing and focusing on treatment interventions that emphasize the preservation of these social assets.
Bishop, Kathleen Kirk, Ed.; Taylor, Mary Skidmore, Ed.; Arango, Polly, Ed.
Designed to celebrate family/interprofessional collaborative partnerships, this publication describes high-quality examples of how families and professionals at the family, community, state, and national levels have worked together to create programs and practices that are family-friendly and responsive to what families have said they want and…
Tsai, Jack; Mares, Alvin S; Rosenheck, Robert A
Although veterans have been found to be at increased risk for homelessness as compared to non-veterans, it is not clear whether those who are homeless have more severe health problems or poorer outcomes in community-based supported housing. This observational study compared 162 chronically homeless veterans to 388 non-veterans enrolled in a national-supported housing initiative over a 1-year period. Results showed that veterans tended to be older, were more likely to be in the Vietnam era age group, to be male, and were more likely to have completed high school than other chronically homeless adults. There were no differences between veterans and non-veterans on housing or clinical status at baseline or at follow-up, but both groups showed significant improvement over time. These findings suggest that the greater risk of homelessness among veterans does not translate into more severe problems or treatment outcomes. Supported housing programs are similarly effective for veterans and non-veterans.
McBride, Cami K.; Baptiste, Donna; Traube, Dorian; Paikoff, Roberta L.; Madison-Boyd, Sybil; Coleman, Doris; Bell, Carl C.; Coleman, Ida; McKay, Mary M.
SUMMARY Social indicators suggest that African American adolescents are in the highest risk categories of those contracting HIV/AIDS (CDC, 2001). The dramatic impact of HIV/AIDS on urban African American youth have influenced community leaders and policy makers to place high priority on programming that can prevent youth’s exposure to the virus (Pequegnat & Szapocznik, 2000). Program developers are encouraged to design programs that reflect the developmental ecology of urban youth (Tolan, Gorman-Smith, & Henry, 2003). This often translates into three concrete programmatic features: (1) Contextual relevance; (2) Developmental-groundedness; and (3) Systemic Delivery. Because families are considered to be urban youth’s best hope to grow up and survive multiple-dangers in urban neighborhoods (Pequegnat & Szapocznik, 2000), centering prevention within families may ensure that youth receive ongoing support, education, and messages that can increase their capacity to negotiate peer situations involving sex. This paper will present preliminary data from an HIV/AIDS prevention program that is contextually relevant, developmentally grounded and systematically-delivered. The collaborative HIV/AIDS Adolescent Mental Health Project (CHAMP) is aimed at decreasing HIV/AIDS risk exposure among a sample of African American youth living in a poverty-stricken, inner-city community in Chicago. This study describes results from this family-based HIV preventive intervention and involves 88 African American pre-adolescents and their primary caregivers. We present results for the intervention group at baseline and post intervention. We compare post test results to a community comparison group of youth. Suggestions for future research are provided. PMID:20852742
Lester, Patricia; Stein, Judith A.; Saltzman, William; Woodward, Kirsten; MacDermid, Shelley W.; Milburn, Norweeta; Mogil, Catherine; Beardslee, William
Family-centered preventive interventions have been proposed as relevant to mitigating psychological health risk and promoting resilience in military families facing wartime deployment and reintegration. This study evaluates the impact of a family-centered prevention program, Families OverComing Under Stress Family Resilience Training (FOCUS), on the psychological adjustment of military children. Two primary goals include: 1) Understanding the relationships of distress among family members using a longitudinal path model to assess relations at the child and family level, and 2) Determining pathways of program impact on child adjustment. Multilevel data analysis using structural equation modeling was conducted with de-identified service delivery data from 280 families (505 children ages 3-17) in two follow-up assessments. Standardized measures included Service Member and Civilian parental distress (Brief Symptom Inventory, PTSD Checklist – Military), child adjustment (Strengths and Difficulties Questionnaire), and family functioning (McMaster Family Assessment Device). Distress was significantly related among the service member parent, civilian parent and children. FOCUS improved family functioning, which in turn significantly reduced child distress at follow-up. Salient components of improved family functioning in reducing child distress mirrored resilience processes targeted by FOCUS. These findings underscore the public health potential of family-centered prevention for military families, and suggest areas for future research. PMID:23929043
Lester, Patricia; Stein, Judith A; Saltzman, William; Woodward, Kirsten; MacDermid, Shelley W; Milburn, Norweeta; Mogil, Catherine; Beardslee, William
Family-centered preventive interventions have been proposed as relevant to mitigating psychological health risk and promoting resilience in military families facing wartime deployment and reintegration. This study evaluates the impact of a family-centered prevention program, Families OverComing Under Stress Family Resilience Training (FOCUS), on the psychological adjustment of military children. Two primary goals include (1) understanding the relationships of distress among family members using a longitudinal path model to assess relations at the child and family level and (2) determining pathways of program impact on child adjustment. Multilevel data analysis using structural equation modeling was conducted with deidentified service delivery data from 280 families (505 children aged 3-17) in two follow-up assessments. Standardized measures included service member and civilian parental distress (Brief Symptom Inventory, PTSD Checklist-Military), child adjustment (Strengths and Difficulties Questionnaire), and family functioning (McMaster Family Assessment Device). Distress was significantly related among the service member parent, civilian parent, and children. FOCUS improved family functioning, which in turn significantly reduced child distress at follow-up. Salient components of improved family functioning in reducing child distress mirrored resilience processes targeted by FOCUS. These findings underscore the public health potential of family-centered prevention for military families and suggest areas for future research. Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.
Pronatalist attitudes are traditional in Rwanda, a country in which more than 90% of the population lives by peasant agriculture and the Catholic church is strong. A rapid change in thinking will be inevitable if the country is to attain its goal of food self-sufficiency and to improve the health of its mothers and infants. Population densities were already high in Rwanda in the early 20th century, and they have become much higher. The total population increased from an estimated 2 million around 1940 to 4 million in 1970 and about 6 million in 1984. If the current rate of growth of 3.7% is maintained, the population will exceed 10 million before the year 2000. Already the size of the average farm is only .4 hectare. The health situation is equally alarming. Infant and child mortality rates are each about 125/1000 live births. The high death rate among mothers is partly due to too many births, too closely spaced. At age 49 a Rwandan woman will have given birth to an average of 8.5 children. Prematurity, malnutrition, and diarrhea and other diseases take their toll on the children of chronically exhausted mothers. Family planning alone will not solve the problems; better prenatal care, medical surveillance of infants and young children, improved obstetrical facilities, vaccination programs, oral rehydration programs and a range of other services are needed. The government of Rwanda created the Scientific Consultative Council for Sociodemographic Problems in 1974 and the National Office of Population (ONAPO) in 1981. ONAPO is responsible for promotion and provision of family planning services. A project to increase acceptance of family planning in the 2 prefectures of Butare and Gikongoro and to integrate family planning into maternal-child health services has received support from the German government since 1986. The 1st phase of the project, in 1986-87, involved informing the population and political-administrative authorities of Gikongoro of the benefits of
Full Text Available No abstract available. Article truncated at 150 words. Today is Armistice Day, renamed Veterans Day in 1954, to honor our Nation's Veterans. In Washington the rhetoric from both the political right and left supports our Veterans. My cynical side reminds me that this might have something to do with Veterans voting in a higher percentage than the population as a whole, but let me give the politicians this one. Serving our Country in the military is something that deserves to be honored. I was proud to serve our Veterans over 30 years at the four Department of Veterans Affairs (VA hospitals. However, the VA has had a very bad year. First, in Washington there were the resignations of the Secretary of Veterans Affairs, Eric Shinseki; the undersecretary for the Veterans Health Administration, Robert Petzel; and the undersecretary for the Veterans Benefits Administration, Allison Hickey. Locally, in the light of the VA wait scandal there were the firing of ...
... Administration's priority of supporting America's veterans and military families, as well as the objectives of... Federal Transit Administration FY 2011 Discretionary Funding Opportunity; Section 5309 Bus and Bus Facilities Veterans Transportation and Community Living Initiative AGENCY: Federal Transit Administration...
Lee A James
Full Text Available Abstract This short report investigates scale effects in family substance abuse treatment programs. In Massachusetts, the family substance abuse treatment programs were much more costly than other adult residential treatment models. State officials were concerned that the "scale" or size of these programs (averaging just eight families was too small to be economical. Although the sample size (just nine programs was too small to permit reliable inference, the data clearly signalled the importance of "scale effects" in these family substance abuse treatment programs. To further investigate scale effects in family substance abuse treatment programs, data from the Center for Substance Abuse Treatment's (CSAT's Residential Women and Children and Pregnant and Postpartum Women (RWC-PPW Demonstration were re-analyzed, focusing on the relationship between cost per family-day and the estimated average family census. This analysis indicates strong economies of scale up until an average family census of about 14, and less apparent scale effects beyond that point. In consideration of these and other study findings, a multidisciplinary interagency team redesigned the Massachusetts' family treatment program model. The new programs are larger than the former family treatment programs, with each new program having capacity to treat 11 to 15 families depending on family makeup.
Powers, Robert J.; And Others
Compared film programs on family violence and alcoholism, in an alcohol rehabilitation program. Patients (N=77) were evaluated for their reactions to the two film programs. A majority of patients rated the film program on family violence very highly, indicating a need for such interventions in alcohol rehabilitation. (JAC)
Natxo MARTÍNEZ RUEDA
Full Text Available This paper is grounded on current conceptions on Family Quality of Life (FQoL and family-centered intervention. It describes a part of the building process of a ‘Program for Supporting Family Quality of Life’, within the SAIOA-BBK frame a Gorabide’s information, guidance and support service for people with intellectual disability and their families. A major goal of this project is making proposals for professionals to fit the link between FQoL assessment and its improvement. The program was developed, constructed and tested through collaborative methods between professionals and university researchers, aiming to an increase of FQoL of families with sons or daughters among the youth and adulthood period. Program features, and how it was experimented in a pilot sample of families (n = 5 is presented.
Jarrett, Jennie B; Lounsbery, Jody L; D'Amico, Frank; Dickerson, Lori M; Franko, John; Nagle, John; Seehusen, Dean A; Wilson, Stephen A
The clinical pharmacist's role within family medicine residency programs (FMRPs) is well established. However, there is limited information regarding perceptions of program directors (PDs) about clinical pharmacy educators. The study objectives were (1) to estimate the prevalence of clinical pharmacists within FMRPs and (2) to determine barriers and motivations for incorporation of clinical pharmacists as educators. The Council of Academic Family Medicine Educational Research Alliance (CERA) distributed an electronic survey to PDs. Questions addressed formalized pharmacotherapy education, clinical pharmacists in educator roles, and barriers and benefits of clinical pharmacists in FMRPs. The overall response rate was 50% (224/451). Seventy-six percent (170/224) of the responding PDs reported that clinical pharmacists provide pharmacotherapy education in their FMRPs, and 57% (97/170) consider clinical pharmacists as faculty members. In programs with clinical pharmacists, 72% (83/116) of PDs reported having a systematic approach for teaching pharmacotherapy versus 22% (21/95) in programs without. In programs without clinical pharmacists, the top barrier to incorporation was limited ability to bill for clinical services 48% (43/89) versus 29% (32/112) in programs with clinical pharmacists. In both programs with and without clinical pharmacists, the top benefit of having clinical pharmacists was providing a collaborative approach to pharmacotherapy education for residents (35% and 36%, respectively). Less than half of FMRPs incorporate clinical pharmacists as faculty members. Despite providing collaborative approaches to pharmacotherapy education, their limited ability to bill for services is a major barrier.
... placement for senior Veterans, homeless Veterans and Veterans at risk of homelessness and their families... self-sufficiency. FOR FURTHER INFORMATION CONTACT: Edward Bradley, Office of Asset Enterprise Management (044), Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 20420, (202) 461...
Chase, Rachel P; McMahon, Shannon A; Winch, Peter J
During the Iraq and Afghanistan wars, blasts were the most common cause of combat injuries, including traumatic brain injury (TBI). Prior to 2007, service members were not systematically screened for TBI, and estimates suggest that tens of thousands of mild TBIs went undiagnosed. This study sought to understand post-acute "injury careers," documenting the life- and health-related narratives of veterans who were at high risk of undocumented TBI due to being blast-exposed before 2007. Researchers conducted 38 in-depth interviews between May 2013 and August 2014 with Army veterans who served in combat-intense settings (n = 16) and their family members (n = 10). Respondents detailed a series of experiences in the months and years following blast exposure. We present this series as a model that draws upon the vernacular of participants who described veterans "downplaying" their injuries and later "detaching" themselves from friends, family, and communities, and "denying" or being "oblivious" to their circumstances until a "wake-up call" pushed them to "get help." Looking to the future, veterans grapple with uncertainties related to personal identity and professional or social expectations. This model is presented within a member-checked metaphor of an individual being hurled into--and emerging from--a canyon. Policies and programs addressing veteran health, particularly among those exposed to multiple blasts prior to systematic TBI documentation, must consider the personal, social, and health system challenges faced by veterans and their families throughout their injury careers. Copyright © 2015 Elsevier Ltd. All rights reserved.
Damschroder, Laura J; Reardon, Caitlin M; AuYoung, Mona; Moin, Tannaz; Datta, Santanu K; Sparks, Jordan B; Maciejewski, Matthew L; Steinle, Nanette I; Weinreb, Jane E; Hughes, Maria; Pinault, Lillian F; Xiang, Xinran M; Billington, Charles; Richardson, Caroline R
The Diabetes Prevention Program (DPP) is an effective lifestyle intervention to reduce incidence of type 2 diabetes. However, there are gaps in knowledge about how to implement DPP. The aim of this study was to evaluate implementation of DPP via assessment of a clinical demonstration in the Veterans Health Administration (VHA). A 12-month pragmatic clinical trial compared weight outcomes between the Veterans Affairs Diabetes Prevention Program (VA-DPP) and the usual care MOVE!® weight management program (MOVE!). Eligible participants had a body mass index (BMI) ≥30 kg/m2 (or BMI ≥ 25 kg/m2 with one obesity-related condition), prediabetes (glycosylated hemoglobin (HbA1c) 5.7-6.5% or fasting plasma glucose (FPG) 100-125 mg/dL), lived within 60 min of their VA site, and had not participated in a weight management program within the last year. Established evaluation and implementation frameworks were used to guide the implementation evaluation. Implementation barriers and facilitators, delivery fidelity, participant satisfaction, and implementation costs were assessed. Using micro-costing methods, costs for assessment of eligibility and scheduling and maintaining adherence per participant, as well as cost of delivery per session, were also assessed. Several barriers and facilitators to Reach, Adoption, Implementation, Effectiveness and Maintenance were identified; barriers related to Reach were the largest challenge encountered by site teams. Fidelity was higher for VA-DPP delivery compared to MOVE! for five of seven domains assessed. Participant satisfaction was high in both programs, but higher in VA-DPP for most items. Based on micro-costing methods, cost of assessment for eligibility was $68/individual assessed, cost of scheduling and maintaining adherence was $328/participant, and cost of delivery was $101/session. Multi-faceted strategies are needed to reach targeted participants and successfully implement DPP. Costs for assessing patients for
Werber, Laura; Derose, Kathryn Pitkin; Rudnick, Mollie; Harrell, Margaret C.; Naranjo, Diana
Abstract Faith-based organizations (FBOs) are an important community-based resource for veterans as they readjust to civilian life. Through interviews with both national-level and smaller, local FBOs, the authors sought to understand better the current and potential roles for FBOs in veteran reintegration. Interviewees suggested that veterans may look to FBOs for support because they offer privacy and confidentiality, two features that may be especially critical when a potential stigma is involved. Some FBOs have also developed a reputation as safe places for veterans, providing supportive, judgment-free environments. FBOs not only help veterans with spiritual matters but address diverse areas of veteran health and wellness, including vocation, education, financial and legal stability, shelter, access to goods and services, mental health, access to health care, physical health, family, and social networks. In some cases, the support is offered to veterans directly; in other instances, the support is indirect, via training individuals to help veterans or educating the public about them. In the process of providing support, FBOs interact with varied organizations, including government entities, private nonprofits, and one another, for training, outreach, referrals, information exchange, obtaining donations, and collaboration. Yet challenges exist, including insufficient connections with chaplains working in different settings and others in the web of support, resource and capacity constraints, lack of awareness of experience with veterans, issues related to religious philosophy or orientation, and characteristics of veterans themselves. To move forward, the authors offer recommendations for policymakers, organizations that interact with FBOs, and FBOs themselves to help FBOs engage fully in the web of reintegration support. PMID:28083391
The population explosion has been abating since the 2nd half of the 1960s. The birth rate of the 3rd World dropped from 45/1000 during 1950-55 to 31/1000 during 1985-90. From the 1st half of the 1960s to the 1st half of the 1980s the total fertility of such countries dropped from 6.1 to 4.2 children/woman. In Taiwan, Singapore, Hong Kong, South Korea, and Malaysia living standards improved as a result of industrialization, and fertility decreased significantly. In Sri Lanka, China, North Vietnam, and Thailand the drop of fertility is explained by cultural and religious factors. In 1982 about 78% of the population of developing countries lived in 39 states that followed an official policy aimed at reducing the population. Another 16% lived in countries supporting the concept of a desired family size. However, World Bank data showed that in the mid-1980s in 27 developing countries no state family planning (FP) programs existed. India adopted an official FP program in 1952, Pakistan followed suit in 1960, South Korea in 1961, and China in 1962. In Latin America a split policy manifested itself: in Brazil birth control was rejected, only Colombia had a FP policy. In 1986 the governments of 68 of 131 developing countries representing 3.1 billion people considered the number of children per woman too high. 31 of these countries followed concrete population control policies. On the other hand, in 1986 24 countries of Africa with 40% of the continent's population took no measures to influence population growth. In Latin America and the Caribbean 18 of 33 countries were idle, except for Mexico that had a massive state FP program. These programs also improve maternal and child health with birth spacing of at least 2 years, and the prevention of pregnancies of too young women or those over 40. The evaluation of rapidly spreading FP programs in the 1970s was carried out by the World Fertility Survey in 41 countries. The impact of FP programs was more substantial than
Rotheram-Borus, Mary Jane; Swendeman, Dallas; Rotheram-Fuller, Erin; Youssef, Maryann K
Family Coaching is proposed as a new delivery format for evidence-based prevention programs (EBPPs). Three recent developments in health promotion support the potential efficacy of Family Coaching: (1) renewed interest in integrated prevention programs for multiple risk factors and behavior changes, (2) broad and long-term impacts of family-based interventions, and (3) popular acceptance of "coaching" as a nonstigmatizing, goal-focused intervention strategy. Family coaches are community members and paraprofessionals trained in common elements of EBPP. Family Coaching has specific goals, is short term, and has definable outcomes. Coaches frame the program's goals to be consistent with the family's values, normalize the family's experience, assess their strengths, and help the family set goals and develop skills and routines to problem solve challenging situations. Broad dissemination of EBPP will be facilitated with delivery formats that are flexible to meet families' priorities and providers' desires and capacities to tailor programs to local contexts.
