Development of an evidence-based conceptual framework for workplace assessment

One solution to the underutilization of workplace accommodations is to use teleconferencing technology to conduct remote assessments, effectively expanding the geographical area that experienced rehabilitation specialists can cover. However, such an effort requires a highly structured and comprehensive assessment protocol. This paper reports on the analysis of 53 existing assessments to develop a conceptual framework for assessment and the use of that framework to evaluate the applicability of 10 work-related assessment protocols for remote tele-assessment. While none of the 10 protocols were found to be sufficiently comprehensive for our purposes, the conceptual framework itself will serve as an important tool to structure a new comprehensive protocol that will be developed. Moreover, the framework can also be used by providers of workplace assessments to evaluate the suitability of any assessment protocol to meet the needs of any particular individual or workplace situation.     

Utilizing spiritual ecograms with Native American families and children to promote cultural competence in family therapy

This study signifies an initial step at giving family therapists an important assessment tool as they seek to increase cultural competence with Native American families and children. To determine the relevancy and consistency of utilizing a spiritual ecogram assessment tool with Native Americans, 50 Native American participants, with extensive experience with this population, reviewed, rated, and gave feedback on its use. Although some limitations were noted, results showed that spiritual ecograms were moderately consistent with Native American culture and, if used properly, can help family therapists develop culturally appropriate interventions with Native American families and children.     

Utilizing Spiritual Lifemaps with LDS Clients: Enhancing Cultural Competence in Social Work Practice

Few people realize that the Latter-day Saints (LDS) or Mormon Church currently ranks as the fourth largest religious denomination in the United States. Although spirituality and religion play a central role in the beliefs, lifestyle, and culture, of many LDS clients, very few spiritual assessment tools have been validated with this population. Utilizing a mixed method design, this study modified an existing spiritual assessment tool—spiritual lifemaps—that may be particularly congruent with LDS client populations. A sample of recognized experts in LDS culture (N = 100) examined how consistent the spiritual lifemap assessment tool was with LDS culture, and how consistent the four sample question sets were with LDS culture. Overall, results indicate that the spiritual lifemap assessment tool is consistent with LDS clients’ beliefs, lifestyle, and culture. This study represents an important step at providing more culturally competent practice with LDS clients.     

Risk assessment in context

This article provides an overview of the context in which decisions about risk are made in child welfare including personal, task, and environmental factors that may contribute to uncertainty and less-than-optimal decision making, as well as some of the methodological challenges posed by the use of current risk assessment instruments. Actuarial, consensus-based, and clinical instruments are discussed and the more successful track record of actuarial decision-making in child welfare and related fields is highlighted. Methodological challenges to assessing risk are also presented including lack of reliability and validity of measures, definitional dilemmas, temporal issues such as changes in risk over time, absence of base rate data, predicting for individuals and sensitivity and specificity of measures. Implications for the design and implementation of risk assessment tools are considered in light of contextual influences and methodological limitations. Lastly, an overview of the contents of Part One of this special issue on risk assessment is provided.     

Clinical family assessment: applying structured measurement procedures in treatment settings*

This article describes the use of a battery of structured family measurement procedures to conduct systematic, comprehensive assessments of families who enter treatment. The measures are derived from family research and include self-report questionnaires and structured observation of family interactions. The assessment is multimodal, and examines the entire family unit, the marital subsystem, the individual family members, and the larger social context affecting a family. Two case examples are presented which demonstrate how the structured assessment data are combined with clinical theory and other information about a family to generate initial hypotheses about the functioning of the family system and likely avenues for therapeutic intervention.     

Evaluation of selected ergonomic assessment tools for use in providing job accommodation for people with inflammatory arthritis

Inflammatory arthritis (IA) is a leading cause of work disability, especially for those with jobs involving repetitive, hand-intensive or manual work. Ergonomic interventions may mediate against job loss. Our objective was to identify desirable features of an ergonomic tool for use in providing job accommodation for people with IA, and to evaluate a selection of ergonomic and rehabilitation tools against these features. Eight desirable features were compared across 16 assessment tools. None of the tools met all the pre-determined features. Ergonomic assessment tools should incorporate objective assessment of risk factors together with subjective perceptions of symptom aggravation, and identify risk factors that may not currently be causing problems, but may increase risk of aggravation or injury in the future. To accommodate the needs of people with IA, the tool should allow for evaluation of risks and generation of solutions without a worksite visit in situations where the client does not want to disclose their illness. Finally, an assessment tool needs to be applicable to a wide range of worksites, easy to use, valid, and reliable. Against these criteria, it appears that there is a lack of appropriate ergonomic assessment tools for use in people with IA.     

Spiritual ecomaps: a new diagrammatic tool for assessing marital and family spirituality

This paper develops a new diagrammatic spiritual assessment tool, the spiritual ecomap, for use with individuals, couples, and families. While a genogram portrays a family's history over time, a spiritual ecomap provides a valuable supplement by depicting a family's current relationships to critical ecological systems in space. The spiritual ecomap is based upon an anthropological framework conceptualized in the spiritual formation tradition and can be used with families from diverse spiritual traditions. I use a case study to familiarize the reader with the instrument, and offer suggestions for its application.     

