Background:
School leaders must make sense of the messages they receive from multiple, overlapping contexts of their school environments. Equally important, they must shape meaning of school issues ...and events with and for other school members.
Purpose:
The purpose of this study was to examine the ways in which school leaders defined and made sense of issues of race and demographic change in their schools.
Data Collection:
Interviews, documents, and archival data from a larger study provided information on the programs, policies, and practices that schools modified in response to their growing African American population. For the current study, the author specifically examined the words and actions of school leaders to determine how they defined and made sense of the demographic changes taking place. The author also used other information to establish the contexts around these leaders that might help explain their sensemaking.
Findings:
Generally, school leaders'sensemaking seemed related to the local context and organizational ideology, as well as their racial and role identities. To varying degrees, sensemaking about race influenced school leaders' willingness to challenge or change status quo social structures within their schools.
Recommendation:
School leaders must come to understand their own sociopolitical identities and professional contexts, how these shape their view on issues of race, and the implications of their leadership and sensemaking for all students, particularly students of color.
On June 30, 2012, Interim Federal Health Program (IFHP) funding was cut for refugee claimant healthcare. The potential financial and healthcare impacts of these cuts on refugee claimants are unknown.
...We conducted a one-year retrospective chart review spanning 6 months before and after IFHP funding cuts at The Hospital for Sick Children, a tertiary care children's hospital in Toronto. We analyzed emergency room visits characteristics, admission rates, reasons for admission, and financial records including billing from Medavie Blue Cross.
There were 173 refugee children visits to the emergency room in the six months before and 142 visits in the six months after funding cuts. The total amount billed to the IFHP program during the one-year of this study was $131,615. Prior to the IFHP cuts, 46% of the total emergency room bills were paid by IFHP compared to 7% after the cuts (p<0.001).
After the cuts to the IFHP, The Hospital for Sick Children was unable to obtain federal health coverage for the vast majority of refugee claimant children registered under the IFHP. This preliminary analysis showed that post-IFHP cuts healthcare costs at the largest tertiary pediatric institution in the country increased.
Anxiety often co-occurs with autism spectrum disorder, yet there are few valid and reliable instruments for measuring anxiety in youth with autism spectrum disorder. This article describes the ...modification of the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder and systematic psychometric evaluation in a well-characterized sample of 116 youth (age: 5–17 years) with autism spectrum disorder and a range of anxiety symptoms. The clinician-administered-Pediatric Anxiety Rating Scale for youth with autism spectrum disorder was modified with input from parents of children with autism spectrum disorder and an expert panel. Unlike many other anxiety measures, the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder is more focused on behavioral manifestations of anxiety versus verbal expression. Results provide preliminary support for the psychometric properties of the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder. The internal consistency of the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder was 0.90. The Pediatric Anxiety Rating Scale for youth with autism spectrum disorder was strongly correlated with parent-report anxiety measures (rs = 0.62–0.68), supporting convergent validity. In support of divergent validity, correlations between the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder and parent ratings of autism spectrum disorder symptoms, social withdrawal, stereotypy, hyperactivity, inappropriate speech, and repetitive behaviors were low (rs = 0.13–0.32). The Pediatric Anxiety Rating Scale for youth with autism spectrum disorder was moderately correlated with parent-reported irritability (r = 0.52). The Pediatric Anxiety Rating Scale for youth with autism spectrum disorder showed good test-retest reliability (intraclass correlation coefficient = 0.75–0.82) and inter-rater reliability (ICCs = 0.70–0.92). Overall, results support the use of the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder for assessing anxiety in youth with autism spectrum disorder.
Lay Abstract
Many youth with autism spectrum disorder have anxiety, but it can be difficult to assess anxiety with existing measures. We modified the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder and tested the new measure in a group of 116 youth (age: 5–17 years) with autism spectrum disorder. The Pediatric Anxiety Rating Scale for youth with autism spectrum disorder is an interview that a clinician usually completes with the child and parent together. We modified the interview questions and scoring instructions based on feedback from parents of children with autism spectrum disorder and from a panel of experts in autism spectrum disorder and anxiety. Unlike many other anxiety measures, the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder relies less on a child’s verbal expression of anxiety and more on signs that a parent can easily observe. Training clinicians to administer and score the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder was uncomplicated, and raters showed excellent agreement on video-recorded interviews. Youth who were not currently in treatment for anxiety had stable Pediatric Anxiety Rating Scale for youth with autism spectrum disorder scores with repeat measurement over a 1-month period. The Pediatric Anxiety Rating Scale for youth with autism spectrum disorder is a useful clinician-rated measure of anxiety in youth with autism spectrum disorder and fills a gap for assessing anxiety in this population.
Children under 5 represent 86% of annual malaria deaths in the world. Following increasing trends in international travel, cases of imported malaria are rising in North America. We describe the ...epidemiology of malaria diagnosed at a tertiary care pediatric center in the multicultural city of Toronto.
