scholarly journals 856. Barriers to PrEP Implementation among Patient-Facing Staff in Three Urban Clinics

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S519-S519
Author(s):  
Sheela Shenoi ◽  
Robert J Sideleau ◽  
Sharen E McKay ◽  
Lydia A Aoun-Barakat
Keyword(s):  
Behavioral Interventions ◽  
Safety Data ◽  
Risky Behaviors ◽  
Staff Members ◽  
Company Stock ◽  
Knowledge And Beliefs ◽  
Prep Implementation ◽  
Multidisciplinary Staff ◽  
Patient Outreach ◽  
Systemic Barriers

Abstract Background PrEP implementation has lagged in the US. The role of multidisciplinary staff in PrEP rollout has been neglected. We sought to identify barriers to PrEP implementation among 3 urban federally qualified health centers (FQHCs) in Connecticut that provide HIV and PrEP services in order to inform development of staff training. Methods A link to an anonymous survey was emailed to patient-facing staff members or posted at the end of staff trainings October 2020-April 2021. The survey requested demographics, duration of employment, and using 4 and 5 point Likert scales, ascertained knowledge and beliefs toward PrEP based on established scales, and perceived individual and systemic barriers to PrEP uptake. Results Among 101 respondents, 40% were 36-54yo, 22% were male, 68% were non-prescribing clinicians, and median duration of employment was 6 years (IQR 2-14). Among 32 (31%) prescribers (physicians, PAs, APRNs), 97% felt comfortable discussing sexual risk with patients, though 15% were not familiar with PrEP efficacy and safety data, 28% responded that PrEP use would encourage risky behaviors, 34% were concerned about side effects, 53% responded that educational and behavioral interventions should be attempted prior to prescribing PrEP, and 59% identified lack of provider training as a barrier. Among 69 (68%) non-prescribers, barriers to PrEP uptake included: patients don’t ask for PrEP (43%), lack of insurance (47%), lack of clinic guidelines/protocol (42%), and staff time for counseling (31%). Conclusion Prescribers and non-prescribers identified distinct individual and systemic barriers to PrEP uptake at FQHCs. Among prescribers, uncertainty regarding indications for and safety of PrEP exist, which will be addressed with targeted training. Non-prescribers identified the need for patient outreach, financial assistance, and counseling as the top priorities. The input of clinic multidisciplinary team members is essential to addressing barriers to PrEP implementation. Disclosures Sheela Shenoi, MD, MPH, Merck (Other Financial or Material Support, SS’s spouse worked for Merck pharmaceuticals 1997-2007 and retains company stock in his retirement account. There is no conflict of interest, but it is included in the interest of full disclosure.)

scholarly journals Sensory Environments for Behavioral Health in Dementia: Diffusion of an Environmental Innovation at the Veterans Health Administration

2020 ◽  
Vol 13 (4) ◽  
pp. 44-56
Author(s):  
Lesa Lorusso ◽  
Nam-Kyu Park ◽  
Sheila Bosch ◽  
I. Magaly Freytes ◽  
Ronald Shorr ◽  
...  
Keyword(s):  
Behavioral Interventions ◽  
Veterans Health Administration ◽  
Qualitative Inquiry ◽  
Veterans Health ◽  
Health Administration ◽  
Patient Centered ◽  
Staff Perceptions ◽  
Staff Members ◽  
Individual Interviews ◽  
Inquiry Method

Objectives: To evaluate the diffusion of multisensory environments (MSEs) as an innovation at the Veterans Health Administration (VHA) and gather feedback regarding staff perceptions of barriers to uptake and effectiveness of MSEs for Veterans with dementia. Background: Responding to the need for nonpharmacological behavioral interventions, VHA funded the first MSE for Veterans with dementia in 2010. The room incorporated LED color-changing lights, bubble tubes, vibroacoustic furniture, music, and aromatherapy, and the success of this patient-centered sensory room fueled national rollouts in 2013 and 2015. Method: A qualitative interview approach was used. Thirty-two staff members participated from 12 of the 53 sites producing 21 individual interviews and 1 group interview with 11 participants. Results were analyzed by a team of eight researchers using the rapid qualitative inquiry method to identify common themes and major insights. Results: Important insights emerged with regard to staff members’ perceptions about the effectiveness of MSE therapy as well as barriers to uptake and suggested strategies for overcoming those barriers (e.g., empowering a champion, developing a clear maintenance plan). Conclusions: The findings from this research indicate MSEs are perceived as effective in improving behavior for Veterans with dementia and represent an innovation that has been well-diffused within the VHA, with great potential for future clinical applications.

