Procardia

Gary Matthew Cox, MD

• Professor of Medicine
• Associate Vice-chair for Clinical Services in the Department of Medicine

https://medicine.duke.edu/faculty/gary-matthew-cox-md

As outlined above coronary heart disease quiz order procardia cheap, the engi design may not be appropriate for all applications heart disease natural treatment procardia 30mg low price, such neering design process includes multiple opportunities as designs that specically address the proprietary needs to involve individuals from outside the eld of engi of an individual capillaries tight junctions buy procardia with visa. However arteries transport blood away from heart purchase 30mg procardia fast delivery, universal design is far more neering cardiovascular urinary system cheap procardia 30mg on-line, including during the stages of Problem De sustainable for most design situations coronary heart wants cheap 30 mg procardia with visa, as it benets more nition, Generation of Design Alternatives, Conceptual potential users than other approaches. Engineering programs ciples of universal design are: Equitable Use, Flexibility have begun to build in these opportunities to various in Use, Simple and Intuitive, Perceptible Information, degrees. At the University of Dayton, for example, Tolerance for Error, Low Physical Effort, and Size and brainstorming sessions in the senior capstone design Space for Approach and Use (Story, Mueller, & Mace, classes include the design team, project sponsors (cli 1998; Zeff, 2007). The fundamental principle behind ents), any users they would like represented, faculty universal design is to design products and environments mentor(s) with expertise in the eld, and sometimes to respond to the unique nature of all potential users. The success of these types of projects requires Barriers to increasing diversity in the engineer a strong interface between the engineering design ing eld. In recent years, there has been a national push team, professionals in the disability eld, and often the to increase diversity in the engineering workforce by specic individual with disability being designed for. It is believed that greater diversity will all engineering teams, in an effort to make any product help to sustain and promote innovation (National Sci design more usable for potential users with disabilities. Current estimates indicate that However, many professionals in disability services, es individuals with disabilities remain poorly represented pecially those working outside of academia, may not be in engineering elds, with only 1. These Research has highlighted numerous reasons for individuals could serve an important role in educating the poor representation of individuals with disabilities and raising awareness among engineering students in engineering careers. It is imperative that this occurs on a barriers of individuals with disabilities to pursue careers more widespread scale. The engi Objective of the Current Research neering design process is one such example where these In an effort to address the need for engineers to issues can play out. For example, the requirement that be more prepared to design for all, this research study students work together in a team may heighten issues evaluated the implementation and effect of a rst-year related to acceptance, while the expectation that students engineering design course project explicitly focused have the prior knowledge and ability to use power tools on universal design. It was hypothesized that students can limit participation by some individuals with physical who participated in this project would exhibit clear or cognitive disabilities (access). Because engineering indications of having considered universal design design is so fundamental to the engineering curriculum, principles during design selection, as compared to there is a need to ensure that the design curriculum, and previous projects focused on designing for individuals especially the design classroom or lab, tries to address with disabilities and well-dened intro to engineer these issues to be more inclusive to all. Bigelow; Designing for Success 215 the chosen universal design project challenged each semester, with each section taught by a different students to redesign elements in their engineering instructor. The instructors follow a common course classroom to ensure a more inclusive environment for structure, but are given freedom to choose a course all who use, and interact in, the room. This project, project that aligns with their own area of expertise or therefore, had not only the goal of building awareness interest. Projects are intended to address real-world and skills related to universal design, but also improv issues, and instructors are encouraged to consider ing inclusiveness and accessibility of the engineering service-learning type projects focused on humanitar design curriculum through the ideas and products that ian need, sustainability, or assistive devices. Professionals in disability services, majority of projects, it is expected that the project be and other individuals with personal experiences re driven by an external partner, such as a local non-prot lating to diverse needs and abilities, served as class organization or a local company. This partner, and mentors in an effort to establish a possible model for any other mentors identied by the instructor, serve other such partnerships. Methods Students are given over 2 months for the project, and work in design teams of approximately four. A total of 48 rst with time for the design team to receive feedback from year engineering students, 24 students per course class mentors who can attend. Students completed either a builds a prototype or model, and concludes the semes design project explicitly focused on universal design ter by giving a presentation and writing a design report. To compare the students, the built product is not typically developed effectiveness of each project on increasing student enough or safe enough to provide an end-product to the awareness and consideration of usability, inclusiveness, client. There is, however, the opportunity for especially accessibility, and exibility of design, the decision promising devices to be pursued in future semesters by analysis matrices produced during the Design Selection upperclassmen or senior design classes. As a secondary Project Descriptions comparison, a similar analysis was performed on a the Universal Design Project. The Universal small-scale, well-dened, intro to engineering design Design Project was implemented for the rst time in project that lacked a human-centered focus. Details on one section of Engineering Innovation during Spring all course projects, as well as more information about 2011. For this project, the instructor approached the the data analysis, are presented below. All panelists rst discussed some of the key Universal Design is about improving accessibil points they felt were important and then allowed for ity and usability of a product, building, or service question and answer time with the class. Another guest speaker for the class was a teacher sidering the entire spectrum of users when con who had been temporarily disabled, and who had taught ceiving possible solutions. A driving factor behind in the particular classroom while using a wheelchair, Universal Design is that changes that are made to then later using crutches. The third guest speaker was make the product, building, or service better ac a student with an injury requiring the use of crutches, commodate a certain type of user will often have and later a cane, who had used the classroom for the benets that carry over into improving usability Engineering Innovation course. For example, a common illustration he had experienced when working with his team while of Universal Design is the curb cutaways that were having limited mobility. Who else engineering student designing an assistive custodial benets from this design feature, however This last speaker provided the class insight about considerations that should be taken into account To help guide students through preliminary prob regarding the care and maintenance of the room. These At the conclusion of this discussion, which lasted included web-based resources, news articles, academic for approximately one hour, a rened problem state journals, personal interviews, eld observations, etc. This included the Design for Individuals with Disabilities suggesting that students concentrate on one of the fol Project. In En Project has been used for multiple semesters as a lead gineering Innovation, design decision analysis criteria in to the engineering design process. Compared to the are developed by the students based