Moving the Needle: Cultivating Systemic Change in Juvenile Services

Approximately 1.7 million delinquency cases are disposed in juvenile courts annually (Puzzanchera, Adams, & Sickmund, 2011). Of these youth, tens of thousands experience confinement in the US (Sawyer, 2019), while hundreds of thousands experience probation or are sentenced to community based programs (Harp, Muhlhausen, & Hockenberry, 2019). These youth are placed in the care of programs overseen by directors and clinicians. A survey of facility directors and clinicians from member agencies of the National Partnership for Juvenile Services (NPJS) Behavioral Health Clinical Services (BHCS) committee identified three primary concerns practitioners face in caring for these youth; 1) low resources to recruit and retain quality staff, 2) training that is often not a match for, and does not equip staff to effectively manage the complex needs of acute youth, and 3) the perspective of direct care as an unskilled entry-level position with limited impact on youth’s rehabilitation. This article seeks to address these issues and seeks to highlight potential best practices to re-solve for those obstacles within juvenile services.

Empowered Stakeholders: Female University Students’ Leadership During the COVID-19-Triggered On-campus Evictions in Canada and the United States

The study of disaster-specific leadership of female university students has been largely neglected, especially during on-campus emergency eviction and evacuation. Based on the COVID-19-triggered, on-campus evictions across Canada and the United States, this cross-national partnership examined the out-of-province/state and international female university students’ leadership during the entire eviction process. Through in-depth interviews, this study revealed the female university students’ leadership behaviors during three stages: (1) pre-eviction: their self-preparedness formed an emotional foundation to support others; (2) peri-eviction: their attitude and leadership behavior enabled them to facilitate (psychologically and physically) their peers’ eviction process; and (3) post-eviction: they continued to support their peers virtually and raised the general public’s awareness regarding the plight of vulnerable and marginalized populations. This article argues that the female university students’ leadership that emerged during the eviction process became complementary to and even augmented the universities’ official efforts and beyond. This leadership represents empirical evidence that contributes to the existing literature on gender and leadership by demonstrating female youth as empowered stakeholders rather than as merely passive victims. Future studies could develop detailed stratification of gender and age dimensions in order to portray a more comprehensive picture of the younger generation’s leadership in hazards and disaster research and practice.

How Collaborative Project Development Theory Can Be Used to Provide Guidance for International Curriculum Partnerships

In this paper we explore collaboration in the context of the educational services industry (ESI). We look to literature from the communication field to consider ethical strategies and methods for ensuring the validity of the outcomes of collaborative working. Drawing on Collaborative Product Development and conversation theory we devise four principles that can guide the collaborative process within an education-based partnership project. We then use a case study to consider how these principles supported the outcomes of a cross-national partnership project. Finally, we draw on these principles to consider the lessons for project management in education public private partnerships.

The Impact of Changing the CMS Nursing Home Compare 5-Star Ratings on the Use of Antipsychotics

Due to their potential to increase falls and death in people with dementia, antipsychotic medications (APMs) have been the subject of several federal efforts to reduce their use in nursing homes (NHs). In 2015, the Centers for Medicare & Medicaid Services added inappropriate APM use to their NH 5-star quality ratings. We examined the impact of this policy decision on NH residents with dementia by race/ethnicity. Using a quasi-experimental study design and Minimum Data Set (MDS) 3.0 assessments, we examined long-stay NH residents with dementia. We examined changes in APM use quarterly (2013-2016) using interrupted time series analyses, stratified by race/ethnicity. There were about 1 million NH residents per quarter. Baseline use of APMs among persons with dementia was 29.1% for Whites, 29.2% for Blacks, and 33.7% for Hispanics. All three races experienced significant declines in APM use prior to the addition of AP use into the quality rating (p<0.001). During the first quarter of rating system changes, there were significant declines in APM use for all three races: Blacks, 0.48%; Hispanics, 1.0%; Whites, 0.49%. Subsequent rates of decrease in APM use did not differ from the baseline rate of decline (p> 0.5). The policy change did result in a one-time, significant drop in APM use, but did not alter the rate of decline already in place, presumably stemming from the National Partnership instituted in 2012. Hispanics started with the highest rate of APM use and experienced the greatest decreases over time and with the new star rating measure.

