BACKGROUND/OBJECTIVES
Coronavirus disease 2019 (COVID‐19) has pushed many geriatric healthcare providers to attempt video visits for the first time. Although the Veterans Health Administration (VA) ...is a pioneer in telemedicine, rapid shifts to nearly exclusive use of telehealth for healthcare delivery and changes regarding trainee engagement in telehealth served as the impetus for rapidly assessing telehealth training needs.
DESIGN
National needs assessment (online survey) of associated health trainees and medical fellows affiliated with Geriatric Research Education and Clinical Centers (GRECCs).
SETTING
National GRECC network ‐‐ 20 VA centers of excellence focused on supporting Veterans as they age. Each GRECC is affiliated with a school of medicine at a major university.
PARTICIPANTS
Trainees (n = 89) representing 12 disciplines.
RESULTS
Two‐thirds of participants had received some telehealth training. However, most had never done a video‐to‐home visit, and, regardless of telehealth experience, they reported low confidence. Based on open‐ended questions exploring training needs, educational resources were rapidly developed and disseminated.
INTERVENTION
Within 1 week of the assessment, a nuts‐and‐bolts guide regarding remote access, technology requirements, video‐conferencing platforms, and managing emergencies was sent to the national network of GRECC associate directors for education for dissemination among discipline‐specific training directors at their sites. This resource was subsequently submitted to the national VA COVID Strong Practices SharePoint site. An interdisciplinary team of geriatric specialists with extensive video‐to‐home experience also organized a national webinar that peaked at just over 700 participants. GRECC Connect, a network of geriatric specialty teams funded to improve care access for rural older veterans using telehealth and associated health training programs at each GRECC facilitated rapid development and dissemination of both resources.
CONCLUSION
We quickly identified and responded to telehealth training needs of geriatrics trainees to optimize care for rural older adults as part of a rapid response to COVID‐19. Although the webinar and nuts‐and‐bolts resources were developed within the VA context, they have demonstrated high demand and broader applicability. Results should continue to inform curriculum development efforts to address telehealth training gaps within and outside the VA.
Getting Eyes in the Home Fong, Kelley
American sociological review,
08/2020, Letnik:
85, Številka:
4
Journal Article
Recenzirano
Each year, U.S. child protection authorities investigate millions of families, disproportionately poor families and families of color. These investigations involve multiple home visits to collect ...information across numerous personal domains. How does the state gain such widespread entrée into the intimate, domestic lives of marginalized families? Predominant theories of surveillance offer little insight into this process and its implications. Analyzing observations of child maltreatment investigations in Connecticut and interviews with professionals reporting maltreatment, state investigators, and investigated mothers, this article argues that coupling assistance with coercive authority—a hallmark of contemporary poverty governance—generates an expansive surveillance of U.S. families by attracting referrals from adjacent systems. Educational, medical, and other professionals invite investigations of families far beyond those ultimately deemed maltreating, with the hope that child protection authorities’ dual therapeutic and coercive capacities can rehabilitate families, especially marginalized families. Yet even when investigations close, this arrangement, in which service systems channel families to an entity with coercive power, fosters apprehension among families and thwarts their institutional engagement. These findings demonstrate how, in an era of welfare retrenchment, rehabilitative poverty governance renders marginalized populations hypervisible to the state in ways that may reinforce inequality and marginality.
ObjectivesHillingdon Hospital has operated a ‘Providing Assessment and Treatment for Children at Home (PATCH)’ service since May 2021. Clinically stable children who required observation or ...low-intensity treatments were discharged to our PATCH team of senior paediatric nurses who reviewed them in their own homes. If required, PATCH referred children back to the hospital for review by a paediatric registrar or consultant. A large cohort of children our PATCH team reviewed were those who attended A&E or were admitted to our Paediatric Assessment Unit (PAU) or the Paediatric Ward with acute asthma or viral-induced wheeze (VIW). We aim to describe our experience running our PATCH service and highlight its utility.MethodsPATCH referral data from 1st May 2021 to 31st December 2022 was retrospectively collected and analysed.Results252 children were referred to our PATCH team between 1 May 2021 and 31 December 2022 – 157 (62%) for VIW and 95 (38%) for asthma. 147 (58%) of these referrals were from A&E, 64 (26%) from our inpatient ward, 39 (15%) from PAU, and 1 from the community. The median age of children referred was 2.45 years, with 88% of children being between the ages of one and five, 3% under one, and 9% above five. The majority of referrals (59%) were made between September 2021 and March 2022 – September 2021 had the most referrals (33).Children referred to our PATCH team remained under their care for an average of 1.86 days. The mean number of telephone reviews and home visits per child were 1.07 and 0.68 respectively. 25 (11%) children were asked to come back to the hospital for a review. There was a 2% hospital re-admission rate. Figure 1 illustrates the distribution of PATCH team referrals, including hospital reviews and re-admissions.Feedback received from parents was overwhelmingly positive (96%). Indeed, 63% of parents stated that, if concerned, they would have returned to A&E if it was not for our PATCH service, and 37% would have contacted their GPs or called 111, as shown in graph 2.Abstract 877 Figure 1ConclusionOur data shows that PATCH is a safe alternative to hospital admission for observation and low-intensity treatments. The service undoubtedly ensures continuity of care and helps to support parents and carers during their child’s illness. The low re-admission rate, potential reduction of repeat presentations to A&E or GP, and enormous positive feedback are a testament to this.