on the knowledge large-scale projects detailed above, this project was they gain from the original problem statement and in much more contrived, and well-dened, asking students formation presented by the instructor, from discussions to design a cardboard table of certain dimensions, using with the client, mentor, and stakeholders, and through limited materials and time, and being strong enough to research and any additional resources used. No client or potential users were the criteria used in decision analysis indicate what the mentioned in the problem denition, though students design team feels is important in identifying the best were given freedom to come up with their own back design. The weight given to each criterion conveys the story and any other additional objectives important to relative importance. Students spent approximately three the design decision analysis criteria and their weeks completing the entire design project. These criteria were then Data Analysis reviewed and categorized based on common themes the instructor used the design decision analysis that emerged. An understanding and recognition of importance of uni additional team [1] also included the safety-related versal design principles, (b) Criteria that conveyed uni criteria Will Not Tip Over assigning a weight of 5. Team 3 was the only team that had and (d) Criteria related to project feasibility. The aver all of its eight objectives reect universal design or age weight of the criteria within each grouping was cal human-centered design in some way. However, for A review of the design decision analyses for the the particular semester of the Design for Individuals project, which asked students to design a playground with Disabilities project, students had not weighted to be inclusive for children with disabilities, without their criteria based on importance, limiting the direct an explicit focus on universal design, showed differ comparisons that could be made. Similar to the universal design project, however, Analysis of Universal Design Project students did demonstrate a clear focus on accessibil For the Universal Design Project, the six design ity. Five of the six teams included either Accessibility teams used a total of 51 criteria in their decision (3 teams), Accessible (1 team), or Wheelchair/Walker analyses. Additional criteria criterion that clearly conveyed a correct understanding describing accessibility (Rubber Surface and Avoids of universal design principles. For example, after learning that number is noted in the results table, to demonstrate the children with autism often benet from tactile feedback, fairly even distribution amongst teams. The average several design teams chose to include Texture as a weight of importance of these variables was 7. An additional seven criteria were related to uni versal design, but focused specically on accessibility. The average weight of In contrast to either of the other two projects, the importance of these criteria was 8. The average weight of the emphasis was placed on the design team, or the importance of these criteria was 6. The last category of criteria that tangentially touched on universal design principles was safety. For the larger projects, safety was the to consideration for the needs of individuals with spe only criteria that every team included in their decision cic disabilities was included. They were incorporated into the decision analyses Raising Awareness of Universal Design of 5 of 6 teams for each of the large projects, and had an Results suggest that the Universal Design Project average score of weighted importance of 8. Additionally, there were another 10 criteria very limited formal education about universal design, (about 20% of total responses) that indirectly conveyed leaving students to draw only from their own research universal design knowledge through consideration of and the guest panel presentation. For example, the would have reected the inclusive nature that their inclusion of the seven guiding principles of universal playgrounds were aiming for. These ndings suggest that universal design knowledge Similarly, revisiting the project description to better does not happen naturally, and that students do not emphasize certain aspects of design. Results are especially promising in comparison to Results of both the Universal Design Project and the two other types of projects considered. The project the Playground for Children with Disabilities Project posing the challenge of designing a playground where did support, as suggested in the introduction of this children with disabilities can interact with their peers paper, that students do seem to have heightened aware without disabilities had the potential to include a very ness of issues related to accessibility. Even without the Universal Design Project, students rated accessibility explicit focus on universal design principles, there was related criteria as more important, on average, than the 222 Journal of Postsecondary Education and Disability, 25(3) criteria related to universal design principles. Though the lectures on universal design to all students is suffi recognition of accessibility is clearly important, it may cient. Regardless, it was observed that even when the hinder students from looking at the broader scope of the project lends itself to universal design considerations, importance of designing for all. As such, there may be a such as the Playground for Children with Disabilities need to begin to better delineate universal design from Project, students do not think in this mindset without accessibility, as proposed by Welch (1995). This sug Similarly, it is clear that students have some ability gests that universal design knowledge is not inherent to cater their designs to ensure they meet the specic in engineering students and does need to be taught in needs of individuals with disabilities. The Universal Design Project is one model good start, products developed according to the seven to achieve this. It appears that, to develop engineers who strating a much higher level thinking of universal design have a universal design mindset, it is important that principles than the rest of the class. For example, one design instructors de-emphasize the need to design team designed a table that was accessible for a range specically for individuals with disabilities. In fact, of people, including individuals who were pregnant or designing for an individual with a disability in mind, obese, but also showed how the tables could be arranged which is growing in popularity in the engineering in different ways to emphasize either group work or curriculum, often leads to designing specialized as small group teacher-led instruction. This demonstrated sistive devices, which contradicts the driving forces that they had clearly understood the idea of accommo of universal design. Chair Project used to introduce students to the engi Another group designed modular tables, each fully neering design process, not surprisingly, did very little adjustable, arguing that this approach circumvented the to get students to consider the human-centered nature assumption that everyone is the same. This is likely due to the fact that the project were specically designed to show that each individual was not real-world in nature, and was not presented was unique and had different preferences. This Some of the students in the class seemed to enjoy is somewhat of a concern, as these types of contrived the project. Further, they recognized that, by carrying it problems are often used to introduce young engineers to out, they had developed a new skill set that could help engineering design. Though they may achieve this goal, them be more successful designers in the future. Other results suggest that they do little to promote the impor students, however, did not especially like the scope of tant skill of considering the end user. This may have been related to the fact that of six teams even considered safety in their design. This choice was despite the latitude students universal design focus do raise student awareness on were given to design anything, from more adaptable these topics. In the course where the project was framed tools to more user-friendly storage systems. Students around universal design, it was promoted to students claimed that listening to the guest panel led them in as a type of skill set that they could take on to future the direction of tables and workspaces. It is unclear, though, how well this appointing to them, because they had already done a knowledge will translate to future projects where the table for the rst project, and it meant everyone was focus is not specically universal design in nature.

