A qualitative evaluation of a regional early psychosis service 3 years after its commencement

Objective. To outline the major findings of a qualitative evaluation of an Early Psychosis Service 3 years after its establishment.

Design. Data to evaluate the service were collected from team meetings, focus groups, individual interviews and questionnaires administered to clinicians, school staff, patients, carers and families.

Setting. Barwon Health; Mental Health, Drug and Alcohol Services provide public mental health care to the Geelong, Victoria, region (population 270 000), which is a mixed urban and rural setting. The Early Psychosis Service model implemented involved the placement of two early psychosis workers into each offive adult geographically based Area Mental Health Teams rather than the establishment of a single Early Psychosis Team.

Results. The service was found not to adhere to its original design in several key respects. Caseloads and periods of case management were found to be lower and shorter respectively than was originally planned for, caseworkers often experienced isolation and resentment from their adult service coworkers, the service was perceived to be difficult to access and premises not to be youth friendly and communication and engagement with external agencies and service providers was perceived to be poor.

Conclusions. The choice of service model, inadequate consultation with stakeholders and inadequate promotion of the service contributed to its failure to reach early expectations. Because of these and other issues, including difficulties distinguishing between early psychosis and non-psychosis, a decision was made to restructure youth services and

Implementation and evaluation of brief depression and anxiety screening in clients contacting a drug and alcohol service

Introduction and Aims. High prevalence mental health (HPMH) comorbidity is common in clients seeking alcohol and other drug (AOD) treatment yet can remain undetected. Although research has reported on the introduction of screening into AOD services, little research has reported on the processes surrounding the introduction or evaluated its effectiveness.This study reports on the implementation and evaluation of brief anxiety and depression screening within a specialised, publicly funded AOD service in South-East Victoria.
Design and Methods. Study one examined the implementation of standardised HPMH screening with 114 adult clients (Mean age = 35.49, SD = 9.53; 64% male) telephoning an AOD service over a 5 week period. Measures included severity of HPMH problems,AOD use, care plans and referrals. Study two used semistructured interviews with nine staff/managers to evaluate the effectiveness of screening and its impact on service delivery.
Results. Ninety-four per cent of clients were identified at risk of anxiety or depression. Most care plans incorporated counselling, and concurrent referrals commonly involved a general practitioner. Staff and management found systematic screening increased identification and understanding of comorbid issues and enhanced client interaction but impacted on resource requirements.
Discussion and Conclusions. Most AOD treatment seekers were identified HPMH comorbid and care plans generally included counselling.Adjunctive referrals were more common for severely depressed clients. Screening was effective and enhanced client rapport.Evaluations revealed low confidence in treating HPMH issues in-house.Training may increase worker confidence in managing mental health interventions with subclinical cases, enhancing services’ ability to move towards dual diagnosis capability.

The CDM-Net project : the development, implementation and evaluation of a broadband-based network for managing chronic disease

Background. In Australia most chronic disease management is funded by Medicare Australia through General Practitioner Management Plans (GPMPs) and Team Care Arrangements (TCAs). Identified barriers may be reduced effectively using a broadband-based network known as the Chronic Disease Management Service (CDMS).

Aims. To measure the uptake and adherence to CDMS, test CDMS, and assess the adherence of health providers and patients to GPMPs and TCAs generated through CDMS.

Methods. A single cohort before and after study.

Results. GPMPs and TCAs increased. There was no change to prescribed medicines or psychological quality of life. Attendance at allied health professionals increased, but decreased at pharmacies. Overall satisfaction with CDMS was high among GPs, allied health professionals, and patients.

Conclusion. This study demonstrates proof of concept, but replication or continuation of the study is desirable to enable the impact of CDMS on diabetes outcomes to be determined.

