Evaluation & the Health Professions最新文献

In the United States, only approximately one-third of students read at or above proficiency level. Moreover, the difference in reading proficiency of students is severely disproportionate for students with disabilities compared to students without disabilities. Reading fluency is a precursor for academic success and one of the six aspects of reading that contributes to effective reading skills. Many studies have examined the effectiveness of repeated reading to improve reading fluency. However, existing literature has mixed evaluations of whether repeated reading can be considered evidence-based reading intervention practice for students with disabilities. The current study examined the effects of a repeated reading intervention on reading fluency for three middle school students with learning disabilities. To address limitations of traditional single-case experimental design analytical methods such as visual analysis and nonoverlap indices, our study provided empirical researchers with a step-by-step procedure of using an advanced statistical method for single-case experimental designs, namely, generalized linear mixed models (GLMM) to analyze data. The results presented by GLMMs showed that repeated reading intervention can significantly improve reading fluency for some students with learning disabilities. Implications, limitations, and future directions from both empirical and methodological perspectives were also discussed.

Transitioning to motherhood comes with new and intensive tasks that may cause parental stress, low parental self-efficacy, and internalizing problems. This can in turn negatively affect the mother-child relationship. Mindful with your Baby/Toddler (MwyB/T) is a mindfulness-based intervention for parents of young children experiencing parental stress and internalizing problems. Previous evaluative studies showed promising results, but methodology of these studies was limited. The current study used a single case design, including a baseline, intervention, posttest, and follow-up phase, to evaluate the effectiveness of MwyB/T. Ten participants were included and completed daily administered personalized items and validated questionnaires measuring mindfulness, mindful parenting, parental self-efficacy, internalizing problems, and parental stress, for 10 participants. Personalized items were first coded into themes and then assessed using visual analysis and descriptive effect size measures. Reliable change indices were computed for the questionnaires. All mothers improved on personalized items, with most improving on most (or all) of their items. On the questionnaires the majority of mothers improved. Results indicate that MwyB/T could benefit mothers with various intervention goals. More research is needed on the role of personalized items, both as a research measure and an as a possible additional element of interventions.

Secure residential care (SRC) is criticized for several reasons. Therefore, in many countries, the general policy is to limit the length of stay of adolescents in SRC. However, research on length of stay and treatment effects of SRC on adolescents' behavioral problems is sparse. Using single case experimental designs with time-series, forty adolescents referred to SRC completed a questionnaire on behavioral and attention problems every two weeks during a baseline (A) and treatment period (B). Two-level regression analyses were used to investigate the effects of SRC on behavioral and attention problems. In addition, we tested whether length of stay moderated effectiveness. On the individual level, the treatment showed a positive statistically significant effect on the behavioral problems of 0%-8% of the adolescents and a statistically significant negative effect on behavioral problems was found in 3%-10% of the adolescents. On the group level, adolescents showed no significant decrease in problem behavior or attention problems from baseline to discharge. Length of stay did not moderate the results. Based on the results we conclude that most adolescents fail to improve. In addition, length of stay was not associated with effectiveness, nor could it be explained by adolescents' characteristics.

Generalized linear mixed models (GLMMs) have great potential to deal with count and rate data in single-case experimental designs (SCEDs). However, applied researchers face challenges to apply such an advanced approach in their own studies. Hence, our study aimed to provide a tutorial and demonstrate a step-by-step procedure of using GLMMs to handle SCED count and rate outcomes. We utilized an empirical examplewith a purpose to examine the effect of prelinguistic milieu teaching (PMT) on prelinguistic intentional communication for six school-age children with autism. The outcomes were sustained intentional communication (frequency count) and initiated intentional communication (rate). A step-by-step analytical approach with GLMMs was illustrated and associated R and SAS code was provided. The results overall supported the original conclusions of the effectiveness of PMT, whereas additional evidence regarding the precise estimate of the individual treatment effect and between-case variation of the treatment effect were also interpreted. The implications of the similarities and differences between the findings based on GLMMs and from the original study were discussed.

Parents with borderline personality disorder (BPD) experience deficiencies in parenting skills leading to increased family burden, stress, mental health problems in children and even family violence. The present study evaluated a Dutch version of the parenting training based on Dialectical Behavior Therapy (DBT) for mothers with BPD. A multiple baseline single-case experimental design study was conducted with standardized and idiosyncratic assessments of parenting behavior and parental stress before, biweekly during, and after training. Participants (N = 10) were mothers with a BPD diagnosis with a child under the age of 6. Four participants discontinued the training. Among six training completers, clinically reliable improvements in parenting skills were most pronounced for inconsistent discipline, involvement, positive parenting and corporal punishment. Frequent, idiosyncratic assessments showed that for six mothers training had a positive effect on parenting skills, while for five mothers this effect was large. Overall, less improvement was found for parenting stress. DBT parenting training seems to have clinical value for mothers with BPD struggling with raising their children. Most prominent improvement was found in relation to mothers disciplining their child in a more consistent manner. The complexity and heterogeneity of mothers with BPD requires a more idiosyncratic, patient-centered approach. This study was registered (retrospectively) in ISRCTN (ID ISRCTN74447767). https://www.isrctn.com/ISRCTN74447767, March 2022.