Poogiphalam (Andrographis). Procardia.

• Familial Mediterranean fever, influenza, allergies, sinus infections, HIV/AIDS, anorexia, heart disease, liver problems, parasites, infections, skin diseases, ulcers, preventing the common cold, and other conditions.
• Are there any interactions with medications?
• Reducing the fever and sore throat associated with tonsillitis.
• Dosing considerations for Andrographis.
• Are there safety concerns?

Source: http://www.rxlist.com/script/main/art.asp?articlekey=96934

Opioid antagonist treatment (naltrexone) offers many advantages over methadone mainte nance cardiovascular disease menopause purchase procardia once a day, including the fact that it is nonaddicting and can be prescribed without concerns about diversion coronary heart valves cheap procardia 30mg with amex, has a benign side effect profile cardiovascular disease us statistics buy 30 mg procardia, and can be less costly in terms of demands on pro fessional time and patient time than the daily or near-daily clinic visits required for methadone maintenance (165) cardiovascular ultrasound tech buy procardia 30mg lowest price. Most important are the behavioral aspects of treatment arteries blockage symptoms buy procardia 30 mg low cost, as unreinforced opiate use allows the extinction of the association between cues and drug use 2 blood vessels in the heart order generic procardia pills. Naltrexone treatment programs remain comparatively rare and underutilized as compared with methadone maintenance programs (165), largely because of problems with retention, particularly during the induction phase; an average of 40% of patients drop out during the first month of treatment and 60% drop out by 3 months (166). However, the interventions were not widely adopted, adherence remained a major problem, and naltrexone treatment and research dropped off considerably until the past few years, when the need for alternatives to methadone maintenance stimulated a modest revival of interest in naltrexone. Some of the most recent promising data about strategies to enhance retention and outcome in naltrexone treatment have come from investigations of contingency management approaches. Carroll and colleagues (167, 1407) found that reinforcement of naltrexone treatment adherence and drug-free urine specimens, alone or in combination with family involvement in treatment, improved retention rates and reduced drug use among recently detoxified opioid-dependent individuals. Patients with opioid dependence who met the inclusion criteria (including the presence of an additional nonpsy chotic psychiatric diagnosis) were randomly assigned to the two groups. However, only 5% of the eligible patients agreed to participate (compared with 60% in the Woody et al. Psychodynamically oriented group therapy modified for substance-dependent patients ap pears to be effective in promoting abstinence when combined with behavioral monitoring and individual supportive psychotherapy (1301). One broad area involves delineating the multiple factors that alter the development, manifestations, clinical course, and prognosis of substance use disorders. Such factors may include developmental, biological, cognitive, and sociocultural factors, as well as the impact of early experiences with substances of abuse and the effects of co-occurring psy chiatric or general medical conditions. Given the significant numbers of individuals with a co occurring psychiatric and substance use disorder, improved methods for diagnosis are needed, including approaches for defining the precise temporal and etiological relation between sub stance use and other forms of psychopathology. Enhanced approaches for identifying prescrip tion opioid dependence would also be beneficial, particularly in individuals with underlying physical disorders that are associated with significant pain. Research on the modifying factors and underlying causes of substance use disorders is inex tricably linked to a need for studies of the gene or genes that influence the heritability of abuse and dependence on specific substances. Genetic factors may also augment risk for or exert protective influences on the development and manifestations of substance use disorders. In a similar vein, other research approaches, including epidemiological studies, can assist in identifying risk and protective factors that influence vulnerability to substance use disorders. Another topic that requires further research relates to the acute and chronic effects of abused substances. This includes the effects of substances on a variety of organ systems as well as the pathogenesis of substance-induced fetal abnormalities after in utero exposure to substances of abuse. The time course of recovery from these effects once a patient is free of substances also needs delineating. Such studies may complement assessments of the biological, cognitive, and behavioral factors contributing to the development of prolonged abstinence syndromes in patients previously de pendent on nicotine, alcohol, marijuana, cocaine, or opioids. Virtually every aspect of substance use disorder treatment provides an opportunity for further study and improvements in clinical care. More information is needed about the selection of treat ment settings according to the unique needs of the individual patient. The utility of a particular treatment setting for specific disorders may also be worthy of further study. Treatment programs may exhibit differential efficacies or cost-ef fectiveness depending on the site of treatment, the mix of specific treatment modalities used, the organizational and managerial aspects of the treatment program, and the specific population of patients being served. In addition to learning about specific treatment settings, more information is needed on the specific treatments for intoxication and withdrawal. Even in the treatment of alcohol with drawal, for which there is considerable evidence and consensus, questions remain about the most effective class(es) of agents, the most effective agent(s) within a particular class, the most effective dosing regimen(s), and the choice of specific agents for treating specific patient sub groups or specific symptoms of withdrawal. For all substance use disorders, research should delineate the intensity and staging of treatment. Such studies of treatment modalities, including those in current use and those being developed, will need to examine short-, intermediate-, and long-term outcomes in specific patient populations. The impact of sociodemographic, psychiatric, and general medical characteristics and patient treatment preferences on treatment adherence and outcome are also relevant. In terms of pharmacotherapeutic approaches to treatment, the development of new therapies might focus on effectively decreasing symptoms of withdrawal. For pregnant substance-abusing women, it will be important to develop new pharma cotherapies that do not affect the fetus. In terms of existing pharmacotherapies, additional studies are needed on using combinations of