Gina Browne | McMaster University (original) (raw)
Papers by Gina Browne
The Journal of family practice, 1982
The Qualitative Report, 2014
A new group of medically fragile young adults are graduating from pediatric palliative care progr... more A new group of medically fragile young adults are graduating from pediatric palliative care programs with limited expectations to live beyond early adulthood, and no comparable adult services to support their complex needs. Accessing this population is difficult because of the complexity of their conditions, the extensive personal and equipment supports that limit feasibility for travel, and divergent communication abilities. Therefore, we undertook a descriptive case study using an asynchronous modification of an online focus group, a bulletin board focus group (BBFG). The greatest strengths of the BBFG are the appeal of this methodology for young adults and the multi day focus group becomes both a community and an intervention. An important limitation of this method was participant follow through on discussion threads. This BBFG provided rich and varied types of data, and very positive participant experiences.
International Journal of Integrated Care, 2008
Introduction: Interprofessional health and social service partnerships (IHSSP) are internationall... more Introduction: Interprofessional health and social service partnerships (IHSSP) are internationally acknowledged as integral for comprehensive chronic illness care. However, the evidence-base for partnership effectiveness is lacking. This paper aims to clarify partnership measurement issues, conceptualize IHSSP at the front-line staff level, and identify tools valid for group process measurement. Theory and methods: A systematic literature review utilizing three interrelated searches was conducted. Thematic analysis techniques were supported by NVivo 7 software. Complexity theory was used to guide the analysis, ground the new conceptualization and validate the selected measures. Other properties of the measures were critiqued using established criteria. Results: There is a need for a convergent view of what constitutes a partnership and its measurement. The salient attributes of IHSSP and their interorganizational context were described and grounded within complexity theory. Two measures were selected and validated for measurement of proximal group outcomes. Conclusion: This paper depicts a novel complexity theory-based conceptual model for IHSSP of front-line staff who provide chronic illness care. The conceptualization provides the underpinnings for a comprehensive evaluative framework for partnerships. Two partnership process measurement tools, the PSAT and TCI are valid for IHSSP process measurement with consideration of their strengths and limitations.
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières, 1996
This essay is about the factors that influence the making of judgements in science: the shadow an... more This essay is about the factors that influence the making of judgements in science: the shadow and the substance. We will review some studies that indicate the clear requirements of quality nursing research in order to examine outcomes and measures. The knowledge of methods assumes - and this is particularly true of quantitative traditions - objectivity or neutrality in the science of inquiry. The epistemological problem is that any process that generates and interprets outcome research is value-laden. Often left unexamined is the impact of the researcher's biases and values on the direction of the inquiry and the interpretation of findings. For example, we recently found that 45% of sole-supporting parents on welfare were depressed, as observed by the nurses. Our social scientist colleagues, from the same data set, noted, "Isn't it amazing that as many as 55% of sole-supporting parents on social assistance programs are not depressed?" Given the current emphasis on evidence-based nursing, who will raise questions concerning the impact of this value-laden evidence on practice, and on planning and policies, considering the nature and extent of our services? Is there such a thing as comprehensiveness in science? What we set out to quantitatively measure or qualitatively notice reflects our values and assumptions about important variables, mechanisms, pathways, and interactions. We find what we intend to notice, or indeed fail to find what we did not even know enough to notice. Do we ever consider measuring simultaneously (noticing) the opposite, or the unintended effects - the harms and risks - as well as the benefits and impacts? Is the glass half empty or half full? Is it short or tall? Are the contents 7-Up
Canadian family physician Médecin de famille canadien, 1995
To determine the prevalence of recognized and unrecognized health concerns and risks in an elderl... more To determine the prevalence of recognized and unrecognized health concerns and risks in an elderly population. Questionnaire survey. Institutional primary care practice in a small southern Ontario city. Volunteer sample of all patients older than 65 years (N = 1385) who were registered with the practice; were not demented, unstable, or residing in institutions at the time of contact; consented to participate; and completed a questionnaire (n = 674). Self-reported health concerns and health risks, including compliance with periodic health examinations; patient-generated concerns; and medical, lifestyle, and psychosocial issues. Most (92%) patients had at least one health concern or risk; 83% of these had one or more unreported or unrecognized health concerns or risks. The proportion with at least one concern or risk did not differ by sex or by age group. Many but not all complied with periodic health examinations. Loneliness was a meaningful psychosocial problem. Many patients had un...
