PRISM :: Browsing by Author "Zwicker, Jennifer"

Browsing by Author "Zwicker, Jennifer"

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Open Access
A look at policy surrounding long-term neurorehabilitation for people with acquired brain injury in Alberta
(2018-09-11) Ryan, Shrianne; Zwicker, Jennifer
In Alberta, there is an inadequate amount of community and outpatient neurorehabilitation services available to support the growing number of individuals who suffer from acquired brain injury (ABI). ABI is an injury to the brain that is not hereditary, congenital, degenerative, or induced by birth trauma. Many individuals with ABI become dependent on costly health and social services, resulting in high-expenses for Alberta. Even though ABI is a growing concern for Alberta, no provincial policy strategy has been put in place to ensure Albertan’s get timely access to community and outpatient rehabilitation programs after being discharged from acute care and inpatient rehabilitation. Instead, many individuals either wait a long time before being admitted to important rehabilitation programs or they never receive treatment at all. A reason for a lack of policy can be attributed to how there is limited research in Alberta that looks at the overall benefits of community-based neurorehabilitation programs. Therefore, the overall policy recommendation is that the provincial government should establish a comprehensive and province-wide study that looks at the effectiveness and benefits associated with community neurorehabilitation programs in Alberta. To accomplish this study, Alberta should fund additional community neurorehabilitation programs to the ones already in existence so that more individuals with ABI can be included. The results of this study came from the analysis of data from a rehabilitation centre located in Alberta called the Association for the Rehabilitation of the Brain Injury (ARBI). The purpose of the analysis was to determine if there was an overall significant improvement for clients in terms of health outcomes and quality of life after undertaking community neurorehabilitation. In addition to improved health outcomes, cost of care based on place of residence at admission, discharge and follow-up was analyzed to determine if rehabilitation is a cost-effective solution to the growing ABI health crisis. First, the costs of care were determined by looking at the costs associated with four different residence categories including one’s own home, the hospital and two living support services under Alberta’s continuing care system for individuals with ABI. These living support services include personal care home (PCH) and long-term care (LTC). The costliest place of residence was determined to be the hospital, followed by LTC, PCH and own-home in that order. Depending on the severity of disability, individuals may need more support and thus reside in a more expensive place of residence, proving costly for Alberta. Next, the cost of care data was analyzed by comparing two different cases, case 1 and case 2. Case 1 represented client’s undergoing rehabilitation at ARBI and case 2 represented the situation where clients did not go to ARBI. First, the two cases were compared to see if there was statistical significance, and then the calculated difference between case 1 and case 2 was compared to the cost of rehabilitation at ARBI. The results of this study found there to be both a clinically significant and statistically significant improvement for client’s in different areas of impairment, suggesting that community neurorehabilitation positively improves health and social outcomes for individuals with ABI. Additionally, the cost of care results found there to be positive cost savings associated with undergoing rehabilitation at ARBI. The total cost of case 1 and case 2 was calculated to be $11,377,800 and $17,980,950.00, respectively for an overall cost savings of $6,603,150.00 or $194,210.29 per person over 65 months. When the cost of ARBI was added to case 1, there was still an overall cost savings of $5,637,550.00, or $165,810.29 per person over 65 months. Overall, the results of this study indicate that the Government of Alberta only needs to help a few individuals through neurorehabilitation programs like ARBI to experience substantial gains. Therefore, the overall policy recommendation is based on the results of this study, as well as from other research studies, that found community neurorehabilitation to be a critical next step in the recovery of individuals with ABI. Community neurorehabilitation is a multidisciplinary approach that combines specialized clinical and social supports to deliver an individualized and evidence-based pathway of care. ABI can have a lot of different negative impacts on an individual, and so a multidisciplinary approach is important. This study, along with other research has shown that timely access to equitable and intensive multidisciplinary neurorehabilitation services can improve patient outcomes and quality of life while also reducing an individual’s reliance on health and social services. Therefore, the overall policy recommendation is based on how Alberta needs to take more action to fully understand how to best help individuals with ABI while also reducing the burden on government health and social services.