pharmacotherapies. Addi tional studies may help guide the identification of patient populations that will benefit from specific treatments. Other therapeutic options could be developed depending on the gene or genes involved in the etiology or treatment responsiveness of substance use disorders. Equally essential is additional research on psychosocial therapies for substance use disorders. Effective psychosocial interventions for the treatment of marijuana dependence are particularly important given the limited options for addressing this problem at present. However, the study of a broad range of psychosocial therapies will enhance therapeutic options for each substance use disorder. For children, adolescents, and adults at risk for a substance use disorder, research is needed on the long-term efficacy of behavioral, psychosocial, and family-based interventions. For individuals with multiple disor Treatment of Patients With Substance Use Disorders 179 Copyright 2010, American Psychiatric Association. Combinations of psychosocial and pharmacological therapies should be examined in terms of augmenting short-term, imme diate, and long-term patient outcomes. With each of the psychosocial therapies, research should determine the impact of sociodemographic, psychiatric, and general medical character istics and patient treatment preferences on treatment participation and outcome. Academy of Psychosomatic Medicine American Academy of Addiction Psychiatry American Academy of Child and Adolescent Psychiatry American Academy of Clinical Psychiatrists American Academy of Pediatrics American Academy of Psychiatry and the Law American Association of Oriental Medicine American Group Psychotherapy Association American Mental Health Counselors Association American Music Therapy Association American Psychological Association American Society of Addiction Medicine Association for Academic Psychiatry Association for Cognitive and Behavioral Therapies Association for Medical Education and Research on Substance Abuse Group for the Advancement of Psychiatry Managed Health Network, Inc. Treatment of Patients With Substance Use Disorders 181 Copyright 2010, American Psychiatric Association. Bernstein J, Bernstein E, Tassiopoulos K, Heeren T, Levenson S, Hingson R: Brief mo tivational intervention at a clinic visit reduces cocaine and heroin use. Siqueland L, Crits-Christoph P: Current developments in psychosocial treatments of alcohol and substance abuse. Tatarsky A: Harm reduction psychotherapy: extending the reach of traditional sub stance use treatment. Stewart J: Pathways to relapse: the neurobiology of drug and stress-induced relapse to drug-taking. De Leon G: Therapeutic communities, in the American Psychiatric Publishing Text book of Substance Abuse Treatment, 3rd ed. Rockville, Md, Substance Abuse and Mental Health Services Administration, 1999 [G] 90. Fleisch B: Approaches in the Treatment of Adolescents With Emotional and Substance Abuse Problems. Weisner C, Mertens J, Parthasarathy S, Moore C, Lu Y: Integrating primary medical care with addiction treatment: a randomized controlled trial. Granholm E, Anthenelli R, Monteiro R, Sevcik J, Stoler M: Brief integrated outpatient dual-diagnosis treatment reduces psychiatric hospitalizations. Substance Abuse and Mental Health Services Administration: Report to Congress on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders and Men tal Disorders. Rockville, Md, Substance Abuse and Mental Health Services Administration, 1999 [G] 124. Rockville, Md, Substance Abuse and Mental Health Services Administration, 1998 [G] 126. Gowing L, Farrell M, Ali R, White J: Alpha2 adrenergic agonists for the management of opioid withdrawal. Streeton C, Whelan G: Naltrexone, a relapse prevention maintenance treatment of alcohol dependence: a meta-analysis of randomized controlled trials. Littleton J, Zieglgansberger W: Pharmacological mechanisms of naltrexone and acampro sate in the prevention of relapse in alcohol dependence. Spanagel R, Zieglgansberger W: Anti-craving compounds for ethanol: new pharmaco logical tools to study addictive processes. Amato L, Minozzi S, Davoli M, Vecchi S, Ferri M, Mayet S: Psychosocial combined with agonist maintenance treatments versus agonist maintenance treatments alone for treatment of opioid dependence. Monti P, Abrams D, Kadden R, Cooney N: Treating Alcohol Dependence: A Coping Skills Training Guide. Luborsky L: Principles of Psychoanalytic Psychotherapy: A Manual for Supportive Expressive Treatment. Chevy Chase, Md, American Society of Addiction Medicine, 1998, pp 707-718 [F] 262. Rockville, Md, National Institute on Alcohol Abuse and Alcoholism, 1992 [G] Treatment of Patients With Substance Use Disorders 195 Copyright 2010, American Psychiatric Association. Edwards G, Orford J, Egert S, Guthrie S, Hawker A, Hensman C, Mitcheson M, Op penheimer E, Taylor C: Alcoholism: a controlled trial of treatment and advice. Marijuana Treatment Project Research Group: Brief treatments for cannabis depen dence: findings from a randomized multisite trial. Saunders B, Wilkinson C, Phillips M: the impact of a brief motivational intervention with opiate users attending a methadone programme. Baker A, Lewin T, Reichler H, Clancy R, Carr V, Garrett R, Sly K, Devir H, Terry M: Evaluation of a motivational interview for substance use within psychiatric in-patient services. Bock B, Graham A, Sciamanna C, Krishnamoorthy J, Whiteley J, Carmona-Barros R, Niaura R, Abrams D: Smoking cessation treatment on the Internet: content, quality, and usability. Rockville, Md, Substance Abuse and Mental Health Services Administration, 2005 [G] 289. Arsenault-Lapierre G, Kim C, Turecki G: Psychiatric diagnoses in 3275 suicides: a meta-analysis. American Psychiatric Association: Practice guideline for the assessment and treatment of patients with suicidal behaviors. Suominen K, Henriksson M, Suokas J, Isometsa E, Ostamo A, Lonnqvist J: Mental dis orders and comorbidity in attempted suicide. Langevin R, Paitich D, Orchard B, Handy L, Russon A: the role of alcohol, drugs, suicide attempts and situational strains in homicide committed by offenders seen for psychiatric assessment: a controlled study. Hien D, Zimberg S, Weisman S, First M, Ackerman S: Dual diagnosis subtypes in urban substance abuse and mental health clinics. RachBeisel J, Scott J, Dixon L: Co-occurring severe mental illness and substance use disorders: a review of recent research. Ziedonis D: Integrated treatment of co-occurring mental illness and addiction: clinical intervention, program, and system perspectives. Rockville, Md, Substance Abuse and Mental Health Services Administration, 1994 [G] 354. Triffleman E, Carroll K, Kellogg S: Substance dependence posttraumatic stress disor der therapy: an integrated cognitive-behavioral approach. Brown S, Inskip H, Barraclough B: Causes of the excess mortality of schizophrenia. Minkoff K: An integrated treatment model for dual diagnosis of psychosis and addic tion. American Psychiatric Association: Practice guideline for the treatment of patients with schizophrenia, 2nd ed. McEvoy J, Freudenreich O, McGee M, VanderZwaag C, Levin E, Rose J: Clozapine decreases smoking in patients with chronic schizophrenia. Batki S, Dimmock J, Cornell M, Wade M, Carey K, Maisto S: Naltrexone treatment of alcohol dependence in schizophrenia: relationship of alcohol use to psychosis severity and antipsychotic medication.