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières, 1994
The characteristics and use of respite services of 64 caregivers of severely cognitively impaired... more The characteristics and use of respite services of 64 caregivers of severely cognitively impaired clients were correlated with the caregivers' purposes-in-life and burden outcome scores. Caregiver well-being was similar across users of a variety of respite service packages. Correlates of caregiver well-being, in spite of their burdens, were caregiver hardiness and favourable meaning given illness. Both of these cognitive variables exceeded the importance of perceived social support in explaining the variation in caregiver purpose-in-life.
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières, 1994
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières, 1994
Canadian journal of public health = Revue canadienne de santé publique
This study was designed to determine (1) the extent to which public health nursing visits and soc... more This study was designed to determine (1) the extent to which public health nursing visits and social services income programs serve the same population (shared clientele), (2) whether shared and unshared clientele differ in their characteristics, and (3) whether those who use both these services are high users of other health and social services. A computerized record linkage showed that 17% of individual public health nursing clients were shared with social services. Shared clientele had more social, perinatal, emotional and mental health problems. It is these characteristics, rather than the simultaneous use of both services, that were associated with more public health nursing visits, days in care, and use of all other health providers. The trend away from in-home nursing visits may create a situation of unmet need. While health and social resources are expended on persons with children with greater risk circumstances, the question remains about the efficacy and efficiency of thi...
Heart & lung : the journal of critical care, 1988
Various prevalence rates have been estimated for pulmonary complications after abdominal surgery,... more Various prevalence rates have been estimated for pulmonary complications after abdominal surgery, and fever has been thought to be a diagnostic indicator. This study quantifies the diagnostic accuracy of fever as a measure of postoperative pulmonary complications and includes the sensitivity, specificity, and positive and negative predictive values. Assessments using fever and chest x-ray film were determined for 270 patients after elective intra-abdominal surgery in three hospitals with six practicing surgeons in a Southern Ontario city. With use of reliable chest x-ray reports indicating lung pathologic findings as positive for pulmonary complication, the prevalence of a positive finding was 57%. The prevalence of a fever (temperature greater than or equal to 38 degrees C) was 40%. The sensitivity and negative predictive value of fever were slightly below 50%, and the specificity and positive predictive value of fever was 68% and 66% respectively. Fever was an accurate indicator o...