Process and impact evaluation of the romp & chomp obesity prevention intervention in early childhood settings : lessons learned from implementation in preschools and long day care settings

Background: The Romp & Chomp controlled trial, which aimed to prevent obesity in preschool Australian children, was recently found to reduce the prevalence of childhood overweight and obesity and improve children’s dietary patterns. The intervention focused on capacity building and policy implementation within various early childhood settings. This paper reports on the process and impact evaluation of this trial and the lessons learned from this complex community intervention.
Methods: Process data was collected throughout and audits capturing nutrition and physical activity-related environments and practices were completed postintervention by directors of Long Day Care (LDC) centers (n = 10) and preschools (n = 41) in intervention and comparison (n = 161 LDC and n = 347 preschool) groups.
Results: The environmental audits demonstrated positive impacts in both settings on policy, nutrition, physical activity opportunities, and staff capacity and practices, although results varied across settings and were more substantial in the preschool settings. Important lessons were learned in relation to implementation of such community-based interventions, including the significant barriers to implementing health-promotion interventions in early childhood settings, lack of engagement of for-profit LDC centers in the evaluation, and an inability to attribute direct intervention impacts when the intervention components were delivered as part of a health-promotion package integrated with other programs.
Conclusions: These results provide confidence that obesity prevention interventions in children’s settings can be effective; however, significant efforts must be directed toward developing context-specific strategies that invest in policies, capacity building, staff support, and parent engagement. Recognition by funders and reviewers of the difficulties involved in implementing and evaluating such complex interventions is also critical to strengthening the evidence base on the effectiveness of such public health approaches to obesity prevention.

Leading the evaluation of institutional online learning environments for quality enhancement in times of change

This paper reports on findings from a nationally funded project which aims to design and implement a quality management framework for online learning environments (OLEs). Evaluation is a key component of any quality management system and it is this aspect of the framework that is the focus of this paper. In developing the framework initial focus groups were conducted at the five participating institutions. These revealed that, although regarded as important, there did not appear to be a shared understanding of the nature and purpose of evaluation. A second series of focus groups revealed there were multiple perspectives arising from those with a vested interest in online learning. These perspectives will be outlined. Overall, how evaluation was undertaken was highly variable within and across the five institutions reflecting where they were at in relation to the development of their OLE.

Evaluation of the YWCA NSW Aboriginal women's wellbeing education program 2010-2011

An evaluation of the effectiveness of the YWCA NSW Aboriginal Women's Wellbeing Program which sought to collaborate with and support local communities to further develop the knowledge, skills and practical strategies of Aboriginal women in establishing healthier living practices for themselves and their families.

Performance evaluation of e-government services using balance scorecard : an empirical study in Jordan

Purpose - the purpose of this paper is to emphasise on a balance between quantitative and qualitative measures, and examine the use of Balanced Scorecard to evaluate and estimate the performance of information and communication technologies (ICT) in delivering valuable e-government services through the internet. Design/methodology/approach - This study tests the hypotheses of e-government effectiveness using Balanced Scorecard technique by incorporating qualitative measures within a quantitative research methodology with data collected by means of a survey questionnaire. The survey sample of 383 stakeholders includes common customers, employees of e-government, and employees from the IT sector. The survey data were analysed to test the hypothesis in measuring e-government effectiveness from Balanced Scorecard's four dimensions: customer perspective, financial perspective, internal business process perspective, and innovation and learning perspective. Findings - The results show that the Balanced Scorecard factors fit very well with monitoring and measuring the performance of e-government in Jordan, and also in evaluating their success in IT project investments. Originality/value - This study attempts to address this gap in the literature and would benefit future studies in applying Balanced Scorecard for performance evaluation of various IT projects that are gaining huge investments from governments and organisations .