There are many ways proposed to achieve better societal outcomes (e.g., in health, education, and well-being) including: (1) bridging research and practice, (2) building the motivation and capacity of service delivery organizations (e.g., schools, hospitals, clinics, and community-based organizations) to innovate, and (c) providing service delivery systems with high-quality support via training and technical assistance. The Interactive Systems Framework for Dissemination and Implementation (ISF) was developed to describe how relevant systems, organizations, and processes can interact and work toward these goals. Stimulated by the 13 articles contained in the two special issues of Strengthening the Science and Practice of Implementation Support: Evaluating the Effectiveness of Training and Technical Assistance Centers, we describe several enhancements to the ISF including: how service delivery systems can operate better, how motivation and capacity can be built, and how training and technical assistance centers can provide more evidence-informed technical assistance and other promising innovations. ISF 2.0 incorporates these and other enhancements with the goal of achieving better outcomes. We conclude that the actions and accountability of funders and of organizations and systems to funders would accelerate progress in the systems to achieve outcomes-and result in improving the science and practice of implementation support.

Despite a growing body of research demonstrating the value of using evidence-based programs and practices (EBPPs) to address health and education issues, the gap between research evidence and practice in education and human services continues to be a vexing problem. Technical assistance (TA) is widely accepted as a key strategy to support evidence-based programs and practices (EBPP) uptake and implementation. However, little is known about how TA practices are used in TA delivery. Moreover, little attention has been paid to building the capacity of TA providers and assessing the fidelity of the implementation of TA practices. The case example presented in this article describes one organization's efforts to develop common language and definitions of TA services, core principles, and methods, and to standardize the delivery of TA by enhancing the capacity and retention of TA providers. We conclude with recommendations about how like organizations can employ similar efforts to improve the quality and consistency of TA delivery, thereby establishing a foundation for building a strong evidence base.

In low- and middle-income countries (LMICs), barriers such as low system readiness, contextual mismatches, and resource limitations impede effective implementation of evidence-based interventions. This commentary offers insights into overcoming these challenges with a case study of the PRISM project, designed to reduce behavioral and psychological symptoms of dementia in older adults living in Thailand. The case highlights how combining two evidence-based models - the Reducing Disability in Alzheimer's Disease clinical intervention and the Getting To Outcomes implementation science process enhances program success. Using interviews with stakeholders across various health system levels, we identify factors critical to successful program implementation: (1) integrating interventions into policy frameworks, (2) empowering local implementers, (3) fostering collaborative learning, and (4) adapting interventions to local contexts. The case demonstrates that building system readiness through local engagement and ownership is central to scaling up health programs in LMICs. This commentary's contribution lies in its emphasis on the role of implementation science as a vehicle for translating research into practice. It presents a practical, adaptive model for embedding interventions into routine health systems, thereby offering a pathway for successfully scaling up evidence-based programs in LMICs. Such findings provide lessons for overcoming barriers to implementation in resource-limited environments.

This article describes (a) key elements of a high-quality technical assistance (TA) system; (b) the operationalization of a high-quality TA system (Getting To Outcomes-Technical Assistance; GTO-TA) being implemented in a training and TA center (TTAC) interested in transforming its support services to include an evidence-informed approach to TA; and (c) key lessons learned in successfully transitioning from "TA-as-usual" to an evidence-informed TA system. GTO-TA is one operationalization of a systematic, proactive, evidence-informed approach to TA. GTO-TA includes best practices and core elements for a comprehensive TA system; it aims to increase the readiness (reduce barriers and increase facilitators) of an organization to deliver an innovation (program, policy, practice, and process new to an organization) with quality. We describe the collaboration between the Wandersman Center and the Geographic Health Equity Alliance team to co-design and implement the GTO-TA system. Data from surveys, interviews, and consensus conversations led to important lessons learned, which are applicable to other TTACs seeking to develop a more proactive and systematic approach to TA. Lessons include: changing internal operations to facilitate TA providers making necessary changes in providing TA and understanding the relative advantage perceptions about a new TA system that influence adoption and must be considered.