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières, 2009
The knowledge translation movement emphasizes implementing efficacious interventions in practice ... more The knowledge translation movement emphasizes implementing efficacious interventions in practice or using practice guidelines. However, a goal stated this way is demeaning of "usual care," has a flavour of superiority, and fails to acknowledge the value of "the way we do it now" for some people with particular characteristics. There is little wonder why some approaches to the implementation of efficacious interventions are met with resistance by frontline providers. I would like to offer some lessons learned from implementing random controlled trials of new practices compared to following usual or current care practices. Approach Approach refers to the style with which an investigator or clinician scientist goes about implementing or testing a new or best practice in a clinical setting. One successful approach to improving practice is to begin by having conversations with providers and managers in order to establish
Western Journal of Nursing Research, 1990
Medical Care, 1997
The purpose of this randomized controlled trial was to test the efficacy and effectiveness of pro... more The purpose of this randomized controlled trial was to test the efficacy and effectiveness of process consultation consisting of a series of nurse manager-consultant problem-solving meetings for leadership development that would lead to their staff's improved morale, quality of care, and reduced absenteeism. Thirteen consenting clinical inpatient units were stratified for four variables known to affect outcome and were then randomly assigned to treatment and control conditions. The nurse managers from the seven experimental units were paired with outside nurse consultants from the McMaster University School of Nursing (Hamilton, Ontario, Canada) in a cooperative form of retraining in problem-solving through process consultation. Morale was determined through measures of perceptions of the work environment, an attitude scale concerning work (alienation), a personality measure (hardiness), and one of each scale for work satisfaction and for sources of satisfaction and dissatisfaction. Demographic data and information regarding family life responsibilities were collected as well. Assessment of quality of care was determined by the frequency and type of incident reports and by patients' perception of their satisfaction. A ratio of absence hours to total paid hours of work was used to compare experimental and control units' absenteeism rates. Experimental subjects reported a statistically significant improvement in the characteristics of their work setting and in the quality of working relationships. The consultation process facilitated a perceived change in the organizational context of the experimental hospital units with less centralization of authority and more clarity about expectation. These organizational changes were accompanied by improved working relationships and less alienation from work. There was no statistically significant difference in absenteeism. However, a subanalysis of the units by "dose" of the intervention identified those who benefited from the effects of the consultation. Subjects whose nurse managers participated more actively in the consultation process accounted for the changes in working relationships and perceived organizational changes. The "low-dose" experimental subjects were more like the control subjects, with the exception of absenteeism, for which they had higher rates. The findings of this study suggest that process consultation can alter the staff's perceptions of the characteristics of the work setting, can reverse negative attitudes (alienation), and can create a more positive and supportive working environment (improved working relationship). However, the results suggest the need to target this type of intervention to managers who have the personal resources to engage in self-evaluation and personal development and thus to participate in the consultative process.
Journal of Advanced Nursing, 1999
Issues and innovations in nursing practice 448 Ó 1999 Blackwell Science Ltd to be substance or dr... more Issues and innovations in nursing practice 448 Ó 1999 Blackwell Science Ltd to be substance or drug abusers, received greater doses of chlorpromazineequivalent medications, and had longer lengths of hospital stay than their non-secluded cohorts. Two predictive regression equations were formulated on the basis of these results. This study has raised several questions for further prospective investigation, has validated previous ®ndings in the literature, and has produced new ®ndings that may be of interest to administrators and clinicians providing quality care to this high-risk population. Keywords: acute management of psychotic illness, impact of seclusion on treatment outcome, individuals with psychosis, in-patient treatment of psychosis, length of hospital stay, locked seclusion, nursing issues regarding locked seclusion, predictors of treatment outcome, psychiatric intensive care units, psycho-social predictors, quantitative nursing research
Evidence-Based Mental Health, 2002
QUESTION: Does feedback of results of routinely administered patient psychiatric questionnaires t... more QUESTION: Does feedback of results of routinely administered patient psychiatric questionnaires to clinicians improve the recognition, management, and outcomes of psychiatric disorders in non-psychiatric settings? Data sources
Canadian Oncology Nursing Journal, 2010
International Journal of Integrated Care, 2004
Purpose: This paper proposes both a model and a measure of human service integration through stra... more Purpose: This paper proposes both a model and a measure of human service integration through strategic alliances with autonomous services as one way to achieve comprehensive health and social services for target populations. Theory: Diverse theories of integrated service delivery and collaboration were combined reflecting integration along a continuum of care within a service sector, across service sectors and between public, not-for-profit and private sectors of financing services. Methods: A measure of human service integration is proposed and tested. The measure identifies the scope and depth of integration for each sector and service that make up a total service network. It captures in quantitative terms both intra and inter sectoral service integration. Results: Results are provided using the Human Service Measure in two networks of services involved in promoting Healthy Babies and Healthy Children known to have more and less integration. Conclusions: The instrument demonstrated discriminate validity with scores correctly distinguishing the two networks. The instrument does not correlate (rs0.13) with Weiss (2001) measure of partnership synergy confirming that it measures a distinct component of integration. Discussion: We recommend the combined use of the proposed measure and the Weiss (2001) measure to more completely capture the scope and depth of integration efforts as well as the nature of the functioning of a service program or network.