Brief Family Therapy: A Critique of Kinston and Bentovim

There has been a growing interest in the use of brief family therapy with children. Despite this increased interest, research into the effectiveness of this approach appears to have lagged behind clinical practice. The present paper critically reviews a study by Kinston and Bentovim (1978) which could be viewed as typical in the area of brief family therapy. Analysis of Kinston and Bentovim's investigation revealed serious methodological deficiencies and raised some important clinical issues in brief family therapy studies. These include the importance of training in family therapy, the use of a consistent theoretical framework, and flexibility in the application of techniques. On the basis of this review, recommendations are made that future investigations of brief family therapy follow the guidelines necessary for valid psychotherapy research.     

Spiritual Interventions in Substance Abuse Treatment and Prevention

Abstract

This article reviews the recent research literature related to the use of spiritual interventions in the prevention and treatment of substance abuse. Empirical outcome studies are critically reviewed and a brief overview is given of spiritual interventions which have yet to be studied empirically. Areas for further research are delineated and philosophical and methodological issues related to the study of spiritual interventions are discussed.     

Evaluability assessment: Reflections on the process

As a formal process, evaluability assessment is 10 years old. In the Cooperative Extension Service (CES), the process is 5 years old. Since 1984, evaluability assessments have been implemented in five states with six different major programs in an effort to define the process in a practical methodological sense and to encourage its adoption in CES. Implementation proceeded iteratively and after each study, procedures were analyzed, clarified, and, wherever possible, simplified to make the process more usable and more “operator robust.” The purpose of this article is to reflect on the process as it evolved in applications in CES. Underlying philosophy and methodological considerations are discussed. To put these in perspective, background information is provided on the evaluability assessment process and on the studies conducted in CES.     

Development of the Emergency Department Senior Abuse Identification (ED Senior AID) tool

Emergency departments (EDs) are an important health care setting for the identification of elder abuse (EA). Our objective was to develop an ED-based tool to identify EA. The initial tool included a brief cognitive assessment, questions to detect multiple domains of EA, and a physical examination. Refinement of the tool was based on input from clinical experts and nurse and patient feedback. The revised tool, which included 15 questions about EA, was then tested in an academic ED. We calculated the inter-rater reliability, sensitivity, and specificity of individual EA questions. Among ED patients age≥65 (N = 259), 17 (7%) screened positive for suspicion of EA. We identified a combination of six questions that cover the included domains of EA, demonstrated good or excellent inter-rater reliability, and had a sensitivity and specificity of 94% (95% confidence interval (CI) 71–100%) and 90% (95% CI 85–93%), respectively. These results inform a proposed screening tool for multisite validation testing.     

The assessment of values in medical decision making

Individuals, families, and health care providers consider medical treatment decisions in light of their respective values about life iin varying states of health. The clarification of health care values is important not only in the context of everyday clinical decision making, but also for advance care planning and the resolution of ethical dilemmas. This article argues that objective assessment tools may facilitate the process of clarifying and communicating health care values in these contexts. The article reviews arguments for the importance of values assessment in health care planning, methods used to date for health care values assessment, conceptual and methodological challenges for the measurement of health care values, and lessons learned through the process of developing and piloting a Health Care Values Survey. Objective values assessment tools appear useful for eliciting health care values, although multiple challenges for reliable, valid, and clinically useful measurement of values are identified.     

Comprehensive college student suicide assessment: application of the BASIC ID

Whether one knows someone who is thinking of suicide, has attempted suicide, or has completed suicide, nearly all individuals who encounter suicide are affected. The influence and residual affects of suicide are further amplified as the issue reaches across communities such as college or university campuses. College and university staff must improve their response to suicidal ideation with comprehensive assessment and intervention. The authors discuss risk factors and basic screening methods for suicide risk. They present Lazarus' BASIC ID tool (ie, Behavior, Affective Responses, Sensations, Images, Cognitions, Interpersonal Relationships, and Drugs or Biological Influences) as a method for conducting a comprehensive suicide assessment. The authors demonstrate assessment procedures through a case vignette.     

Development and Validation of a Tool to Improve Physician Identification of Elder Abuse: The Elder Abuse Suspicion Index (EASI)©

ABSTRACT

This study aimed to develop and validate a brief tool for physician use to improve suspicion about the presence or absence of elder abuse. A literature review on elder abuse, obstacles to its identification, limitations of detection tools, and characteristics of screeners employed by physicians were used to generate elder abuse detection questions for critique by 31 doctors, nurses, and social workers in focus groups. Six resulting questions became the Elder Abuse Suspicion Index (EASI) administered by 104 family doctors to 953 cognitively intact seniors in ambulatory-care settings. Findings were compared to a recognized, detailed elder abuse Social Work Evaluation (SWE) later administered to participants by social workers blinded to the results of the EASI. The EASI had an estimated sensitivity and specificity of 0.47 and 0.75, usually took less than 2 minutes to ask, and 97.2% of doctors felt it would have some or big practice impact. This research is a first phase in the development and validation of a user-friendly tool that might sensitize physicians to elder abuse and promote referrals of possible victims for in-depth assessment by specialized professionals.     

