Characteristics, Challenges, and Support of Maryland's Direct Care Workers: Findings From a Statewide Agency Survey

Direct care workers (e.g., personal care aides) are paid health care professionals who provide hands on assistance with daily activities to persons with disabilities in home, community, and institutional settings. Many workers are employed by direct care agencies, but little is known or understood about the organizational attributes of these agencies. We describe results from a mixed mode (postal mail, electronic, and telephone) survey of n=1112 residential care agency administrators in Maryland to assess organizational (e.g., size, supplemental services) and direct care worker (e.g., training) characteristics. Preliminary findings indicate that half of direct care agencies’ revenue comes from Medicaid and roughly 40% of clients are living with dementia. Administrators report challenges managing dementia-related behaviors (70%), communicating with persons living with dementia (63%) and interacting with family caregivers (63%). Findings from this work will inform the development of an organizational level intervention that targets training and support of direct care workers.

Interim Federal Health Program: Survey of access and utilization by paediatric health care providers

Background The Interim Federal Health Program (IFHP) provides health care coverage to refugees and refugee claimants, yet remains underused by providers. The objective of this study was to assess Canadian paediatricians’ current understanding and utilization of the IFHP, and perceived barriers to utilization. Methods A one-time survey was administered via the Canadian Paediatric Surveillance Program in February 2020. In addition to descriptive statistics, multinomial logistic regressions were built to examine paediatrician use of the IFHP, and characteristics associated with registration and use. Results Of the 2,753 physicians surveyed, there were 1,006 respondents (general paediatricians and subspecialists). 52.2% of respondents had provided care to IFHP-eligible patients in the previous 6 months. Of those participants, only 26.4% were registered IFHP providers, and just 16% could identify 80% or more of IFHP-covered services. Knowledge of 80% or more of IFHP-covered services was associated with registration status (adjusted odds ratio [aOR] 1.92; 95%CI 1.09 to 3.37). Among those who knew they were not registered, 70.2% indicated they did not know they had to register. aOR demonstrated that those with fewer years of practice had higher odds of not knowing that they had to register (aOR 1.22; 95%CI 1.01 to 1.49). Conclusions We demonstrate that IFHP is poorly utilized by paediatric providers, with low registration rates and poor understanding of IFHP-covered supplemental services, even among those who have recently provided care to IFHP-eligible patients. Efforts to improve registration and knowledge of IFHP are essential to improving access to health care for refugee children and youth.

Intravitreal Injection Therapy: Current Techniques and Supplemental Services

Purpose: Intravitreal injection is the most frequently performed eye procedure in the world and is an essential component in the management of sight-threating retinal diseases and conditions. Given the seriousness and range of diseases treated and the risks of the procedure, retina specialists must weigh the pros and cons of each individual treatment. Complexities guiding injection treatment are multifaceted and involve patient-history review, careful examination, diagnostic testing selection and interpretation, customized medical decision-making, and follow-up considerations. Methods: This article by the Intravitreal Injection Task Force Committee of the American Society of Retina Specialists documents the intricacies and necessary components of the intravitreal injection procedure. Results: By expert consensus, the task force further recommends ancillary services and decision-making that may accompany intravitreal injection visits, when appropriate, to monitor response to treatment, adjust treatment, and manage additional considerations in the same or fellow eye. Conclusions: Retina specialists can optimize safety and therapeutic outcomes with individualized consideration and customization of intravitreal injection treatment for each patient.

Maintaining Zero Trust With Federation

Federated activity presents a challenge for enterprises with high-level security architectures. Federation involves information sharing among services and with working partners, coalition partners, first responders, and other organizations. Federation may be unilateral or bilateral with similar or dissimilar information-sharing goals. Strong internal security, including zero trust controls, often do not extend cleanly across enterprise boundaries, potentially leading to insecure shortcuts and workarounds that can become the rule instead of the exception. This paper presents methods for an enterprise to extend its zero trust security policies to include federation partners. It applies to federation partners that support the same security policies with compatible standards and services and to partners that provide a similar but incompatible security framework, a subset of required security services, or no security services. The partner organization may be fully trusted, partially trusted, or untrusted. Even for trusted partners, the services may not meet required security standards. Our solution combines selected partner security services, internal services, derived credentials, delegated authorities, and supplemental services to form the federation security architecture based on zero trust premises to the maximum extent. This paper uses the Zero Trust for Enterprise (ZTE) architecture as the starting point for a secure enterprise and addresses the challenge of extending this model to federate with different types of partners. We review the security approach, the security properties, and several options for an enterprise to maintain the ZTE security properties while enabling federated sharing with other enterprises that have different capabilities and levels of trust

Exploring common therapeutic elements in providing support services to parents whose children are in public care: A qualitative study

Parents whose children are in public care are a vulnerable, hard-to-reach and under-focused group. Their needs are numerous, complex, and range from acute to long-term. The Family Counselling Services have recently assumed particular responsibility to provide emotional and support services to this parent group. The study aimed to explore the experiences and needs of family therapists currently working with the parent group. A national sample of 21 therapists participated in the study. Data was collected based on focus-group interviews and analysed using themes from the Contextual Model presented by Wampold (2015). Responses covered the initial bond and the three therapeutic pathways offered by the model. Further, therapists had a positive attitude but also expressed their concerns. Providing supplemental services to the parent group had an excellent fit with the Family Counseling Services.