International Journal of Pediatrics, 2010
Purpose. To explore the interactions between child and parents psychosocial factors and team inte... more Purpose. To explore the interactions between child and parents psychosocial factors and team integration variables that may explain improvements in physical dimensions of the PEDS QL quality of life of children with complex needs after 2 years.Methods. In this 2-year study, parents were identified by the Children's Treatment Network. Families were eligible if the child was aged 0–19 years, had physical limitations, resided in either Simcoe County or the Region of York, Ontario, and there were multiple other family needs. Regression analysis used to explore associations and interactions;n=110.Results. A child's physical quality of life was affected by interacting factors including child's behavior, parenting, and integrated care. Statistically significant interactions between team integration, processes of care, and child/parent variables highlight the complexity of the rehabilitation approach in real-life situations.Conclusions. Rehabilitation providers working with chil...
International Journal of Pediatrics, 2010
Purpose. To determine the quality of life, associations, and costs of a multidiagnosis group of s... more Purpose. To determine the quality of life, associations, and costs of a multidiagnosis group of special needs children.Methods. In this cross-sectional survey families were identified from the Children's Treatment Network, a Canadian multisector program for children with special needs. Families were eligible if the child was aged 2–19 years, resided in Simcoe/York, and if there were multiple child/family needs. Quality of life was measured using the PedsQL (n=429).Results. Quality of life scores were lower in this group compared to published healthy and single disorder groups of children. Quality of life scores decreased with advancing age. Child psychosocial well-being was more strongly associated with child/family variables compared to physical well-being. Health Utilization costs were higher in children with greater physical challenges.Conclusions. Further research is needed in other complex needs child samples to confirm the decrease in quality of life found in these childre...
The Journal of family practice, 1982
The Qualitative Report, 2014
A new group of medically fragile young adults are graduating from pediatric palliative care progr... more A new group of medically fragile young adults are graduating from pediatric palliative care programs with limited expectations to live beyond early adulthood, and no comparable adult services to support their complex needs. Accessing this population is difficult because of the complexity of their conditions, the extensive personal and equipment supports that limit feasibility for travel, and divergent communication abilities. Therefore, we undertook a descriptive case study using an asynchronous modification of an online focus group, a bulletin board focus group (BBFG). The greatest strengths of the BBFG are the appeal of this methodology for young adults and the multi day focus group becomes both a community and an intervention. An important limitation of this method was participant follow through on discussion threads. This BBFG provided rich and varied types of data, and very positive participant experiences.
International Journal of Integrated Care, 2008
Introduction: Interprofessional health and social service partnerships (IHSSP) are internationall... more Introduction: Interprofessional health and social service partnerships (IHSSP) are internationally acknowledged as integral for comprehensive chronic illness care. However, the evidence-base for partnership effectiveness is lacking. This paper aims to clarify partnership measurement issues, conceptualize IHSSP at the front-line staff level, and identify tools valid for group process measurement. Theory and methods: A systematic literature review utilizing three interrelated searches was conducted. Thematic analysis techniques were supported by NVivo 7 software. Complexity theory was used to guide the analysis, ground the new conceptualization and validate the selected measures. Other properties of the measures were critiqued using established criteria. Results: There is a need for a convergent view of what constitutes a partnership and its measurement. The salient attributes of IHSSP and their interorganizational context were described and grounded within complexity theory. Two measures were selected and validated for measurement of proximal group outcomes. Conclusion: This paper depicts a novel complexity theory-based conceptual model for IHSSP of front-line staff who provide chronic illness care. The conceptualization provides the underpinnings for a comprehensive evaluative framework for partnerships. Two partnership process measurement tools, the PSAT and TCI are valid for IHSSP process measurement with consideration of their strengths and limitations.