Rait, Douglas; Glick, Ira
Objective: The authors propose a family-systems training model for general residency training programs in psychiatry based on the couples and family therapy training program in Stanford's Department of Psychiatry and Behavioral Sciences. Methods: The authors review key elements in couples and family therapy training. Examples are drawn from the…
... for VA health care services and are experiencing homelessness. VA case managers may connect these Veterans with ... Veterans who have experienced long-term or repeated homelessness. As of Sept. 30, 2015, HUD had allocated ...
Department of Veterans Affairs — This report is the first comprehensive report that chronicles the history of racial and ethnic minorities in the military and as Veterans, profiles characteristics...
Department of Veterans Affairs — This report is the first comprehensive report that chronicles the history of racial and ethnic minorities in the military and as Veterans, profiles characteristics...
... Clothing Donate a Vehicle Matching Gifts Buy PVA Gear Donate Donate Now Give Monthly Planned Giving View ... PVA1946 National Veterans Wheelchair Games App Download Now TOP Contact Us Paralyzed Veterans of America 801 Eighteenth ...
Department of Veterans Affairs — As of June 28, 2010, the Master Veteran Index (MVI) database based on the enhanced Master Patient Index (MPI) is the authoritative identity service within the VA,...
worldwide in the war on terrorism. U.S. Air Force photo by Staff Sgt. Bennie J. Davis III DCoE Real Warriors Campaign DCoE Real Warriors Campaign DCoE...Psychological Health Programs “I didn’t know where to turn, where to go.” — Brooke Warren , a former Fort Hood soldier needing assistance reintegrating post... manager with the Real Warriors Campaign. The 2011 Family Resilience Conference provided a forum for DCoE to showcase efforts to advance
B and flu vaccinations . 25 Department of Veterans Affairs, FY2014 Budget Submission, Medical Programs and Information Technology Programs, Volume 2...veterans of World War II allied nations, and employees receiving preventative occupational immunizations such as Hepatitis A&B and flu vaccinations . The...based counseling centers that provide a wide range of social and psychological services such as professional readjustment counseling to veterans who
Abbey, Antonia; Pilgrim, Colleen; Hendrickson, Peggy; Buresl, Sue
Evaluates family-based substance abuse prevention program implemented in a rural community for families with middle school students. In comparison with nonparticipants, students had higher family cohesion, less family fighting, greater school attachment, higher self-esteem, and believed alcohol should be consumed at an older age, at one-year…
Blonigen, Daniel M; Rodriguez, Allison L; Manfredi, Luisa; Britt, Jessica; Nevedal, Andrea; Finlay, Andrea K; Rosenthal, Joel; Smelson, David; Timko, Christine
The availability and utility of services to address recidivism risk factors among justice-involved veterans is unknown. We explored these issues through qualitative interviews with 63 Specialists from the Department of Veterans Affairs' (VA) Veterans Justice Programs. To guide the interviews, we utilized the Risk-Need-Responsivity (RNR) model of offender rehabilitation. Specialists reported that justice-involved veterans generally have access to services to address most RNR-based risk factors (substance abuse; lack of positive school/work involvement; family/marital dysfunction; lack of prosocial activities/interests), but have less access to services targeting risk factors of antisocial tendencies and associates and empirically-based treatments for recidivism in VA. Peer-based services, motivational interviewing/cognitive-behavioral therapy, and Veterans Treatment Courts were perceived as useful to address multiple risk factors. These findings highlight potential gaps in provision of evidence-based care to address recidivism among justice-involved veterans, as well as promising policy-based solutions that may have widespread impact on reducing recidivism in this population.
Department of Veterans Affairs — The Monthly Program Cost Report (MPCR) replaces the Cost Distribution Report (CDR). The MPCR provides summary information about Veterans Affairs operational costs,...
The assessment process can be integrated with treatment and evaluation for helping teenage suicide attempters and families in short term psychiatric hospitalization programs. The method is an extremely efficient way for the therapist to work within a given time constraint. During family assessment sufficient information can be gathered to…
Brahmi, Dalia; Dehlendorf, Christine; Engel, David; Grumbach, Kevin; Joffe, Carole; Gold, Marji
Access to abortion services in the United States is declining. While family physicians are well suited to provide this care, limited training in abortion occurs in family medicine residency programs...
... HUMAN SERVICES Health Resources and Services Administration Family-to-Family Health Information Center... Resources and Services Administration (HRSA) will be transferring the Florida Family-to-Family Health... parent-to-parent support for families with children and youth with special health care needs (CYSHCN) in...
... HUMAN SERVICES Health Resources and Services Administration Family-to-Family Health Information Center... Resources and Services Administration (HRSA) will be transferring the Vermont Family-to-Family Health... support for families with children and youth with special health care needs (CYSHCN) in the state of...
Norquist, G S; Hough, R L; Golding, J M; Escobar, J I
Prevalences of Diagnostic Interview Schedule/DSM-III psychiatric disorders for male veterans and nonveterans from four war eras were estimated using data from over 7500 male community respondents interviewed by the Epidemiologic Catchment Area program at five geographic areas across the country. Veterans serving after Vietnam (Post-Vietnam era) had greater lifetime and 6-month prevalences of psychiatric disorder than their nonveteran counterparts, whereas the reverse tended to be the case for the Vietnam, Korean, and World War II war eras. Comparisons across war eras revealed a trend for more psychiatric disorder, especially substance abuse, in younger veterans and nonveterans than in older respondents.
overall exposure of troops to Leishmania tropica? 3. What were the exposure concentrations to various petroleum products, and their combustion products...have been identified in Veterans of the 1990 – 1991 Gulf War. 3. What were the exposure concentrations to various petroleum products, and their...Research Program within CDMRP (DoD). A clinical study to examine the effects of aspirin and Clopidogrel on biomarkers of Gulf War Veterans
Foshee, Vangie A; McNaughton Reyes, Heath Luz; Ennett, Susan T; Cance, Jessica D; Bauman, Karl E; Bowling, J Michael
To examine the effects of a family-based teen dating abuse prevention program, Families for Safe Dates, primarily on outcomes related to testing the conceptual underpinnings of the program including (1) factors motivating and facilitating caregiver engagement in teen dating abuse prevention activities, and 2) risk factors for teen dating abuse, and secondarily on dating abuse behaviors. Families were recruited nationwide using listed telephone numbers. Caregivers and teens completed baseline and 3-month follow-up telephone interviews (n = 324). Families randomly allocated to treatment condition received the Families for Safe Dates program including six mailed activity booklets followed-up by health educator telephone calls. There were significant (teen dating abuse prevention activities including caregiver perceived severity of dating abuse, response efficacy for preventing dating abuse, self-efficacy for talking about dating abuse, knowledge of dating abuse, acceptance of dating abuse, communication skills with the teen, and belief in the importance of involvement in their male (but not female) teen's dating. The latter effect was the only one moderated by sex of the teen. The targeted risk factor affected by the program was teen acceptance of dating abuse. Treatment was also significantly associated with less physical dating abuse victimization. Modifications to the program are warranted, but overall, the findings are very favorable for the first family-based teen dating abuse prevention program to be evaluated. Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Kitzman-Ulrich, Heather; Wilson, Dawn K.; St. George, Sara M.; Lawman, Hannah; Segal, Michelle; Fairchild, Amanda
Rates of overweight in youth have reached epidemic proportions and are associated with adverse health outcomes. Family-based programs have been widely used to treat overweight in youth. However, few programs incorporate a theoretical framework for studying a family systems approach in relation to youth health behavior change. Therefore, this review provides a family systems theory framework for evaluating family-level variables in weight loss, physical activity, and dietary approaches in yout...
Yaffe, Diane; Williams, Cheri Lynn
Finds that the supportive environment of "women helping women" was the hallmark characteristic of a local Even Start family literacy program and that participants were not consciously thinking about family literacy but joined the program for themselves and gave no indication of seeing the connection between the adult literacy component…
Full Text Available Studies aiming to identify if war veterans are at higher risk of suicide have often produced inconsistent results; this could be due to the complexity of comparisons and different methodological approaches. It should be noted that this contingent has many risk factors, such as stressful exposures, wounds, brain trauma and pain syndrome. Most recent observations confirm that veterans are really more likely to die of suicide as compared to the general population; they are also more likely to experience suicidal ideation and suffer from mental health problems. Suicides are more frequent in those who develop PTSD, depression and comorbid states due to war exposure. Combat stress and its’ frequency may be an important factor leading to suicide within the frame of the stress-vulnerability model. According to this model, the effects of stress may interact with social factors, interpersonal relations and psychological variables producing suicidal tendencies. Modern understanding of stress-vulnerability mechanisms based on genetic predispositions, early life development, level of exposure to stress and stress-reactivity together with interpersonal aspects may help to build more effective suicide prevention programs based on universal/selective/indicated prevention principles.
Rozanov, Vsevolod; Carli, Vladimir
Studies aiming to identify if war veterans are at higher risk of suicide have often produced inconsistent results; this could be due to the complexity of comparisons and different methodological approaches. It should be noted that this contingent has many risk factors, such as stressful exposures, wounds, brain trauma and pain syndrome. Most recent observations confirm that veterans are really more likely to die of suicide as compared to the general population; they are also more likely to experience suicidal ideation and suffer from mental health problems. Suicides are more frequent in those who develop PTSD, depression and comorbid states due to war exposure. Combat stress and its’ frequency may be an important factor leading to suicide within the frame of the stress-vulnerability model. According to this model, the effects of stress may interact with social factors, interpersonal relations and psychological variables producing suicidal tendencies. Modern understanding of stress-vulnerability mechanisms based on genetic predispositions, early life development, level of exposure to stress and stress-reactivity together with interpersonal aspects may help to build more effective suicide prevention programs based on universal/selective/indicated prevention principles. PMID:22851956
McWey, Lenore M; Humphreys, Julie; Pazdera, Andrea L
The purpose of this study was to conduct an action-oriented evaluation of an in-home family therapy program serving families deemed at risk for the placement of children in foster care. In this study, feedback was solicited from both clients and therapists. Results indicate "duality" associated with several aspects of in-home family therapy, including the opportunity to observe families in their own homes versus the vulnerability some families feel when therapy is conducted in-home; therapists suggesting that sufficient training is required for in-home family therapy to be effective versus clients' opinions that therapists' lived experiences are more relevant; and the importance of the therapeutic alliance versus feelings of abandonment upon termination. Implications for researchers and practitioners are discussed. © 2009 American Association for Marriage and Family Therapy.
J.E. Drummond; A.E. Weir; G.M. Kysela
... home visitation for at-risk young families as the major delivery method. Objectives: To describe the program components, practices, outcomes, and reliability of the evaluation approaches. Methods...
... AFFAIRS Notice of Funds Availability Inviting Applications for Grants for Transportation of Veterans in... deadline for funds available under the Grant Program for Transportation of Veterans in Highly Rural Areas..., Highly Rural Transportation Grants, Veterans Transportation Program, Chief Business Office (10NB2G), 2957...
Lacasse, Miriam; Ratnapalan, Savithiri
To review the literature on teaching-skills training programs for family medicine residents and to identify formats and content of these programs and their effects. Ovid MEDLINE (1950 to mid-July 2008) and the Education Resources Information Center database (pre-1966 to mid-July 2008) were searched using and combining the MeSH terms teaching, internship and residency, and family practice; and teaching, graduate medical education, and family practice. The initial MEDLINE and Education Resources Information Center database searches identified 362 and 33 references, respectively. Titles and abstracts were reviewed and studies were included if they described the format or content of a teaching-skills program or if they were primary studies of the effects of a teaching-skills program for family medicine residents or family medicine and other specialty trainees. The bibliographies of those articles were reviewed for unidentified studies. A total of 8 articles were identified for systematic review. Selection was limited to articles published in English. Teaching-skills training programs for family medicine residents vary from half-day curricula to a few months of training. Their content includes leadership skills, effective clinical teaching skills, technical teaching skills, as well as feedback and evaluation skills. Evaluations mainly assessed the programs' effects on teaching behaviour, which was generally found to improve following participation in the programs. Evaluations of learner reactions and learning outcomes also suggested that the programs have positive effects. Family medicine residency training programs differ from all other residency training programs in their shorter duration, usually 2 years, and the broader scope of learning within those 2 years. Few studies on teaching-skills training, however, were designed specifically for family medicine residents. Further studies assessing the effects of teaching-skills training in family medicine residents are
Full Text Available ... Hands PSA see more videos from Veterans Health Administration I am A Veteran Family/Friend Active Duty/Reserve and Guard Signs of Crisis Identifying Take a Self-Check Quiz Resources Spread the Word Videos Homeless Resources Additional Information ...
... Loan Program; 64.127, Monthly Allowance for Children of Vietnam Veterans Born with Spina Bifida; and 64... Disabled Veterans and Members of the Armed Forces; 64.101, Burial Expenses Allowance for Veterans; 64.103..., Pension to Veterans Surviving Spouses, and Children; 64.106, Specially Adapted Housing for Disabled...
Tsai, Jack; Rosenheck, Robert A.