Social workers provide individualized services to help each child develop the skills he or she needs to succeed in 15 See socialwork cardiovascular associates louisville cheap procardia online visa. For instance 4 main arteries purchase procardia american express, among children who have intellectual or developmental disabilities capillaries exchange food oxygen and what in cells buy cheap procardia 30mg line, school social workers perform individual and family interventions to help with social and emotional functioning cardiovascular associates 77089 discount generic procardia uk. Hence capillaries on legs discount 30 mg procardia mastercard, they also play an important role in supporting the families of children with disabilities blood vessels 24 order cheapest procardia and procardia. Social workers aid families in ensuring continuity of services during moments of critical transition, including from early intervention services to preschool services and from preschool services to kindergarten services and beyond (Rosenkoetter et al. In the event of a crisis at school, the social worker reaches out to the family to ascertain their immediate wishes and provide them with follow-up support (Constable, 2009). School social workers also serve as advocates for children to have access to any accommodations to which they may be entitled under the law. School social workers help identify where other marginalized populations of children. School social workers are also natural points of contact for children who are in the foster care system, as these children have often experienced abuse or neglect and had unstable living situations. When foster children with disabilities are enrolled in a new school, their foster parents may know very little about the history of their disability or their special education needs. Moreover, foster parents may not know their rights and responsibilities for making educational decisions for foster children in their care. Under these circumstances, school social workers are indispensable, as they have been trained to understand the language used by child welfare caseworkers and the language of education legislation (Altshuler and Kopels, 2003). Responses further indicated that the most common school mental health providers were school counselors, followed by nurses, school psychologists, and social workers. When applicable, school nurses estimated that they spent one-third of their time providing mental health services. The most common mental health services provided by school staff included mental health assessments, behavior management interventions, group or individual counseling (most often related to family issues), and referrals to community mental health specialists. While most schools reported willingness to refer students to community mental health services, only half of schools reported having a contract or other formal arrangement with local mental health service agencies to refer students in need of treatment (Foster et al. The three-part model emphasizes both a continuum and six content areas that should be considered when creating school-based intervention programs: enabling learning, transition services, crisis prevention, home engagement, community outreach, and individualized assistance where appropriate (Adelman and Taylor, 2012). Successful school-based mental health programs and initiatives should consider these components when seeking out opportunities to collaborate with local community service providers to prevent, screen, treat, and provide continual care for mental, emotional, and behavioral health issues. Despite the fact that few studies of transition prior to 2010 involved classic research rigor or empirically validated interventions, they nevertheless have led to general agreement among researchers and practitioners on appropriate interventions that promise a favorable impact on transition outcomes. Simultaneously, there have been efforts to identify those factors that affect optimum postschool outcomes, especially postschool employment outcomes. Future research needs to determine the relative effectiveness of the strategies, experiences, and student behavior predictors by disability category, severity of disability, or environmental context. Currently, almost half of all states begin required transition education services earlier, typically by age 14 (Cameto, 2005). Accordingly, schools are responsible for addressing multiple factors that impact social and human capital development over the life span. In general, this means postsecondary goals should include the timeframe for the completion, the level of proficiency, how progress will be measured, and how the student will demonstrate the skill or behavior at the accepted level of performance. To ensure that students with disabilities have a successful transition from school to postschool life, educators must make sure they have the necessary supports in place (Mazzotti et al. The hope is that the summary will strengthen the likelihood that when the child leaves high school, she or he will have the relevant information about her or his academic achievement and functional performance, which could help improve postschool outcomes. The summary may include the accommodations, modifications, and supports that were effective in high school and may have utility in postsecondary settings. Youth programs focused on improving educational attainment include tutoring services, study skills training, alternative secondary school offerings, and dropout recovery services (Hoff, 2014). Because many students with disabilities expect to access postsecondary education after high school graduation, it is important to ensure that they have appropriate coursework, supports, and accommodations to help them reach their goals (Shaw et al. When students attain the necessary transition skills, they will have improved postsecondary outcomes. For example, when individuals with and without disabilities complete postsecondary programs, their chances for gainful employment and financial independence greatly improve (Shaw and Dukes, 2013). Accordingly, postsecondary institutions need to obtain information to document a disability, determine the current impact of the disability, and justify the need for the accommodations (Harrington, 2013). Student Involvement in Transition Planning and Increasing Self-Determination It is important that the transition process include a discussion of the activities and services necessary for students to attain their postsecondary goals. Another study found that students with autism who were involved in transition planning were more likely to move on to postsecondary education (Chiang et al. An important aspect of promoting the