Jeane Ann Grisso

Attempts to Reach the Oldest and Frailest: Recruitment, Adherence, and Retention of Urban Elderly Persons to a Falls Reduction Exercise Program

PURPOSE OF THE STUDYnTo assess the recruitment, adherence, and retention of urban elderly, predominantly African Americans to a falls reduction exercise program.nnnDESIGN AND METHODSnThe randomized controlled trial was designed as an intervention development pilot study. The goal was to develop a culturally sensitive intervention for elderly persons who suffered a fall and visited an emergency department (ED). Participants were taught exercises during 4 on-site group classes and encouraged to continue exercising at home for 12 weeks and attend additional on-site monthly classes. The protocol included a specifically designed intervention for increasing retention through trained community interventionists drawn from the participants neighborhoods.nnnRESULTSnThe screening of 1,521 ED records after falling yielded the recruitment of 204 patients aged 65 years and older. Half were randomized into the falls prevention program. Of the 102 people in the intervention group, 92 completed the final 6-month assessment, 68 attended all on-site sessions, but only 1 reported exercising at home all 12 weeks. Those who lived alone were more likely (p = .03) and those with symptoms of depression were less likely (p = .05) to attend all on-site exercise classes. The final recruitment rate was estimated as 31.8%. The final retention rates were 90.2% and 87.3% for the intervention and control groups, respectively.nnnIMPLICATIONSnRecruitment of frail elderly African American patients is resource intensive. Adherence to the on-site exercise classes was better than to the home-based component of the program. These findings have implications for the design of future community-based exercise programs and trials.

A Culture Conducive to Women's Academic Success: Development of a Measure

Purpose The work environment culture inhibits women’s career success in academic medicine. The lack of clarity and consistency in the definition, measurement, and analysis of culture constrains current research on the topic. The authors addressed this gap by defining the construct of a culture conducive to women’s academic success (CCWAS) and creating a measure (i.e., tool) to evaluate it. Method First, the authors conducted a review of published literature, held focus groups, and consulted with subject matter experts to develop a measure of academic workplace culture for women. Then they developed and pilot-tested the measure with a convenience sample of women assistant professors. After refining the measure, they administered it, along with additional scales for validation, to 133 women assistant professors at the University of Pennsylvania. Finally, they conducted statistical analyses to explore the measure’s nature and validity. Results A CCWAS consists of four distinct, but related, dimensions: equal access, work–life balance, freedom from gender biases, and supportive leadership. The authors found evidence that women within departments/divisions agree on the supportiveness of their units but that substantial differences among units exist. The analyses provided strong evidence for the reliability and validity of their measure. Conclusions This report contributes to a growing understanding of women’s academic medicine careers and provides a measure that researchers can use to assess the supportiveness of the culture for women assistant professors and that leaders can use to evaluate the effectiveness of interventions designed to increase the supportiveness of the environment for women faculty.

Employee Assistance Programs: A Workplace Resource to Address Intimate Partner Violence

PURPOSEnIntimate partner violence (IPV) is a major public health problem with significant impact on the workplace. Employee assistance programs (EAPs) are a confidential benefit to assist employees and their families with a variety of problems that may negatively affect their job performance. The purpose of this systematic review is to study the extant literature to identify articles that have explored the role of EAPs in addressing IPV.nnnMETHODSnWe searched Medline, PsychINFO, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) for English-language papers that have explored how EAPs can address IPV. Articles published through 2008 were included.nnnRESULTSnOur review yielded nine articles, mostly from EAP-centered journals. Nearly all of the studies were published before the year 2000 and primarily describe the need for EAPs to be more engaged in preventing violence against women. Most of the studies were commentaries, often using case reports to support recommendations on how EAPs could address IPV. Results from the two intervention studies revealed close connections between EAP clients being treated for alcoholism and IPV perpetration and the effectiveness of a standardized tool to identify EAP clients experiencing IPV.nnnCONCLUSIONSnResearch in this area is in its infancy, and more studies are needed to inform the formulation of evidence-based policies and programs that guide the role of EAPs in addressing IPV. The lack of research on how EAPs address IPV is alarming, as many employers state that they often refer employees affected by IPV to the EAP for assistance.

Tradition Meets Innovation: Transforming Academic Medical Culture at the University of Pennsylvania's Perelman School of Medicine

Traditional performance expectations and career advancement paths for academic physicians persist despite dramatic transformations in the academic workflow, workload, and workforce over the past 20 years. Although the academic physician’s triple role as clinician, researcher, and educator has been lauded as the ideal by academic health centers, current standards of excellence for promotion and tenure are based on outdated models. These models fail to reward collaboration and center around rigid career advancement plans that do little to accommodate the changing needs of individuals and organizations. The authors describe an innovative, comprehensive, multipronged initiative at the Perelman School of Medicine at the University of Pennsylvania to initiate change in the culture of academic medicine and improve academic productivity, job satisfaction, and overall quality of life for junior faculty. As a key part of this intervention, task forces from each of the 13 participating departments/divisions met five times between September 2010 and January 2011 to produce recommendations for institutional change. The authors discuss how this initiative, using principles adopted from business transformation, generated themes and techniques that can potentially guide workforce environment innovation in academic health centers across the United States. Recommendations include embracing a promotion/tenure/evaluation system that supports and rewards tailored individual academic career plans; ensuring leadership, decision-making roles, and recognition for junior faculty; deepening administrative and team supports for junior faculty; and solidifying and rewarding mentorship for junior faculty. By doing so, academic health centers can ensure the retention and commitment of faculty throughout all stages of their careers.