Homelessness among US veterans has been a focus of research for over 3 decades. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this is the first systematic review to summarize research on risk factors for homelessness among US veterans and to evaluate the evidence for these risk factors. Thirty-one studies published from 1987 to 2014 were divided into 3 categories: more rigorous studies, less rigorous studies, and studies comparing homeless veterans with homeless nonveterans. The strongest and most consistent risk factors were substance use disorders and mental illness, followed by low income and other income-related factors. There was some evidence that social isolation, adverse childhood experiences, and past incarceration were also important risk factors. Veterans, especially those who served since the advent of the all-volunteer force, were at greater risk for homelessness than other adults. Homeless veterans were generally older, better educated, and more likely to be male, married/have been married, and to have health insurance coverage than other homeless adults. More studies simultaneously addressing premilitary, military, and postmilitary risk factors for veteran homelessness are needed. This review identifies substance use disorders, mental illness, and low income as targets for policies and programs in efforts to end homelessness among veterans. PMID:25595171
Tsai, Jack; Rosenheck, Robert A
Homelessness among US veterans has been a focus of research for over 3 decades. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this is the first systematic review to summarize research on risk factors for homelessness among US veterans and to evaluate the evidence for these risk factors. Thirty-one studies published from 1987 to 2014 were divided into 3 categories: more rigorous studies, less rigorous studies, and studies comparing homeless veterans with homeless nonveterans. The strongest and most consistent risk factors were substance use disorders and mental illness, followed by low income and other income-related factors. There was some evidence that social isolation, adverse childhood experiences, and past incarceration were also important risk factors. Veterans, especially those who served since the advent of the all-volunteer force, were at greater risk for homelessness than other adults. Homeless veterans were generally older, better educated, and more likely to be male, married/have been married, and to have health insurance coverage than other homeless adults. More studies simultaneously addressing premilitary, military, and postmilitary risk factors for veteran homelessness are needed. This review identifies substance use disorders, mental illness, and low income as targets for policies and programs in efforts to end homelessness among veterans. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.
... VETERANS AFFAIRS (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Temporary Program of Vocational... Coordination with the Veterans Service Center. It is the responsibility of the VR&E Division to inform the...
... AFFAIRS 38 CFR Part 9 RIN 2900-AO42 Servicemembers' Group Life Insurance and Veterans' Group Life... Insurance (SGLI), Family SGLI, SGLI Traumatic Injury Protection, and Veterans' Group Life Insurance (all...-AO42 Servicemembers' Group Life Insurance and Veterans' Group Life Insurance Information Access...
Mayberry, Lindsay S.; Shinn, Marybeth; Benton, Jessica Gibbons; Wise, Jasmine
Maintenance of family processes can protect parents, children, and families from the detrimental effects of extreme stressors, such as homelessness. When families cannot maintain routines and rituals, the stressors of poverty and homelessness can be compounded for both caregivers and children. However, characteristics of living situations common among families experiencing homelessness present barriers to the maintenance of family routines and rituals. We analyzed 80 in-depth interviews with ...
Investigates the needs, as perceived by the offender, of families with incarcerated individuals. Seeks to determine inmates' family and parenting issues and concerns, and to assess their interest in formal and informal family services. Results demonstrate that although male and female inmates have different concerns, both seem to value their…
Mace, K C; Holm, C E; Lipsky, M S; Bartscht, K G
On Match Day in 1991, Broadlawns Medical Center in Des Moines, Iowa, learned that no residents had matched for the family practice residency program. In the 1992 match, the medical center filled all its residency positions, and repeated the success in the 1993 and 1994 matches. Broadlawns affected this impressively rapid turnaround through a strong commitment to bring its program to a level competitive with leading family practice residency programs, substantive changes to the structure and curriculum of the program, and significant expenditures of time, resources and personal energy. The Broadlawns' case illustrates the need for family practice residency programs to position themselves as strong competitors in the residency market.
Saulo Lacerda Borges de Sá
Full Text Available Objective: To assess the knowledge and satisfaction of users of a Basic Health Unit about the strategy of embracement. Methods: Descriptive study with qualitative approach, carried out in a Basic Health Unit, Fortaleza, Brazil, where practical activities of the Education Program of Work for Health of the University of Fortaleza were performed. Fifty eight service users were involved, following inclusion criteria: being present during the data collection, age over 18, regardless of sex, and voluntary participation. Data collection occurred in December 2009, through semi-structured interview. The data associated with the identification of users were processed in Microsoft Office Excel 2007, being organizedstatistically in table. Data related to qualitative aspects were analyzed according to the technique of content analysis. Results: 56 (97% were women, with ages ranging between 21 and 40 years, 34 (59% were married and 53 (91% are literate. On family income, 55 (95%received less than two minimum salaries per month. In order to facilitate understanding the speech of users, these were evaluated from the perspective of two categories: knowledge about embracement and satisfaction with embracement. Conclusion: Users have a limited view of the significance and magnitude of the embracement to provide the care. Although satisfied with the service, respondents report as negative aspects: the shortage of professionals, the professional relationship with user impaired due to constant delays of the professional, and the dehumanization of care.
Gray, S W; Ruttle, K
Designed and tested a home-based intervention program for low-income mothers with toddler and at least one other child under five. Sex of toddlers and race (black or white) about equally divided. Nine months of weekly home visits were specifically planned for each mother to enhance her effectiveness as an educational change agent. Treatment was planned to promote skills and understandings applicable over range of ages. Pretests, immediate posttests, and posttests one and two years later were administered to 27 experimental families and to a randomly assigned control group of 20. At .05 level of significance or beyond, experimentals excelled controls on receptive language test (toddler), on the Caldwell HOME (mother was indirectly rated as an educational change agent), and on a measure of teaching style (mother). They were also significantly superior on the Binet (toddler) at second posttest. No differences found with older siblings on Slosson Intelligence Test. Differences at third posttest were at least as great as earlier ones on mother measures. Relationships among child and mother measures are discussed.
Sung, Minjung; Park, Jiyeon
In this study, a family support program was carried out for primary caregivers of children with disabilities. The program included respite care, recreation programs, counseling, and social support coordination based on individual needs of each family. In order to verify the intervention effects, parenting stress and family quality of life were…
Peterson, Erica L; McGlothlin, James D; Blue, Carolyn L
Nursing assistants (NAs) who work in nursing and personal care facilities are twice and five times more likely, respectively, to suffer a musculoskeletal disorder compared to service industries and other health care facilities, respectively. The purpose of this study was to develop an ergonomics training program for selected NAs at a state-run veterans' home to decrease musculoskeletal disorders by 1) developing questionnaires to assess musculoskeletal stress, 2) evaluating the work environment, 3) developing and using a training package, and 4) determining the application of the information from the training package by NAs on the floor. Results show two new risk factors not previously identified for nursing personnel in the peer-reviewed literature. Quizzes given to the nursing personnel before and after training indicated a significant improvement in understanding the principles of ergonomics and patient-handling techniques. Statistical analysis comparing the pre-training and post-training questionnaires indicated no significant decrease in musculoskeletal risk factors and no significant reduction in pain or discomfort or overall mental or physical health.
...-sufficiency. FOR FURTHER INFORMATION CONTACT: Edward Bradley, Office of Asset Enterprise Management (044... placement for homeless Veterans and Veterans at risk of homelessness and their families; and provide a...
... placement for senior, disabled, homeless and/or at-risk Veterans and their families. FOR FURTHER INFORMATION CONTACT: Edward Bradley, Office of Asset Enterprise Management (044), Department of Veterans Affairs, 810...
... From the Federal Register Online via the Government Publishing Office ] DEPARTMENT OF EDUCATION Federal Perkins Loan Program: Federal Family Education Loan Program and William D. Ford Federal Direct... (FFEL), and William D. Ford Federal Direct Loan (Direct Loan) program loans repaid by the Secretary...
DaWalt, Leann Smith; Greenberg, Jan S.; Mailick, Marsha R.
Currently there are few evidence-based programs available for families of individuals with ASD during the transition to adulthood. The present study provided a preliminary evaluation of a multi-family group psychoeducation intervention using a randomized waitlist control design (n = 41). Families in the intervention condition participated in…
Lambert, Ashley Nehrt
Research has shown that behaviors associated with Autism Spectrum Disorder (ASD) are a consistent source of stress on the family unit. Given the increased amount of stress that families endure and the importance of the family unit to the child with ASD, treatment programs should not only take the child with ASD's needs into account, but also the…
Al, C.M.W.; Stams, G.J.J.M.; Asscher, J.J.; van der Laan, P.H.
This study evaluated the Family Crisis Intervention Program (FCIP), focusing on crisis, child safety, family functioning and child behaviour problems. Questionnaires were completed by 183 families in crisis and their FCIP worker. After FCIP, the crisis had decreased and child safety had increased.
Carek, Peter J; Anim, Tanya; Conry, Colleen; Cullison, Sam; Kozakowski, Stan; Ostergaard, Dan; Potts, Stacy; Pugno, Perry A
Residency programs have been integral to the development, expansion and progression of family medicine as a discipline. Three reports formed the foundation for graduate medical education in family medicine: Meeting the Challenge of Family Practice, The Graduate Education of Physicians, and Health is a Community Affair. In addition, the original core concepts of comprehensiveness, coordination, continuity, and patient centeredness continue to serve as the foundation for residency training in family medicine. While the Residency Review Committee for Family Medicine of the Accreditation Council for Graduate Medical Education has provided the requirements for training throughout the years, key organizations including the Society of Teachers of Family Medicine, the American Academy of Family Physicians, the Association of Family Medicine Residency Directors, and the American Board of Family Medicine have provided resources for and supported innovation in programs. Residency Program Solutions, National Institute for Program Director Development, and Family Medicine Residency Curriculum Resource are several of the resources developed by these organizations. The future of family medicine residency training should continue the emphasis on innovation and development of resources to enhance the training of residents. Areas for further development include leadership and health care systems training that allows residents to assume leadership of multidisciplinary health care teams and increase focus on the family medicine practice population as the main unit for resident education.
Sirin, Hatice Deveci; Deniz, M. Engin
This study aims to investigate the effect of Modules 2 and 3 of the Family Communication Section of the Family Training Program as prepared by the Ministry of Family and Social Policies on married women's couple-burnout levels. The study group consists of 40 married women in total: 20 constituting the experimental group and the remaining 20…
DCoE Family Initiatives Sesame Street: Talk, Listen, Connect Sesame Street’s Talk, Listen, Connect, is a bilingual educational outreach initiative...and early childhood professionals offer some tips and strategies for families. Operation Parenting Edge These brochures focus on the unique...Early Childhood Univ. of Minnesota’s Children, Youth and Family Consortium: Early Childhood addresses individual, family and
Ohl, Michael E; Richardson, Kelly; Kaboli, Peter J; Perencevich, Eli N; Vaughan-Sarrazin, Mary
Rural-dwelling persons with HIV infection often have limited access to HIV specialty care, and they may instead use more nearby primary care. This study described use of infectious disease (ID) specialty and general primary care services among rural compared with urban veterans with HIV in the United States and determined associations between geographic access to ID and primary care and use of care. The sample included all veterans in the national Veterans Administration (VA) HIV clinical case registry in 2009 (N = 23,669, 10.2% rural). Geographic access was measured by calculating travel times to the nearest VA primary care and ID specialty clinic. Rural veterans were less likely than urban to use ID clinics (82% of rural vs 87% of urban, P shared care" relationships with distant primary care providers. © 2014 National Rural Health Association.
Kypraiou, Aspa; Sarafis, Pavlos; Tsounis, Andreas; Bitsi, Georgia; Andreanides, Elias; Constantinidis, Theodoros; Kotrotsiou, Evaggelia; Malliarou, Maria
Retirement is a turning point in human life, resulting in changes to physical and mental health status. The aim of this study was to examine the factors that are related with depression and anxiety symptoms in Greek male veterans after retirement. A total of 502 veterans participated in a cross-sectional study. Beck Depression Inventory for depression assessment and Spielberger Trait Anxiety Inventory for anxiety assessment were used. The Ethics Committee of the Technological Educational Institution of Thessaly granted permission for conducting the research, and informed consent was obtained from all the participants. Questionnaires were filled in electronically using a platform that was made for the specific research. Mean values, standard deviations, Student t test, nonparametric cluster analysis of variance, Pearson's and Spearman's coefficients, and linear regression were conducted, using the Statistical Program for Social Services version 19.0. Severe depression was found in 3.8% of veterans with a mean score of 6.78, whereas 23.2% displayed mild-to-moderate symptoms of depression. Mean score of state anxiety was found to be 36.55 and of trait anxiety 33.60. Veterans who were discharged because of stressful working conditions, those who have a high body mass index, consume regularly alcohol, smoke and were not satisfied by changes in their everyday life after retirement had significantly more symptoms of depression and anxiety, although those who retired because of family problems had significantly more symptoms of depression. Multivariate linear regression analyses indicated that dissatisfaction related to lifestyle changes had statistically significant effect on symptoms of depression and anxiety, and stressful working conditions as a leading cause for retirement had statistically significant effect on depression. Finally, according to linear regression analyses results, those who were satisfied with their professional evolution had 1.80 times lower score in
Cavaleri, Mary A.; Olin, S. Serene; Kim, Annie; Hoagwood, Kimberly E.; Burns, Barbara J.
We conducted a review of empirically based prevention programs to identify prevalence and types of family support services within these programs. A total of 238 articles published between 1990 and 2011 that included a family support component were identified; 37 met criteria for inclusion. Following the Institute of Medicine's typology, prevention…
Kitzman-Ulrich, Heather; Wilson, Dawn K.; St. George, Sara M.; Lawman, Hannah; Segal, Michelle; Fairchild, Amanda
Rates of overweight in youth have reached epidemic proportions and are associated with adverse health outcomes. Family-based programs have been widely used to treat overweight in youth. However, few programs incorporate a theoretical framework for studying a family systems approach in relation to youth health behavior change. Therefore, this…
Rusell, Candyce S.; Peterson, Colleen M.
This research addresses the extent of student impairment in Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) accredited marriage and family therapy programs, indicators of impairment used by program directors, faculty time devoted to impaired students, and the frequency of student dismissal. The data come from a…
... URBAN DEVELOPMENT Housing Choice Voucher (HCV) Family Self-Sufficiency (FSS) Program AGENCY: Office of... independence and self- sufficiency. Housing agencies consult with local officials to develop an Action Plan... Title of Proposal: Housing Choice Voucher (HCV) Family Self- Sufficiency (FSS) Program. OMB Approval...
Gall, Joseph A.
This study sought to understand how the Army Family Team Building program influences self-reliance and self-sufficiency in Army spouses as they integrate into the Army community. The purpose of the Army Family Team Building program is to empower Army spouses with knowledge and skills, which foster well-being and improve quality of life. The…
... 34 Education 3 2010-07-01 2010-07-01 false The Federal Family Education Loan programs. 682.100 Section 682.100 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION FEDERAL FAMILY EDUCATION LOAN (FFEL) PROGRAM Purpose and Scope...
Blumberg, Daniel M.; Griffin, Dawn A.
This article introduces a successful reading program, Family Connections, for incarcerated parents and their children. A comprehensive review of the literature supports the need to implement prison programs from an ecological perspective, in which the needs of inmates and their families are considered. More specifically, the benefits of directing…
Kathleen B. Jager
Full Text Available Healthy Kids, Healthy Families is a program of outreach and research that has been developed to address treatment and prevention of the childhood obesity epidemic through a family-centered, multidisciplinary approach. The American Dietetic Association recommends community-based and environmental interventions as the most feasible methods to support healthful lifestyles for the greatest numbers of children and families (Ritchie, Crawford, Hoelscher, & Sothern, 2006. Healthy Kids, Healthy Families was developed as an innovative, collaborative program to help children and families maintain healthy weight, through impacting the systemic medical and psychosocial aspects of overweight in children. The program involves in-home, family-based intervention followed by multi-family group education and community outreach.
... Continues Support of National Campaign to End Veteran Homelessness Nov. 14, 2017 This Veterans Day, Harbor Freight ... support of the national campaign to end veteran homelessness through generous contributions to the National Coalition for ...
Department of Veterans Affairs — The spreadsheet of Korean War Veterans by State includes the total Korean War Veteran population for each state and broken out by age and gender. It also includes...
