Final Priority. Rehabilitation Training: Vocational Rehabilitation Workforce Innovation Technical Assistance Center. Final priority

The Assistant Secretary for Special Education and Rehabilitative Services announces a priority under the Rehabilitation Training program. The Assistant Secretary may use this priority for competitions in fiscal year 2015 and later years. We take this action to provide training and technical assistance to State vocational rehabilitation agencies to improve services under the State Vocational Rehabilitation Services program and State Supported Employment Services program for individuals with disabilities, including those with the most significant disabilities, and to implement changes to the Rehabilitation Act of 1973, as amended by the Workforce Innovation and Opportunity Act (WIOA), signed into law on July 22, 2014.

Final Priority and Definitions; Demonstration and Training Program: Career Pathways for Individuals With Disabilities. Final priority and definitions

The Assistant Secretary for Special Education and Rehabilitative Services announces a priority designed to demonstrate promising practices in the use of career pathways to improve employment outcomes for individuals with disabilities. Specifically, this priority will establish model demonstration projects that engage State vocational rehabilitation (VR) agencies in partnerships with other entities to develop and use career pathways to help individuals with disabilities eligible for VR services, including youth with disabilities, acquire necessary marketable skills and recognized postsecondary credentials. The Assistant Secretary may use this priority for competitions in fiscal year (FY) 2015 and later years.

Final Priority; Rehabilitation Training: Vocational Rehabilitation Technical Assistance Center--Youth With Disabilities. Final priority

The Assistant Secretary for Special Education and Rehabilitative Services announces a priority under the Rehabilitation Training program. The Assistant Secretary may use this priority for competitions in fiscal year (FY) 2015 and later years. This priority is designed to ensure that professionals working in State vocational rehabilitation (VR) agencies receive the technical assistance (TA) they need to provide youth with disabilities with services and supports that lead to postsecondary education and competitive integrated employment.

Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial

BACKGROUND

Falls are the most frequent adverse events that are reported in hospitals. We examined the effectiveness of individualised falls-prevention education for patients, supported by training and feedback for staff, delivered as a ward-level programme.

METHODS

Eight rehabilitation units in general hospitals in Australia participated in this stepped-wedge, cluster-randomised study, undertaken during a 50 week period. Units were randomly assigned to intervention or control groups by use of computer-generated, random allocation sequences. We included patients admitted to the unit during the study with a Mini-Mental State Examination (MMSE) score of more than 23/30 to receive individualised education that was based on principles of changes in health behaviour from a trained health professional, in addition to usual care. We provided information about patients' goals, feedback about the ward environment, and perceived barriers to engagement in falls-prevention strategies to staff who were trained to support the uptake of strategies by patients. The coprimary outcome measures were patient rate of falls per 1000 patient-days and the proportion of patients who were fallers. All analyses were by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials registry, number ACTRN12612000877886).

FINDINGS

Between Jan 13, and Dec 27, 2013, 3606 patients were admitted to the eight units (n=1983 control period; n=1623 intervention period). There were fewer falls (n=196, 7·80/1000 patient-days vs n=380, 13·78/1000 patient-days, adjusted rate ratio 0·60 [robust 95% CI 0·42-0·94], p=0·003), injurious falls (n=66, 2·63/1000 patient-days vs 131, 4·75/1000 patient-days, 0·65 [robust 95% CI 0·42-0·88], p=0·006), and fallers (n=136 [8·38%] vs n=248 [12·51%] adjusted odds ratio 0·55 [robust 95% CI 0·38 to 0·81], p=0·003) in the intervention compared with the control group. There was no significant difference in length of stay (intervention median 11 days [IQR 7-19], control 10 days [6-18]).

INTERPRETATION

Individualised patient education programmes combined with training and feedback to staff added to usual care reduces the rates of falls and injurious falls in older patients in rehabilitation hospital-units.

FUNDING

State Health Research Advisory Council, Department of Health, Government of Western Australia.

Prospects and services for medical rehabilitation

In the developed world, comprehensive services for disabled patients are usually well established for children and elderly people. Services for rehabilitation of middle-aged patients generally consist of specific treatment facilities, such as for physiotherapy. On the other hand, a range of services of psychiatric patients is now established, with a model suitable for most disorders. Arrangements are flexible, ranging from crisis intervention to long-term care, in some places being remarkably comprehensive and well coordinated. There is a need to plan development of medical and social services for patients prone to chronic morbidity from whatever cause; this plan for the physicially disabled should take account of their many needs, and of the many facilities now available, some statutory, some voluntary. There is reason to believe that redeployment of resources existing in many countries could improve the standard of medical rehabilitation for patients of all ages.

