Positive behavioural support for children and adolescents with learning disabilities and behaviour that challenges: an initial exploration of service use and costs

2016 ◽  
Vol 21 (4) ◽  
pp. 169-180 ◽  
Author(s):  
Valentina Iemmi ◽  
Martin Knapp ◽  
Caroline Reid ◽  
Catherine Sholl ◽  
Monique Ferdinand ◽  
...  
Keyword(s):  
Learning Disabilities ◽  
Children And Adolescents ◽  
Service Use ◽  
Potential Cost ◽  
Content Type ◽  
Total Cost ◽  
Behavioural Support ◽  
Delphi Exercise ◽  
The Cost

Purpose Positive behavioural support has been considered as a valuable alternative to residential care for children and adolescents with learning disabilities and behaviour that challenges. While recent evidence suggests it has a positive impact on behaviour and carer ability to cope, there is little evidence of its economic costs or benefits. The paper aims to discuss this issue. Design/methodology/approach An exploratory cross-sectional study was conducted to evaluate the cost of providing positive behavioural support to ten children and adolescents with learning disabilities and behaviour that challenges living in the community in Ealing, West London. Comparison was also made with the cost estimate of possible alternative support packages for children and adolescents with learning disabilities and behaviour that challenges in the UK, as obtained through a Delphi exercise. Findings Total cost of services per child was £1,454 per week for young people supported short-term, and £1,402 supported long-term. Children and adolescents were making use of a range of social care, education and health services. Over the full sample, half of the total cost was accounted for by education services. The Delphi exercise estimated the weekly cost of residential-based care as more expensive than the cost of community-based care for children and adolescents with learning disabilities and behaviour that challenges. At the end of the ITSBS, all ten children and adolescents initially at risk of imminent residential placement were living in the community with less service-intensive and less expensive support. This suggests that avoiding residential-based care could reduce costs in the long term. Originality/value Positive behavioural support has potential to support people with learning disabilities and behaviour that challenges in the community, leading to potential cost advantages. However, this is a small study and more robust research is needed.

scholarly journals Day services and home care for adults with learning disabilities across the UK

2017 ◽  
Vol 22 (2) ◽  
pp. 109-115 ◽  
Author(s):  
Chris Hatton
Keyword(s):  
Learning Disabilities ◽  
Northern Ireland ◽  
Home Care ◽  
Service Use ◽  
Social Care ◽  
Content Type ◽  
Adults With Learning Disabilities ◽  
Day Services ◽  
The Uk ◽  
Over Time

Purpose The purpose of this paper is to compare data from national social care statistics on day services and home care for people with learning disabilities across England, Scotland, Wales and Northern Ireland. Design/methodology/approach National social care statistics (England, Scotland, Wales and Northern Ireland) reporting the number of adults with learning disabilities accessing day services and home care were reviewed, with data extracted on trends over time and rate of service use. Findings Regarding day services, despite some variations in definitions, the number of adults with learning disabilities in England, Scotland and Wales (but not Northern Ireland) using building-based day services decreased over time. Data from Scotland also indicate that adults with learning disabilities are spending less time in building-based day services, with alternative day opportunities not wholly compensating for the reduction in building-based day services. Regarding home care, there are broadly similar rates of usage across the four parts of the UK, with the number of adults with learning disabilities using home care now staying static or decreasing. Social implications Similar policy ambitions across the four parts of the UK have resulted (with the exception of Northern Ireland) in similar trends in access to day services and home care. Originality/value This paper is a first attempt to compare national social care statistics concerning day services and home care for adults with learning disabilities across the UK. With increasing divergence of health and social service systems, further comparative analyses of services for people with learning disabilities are needed.

scholarly journals Cultivate, assess, advocate, implement, and sustain

2017 ◽  
Vol 33 (2) ◽  
pp. 100-116 ◽  
Author(s):  
Sara Mannheimer ◽  
Conor Cote
Keyword(s):  
Cost Savings ◽  
Digital Preservation ◽  
Shared Vision ◽  
Limited Resources ◽  
Shared Knowledge ◽  
Collective Knowledge ◽  
Content Type ◽  
The Cost ◽  
Ongoing Support