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières, 1996
This essay is about the factors that influence the making of judgements in science: the shadow an... more This essay is about the factors that influence the making of judgements in science: the shadow and the substance. We will review some studies that indicate the clear requirements of quality nursing research in order to examine outcomes and measures. The knowledge of methods assumes - and this is particularly true of quantitative traditions - objectivity or neutrality in the science of inquiry. The epistemological problem is that any process that generates and interprets outcome research is value-laden. Often left unexamined is the impact of the researcher's biases and values on the direction of the inquiry and the interpretation of findings. For example, we recently found that 45% of sole-supporting parents on welfare were depressed, as observed by the nurses. Our social scientist colleagues, from the same data set, noted, "Isn't it amazing that as many as 55% of sole-supporting parents on social assistance programs are not depressed?" Given the current emphasis on evidence-based nursing, who will raise questions concerning the impact of this value-laden evidence on practice, and on planning and policies, considering the nature and extent of our services? Is there such a thing as comprehensiveness in science? What we set out to quantitatively measure or qualitatively notice reflects our values and assumptions about important variables, mechanisms, pathways, and interactions. We find what we intend to notice, or indeed fail to find what we did not even know enough to notice. Do we ever consider measuring simultaneously (noticing) the opposite, or the unintended effects - the harms and risks - as well as the benefits and impacts? Is the glass half empty or half full? Is it short or tall? Are the contents 7-Up
Canadian family physician Médecin de famille canadien, 1995
To determine the prevalence of recognized and unrecognized health concerns and risks in an elderl... more To determine the prevalence of recognized and unrecognized health concerns and risks in an elderly population. Questionnaire survey. Institutional primary care practice in a small southern Ontario city. Volunteer sample of all patients older than 65 years (N = 1385) who were registered with the practice; were not demented, unstable, or residing in institutions at the time of contact; consented to participate; and completed a questionnaire (n = 674). Self-reported health concerns and health risks, including compliance with periodic health examinations; patient-generated concerns; and medical, lifestyle, and psychosocial issues. Most (92%) patients had at least one health concern or risk; 83% of these had one or more unreported or unrecognized health concerns or risks. The proportion with at least one concern or risk did not differ by sex or by age group. Many but not all complied with periodic health examinations. Loneliness was a meaningful psychosocial problem. Many patients had un...
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières, 1994
The characteristics and use of respite services of 64 caregivers of severely cognitively impaired... more The characteristics and use of respite services of 64 caregivers of severely cognitively impaired clients were correlated with the caregivers' purposes-in-life and burden outcome scores. Caregiver well-being was similar across users of a variety of respite service packages. Correlates of caregiver well-being, in spite of their burdens, were caregiver hardiness and favourable meaning given illness. Both of these cognitive variables exceeded the importance of perceived social support in explaining the variation in caregiver purpose-in-life.
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières, 1994
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières, 1994
Canadian journal of public health = Revue canadienne de santé publique
This study was designed to determine (1) the extent to which public health nursing visits and soc... more This study was designed to determine (1) the extent to which public health nursing visits and social services income programs serve the same population (shared clientele), (2) whether shared and unshared clientele differ in their characteristics, and (3) whether those who use both these services are high users of other health and social services. A computerized record linkage showed that 17% of individual public health nursing clients were shared with social services. Shared clientele had more social, perinatal, emotional and mental health problems. It is these characteristics, rather than the simultaneous use of both services, that were associated with more public health nursing visits, days in care, and use of all other health providers. The trend away from in-home nursing visits may create a situation of unmet need. While health and social resources are expended on persons with children with greater risk circumstances, the question remains about the efficacy and efficiency of thi...