Exploring professional development needs of educators in the health sciences professions

An increasing number of institutions of higher education are clustering their health sciences schools into a common unit. Therefore, it is imperative that the individual faculty development units assume new mandates to meet faculty development needs for stakeholders across these disciplines. Critical to providing current and relevant professional development activities is an awareness of the needs of academicians, including common as well as discipline-specific needs. Hence, the aim of this study was to explore the extent to which factors such as discipline, rank, gender, education, and years as an academician impact on perceived needs for faculty development. In February 2012, a cross-sectional survey of the perceived faculty development needs of academicians in the health sciences unit of a Canadian university was conducted using an online assessment tool. A total of 133 out of 1,409 potential participants completed the survey, for a response rate of 9.4%. The findings revealed more similarities than differences in terms of perceived faculty development needs. In addition, differences were found across all health professions schools and in factors such as discipline, academic rank, education, gender, and years as an academician. These findings suggest that faculty development and educational specialists should understand the shared as well as the unique needs of the individual health sciences schools in planning their professional development services.

How should we prepare rehabilitation sciences students to work with low English-proficient Spanish-speaking patients?

Misinterpretations or lack of compliance with national standards established to guide health professionals working with low-English-proficient (LEP) patients continue to negatively impact patient care. Most of the literature on training health professionals to work with interpreters focuses on physicians. We reviewed this current literature and propose an interprofessional educational module to extend the interpreter training to other health professions. Our module trains rehabilitation science students from different health disciplines (physical therapy, occupational therapy, and speech-language pathology) using strategies from the literature. The educational module is tailored to student's bilingual proficiency, suggests relevant outcomes measures, and highlights unanswered questions and areas for future research.

Analyzing international clinical education practices for Canadian rehabilitation students

BACKGROUND

Clinical training in low-income countries has become increasingly popular among pre-licensure trainees from high-income countries. The Working Group on Ethics Guidelines for Global Health Training ("WEIGHT Guidelines") were designed to identify and inform the complex and contentious field of international clinical education. The purpose of this study was to use the WEIGHT Guidelines to evaluate an international clinical internship programme for Master's-level rehabilitation students at a Canadian university.

METHODS

In-depth, semi-structured interviews were conducted with eight Canadian rehabilitation researchers, educations and/or clinicians responsible for administering international internships across three clinical training programmes. Interview questions were informed by the WEIGHT Guidelines. Directed content analysis was used to identify priorities for policy, practice and research.

RESULTS

Five themes relating to strengthening international clinical education were identified: (1) from one-time internships to long-term partnerships, (2) starting a discussion about "costs", (3) a more informed approach to student selection, (4) expanding and harmonizing pre-departure training across disciplines, and (5) investing in post-internship debriefing.

CONCLUSIONS

International clinical education is fraught with ethical, pedagogical and logistical issues that require recognition and ongoing management. This is the first study to use the WEIGHT Guidelines as a qualitative research tool for assessing an existing global health education programme. Results highlight new priorities for action at the Canadian "sending institution", including more explicit attention to the costs (broadly defined) borne by all parties. A crucial next step is deepened engagement with educational partners at the "receiving organizations" based in low-income countries to nurture dialogue regarding reciprocity, trust and sustainability of the partnership. Education research is also needed that evaluates models of pre-departure training and post-internship debriefing for trainees.

Using developmental research to design innovative knowledge translation technology for spinal cord injury in primary care: Actionable Nuggets™ on SkillScribe™

CONTEXT/OBJECTIVE

Actionable Nuggets™ for spinal cord injury (SCI) are a knowledge translation tool facilitating evidence-based primary care practice, originally developed in 2010 and refined in 2013. Evaluation results from these two phases of development have informed the design of SkillScribe™, an innovative electronic platform intended to offer reflective continuing medical education (CME) programming through mobile devices in order to support the key features of the Actionable Nuggets™ approach. This brief article describes the ongoing development of Actionable Nuggets™ for SCI on SkillScribe™ by: (1) summarizing the work to date on Actionable Nuggets™; (2) describing evaluation results of Actionable Nuggets™; (3) placing SkillScribe™ in the context of adult education.