Open Access
A multi-center, pragmatic, effectiveness-implementation (hybrid I) cluster randomized controlled trial to evaluate a child-oriented goal-setting approach in paediatric rehabilitation (the ENGAGE approach): a study protocol
(2022-06-29) Pritchard-Wiart, Lesley; Thompson-Hodgetts, Sandy; McKillop, Ashley B.; Rosychuk, Rhonda; Mrklas, Kelly; Zwaigenbaum, Lonnie; Zwicker, Jennifer; Andersen, John; King, Gillian; Firouzeh, Pegah
Abstract Background Child-oriented goal-setting in pediatric rehabilitation may improve child motivation, engagement in therapy, child outcomes related to therapy, and service delivery efficiency. The primary objective of this trial is to determine the effectiveness of a principles-driven, child-focused approach to goal-setting, Enhancing Child Engagement in Goal-Setting (ENGAGE), on pediatric rehabilitation outcomes compared to usual practice. The three secondary objectives are to 1) compare costs and secondary outcomes of the ENGAGE approach to usual practice, 2) determine the influence of child, parent and therapist characteristics on child engagement in therapy and rehabilitation outcomes, and 3) identify barriers and facilitators to the implementation of ENGAGE. Methods This research protocol describes a pragmatic, multi-site, cluster, effectiveness-implementation (hybrid type 1 design) randomized controlled trial. Therapists (n = 12 clusters of two therapists) at participating sites (n = 6) will be randomized to 1) the ENGAGE intervention group, or 2) usual care (control) using a computer-generated, permuted-block randomization sequence with site as a stratification variable designed by a statistician (RR). Each therapist will recruit four children 5–12 years old with neurodevelopmental conditions (n = 96), who will receive ENGAGE or usual care, according to therapist group allocation. ENGAGE therapists will be trained to use a 'toolbox' of evidence-driven, theory-informed principles to optimize child and parent motivation, engagement in the goal-setting process, and performance feedback strategies. Outcomes include goal performance (primary outcome), engagement in therapy, functional abilities, participation, and parent and child quality of life. Qualitative interviews with children, parents, ENGAGE therapists, and managers will explore challenges to implementation and potential mitigation strategies. Mixed effects multiple linear regression models will be developed for each outcome to assess group differences adjusted for clustering. A cost-effectiveness analysis will combine cost and a measure of effectiveness into an incremental cost-effectiveness ratio. Qualitative data on implementation will be analyzed inductively (thematic analysis) and deductively using established implementation science frameworks. Discussion This study will evaluate the effects of collaborative goal-setting in pediatric rehabilitation and inform effective implementation of child-focused goal-setting practices. Trial Registration NCT05017363 (registered August 23, 2021 on ClinicalTrials.gov).
Open Access
Academic, Political, and Community Engagement: Crafting Pandemic Preparedness Policies for Vulnerable Families
(2020-09-04) Kohek, Jessica Ann; Zwicker, Jennifer
To optimally support the health of families, interventions provided by community organizations must be evidence-based. Research attracts awareness to particular community issues; however, there is often a disconnect between research collection and subsequent translation into community-level policies. Evidence-based interventions may have proven efficiency, yet research rarely results in the political action necessary to translate interventions into community practices. When research does inform policies, and programs, the process can take decades. Implementation of evidence-based practices is necessary to mobilize research into practice and improve outcomes for families who rely on services. This project sought to identify the challenges community organizations face in accessing and providing evidence-based services, as these services promote optimal outcomes for families. COVID-19, as a focusing event, has highlighted pre-existing political, economic, and structural impediments to knowledge mobilization. The barriers and solutions proposed by participants in the research have pre-existed, but been exacerbated by, the context of a pandemic. Prior to conducting research, a literature review informed the need for increased support, communication, and funding for community organizations. The Nominal Group Technique (NGT) was used after the literature review was conducted to contextualize this need in Calgary. Five NGT groups were held over the course of two weeks to generate ideas surrounding barriers to evidence-based service provision throughout COVID-19, as well as solutions that have the potential to address aforementioned challenges. The three main barriers prioritized by participants included reduced revenue streams, transition to online service delivery, and inadequate communication and collaboration with government. Participants emphasized two solutions: person-centred policies and programs, and reciprocal collaboration. The literature and NGT groups result both support a need for cross-ministerial collaboration, community-based research partnerships, and engagement and consultation with community organizations. These findings are not novel or unique to COVID-19. Barriers mentioned preceded the pandemic, and solutions provided have continual impacts to support the health of families outside the context of a pandemic. Policy recommendations promote the priorities iterated by participants in the NGT groups. To address the barriers to evidence-based service provision throughout COVID-19, three policy options are recommended: (1) education and consultation with community organizations, (2) subsidy and grant provision for community-based research, and (3) formalizing a local network of researchers, community organizations, and policymakers. Next steps include validating the results of this study with an online Delphi and conducting a multijurisdictional environmental scan to determine best practices to support families with evidence-based service.
Open Access
Advancing Inclusive Policies for Children and Youth with Disabilities in Alberta
(2023-05-29) Vashist, Neha; Zwicker, Jennifer
The COVID-19 pandemic revealed significant gaps in disability-inclusive policy. Children and youth with disabilities encountered heightened difficulties due to barriers already in place at the onset of the pandemic. While policy responses to public health crises tend to offer "universal" measures, individuals with disabilities face intersecting vulnerabilities that require targeted attention. Policies in place before and during the pandemic failed to provide the necessary supports to navigate these challenges effectively. The pandemic revealed an urgent need for comprehensive and targeted disability policies that consider intersectional vulnerabilities, diverse healthcare needs, and barriers to access. This study aimed to explore how lessons learned from the pandemic can guide the creation of equitable policies that support children and youth with disabilities in Alberta. A virtual focus group was conducted using the Nominal Group Technique. Participants included youth with disabilities, families of children and youth with disabilities, and non-profit stakeholders. The goal of the focus group was to better understand the challenges and barriers that disabled children, youth, and their families faced during the pandemic to inform future inclusive disability-policy recommendations. Data gathered from the focus group was transcribed to text so that participant responses to policy recommendations could be effectively analyzed. Based on the focus group findings and current literature, the following policy recommendations are offered to policymakers in Alberta: 1. Recognize disability services as essential services to ensure continuous access. 2. Design fair and sustainable economic supports for parents/caregivers of children & youth with disabilities. 3. Co-design policy with relevant stakeholders, including children & youth with disabilities, their families, service providers, and community organizations. 4. Implement a flexible design for disability programs and healthcare services, prioritizing a patient-centric approach. 5. Reduce reliance on the education system to provide all types of services.