Heart & lung : the journal of critical care, 1988
Various prevalence rates have been estimated for pulmonary complications after abdominal surgery,... more Various prevalence rates have been estimated for pulmonary complications after abdominal surgery, and fever has been thought to be a diagnostic indicator. This study quantifies the diagnostic accuracy of fever as a measure of postoperative pulmonary complications and includes the sensitivity, specificity, and positive and negative predictive values. Assessments using fever and chest x-ray film were determined for 270 patients after elective intra-abdominal surgery in three hospitals with six practicing surgeons in a Southern Ontario city. With use of reliable chest x-ray reports indicating lung pathologic findings as positive for pulmonary complication, the prevalence of a positive finding was 57%. The prevalence of a fever (temperature greater than or equal to 38 degrees C) was 40%. The sensitivity and negative predictive value of fever were slightly below 50%, and the specificity and positive predictive value of fever was 68% and 66% respectively. Fever was an accurate indicator o...
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières, 2009
The knowledge translation movement emphasizes implementing efficacious interventions in practice ... more The knowledge translation movement emphasizes implementing efficacious interventions in practice or using practice guidelines. However, a goal stated this way is demeaning of "usual care," has a flavour of superiority, and fails to acknowledge the value of "the way we do it now" for some people with particular characteristics. There is little wonder why some approaches to the implementation of efficacious interventions are met with resistance by frontline providers. I would like to offer some lessons learned from implementing random controlled trials of new practices compared to following usual or current care practices. Approach Approach refers to the style with which an investigator or clinician scientist goes about implementing or testing a new or best practice in a clinical setting. One successful approach to improving practice is to begin by having conversations with providers and managers in order to establish
Western Journal of Nursing Research, 1990
Medical Care, 1997
The purpose of this randomized controlled trial was to test the efficacy and effectiveness of pro... more The purpose of this randomized controlled trial was to test the efficacy and effectiveness of process consultation consisting of a series of nurse manager-consultant problem-solving meetings for leadership development that would lead to their staff's improved morale, quality of care, and reduced absenteeism. Thirteen consenting clinical inpatient units were stratified for four variables known to affect outcome and were then randomly assigned to treatment and control conditions. The nurse managers from the seven experimental units were paired with outside nurse consultants from the McMaster University School of Nursing (Hamilton, Ontario, Canada) in a cooperative form of retraining in problem-solving through process consultation. Morale was determined through measures of perceptions of the work environment, an attitude scale concerning work (alienation), a personality measure (hardiness), and one of each scale for work satisfaction and for sources of satisfaction and dissatisfaction. Demographic data and information regarding family life responsibilities were collected as well. Assessment of quality of care was determined by the frequency and type of incident reports and by patients' perception of their satisfaction. A ratio of absence hours to total paid hours of work was used to compare experimental and control units' absenteeism rates. Experimental subjects reported a statistically significant improvement in the characteristics of their work setting and in the quality of working relationships. The consultation process facilitated a perceived change in the organizational context of the experimental hospital units with less centralization of authority and more clarity about expectation. These organizational changes were accompanied by improved working relationships and less alienation from work. There was no statistically significant difference in absenteeism. However, a subanalysis of the units by "dose" of the intervention identified those who benefited from the effects of the consultation. Subjects whose nurse managers participated more actively in the consultation process accounted for the changes in working relationships and perceived organizational changes. The "low-dose" experimental subjects were more like the control subjects, with the exception of absenteeism, for which they had higher rates. The findings of this study suggest that process consultation can alter the staff's perceptions of the characteristics of the work setting, can reverse negative attitudes (alienation), and can create a more positive and supportive working environment (improved working relationship). However, the results suggest the need to target this type of intervention to managers who have the personal resources to engage in self-evaluation and personal development and thus to participate in the consultative process.
