Janet Clinton

Health equity in the New Zealand health care system: a national survey

IntroductionIn all countries people experience different social circumstances that result in avoidable differences in health. In New Zealand, Māori, Pacific peoples, and those with lower socioeconomic status experience higher levels of chronic illness, which is the leading cause of mortality, morbidity and inequitable health outcomes. Whilst the health system can enable a fairer distribution of good health, limited national data is available to measure health equity. Therefore, we sought to find out whether health services in New Zealand were equitable by measuring the level of development of components of chronic care management systems across district health boards. Variation in provision by geography, condition or ethnicity can be interpreted as inequitable.MethodsA national survey of district health boards (DHBs) was undertaken on macro approaches to chronic condition management with detail on cardiovascular disease, chronic obstructive pulmonary disease, congestive heart failure, stroke and diabetes. Additional data from expert informant interviews on program reach and the cultural needs of Māori and Pacific peoples was sought. Survey data were analyzed on dimensions of health equity relevant to strategic planning and program delivery. Results are presented as descriptive statistics and free text. Interviews were transcribed and NVivo 8 software supported a general inductive approach to identify common themes.ResultsSurvey responses were received from the majority of DHBs (15/21), some PHOs (21/84) and 31 expert informants. Measuring, monitoring and targeting equity is not systematically undertaken. The Health Equity Assessment Tool is used in strategic planning but not in decisions about implementing or monitoring disease programs. Variable implementation of evidence-based practices in disease management and multiple funding streams made program implementation difficult. Equity for Māori is embedded in policy, this is not so for other ethnic groups or by geography. Populations that conventional practitioners find hard to reach, despite recognized needs, are often underserved. Nurses and community health workers carried a disproportionate burden of care. Cultural and diversity training is not a condition of employment.ConclusionsThere is a struggle to put equity principles into practice, indicating will without enactment. Equity is not addressed systematically below strategic levels and equity does not shape funding decisions, program development, implementation and monitoring. Equity is not incentivized although examples of exceptional practice, driven by individuals, are evident across New Zealand.

The True Impact of Evaluation Motivation for ECB

There is a growing call for evaluation capacity building (ECB); although the area currently lacks a rich research base, there are few robust methods and practice through which to define it. The argument in this article is that the impact of evaluation is mediated by program stakeholders’ engagement in evaluation activities. This mediation provides a foundation for a consideration of the merit of ECB. This study sought to find confirmation that stakeholder engagement in evaluation could influence the outcomes of a program and thus subsequently provide evidence as to the merit and significance of evaluation engagement. Multiple forms of evaluation data were collected for two long-term public health evaluations and coded and collated again on an evidence-based rubric in close consultation with the community. The influence of stakeholder’s willingness and capacity to engage in evaluation activity was also investigated. The analysis revealed that stakeholders’ engagement in evaluations provided reasonably unique contributions to the overall program outcomes. This article provides the impetus for evaluation-based capacity building, in that it presents empirical evidence that willingness, capacity to engage in evaluation activities, and the use of evaluation information increases the probability of achieving desired outcomes and sustainability.

Understanding Evaluation Influence within Public Sector Partnerships: A Conceptual Model.

The importance of evaluation use has led to a large amount of theoretical and empirical study. Evaluation use, however, is still not well understood. There is a need to capture the complexity of this phenomenon across a diverse range of contexts. In response to such complexities, the notion of “evaluation influence” emerged. This article presents a theory of evaluation influence within public sector partnerships. An analysis of key concepts is used to develop propositions about the relationships between evaluation attributes, partnership functioning and characteristics, partnership evaluation behavior, individual characteristics, contextual factors, and evaluation influence. The model highlights the complexities of evaluation influence and identifies a range of factors that evaluators can consider in practice. The model also extends on existing theories of evaluation influence in considering the role of individual characteristics, stakeholder evaluation behavior, and partnership contexts.

Chapter 11 Identifying accomplished teachers: A validation study

This chapter aims to present a methodology to address the construct validity of the NBPTS standards, exercises, and decisions to identify accomplished teachers, by asking whether National Board Certified Teachers (NBCTs) teach differently in their classrooms such that they have a greater positive and worthwhile impact on their students. The critical attributes of expert teachers are identified via a synthesis of meta-analyses and a more traditional review of the literature on expert teachers. These attributes of expert teachers then form the basis of the study to identify the characteristics that discriminate between NBCTs and non-NBCTs.

The Assessment of Teachers

This article outlines criteria of acceptability for teacher assessments (credibility, dependability, fairness), the major dimensions of teacher assessment (attributes, behaviours, knowledge), details the methods used by the United States National Board for Professional Teaching Standards, and places a major emphasis on assessment schemes based on teacher effects on the students (value-added models, achievement, quality of learning, and normative reference points). Given that the majority of teachers are acceptably proficient, the major argument for teacher assessment should be to identify and promote excellence, to guide professional development programmes, and to demonstrate to the education/school communities that excellence is present, fostered, and esteemed.

Enfranchising the Profession through Evaluation: A Story from Australia.

Abstract Educational reform in Australia recognizes the need for an effective teacher evaluation system but has fallen short of actually prescribing one. Current practice does not align to policy intent, with teacher evaluation largely an exercise in compliance around performance management as opposed to a process that promotes evaluative thinking, continuous improvement and connection to student outcomes. The recent introduction of the Australian Professional Standards for Teaching has gone some way to providing a common language and the idea of a nationally acceptable pathway for teacher development and performance. Nonetheless, two things are missing in the Australian context: the privileging of developing evaluative mindsets in teachers and school leaders and the tools and methods that provide the ‘how’ of evaluation and support this thinking. Situated against a period of reform in Australia’s diverse federal and multi-sectoral education system, this article first provides an analytical review of the Australian approach to teacher evaluation. It then presents two innovative approaches that support the process of evaluation and the broader information needs of an evaluation system while developing teachers’ and school leaders’ evaluative thinking which engages evidence-informed change and ultimately more sustainable outcomes for the education system.

Testing of a synthetic phonics-based targeted reading intervention for students with reading difficulties in Year 1: protocol for an efficacy randomised controlled trial

Introduction Literacy is fundamental for educational achievement, and in the longer term contributes substantially to a range of life skills. Literacy difficulties during the early years of school are associated with long-term impacts on academic success, with differences in academic achievement sustained through children’s schooling. Therefore, addressing literacy difficulties during the early years of school is essential in reducing the risk of children progressing onto negative academic, psychosocial and vocational trajectories. This trial will determine whether a phonics-based reading intervention can improve the reading comprehension of students identified as low-progress readers in the second year of primary school. Methods/design We recruited 236 students fromnine schools after screening for reading difficulties in the second year of primary school (Year 1). Schools in Sydney and Central Coast of New South Wales will be invited to participate via an opt-out consent process. All children identified as being in the bottom 25th percentile using the Wheldall Assessment of Reading Lists will be eligible for the trial. These children will be randomised into either ‘usual teaching’ or ‘intervention’ groups. Trained school support teachers will deliver the MiniLit intervention. Intervention: In groups of four, children will complete a daily 1-hour lesson with their MiniLit teacher over 20 school weeks. Follow-up: Immediately after intervention completion and 6 months later using child face-to-face assessments. Primary outcome: Reading comprehension at 6 months after intervention completion. The study will have an embedded process and cost-effectiveness evaluation. Discussion The Building Better Readers trial will be the first efficacy randomised controlled trial comparing usual teaching with a phonics-based reading intervention for children with reading difficulties in Year 1 of primary school in Australia. The randomised design will limit the effect of bias on outcomes seen in other studies. Trial registration number ACTRN12617000179336