Browsing by Subject "disability"
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Item A Quality Improvement Network for Interdisciplinary Training in Developmental Disabilities(American Academy of Pediatrics, 2022-11-09) Smith, Jennifer D.; Nidey, Nichole; Chödrön, Gail S.; Czyzia, Jackie; Donahue, Michelle L.; Ford, Kristie; James, Cristina; Klimova, Oksana; Macias, Michelle M.; Rabidoux, Paula; Whitaker, Toni M.; Brosco, Jeffrey P.; Pediatrics, School of MedicineChildren with developmental disabilities (DD), such as autism spectrum disorder (ASD), have complex health and developmental needs that require multiple service systems and interactions with various professionals across disciplines. The growing number of children and youth identified with ASD or DD, including anxiety and depression, has increased demand for services and need for highly qualified pediatric providers. Federally funded Leadership Education in Neurodevelopmental and related Disabilities (LEND) programs across the United States address today's health care shortages by providing comprehensive, interdisciplinary training to providers from multiple pediatric disciplines who screen, diagnose, and treat those with ASD and DD. Each LEND program develops training methods independently, including quality improvement efforts. In 2014, LEND programs began designing and validating common measures to evaluate LEND training. The LEND Program Quality Improvement (LPQI) Network was established in 2016. Participating LEND programs in the LPQI Network administer validated trainee self-report and faculty-observation measures that address skills in key competency domains of Interdisciplinary or Interprofessional Team Building, Family-Professional Partnerships, and Policy. This study reports data from faculty and trainees from 22 LEND programs that participated in the LPQI Network across the 5-year data collection period. The main outcome of this study was the change in trainee knowledge, skills, and attitudes scores in key competency domains across programs. Overall, trainees made significant knowledge, skills, and attitude gains based on both self-report and faculty observation scores for all 3 competency domains. Data demonstrate the value of LEND programs and feasibility of a national quality improvement approach to evaluate interdisciplinary training and systems-level improvement.Item The association between socioeconomic status and disability after stroke: Findings from the Adherence eValuation After Ischemic stroke Longitudinal (AVAIL) registry(2014-03) Bettger, Janet Prvu; Zhao, Xin; Bushnell, Cheryl; Zimmer, Louise; Pan, Wenqin; Williams, Linda S.; Peterson, Eric DBackground Stroke is the leading cause of disability among adults in the United States. The association of patients’ pre-event socioeconomic status (SES) with post-stroke disability is not well understood. We examined the association of three indicators of SES—educational attainment, working status, and perceived adequacy of household income—with disability 3-months following an acute ischemic stroke. Methods We conducted retrospective analyses of a prospective cohort of 1965 ischemic stroke patients who survived to 3 months in the Adherence eValuation After Ischemic stroke – Longitudinal (AVAIL) study. Multivariable logistic regression was used to examine the relationship of level of education, pre-stroke work status, and perceived adequacy of household income with disability (defined as a modified Rankin Scale of 3–5 indicating activities of daily living limitations or constant care required). Results Overall, 58% of AVAIL stroke patients had a high school or less education, 61% were not working, and 27% perceived their household income as inadequate prior to their stroke. Thirty five percent of patients were disabled at 3-months. After adjusting for demographic and clinical factors, stroke survivors who were unemployed or homemakers, disabled and not-working, retired, less educated, or reported to have inadequate income prior to their stroke had a significantly higher odds of post-stroke disability. Conclusions In this cohort of stroke survivors, socioeconomic status was associated with disability following acute ischemic stroke. The results may have implications for public health and health service interventions targeting stroke survivors at risk of poor outcomes.Item Associations between neuropsychiatric and health status outcomes in individuals with probable mTBI(Elsevier, 2019-02) Bomyea, Jessica; Flashman, Laura A.; Zafonte, Ross; Andaluz, Norberto; Coimbra, Raul; George, Mark S.; Grant, Gerald A.; Marx, Christine E.; McAllister, Thomas W.; Shutter, Lori; Lang, Ariel J.; Stein, Murray B.; Psychiatry, School of MedicineMild traumatic brain injury (mTBI) is a common occurrence, and may impact distal outcomes in a subgroup of individuals. Improved characterization of health outcomes and identification of factors associated with poor outcomes is needed to better understand the impact of mTBI, particularly in those with co-occurring posttraumatic stress disorder (PTSD). Participants in a data repository of the Injury and Traumatic Stress (INTRuST) Clinical Consortium (n = 625) completed functional disability [FD] and health-related quality of life [HRQOL] questionnaires, and a subset completed a neuropsychological assessment. FD and HRQOL were compared among participants with probable mTBI (mTBI), probable mTBI with PTSD (mTBI/PTSD), and health comparison participants (HC). Associations between symptoms, neuropsychological performance, and health outcomes were examined in those with probable mTBI with and without PTSD (n = 316). Individuals in the mTBI/PTSD group endorsed poorer health outcomes than those in the mTBI group, who endorsed poorer outcomes than those in the HC group. Individuals in either mTBI group performed worse than those in the HC on verbal learning and memory and psychomotor speed. Health outcomes were correlated with mental health and postconcussive symptoms, as well as neuropsychological variables. mTBI may adversely impact self-reported health, with the greatest effect observed in individuals with co-occurring mTBI/PTSD.Item Cancer-Related Pain and Disability: A Longitudinal Study(2011-12) Wang, Hsiao-Lan; Kroenke, Kurt; Wu, Jingwei; Tu, Wanzhu; Theobald, Dale; Rawl, Susan