Journal of Advanced Nursing, 1999
Issues and innovations in nursing practice 448 Ó 1999 Blackwell Science Ltd to be substance or dr... more Issues and innovations in nursing practice 448 Ó 1999 Blackwell Science Ltd to be substance or drug abusers, received greater doses of chlorpromazineequivalent medications, and had longer lengths of hospital stay than their non-secluded cohorts. Two predictive regression equations were formulated on the basis of these results. This study has raised several questions for further prospective investigation, has validated previous ®ndings in the literature, and has produced new ®ndings that may be of interest to administrators and clinicians providing quality care to this high-risk population. Keywords: acute management of psychotic illness, impact of seclusion on treatment outcome, individuals with psychosis, in-patient treatment of psychosis, length of hospital stay, locked seclusion, nursing issues regarding locked seclusion, predictors of treatment outcome, psychiatric intensive care units, psycho-social predictors, quantitative nursing research
Evidence-Based Mental Health, 2002
QUESTION: Does feedback of results of routinely administered patient psychiatric questionnaires t... more QUESTION: Does feedback of results of routinely administered patient psychiatric questionnaires to clinicians improve the recognition, management, and outcomes of psychiatric disorders in non-psychiatric settings? Data sources
Canadian Oncology Nursing Journal, 2010
International Journal of Integrated Care, 2004
Purpose: This paper proposes both a model and a measure of human service integration through stra... more Purpose: This paper proposes both a model and a measure of human service integration through strategic alliances with autonomous services as one way to achieve comprehensive health and social services for target populations. Theory: Diverse theories of integrated service delivery and collaboration were combined reflecting integration along a continuum of care within a service sector, across service sectors and between public, not-for-profit and private sectors of financing services. Methods: A measure of human service integration is proposed and tested. The measure identifies the scope and depth of integration for each sector and service that make up a total service network. It captures in quantitative terms both intra and inter sectoral service integration. Results: Results are provided using the Human Service Measure in two networks of services involved in promoting Healthy Babies and Healthy Children known to have more and less integration. Conclusions: The instrument demonstrated discriminate validity with scores correctly distinguishing the two networks. The instrument does not correlate (rs0.13) with Weiss (2001) measure of partnership synergy confirming that it measures a distinct component of integration. Discussion: We recommend the combined use of the proposed measure and the Weiss (2001) measure to more completely capture the scope and depth of integration efforts as well as the nature of the functioning of a service program or network.
International Journal of Pediatrics, 2010
Purpose. To explore the interactions between child and parents psychosocial factors and team inte... more Purpose. To explore the interactions between child and parents psychosocial factors and team integration variables that may explain improvements in physical dimensions of the PEDS QL quality of life of children with complex needs after 2 years.Methods. In this 2-year study, parents were identified by the Children's Treatment Network. Families were eligible if the child was aged 0–19 years, had physical limitations, resided in either Simcoe County or the Region of York, Ontario, and there were multiple other family needs. Regression analysis used to explore associations and interactions;n=110.Results. A child's physical quality of life was affected by interacting factors including child's behavior, parenting, and integrated care. Statistically significant interactions between team integration, processes of care, and child/parent variables highlight the complexity of the rehabilitation approach in real-life situations.Conclusions. Rehabilitation providers working with chil...
International Journal of Pediatrics, 2010
Purpose. To determine the quality of life, associations, and costs of a multidiagnosis group of s... more Purpose. To determine the quality of life, associations, and costs of a multidiagnosis group of special needs children.Methods. In this cross-sectional survey families were identified from the Children's Treatment Network, a Canadian multisector program for children with special needs. Families were eligible if the child was aged 2–19 years, resided in Simcoe/York, and if there were multiple child/family needs. Quality of life was measured using the PedsQL (n=429).Results. Quality of life scores were lower in this group compared to published healthy and single disorder groups of children. Quality of life scores decreased with advancing age. Child psychosocial well-being was more strongly associated with child/family variables compared to physical well-being. Health Utilization costs were higher in children with greater physical challenges.Conclusions. Further research is needed in other complex needs child samples to confirm the decrease in quality of life found in these childre...