DESIGN

Developmental Research Design.

SETTING

Canadian primary care.

PARTICIPANTS

Primary care physicians; specialist physicians.

INTERVENTIONS

Twenty educational modules on SCI.

OUTCOME MEASURES

Pre- and post-test knowledge survey, feedback and use statistics, impact assessment survey, qualitative analysis of evaluation data.

RESULTS

In both hard copy and electronic form, physicians report that Actionable Nuggets™ are an acceptable and useful approach to providing CME for low-prevalence, high-impact conditions like SCI. The key elements of this tool are that they: offer evidence-based information in small, focused "nuggets"; position information where physicians most frequently seek it; offer information in a format that permits direct translation into action in primary care; allow time for reflection; attach practice tools; and offer CME credit.

CONCLUSION

Actionable Nuggets™ for SCI, delivered using a convenient and portable electronic medium, with time-released content and interactive testing has the potential to improve the primary care of patients with SCI.

Final priority. Rehabilitation Training: Job-Driven Vocational Rehabilitation Technical Assistance Center. Final priority

The Assistant Secretary for Special Education and Rehabilitative Services announces a priority under the Rehabilitation Training program to establish a Job-Driven Vocational Rehabilitation Technical Assistance Center (JDVRTAC). The Assistant Secretary may use this priority for competitions in fiscal year (FY) 2014 and later years. We take this action to focus on training in an area of national need. Specifically, this priority responds to the Presidential Memorandum to Federal agencies directing them to take action to address job-driven training for the Nation's workers. The JDVRTAC will provide technical assistance (TA) to State vocational rehabilitation (VR) agencies to help them develop for individuals with disabilities training and employment opportunities that meet the needs of today's employers.

The case Conference Assessment Tool (cCAT): a new workplace-based assessment

Rehabilitation medicine is an educational, problem-solving specialty that relies on excellent team communication, honest discussion with patients and their families, and collaborative goal setting. The case conference has been described as the technology of rehabilitation medicine because it encompasses all of these functions. Trainees should have the opportunity to develop skills in chairing case conferences through receipt of constructive feedback on their performance from their trainers. The aim of this project was to develop and evaluate the case Conference Assessment Tool (cCAT), a workplace-based assessment designed to score a trainee's performance on the key elements of chairing a case conference. Experienced rehabilitation medicine educational supervisors participated in a training workshop and then rated a series of simulated case conferences using the cCAT. Internal consistency was high (Cronbach's α =: 0.945) and interrater reliability was acceptable (intraclass correlation coefficient range 0.673-0.777). Following feedback from the workshops, a final version of the cCAT was developed. The cCAT has now been adopted as a workplace-based assessment for specialty trainees in rehabilitation medicine by the Training Board of the Joint Royal Colleges of Physicians. Further work will explore its utility for trainees in other specialties and in communication and leadership skill training for undergraduate students.

Final priority; Rehabilitation Training: Rehabilitation Long-Term Training program--rehabilitation specialty areas. Final priority

The Assistant Secretary for Special Education and Rehabilitative Services announces a priority under the Rehabilitation Training: Rehabilitation Long-Term Training program. The Assistant Secretary may use this priority for competitions in fiscal year (FY) 2014 and later years in order to fund any of the rehabilitation specialty areas listed in this notice. The specific rehabilitation specialty areas to be funded in a given year will be listed in a notice inviting applications. This priority is designed to ensure that the Department funds high-quality rehabilitation programs in the following nine rehabilitation specialty areas of national need: Rehabilitation Administration (84.129C); Rehabilitation Technology (84.129E); Vocational Evaluation and Work Adjustment (84.129F); Rehabilitation of Individuals Who Are Mentally Ill (84.129H); Rehabilitation Psychology (84.129J); Rehabilitation of Individuals Who are Blind or Have Vision Impairments (84.129P); Rehabilitation of Individuals Who are Deaf or Hard of Hearing (84.129Q); Job Development and Job Placement Services (84.129R); and Comprehensive System of Personnel Development (84.129W). These programs must meet rigorous standards in order to provide rehabilitation professionals the training and qualifications necessary to meet the current challenges facing State vocational rehabilitation (VR) agencies and related agencies and assist individuals with disabilities in achieving high-quality employment outcomes.