Yoon, Jean; Vanneman, Megan E; Dally, Sharon K; Trivedi, Amal N; Phibbs, Ciaran S
To examine how dual coverage for nonelderly, low-income veterans by Veterans Affairs (VA) and Medicaid affects their demand for care. Veterans Affairs utilization data and Medicaid Analytic Extract Files. A retrospective, longitudinal study of VA users prior to and following enrollment in Medicaid 2006-2010. Veterans Affairs reliance, or proportion of care provided by VA, was estimated with beta-binomial models, adjusting for patient and state Medicaid program factors. In a cohort of 19,890 nonelderly veterans, VA utilization levels were similar before and after enrolling in Medicaid. VA outpatient reliance was 0.65, and VA inpatient reliance was 0.53 after Medicaid enrollment. Factors significantly associated with greater VA reliance included sociodemographic factors, having a service-connected disability, comorbidity, and higher state Medicaid reimbursement. Factors significantly associated with less VA reliance included months enrolled in Medicaid, managed care enrollment, Medicaid eligibility type, longer drive time to VA care, greater Medicaid eligibility generosity, and better Medicaid quality. Veterans Affairs utilization following new Medicaid enrollment remained relatively unchanged, and the VA continued to provide the large majority of care for dually enrolled veterans. There was variation among patients as Medicaid eligibility and other program factors influenced their use of Medicaid services. © Health Research and Educational Trust.
Gertler, Paul; Levine, David I; Moretti, Enrico
Families in developing countries face enormous financial risks from major illness both in terms of the cost of medical care and the loss in income associated with reduced labor supply and productivity. We test whether access to microfinancial savings and lending institutions helps Indonesian families smooth consumption after declines in adult health. In general, results support the importance of these institutions in helping families to self-insure consumption against health shocks.
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Shen, Chen; Wan, Alice; Kwok, Lit Tung; Pang, Sally; Wang, Xin; Stewart, Sunita M; Lam, Tai Hing; Chan, Sophia Siu Chee
Family communication is important to maintain family relationships and family well-being. To enhance family communication and family well-being, a community-based "Learning Families Project," based on the social ecological model was developed in Kwun Tong in Hong Kong, a district with high prevalence of family problems. This quasi-experimental study included two nearby government subsidized low-rent housing estates separated by busy main roads, as the intervention [Tsui Ping (South) Estate] and control (Shun Tin Estate) estate. The main intervention was resident training programs, such as talks, day camps, and thematic activities. No program was implemented in the control estate. Participants in the intervention group received assessments before the intervention (T1), immediately after the intervention (T2), and 6 weeks after the intervention (T3). Control group participants were assessed at baseline (March to April 2011) and follow-up (December 2011 to March 2012). Assessments of family communication (time and perceived adequacy) and family well-being (harmony, happiness, and health) at T1 and T3 were obtained in the intervention group to examine within-group changes. In addition, these differences in outcomes in the intervention group were compared with those in the control group to examine the effectiveness of the intervention. Family communication time and perceived communication adequacy increased significantly in the intervention group ( n = 515) with a small effect size (Cohen effect d : 0.10 and 0.24, respectively). Compared with the control group ( n = 476), the improvements in family communication time and perceived communication adequacy (Cohen effect d : 0.13 and 0.14, respectively), and perceived family harmony and happiness (Cohen effect d : 0.12 and 0.12, respectively) were significantly greater in the intervention group, adjusting for age and education, suggesting the intervention was effective in improving family communication and
Full Text Available ... see more videos from Blue Star Families These Hands PSA see more videos from Veterans Health Administration ... Line text-messaging service does not store mobile phone numbers of users who access information via text ...
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Beamish, Patricia; Navin, Sally
This document presents a review of the literature on salient ethical issues in marriage and family counseling. Issues addressed in the paper include: (1) defining the client and the welfare and rights of individuals versus those of the family system; (2) issues of informed consent and manipulative therapeutic interventions; (3) issues related to…
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Danucalov, M. A. D.; Kozasa, E. H.; Ribas, K. T.; Galdur?z, J. C. F.; Garcia, M. C.; Verreschi, I. T. N.; Oliveira, K. C.; Romani de Oliveira, L.; Leite, J. R.
Familial caregivers of patients with Alzheimer's disease exhibit reduced quality of life and increased stress levels. the aim of this study was to investigate the effects of an 8-week yoga and compassion meditation program on the perceived stress, anxiety, depression, and salivary cortisol levels in familial caregivers. A total of 46 volunteers were randomly assigned to participate in a stress-reduction program for a 2-month period (yoga and compassion meditation program-YCMP group) (n = 25) ...
Corea V, M Loreto; Zubarew G, Tamara; Valenzuela M, M Teresa; Salas P, Francisca
"Strong Families" is a family program aimed at preventing risk behaviors in adolescents from 10 to 14 years of age. It has been developed by the Pan American Health Organization (PAHO/WHO) and is based on the Iowa Strengthening Families Program. This program has been certified and has been proven to effectively prevent adolescent drug and alcohol abuse in several countries around the globe. To evaluate the Strong Families Program toward adjusting current parenting styles, aiming to decrease risk behaviors in Chilean adolescents. A quasi-experimental study involving 120 families, selected from 6 schools within the Metropolitan Region of Santiago, Chile. A group of 129 adolescents and 124 parents were chosen by convenience to be intervened. A control group of 223 adolescents and 165 parents were not intervened. The families that underwent intervention attended to 7 educational sessions. The intervened and control groups were evaluated before intervention as well as 6 months after intervention, by means of self-administered evaluation tools. The intervened parents showed significant parenting changes six months after intervention, which resulted in less yelling (p = 0.007), insults (p = 0.002) and lack of control when their children misbehaved (p = 0.008). Regarding the risk behaviors in the intervened and control adolescents, no changes were observed in terms of the consumption rate of tobacco, alcohol or illegal drug use, or in sexual risk behaviors. After six months of intervention, the Program proved to be effective in modifying parenting styles. However, no changes were observed in risk behaviors among adolescents, which could occur within a longer period of time, as reported in other studies.
Eck, Kaitlyn; Alleman, Gayle Povis; Quick, Virginia; Martin-Biggers, Jennifer; Hongu, Nobuko; Byrd-Bredbenner, Carol
Community family educators have the opportunity to incorporate childhood obesity prevention concepts in their programming with families of young children, but often lack formal health and nutrition education. The purpose of this feasibility study was to create an online training certificate program for community family educators and assess the program's effectiveness at improving participant's knowledge, attitudes, and intended and actual behaviors related to healthy lifestyles. Community family educators (n = 68) completed an online pretest, viewed 13 brief videos (8-15 min) focused on childhood obesity related topics and took mini-knowledge self-checks after each video followed by an online posttest. At posttest, paired t tests showed participants' childhood obesity prevention related knowledge (i.e., nutrition, physical activity, screen time and sleep) improved significantly (p family meals, physical activity, screen time control and parent modeling significantly (p family educators' knowledge, attitudes, and intentions for obesity-prevention related parenting practices.
Full Text Available Abstract Secondary stroke prevention is championed by the stroke guidelines; however, it is rarely systematically delivered. We sought to develop a locally tailored, evidence-based secondary stroke prevention program. The purpose of this paper was to apply intervention mapping (IM to develop our locally tailored stroke prevention program and implementation plan. We completed a needs assessment and the five Steps of IM. The needs assessment included semi-structured interviews of 45 providers; 26 in Indianapolis and 19 in Houston. We queried frontline clinical providers of stroke care using structured interviews on the following topics: current provider practices in secondary stroke risk factor management; barriers and needs to support risk factor management; and suggestions on how to enhance secondary stroke risk factor management throughout the continuum of care. We then describe how we incorporated each of the five Steps of IM to develop locally tailored programs at two sites that will be evaluated through surveys for patient outcomes, and medical records chart abstraction for processes of care.
Schmid, Arlene A; Andersen, Jane; Kent, Thomas; Williams, Linda S; Damush, Teresa M
Secondary stroke prevention is championed by the stroke guidelines; however, it is rarely systematically delivered. We sought to develop a locally tailored, evidence-based secondary stroke prevention program. The purpose of this paper was to apply intervention mapping (IM) to develop our locally tailored stroke prevention program and implementation plan. We completed a needs assessment and the five Steps of IM. The needs assessment included semi-structured interviews of 45 providers; 26 in Indianapolis and 19 in Houston. We queried frontline clinical providers of stroke care using structured interviews on the following topics: current provider practices in secondary stroke risk factor management; barriers and needs to support risk factor management; and suggestions on how to enhance secondary stroke risk factor management throughout the continuum of care. We then describe how we incorporated each of the five Steps of IM to develop locally tailored programs at two sites that will be evaluated through surveys for patient outcomes, and medical records chart abstraction for processes of care.
More than a few pediatric nurses experience difficulty in communicating with children's family members. However, effective means of providing communication support for pediatric nurses have not been examined sufficiently. This study aimed to develop and implement a communication support program for nurses to facilitate improved communication with families of hospitalized children, and to clarify changes in nurses' recognition and behavior toward communication with families in clinical settings. The program lasted 6 months and consisted of lectures, role-play, 4 communication models in which nurses experienced difficulty communicating with family members, and continued individual support. The effects of the program were evaluated qualitatively and descriptively using semi-structured interviews. A total of 7 nurses with less than 5 years of pediatric nursing experience completed the program. Subsequent to program completion, nurses' awareness of careful communication with families increased, and they began to approach families actively using thoughtful words. Furthermore, as nurses received favorable reactions from families, they realized that communication was interactive and recognized that their perception of their communication skills as poor had changed. This program could contribute in reducing nurses' difficulty in communicating with families and encourage them to improve their communication.
Simoneau, T L; Miklowitz, D J; Richards, J A; Saleem, R; George, E L
Family psychoeducational programs are efficacious adjuncts to pharmacotherapy for patients with schizophrenic and bipolar disorders, but little is known about what these programs change about families. The authors assessed changes in face-to-face interactional behavior over 1 year among families of bipolar patients who received a 9-month family-focused psychoeducational therapy (FFT; n = 22) or crisis management with naturalistic follow-up (CMNF; n = 22), both administered with maintenance pharmacotherapy. Members of families who received FFT showed more positive nonverbal interactional behavior during a 1-year posttreatment problem-solving assessment than families who received CMNF, although no corresponding decreases were seen in negative interactional behaviors. The positive effect of family treatment on patients' symptom trajectories over 1 year was partially mediated by increases in patients' positive nonverbal interactional behaviors during this same interval.
Olenick, Maria; Flowers, Monica; Diaz, Valerie J
United States veterans are a multifaceted population with a distinct culture that includes, but is not limited to, values, customs, ethos, selfless duty, codes of conduct, implicit patterns of communication, and obedience to command. Veterans experience mental health disorders, substance use disorders, post-traumatic stress, and traumatic brain injury at disproportionate rates compared to their civilian counterparts. Eighteen to 22 American veterans commit suicide daily and young veterans aged 18-44 are most at risk. Health care professionals must be aware of patients' military history and be able to recognize suicide-risk factors, regardless of age. Advancement in medical technology has allowed servicemen to survive their injuries but, for many, at the cost of a traumatic limb amputation and associated mental scarring. Health care professionals must be able to address physical safety concerns, as well as, emotional health of veterans. Approximately 49,933 American veterans are homeless and face the same difficulties as non-veterans in addition to service-related matters. Separation from military service and issues related to complex multiple deployments are among specifically identified veteran issues. Successful veteran reintegration into civilian life rests upon providing veterans with training that builds on their military knowledge and skill, employment post-separation from service, homelessness prevention, and mental health programs that promote civilian transition. Preparing health care providers to meet the complex needs of a vast veteran population can be facilitated by implementing veteran content into curricula that includes veteran patient simulations and case studies, and utilizes veteran clinical faculty.
One in three veterans has arthritis. This podcast provides information on how veterans can improve their quality of life with physical activity and other arthritis management strategies. Created: 11/9/2015 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). Date Released: 11/9/2015.
... such programs and activities. The agenda will include overviews of the Veterans Health Administration..., military sexual trauma, the claims process, and homeless initiatives for women Veterans. No time will be... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS...
... such programs and activities. The agenda will include overviews of the Veterans Health Administration..., the claims process, and homeless initiatives for women Veterans. No time will be allocated at this... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS...
Gonzalez, Gabriella C.; Miller, Laura L.; Buryk, Peter; Wenger, Jennie W.
This testimony was presented before the House Veterans' Affairs Committee, Subcommittee on Economic Opportunity on March 17, 2015. To inform the Subcommittee hearing on the Department of Veterans Affairs' administration of its education programs, and the educational and training needs of post-9/11 veterans, the presenters offered the statement in…
... AFFAIRS Veterans Health Administration Fund Availability Under the VA's Homeless Providers Grant and Per... continue to deliver services to the homeless Special Need veteran population as outlined in their FY 2009.... Quarles, Director, VA's Homeless Providers GPD Program, Department of Veterans Affairs, 10770 N. 46th...
...." The Mexico City policy denies U.S. funds to foreign nongovernmental organizations (NGOs) that perform or promote abortion as a method of family planning -- even if the activities are undertaken with non-U.S. funds...
Full Text Available The leaders of youth programs encounter a range of challenging situations that involve youth’s parents or families. This qualitative study obtained data on the variety and nature of these family-related “dilemmas of practice.” Longitudinal interviews with leaders of 10 high quality programs for high-school-aged youth yielded narrative information on a sample of 32 family dilemmas that they had encountered. Grounded theory analysis identified four categories of family dilemmas: 1 problems at home that become a concern to the leader, 2 parents’ expectations are incongruent with program norms or functioning, 3 parents do not support youth’s participation in the program or an aspect of the program, and 4 communicating with parents on sensitive matters. Each of these categories of dilemmas entailed distinct considerations and underlying issues that effective leaders need to be able to understand.
Rosenblum, Kate; Muzik, Maria; Waddell, Rachel; Thompson, Stephanie; Rosenberg, Lauren; Masini, Gabriella; Smith, Karen
Military families frequently display remarkable resilience in the face of significant challenges, and yet deployment and parental separation are significant stressors for parents, particularly those with infants and young children. The Strong Military Families preventive intervention is a multifamily parenting and self-care skills group that aims…
Cretzmeyer, Margaret; Moeckli, Jane; Liu, William Ming
Since 2009, the U.S. Veterans Administration has made concentrated efforts to end homelessness among veterans. As part of these efforts, the Iowa City, Iowa, VA Health Care System in collaboration with local community providers deployed a supportive housing program aimed at homeless veterans. Called the Lodge program, it is intended to serve a Mid-Western mid-size city and its surrounding rural communities. This article presents qualitative findings from a mixed-method, two-year formative evaluation of the Lodge's implementation. Primary barriers to the effectiveness of the Lodge program were regulations hindering cooperation between service programs, followed by problems regarding information sharing and client substance abuse. Facilitators included personal communication and cooperation between individuals within and among service groups. The feasibility of implementing a Lodge program in a more rural community than Iowa City was also discussed.
Pomernacki, Alyssa; Carney, Diane V; Kimerling, Rachel; Nazarian, Deborah; Blakeney, Jill; Martin, Brittany D; Strehlow, Holly; Yosef, Julia; Goldstein, Karen M; Sadler, Anne G; Bean-Mayberry, Bevanne A; Bastian, Lori A; Bucossi, Meggan M; McLean, Caitlin; Sonnicksen, Shannan; Klap, Ruth; Yano, Elizabeth M; Frayne, Susan M
The Veterans Health Administration (VA) Women's Health Practice-Based Research Network (WH-PBRN) was created to foster innovations for the health care of women veterans. The inaugural study by the WH-PBRN was designed to identify women veterans' own priorities and preferences for mental health services and to inform refinements to WH-PBRN operational procedures. Addressing the latter, this article reports lessons learned from the inaugural study. WH-PBRN site coordinators at the 4 participating sites convened weekly with the study coordinator and the WH-PBRN program manager to address logistical issues and identify lessons learned. Findings were categorized into a matrix of challenges and facilitators related to key study elements. Challenges to the conduct of PBRN-based research included tracking of regulatory documents; cross-site variability in some regulatory processes; and troubleshooting logistics of clinic-based recruitment. Facilitators included a central institutional review board, strong relationships between WH-PBRN research teams and women's health clinic teams, and the perception that women want to help other women veterans. Our experience with the inaugural WH-PBRN study demonstrated the feasibility of establishing productive relationships between local clinicians and researchers, and of recruiting a special population (women veterans) in diverse sites within an integrated health care system. This identified strengths of a PBRN approach. © Copyright 2015 by the American Board of Family Medicine.