Recruitment evaluation of a preschooler obesity-prevention intervention

The aim of this paper was to compare the recruitment strategies of two recent studies that focused on the parental influences on childhood obesity during the preschool years. The first study was a randomised controlled trial (RCT) of the Mind, Exercise, Nutrition … Do It! 2–4 obesity prevention programme and the second was a longitudinal cohort study. For both studies, the desired population were families with preschool children at risk of developing overweight or obesity. Hence, families from diverse ethnic and socio-economic backgrounds were sought. Funding for the RCT provided the resources to adopt a targeted approach to recruitment whereas for the longitudinal study, recruitment was random and opportunistic, rather than specific and targeted. The RCT reported higher child body mass index-for-age z scores, more families not from an Australian or New Zealand background, and more families in the lowest income bracket, suggesting that strategically targeted approaches to recruitment are more likely to achieve the desired sample.

Evaluation of community participation for the development of culture-based fisheries in village reservoirs of Sri Lanka

In this paper, an attempt is made to identify the socioeconomic characteristics of a community that influence the development and management of culture-based fisheries in village reservoirs of Sri Lanka. Socioeconomic data were collected from 46 agricultural farming communities associated with 47 village reservoirs in Sri Lanka. Principal component analysis indicated that scores of the first principal component were positively influenced by socioeconomic characteristics that are favorable for making collective decisions. These included leadership of the officers, age of the group, percentage of active members of the group, percentage of kinship of the group, percentage of common interest of the group, and percentage of participation of the group. The size of the group had a negative effect on the first principal component. The principal component scores of communities were positively related to willingness to pay (P < 0.001). The communities with socioeconomic characteristics favoring collective decision making were in favor of culture-based fisheries. Homogeneity of group characteristics facilitated successful development of culture-based fisheries.

Process evaluation of an integrated health promotion/occupational health model in WellWorks-2

Disparities in chronic disease risk by occupation call for newapproaches to health promotion. Well Works-2 was a randomized, controlled study comparing the effectiveness of a health promotion/occupational health program (HP/OHS) with a standard intervention (HP). Interventions in both studies were based on the same theoretical foundations. Results from process evaluation revealed that a similar number of activities were offered in both conditions and that in the HP/OHS condition there were higher levels of worker participation using three measures: mean participation per activity (HP: 14.2% vs. HP/OHS: 21.2%), mean minutes of worker exposure to the intervention/site (HP: 14.9 vs. HP/OHS: 33.3), and overall mean participation per site (HP: 34.4% vs. HP/ OHS: 45.8%). There were a greater number of contacts with management (HP: 8.8 vs. HP/OHS: 24.9) in the HP/ OHS condition. Addressing occupational health may have contributed to higher levels of worker and management participation and smoking cessation among blue-collar workers.

Assessing and intervening on OSH programmes : effectiveness evaluation of the Wellworks-2 intervention in 15 manufacturing worksites

To develop a transparent and broadly applicable method for assessing occupational safety and health (OSH) programmes or management systems; (2) to assess OSH programmes in a sample of manufacturing worksites; and (3) to determine whether a management focused occupational health intervention results in greater improvement in OSH programmes compared to minimal intervention controls. OSH programmes were assessed using an adaptation of the US Occupational Safety & Health Administration's 1995 Program Evaluation Profile. Scores were generated from 91 binary indicator variables grouped under four "Essential Elements". Essential Element scores were weighted to contribute to an overall programme score on a 100 point scale. Seventeen large manufacturing worksites were assessed at baseline; 15 sites completed the 16 month intervention and follow up assessments. There was considerable variation in Essential Element scores across sites at baseline as judged by our instrument, particularly in "management commitment and employee participation" and "workplace analysis". Most sites scored highly on "hazard prevention and control" and "training and education". For overall OSH programme scores, most sites scored in the 60-80% range at baseline, with four sites scoring below 60%, suggesting weak programmes. Intervention sites showed greater improvements than controls in the four programme elements and in overall programme scores, with significantly greater improvements in "management commitment and employee participation". The OSH programme assessment method used is broadly applicable to manufacturing work settings, and baseline profiles suggest needs for improvement in OSH programmes in most such worksites. Despite a small sample size, results showed that sustained management focused intervention can result in improvement in these OSH programme measures.

