Pat L. Sample

Unmet service needs of persons with traumatic brain injury

ObjectivesAssess unmet needs of persons with traumatic brain injury (TBI) 1 year after hospital discharge; compare perceived need with needs based on deficits (unrecognized need); determine major barriers to services; evaluate association of needs with satisfaction with life. ParticipantsRepresentative sample of 1830 community-dwelling persons with TBI aged 15 years and older. MeasuresPerceived and unrecognized unmet needs, barriers to receiving services, and satisfaction with life as a function of met service needs. Results35.2% of participants reported at least 1 unmet need, 51.5% had unrecognized needs, 47% reported at least 1 barrier to receiving help. Receipt of services significantly increased satisfaction with life. ConclusionsMany persons experiencing TBI report having unmet service needs 1 year after hospital discharge.

Exploring the service needs and experiences of persons with TBI and their families: The South Carolina experience

Primary objective: This article presents the results of four focus groups with persons with traumatic brain injury (TBI) and their families living in South Carolina. The objective was to learn what participants perceive their service needs to be and where they experience service gaps in the existing system of TBI services. Methods and procedures: Four focus groups were conducted. In each group, a convenience sample of persons <5 years post-injury and family members responded to 10 semi-structured questions. Main outcomes: Qualitative content analysis revealed overwhelming consensus regarding the need for (1) early, continuous, comprehensive service delivery; (2) information/education; (3) formal/informal advocacy; (4) empowerment of persons with TBI/families; and (5) human connectedness/social belonging. Conclusions: Persons with TBI and families in South Carolina experience the service system as unorganized, uneducated, unresponsive and uncaring. Effective strategies are needed that link services into an ongoing continuum of TBI care, increase TBI-specific education and awareness and foster social re-integration.

Perceptions of care access: The experience of rural and urban women following brain injury

To examine care access among women with brain injuries, a qualitative, phenomenological study was conducted. Twenty-one women with acquired brain injuries were recruited for the inquiry, representing rural and urban regions of Colorado. The phenomenological approach allowed the investigators to examine the shared experiences of women with brain injuries as they sought rehabilitative supports and services, and attempted to re-enter their lives and communities. Each woman was interviewed one or two times, the interviews were transcribed and then coded and analysed by both authors separately. Thematic analysis of the data revealed two major emergent themes: issues surrounding diagnosis and barriers to accessing care. A total of 10 women interviewed experienced difficulty obtaining a diagnosis of brain injury and experienced serious personal and professional consequences as a result. All the women experienced barriers to accessing care, including problems with service providers and service systems, financial challenges, travelling for services, lack of information or services in their area, lack of care coordination and funneling. Some of the barriers cannot be changed secondary to cost, efficiency and logistics. Other barriers, could be changed through education, training and policy making.

Environment Effect on Functional Task Performance in Adults With Acquired Brain Injuries: Use of the Assessment of Motor and Process Skills

OBJECTIVE To examine household task performance in both familiar (home) and unfamiliar (clinic) environments in adults with acquired brain injuries. DESIGN The research performed was a comparison study examining the effect of the environment on functional task performance. Individuals were evaluated using the Assessment of Motor and Process Skills both in their homes and in an unfamiliar clinic setting. PARTICIPANTS Twenty individuals with acquired brain injuries living in the community. MAIN OUTCOME MEASURES The Assessment of Motor and Process Skills, an observational, standardized, occupational therapy assessment tool, was used to evaluate household task performance. RESULTS Paired one-tailed t tests indicated a significant difference between home and clinic performance measures in process ability (t=-4.28, p=.00), but no significant difference in motor ability performance measures (t=-1.84, p=.410). Scatter plot analyses showed that performance scores of 6 of the 20 subjects differed in a clinically meaningful way, and that instrumental activities of daily living motor performance scores for 3 of the 20 differed in a clinically meaningful way. CONCLUSIONS Individuals with acquired brain injuries may be influenced by their environment when performing household tasks, although further study is necessary to determine the extent of the environmental effect.

Cognitive—Behavioral Interventions, Dropout, and Youth With Disabilities A Systematic Review

The relationship between cognitive—behavioral interventions and therapies on the one hand and school dropout outcomes and violent verbal or physical aggression on the other hand for secondary-age youth with disabilities was explored in a systematic review. A total of 16 studies intervening with 791 youth with behavioral disorders, attention-deficit/hyperactivity disorder, and learning disabilities were reviewed. The findings of this review strongly support the efficacy of the use of cognitive—behavioral interventions across educational environments, disability types, age groups, and gender in the reduction of dropout and correlates of dropout. A series of more detailed implications for practice are suggested, as well as directions to the reader to locate more detailed descriptions of how these interventions might be implemented in their secondary education environments.

Postschool Outcomes for Students with Significant Emotional Disturbance Following Best-Practice Transition Services.