Purpose For libraries with limited resources, digital preservation can seem like a daunting responsibility. Forming partnerships can help build collective knowledge and maximize combined resources to achieve digital preservation goals. This paper aims to provide guidance to help libraries with limited resources achieve digital preservation goals by forming partnerships to build collective knowledge and maximize combined resources. Design/methodology/approach In 2015, librarians from four Montana institutions formed the Digital Preservation Working Group (DPWG), a collaboration to increase digital preservation efforts statewide. The group’s immediate goals were to promote digital preservation best-practices at each individual institution, and to learn about and support each other’s work. The group’s long-term goal was to implement a shared digital preservation service that would fill gaps in existing digital preservation efforts. Findings Beyond the cost savings gained by sharing a digital preservation service, the members of DPWG benefitted from shared knowledge and expertise gained during the partnership. The group also functioned as a sounding board as each institution built its digital preservation program, and it became a system of support when challenges arose. Practical/implications This paper proposes a five-point plan for creating digital preservation partnerships: cultivate a foundation of knowledge and identify a shared vision; assess the current digital preservation landscape at each institution; advocate for the value of digital preservation activities; implement shared digital preservation services; and sustain group activities and establish structures for ongoing support. Originality/value The activities of DPWG provide a model for institutions seeking to collaborate to meet digital preservation challenges. This paper shows that by implementing a structured plan, institutions can build and sustain digital preservation partnerships, thus positioning themselves to achieve digital preservation success.

US corporate tax reform would risk highway fund

2015 ◽  
Keyword(s):  
House Of Representatives ◽  
Tax Reform ◽  
Fuel Efficiency ◽  
Corporate Tax ◽  
Short Term ◽  
Content Type ◽  
Long Duration ◽  
Corporate Tax Reform ◽  
The Cost

Significance On July 15, the House of Representatives passed a short-term funding measure, against the wishes of many in the Senate. US infrastructure is facing a fiscal crunch. Taxes on gasoline have traditionally supported highway appropriations. However, eroding purchasing power and greater fuel efficiency means that about 30% of highway funding must be found from other sources, difficult in the current Congress. The present round of appropriations expires on July 31. Impacts A corporate tax might provide a long-term resolution, but the pursuit of it would come at the cost of seeking more modest solutions. These would provide stability for a year or two, necessary for projects of long duration. If corporate tax reform is not completed before the end of 2015, it will probably not get done in a presidential election year. If Congress were to rely on the prospect of these taxes for the HTF, it might find itself in a similar position in a few months.

Better risk pricing can unlock billions in investment

2018 ◽  
Keyword(s):  
Direct Investment ◽  
Cost Of Capital ◽  
Political Risk ◽  
Investment Decisions ◽  
Content Type ◽  
Cross Border ◽  
Percentage Points ◽  
Risk Pricing ◽  
The Cost

Subject Pricing political risk. Significance The mis-measurement of political risk is resulting in the cost of capital being valued 2-4 percentage points higher than it should be in assessments ahead of cross-border investment decisions. Research suggests that in 2016 this could have increased net foreign direct investment (FDI) to non-advanced countries by more than 10%. Impacts Political risk measurement is set for a renaissance, with interest from practitioners and end-users likely to proliferate. Frontier markets that are on the edge of inclusion in 'emerging' portfolio allocations could see an uptick in investment inflows. Returns to long-term capital managers, from insurers to pension funds, will rise as cost-of-capital calculations grow in sophistication.