Disease burden evaluation of fall-related events in the elderly due to hypoglycemia and other diabetic complications: a clinical review

A hypoglycemia-induced fall is common in older persons with diabetes. The etiology of falls in this population is usually multifactorial, and includes microvascular and macrovascular complications and age-related comorbidities, with hypoglycemia being one of the major precipitating causes. In this review, we systematically searched the literature that was available up to March 31, 2014 from MEDLINE/PubMed, Embase, and Google Scholar using the following terms: hypoglycemia; insulin; diabetic complications; and falls in elderly. Hypoglycemia, defined as blood glucose <4.0 mmol/L (70 mg/dL) requiring external assistance, occurs in one-third of elderly diabetics on glucose-lowering therapies. It represents a major barrier to the treatment of diabetes, particularly in the elderly population. Patients who experience hypoglycemia are at a high risk for adverse outcomes, including falls leading to bone fracture, seizures, cognitive dysfunction, and prolonged hospital stays. An increase in mortality has been observed in patients who experience any one of these events. Paradoxically, rational insulin therapy, dosed according to a patient's clinical status and the results of home blood glucose monitoring, so as to achieve and maintain recommended glycemic goals, can be an effective method for the prevention of hypoglycemia and falls in the elderly. Contingencies, such as clinician-directed hypoglycemia treatment protocols that guide the immediate treatment of hypoglycemia, help to limit both the duration and severity of the event. Older diabetic patients with or without underlying renal insufficiency or other severe illnesses represent groups that are at high risk for hypoglycemia-induced falls and, therefore, require lower insulin dosages. In this review, the risk factors of falls associated with hypoglycemia in elderly diabetics were highlighted and management plans were suggested. A target hemoglobin A1c level between 7% and 8% seems to be more appropriate for this population. In addition, the first-choice drugs should have good safety profiles and have the lowest probability of causing hypoglycemia - such as metformin (in the absence of significant renal impairment) and incretin enhancers - while other therapies that may cause more frequent hypoglycemia should be avoided.

An evaluation of the impact of using authentic design and build industry projects in project-based learning

BACKGROUNDChisholm’s ‘first year experience’ is a significant feature of the new industry focused Bachelor of Engineering Technology program delivered in association with the South East Melbourne Manufacturers’ Alliance (SEMMA). This conceive-design-implement-operate (CDIO Initiative) program commenced as a full time program in first semester 2012. Whereas it is common for CDIO Initiative programs to have a first year experience program containing a project typical of the type of industry project they would complete as a graduate engineer or engineering technologist, this goes further by using real industry projects provided by SEMMA members.This design-and-build industry project runs across both semesters supporting project-based learning in three first year subjects. A concern is that the industry involvement of the projects adds substantially to an already heavy student workload. This has been further increased by the addition of two additional first year initiatives: writing workshops, and training in, and substantial use of, student oral presentations. It is recognised that an excessive workload could lead students to adopt surface learning approaches in other subjects.PURPOSEThe goal of the project is to evaluate student perceptions of the value and work load impact of the industry project and the other new first year initiatives.DESIGN/METHODCentral to this project is a student survey-based evaluation of the industry project based learning that is the core of the ‘first year experience’. The participants were limited to the small group of students who, in a single year, completed all three subjects that comprise the ‘first year experience’. To avoid compromising the results the survey was administered by Chisholm Institute’s Department of Strategy and Planning with no engineering technology degree program staff present. The survey included questions to enable responses to be linked with specific student demographics without identifying any of the respondents.RESULTSThe study showed the industry project-based learning had worthwhile outcomes but placed considerable time pressures on most respondents. For some, this also impacted on their other subjects. A first year oral presentation program was also shown to have worthwhile outcomes. However no conclusions could be reliably drawn on the third initiative – writing workshops.CONCLUSIONSThe results confirm that the authentic industry project is considered a worthwhile initiative but contributes significantly to student overload. This applies also – to a lesser extent – to the first year oral presentation program. Both also require new approaches to delivery as student numbers increase. Strategies to address these issues are discussed.