involvement of people with disabilities in decisions about their lives, across the life span is enhancing skills and opportunities for self-determination. Self-determination is increasingly understood to be a key value undergirding services and supports for children, youth, and adults with disabilities, as well as a key outcome of effective services and supports across the life span (Shogren et al. To aid children and youth with and without disabilities in acquiring the necessary self-determination skills for long-term success in such areas as employment and community participation, researchers have developed new models of instruction to embed instruction on self-determination skills into transition planning, as well as other education activities. They found that students in the treatment group showed significantly greater improvement in their self-determination scores over a 2-year period. Shogren and colleagues (2015a) followed a sample of youth who received self-determination instruction for up to 3 years during secondary school, and found significant and positive increases (compared with a control group) 1 and 2 years after school exit in employment and community integration outcomes, suggesting that self-determination instruction influences not only in-school outcomes but also postschool employment and community participation outcomes. However, they note that their sampling plan limited the ability to detect differences based on disability group, so this finding provides preliminary information to be considered in future research. Moreover, eligibility for services in most categories is based on educational criteria rather than on medical diagnoses and other functional capacities. On the other hand, this arrangement all too often lacks continuity across the life span given the focus on short-term outcomes without planning for long-term outcomes. Based on its review of educational and school-based programs for children with disabilities, the committee drew the following conclusions: 5. Schools play an important role as a centralized location for the delivery of a variety of disability-related services. Current practice, research, and evidence related to the design and delivery of educational instruction and support for children with disabilities focus largely on relatively short-term, year-to-year interventions. Cross-cultural therapeutic relationships: Entering the world of African Americans. Factors promoting or potentially impeding school success: Disparities and state variations for children with special health care needs. In Inside the classroom: the language arts classroom experiences of elementary and middle school students with disabilities. Inclusive education for students with severe disabilities in the United States: Effects on selected areas of outcomes. Preliminary validation of the implementation phases inventory for assessing fidelity of schoolwide positive behavior supports. Achieving rehabilitation, individualized education, and employment success for adolescents with emotional disturbance. Increasing social interaction among adolescents with intellectual disabilities and their general education peers: Effective interventions. Efficacy and social validity of peer support arrangements for adolescents with disabilities. Predictive factors of participation in postsecondary education for high school leavers with autism. Effects of inclusion on the academic achievement and adaptive behaviour of children with intellectual disabilities. Development and social competence after two years for students enrolled in inclusive and self-contained educational programs. Use of school nurse services among poor ethnic minority students in the urban Pacific Northwest. Evaluating the educational experiences of students with profound and multiple disabilities in inclusive and segregated classroom settings: An Australian perspective. Peer-assisted learning strategies: Making classrooms more responsive to diversity. Effects of peer-assisted learning strategies on high school students with serious reading problems. Peer-assisted learning strategies in reading: Extensions for kindergarten, first grade, and high school. Charter schools: Additional federal attention needed to help protect access for students with disabilities. Private school choice: Federal actions needed to ensure parents are notified about changes in rights for students with disabilities. The effects of implementation a chapter of Best Buddies International on the frequency and duration of social interaction of students with intellectual disabilities and the attitudes, beliefs, and experiences of students with disabilities. The use of single-subject research to identify evidence-based practice in special education. A randomized, wait-list controlled effectiveness trial assessing school-wide positive behavior support in elementary schools. Student self-determination: A preliminary investigation of the role of participation in inclusive settings. Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Developing schoolwide programs to prevent and manage problem behaviors: A step-by-step approach. Student and teacher variables contributing to access to the general education curriculum for students with intellectual and developmental disabilities. Impact of curriculum modifications on access to the general education curriculum for students with disabilities. Effects of peer-mediated reading instruction on the on-task behavior and social interaction of children with behavior disorders. The student-directed summary of performance: Increasing student and family involvement in the transition planning process. School nurses and care coordination for children with complex needs: An integrative review. Research on peer-assisted learning strategies: the promise and limitations of peer-mediated instruction. Vouchers, education savings accounts, and tax incentive programs: Implications and considerations for students with disabilities. Speech-language impairment: How to identify the most common and least diagnosed disability of childhood. Resolving the lack of private-school accountability in state funded special education voucher programs. Assistive technology for students with disabilities: What to do when funding is limited Successful transitions for young children with disabilities and their families: Roles of school social workers. Communication with individuals with intellectual disabilities and psychiatric disabilities: A summary of the literature. Effects of the self-directed individualized education program on self-determination and transition of adolescents with disabilities. Hospitaltoschool transition for children with chronic illness: Meeting the new challenges of an evolving health care system. The role of autonomy, self-realization, and psychological empowerment in predicting outcomes for youth with disabilities. Effect of intervention with the Self-Determined Learning Model of Instruction on access and goal attainment. Relationships between self-determination and postschool outcomes for youth with disabilities.