Final priority; National Institute on Disability and Rehabilitation Research--Rehabilitation Research and Training Centers. Final priority

The Assistant Secretary for Special Education and Rehabilitative Services announces a priority under the Advanced Rehabilitation Research Training (ARRT) Program administered by the National Institute on Disability and Rehabilitation Research (NIDRR). Specifically, we announce a priority for an ARRT on Advanced Rehabilitation Research Policy Fellowship. The Assistant Secretary may use this priority for competitions in fiscal year (FY) 2014 and later years. We take this action to focus research attention on an area of national need. We intend the priority to strengthen the capacity of the disability and rehabilitation fields to train researchers to conduct advanced policy research in the areas of rehabilitation and disability.

Final priority; National Institute on Disability and Rehabilitation Research--Rehabilitation Research and Training Centers

The Assistant Secretary for Special Education and Rehabilitative Services announces a priority for the Rehabilitation Research and Training Center (RRTC) Program administered by the National Institute on Disability and Rehabilitation Research (NIDRR). Specifically, we announce a priority for an RRTC on Family Support. The Assistant Secretary may use this priority for competitions in fiscal year (FY) 2014 and later years. We take this action to focus research attention on an area of national need. We intend the priority to contribute to improved outcomes for individuals with disabilities and family members who provide assistance to them.

Final priority; National Institute on Disability and Rehabilitation Research--Rehabilitation Engineering Research Centers. Final priority

The Assistant Secretary for Special Education and Rehabilitative Services announces a priority under the Disability and Rehabilitation Research Projects and Centers Program administered by the National Institute on Disability and Rehabilitation Research (NIDRR). Specifically, we announce a priority for a Rehabilitation Engineering Research Center (RERC) on Improving the Accessibility, Usability, and Performance of Technology for Individuals who are Deaf or Hard of Hearing. The Assistant Secretary may use this priority for competitions in fiscal year (FY) 2014 and later years. We take this action to focus research attention on an area of national need. We intend the priority to contribute to improving the accessibility, usability, and performance of technology for individuals who are deaf or hard of hearing.

Final priority; National Institute on Disability and Rehabilitation Research--Rehabilitation and Research Training Centers. Final priority

The Assistant Secretary for Special Education and Rehabilitative Services announces a priority for the Rehabilitation Research and Training Center (RRTC) Program administered by the National Institute on Disability and Rehabilitation Research (NIDRR). Specifically, we announce a priority for an RRTC on Employment for Individuals with Intellectual and Developmental Disabilities. The Assistant Secretary may use this priority for competitions in fiscal year (FY) 2014 and later years. We take this action to focus research attention on areas of national need. We intend for this priority to contribute to improved employment outcomes of individuals with intellectual and developmental disabilities.

Final priority; National Institute on Disability and Rehabilitation Research--Rehabilitation Research and Training Centers. Final priority

The Assistant Secretary for Special Education and Rehabilitative Services announces a priority under the Rehabilitation Research and Training Center (RRTC) Program administered by the National Institute on Disability and Rehabilitation Research (NIDRR). Specifically, this notice announces a priority for an RRTC on Improving Employment Outcomes for Individuals with Psychiatric Disabilities. We take this action to focus research attention on an area of national need. We intend this priority to contribute to improved employment outcomes for individuals with psychiatric disabilities.

Determination of clinically relevant content for a musculoskeletal anatomy curriculum for physical medicine and rehabilitation residents

To address the need for more clinical anatomy training in residency education, many postgraduate programs have implemented structured anatomy courses into their curriculum. Consensus often does not exist on specific content and level of detail of the content that should be included in such curricula. This article describes the use of the Delphi method to identify clinically relevant content to incorporate in a musculoskeletal anatomy curriculum for Physical Medicine and Rehabilitation (PM&R) residents. A two round modified Delphi involving PM&R experts was used to establish the curricular content. The anatomical structures and clinical conditions presented to the expert group were compiled using multiple sources: clinical musculoskeletal anatomy cases from the PM&R residency program at the University of Toronto; consultation with PM&R experts; and textbooks. In each round, experts rated the importance of each curricular item to PM&R residency education using a five-point Likert scale. Internal consistency (Cronbach's alpha) was used to determine consensus at the end of each round and agreement scores were used as an outcome measure to determine the content to include in the curriculum. The overall internal consistency in both rounds was 0.99. A total of 37 physiatrists from across Canada participated and the overall response rate over two rounds was 97%. The initial curricular list consisted of 361 items. After the second iteration, the list was reduced by 44%. By using a national consensus method we were able to objectively determine the relevant anatomical structures and clinical musculoskeletal conditions important in daily PM&R practice.