The High Coverage of Dental, Vision, and Hearing Benefits Among Medicare Advantage Enrollees

While the traditional Medicare program does not cover dental, vision, and hearing services, Medicare Advantage (MA) plans have been given the flexibility to do so. However, it is not known how many MA enrollees are in plans that cover these services. The 2016 Medicare Current Beneficiary Survey linked to MA plan benefit data is used to examine enrollment levels in plans that cover dental, vision, and/or hearing services in MA. Medicaid beneficiaries are excluded from this analysis as coverage of supplemental benefits is largely determined by the state. The highest coverage of supplemental services is vision, followed by hearing and dental (71%, 56%, and 41%, respectively). Across all supplemental services, coverage for supplemental benefits is highest among low-income beneficiaries and those who have not completed high school. Hispanic Medicare beneficiaries had the highest enrollment in plans that offered a supplemental benefit, and white Medicare beneficiaries tended to have the lowest enrollment in these plans. Unlike in traditional Medicare, MA enrollees have access to health plans that offer supplemental benefits, including dental, vision, and/or hearing services. This analysis shows that enrollment in these plans is highest among low-income MA enrollees who may not have the means to purchase stand-alone insurance for these services in traditional Medicare. More analysis is warranted to examine the generosity of the coverage of these services in MA plans. However, for federal policy makers to consider offering supplemental coverage in traditional Medicare, the MA experience suggests this type of benefit would be valuable.

Factors Related to Early Termination From Work for Youth With Disabilities

This study of young adults with disabilities in transition explored what factors contributed to young adults with disabilities terminating early from a transition program. Data from 6,227 young adults with disabilities aged 17–22 living in one of eight major metropolitan areas in the United States were utilised (58.7% of the sample were male, 63.1% were African-American, and 71.4% had a learning disability). All participants were enrolled in a school-to-work transition programme in which service providers place students into paid internships. Service providers at the eight sites collected data while working with participants, and then collected follow-up data at three and twelve months post-programme completion or termination. Hierarchical Linear Modelling was used to explore how personal factors impacted early termination, while controlling for variation at the site level. Results showed the three main reasons for early termination from work to be: programme initiated termination, interpersonal conflicts with coworkers or supervisors and transportation issues. Additionally, the multilevel model that controlled for variance at the site level demonstrated that Asian-American young adults with disabilities were less likely to terminate early from work. These results can help individuals who work with young adults with disabilities, provide supplemental services to students who may need additional assistance to succeed in a transition programme.

Instruction Matters: Lessons from a Mixed-Method Evaluation of Out-Of-School Time Tutoring under No Child Left Behind

Background/Context Under supplemental educational services (“supplemental services”), a parental choice provision of the No Child Left Behind Act (NCLB), schools that have not made adequate yearly progress in increasing student achievement are required to offer low-income families free, afterschool tutoring. Existing research shows low attendance rates among eligible students and little to no aggregate effects on achievement for students who do attend. Focus of study We employ a framework grounded in examining the instructional setting, or “instructional core,” and we draw on the unique contributions of qualitative research to help explain the limited effects of supplemental services on student achievement. Specifically, we address the following research question: How can in-depth examination of the instructional core explain the impact of supplemental services on student learning? Research Design Our findings draw on data from an ongoing mixed-method and multisite study of the implementation and impact of supplemental educational services in five urban school districts located in four states. Although this paper includes quantitative data from this study, analysis focuses on qualitative data, including observations of tutoring sessions using a standardized observation instrument; semistructured interviews with district staff, provider administrators, and tutors; focus groups with parents of eligible students; and document analysis. Findings We identify two primary reasons for a lack of effects. First, there is a “treatment exposure” problem where most students receive far less than 40 hours of tutoring over the course of a school year, a critical threshold for seeing significant effects on achievement. In addition, there are discrepancies between an invoiced hour of tutoring and actual instructional time. Second, supplemental services has an instructional quality problem. Instruction lacks innovation; the curriculum typically does not align to that of the day school; programs do not meet all students’ instructional needs, especially students with disabilities and English language learners; and there can be considerable variation in quality within the same provider. Conclusions Our findings lay the foundations for being able to not only establish best practices for supplemental services, but to suggest policy changes to facilitate these best practices and offer insights to a host of other parental choice, out-of-school time (OST), and accountability-based reforms.