Parent skill development and changes in child behavior proceed in a grad ual and cumulative way capillaries not working purchase 30mg procardia visa. How parents should deliver this praise is easily conveyed through instruc tions cardiovascular 33126 generic 30 mg procardia overnight delivery, but extensive practice is usually required to ensure that several conditions are met cardiovascular dynamics physioex exercise 5 discount 30 mg procardia with amex, as noted in chapter on how to deliver reinforcers effectively heart disease for elderly order procardia now. Structure of Treatment Treatment Sessions Content of the Sessions Treatment is conducted primarily with parents coronary heart disease 2013 statistics procardia 30mg fast delivery, who directly implement sev eral procedures at home cardiovascular vein order 30 mg procardia overnight delivery. We have used the group format with parents who are not experiencing clinically signicant problems. In our clinical work, child impairment and parent and family dysfunction usually require intense focus on the individual family; group treatment becomes more diluted. The treatment sessions, usually provided weekly, cover operant condition ing principles and the procedures that can be derived from them. In our pro gram, the core treatment is to weekly sessions, with each session lasting between and minutes. The parents and therapist dene specic problems that can be observed and develop a specic plan to begin observations. This session focuses on learning the concept of positive reinforcement, factors that contribute to its effec tive application, and rehearsal of applications in relation to the child. Specic pro grams are outlined whereby praise and points are to be provided when behaviors are observed during the week. In this session, parents learn about attending and ignoring and choose undesirable behavior that they will ignore and a positive opposite behavior to which they will attend. Attention and praise for positive behavior are key components of this session and are practiced. Parents are trained to develop behaviors by rein forcement of successive approximations and to use prompts and fading of prompts to develop terminal behaviors. Also, in this session plans are made to implement a home-based reinforcement program to develop school-related behaviors. These behaviors include individual targets in academic domains, classroom deportment, and other tasks. Prior to the session, the therapist identies domains of functioning, specic goals, and concrete opportunities to implement procedures at school. After this session, the school-based program continues to be developed and monitored over the course of treatment, with changes in foci as needed in discussion with the teachers and parents. Second, in relation to our program, these sessions may be supplemented 122 Parent Management Training 6. Observations of the previous week and application of the reinforcement program are reviewed. Details about the administration of praise, points, and backup reinforcers are discussed and enacted so the therapist can identify how to improve parent performance. The purpose is to develop skills that extend beyond implementing programs devised with the therapist. Revisions are made as needed to correct misunderstandings or to alter facets that may not be imple mented in a way that is likely to be effective. The programs are practiced (role played) to see how they are implemented and to make renements. Parents are trained how to deal with low-rate behaviors such as resetting, stealing, or truancy. Specic punishment contingencies (usually using chores as consequences) are planned so they can be presented to the child, as needed for low-rate behaviors. Because parents routinely reprimand children, they learn how to reprimand and how to combine rep rimands for undesirable behavior with positive reinforcement for prosocial behavior. The child and parent meet together to negotiate new be havioral programs and to place these in contractual form. In the rst of these ses sions, negotiating and contracting are introduced, and parent and child practice negotiation. In the second of these sessions, the child and parent practice with each other on a problem or issue in the home and develop a contract that will be used as part of the program. Over the course of the sessions, the therapist shapes negotiating skills in the parent and child, reinforces compromise, and provides less and less guidance. Special emphasis is given to role playing application of indi vidual principles as they are enacted with the therapist. Parents practice designing new programs, revising ailing programs, and responding to a complex array of sit uations in which principles and practices discussed in prior sessions are reviewed. Note: the details of treatment sessions are provided in the manual at the end of this book. Optional sessions are interspersed as needed to address a theme or to vary a procedure that was covered in a previ ous session. Prompting and delivery of contingent praise are so critical to the program that it is not wise to proceed until the par ent achieves some minimal level of performance. The skills can be worked on in an optional session that emphasizes role play, modeling by the therapist, and repeated practice of the behaviors. Further progress may be shaped through the regular sessions, but some remedial work may be needed. An optional session also may be added to complete the session that was given short shrift. In our program, these optional or extra sessions are added in fewer than % of the cases, so the sessions and core treatment noted in Table. Reinforcement as the Core Intervention Positive reinforcement is the core focus of treatment and is emphasized in three ways. First, treatment underscores the importance of conceptualizing problem behaviors in terms of positive reinforcement. Invariably, parents come to treatment with the idea of suppressing, eliminating, or reducing prob lem behavior. The treatment emphasizes that parents ought to think in terms of posi tive opposites; that is, for any behavior they wish to eliminate, the task is to identify the positive behavior the parents would like in its stead. This is taught didactically but more critically is practiced