Implementation of Modified Positive Behavioral Interventions and Supports in a youth psychiatric partial hospital program

2018 ◽  
Vol 24 (2) ◽  
pp. 64-70 ◽  
Author(s):  
Elizabeth K Reynolds ◽  
Marco A Grados ◽  
Nancy Praglowski ◽  
Jessica C Hankinson ◽  
Carisa Parrish ◽  
...  
Keyword(s):  
Behavioral Interventions ◽  
Staff Members ◽  
Positive Behavioral Interventions ◽  
Partial Hospital ◽  
Behavioral Expectations ◽  
Individual Support ◽  
Wide System ◽  
Partial Hospital Program ◽  
Pro Re Nata ◽  
Evidence Based Decision Making

Objective Seclusion and restraint are procedures utilized in youth psychiatric settings. While a number of agencies have called for a reduction and ultimate elimination of the use of these practices, there has been limited research on behavioral programs to reduce seclusion/restraint. This is particularly true for research on behavioral programming in youth psychiatric partial hospital settings. As such, the current study sought to examine the effectiveness of a modified version of Positive Behavioral Interventions and Supports (M-PBIS) implemented on a youth psychiatric partial hospital service to reduce seclusion/restraint. Method This naturalistic, prospective study covered a 26-month period and utilized a pre–post design. M-PBIS features include a defined set of positive behavioral expectations, a system to teach behavioral expectations, reinforcement of appropriate behaviors, data collection/evidence-based decision making, individual support for those not responding to the unit-wide system, active support by all stakeholders (including all staff members agreeing to the program), and positive recognition among staff. Results With a sample of 442 admissions, there were meaningful reductions in the percent of patients who were in seclusion/restraint (from 47.6 to 6.7%) as well as the overall seclusion/restraint rate (from 3.56 ( SD = 1.94) to 0.48 ( SD = 0.64)). Furthermore, there was a significant reduction in the use of Pro Re Nata (PRN) medication for agitation/aggression (percent of patient who received a PRN decreased from 33.3 to 12.9%). Conclusions This naturalistic study suggests that M-PBIS is a promising intervention for use in youth psychiatric partial hospital services to reduce seclusion/restraint and PRN medication for agitation/aggression. Reduction and ultimate elimination of seclusion/restraint is a critical objective in improving the quality and safety of acute mental health services for youth.

Characteristics of Students Referred to School Teams: Implications for Preventive Psychological Services

1992 ◽  
Vol 8 (1) ◽  
pp. 23-36 ◽  
Author(s):  
Ester Cole
Keyword(s):  
School Psychology ◽  
Secondary Schools ◽  
Prevention Programs ◽  
Psychological Services ◽  
Learning Needs ◽  
Staff Members ◽  
Multidisciplinary Staff

A total of 274 multidisciplinary staff members in 54 elementary and secondary schools participated in a study that identified the characteristics of students referred to school teams. The results suggested that meetings addressed academic and learning needs more often than emotional or psychological concerns. Implications for the practice of school psychology and the development of team-facilitated prevention programs are discussed.

scholarly journals Adapting services for autism: Recommendations from a specialist multidisciplinary perspective using freelisting

2021 ◽  
Author(s):  
Stephanie Petty ◽  
Milja-Leea Bergenheim ◽  
Georgina Mahoney ◽  
Lucy Chamberlain
Keyword(s):  
Mental Healthcare ◽  
Cultural Consensus ◽  
Staff Members ◽  
Priority Service ◽  
Specialist Services ◽  
Autistic People ◽  
Therapy Services ◽  
Multidisciplinary Staff ◽  
Multidisciplinary Perspective ◽  
The Uk

AbstractThe guidance available for tailoring mental health services for autistic people is limited and dispersed. Practitioners attempting to appropriately adapt mental healthcare and therapy provision report low confidence and inconsistency in their approach. This study contributes to the guidance by providing a shortlist of usable and priority adaptations for diagnostic and therapy services as described by multidisciplinary staff members responsible for the design and delivery of a specialist autism service in the UK. Individual freelisting interviews were conducted with 15 staff, who were asked to list the ways that they adapt their practice individually, within therapy, and collectively as a service. Salience and cultural consensus analyses demonstrated the following agreed priority service adaptations: ensuring the suitability of the service environment with consideration of sensory demands, adapting communication, knowing individual gender identity preferences and minimising client uncertainty. Detailed examples are given for flexibly adapting therapy to individual needs to inform general and specialist services. The findings require replication and evaluation.