Retrospective chart review of all laboratory confirmed malaria from birth to <18 years between July 1, 1997 and June 30, 2013. Epidemiological data, travel history, chemoprophylaxis history, as well as clinical presentation, diagnosis and treatment were extracted.
In total 107 children were diagnosed with malaria in the 16 year time period. Plasmodium falciparum malaria was identified in 76 (71%), Plasmodium vivax in 28 (26%). Median age of infected children was 6.7 years where 35% of children were born in Canada, 63% were recent or previous immigrants. Of those who resided in Canada, reason for travel included visiting friends or relatives (VFR) 95% and tourism or education (5%). Most common countries of infection were Ghana (22%), Nigeria (20%) and India (14%). Median parasitemia at presentation to our institution was 0.4% (IQR 0.1-2.3) with a maximum parasitemia of 31%. Nineteen (18%) met the WHO criteria for severe malaria due to hyperparasitemia, with 3 of these cases also meeting clinical criteria for severe malaria. One third of patients had a delay in treatment of 2 or more days. Ten percent of children had seen two or more primary health care professionals prior to admission. Prophylaxis was documented in 22 (21%), and out of those, 6 (27%) were appropriate for the region of travel and only 1 case was documented as adherent to their prescription. There were no cases of fatality.
Malaria continues to be a significant disease in returning travelers and immigrant or refugee populations. An increase in physician awareness is required. Appropriate pre-travel advice, insect protection measures, effective chemoprophylaxis is needed to reduce the incidence and improve the management of imported pediatric malaria.
Studies of habitat selection are often of limited utility because they focus on small geographic areas, fail to examine behavior at multiple scales, or lack an assessment of the fitness consequences ...of habitat decisions. These limitations can hamper the identification of successful site-specific management strategies, which are urgently needed for severely declining species like Cerulean Warblers (Setophaga cerulea). We assessed how breeding habitat decisions made by Cerulean Warblers at multiple scales, and the subsequent effects of these decisions on nest survival, varied across the Appalachian Mountains. Selection for structural habitat features varied substantially among areas, particularly at the territory scale. Males within the least-forested landscapes selected microhabitat features that reflected more closed-canopy forest conditions, whereas males in highly forested landscapes favored features associated with canopy disturbance. Selection of nest-patch and nest-site attributes by females was more consistent across areas, with females selecting for increased tree size and understory cover and decreased basal area and midstory cover. Floristic preferences were similar across study areas: White Oak (Quercus alba), Cucumber-tree (Magnolia acuminata), and Sugar Maple (Acer saccharum) were preferred as nest trees, whereas red oak species (subgenus Erythrobalanus) and Red Maple (A. rubrum) were avoided. The habitat features that were related to nest survival also varied among study areas, and preferred features were negatively associated with nest survival at one area. Thus, our results indicate that large-scale spatial heterogeneity may influence local habitat-selection behavior and that it may be necessary to articulate site-specific management strategies for Cerulean Warblers.
This paper examines the reliability and validity of parent target problems (PTPs) in a multi-site randomized controlled trial of parent training (PT) versus psychoeducation (PEP) in children (150 ...boys, 19 girls; mean age 4.7 ± 1.2 years) with autism spectrum disorder (ASD) and disruptive behavior. At baseline, treatment blind, independent evaluators asked parents to nominate the child's top two problems. Each problem was documented in a brief narrative. Narratives were reviewed and revised at follow-up visits during the six-month trial. When the trial was completed, five judges, blind to treatment condition, independently rated change from baseline on a 9-point scale (1 = normal; 2 = markedly improved; 3 = definitely improved; 4 = equivocally improved; 5 = no change; 6 = possibly worse; 7 = definitely worse; 8 = markedly worse; 9 = disastrously worse) at Weeks 8, 12, 16, and 24 (inter-rater intraclass correlation = 0.78). PTP scores for the two target problems were averaged across the five raters, yielding a mean score for each child at each time point. Mean PTP scores showed improvement in both treatment groups over the 24-week study. Compared to PEP, PTP ratings showed a steeper decline in PT based on significant interaction of group and time (t(df) = 2.14(155.9), p = 0.034; Week 24 effect size = 0.75). In categorical analysis, we compared cutoffs mean PTP scores of 3.0 (definitely improved), 3.25, and 3.5 with the positive response rate on the Clinical Global Impressions-Improvement scale from the original study. Sensitivities ranged from 52-78%. PTP narratives offer a systematic, reliable, and valid way to track child-specific outcomes in clinical trials and clinical practice.
The evaluation tool was first derived from the formerly Consortium of British Humanitarian Agencies' (CBHA; United Kingdom), now "Start Network's," Core Humanitarian Competency Framework and ...formatted in an electronic data capture tool that allowed for offline evaluation. During a 3-day humanitarian simulation event, participants in teams of eight to 10 were evaluated individually at multiple injects by trained evaluators. Participants were assessed on five competencies and a global rating scale. Participants evaluated both themselves and their team members using the same tool at the end of the simulation exercise (SimEx).