Michael A. Kilgore; John L. Greene; Michael G. Jacobson; Thomas J. Straka; Steven E. Daniels
Financial incentive programs were evaluated to assess their contribution to promoting sustainable forestry practices on the nationâs family forests. The evaluation consisted of an extensive review of the literature on financial incentive programs, a mail survey of the lead administrator of financial incentive programs in each state forestry agency, and focus groups...
Barratt-Pugh, Caroline; Maloney, Carmel
This paper investigates the implementation and outcomes of "Growing Better Beginnings": a family literacy program for four and five year olds. The program builds on "Better Beginnings: Birth to Three" launched in 2005. Parents, teachers and librarians were surveyed and interviewed to ascertain their perceptions of the program.…
Farming opportunities for veterans are a natural fit and capitalize on skills that made them successful in the military. The project is specifically designed to develop comprehensive training and technical assistance programs and enhance market profitability for military veteran farmers. The project...
Crozier, Mary; Rokutani, Laurie; Russett, Jill L.; Godwin, Emilie; Banks, George E.
Strong school and family ties have long shown success in influencing positive child development and lasting academic success. While a multitude of programs exist to help facilitate the school-family connection, one program in particular, Families and Schools Together, or FAST, stands out as an effective prevention program that is suitable for a…
Huynh, Truong-Giang; Covalesky, Miranda; Sinclair, Samantha; Gunter, Heather; Norton, Tamara; Chen, Alice; Yi, Cassia
Patients discharged from intensive care units are at risk of short- and long-term physical, cognitive, and emotional symptoms known as post-intensive care syndrome. Family members of intensive care unit patients are at risk of similar symptoms known as post-intensive care syndrome-family. Both syndromes are common, and strategies to reduce risk factors should be employed. An intensive care unit diary project to help reduce these syndromes was implemented in 2 intensive care units using an evidence-based framework. The effects of these diaries were studied using the Family Satisfaction with Care in the Intensive Care Unit survey. Rates of referrals to a postintensive care unit recovery clinic were also observed in relation to the diaries. Although preliminary data did not reveal a significant increase in family satisfaction, the surveys provided important staff feedback. The diaries fostered feelings of compassion and caring as well as built trust between staff and family members of intensive care unit patients. The diaries increased referrals to the postintensive care unit recovery clinic. ©2017 American Association of Critical-Care Nurses.
Full Text Available Maria Olenick,1 Monica Flowers,1 Valerie J Diaz1,21Nicole Wertheim College of Nursing and Health Science, Florida International University, Miami, FL, USA; 2Operational Health Support Unit Jacksonville, United States Navy Nurse Corps, Jacksonville, FL, USAAbstract: United States veterans are a multifaceted population with a distinct culture that includes, but is not limited to, values, customs, ethos, selfless duty, codes of conduct, implicit patterns of communication, and obedience to command. Veterans experience mental health disorders, substance use disorders, post-traumatic stress, and traumatic brain injury at disproportionate rates compared to their civilian counterparts. Eighteen to 22 American veterans commit suicide daily and young veterans aged 18–44 are most at risk. Health care professionals must be aware of patients' military history and be able to recognize suicide-risk factors, regardless of age. Advancement in medical technology has allowed servicemen to survive their injuries but, for many, at the cost of a traumatic limb amputation and associated mental scarring. Health care professionals must be able to address physical safety concerns, as well as, emotional health of veterans. Approximately 49,933 American veterans are homeless and face the same difficulties as non-veterans in addition to service-related matters. Separation from military service and issues related to complex multiple deployments are among specifically identified veteran issues. Successful veteran reintegration into civilian life rests upon providing veterans with training that builds on their military knowledge and skill, employment post-separation from service, homelessness prevention, and mental health programs that promote civilian transition. Preparing health care providers to meet the complex needs of a vast veteran population can be facilitated by implementing veteran content into curricula that includes veteran patient simulations and case studies
Full Text Available Both learning how to program and understanding algorithms or data structures are often difficult. This paper presents three complementary approaches that we employ to help our students in learning to program, especially during the first term of their study. We use a web-based programming task database as an easy and risk-free environment for taking the first steps in programming Java. The Animal algorithm visualization system is used to visualize the dynamic behavior of algorithms and data structures. We complement both approaches with tutorial videos on using the Eclipse IDE. We also report on the experiences with this combined approach.
Patrícia Paes Araujo Fialho
Full Text Available OBJECTIVE: It was to examine the effects of a Cognitive-Behavioral Therapy (CBT program administered to family caregivers of dementia patients. METHODS: Forty family caregivers were enrolled in a CBT intervention across eight weekly sessions. Cognitive, functional and behavioral status of patients were evaluated, as well as their own and their family caregivers' perceptions of quality of life. Specific instruments were also applied to evaluate caregiver stress level, coping, anxiety and depression. RESULTS: At the end of the program, family caregivers reported fewer neuropsychiatric symptoms among patients and an improvement in patients' quality of life. In addition, caregivers changed their coping strategies, whereas a significant decrease was observed in their anxiety levels. CONCLUSION: The CBT program employed appears to be a promising and useful tool for clinical practice, displaying positive effects on quality of life and neuropsychiatric symptoms of dementia, as well as proving beneficial for alleviating anxiety and stress in family caregivers.
O'Connell, Maria J; Kasprow, Wesley J; Rosenheck, Robert A
This study examined social network structure and function among a sample of 460 homeless veterans who participated in an experimental trial of the Housing and Urban Development-Veterans Affairs Supported Housing (HUD-VASH) program. Participants were randomly assigned to HUD-VASH (housing subsidies and case management), case management only, or standard care. Mixed-model longitudinal analysis was used to compare treatment groups on social network outcomes over 18 months. Veterans in HUD-VASH reported significantly greater increases in social support than veterans in the two other groups, as well as greater frequency of contacts, availability of tangible and emotional support, and satisfaction with nonkin relationships over time. These gains largely involved relationships with providers and other veterans encountered in treatment. Supported housing may play a pivotal role in fostering constructive new relationships with persons associated with service programs but may have a more limited impact on natural support networks.
Weeks, William B; Wallace, Amy E; West, Alan N; Heady, Hilda R; Hawthorne, Kara
The Veterans Health Administration (VA) provides comprehensive health care services to veterans across the United States. Recently, the VA established an Office of Rural Health to address the health care needs of rural veterans. To review the literature on rural veterans' health care needs in order to identify areas for future research. We conducted a literature review of articles listed in the Medline, CINAHL, and BIOSIS datasets since 1950. We reviewed and summarized the findings of 50 articles that specifically examined rural veterans. The literature on rural veterans included 4 articles examining access to care, 7 evaluating distance technology, 4 examining new models of care delivery, 11 studying rural veterans' patient characteristics, 10 evaluating programs provided in a rural setting, 6 examining rural health care settings, and 8 exploring rural veterans' health services utilization patterns. Most studies were small, based on data obtained before 2000, and consisted of uncontrolled, retrospective, descriptive studies of health care provided in rural VA settings. Definitions of rural were inconsistent, and in 20% of the articles examined the rural aspect of the setting was incidental to the study. The literature on rural veterans' health care needs warrants expansion and investment so that policy makers can make informed decisions in an environment of limited resources and competing interests.
programs and services such as career planning, employment skills training, or premarital counseling in addition to crisis management programs and...of officers fits a different pattern depending on the sex of the officer and their marital status at entry (Rakoff and Doherty, 1989). AFRP
Brent, D A; Poling, K; McKain, B; Baugher, M
The objective of this study was to evaluate the acceptability, feasibility, and efficacy of a family psychoeducational program for the parents of affectively ill adolescents. Sixty-two parents of 34 affectively ill adolescents received one 2-hour psychoeducational session that covered information about the diagnosis, course, and treatment of affective illness. Methods of coping with an affectively ill family member also were discussed. The view of depression as a chronic and recurrent illness was strongly emphasized. Participants showed improvement in knowledge about depression and in modification of dysfunctional beliefs about depression and its treatment. Almost all participants found the program both useful and interesting. These findings support the feasibility, acceptability, and to a modest degree, the efficacy of a family psychoeducational program for parents of affectively ill adolescents. Additional studies should address the impact of such programs on compliance with treatment, clinical outcome, and family life.
Mauldin, W P
) segura de traducir las estadísticas de servicio en práticas y tal vez aún datos sobre suministro comercial en datos sabre tasas de natalidad. Esto incluye, par ejemplo, los esfuerzos para consolidar observaciones coma "cinco años-mujer de usa de IUD, a 400 condones equivalen a la prevención de un nacimiento," y esfuerzos como los de Pakistán de calcular tasas coma "años de protección de una pareja contra el embarazo."In the belief that a decrease in the rate of population growth will increase economic development, more than ten countries have inaugurated family planning programs in the past fifteen years. To provide a model for measuring the immediate, intermediate, and long-term effects of any such program, the authors use the Taiwan evaluation.The model suggests that a good system of evaluation should include monthly statistics on (1) participants, who are grouped by characteristics; (2) the distribution of supplies, reported at first by the characteristics of recipients, but after by gross volume only; (3) family planning activities of private physicians to measure the catalytic effect on the private sector; (4) new contacts and amount of advertising in mass media; (5) costs broken down by areas and by cost categories; and (6) distribution of commercial supplies. In addition, the program should conduct 300-400 interviews every 6-12 months to learn the rates of continuation and the rates and reasons for discontinuation. Finally, a KAP survey should be conducted every two years.The administration of the evaluation should be close to the director for policy decisions and for the ultimate work of evaluation-the finding of new ways to measure the main goal of change in fertility by the translation of statistics on Services provided and commercial supplies into birth rate data.
Rocha, Pedro Carlos Xavier da; Moraes, Claudia Leite
This study seeks to estimate the prevalence of psychological and physical violence practiced against children in the family environment among clients of the Family Medical Program in Niterói (RJ). It also discloses some potential opportunities for action in the prevention, early detection and monitoring of families experiencing violence. This population-based survey was conducted with face-to-face interviews with parents or legal sponsors of 278 children registered in 27 teams of the Family Health Program. The population studied was randomly selected among children up to ten years of age. The Brazilian version of Parent-Child Conflict Tactics Scales - CTSPC was employed to assess the occurrence of this type of violence. Psychological aggression occurred in 96.7% (CI 95%: 94.7-98.8) of the households, and corporal punishment occurred in 93.8% (CI 95%: 92.0-96.7). Minor physical violence was reported by 51.4% (CI 95%: 45.5-57.3) of the respondents, and severe physical maltreatment by 19.8% (CI 95%: 15.1-24.5) of them. Although the mother was the foremost perpetrator of all kinds of maltreatment, most of the children were abused by both parents. In view of these results, domestic violence against children should be seen as a main concern for the Family Health Program.
Tsey, Komla; Whiteside, Mary; Daly, Sathyabhama; Deemal, Audrey; Gibson, Teresa; Cadet-James, Yvonne; Wilson, Andrew; Santhanam, Radhika; Haswell-Elkins, Melissa R
To adapt the Family Wellbeing empowerment program, which was initially designed to support adults to take greater control and responsibility for their decisions and lives, to the needs of Indigenous school children living in remote communities. At the request of two schools in remote Indigenous communities in far north Queensland, a pilot personal development and empowerment program based on the adult Family Wellbeing principles was developed, conducted and evaluated in the schools. The main aims of the program were to build personal identity and to encourage students to recognise their future potential and be more aware of their place in the community and wider society. Participation in the program resulted in significant social and emotional growth for the students. Outcomes described by participating students and teachers included increased analytical and reflective skills, greater ability to think for oneself and set goals, less teasing and bullying in the school environment, and an enhanced sense of identity, friendship and 'social relatedness'. This pilot implementation of the Family Wellbeing Program adapted for schools demonstrated the program's potential to enhance Indigenous young people's personal growth and development. Challenges remain in increasing parental/ family involvement and ensuring the program's sustainability and transferability. The team has been working with relevant stakeholders to further develop and package the School-based Family Wellbeing program for Education Queensland's New Basics curriculum framework.
Huey, Erron L.; Sayler, Michael F.; Rinn, Anne N.
The purpose of the current study was to examine the predictive nature of parenting style and overall family environment on the academic performance and program completion of early college entrants. Furthermore, gender and family form were examined as possible moderators to these relationships. A total of 88 early college entrants participated in…
... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Family Self- Sufficiency Program..., 2013. A. Overview of Information Collection Title of Information Collection: Family Self-Sufficiency... toward economic independence and self-sufficiency. Public Housing Agencies consult with local officials...
Heinrichs, Nina; Jensen-Doss, Amanda
To examine the impact of paying for participation in a preventive parenting program on treatment outcomes, 197 families with preschool-aged children were randomized to paid or unpaid conditions. Although both groups improved on nearly all measures, paid families showed less improvement on 3 of 10 variables, including father-reported child…
DeVoe, Ellen R.; Paris, Ruth
Through Strong Families Strong Forces, a reflective parenting program for military families with young children, we were privileged to work with contemporary military fathers who served in the post-9/11 conflicts in Afghanistan and Iraq. Due to this work, the authors gained valuable insight into the complexity of fathering during wartime, the…
WestEd, San Francisco, CA.
Marin City is an isolated African American community located in mostly affluent Marin County, California. Thirty-six percent of households in Marin City fall below the poverty line. This report provides three case studies from the Marin City Families First (MCFF) program, an intervention that aims to develop a model comprehensive child and family…
Nuño-Gutiérrez, Bertha Lidia; Alvarez-Nemegyei, José; Madrigal-de León, Eduardo; Martínez-Becerra, Bertha Alicia; Miranda-Moreno, Rosaura
Evaluation of effect in short term of the parents school program (PSP) about the family environment and the different results between participating and non-participating parents. A cohort study was performed on 112 parents of students from the High School 5 (University of Guadalajara) during six months, 61 parents received the program (intervention group, IG) and 51 were the control group (CG). The program was made in 17 weekly interactive meetings, where the topics were: adolescent psychology and sexuality; parent-children relationship; family communication; self esteem; and addiction prevention. All of these topics were discussed. To evaluate family relationship the key word used was: How is your family relationship? There were found at baseline, a smaller family, and lesser family income in the IG. On the other hand, the CG showed higher scores on satisfaction with the academic and work performance; participation and problem solving; power, money and sex; and life satisfaction. At the end of the program, only 4% subjects of the IG and 59% of the CG were available for assessment. At this point we found that all differences have disappeared except life satisfaction, In addition new differences appeared as: in the control group there was a higher score for children's problems, and satisfaction with life. On the other hand, the IG showed an increased score on professional support searching, a lower score in parent-children communication. Our findings suggest that parents who voluntary received the PSP came from vulnerable families. The program improves the search for Professional support.
David Wilkerson; Philip M. Ouellette
Family strengthening has become a source of growing interest, research, and program design in the fields of prevention and treatment for problems of youth delinquency, school failure, alcohol, tobacco and other drug abuse (ATOD). Despite many studies that illustrate the positive outcomes of family strengthening programs and family-focused interventions, their use in communities has not advanced commensurate with their promise. This article offers a rationale for why programming efforts shou...
Department of Veterans Affairs — The VA's Veteran Health Administration, in support of the Open Data Initiative, is providing the Veterans Affairs Suicide Prevention Synthetic Dataset (VASPSD). The...
Gethin, Anni; Trimingham, Tony; Chang, Theo; Farrell, Michael; Ross, Joanne
Problematic substance use by an individual is often highly destructive to their family, creating emotional turmoil and destroying healthy family functioning. The aim of this study was to evaluate the impact of participation in the Stepping Stones family support program on the coping capacity of family members affected by another's substance use. A pre and post study of the Stepping Stones intervention for families was conducted, involving 108 participants recruited from March 2013 to March 2014. Significant improvement in coping across all domains was observed post course and at follow up on both outcome measures (Coping Questionnaire and the Family Drug Support Questionnaire). Improvements for participants were either increased or sustained at 3 months follow up. Participants recorded high satisfaction ratings. The findings from this study demonstrate that participation in the Stepping Stones program assists family members to cope better with problematic substance use of a family member, as indicated by reductions in negative coping strategies, such as over-engagement, making excuses for the drug user or hopelessly tolerating the problem, and improvements in positive coping strategies such as self-care and engagement with their own activities and interests. [Gethin A, Trimingham T, Chang T, Farrell M, Ross J. Coping with problematic drug use in the family: An evaluation of the Stepping Stones program. Drug Alcohol Rev 2016;35:470-476]. © 2015 Australasian Professional Society on Alcohol and other Drugs.