Organ Donation After Cardiac Death in Children: Acceptance of a Protocol by Multidisciplinary Staff

2012 ◽  
Vol 21 (5) ◽  
pp. 322-327 ◽  
Author(s):  
Allison S. Cowl ◽  
Brian M. Cummings ◽  
Phoebe H. Yager ◽  
Brenda Miller ◽  
Natan Noviski
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Brain Death ◽  
Organ Donation ◽  
Cardiac Death ◽  
Pediatric Intensive Care ◽  
Donation After Cardiac Death ◽  
Staff Members ◽  
Donation After Brain Death ◽  
Multidisciplinary Staff

Background Organ donation after cardiac death is increasingly implemented, with outcomes similar to those of organ donation after brain death. Many hospitals hesitate to implement a protocol for donation after cardiac death because of the potential negative reactions among health care providers. Objectives To determine the acceptance of a protocol for donation after cardiac death among multidisciplinary staff in a pediatric intensive care unit. Methods An anonymous, 15-question, Likert-scale questionnaire (scores 1–5) was used to determine the opinions of staff about donation after brain death and after cardiac death in a pediatric intensive care unit of a tertiary-care university hospital. Results Survey response rate was 67% (n = 60). All physicians, 89% of nurses, and 82% of the remaining staff members stated that they understood the difference between donation after brain death and donation after cardiac death; staff supported both types of donation, at rates of 90% and 85%, respectively. Staff perception was the same for each type of donation (ρ = 0.82; r = 0.92; P < .001). The 20 staff members who provided care directly to patients who were donors after cardiac death considered such donation worthwhile. However, 60% of those providers offered suggestions to improve the established protocol for donation. Conclusions The multidisciplinary staff has accepted organ donation after cardiac death and has fully integrated this kind of donation without reported differences from their acceptance of donation after brain death.

Increasing Praise Delivery Within Dorms of a Juvenile Justice Facility

2020 ◽  
pp. 014544552098297
Author(s):  
Odessa Luna ◽  
John T. Rapp
Keyword(s):  
Juvenile Justice ◽  
Disruptive Behavior ◽  
Behavioral Interventions ◽  
Behavioral Measures ◽  
Staff Members ◽  
Treatment Facilities ◽  
Negative Statements ◽  
Low Levels ◽  
Staff Behavior ◽  
Direct Measures

Researchers have shown that adolescents in residential treatment facilities benefit from behavior-analytic intervention. However, it remains unclear whether practitioners can apply behavioral interventions to increase staff members’ appropriate interactions with residents within a juvenile justice facility. In Study 1, researchers compared direct measures of staff behavior in three target dorms (D1, D2, and D3) containing high levels of resident disruptive behavior to a dorm (D4) with consistently low levels of resident disruptive behavior. Results indicated that staff members in the target dorms engaged in significantly higher rates of reprimands and negative statements than in D4. In Study 2, researchers used didactic and video instruction to train staff members in D1, D2, and D3 to increase contingent and noncontingent praise delivery. Results indicated praise delivery by staff members increased slightly in each target dorm. In Study 3, researchers first evaluated the extent to which measures of staff members’ and residents’ behaviors improved following training within each dorm. Subsequently, researchers compared the post-training behavioral measures from D1, D2 and D3 to D4 to determine the extent to which staff behavior in the training dorms was distinguishable from D4. Results of Study 3 indicated that one or more staff behaviors improved in each training dorm. Nevertheless, residents’ disruptive behavior was unchanged in each target dorm. In addition, staff members’ behavior in each target dorm continued to be distinguishable from staff members’ behavior in D4 on most behavioral measures.

Family Presence During Resuscitation: A Critical Review of the Literature

2005 ◽  
Vol 14 (6) ◽  
pp. 494-511 ◽  
Author(s):  
Margo A. Halm
Keyword(s):  
Lived Experience ◽  
Healthcare Providers ◽  
Family Members ◽  
Review Of The Literature ◽  
Family Presence ◽  
Staff Members ◽  
Current State ◽  
Theoretical Perspectives ◽  
Considerable Controversy ◽  
Multidisciplinary Staff

