Background: Early detection and remediation of language disorders are important in helping children to establish appropriate communicative and social behaviour and acquire additional information about the world through the use of language. In the Netherlands, children with (a suspicion of) language disorders are referred to speech and hearing centres for multidisciplinary assessment. Reliable data are needed on the nature of language disorders, as well as the age and source of referral, and the effects of cultural and socioeconomic profiles of the population served in order to plan speech and language therapy service provision. Aims: To provide a detailed description of caseload characteristics of children referred with a possible language disorder by generating more understanding of factors that might influence early identification. Methods & Procedures: A database of 11,450 children was analysed consisting of data on children, aged 2–7 years (70% boys, 30% girls), visiting Dutch speech and hearing centres. The factors analysed were age of referral, ratio of boys to girls, mono‐ and bilingualism, nature of the language delay, and language profile of the children. Outcomes & Results:Results revealed an age bias in the referral of children with language disorders. On average, boys were referred 5 months earlier than girls, and monolingual children were referred 3 months earlier than bilingual children. In addition, bilingual children seemed to have more complex problems at referral than monolingual children. They more often had both a disorder in both receptive and expressive language, and a language disorder with additional (developmental) problems. Conclusions & Implications: This study revealed a bias in age of referral of young children with language disorders. The results implicate the need for objective language screening instruments and the need to increase the awareness of staff in primary child healthcare of red flags in language development of girls and multilingual children aiming at earlier identification of language disorders in these children.
DOCUMENT
Background: The maternity care system in the Netherlands is well known for its support of community-based midwifery. However, regular midwifery practices typically do not offer caseload midwifery care – one-to-one continuity of care throughout pregnancy and birth. Because we know very little about the outcomes for women receiving caseload care in the Netherlands, we compared caseload care with regular midwife-led care, looking at maternal and perinatal outcomes, including antenatal and intrapartum referrals to secondary (i.e., obstetrician-led) care. Methods: We selected 657 women in caseload care and 1954 matched controls (women in regular midwife-led care) from all women registered in the Dutch Perinatal Registry (Perined) who gave birth in 2015. To be eligible for selection the women had to be in midwife-led antenatal care beyond 28 gestational weeks. Each woman in caseload care was matched with three women in regular midwife-led care, using parity, maternal age, background (Dutch or non-Dutch) and region. These two cohorts were compared for referral rates, mode of birth, and other maternal and perinatal outcomes. Results: In caseload midwifery care, 46.9% of women were referred to obstetrician-led care (24.2% antenatally and 22.8% in the intrapartum period). In the matched cohort, 65.7% were referred (37.4% antenatally and 28.3% in the intrapartum period). In caseload care, 84.0% experienced a spontaneous vaginal birth versus 77.0% in regular midwife-led care. These patterns were observed for both nulliparous and multiparous women. Women in caseload care had fewer inductions of labour (13.2% vs 21.0%), more homebirths (39.4% vs 16.1%) and less perineal damage (intact perineum: 41.3% vs 28.2%). The incidence of perinatal mortality and a low Apgar score was low in both groups. Conclusions: We found that when compared to regular midwife-led care, caseload midwifery care in the Netherlands is associated with a lower referral rate to obstetrician-led care – both antenatally and in the intrapartum period – and a higher spontaneous vaginal birth rate, with similar perinatal safety. The challenge is to include this model as part of the current effort to improve the quality of Dutch maternity care, making caseload care available and affordable for more women.
DOCUMENT
Nieuwe wetgeving voor jeugdzorg in Nederland heeft geleid tot de implementatie van teams, die geïntegreerde eerstelijns jeugdzorg bieden. Belangrijke doelen van de nieuwe Jeugdwet waren meer geïntegreerde, tijdige zorg en minder gebruik van intensieve vormen van zorg. Het doel van dit onderzoek was het bestuderen van veranderingen in het gebruik van jeugdzorg in de tijd en de rol van nieuw ingevoerde wijkgerichte ondersteuningsteams hierin. Patronen van jeugdzorggebruik veranderden naar meer lokaal geleverde primaire jeugdzorg, iets minder gespecialiseerde en iets meer residentiële jeugdzorg. Bovendien nam het jeugdzorggebruik onder jongere kinderen toe in de tijd. Deze trends komen deels overeen met de trends die de Jeugdwet beoogt. Er is weinig bewijs gevonden voor de rol van specifieke teamkenmerken op veranderingen in jeugdzorggebruik in de tijd.
MULTIFILE
Organizations are struggling to choose from or combine the different business process management paradigms offered in today's BPM landscape, such as workflow management, dynamic case management and straight through processing. The field of declarative processes seems to be able to address this challenge by offering a unified approach to business process modeling, providing variable amounts of flow at execution time and different levels of autonomy to the actors based on models using a single formalism. The notion of declarativity in business processes seems to be ill defined and is often treated as a black and white distinction. However, a number of quite different formalisms have been developed that are broadly agreed to be declarative. This paper proposes a number of qualitative characteristics to characterize the declarative nature of process modeling formalisms. The characteristics are evaluated by applying them to a number of relevant process modeling formalisms, both imperative and declarative, and we discuss how these characteristics can be utilized to create business processes that offer activity flows that are known up front where needed, and allow ad hoc approaches to offer experts freedom and to support impediment driven approaches in an STP context.