The Relationship Between Dementia, Race, and Schizophrenia Labeling in Nursing Homes Following the CMS Partnership

Preliminary research demonstrated an increase in the reporting of schizophrenia diagnoses among nursing home (NH) residents subsequent to the Centers for Medicare & Medicaid Services (CMS) National Partnership to Improve Dementia Care. Given known health disparities and higher antipsychotic use for Black NH residents, we examined how race and dementia influence the rate of schizophrenia diagnoses among NH residents. Using a quasi-experimental study design, we examined changes in schizophrenia reporting among long-stay NH residents’ quarterly and/or yearly Minimum Data Set 3.0 assessments between 2011-2015. Employing a difference-in-difference analysis adjusting for independent variables (e.g. demographics, diabetes, heart conditions, and functional status), we examined the relationship before and after the partnership. There were over 4 million MDS assessments annually. Schizophrenia reporting increased 12.3% in the dementia group as compared to 9.3% in the non-dementia group (p<0.0001). Black residents had a significantly higher likelihood of schizophrenia reporting (4%, p<0.0001). After controlling for covariates, there was a 16.5% increase in schizophrenia reporting for Blacks with dementia and 14.9% increase for non-Blacks with dementia (p<0.0001). There were no racial disparities identified among the non-dementia group after controlling for covariates. NH residents were more likely to have schizophrenia documented on their MDS assessments, and following the partnership, schizophrenia reporting rates increased faster for Blacks with dementia than their non-Black peers and their peers without dementia. Further work is needed to determine if schizophrenia diagnoses are appropriately employed in NH practice, particularly for Black Americans and persons with dementia.

“Medication Is Just One Piece of the Whole Puzzle”: How Nursing Homes Change Their Use of Antipsychotic Medications

Antipsychotic medication use for nursing home residents with dementia poses major patient safety challenges. This article investigates health professionals’ experiences with decision-making during changes under the National Partnership to Improve Dementia Care in Nursing Homes (National Partnership) and its companion state coalitions. These programs were introduced in 2012 to encourage reductions in antipsychotic use and increased use of nonpharmacological treatments for dementia. Interviews with 40 nursing home physicians and staff in seven states found that reducing antipsychotics is more time and resource-intensive than relying on medication, because it requires a person-centered approach. However, respondents supported reductions in antipsychotic use, and indicated that with sufficient staffing, effective communications, and training, they could create or implement individualized treatments. Their positive attitudes suggest that the National Partnership has been a catalyst in reducing antipsychotic medications, and their perspectives can inform further research, policy and practice in nursing homes toward achieving quality dementia care.

Alexandru Popa, The Frontiers of the Roman Empire in Eastern Dacia. Preliminary Results of Research Conducted in the Context of the Romanian National Limes Program

The visible and invisible traces of the Roman Frontier in Dacia have been, for quite a long time, one of the most representative archaeological sites in Romania, and especially in Transylvania. On one hand, the Roman frontier in Transylvania, also known as Limes, symbolises a border between the GreekRoman world and the local civilisations found in the regions north of the Danube. On the other hand, we rather deal with a large contact zone between the two parts of the antique ecumene. Romania decided to join the international initiative known as Frontiers of the Roman Empire (FRE) UNESCO site by inscribing on the UNESCO Heritage List the components found on its territory – the Dacian Limes and the segments of the Danubian Roman Border. The activity of preparing the nominations is conducted by several institutions. Along with the National Heritage Institute, that is responsible, by tradition, of all the UNESCO nominations in Romania, the activity also involves the National History Museum from Bucharest, the National Museum of Transylvanian History from Cluj-Napoca and the National Museum of the Eastern Carpathians from Sf. Gheorghe. The National Limes Commission has been established to coordinate all the undertaken activities and to assure proper communication between the above-mentioned institutions, both inside the national partnership and with the international partners.