Effect of ISO 9001 non-conformity process on cost of poor quality in capital-intensive sectors

2015 ◽  
Vol 32 (2) ◽  
pp. 144-155 ◽  
Author(s):  
Andrea Chiarini
Keyword(s):  
Poor Quality ◽  
Iso 9001 ◽  
Content Type ◽  
Total Cost ◽  
Periodic Maintenance ◽  
Research Findings ◽  
The Cost ◽  
First Time ◽  
Capital Intensive ◽  
Cost Of Poor Quality

Purpose – The purpose of this paper is to investigate whether there are differences in terms of the effect of the ISO 9001 non-conformity process on the cost of poor quality in different sectors. In particular, to investigate the effect on six sectors of companies which manufacture their products mainly through machines and plant (i.e. capital-intensive companies). An additional aim is to understand what the reasons for these differences are and why ISO 9001 has limitations in reducing the different categories of costs of poor quality. Design/methodology/approach – The paper is based on a questionnaire administered to a sample of 42 companies divided into six different sectors: chemical, pharmaceutical, mechanical, food, ceramic and steel. Respondents were asked to give a percentage score for the contribution the ISO 9001 non-conformity process makes to the reduction in total cost of poor quality and to its categories: scrap, rework, machine stoppage, re-inspections, rejected products and recall cost. A one-way Anova test was applied to the means of the percentage scores to determine whether there are differences between the means of the total cost of poor quality and its categories. Qualitative comments and suggestions from the companies provided information that helped explain the reasons for such differences. Findings – The results of the research show that there is no difference within and between the sectors in the means of the total cost of poor quality and scrap cost, whereas there are significant differences in the means of the other costs of poor quality between the six sectors. The ISO 9001 non-conformity process has limitations in reducing the costs of poor quality and suggestions concerning the limitations of ISO 9001 in the Research and Development process emerge. Research limitations/implications – The generalizability of the research findings is limited because of the use of just six sectors of capital-intensive companies. Further research about differences in different sectors is needed. Practical implications – The implications of this research are useful for consultants and managers who want to understand what the limitations of the ISO 9001 non-conformity process are on the cost of poor quality in the six sectors. The findings clearly show how, together with ISO 9001, they should take into account other improvement processes such as periodic maintenance and revamping. Originality/value – The paper discusses in a quantitative way and for the first time the effects of the ISO 9001 non-conformity process on the cost of poor quality.

scholarly journals Developing a logic model to guide evaluation of impact for learning disability projects: the case of the Positive Behavioural Support (PBS) Academy

2018 ◽  
Vol 23 (3) ◽  
pp. 125-132 ◽  
Author(s):  
Suzi J. Scott ◽  
Louise D. Denne ◽  
Richard P. Hastings
Keyword(s):  
Learning Disabilities ◽  
Logic Model ◽  
Content Type ◽  
Policy Practice ◽  
Stakeholder Groups ◽  
Behavioural Support ◽  
Logic Models ◽  
The Uk ◽  
The Impact ◽  
The Relationship

Purpose Measuring “impact” is an important aspect of the dissemination of evidence-based practice and relevant to all disciplines. However, it has only recently become a focus of enquiry and is not commonly directly researched within the learning disabilities field. The purpose of this paper is to describe the process of developing a logic model for the UK Positive Behavioural Support (PBS) Academy as part of an evaluation and impact study of its work to date. Design/methodology/approach Logic models are a visual representation of the relationship between a project’s resources, activities and outputs and identified outcomes, in relation to key stakeholder groups. This representation allows for key impact measures to be identified and can be a useful tool for evaluation purposes. The authors used the process outlined by McLaughlin and Jordan (1998) to develop a bespoke logic model for the PBS Academy. Findings The model was particularly helpful in making clear the distinction between output and impact, identifying impact criteria differentiated by stakeholder group and across time scales, and highlighting areas of activity that are needed to increase the impact of the work of the PBS Academy in the longer term. Originality/value In the absence of any generalised impact evaluation frameworks in the learning disabilities field, the authors suggest that logic models may provide a useful framework for evaluating the impact of policy, practice, and research interventions.

scholarly journals Specialist inpatient services for people with learning disabilities across the four countries of the UK

2016 ◽  
Vol 21 (4) ◽  
pp. 220-225 ◽  
Author(s):  
Chris Hatton
Keyword(s):  
Learning Disabilities ◽  
Northern Ireland ◽  
Young People ◽  
Length Of Stay ◽  
Service Use ◽  
Inpatient Service ◽  
Content Type ◽  
Inpatient Services ◽  
Trends Over Time ◽  
The Uk