Development and validation of a tool to improve physician identification of elder abuse: the Elder Abuse Suspicion Index (EASI)

This study aimed to develop and validate a brief tool for physician use to improve suspicion about the presence or absence of elder abuse. A literature review on elder abuse, obstacles to its identification, limitations of detection tools, and characteristics of screeners employed by physicians were used to generate elder abuse detection questions for critique by 31 doctors, nurses, and social workers in focus groups. Six resulting questions became the Elder Abuse Suspicion Index (EASI) administered by 104 family doctors to 953 cognitively intact seniors in ambulatory-care settings. Findings were compared to a recognized, detailed elder abuse Social Work Evaluation (SWE) later administered to participants by social workers blinded to the results of the EASI. The EASI had an estimated sensitivity and specificity of 0.47 and 0.75, usually took less than 2 minutes to ask, and 97.2% of doctors felt it would have some or big practice impact. This research is a first phase in the development and validation of a user-friendly tool that might sensitize physicians to elder abuse and promote referrals of possible victims for in-depth assessment by specialized professionals.     

Human error assessment in electric power company of Serbia

This paper presents a case study which confirmed that the use of APJ for proper assessment of human error in the Electric Power Company of Serbia (hereinafter EPS). The proposal methodological framework was used for human error identification and quantification in the case of a repair intervention on a steel lattice tower 10/0.4 kV (jurisdiction of an EPS subsidiary ED "Jugoistok", Nis, Serbia) which resulted in an accident with a fatal outcome. One of the aims of this study is to show the necessity of human error assessment not only in manufacturing industries but, as it will be shown in this paper, in companies that distribute electric energy, as well.     

A toolkit for MSDs prevention--WHO and IEA context

Many simple MSD risk management tools have been developed by ergonomists for use by workers and employers with little or no training to undertake injury prevention programs in their workplace. However, currently there is no "toolkit" which places such tools within an holistic, participative ergonomics framework and provides guidance on how best to use individual tools. It is proposed that such an holistic approach should entail initial analysis and evaluation of underlying systems of work and related health and performance indicators, prior to focusing in assessment of MSD risks stemming from particular hazards. Depending on the context, more narrowly focused tools might then be selected to assess risk associated with jobs or tasks identified as problematic. This approach ensures that biomechanical risk factors are considered within a broad context of organizational and psychosocial risk factors. This is consistent with current research evidence on work- related causes of MSDs.     

Polymorphism-screening: genetic testing for predisposition—guidance for technology assessment

Health policy is increasingly confronted with the demand for financing genetic testing on inherited susceptibility to disease. Tests on polymorphism/SNP associated with multicausal and chronic conditions are already offered in private commercial institutions or in academic hospitals. The increasing pressure on public health services to offer SNP testing leads to first methodological approaches for a generally valid regulatory framework applicable for inclusion or refusal of genetic tests into the public health services. Systematic search in Medline, Embase and the Web for methodological papers or guidelines for the assessment of polymorphism-screening. Since genetic testing has not only clinical and economic effects on health care, but also primarily ethical consequences by profiling our understanding of “health” and “disease”, this paper gives an overview of relevant aspects and background information to consider in the assessment of genetic tests. Although 2–3 million SNPs are identified and the journals are full of reported “significant” associations between disease and mutation, only a few can be replicated unequivocally. The ACCE (Analytic and Clinical Validity, Clinical utility; Ethical, legal and social implications)-framework was developed by the Center of Disease Control for the assessment of genetic testing. This standardised appraisal approach proposes collecting and evaluating: (a) Prevalence, genotype-/phenotype-relation. (b) Clinical presentation: natural history; the different expressions of disease. (c) Performance of the genetic test. (d) Implications for therapy and prevention. (e) Conclusion for clinical applications of risk-profiling of health on their susceptibility to disease and/or for clarification of disease for therapy planning. Since genetic testing is urging its way into the health care system, the actual danger is, that population screening starts before valid evidence from big prospective studies have been carried out and delivered proofs of direct causal associations. Before diffusing into the health care system we are suggesting to take a cautious and standardised approach.     

The spiritual genogram in family therapy

Spiritual and religious issues often surface during marital and family therapy. In this article, I describe a spiritual genogram that is a multigenerational map of family members' religious and spiritual affiliations, events, and conflicts. Used as a tool in family therapy, the spiritual genogram enables clients to make sense of their families' religious/spiritual heritage and to explore the ways in which their experiences impact present couple or family issues.