M.Context Although the cross-sectional association between cancer-related pain and disability is well established, their longitudinal relationship has been less studied. Objectives Data from the Indiana Cancer Pain and Depression (INCPAD) trial were analyzed to determine whether baseline cancer-related pain and changes in pain over time predict disability over 12 months. Methods A total of 274 cancer survivors with cancer-related pain were accrued in the INCPAD trial. Data were collected at baseline, one, three, six, and 12 months by interviewers blinded to treatment arm. Disability outcomes included a continuous measure (Sheehan Disability Scale [SDS] score) and a categorical measure (≥14 days in the past four weeks with a ≥50% reduction in usual activities). Predictor variables, operationalized by the Brief Pain Inventory, included baseline pain severity and changes in pain severity scores between each time point. Multivariable analyses were conducted adjusting for treatment group, baseline disability, and selected covariates including depression. Results Baseline pain severity did not predict disability outcomes at 12 months. However, improvement in pain severity predicted less disability over 12 months both in terms of SDS scores (b = −0.17, t = −5.33, P < 0.001) and ≥14 disability days in the past month (odds ratio = 0.85; 95% confidence interval, 0.79–0.93; P < 0.001). Conclusion Disability over 12 months in patients with cancer-related pain is predicted by changes in pain severity over time. Results suggest that effective pain management may reduce subsequent disability among cancer survivors.Item Educators’ and caregivers’ perceptions on the implementation of social narratives with individuals with autisim spectrum disorder(2016-09) Jordan, Kristi Ann; Crabtree, Jeffrey L.; Solas Allen, Martina; Fisher, ThomasSocial narratives are considered by the National Professional Development Center on Autism Spectrum Disorders (NPDC) to be effective in reducing challenging behaviors, improving expected behaviors, and preparing for change. This study is addressing the gap in literature about educators’ and caregivers’ perceptions of the implementation of and the differences in implementation of social narratives with individuals with Autism Spectrum Disorder (ASD).Item Family resistance as a tool in urban school reform(Teachers College Press, 2014-08) Santamaría Graff, CristinaItem IUD Use in Adolescents With Disabilities(AAP, 2020-08) Robbins, Cynthia; Ott, Mary A.; Pediatrics, School of MedicineIntrauterine devices (IUDs) are safe, highly effective, and recommended by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists as a first-line contraceptive option for adolescents.1,2 In this month’s Pediatrics, Schwartz et al3 examine the use of IUDs among adolescents with disabilities, providing further evidence that IUDs are safe for menstrual management and contraception in this population. In their work, Schwartz et al3 raise 3 important issues in IUD use and contraceptive decisions among adolescents with disabilities: recognition of the adolescent’s sexuality and rights to sexual and reproductive health; the need to incorporate quality of life into risk/benefit decisions; and the use of shared and supported decision-making approaches to maximize autonomy and dignity.Item Rehabilitation research at the National Institutes of Health: Moving the field forward (Executive Summary)(Taylor & Francis, 2017) Frontera, Walter R.; Bean, Jonathan F.; Damiano, Diane; Ehrlich-Jones, Linda; Fried-Oken, Melanie; Jette, Alan; Jung, Ranu; Lieber, Rick L.; Malec, James F.; Mueller, Michael J.; Ottenbacher, Kenneth J.; Tansey, Keith E.; Thompson, Aiko; Physical Medicine and Rehabilitation, School of MedicineItem Resistance and Resilience as Resource: Families’ Participation in Urban School Reform(Teachers College Press, 2014) Santamaría Graff, Cristina C.This comprehensive book is grounded in the authentic experiences of educators who have done, and continue to do, the messy everyday work of transformative school reform. The work of these contributors, in conjunction with research done under the aegis of the National Institute of Urban School Improvement (NIUSI), demonstrates how schools and classrooms can move from a deficit model to a culturally responsive model that works for all learners. To strengthen relationships between research and practice, chapters are coauthored by a practitioner/researcher team and include a case study of an authentic urban reform situation. This volume will help practitioners, reformers, and researchers make use of emerging knowledge and culturally responsive pedagogy to implement reforms that are more congruent with the strengths and needs of urban education contexts.Item Social Influences on Peer Judgments about Chronic Pain and Disability(Elsevier, 2019) Anastas, Tracy M.; Meints, Samantha M.; Gleckman, Ari D.; Hirsh, Adam T.; Psychology, School of ScienceChronic pain is a leading cause of work absenteeism and disability compensation. Previous work demonstrates that patients with chronic illness often seek advice, such as whether or not to pursue disability benefits, from peers with similar health conditions. The current study examined the extent that social factors influence patients with chronic pain (“peers”) when making disability judgments and recommendations for other patients with chronic pain. Participants (N = 71) made pain-related and disability ratings for fictional vignette patients that varied in weight (normal vs obese), fault of accident, and physical work demands. Results of repeated measures analyses of variance indicated that participants rated patients with obesity, who were not at fault, and who held a physically demanding job as experiencing more severe pain symptoms and disability and were more likely to recommend they seek disability benefits. Participants who had applied for disability benefits themselves rated patients as more disabled than participants who had not applied for disability. These data suggest that patients with chronic pain are influenced by patient and contextual factors when making pain-related and disability judgments for peers. These judgments may impact patient decision making via peer support programs and online forums.