AimsThe 2012 NHS mandate made recommendations to improve the quality of care delivered to patients whilst also reducing their inpatient length of stay. In response to this, we developed a paediatric ...healthcare at home (HAH) service at our hospital in April 2014. This provides consultant led, nurse delivered acute care for paediatric patients in their own home.Patient safety and outcomes are paramount and the neonatal subgroup of patients is potentially the most vulnerable of the paediatric population.In this review, we therefore aim to examine the diagnoses and outcomes for neonates cared for utilising the HAH service during a 12 month period.MethodsThis was a retrospective study of all neonates identified from the HAH patient database over a 12 month period. The data set collected included clinical diagnoses, clinical outcomes and patient satisfaction. Parallel data collection was also undertaken for neonates cared for on the postnatal wards who could potentially benefit from being cared for utilising the HAH model.ResultsDuring the 12 month study period, 28 neonates were cared for utilising the HAH service representing 17% of the overall referrals. Collectively, they had 201 home visits and saved 108 inpatient bed days. All of the neonates received treatment with iv antibiotics, 100% needed to be administered more than once daily. There was one re-admission who subsequently completed their treatment at home following a 24 h period of observation as an inpatient. There were no adverse incidents reported and patient satisfaction was overwhelmingly positive: 100% of respondents would recommend the HAH service to friends and relatives.During the same 12 month study period, 68 clinically stable neonates were cared for on the postnatal wards with iv antibiotics for ≥ 5 days for presumed infection. Their diagnostic microbiology outcomes are detailed in Figure 1. This group collectively spent 409 bed days in hospital.ConclusionThe HAH model delivers a safe, effective, high quality clinical service for a selected group of neonatal patients. There is great scope for expansion as a significant number of babies on post- natal wards could safely receive their care utilising the HAH model.Abstract G172 Figure 1
Child Protective Service (CPS) workers experience workplace violence at the hands of their clients. Some of these incidents have led to severe injuries and fatalities. Legislation has been created to ...maintain workplace safety of employees in service- related fields; however, these policies have not extended into specific laws for CPS workers. Using grounded theory, this qualitative study examined the effectiveness of safety measures from the perspective of current and former CPS workers. A total of 10 former and current CPS workers were interviewed individually. This study found that workers believe increased legislation, funding, and training are needed to increase the safety of CPS workers as they investigate alleged child abuse and neglect cases. Legislative-related responses included police protections, armed self-defense, and a mandatory buddy system policy. Funding-related responses included hazardous duty pay, resources for families, employing more staff, and mental health services for CPS workers. Training-related responses included increased training for police officers and CPS workers.
La visite à domicile (VAD) est une modalité d’intervention préventive reconnue. La littérature a documenté les meilleures conditions de sa mise en œuvre. Les programmes de VAD recourent fréquemment ...aux visiteurs para-professionnels. Cependant, peu de recommandations ont été formulées par rapport aux compétences relationnelles, à la formation à la VAD ou à la supervision à apporter à ces intervenants. Cette étude de portée met en avant les principales caractéristiques des interventions recourant à des para-professionnels en VAD. Les résultats portent sur le détail des formations et des supervisions, et mettent en évidence le moindre intérêt porté par les auteurs des interventions sur les compétences interpersonnelles de ces visiteurs à domicile.
An extensive literature documents racial discrimination in housing, focusing on its prevalence and effect on non-White populations. This article studies how such discrimination operates, and the ...intermediaries who engage in it: landlords. A fundamental assumption of racial discrimination research is that gatekeepers such as landlords are confronted with a racially heterogeneous applicant pool. The reality of urban housing markets, however, is that historical patterns of residential segregation intersect with other structural barriers to drive selection into the applicant pool, such that landlords are more often selecting between same-race applicants. Using interviews and observations with 157 landlords in four cities, we ask: how do landlords construct their tenants’ race within racially segmented housing markets, and how does this factor into their screening processes? We find that landlords distinguish between tenants based on the degree to which their behavior conforms to insidious cultural narratives at the intersection of race, gender, and class. Landlords with large portfolios rely on screening algorithms, whereas mom-and-pop landlords make decisions based on informal mechanisms such as “gut feelings,” home visits, and the presentation of children. Landlords may put aside certain racial prejudices when they have the right financial incentives, but only when the tenant also defies stereotypes. In this way, landlords’ intersectional construction of race—even within a predominantly Black or Latino tenant pool—limits residential options for low-income, subsidized tenants of color, burdening their search process. These findings have implications for how we understand racial discrimination within racially homogenous social spheres. Examining landlords’ screening practices offers insight into the role housing plays in how racism continues to shape life outcomes—both explicitly through overt racial bias, and increasingly more covertly, through algorithmic automation and digital technologies.
Collaborative relationships between families and teachers of elementary-aged children are complicated by teachers’ lack of training for family engagement and by hierarchical and racialized power ...differentials. Home visiting can create a space for teachers to center and honor families’ ways of knowing and being, but those home visits need to be conducted in ways specifically intended to build relationships with families; otherwise, the visits can do damage. In this descriptive exploratory study, we examined how teachers responded to families’ openings during home visits. We articulate a theory that describes actions teachers can employ to build rapport, particularly across difference. This work has implications for research on family engagement and for teacher preparation for home visiting.
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