with all sorts of hypothetical and real examples. For example, the parents are asked what to do if they want their child to stop screaming, slamming the door, or throwing breakable objects. The answers involve reinforcing talking quietly, closing the door gently, and handling objects with care or not throwing objects. Technically, these sched ules would be referred to as reinforcing other behavior or incompatible beha vior, but positive opposite is a useful term to encompass these; what the term loses in precision, it gains in ease of communication. Positive opposite is not merely an abstract way of discussing the goal and focus of the program. From the second session on, parents have programs in the home to develop positive prosocial behaviors that are opposites or the prosocial counterparts of behav iors they wish to suppress or eliminate completely. Second, positive reinforcement pervades treatment by emphasizing pa rental use of praise in the home. Training parents to praise is more complex than it sounds in that parents are often hesitant to praise a behavior or to use 124 Parent Management Training reinforcers in general, because they feel the behavior ought not require any in tervention. However, a key issue is whether the child performs in the way parents want from the standpoint of treatment or child-rearing goals. Positive reinforcement can in crease the level of performance (change the mean) and reduce the inconsis tency (variability) in performance. Apart from parental hesitancy to praise, typically parents do not praise very well when they do praise. A vacuous, unenthusiastic statement of good is not likely to change child behavior. Recall from chapter that several conditions must be met to make reinforcement effective. Parents are trained to provide praise that is enthusiastic, that mentions specically what the great behaviors were, and that usually includes nonverbal behavior (touch ing, high ves). Third, reinforcement plays a central role in the development of a point or token reinforcement program in the home. A token program provides the par ent with a structured way of implementing the reinforcement contingencies. The tokens may include stars, marks, points, coins, and other materials, based on the age of the child, ease of delivery for the parent, and other practical is sues. The many advantages of using tokens as reinforcers were presented previously (chapter ). Among them is the prompting function tokens serve for the par ent to reinforce consistently. That is, delivering something tangible (points, check marks) increases the likelihood of delivery and is more reliable than praise alone. Tokens facilitate tracking reinforcement exchanges between par ent and child (earning and spending the tokens). Over the course of treatment, child behaviors included in the token reinforce ment may become increasingly complex. Also, more complex token programs may be implemented Characteristics of Treatment 125. At the beginning of each treatment ses sion, the therapist reviews precisely what occurred in the previous week or since the previous phone contact and in many cases reenacts what the parent actually did in relation to the child. Teach ers are contacted to discuss individual problem areas, including deportment, grades, and homework completion. A home-based reinforcement system is de vised in which child performance at school is monitored, with consequences provided at home by the parents. Teachers may also implement programs in the classroom, but this is not central to the treatment program. The school program is monitored through phone contact with the school, as well as in dis cussions in the treatment sessions with the parent. Structure of the Sessions the general format of the individual sessions is to convey content, to teach spe cic skills, and to develop use of the skill in the home in relation to child be havior. The sessions are likely to include one or more of the following features, which characterize treatment after a reinforcement program is implemented in the home (session on Table. Typically, parents bring in a chart to discuss the point program, and the therapist can see what was done during the week, whether the child earned points, whether and how often consequences were delivered, and related matters. The therapist is searching for what the parent has done well in relation to the skills taught and the program implementation. In addition, the therapist is looking for any problems that emerged, including programs that are not working or not working well, but also for behaviors the parents did well. For ex ample, if the parent says the child cleaned up her room as asked or did not have a horrible tantrum when he was told no, the therapist responds that this is great and then asks the parent to show what he or she did. The therapist may play the role of the child as the parent reenacts what happened. In most cases, the rst minutes of treat ment serves as a review, and the therapist can move on. The parents are en couraged to discuss problems and departures from the program rather than just convey that all is well. The general tenor of the review part of the session is to work on the program together so that it ts within the family situation (is feasible) and is leading to behavior change (is effective). Conveying information (to a parent or child) is not one of the stronger interventions for changing what people actu ally do. Consequently, the session moves next and relatively quickly to proce dures directly designed to change parent behavior. The therapist provides examples of situations, and the parent and the therapist get up from their chairs and engage in role-play. In the initial situa tion, the therapist plays the role of the parent and models what is to be done, while the parent plays the role of the child. Some of the situations are hypo thetical, especially early in treatment, to facilitate developing parent behaviors in relatively simple and nonprovocative situations. The situations evolve to re alistic and difficult situations over the course of treatment. For this segment of the session, the parent and therapist usually take turns delivering praise in the parent role.

Discount 30mg procardia visa. Cardiovascular Examination - OSCE Guide.