Programming multiprocessor architectures is a critical research issue. An overview is given of the various approaches to programming these architectures that are currently being explored. It is argued that two of these approaches, interactive programming environments and functional parallel languages, are particularly attractive since they remove much of the burden of exploiting parallel architectures from the user. Also described is recent work by the author in the design of parallel languages. Research on languages for both shared and nonshared memory multiprocessors is described, as well as the relations of this work to other current language research projects.
National Center for Homeless Education at SERVE, 2015
According to research (Fargo et al, 2012) and federal data (U.S. Department of Housing and Urban Development [HUD], 2015), veterans experience homelessness at a higher rate than non-veterans. Many veterans experience homelessness as individuals, while others experience homelessness with their families (2015), which may include school-age children.…
The Department of Veterans Affairs (VA) is issuing a final rule to amend its adjudication regulations regarding special home adaptation grants for members of the Armed Forces and veterans with certain vision impairment. This regulatory amendment is necessary to conform the regulations to changes mandated in the Honoring America's Veterans and Caring for Camp Lejeune Families Act of 2012.
Sabet Sarvestani, Raheleh; Najafi Kalyani, Majid; Alizadeh, Fariba; Askari, Alireza; Ronaghy, Hossain; Bahramali, Ehsan
Family physicians play an essential role and act as a communicational bridge between people and the healthcare system in providing healthcare services efficiently and equitably. This study aimed at exploring the challenges of the family physician program in urban areas in Iran in 2015. This research had a descriptive exploratory design with a qualitative content analysis approach. Data were collected through semi-structured interviews between 2014 and 2015. Seventeen physicians enrolling in family physician program for at least two years were selected through purposeful sampling. Conventional content analysis was used to analyze the data. Coding and analysis of the interview data generated two categories and seven subcategories related to the challenges of the family physician program. The categories were poor infrastructure and poor incentive mechanism. Our findings captured a good picture of family physician program in urban areas to better clarify the challenges of the program and provide a foundation to plan and implement appropriate changes. Thus, our findings will give policymakers a deeper perception to confront the challenges of the family physician program in urban areas.
Tracy L. Schumacher
Full Text Available Offspring of parents with a history of cardiovascular disease (CVD inherit a similar genetic profile and share diet and lifestyle behaviors. This study aimed to evaluate the feasibility of recruiting families at risk of CVD to a dietary prevention program, determine the changes in diet achieved, and program acceptability. Families were recruited into a pilot parallel group randomized controlled trial consisting of a three month evidence-based dietary intervention, based on the Mediterranean and Portfolio diets. Feasibility was assessed by recruitment and retention rates, change in diet by food frequency questionnaire, and program acceptability by qualitative interviews and program evaluation. Twenty one families were enrolled over 16 months, with fourteen families (n = 42 individuals completing the study. Post-program dietary changes in the intervention group included small daily increases in vegetable serves (0.8 ± 1.3 and reduced usage of full-fat milk (−21%, cheese (−12% and meat products (−17%. Qualitative interviews highlighted beneficial changes in food purchasing habits. Future studies need more effective methods of recruitment to engage families in the intervention. Once engaged, families made small incremental improvements in their diets. Evaluation indicated that feedback on diet and CVD risk factors, dietetic counselling and the resources provided were appropriate for a program of this type.
.... USDA Nondiscrimination Statement The U.S. Department of Agriculture (USDA) prohibits discrimination... origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political... complaint of discrimination, complete the USDA Program Discrimination Complaint Form (PDF), found online at...
... Agency oversight or minimum competency standards. This proposed rule will impose experience, training... Agency's housing program, increasing specialized support available to them to complete the application..., ensure those packagers are qualified and trained, perform quality assurance reviews to prevent the...
This paper gives an overview of the various approaches to programming multiprocessor architectures that are currently being explored. It is argued that two of these approaches, interactive programming environments and functional parallel languages, are particularly attractive, since they remove much of the burden of exploiting parallel architectures from the user. This paper also describes recent work in the design of parallel languages. Research on languages for both shared and nonshared memory multiprocessors is described.
Gajardo, Jean; Aravena, José M; Budinich, Marilú; Larraín, Alberto; Fuentes, Patricio; Gitlin, Laura N
The Kintun program is the first public health strategy specifically designed for dementia care in Chile. It was launched in 2013 in the city of Santiago with support from the National Service for the Elderly and the Municipality of Peñalolén. Using an interdisciplinary team, the program seeks to promote community integration and better support for persons with dementia and their caregivers. The multicomponent program includes: an activity-based day care center, training and education of family caregivers, home visits, and community outreach to increase dementia awareness. Case management helps to monitor ongoing needs and link families to resources. To date, 259 dyads (persons with dementia and their families) have been enrolled in the program. Due to its success in 2015, the Kintun program received funding from the Ministry of Health. This has led to the integration of previously disparate initiatives, better consistency across services, and the development of a comprehensive national dementia plan for Chile.
HFS mobile website and Administrative Console have the potential to significantly impact the well-being of military and veteran spouses/partners who...AWARD NUMBER: W81XWH-14-1-0362 TITLE: HomeFront Strong: Building Resiliency in Military Families PRINCIPAL INVESTIGATOR: Michelle Kees...Strong: Building Resiliency in Military Families 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Michelle Kees, PhD
Teufel-Shone, Nicolette I; Drummond, Rebecca; Rawiel, Ulrike
The prevalence of diabetes among Hispanics is more than twice that of non-Hispanic whites in communities along the U.S.-Mexico border. The University of Arizona and two community health agencies on the Arizona border, Campesinos Sin Fronteras and Mariposa Community Health Center, collaborated to design, pilot and assess the feasibility of a lay health-outreach worker- (promotora-) delivered diabetes education program for families. La Diabetes y La Unión Familiar was developed to build family support for patients with diabetes and to teach primary prevention behaviors to family members. Community and university partners designed a culturally appropriate program addressing family food choices and physical activity, behavior change, communication, and support behaviors. The program offers educational content and activities that can be presented in home visits or multifamily group sessions. Community partners led the implementation, and university partners guided the evaluation. Seventy-two families (249 total participants) including children and grandchildren participated. Preintervention and postintervention questionnaires completed by adults (n = 116) indicate a significant increase in knowledge of eight diabetes risk factors (P values for eight factors range from < 001 to .006) and a significant increase in family efficacy to change food (P < .001) and activity behaviors (P < .001). Interviews with participants highlight the program's positive psychosocial impact. Community and university collaboration involved building upon the promotoras' expertise in engaging the community and the university's expertise in program design and evaluation. A promotora-delivered family-based diabetes prevention program that emphasizes family support, communication, and health behaviors is feasible and can yield change in family knowledge, attitude, and behavior relative to diabetes risk factors.
specific aim, research or study questions, and/or hypothesis : The purpose of the MSBP was to improve the quality of life of military family caregivers by...adopting a healthier lifestyle through healthier eating, meditating , and in exercising. Cognitive changes involved an improved ability to...subjective). Improvement was shown by 97.4% of caregivers who participated in the study with 61% showing improvement on all measures tested .” The
O'Toole, Thomas P; Roberts, Christopher B; Johnson, Erin E
We assessed findings from a food-insecurity screening of a national sample of Veterans Administration clinics for homeless and formerly homeless veterans. We reviewed results from initial screenings administered at 6 Veterans Administration primary care clinics for the homeless and responses from clinic staff members interviewed about the screening program. A total of 270 patients were screened. The average age was 53 years, and most were male (93.1%). Screening showed a high prevalence of food insecurity. Of the 270, 48.5% reported they experienced food insecurity in the previous 3 months, 55.0% reported averaging 2 meals a day, and 27.3% averaged 1 meal a day. Eighty-seven percent prepared their own meals, relying on food they bought (54.2%), help from friends and family (19.1%), and soup kitchens and food pantries (22%); 47.3% received Supplemental Nutrition Assistance Program benefits (food stamps). Additionally, of those who screened positive for food insecurity 19.8% had diabetes or prediabetes, and 43.5% reported hypoglycemia symptoms when without food. Clinic staff members responded positively to the screening program and described it as a good rapport builder with patients. Integrating screening for food insecurity among patients in clinical settings was well received by both patients and health care providers. Addressing these positive findings of food insecurity requires a multidisciplinary health care approach.
McCall, Janice D; Tsai, Jack
The majority of U.S. veterans in prisons and local jails are men, but incarcerated women veterans remain an important and understudied group. This study reported differences in sociodemographic, health, and criminal justice characteristics using Veterans Affairs (VA) administrative data on a national sample of 30,964 incarcerated veterans (30,440 men and 524 women) who received outreach from the VA Health Care for Reentry Veterans program between 2007 and 2011. Descriptive statistics and multivariable logistic regressions determined gender and racial differences in this population. Compared with incarcerated veterans who were men, incarcerated women veterans were younger (d = 0.68), had significantly lower lifetime arrests (AOR, 0.65; p problems, hypertension, chronic obstructive pulmonary disease, and seizure disorder, and were more likely to receive a preliminary diagnosis of mood disorder than men. Women were more likely to have received VA benefits, used VA health care before, and be willing to use VA services after release. A few important differences emerged when stratified by race. These findings suggest that incarcerated women veterans are interested in VA health care services, but there is lack of information about women's health needs through the Health Care for Reentry Veterans program. The inclusion of Health Care for Reentry Veterans screening questions about women's health issues may support the VA's interests to better engage women veterans in care. Published by Elsevier Inc.
Schmied, Emily A; Chuang, Emmeline; Madanat, Hala; Moody, Jamie; Ibarra, Leticia; Ortiz, Kenia; Macias, Karla; Ayala, Guadalupe X
Low parent engagement is frequently identified as a barrier to effective implementation of family-based childhood obesity prevention and control programs. A more nuanced understanding of factors affecting parent engagement is important for improving implementation and, ultimately, program efficacy. This qualitative study examined factors influencing parent engagement in a family-based childhood obesity prevention and control program. Semistructured interviews informed by the health belief model and the transtheoretical model were conducted with 22 predominantly Latina mothers following the scheduled conclusion of program activities. Spanish- and English-language interviews were transcribed, translated into English (if Spanish), coded, and summarized using established protocols. Differences between parents who attended at least two thirds of program activities and those who did not were examined. There were no significant demographic differences between parents who did and did not complete two thirds of program activities. Findings indicated that differences in parent engagement may be at least partially explained by differences in parental motivations for participating and in barriers and facilitators, such as children's level of support and enthusiasm for the program. Parents were highly satisfied with the program content and the community health workers who delivered the program. This study adds to emergent literature regarding parents' experiences in family-based childhood obesity prevention and control programs. Potential targets for improving program engagement are discussed.
Social Security Administration — The purpose of this agreement is for SSA to verify SSNs and other identifying information for the Department of Veterans Affairs, VHA. DVA will use the information...
Full Text Available BackgroundFamily communication is important to maintain family relationships and family well-being. To enhance family communication and family well-being, a community-based “Learning Families Project,” based on the social ecological model was developed in Kwun Tong in Hong Kong, a district with high prevalence of family problems.MethodsThis quasi-experimental study included two nearby government subsidized low-rent housing estates separated by busy main roads, as the intervention [Tsui Ping (South Estate] and control (Shun Tin Estate estate. The main intervention was resident training programs, such as talks, day camps, and thematic activities. No program was implemented in the control estate. Participants in the intervention group received assessments before the intervention (T1, immediately after the intervention (T2, and 6 weeks after the intervention (T3. Control group participants were assessed at baseline (March to April 2011 and follow-up (December 2011 to March 2012. Assessments of family communication (time and perceived adequacy and family well-being (harmony, happiness, and health at T1 and T3 were obtained in the intervention group to examine within-group changes. In addition, these differences in outcomes in the intervention group were compared with those in the control group to examine the effectiveness of the intervention.ResultsFamily communication time and perceived communication adequacy increased significantly in the intervention group (n = 515 with a small effect size (Cohen effect d: 0.10 and 0.24, respectively. Compared with the control group (n = 476, the improvements in family communication time and perceived communication adequacy (Cohen effect d: 0.13 and 0.14, respectively, and perceived family harmony and happiness (Cohen effect d: 0.12 and 0.12, respectively were significantly greater in the intervention group, adjusting for age and education, suggesting the intervention was effective in improving
Martins, Maria Manuela; Fernandes, Carla Sílvia; Gonçalves, Lucia Hisako Takase
This paper reports an educational program experience for nurses on caring for the family, at the hospital environment. The objective was to train nurses for the care of the family. The strategies adopted for teaching/learning focused on the Calgary Model of Assessment and Family Intervention, with a group of nurses from a general hospital located in the north of Portugal. In the subjective evaluation of the participants, the pedagogic experience was useful because they could recognize the need for a change on nursing care, and move towards an integrated approach to the family attention.
... protected veteran in all employment practices including the following: (i) Recruitment, advertising, and job... social or recreational programs. (ix) Any other term, condition, or privilege of employment. (2) The...
... (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Temporary Program of Vocational Training and....S.C. 1163(c)) (b) Coordination with the Veterans Service Center. The VR&E Division will inform the...
Wilmoth, Janet M; London, Andrew S; Heflin, Colleen M
Although there is substantial disability among veterans, relatively little is known about working-aged veterans' uptake of Department of Veterans Affairs (VA) Disability Compensation and Social Security Disability Insurance (DI). This study identifies levels of veteran participation in VA disability and/or DI benefit programs, examines transitions into and out of VA and DI programs among veterans, and estimates the size and composition of the veteran population receiving VA and/or DI benefits over time. Data from the 1992, 1993, 1996, 2001, 2004, and 2008 Survey of Income and Program Participation (SIPP) are used to describe VA and DI program participation among veterans under the age of 65. The majority of working-aged veterans do not receive VA or DI benefits and joint participation is low, but use of these programs has increased over time. A higher percentage of veterans receive VA compensation, which ranges from 4.9% in 1992 to 13.2% in 2008, than DI compensation, which ranges from 2.9% in 1992 to 6.7% in 2008. The rate of joint participation ranges from less than 1% in 1992 to 3.6% in 2008. Veterans experience few transitions between VA and DI programs during the 36-48 months they are observed. The number of veterans receiving benefits from VA and/or DI nearly doubled between 1992 and 2008. There have been substantial shifts in the composition of veterans using these programs, as cohorts who served prior to 1964 are replaced by those who served after 1964. The findings suggest potential gaps in veterans' access to disability programs that might be addressed through improved coordination of VA and DI benefits. Copyright © 2015 Elsevier Inc. All rights reserved.
... INFORMATION CONTACT: Edward Bradley, Office of Asset Enterprise Management (044), Department of Veterans... permanent housing facility for homeless and at-risk Veterans and their families where the lessee will give...
Winston, Ebony Joy; Piercy, Fred P.
This article explores how the topics of gender and diversity are being taught and defined in accredited marriage and family therapy programs through syllabi content analysis and interviews with selected faculty. We examined findings by program (master's and doctoral) and type of training (those that taught specific gender and culture courses and…
Grossmont District Hospital, La Mesa, CA.
This demonstration program was designed to impart specific nursing, psychosocial, and community knowledge skills to caregivers, particularly those who themselves were older adults and were caring for a family member at home. Begun in October 1986, this program featured basic home nursing instruction and an orientation to the demands and rewards of…
Jurich, Anthony P.; Collins, Olivia P.
Evaluates a program designed to improve self-esteem in adolescents. Used commercial movies about teenagers to enhance adolescents' interest and understanding of their world. Findings indicated significant increases in measures of self concept, self satisfaction, family self, and social self over the course of the program. (RJM)
Center on Budget and Policy Priorities, Washington, DC.