Presence of patients’ families during resuscitation has emerged as an important practice issue, sparking considerable controversy worldwide. Early advocates of allowing patients’ families to be present during resuscitation faced more resistance than did current advocates because the former had little or no scientific research results to support their ideas. In the past 15 years, a number of quantitative studies, especially descriptive surveys, have been conducted. Qualitative researchers have also explored the lived experience of family members present during resuscitation and less commonly the perspectives of patients and healthcare providers. In this review of the literature, the current state of the science is critically reviewed and the ethical-theoretical perspectives of respective researchers and staff participants in the reviewed studies are discussed. Surveys were used to collect data in most studies to date. Limitations of these designs include small convenience samples, low response rates, use of retrospective surveys and the associated potential selection bias, and lack of consistency in survey instruments, factors that make comparison of findings between studies difficult. Recommendations to address the gaps in the current state of knowledge about family members’ presence during resuscitation are discussed. Experimental and qualitative methods are especially needed to investigate the effect of family presence during resuscitation on patients, families, nurses and physicians, and other multidisciplinary staff members.

scholarly journals Distraction of cyclists: how does it influence their risky behaviors and traffic crashes?

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e5616 ◽  
Author(s):  
Sergio A. Useche ◽  
Francisco Alonso ◽  
Luis Montoro ◽  
Cristina Esteban
Keyword(s):  
Safety Data ◽  
Risky Behaviors ◽  
Health Concern ◽  
Severe Injuries ◽  
Explanatory Role ◽  
Cross Sectional ◽  
Traffic Crashes ◽  
The Road ◽  
Phone Calls ◽  
On The Road

BackgroundUndisputedly, traffic crashes constitute a public health concern whose impact and importance have been increasing during the past few decades. Specifically, road safety data have systematically shown how cyclists are highly vulnerable to suffering traffic crashes and severe injuries derived from them. Furthermore, although the empirical evidence is still very limited in this regard, in addition to other human factors involved in cycling crashes, distractions while cycling appear to be a major contributor to the road risk of cyclists.ObjectivesThe main objectives of this study were, first, to explore the prevalence and trends of cycling distractions within an international sample of bike users, and second, to determine the influence of such distractions on road crashes suffered by cyclists, simultaneously considering the explanatory role of risky behaviors (errors and traffic violations) as potentially mediating variables between cycling distractions and traffic crashes.MethodsFor this cross-sectional study, we analyzed the data obtained from 1,064 cyclists—61.2% male and 38.8% female—from 20 different countries, who answered an on-line questionnaire on cycling-related features, habits, behaviors and accidents.ResultsThe prevalence of different cycling distractions oscillated between 34.7% and 83.6%. The most common distractions were those related to the behavior of other users, physical elements of the road, weather conditions and phone calls. Age trends and differences were also found, thus establishing a positive association between age and distractibility during cycling. Furthermore, the effect of distractions on traffic crashes of cyclists was significant when tested together with age, risk perception and risky behaviors on the road.ConclusionThe results of this study support the hypotheses that distractions have a major prevalence among bike users, and that they play a significant role in the prediction of the traffic crash rates of cyclists, through the mediation of risky behaviors.

scholarly journals Exploring Implementation and Fidelity of Evidence-Based Behavioral Interventions for HIV Prevention: Lessons Learned From the Focus on Kids Diffusion Case Study

2008 ◽  
Vol 36 (3) ◽  
pp. 532-549 ◽  
Author(s):  
Jennifer S. Galbraith ◽  
Bonita Stanton ◽  
Bradley Boekeloo ◽  
Winifred King ◽  
Sharon Desmond ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Behavioral Interventions ◽  
Technical Assistance ◽  
Lessons Learned ◽  
Evidence Based ◽  
Cross Sectional ◽  
Staff Members ◽  
Hiv Intervention ◽  
Core Elements

Evidence-based interventions (EBIs) are used in public health to prevent HIV infection among youth and other groups. EBIs include core elements, features that are thought to be responsible for the efficacy of interventions. The authors evaluate experiences of organizations that adopted an HIV-prevention EBI, Focus on Kids (FOK), and their fidelity to the intervention's eight core elements. A cross-sectional telephone survey was administered to 34 staff members from organizations that had previously implemented FOK. Questions assessed how the organization adhered to, adapted, dropped, or altered the intervention. None of the organizations implemented all eight core elements. This study underscores the importance for HIV intervention researchers to clearly identify and describe core elements. More effort is needed to reflect the constraints practitioners face in nonresearch settings. To ensure intervention effectiveness, additional research and technical assistance are needed to help organizations implement HIV prevention EBIs with fidelity.

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