Purpose The purpose of this paper is to compare data from national censuses on specialist inpatient service use by people with learning disabilities across England, Scotland, Wales and Northern Ireland. Design/methodology/approach National statistics (England, Scotland, Wales, Northern Ireland) reporting inpatient service censuses including people with learning disabilities were accessed, with data extracted on trends over time, rate of service use, young people and length of stay. Findings The number and rate of people with learning disabilities in specialist inpatient services varied across the UK: 230 people in Scotland (rate 4.88 per 100,000 population); 3,250 people in England (5.48); 183 people in Wales (5.90); 144 people in Northern Ireland (7.82). The number of people in inpatient services in Northern Ireland halved over four years, in other areas reductions were modest. Between 5 and 8 per cent of people in inpatient services were children/young people. Median length of stay in the person’s current inpatient service varied: 19 months in England; 33 months in Scotland; three to five years in Northern Ireland. Social implications Different parts of the UK vary in the scale of their specialist inpatient services for people with learning disabilities. With the exception of Northern Ireland, which may still be in the last stages of completing a “regular” deinstitutionalisation programme, strong policy prescriptions for substantial reductions in specialist inpatient services are currently only resulting in modest reductions. Originality/value This paper is a first attempt to compare national inpatient service statistics across the UK. With increasing divergence of health and social service systems, further comparative analyses of services for people with learning disabilities are needed.

scholarly journals Use of levosimendan versus dobutamine when inotropic support is needed in patients with severe acute decompensated chronic heart failure

2021 ◽  
Vol 27 (6) ◽  
pp. 47-60
Author(s):  
M. A. Aristov ◽  
O. M. Melnychuk
Keyword(s):  
Clinical Trials ◽  
Cost Effectiveness ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Cost Effectiveness Ratio ◽  
Total Cost ◽  
Total Budget ◽  
Cost Of Drugs ◽  
The Cost

The aim – to conduct clinical effectiveness, meta-analysis of 30 and 120-days mortality data, pharmacoeconomic evaluation of levosimendan treatment compared with dobutamine in patients with severe acute decompensated chronic heart failure (ADCHF) who require inotropic support. Materials and methods. The PubMed and Cochrane databases were searched for direct randomized clinical trials of levosimendan treatment compared with dobutamine in patients with ADCHF. The clinical efficacy of levosimendan and dobutamine was analyzed. Pharmacoeconomic analysis was carried out using the cost-effectiveness method with an assessment of the incremental cost-effectiveness ratio. A decision tree model of levosimendan or dobutamine treatments was constructed. The efficacy endpoints and impact on the budget were analyzed in terms of long-term effectiveness of levosimendan and dobutamine use. Discounted was conducted with rate of 3 %. Sensitivity analysis was carried out in terms of price changing of drugs, the cost of drugs in mg, the likelihood of re-hospitalization of the patient in a 3-year horizon and survival in the long term.Results and discussion. Analysis of clinical data and meta-analysis of randomized clinical trials found that mortality rates with levosimendan and dobutamine in the 30-day period were 9.6 % and 13.8 %, RR 0.71 (95 % CI 0.53–0.95) and in the 120-day period – 13.5 % and 25.2 %, RR 0.54 (95 % CI 0.32–0.92), respectively. The total cost of the course of treatment, taking into account the price of the drug, medical devices, staff services, diagnostic procedures and treatment of adverse reactions when using levosimendan, was 34 003.02 UAH per patient and 18 787.28 UAH when treated with dobutamine. The weighted average hospital stay was 6.4 days in case of levosimendan treatment and 7.5 days of dobutamine treatment. Extrapolation of the data from clinical trials to the 3-year survival rate of patients allowed us to determine an additional indicator of efficacy – the number of life years saved with levosimendan – 2.64 and 2.37 with dobutamine treatment. A cost-effectiveness analysis found that levosimendan is more efficient but more expensive technology compare to dobutamine. The incremental cost-effectiveness ratio for the additional life year saved of a patient with severe CHF is 43,473.55 UAH, which is 6 times less than the likely threshold of willingness to pay in Ukraine.Conclusions. The multivariate sensitivity analysis detected the model sustainability to the most crucial parameters of the model – drug price; the cost of drugs associated with their actual use in mg, the possibility of re-hospitalization of the patient in a 3-year horizon, and long-term survival, which is associated with the time horizon of the model. The total cost of a cohort of patients with ADCHF in Ukraine when using scenario 1 (100 % distribution of costs for dobutamine treatment) over 5 years is 268 188 351.94 UAH, when using scenario 2 (100 % distribution for treatment with levosimendan) total budget costs will be in amount of 485 393 073.09 UAH, if scenario 3 is applied (gradual 5 % transition in the treatment of patients with ADCHF with dobutamine for treatment with levosimendan within 5 years), the total budget costs will amount to 289 916 431.92 UAH

