UPTAKE OF THE PERIODIC HEALTH EXAM AMONG ADULTS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES FROM 2003 TO 2015

Background: Over the past decade, annual heath exams have been de-emphasized for the general population but emphasized for adults with intellectual and developmental disabilities (IDD). The purpose of this project was to determine if there has been an increase in the uptake of the health exam among adults with IDD in Ontario, to what extent, and the effect on the quality of preventive care provided. Methods: Using administrative health data, the proportion of adults (18-64 years old) with IDD who received a health exam (long appointment, general assessment, and “true” health exam), a high value on the primary care quality composite score (PCQS), and a health exam or high PCQS each year was compared to the proportion in a propensity score matched sample of the general population. Negative binomial and segmented negative binomial regression controlling for age and sex were used to determine the relative risk of having a health exam/high PCQS/health exam or PCQS over time. Results: Pre joinpoint, the long appointment and general assessment health exam definitions saw a decrease and the “true” health exam saw an increase in the likelihood of adults having a health exam. Post joinpoint, all health exam definitions saw a decrease in the likelihood of adults having a health exam. Pre joinpoint, all PCQS measures (high PCQS, long appointment or high PCQS, “true” health exam or high PCQS) saw an increase in the likelihood for adults to achieve a high PCQS or high PCQS/have a health exam. Post joinpoint, all PCQS measures saw a decrease in the likelihood for adults to achieve a high PCQS or high PCQS/have a health exam. Achieving a high PCQS was strongly associated with having a health exam regardless of health exam definition or IDD status. Conclusions: Despite the publication of guidelines, only a small proportion of adults with IDD are receiving health exams. This indicates that the publication of guidelines alone was not sufficient to change practice. More targeted measures, such as the implementation of an IDD-specific health exam fee code, should be considered to increase the uptake of the health exam among adults with IDD.

THE ELEMENTARY TEACHERS’ PERCEPTIONS OF MOTIVATION FOR AND THE PRINCIPAL’S INFLUENCE ON THEIR ENGAGEMENT IN SELF-DIRECTED PROFESSIONAL DEVELOPMENT

All teachers participate in self-directed professional development (PD) at some point in their careers; however, the degree to which this participation takes place varies greatly from teacher to teacher and is influenced by the leadership of the school principal. The motivation behind why teachers choose to engage in PD is an important construct. Therefore, there is a need for better understanding of the leader’s role with respect to how and why teachers engage in self-directed professional development. The purpose of the research was to explore the elementary teachers’ motivation for and the school principal’s influence on their engagement in self-directed professional development. Three research questions guided this study: 1. What motivates teachers to engage in self-directed professional development? 2. What are the conditions necessary for promoting teachers’ engagement in self-directed professional development? 3. What are teachers’ perceptions of the principal’s role in supporting, fostering, encouraging, and sustaining the professional development of teachers? A qualitative research approach was adopted for this study. Six elementary teachers from one south-eastern Ontario school board, consisting of three novice and three more experienced teachers, provided their responses to a consistent complement of 14 questions. Their responses were documented via individual interviews, transcribed verbatim, and thematically analysed. The findings suggested that, coupled with the individual motivating influences, the culture of the school was found to be a conditional dynamic that either stimulated or dissuaded participation in self-directed PD. The school principal provided an additional catalyst or deterrence via relational disposition. When teachers felt their needs for competency, relatedness, and autonomy were satisfied, the conditions necessary to motivate teachers to engage in PD were fulfilled. A principal who personified the tenets of transformational leadership served to facilitate teachers’ inclinations to take on PD. A leadership style that was collaborative and trustful and allowed for personal autonomy was a dominant foundational piece that was critical for participant participation in self-directed PD. Finally, the principals were found to positively impact school climate by partaking in PD alongside teachers and ensuring there was a shared vision of the school so that teachers could tailor PD to parallel school interests.

An Investigation into the Failure to Implement a Universal School Lunch Program during WWII and Postwar Reconstruction in Canada: The Case of Ontario

The purpose of this research is to investigate the various social, political and economic factors that contributed to Canada’s failure to implement a universal school lunch program during the 1940s. Although Canada developed several other social welfare programs in the post-war period, it remains one of the only industrialized nations that does not provide hot meals to children in elementary or secondary schools. Data from the province of Ontario, a major site of postwar reconstruction and policy-making, has been taken up to inform the broader national discourse on school lunches from the 1940s. National, Ontario provincial and City of Toronto archival records were collected and analyzed according to common themes, in order to identify key barriers that constrained government support of a hot meal program. Archival records were identified using key words, and were limited to materials created between 1930-1952. Analysis suggests that sufficient need for a hot meal program had not been established during the 1940s. Despite misleading nutrition messages, rates of malnutrition and nutrient-related disease were at an all-time low, and many Ontario school boards did not appear to have the necessary infrastructure required to supply all pupils with hot meals. The Canadian government had already employed significant resources to improve existing social security programs by coupling them with health education. This strategy reflected a shift in understanding malnutrition as a knowledge-based problem, as opposed to income-based. This understanding was further reinforced through the moralized dissemination of nutrition information, which placed blame on women for improperly raising their children. Ultimately, the strong uptake of nutrition as a public health issue in Ontario may have limited prospective responses to solutions already utilized in the public health domain, and directed favour away from a universal school lunch program for Canada.