DOCUMENT
Abstract Introduction: In 2017, the role of coordinating practitioner was introduced in the Netherlands in order to improve quality of care for patients who receive treatment in specialized mental health care. Psychiatric-mental health nurse practitioners (PMHNPs) can fulfil this role. Aim/Question: The aim was to obtain insight into how PMHNPs fulfil the coordinating practitioner role and what is needed to improve fulfilment of this role. Method: A survey among PMHNPs in the Netherlands was conducted between July-September 2018. In total, 381 PMHNP filled out the questionnaire; the response rate was 47.6%. Descriptive analyses were performed using SPSS 22® (IBM). Results: 92% Of the PMHNPs fulfilled the coordinating practitioner role and were generally satisfied with their role performance. The following conditions were formulated to improve this role: 1) recognition and trust in the expertise of PMHNPs, 2) a clear description of their role as coordinating practitioner, 3) strengthening multidisciplinary collaboration, and 4) sufficient training budget and opportunities. Discussion: In Dutch mental health care, PMHNPs have strengthened their position as coordinating practitioner in a short period of time. Follow-up research should be conducted to obtain further insights into elements that contribute to an optimal role as coordinating practitioner. Implications for Practice: Having PMHNPs act as coordinating practitioners can contribute to solving the challenges in mental health care regarding coordination of care and effective multidisciplinary collaboration.
DOCUMENT
An effective implementation approach is crucial for successful integration of structured risk assessment instruments into practice. This qualitative study explored barriers and facilitators to the implementation of the Short-Term Assessment of Risk and Treatability: Adolescent Version (START:AV) in a Dutch residential youth care service. Perceptions of staff members from various disciplines were gathered through focus group interviews at three consecutive occasions. After inductive coding of the interview extracts using thematic analysis, the identified codes were linked to the consolidated framework for implementation research. Through this framework, factors that influence an implementation project can be organized into multiple domains and constructs. In the present study, staff members described implementation barriers related to characteristics of the risk assessment instrument, staff, and the implementation process. In addition, features of the setting were frequently mentioned as hindering the implementation, such as hierarchy, culture, communication, as well as implementation climate and readiness for change. Staff members also identified multiple facilitators, such as experienced advantages of the START:AV compared to the previous risk assessment practice and positive beliefs about the instrument. The article concludes with recommendations for successful implementation of structured risk assessment instruments in forensic-clinical practice.
DOCUMENT
Background: Interprofessional collaboration in practice (IPCP) between professionals from the medical and social domain within primary care is desirable; however, it is also challenging due to fragmented healthcare. Little is known about the development of IPCP in primary care to fit the implementation context. is article describes the methodological development and the final content of an IPCP program. Methods and findings:e development process started with the identification of IPCP competencies in a literature review and a qualitative needs analysis with semi-structured interviews among eight elders and four healthcare professionals. e results were discussed during a first consultation with an expert team, which consisted of ten healthcare professionals. Consensus was reached on the themes role identity, communication, and shared vision development to form the basis of the program. A second consultation with the experts discussed the first version of the program. en, consensus was reached on the final version of the program, which included a blended learning approach consisting of two face-to-face meetings, online learning, and on-the-job learning with a sixteen-hour time investment over a six-week period. Conclusions: e IPCP program was developed based on educational strategies and evidence, and with the support and knowledge of practice experts to fit the implementation context.
DOCUMENT
Hoofdstuk 20 Part II in Understanding Penal Practice van Ioan Durnescu en Fergus McNeill Criminological and penological scholarship has in recent years explored how and why institutions and systems of punishment change – and how and why these changes differ in different contexts. Important though these analyses are, this book focuses not so much on the changing nature of institutions and systems, but rather the changing nature of penal practice and practitioners The first part of the book focuses on understanding practice and practitioners, exploring how changing social, cultural, political, and organisational contexts influence practice, and how training, development, professional socialisation and other factors influence practitioners. The second part is concerned with how practitioners can be best supported to develop the skills and approaches that seem most likely to generate positive impacts. It contains accounts of new practice models and approaches, as well as reports of research projects seeking both to discover and to encourage effective practices
MULTIFILE
Purpose: This case study is presented to inform the reader of potential speech, language, cognitive, and emotional characteristics in preadolescent cluttering. Method: This case study describes a 10-year-old boy who started to clutter during preadolescence. The case illustrates that, in some adolescents, cluttering can co-occur with temporary stuttering-like behavior. In this case, signs of disturbances in speech-language production associated with behavioral impulsiveness as a young child were noted. Speech, language, cognitive, and emotional results of the case are reported in detail. Results: The changes in fluency development are reported and discussed within the context of changes in the adolescent brain as well as adolescent cognitive and emotional development. While being unaware of their speech condition before adolescence, during preadolescence, the changes in brain organization lead to an increase in rate and a decrease in speech control. Given that the client had limited understanding of what was occurring, they were at risk of developing negative communication attitudes. Speech-language therapists are strongly advised to monitor children with cluttering signals in the early years of their adolescence.
DOCUMENT