The paper summarizes the results of an analysis of recently issued Census data. Examining the anti-poverty effectiveness of cash and non-cash benefit programs from 1979 to 1986, the analysis focuses on the impacts of those programs on families with children, the group whose poverty rate has risen most rapidly since 1979. The data reveal that…
Brock, Estelle; Travis, Nancy
This manual explains what is involved in sponsoring a Child Care Food Program (CCFP) for family day care providers. It draws on the experience of Save the Children's Southern States Office in sponsoring the "Child Care Food Umbrella," a CCFP program serving over 1,000 providers, which Save the Children has operated for 6 years. Chapter 1…
Rahimi, Mohd Khairul Anuar
This phenomenological study explored the experiences of international students in CACREP-accredited marriage, couple, and family counseling programs. Seven former international students from the program who have practiced counseling in their home country were interviewed to understand their learning experiences, adaptation process and counseling…
Hertlein, Katherine M.; Lambert-Shute, Jennifer
To understand which factors students consider most important in choosing a marriage and family therapy (MFT) graduate program and how programs met or did not meet these expectations of students over the course of graduate study, we conducted an online mixed-method investigation. One hundred twelve graduate students in Commission on Accreditation…
Maher, Erin J.; Kelly, Jean F.; Scarpa, Juliet P.
The early care and education field lacks an evidence base of effective programs to support caregiving quality among family, friend, and neighbor, or unlicensed, caregivers. This article presents the results of a qualitative evaluation of a program implemented with 20 primarily low-income English- and Spanish-speaking grandparents providing…
Olson, Jonathan R.; Hawkey, Kyle R.; Smith, Burgess; Perkins, Daniel F.; Borden, Lynne M.
In this article, we describe how a peer-coaching model has been applied to support community-based Extension programming through the Children, Youth, and Families at Risk (CYFAR) initiative. We describe the general approaches to coaching that have been used to help with CYFAR program implementation, evaluation, and sustainability efforts; we…
Funge, Simon P.; Sullivan, Dana J.; Tarter, Kirsten
The Dolly Parton Imagination Library (DPIL) program encourages reading among families of preschool children by mailing age-appropriate books, once per month, until the child reaches the age of five. An evaluation of a DPIL program in a southern state in the U.S. was conducted to assess the impact on enrolled children. Focus groups were conducted…
Selber, Katherine; Streeter, Calvin
The conceptualization and empirical assessment of service quality in juvenile justice remains limited. There are few reports on programmatic attempts to assess satisfaction in juvenile justice programs or attempts to include what constitutes quality of service from multiple customer perspectives. This article describes a potential model, the Gap…
Bavolek, Stephen J.
This bulletin describes how parenting patterns are learned and how the Nurturing Parenting Programs, a group- and home-based intervention effort begun with the support of the National Institute of Mental Health, help stop generational cycles of abuse and neglect by building nurturing parenting skills. Section 1 examines the need for effective…
... compared to non-metropolitan rural homeowners indicates the guaranteed program has a positive impact in... in pursuing homeownership. The impacts of changes to the rule are positive to the federal budget... divorces, the wife gets the home if she desires, and can thus argue for custody of the children because the...
Cushing Herbert E
Full Text Available Abstract Background A Family Day program was implemented at Indiana University School of Medicine to educate the families and friends of in-coming medical students about the rigors of medical school and the factors that contribute to stress. Methods Surveys that assessed knowledge, beliefs, and attitudes about medical school were administered to participants before and after the program. Results After the program, participants showed a significant improvement in their understanding of medical school culture and the importance of support systems for medical students. Post-test scores improved by an average of 29% (P Conclusions The inclusion of family members and other loved ones in pre-matriculation educational programs may serve to mitigate the stress associated with medical school by enhancing the students' social support systems.
Danucalov, M A D; Kozasa, E H; Ribas, K T; Galduróz, J C F; Garcia, M C; Verreschi, I T N; Oliveira, K C; Romani de Oliveira, L; Leite, J R
Familial caregivers of patients with Alzheimer's disease exhibit reduced quality of life and increased stress levels. The aim of this study was to investigate the effects of an 8-week yoga and compassion meditation program on the perceived stress, anxiety, depression, and salivary cortisol levels in familial caregivers. A total of 46 volunteers were randomly assigned to participate in a stress-reduction program for a 2-month period (yoga and compassion meditation program-YCMP group) (n = 25) or an untreated group for the same period of time (control group) (n = 21). The levels of stress, anxiety, depression, and morning salivary cortisol of the participants were measured before and after intervention. The groups were initially homogeneous; however, after intervention, the groups diverged significantly. The YCMP group exhibited a reduction of the stress (P anxiety (P meditation program may offer an effective intervention for reducing perceived stress, anxiety, depression, and salivary cortisol in familial caregivers.
Honarvar, Behnam; Lankarani, Kamran Bagheri; Ghahramani, Sulmaz; Akbari, Maryam; Tabrizi, Reza; Bagheri, Zahra; Poostforoushfard, Sima
A national project of extending a family physician program to urban areas has been started since May 2013 in Iran. The present study aimed to detect correlates of people's satisfaction and dissatisfaction about urban family physician program. This cross-sectional and population-based study was conducted in Shiraz, Southern Iran. Multistage and proportional to size random sampling were used. Different items about satisfaction and dissatisfaction toward urban family physician program were queried. Single variable and then multiple variable analyses of data were done using SPSS software (Chicago, IL. USA). Mean age of 1257 participants in the study was 38.1 ± 13.2 years. Respondents included men (634; 50.4%), married (882; 70.2%), those who were educated at universities (529; 42%) and self-employed groups (405; 32.2%). One thousand fifty-eight (84.1%) were covered by the family physician program. Mean of referral times to a family physician was 2.2 ± 2.9 during the year before the study. Satisfaction toward urban family physician program was high in 198 (15.8%), moderate in 394 (31.3%), and low in 391 (31.1%). Dissatisfaction about this program was more among younger than 51-year-old groups (for 31-50 years odds ratio [OR] =2.3, 95% confidence interval [CI] =1.4-3.7, P < 0.001 and for 18-30 years OR = 2, 95% CI = 1.2-3.4, P = 0.005), less knowledgeable ones (OR = 2.2, 95% CI = 1.3-3.6, P = 0.001), singles (OR = 2.1, 95% CI = 1.2-3.4, P = 0.003), and those with more than 4 of family members (OR = 1.3, 95% CI = 1-1.7, P = 0.05). Overall, the majority of the people are not very satisfied with the urban family physician program. This shows the need for a multi-disciplinary approach including training, improvement of infrastructures and referral system, continuous supervision, and frequent monitoring of user's and provider's feedback about this program. According the results, the family physician program should be improved prior to extending this program to other
Full Text Available Background: A national project of extending a family physician program to urban areas has been started since May 2013 in Iran. The present study aimed to detect correlates of people′s satisfaction and dissatisfaction about urban family physician program. Methods: This cross-sectional and population-based study was conducted in Shiraz, Southern Iran. Multistage and proportional to size random sampling were used. Different items about satisfaction and dissatisfaction toward urban family physician program were queried. Single variable and then multiple variable analyses of data were done using SPSS software (Chicago, IL. USA. Results: Mean age of 1257 participants in the study was 38.1 ± 13.2 years. Respondents included men (634; 50.4%, married (882; 70.2%, those who were educated at universities (529; 42% and self-employed groups (405; 32.2%. One thousand fifty-eight (84.1% were covered by the family physician program. Mean of referral times to a family physician was 2.2 ± 2.9 during the year before the study. Satisfaction toward urban family physician program was high in 198 (15.8%, moderate in 394 (31.3%, and low in 391 (31.1%. Dissatisfaction about this program was more among younger than 51-year-old groups (for 31-50 years odds ratio [OR] =2.3, 95% confidence interval [CI] =1.4-3.7, P < 0.001 and for 18-30 years OR = 2, 95% CI = 1.2-3.4, P = 0.005, less knowledgeable ones (OR = 2.2, 95% CI = 1.3-3.6, P = 0.001, singles (OR = 2.1, 95% CI = 1.2-3.4, P = 0.003, and those with more than 4 of family members (OR = 1.3, 95% CI = 1-1.7, P = 0.05. Conclusions: Overall, the majority of the people are not very satisfied with the urban family physician program. This shows the need for a multi-disciplinary approach including training, improvement of infrastructures and referral system, continuous supervision, and frequent monitoring of user′s and provider′s feedback about this program. According the results, the family physician program should be
Goede, Simon Lucas; Rabeneck, Linda; Lansdorp-Vogelaar, Iris; Zauber, Ann G; Paszat, Lawrence F; Hoch, Jeffrey S; Yong, Jean H E; van Hees, Frank; Tinmouth, Jill; van Ballegooijen, Marjolein
In the province-wide colorectal cancer (CRC) screening program in Ontario, Canada, individuals with a family history of CRC are offered colonoscopy screening and those without are offered guaiac fecal occult blood testing (gFOBT, Hemoccult II). We used microsimulation modeling to estimate the cumulative number of CRC deaths prevented and colonoscopies performed between 2008 and 2038 with this family history-based screening program, compared to a regular gFOBT program. In both programs, we assumed screening uptake increased from 30% (participation level in 2008 before the program was launched) to 60%. We assumed that 11% of the population had a family history, defined as having at least one first-degree relative diagnosed with CRC. The programs offered screening between age 50 and 74 years, every two years for gFOBT, and every ten years for colonoscopy. Compared to opportunistic screening (2008 participation level kept constant at 30%), the gFOBT program cumulatively prevented 6,700 more CRC deaths and required 570,000 additional colonoscopies by 2038. The family history-based screening program increased these numbers to 9,300 and 1,100,000, a 40% and 93% increase, respectively. If biennial gFOBT was replaced with biennial fecal immunochemical test (FIT), annual Hemoccult Sensa or five-yearly sigmoidoscopy screening, both the added benefits and colonoscopies required would decrease. A biennial gFOBT screening program that identifies individuals with a family history of CRC and recommends them to undergo colonoscopy screening would prevent 40% (range in sensitivity analyses: 20-51%) additional deaths while requiring 93% (range: 43-116%) additional colonoscopies, compared to a regular gFOBT screening program. © 2015 UICC.
Tsai, Jack; Kasprow, Wesley J; Culhane, Dennis; Rosenheck, Robert A
Among homeless veterans and those at risk of homelessness currently enrolled in Veterans Affairs (VA) health care, this study examined the proportion likely to become eligible for Medicaid in 2014 and their health needs. A total of 114,497 homeless and at-risk veterans were categorized into three groups: currently covered by Medicaid, likely to become eligible for Medicaid, and not likely. Seventy-eight percent of the sample was determined to be likely to become eligible for Medicaid in states that expand Medicaid. Compared with veterans not likely to become eligible for Medicaid, those likely to become eligible were less likely to have general medical and psychiatric conditions and to have a VA service-connected disability but more likely to have substance use disorders. Programs serving homeless and at-risk veterans should anticipate the potential interplay between VA health care and the expansion of Medicaid in states that implement the expansion.
The enTECH Telerehabilitation Program explored the use of telerehabilitation as an alternative service delivery model for early intervention therapy services. Utilizing the Kentucky Telehealth Network, two families living in rural Kentucky received occupational therapy services over a 12-week period. Following program implementation, qualitative data was collected using participant journals and interviews. Data analysis identified three thematic categories related to the program: benefits/str...
de Graaf, I.M.
In this thesis the implementation of the evidence-based Triple P Positive Parenting Program in the Netherlands was examined. Because parenting is associated with the wellbeing of children, parenting programs are developed to address the child problems. Among all developed parenting programs, the Behavioral Family Interventions (BFI) have the strongest empirical evidence. The aim of Triple P is to prevent and offer treatment for mild and severe behavioral, emotional and developmental problems ...
Johnson, R Scott; Stolar, Andrea G; McGuire, James F; Mittakanti, Krithika; Clark, Sean; Coonan, Loretta A; Graham, David P
Significant variability exists regarding the criteria and procedures used by different veterans' courts (VCs) across the country. Limited guidance is available regarding which VC model has the most successful outcomes. The purpose of this study was to examine factors associated with incarceration during VC participation. This study used data for 1,224 veterans collected from the HOMES (Homeless Operations Management and Evaluation System) database of the Department of Veterans Affairs, as well as data from a national phone survey inventory of all U.S. VCs. To identify variables associated with incarceration during VC participation, four backward conditional logistic regressions were performed. The following variables were associated with higher rates of incarceration because of a veteran's noncompletion of the VC program: charges of probation or parole violations, longer stays in the VC program, end of VC participation because of incarceration for a new arrest or case transfer by the legal system, and requiring mental health follow-up but not undergoing treatment. The following variables were associated with lower rates of incarceration: stable housing and participating in a VC program that referred veterans for substance abuse treatment. This study offers VCs a thorough review of an extensive set of recidivism data. Further investigation is necessary to understand the impact of VCs.
A facility designated for temporary, emergency housing for victims of abuse. Its use is normally limited to female victims of spouse abuse and her...sexual activity such as pornography cr prostitution in which the offender does not have direct physical contact with the child. 3. Rape and Intercourse...Support Groups. 8. Parent and/or Teen Groups. 4-10 Educationally-based programs are those whose intent is to convey informa- tion and awareness to the
2/76) 2 Suspected Abuzso/Malect/Sexua1 Assault an ae2404 65.) "Suspected Abuso /Neglect/ Sexual Assault and Rape Report" 2226 60.5 NAVMED 6320/15A...ANALYSIS OF SEXUAL ASSAULT REPORTS ........... 50 HAPTER V: SUMAY ANALYSIS Or rAMILY ADVOCACY PROGRAM REPORTS . 56 APPENDIX...cont’d)I PAGE CHAPTER IV: SEXUAL ASSAULT TV-1 Fore . . . . . . . . . . . . . . . . . . . . . 51 IV-2 Type of Maltreatment ............... 53 IV-3
Hempstead, Laura K; Shaffer, Todd D; Williams, Karen B; Arnold, Lt Col James
Between 2015 and 2020, residency programs accredited through the American Osteopathic Association (AOA) are preparing the single graduate medical education (GME) system through the Accreditation Council for Graduate Medical Education (ACGME). (1) To assess the attitudes of family medicine program directors in programs accredited dually by the AOA and ACGME (AOA/ACGME) or ACGME only toward the clinical and academic preparedness of osteopathic residency candidates and (2) to determine program director attitudes toward the perceived value of osteopathic-focused education, including osteopathic manipulative treatment (OMT) curricula. A survey was sent to program directors of AOA/ACGME and ACGME-only accredited family medicine residency programs. Items concerned program directors' perception of the academic and clinical strength of osteopathic residents at the onset of residency, the presence of osteopathic faculty and residents currently in the program, and the presence of formal curricula for teaching OMT. The perceived value of osteopathic focus was obtained through a composite score of 5 items. A total of 38 AOA/ACGME family medicine residency program directors (17%) and 211 ACGME family medicine residency program directors (45.6%) completed the survey (N=249). No difference was found in the ranking of the perceived clinical preparation of osteopathic residents vs allopathic residents in programs with and without OMT curricula (P=.054). Directors of programs with OMT curricula perceived the academic preparation of their osteopathic residents vs allopathic residents more highly than those without OMT curricula (P=.039). Directors of AOA/ACGME programs perceived both the academic preparation and clinical preparation of their osteopathic residents more highly than those at ACGME-only programs (P=.004 and P=.002, respectively). Directors of AOA/ACGME programs, as well as those whose programs have an osteopathic focus in curricular offerings, were more likely to rank the
Brown, Lisa M; Barnett, Scott D; Frahm, Kathryn A; Schinka, John A; Schonfeld, Lawrence; Casey, Roger J
This study examined age-related differences in general medical and mental health risk factors for veterans participating in the U.S. Department of Veterans Affairs (VA) Grant Per Diem (GPD) transitional supportive housing program. The subpopulation of older homeless veterans is growing, and little is known about the implications of this fact for health care providers and for supportive programs intended to meet homeless veterans' needs. Data were obtained from the VA records of all veterans (N=40,820) who used the GPD program during fiscal years 2003 to 2009. Unconditional adjusted and unadjusted odds ratios for general medical and psychiatric characteristics were calculated and were the primary study focus. Significant predictors of homeless program completion assessed from univariate models were then evaluated in multivariate models. Younger (homeless veterans reported an equal number of days homeless before enrollment. Younger veterans averaged 19 fewer days in GPD. Older veterans had more general medical problems and approximately $500 more in program costs. Findings from this study indicate that older homeless veterans are at increased risk of serious medical problems. This group is especially vulnerable to experiencing negative consequences related to homelessness. Addressing these complex needs will allow the VA to provide enhanced care to older homeless veterans.