Six best practices—vocational intervention, paid work experience, social skills curriculum, interagency collaboration, parent involvement, and individualized plans/planning—were linked to postschool outcomes of employment and community adjustment for students with significant emotional disturbance (SED). Telephone and in-person interviews were conducted with 30 (57%) of 53 former students who had participated in supported employment and entrepreneurial education transition grant projects between 1989 and 1994. The former students answered questions about their employment, residential situations, community involvement, recreational pursuits, and citizenship activities 6 months, 12 months, and 24 months after leaving school. Univariate analyses of individual interventions and student outcomes showed that students out of school for 6 months who had been employed for long periods of time while in school had higher rates of employment than those who had not worked. Students out of school for 7 year whose parents were actively involved in their educational programs were more likely than their peers with uninvolved parents to have a successful community adjustment. Recommendations for further study include pursuing the development of appropriate definitions and assessment of transition services and interventions and exploring further interventions over which educators have direct control.

Perspectives on safety and health among migrant and seasonal farmworkers in the United States and México: a qualitative field study.

CONTEXT A large number of hired farmworkers in the United States come from México. Understanding safety and health concerns among the workers is essential to improving prevention programs. PURPOSE The purpose of this pilot study was to obtain detailed information about safety and health concerns of hired farmworkers in Colorado and in México. METHODS A total of 10 migrant farmworkers from northern Colorado and 5 seasonal farmworkers from Guanajuato, México, were interviewed using a semi-structured interview process. The social cognitive theory (SCT) served as a framework to gain understanding of safety and health among workers. FINDINGS Topics of concern identified included causes of farm, home and motor vehicle injuries, and treatment preferences for injuries and illnesses. Four main themes emerged: safety and health concerns, personal control and prevention strategies, factors affecting control and prevention strategies, and the importance of family. CONCLUSIONS Further study of the themes using a revised semi-structured interview will be done in a larger study among hired farmworkers. The results add to the current work to understand specific health and safety concerns among these workers.

Perceptions of Farm Hazards and Personal Safety Behavior Among Adolescent Farmworkers

This qualitative study was performed to investigate the perceptions of safety, behavior, and hazards of children working on farms. Thirty-six adolescents, ages 14-18, were interviewed in four focus groups. All participants were living in eastern Colorado and were members of the Future Farmers of America. They were asked questions regarding work they do on the farm, how they learned, and what safety rules they do and do not follow. Emergent themes include Age Started Chores, Safety Behavior, Attitude Toward Injury, and Attitude Toward Prev ention. These themes provide information on learning safety information, why injuries occur, the inevitability of injury, injuries sustained during farmwork and play, and attitudes of participants regarding injuries and injury prevention. The results indicate that these adolescents have been and are at risk of injury on the farm while working, playing, and playing in the context of work. They recognize the importance of safety rules, but bend or break those rules based on a personal assessment of risk. They take more risks while playing than while working, but playing often occurs in the context of work, and involves some of the same equipment or machinery (i.e., ATVs). Finally, many of the students reported modeling the unsafe practices of parents, grandparents, and other authority figures as opposed to performing chores the way those individuals taught them. Language: en

Fall Prevention: Relatedness of Adherence to Recommendations and Self-Rated Knowledge

ABSTRACT Objective: Our intent was to explore the relationships between adherence to fall-prevention recommendations and client characteristics possibly related to adherence. Method: We used secondary data originally collected from the initial interviews/home evaluations and follow-up interviews of 120 participants from a previously completed community-based fall-prevention program. Correlations of data from all participants explored relationships between adherence to fall-prevention recommendations and initial concern for falling, self-rated health, and self-rated fall-prevention knowledge. To better understand whether participants gained understanding of the impact of adherence to recommendations, a content analysis was performed on narrative responses to a question regarding the effect of adherence to recommendations on ones ability to independently perform daily tasks. Results: Considering the entire sample, concern about falling was related to adherence to fall-prevention recommendations, but adherence and increased self-rated fall-prevention knowledge was correlated only in a subgroup of participants who identified helpful attributes of recommendations in their narrative responses. Conclusion: Occupational therapy fall-prevention recommendations cannot invoke change without adherence. The relationship demonstrated here between adherence to fall-prevention recommendations and increased self-rated fall-prevention knowledge in participants verbalizing positive aspects of following the recommendations supports previous findings and suggests that an understanding of the benefit may be associated with adherence to fall-prevention recommendations, hopefully leading to fewer falls.

Fall-Prevention Pilot: Hazard Survey and Responses to Recommendations

This work reports a partial inventory of fall hazards for community-dwelling elders and characterizes older adult responses to fall prevention. Thirty-five seniors living in their homes participated in a fall-prevention initiative designed to identify hazards and make recommendations. Fifteen external hazards were identified and operationalized, and between one and four changes were reported per home in 18 of 22 homes, consistent with recommendations; however, most of the recommendations were unrelated to the cause of later participant falls. Considering the varied circumstances of falls in the community, we question the wisdom of designating specific risk posed by individual hazards and encourage future investigation on the merits of multifaceted evaluation and intervention including the consideration of combinations and interactions of hazards as well as raising caution and awareness.