All participants (63) were evaluated. A total of 1,008 individual evaluations were completed. There were 90 (9.0%) missing evaluations. All 63 participants also evaluated themselves and each of their teammates using the same tool. Self-evaluation scores were significantly lower than peer-evaluations, which were significantly lower than evaluators' assessments. Participants with a medical degree, and those with humanitarian work experience of one month or more, scored significantly higher on all competencies assessed by evaluators compared to other participants. Participants with prior humanitarian experience scored higher on competencies regarding operating safely and working effectively as a team member.
This study presents a novel electronic evaluation tool to assess individual performance in five of six globally recognized humanitarian competency domains in a 3-day humanitarian SimEx. The evaluation tool provides a standardized approach to the assessment of humanitarian competencies that cannot be evaluated through knowledge-based testing in a classroom setting. When combined with testing knowledge-based competencies, this presents an approach to a comprehensive competency-based assessment that provides an objective measurement of competency with respect to the competencies listed in the Framework. There is an opportunity to advance the use of this tool in future humanitarian training exercises and potentially in real time, in the field. This could impact the efficiency and effectiveness of humanitarian operations. Evans AB , Hulme JM , Nugus P , Cranmer HH , Coutu M , Johnson K . An electronic competency-based evaluation tool for assessing humanitarian competencies in a simulated exercise. Prehosp Disaster Med. 2017;32(3):253-260.
Background About 7% of youth in Ontario will have child welfare involvement at some point in their life. (Fallon, 2011) Up to 60% of children will meet criteria for a mental health diagnosis, and ...upon transition out of care 30% will have unaddressed health care needs. Following coroner recommendations from inquests into the deaths of Katelynn Sampson and Jeffrey Baldwin, last year another twelve youth died while in the care of the child welfare system. The 2018 coroner’s report again concluded there was lack of information sharing between societies and healthcare providers. (Cromarty, 2018) It has been established that social determinants of health contribute to the unaddressed health needs of these youth. In contrast, modifiable system level factors that can improve the collaboration and coordination between the healthcare system and Children’s Aid Societies has not been extensively analyzed. Objectives To use a policy analytic framework to outline the linkages between the healthcare system and the Children’s Aid Societies (CAS)s with the purpose of identifying factors that increase coordination, collaboration and information sharing within the child welfare system, and between the child welfare system and the healthcare system in Ontario. Design/Methods This paper will explore policy developments and choices that influence the information sharing structures between the child welfare and health care system using the policy analysis “3-i” conceptual framework – an analysis of the role of interests, ideas, and institutions. Interests refers to agendas of societal groups, civil servants, researchers etc. Ideas refers to knowledge and beliefs including research. Institutions refers to formal and informal rules (legislation) and organizational factors. Although some of the issues presented in this paper intersect with those of Indigenous child wellbeing societies, the health needs for this overrepresented population in the child welfare system necessitates a distinct analysis, and are not included in this paper. Results Institutions: Children are admitted to one of 49 CASs in Ontario. On admission or transfer to any CAS, legislation requires physician physical examinations within 48 hours. In Ontario these are most often completed at walk-in-clinics without medical history. No mental health screening or plan for healthcare follow-up is mandated. The current legislation does not does not track child health outcomes and the current funding formula for CASs does not include healthcare. See Figure 1.Ideas: Despite access to healthcare children did not use healthcare if a need was not identified by their CAS worker, or if workers were not equipped with resources to navigate the healthcare system. (Stiffman, 2004) In Ontario, only 1/3 of children in the child welfare system who were self-harming or voiced suicidality were referred to a mental health professional by their worker. (Baiden, 2018) The gateway providers for healthcare for children in care are their CAS workers. Interests: The Canadian Paediatric Society (CPS) is one of the governing medical bodies with interest in providing the primary health care to children and youth in care. A joint position statement by the CPS and family physicians could set the standard of medical care for children in the welfare system. The Ontario Association of CASs (OACAS) has the potential to systematically report upon performance indicators and outcomes without attributing results to specific CASs thereby providing a form of liability protection. Conclusion Adverse childhood events and social determinants of health contribute to the health of children in the child welfare system. However, this analysis has identified modifiable system level factors that need to be targeted or else health advocacy initiatives will not have their expected impact. Importantly, we have identified child health workers as the gateway providers for the health of children in care, implying that future advocacy initiatives should include workers as key collaborators.
Race and gender affect the way in which African-American female principals perceive and enact their roles in predominantly African-American urban schools. Using empirical data drawn from a larger ...qualitative study, this article examines and challenges racial and gendered assumptions about African-American leadership, and specifically American female leadership. This article suggests that the complex intersection between race, gender, and professional socialization may shape African-American leaders' perception of and orientation toward predominantly African-American schools and communities in some unanticipated ways.
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