scholarly journals Cry for health: a quantitative evaluation of a hospital-based advocacy intervention for domestic violence and abuse

2019 ◽  
Author(s):  
Gemma Halliwell ◽  
Sandi Dheensa ◽  
Elisabetta Fenu ◽  
Sue K Jones ◽  
Jessica Asato ◽  
...  
Keyword(s):  
Domestic Violence ◽  
Health Service ◽  
Health Services ◽  
Service Use ◽  
Cost Savings ◽  
Health Service Use ◽  
Potential Cost ◽  
Safety Outcomes ◽  
The Cost ◽  
Domestic Violence And Abuse

Abstract Background Domestic violence and abuse damages the health of survivors and increases use of healthcare services. We report findings from a multi-site evaluation of hospital-based advocacy services, designed to support survivors attending emergency departments and maternity services. Methods Independent Domestic Violence Advisors (IDVA) were co-located in five UK hospitals. Case-level data were collected at T1 (initial referral) and T2 (case closure) from survivors accessing hospital (T1 N = 692; T2 N = 476) and community IDVA services (T1 N = 3,544; T2 N = 2,780), used as a comparator. Measures included indicators of sociodemographic characteristics, experience of abuse, health service use, health and safety outcomes. Multivariate analyses tested for differences in changes in abuse, health and factors influencing safety outcomes. Health service use data in the six months pre-and post- intervention were compared to generate potential cost savings by hospital IDVA services. Results Hospital IDVAs worked with survivors less visible to community IDVA services and facilitated intervention at an earlier point. Hospital IDVAs received higher referrals from health services and enabled access to a greater number of health resources. Hospital survivors were more likely to report greater reductions in and cessation of abuse. No differences were observed in health outcomes for hospital survivors. The odds of safety increased two-fold if hospital survivors received over five contacts with an IDVA or accessed six or more resources / programmes over a longer period of time. Six months preceding IDVA intervention, hospital survivors cost on average £2,463 each in use of health services; community survivors cost £533 each. The cost savings observed among hospital survivors amounted to a total of £2,050 per patient per year. This offset the average cost of providing hospital IDVA services. Conclusions Hospital IDVAs can identify survivors not visible to other services and promote safety through intensive support and access to resources. The co-location of IDVAs within the hospital encouraged referrals to other health services and wider community agencies. Further research is required to establish the cost-effectiveness of hospital IDVA services, however our findings suggest these services could be an efficient use of health service resources.

Volcano highlights Chile's long-term relief shortfall

2015 ◽  
Keyword(s):  
Disaster Response ◽  
Fiscal Deficit ◽  
Economic Implications ◽  
Content Type ◽  
Recovery System ◽  
Response And Recovery ◽  
The Cost ◽  
Serious Injuries ◽  
Disaster Response And Recovery

Significance Although it caused no deaths or serious injuries, the eruption has important economic implications for one of the country's key agricultural and salmon-farming regions. Together with recent flash floods in northern Chile, it also draws attention to the need to continue strengthening the disaster response and recovery system. Impacts Even if Calbuco quickly subsides, it will be months before the area can be completely cleaned and years before vegetation fully recovers. The cost of relief after the eruption and recent floods may increase this year's fiscal deficit. A bill to modernise ONEMI is unlikely to be a legislative priority in coming months when attention will focus on anti-corruption measures.

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