Childhood Violence and Behavioral Effects Among Urban Pregnant Women

BACKGROUNDnChildhood violence has been linked to a variety of health outcomes in adulthood; however, little research has focused on the impact of childhood violence on behavior and health during pregnancy. We aimed to explore the role of experiencing childhood physical and sexual violence in health status and high-risk behaviors among young, urban pregnant women.nnnMETHODSnPregnant women seeking care in an urban emergency department were recruited. Information on demographics, prior and current violence, depressive symptoms, stress, substance use, and health conditions was collected, and multivariate analyses were used.nnnRESULTSnTwenty-nine percent of women reported at least one episode of childhood physical violence before the age of 16, and 14% reported at least one episode of rape during childhood. Women reporting any type of childhood violence were > twice as likely to be experiencing current violence (odds ratio [OR] 2.45, 95% confidence interval [95% CI] 1.83-2.74). Pregnant women who reported childhood physical violence without current violence had a higher odds of prior sexually transmitted diseases (STDs), confirmed cigarette use (OR 1.98, 95% CI 1.44-2.74), and depressive symptoms, adjusting for age, race, and education. The group of pregnant women reporting childhood sexual violence/rape without current violence reported significantly higher levels of depressive symptoms, stress, problem drinking, and cigarette use during pregnancy (OR 4.11, 95% CI 2.24-7.55). Women who experienced any type of childhood violence and reported current violence were > five times more likely to report depressive symptoms and have confirmed, recent cocaine use compared with women without a history of prior or current violence.nnnCONCLUSIONSnThese findings underscore the importance of understanding the full impact of early childhood violence on behaviors during pregnancy and provide direction for substance use and depression prevention strategies among pregnant women.

Stresses and workplace resources for academic junior faculty: track and gender comparisons.

Despite the increasing numbers of women at all levels of academic medicine, women remain significantly less likely than are men to achieve senior rank or leadership positions. Possible explanations for the differences include limited access to mentoring, fewer rewards such as promotions, lower salaries, and less appropriate recognition. The slower progress of women faculty has also been related to fewer hours worked and decreased academic productivity related to childbearing, although studies have disputed this finding. The academic track has also been the focus of recent studies. Faculty with more than 50% clinical activity have less time, resources, and mentoring for academic career development. As academic medical centers have become more dependent on clinical revenue, expectations for clinical productivity of faculty have increased. Faculty in clinician–educator tracks might feel more stresses than those in more research-oriented tracks. Accordingly, the purpose of this study was to examine the experiences of assistant professors with respect to both gender and academic track to determine whether previously documented differences persist. We were also interested in examining how home responsibilities and support systems related to stress and productivity.

Employee Assistance Program Services for Intimate Partner Violence and Client Satisfaction With These Services

Objective: To describe intimate partner violence (IPV) services available through employee assistance programs (EAPs) and determine womens satisfaction with these services. Methods: A mixed-methods study consisting of semistructured telephone interviews with 28 EAPs about IPV-related services and a national web-based survey of 1765 women regarding their interactions with EAPs when seeking IPV-related assistance. Data were collected in the fall of 2008. Results: EAPs provide fairly extensive services to individuals experiencing IPV. Satisfaction with EAP services for IPV was significantly associated with annual income and the type of help received from the EAP, but not with type of IPV experienced. EAP representatives described challenges with accurately identifying IPV victims and women expressed concerns with confidentiality. Conclusions: Future efforts to enhance the ability of EAPs to respond effectively to IPV should address confidentially and strengthen how IPV-related assistance is delivered.

Reasons Women Experiencing Intimate Partner Violence Seek Assistance From Employee Assistance Programs

This research explores the reasons that employed adult women (N = 760), living in the United States, who experienced intimate partner violence (IPV) contacted the Employee Assistance Program (EAP). Women who contacted their EAP most often sought counseling or referrals for mental health or legal services. Most women who contacted their EAP did so because they did not know where to turn for help, gained access to an EAP, or were encouraged by a workplace manager/supervisor of family/friend. These results suggest that EAPs should work closely with workplace supervisors/managers and employees to provide information regarding EAP access and available resources.

Understanding women's experiences with employee assistance programs for assistance with intimate partner violence

Intimate partner violence (IPV) is a serious, preventable global public health problem with significant impacts on work. Limited research exists on the scope of services and programs that Employee Assistance Programs (EAPs) offer to address IPV and the experiences of IPV victims when they interact with EAPs. To address this gap, we used a web panel to identify women to complete a survey on their experiences with the EAP for IPV. Data were collected from a nationally representative sample of employed women, 18 years of age and older, living in the U.S. A total of 1765 employed women were surveyed: 760 women contacted their EAP about their experiences with IPV and 1005 women did not contact their EAP about these experiences. Most women (91%) contacted the EAP in need of counselling, especially for mental health treatment and legal services. Most women (63%) were satisfied with the EAP services they received. Multivariate logistic regression analysis showed that satisfaction with EAP services for IPV was significantly associated with annual income and the type of help received from the EAP. Approximately 71% of EAPs users reported that their work performance improved after contacting their EAP. The most common barrier to women seeking help from the EAP was concerns with confidentiality. EAPs appear to be a useful resource for helping women impacted by IPV. Future efforts to increase satisfaction and enhance the role of EAPs in addressing IPV should address confidentially and strengthen how the delivery of IPV-related assistance occurs.