Results of a field test and follow-up study of a restorative care training program

BACKGROUND

To implement restorative care in assisted living facilities, staff and administrators need to understand the philosophy and learn methods to help residents maintain optimal function.

OBJECTIVE

In this study, researchers investigated the use of a Web-based training program to improve the restorative care knowledge, attitudes, and practices of assisted living administrators and staff.

DESIGN

The study design was one group repeated measure to consider the impact of the training program on participant's knowledge of restorative care and restorative care techniques, attitudes toward restorative care, and self-reported practices.

PARTICIPANTS

Participants included 266 administrators and 203 direct care staff from assisted living facilities in eight states.

METHODS

Measurements were done at baseline (pretest), following the instruction (posttest), and one month later (follow-up).

RESULTS

Researchers found that participants (n=469) significantly improved their scores from pre- to posttest. In a follow-up study (n=244), over half of participants reported making changes at their facility as a result of the restorative care training. Most of the changes are related to care practices, such as an emphasis on encouraging, motivating, and offering positive feedback to residents.

CONCLUSIONS

Researchers concluded that there is a need for restorative care training for both administrators and staff of assisted living facilities. The study also demonstrates that a brief training session (2h or less) can bring about significant change in the learner's knowledge of facts, attitudes, and practices. It demonstrates that much of that change continues for at least 1 month after the training. It also demonstrates the loss of knowledge and points out the need for training to be followed up with continuing education and administrator encouragement. Furthermore, this study demonstrates that the Web is a feasible method of delivering restorative care training to assisted living facility administrators and staff.

VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Programs. Final rule

The Department of Veterans Affairs (VA) is amending its VA Health Professional Scholarship Program (HPSP) regulations. VA is also establishing regulations for a new program, the Visual Impairment and Orientation and Mobility Professional Scholarship Program (VIOMPSP). These regulations comply with and implement sections 302 and 603 of the Caregivers and Veterans Omnibus Health Services Act of 2010 (the 2010 Act). Section 302 of the 2010 Act established the VIOMPSP, which authorizes VA to provide financial assistance to certain students seeking a degree in visual impairment or orientation or mobility, in order to increase the supply of qualified blind rehabilitation specialists for VA and the United States. Section 603 of the 2010 Act reauthorized and modified HPSP, a program that provides scholarships for education or training in certain health care occupations.

Final priority; National Institute on Disability and Rehabilitation Research--Rehabilitation Research and Training Centers. Final priority

The Assistant Secretary for Special Education and Rehabilitative Services announces a priority for the Disability and Rehabilitation Research Projects and Centers Program administered by the National Institute on Disability and Rehabilitation Research (NIDRR). Specifically, we announce a priority for a Rehabilitation Research and Training Center (RRTC) on Community Living Policy. The Assistant Secretary may use this priority for competitions in fiscal year (FY) 2013 and later years. We take this action to focus research attention on areas of national need. We intend this priority to improve outcomes among individuals with disabilities.

Final priority; National Institute on Disability and Rehabilitation Research--Disability and Rehabilitation Projects and Centers Program--Rehabilitation Engineering Research Centers. Final priority

The Assistant Secretary for Special Education and Rehabilitative Services announces a priority for a Rehabilitation Engineering Research Center (RERC) on Technologies to Support Successful Aging with Disability under the Disability and Rehabilitation Research Projects and Centers Program administered by the National Institute on Disability and Rehabilitation Research (NIDRR). The Assistant Secretary may use this priority for a competition in fiscal year (FY) 2013 and later years. We take this action to focus research attention on areas of national need. We intend to use this priority to improve outcomes for individuals with disabilities.

Final priority; National Institute on Disability and Rehabilitation Research--Disability and Rehabilitation Research Projects and Centers Program--Rehabilitation Engineering Research Centers. Final priority

The Assistant Secretary for Special Education and Rehabilitative Services announces a priority for a Rehabilitation Engineering Research Center (RERC) on Universal Interfaces and Information Technology Access under the Disability and Rehabilitation Research Projects and Centers Program administered by the National Institute on Disability and Rehabilitation Research (NIDRR). The Assistant Secretary may use this priority for a competition in fiscal year (FY) 2013 and later years. We take this action to focus research attention on areas of national need. We intend to use this priority to improve outcomes for individuals with disabilities.