Vasterling, Jennifer J; Taft, Casey T.; Proctor, Susan P.; MACDONALD, HELEN Z.; Lawrence, Amy; Kalill, Kathleen; Kaiser, Anica P.; Lee, Lewina O.; King, Daniel W.; King, Lynda A.; Fairbank, John A.
Military deployment may adversely affect not only returning veterans, but their families, as well. As a result, researchers have increasingly focused on identifying risk and protective factors for successful family adaptation to war-zone deployment, re-integration of the returning veteran, and the longer-term psychosocial consequences of deployment experienced by some veterans and families. Posttraumatic stress disorder (PTSD) among returning veterans may pose particular challenges to militar...
Full Text Available Abstract Background While family medicine is not well established as a discipline in Japan, a growing number of Japanese medical schools and training hospitals have recently started sougoushinryoubu (general medicine departments. Some of these departments are incorporating a family medicine approach to residency training. We sought to learn from family medicine pioneers of these programs lessons for developing residency training. Methods This qualitative project utilized a long interview research design. Questions focused on four topics: 1 circumstances when becoming chair/faculty member; 2 approach to starting the program; 3 how Western ideas of family medicine were incorporated; and 4 future directions. We analyzed the data using immersion/crystallization to identify recurring themes. From the transcribed data, we selected representative quotations to illustrate them. We verified the findings by emailing the participants and obtaining feedback. Results Participants included: five chairpersons, two program directors, and three faculty members. We identified five lessons: 1 few people understand the basic concepts of family medicine; 2 developing a core curriculum is difficult; 3 start with undergraduates; 4 emphasize clinical skills; and 5 train in the community. Conclusion While organizational change is difficult, the identified lessons suggest issues that merit consideration when developing a family medicine training program. Lessons from complexity science could inform application of these insights in other countries and settings newly developing residency training.
MacGregor, Casey; Heilemann, MarySue V
Veterans recently returned from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) experience many health and mental health problems after deployment. These OEF/OIF veterans are applying and appealing for veterans' disability compensation (VDC) at rapidly increasing rates, often for "invisible conditions" such as posttraumatic stress disorder. Little is known about how veterans experience the process of applying and receiving VDC. In-depth qualitative interviews were conducted with OEF/OIF veterans ages 35 and younger (N = 18). This article addresses how veterans perceive themselves, and other veterans, of being deserving and undeserving of VDC. Veterans' rationales can be categorized into four primary areas: (1) risking and suffering, (2) the cause of the condition, (3) intentions to become self-sufficient, and (4) putting VDC to "good use." © 2017 National Association of Social Workers.
O?Toole, Thomas P.; Johnson, Erin E.; Aiello, Riccardo; Kane, Vincent; Pape, Lisa
Introduction Although the clinical consequences of homelessness are well described, less is known about the role for health care systems in improving clinical and social outcomes for the homeless. We described the national implementation of a ?homeless medical home? initiative in the Veterans Health Administration (VHA) and correlated patient health outcomes with characteristics of high-performing sites. Methods We conducted an observational study of 33 VHA facilities with homeless medical ho...
... programs: Reexamination of family income and composition. 5.657 Section 5.657 Housing and Urban Development...: Reexamination of family income and composition. (a) Applicability. This section states requirements for reexamination of family income and composition in the Section 8 project-based assistance programs, except for...
Miller, Cynthia; Miller, Rhiannon; Verma, Nandita; Dechausay, Nadine; Yang, Edith; Rudd, Timothy; Rodriguez, Jonathan; Honig, Sylvie
Family Rewards was an innovative approach to poverty reduction in the United States that was modeled on the conditional cash transfer (CCT) programs common in lower- and middle-income countries. The program offered cash assistance to low-income families, provided that they met certain conditions related to family health care, children's education,…
Dechausay, Nadine; Miller, Cynthia; Quiroz-Becerra, Victoria
In 2007, New York City launched the first test of a conditional cash transfer program in the United States. Called Family Rewards, the program sought to break the intergenerational cycle of poverty by offering cash assistance to poor families to reduce immediate hardship, but conditioned this assistance on families' efforts to improve their…
Torquati, Julia C.; Raikes, Helen H.; Huddleston-Casas, Catherine A.; Bovaird, James A.; Harris, Beatrice A.
Observed child care quality and parent perceptions of child care quality received by children in poor (below Federal Poverty Line, FPL), low-income (between FPL and 200% of FPL), and non-low-income families were examined. Observations were completed in 359 center- and home-based child care programs in four Midwestern states and surveys were…
Assess the performance of the empowerment program using participatory learning process for the control of Dengue vector The program focuses on using the leaders of families as the main executer of the vector control protocol. This quasi-experimental research utilized the two-group pretest-posttest design. The sample group consisted of 120 family leaders from two communities in Mueang Municipality, Chachoengsao Province. The research was conducted during an 8-week period between April and June 2010. The data were collected and analyzed based on frequency, percentage, mean, paired t-test, and independent t-test. The result was evaluated by comparing the difference between the mean prevalence index of mosquito larvae before and after the process implementation in terms of the container index (CI) and the house index (HI). After spending eight weeks in the empowerment program, the family leader's behavior in the aspect of Dengue vector control has improved. The Container Index and the House Index were found to decrease with p = 0.05 statistical significance. The reduction of CI and HI suggested that the program worked well in the selected communities. The success of the Dengue vector control program depended on cooperation and participation of many groups, especially the families in the community When the family leaders have good attitude and are capable of carrying out the vector control protocol, the risk factor leading to the incidence of Dengue rims infection can be reduced.
Paul, Baldeep; Baranchuk, Adrian
Electrocardiography (ECG) interpretation is an essential skill for a family physician. Teaching and learning electrocardiography is a difficult task, in part due to the erosion of knowledge when interpretation is not part of a daily activity. The objective of this study was to assess the current status of electrocardiography teaching in Canadian family medicine residency programs. A national survey was designed to specifically address the status of the ECG teaching curricula. This national survey was electronically sent to the family medicine program directors of all 17 Canadian accredited medical schools. Approximately 75% of the schools responded to the survey. There was a great variance among Canadian family medicine residency programs with respect to the time allotment, ECG training location, training faculty, and teaching methods utilized. The goals of each respective program are also quite wide-ranging. Family medicine residency programs across Canada are quite diverse regarding ECG training curricula and its goals. The need for a homogeneous way of teaching and evaluating has been identified.
Sota, Satoko; Shimodera, Shinji; Kii, Masaru; Okamura, Kayoko; Suto, Koichirou; Suwaki, Mitsuru; Fujita, Hirokazu; Fujito, Ryosuke; Inoue, Shimpei
Family psychoeducational programs have been shown to be effective in terms of knowledge acquirement and relapse prevention, but few studies have looked at whether one mode of educational method is more effective than another. The aim of the present study was to compare several modes of educational approaches and to elucidate which mode of education is more effective. A total of 110 relatives of 95 patients with schizophrenia received three types of family psychoeducational programs between January 1995 and September 2003: a small group with two sessions (P1), a large group with nine sessions (P2), and a large group with five sessions (P3). In addition to the demographic data, acquired knowledge was measured using the modified Knowledge About Schizophrenia Interview (KASI), family expressed emotion (EE), and relapse episodes. Overall there were significant increases in many KASI subcategory scores after the three programs, in mothers in particular. The change in KASI scores indicated that the low EE group was able to be highly educated and that the relatives of non-relapsers were more effectively educated. As for the mode of the family psychoeducational program, the P1 and P2 groups surpassed the P3 in terms of knowledge acquired. Effects of family psychoeducation may depend not on the number of members or sessions but on the time spent on the program per member.
Johannessen, Aud; Bruvik, Frøydis Kristine; Hauge, Solveig
Background Psychosocial interventions for persons with dementia and their primary family carers are promising approaches to reducing the challenges associated with care, but, obtaining significant outcomes may be difficult. Even though carers in general are satisfied with such interventions, few studies have evaluated the interventions by means of qualitative methods. Aim The objective of the study reported here was to investigate family carers’ experiences of a multicomponent psychosocial intervention program, and also to offer advice on how to develop the intervention program. Methods Content analyses were taken from individual qualitative interviews conducted in 2012 with 20 carers (aged 50–82 years) who participated in a psychosocial intervention program that included education, individual and family counseling, and parallel group sessions for carers and persons with dementia. Results Two main categories emerged: 1) benefits of the intervention program, which sets out the informants’ experiences for the benefits of participation, described in the subcategories “importance of content and group organization” and “importance of social support”; and 2) missing content in the intervention program, which details the informants’ suggestions for future interventions, contained in the subcategories “need for extended content” and “need for new group organization”. Conclusion The carers found the interventions useful. The importance of even earlier and more flexible interventions for the family carers, the extended family, and the persons with dementia was underscored. PMID:25709469
Johannessen, Aud; Bruvik, Frøydis Kristine; Hauge, Solveig
Psychosocial interventions for persons with dementia and their primary family carers are promising approaches to reducing the challenges associated with care, but, obtaining significant outcomes may be difficult. Even though carers in general are satisfied with such interventions, few studies have evaluated the interventions by means of qualitative methods. The objective of the study reported here was to investigate family carers' experiences of a multicomponent psychosocial intervention program, and also to offer advice on how to develop the intervention program. Content analyses were taken from individual qualitative interviews conducted in 2012 with 20 carers (aged 50-82 years) who participated in a psychosocial intervention program that included education, individual and family counseling, and parallel group sessions for carers and persons with dementia. Two main categories emerged: 1) benefits of the intervention program, which sets out the informants' experiences for the benefits of participation, described in the subcategories "importance of content and group organization" and "importance of social support"; and 2) missing content in the intervention program, which details the informants' suggestions for future interventions, contained in the subcategories "need for extended content" and "need for new group organization". The carers found the interventions useful. The importance of even earlier and more flexible interventions for the family carers, the extended family, and the persons with dementia was underscored.
Full Text Available Weyinshet Gossa,1,2 Dawit Wondimagegn,3 Demeke Mekonnen,4 Wondwossen Eshetu,5 Zerihun Abebe,6 Michael D Fetters2 1Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; 2Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA; 3Department of Psychiatry, Addis Ababa University, Addis Ababa, 4Department of Pediatrics, Jimma University, Jimma, 5Federal Ministry of Health, 6St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia Abstract: As a very low-income country, Ethiopia faces significant development challenges, though there is great aspiration to dramatically improve health care in the country. Family medicine has recently been recognized through national policy as one potential contributor in addressing Ethiopia's health care challenges. Family medicine is a new specialty in Ethiopia emerging in the context of family medicine development in Sub-Saharan Africa. The Addis Ababa University family medicine residency program started in 2013 and is the first and the only family medicine program in the country as of March 2016. Stakeholders on the ground feel that family medicine is off to a good start and have great enthusiasm and optimism for its success. While the Ministry of Health has a vision for the development of family medicine and a plan for rapid upscaling of family medicine across the country, significant challenges remain. Continuing discussion about the potential roles of family medicine specialists in Ethiopia and policy-level strategic planning to place family medicine at the core of primary health care delivery in the country is needed. In addition, the health care-tier system needs to be restructured to include the family medicine specialists along with appropriately equipped health care facilities for training and practice. Key stakeholders are optimistic that family medicine expansion can be successful in Ethiopia through a coordinated effort by
Pauls, Merril A
To document the scope of the teaching and evaluation of ethics and professionalism in Canadian family medicine postgraduate training programs, and to identify barriers to the teaching and evaluation of ethics and professionalism. A survey was developed in collaboration with the Committee on Ethics of the College of Family Physicians of Canada. The data are reported descriptively and in aggregate. Canadian postgraduate family medicine training programs. Between June and December of 2008, all 17 Canadian postgraduate family medicine training programs were invited to participate. The first part of the survey explored the structure, resources, methods, scheduled hours, and barriers to teaching ethics and professionalism. The second section focused on end-of-rotation evaluations, other evaluation strategies, and barriers related to the evaluation of ethics and professionalism. Eighty-eight percent of programs completed the survey. Most respondents (87%) had learning objectives specifically for ethics and professionalism, and 87% had family doctors with training or interest in the area leading their efforts. Two-thirds of responding programs had less than 10 hours of scheduled instruction per year, and the most common barriers to effective teaching were the need for faculty development, competing learning needs, and lack of resident interest. Ninety-three percent of respondents assessed ethics and professionalism on their end-of-rotation evaluations, with 86% assessing specific domains. The most common barriers to evaluation were a lack of suitable tools and a lack of faculty comfort and interest. By far most Canadian family medicine postgraduate training programs had learning objectives and designated faculty leads in ethics and professionalism, yet there was little curricular time dedicated to these areas and a perceived lack of resident interest and faculty expertise. Most programs evaluated ethics and professionalism as part of their end-of-rotation evaluations, but
Hepburn, Kenneth W.; Lewis, Marsha; Sherman, Carey Wexler; Tornatore, Jane
Purpose: This article reports on the development and field testing of the Savvy Caregiver Program, the transformation of a successful, academic-based caregiver psychoeducational program into a self-contained program that can be adopted in other locations. Design and Methods: Program development began with a prototype of a 12-hr course with the…
Notkola, V; Nieminen, M
"The article looks in detail at the population development in China since the 1950s, highlighting some dramatic changes. In the late 1950s the country was hit by widespread famine, which resulted in increased mortality and decreased fertility. Infant mortality climbed to almost 300/1,000. During the 1960s fertility began to increase again and mortality declined. From the beginning of the 1970s fertility started to decline, dropping from about six to just over two children per woman in the late 1980s. Today, fertility is thought to be below replacement level. The main reason for this fertility decline lies in the highly efficient family planning programmes implemented in China since the 1950s and particularly since the 1970s. The decline in infant mortality and the favourable socio-economic development have also been important factors in the decline in fertility. Although fertility in China is currently at a low level, the country's population is still set to grow." (SUMMARY IN ENG) excerpt
Cecil, Dawn K.; McHale, James; Strozier, Anne; Pietsch, Joel
Attendant to the exponential increase in rates of incarceration of mothers with young children in the United States, programming has been established to help mothers attend to parenting skills and other family concerns while incarcerated. Unfortunately, most programs overlook the important, ongoing relationship between incarcerated mothers and family members caring for their children—most often, the inmates' own mothers. Research reveals that children's behavior problems escalate when different co-caregivers fail to coordinate parenting efforts and interventions, work in opposition, or disparage or undermine one another. This article presents relevant research on co-caregiving and child adjustment, highlights major knowledge gaps in need of study to better understand incarcerated mothers and their families, and proposes that existing interventions with such mothers can be strengthened through targeting and cultivating functional coparenting alliances in families. PMID:19884977
Baldor, R A; Luckmann, R
Declining hospitalization rates for children and an increased emphasis on ambulatory care may be affecting the way family practice residency programs train their residents in the care of children. We surveyed all US family practice residency program directors to determine the nature of the child care training that programs currently provide to residents. Responses were received from 78% of the programs. Residencies required a mean of 5.2 months of formal pediatric training (range: 1 to 11 months). Thirty percent of programs noted a declining inpatient census on inpatient pediatric teaching services, but since 1978, the mean duration of inpatient pediatric training increased by 0.4 months to a required mean of 2.7 months of general pediatric inpatient training (range: 0 to 6 months). The mean time devoted to structured outpatient pediatric training was only 1.6 months (range: 0 to 6 months). Nine percent of responding programs required no formal pediatric outpatient training other than family health center experience. Despite declining inpatient census and increased emphasis on comprehensive ambulatory care, family practice residencies require more formal inpatient pediatric training than formal outpatient training.
Department of Veterans Affairs — This speadsheet contains data from the 2014 American Community Survey and shows the demographic and socioeconomic characteristics of Veterans who live in rural and...
Department of Veterans Affairs — VetPop2014 is an actuarial projection model developed by the Office of the Actuary (OACT) for Veteran population projection from Fiscal Year FY2014 to FY2043. Using...
Department of Veterans Affairs — This dataset provide a count of Veteran by their religious affiliation and state of residence. The dataset set covers all 50 states, District of Columbia and other...
Department of Veterans Affairs — This spreadsheet contains data from the 2015 American Community Survey and shows the demographic and socioeconomic characteristics of Veterans who live in rural and...
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