Open Access
Aging in Place and Aging in Grace: What Seniors In Alberta Really Want
(2023-05-29) Hodgson, Cayley; Zwicker, Jennifer
Home care for seniors in Alberta has been receiving growing public attention. There are many publicly funded longterm care facilities where clients can reside full-time and receive services as residents, but 77% of Canadians want to "age in place". Alberta budgeted $755.1 million for home care services in 2022, and increased the budget to $902.8 million in 2023. It is unclear exactly how this money is being spent, and even more unclear how this money may or may not be meeting the needs of disabled seniors in Alberta. The theoretical framework used as an underpinning for this analysis is critical gerontology as defined by Chong and Gu (2020). Critical gerontology is a way of understanding aging that recognizes aging as not only a physiological process but a socially defined and dynamic phenomenon. Based on the literature and the current policy landscape in Alberta, the report assesses 3 policy options to improve access to quality home care for disabled seniors: maintaining the status quo, increasing regulatory oversight of home care, and reducing the barriers to self-managed care. The analysis recommends that the Government of Alberta pursue reducing barriers to self-managed care for disabled seniors. Increasing access to guided, self-managed home care for seniors in Alberta would be the most effective use of home care budgetary provisions and would be the most feasible compromise between institutional desires and individual needs.
Embargo
Alternate Level of Care: Challenges and barriers for those who wait the longest
(2016-09) Cornez, MacNeil; Zwicker, Jennifer; Kneebone, Ronald
Each year numerous Albertans are admitted to a hospital but upon discharge are no longer able to return home, despite efforts to provide adequate support. Of these individuals who require continuing care services, some will have care needs exceeding the services that are able to be provided in available LTC beds. When the appropriate continuing care services are not available individuals admitted to acute care hospitals (but no longer requiring their services) continue to occupy a bed and are classified as requiring an “alternate level of care” or ALC. This creates inefficiencies in the utilization of acute care resources, has multiple impacts across the entire healthcare system, and most importantly prohibits patients from receiving the appropriate care in the appropriate setting. In Alberta, between 2012 and 2015, there were an average of 2,706,571 hospital bed days per year; ALC days accounted for 10% of all hospital days in 2012-13, increasing to 12.2% in 2014-15. For the Calgary zone specifically, 15.2% of all 2014-15 hospital days were classified as ALC days this translates into approximately 330,201 Alberta hospital days classified as ALC in 2014-15. This is a stark contrast from previous years; from 2006- 08 ALC days accounted for only 2.2% of all hospital days. This represents an increase of 10 percentage points, or five times as many ALC days in 2014-15 compared to 2006-2008.
Open Access
An implementation history of primary health care transformation: Alberta’s primary care networks and the people, time and culture of change
(2020-12-05) Leslie, Myles; Khayatzadeh-Mahani, Akram; Birdsell, Judy; Forest, P. G; Henderson, Rita; Gray, Robin P; Schraeder, Kyleigh; Seidel, Judy; Zwicker, Jennifer; Green, Lee A
Abstract Background Primary care, and its transformation into Primary Health Care (PHC), has become an area of intense policy interest around the world. As part of this trend Alberta, Canada, has implemented Primary Care Networks (PCNs). These are decentralized organizations, mandated with supporting the delivery of PHC, funded through capitation, and operating as partnerships between the province’s healthcare administration system and family physicians. This paper provides an implementation history of the PCNs, giving a detailed account of how people, time, and culture have interacted to implement bottom up, incremental change in a predominantly Fee-For-Service (FFS) environment. Methods Our implementation history is built out of an analysis of policy documents and qualitative interviews. We conducted an interpretive analysis of relevant policy documents (n = 20) published since the first PCN was established. We then grounded 12 semi-structured interviews in that initial policy analysis. These interviews explored 11 key stakeholders’ perceptions of PHC transformation in Alberta generally, and the formation and evolution of the PCNs specifically. The data from the policy review and the interviews were coded inductively, with participants checking our emerging analyses. Results Over time, the PCNs have shifted from an initial Frontier Era that emphasized local solutions to local problems and featured few rules, to a present Era of Accountability that features central demands for standardized measures, governance, and co-planning with other elements of the health system. Across both eras, the PCNs have been first and foremost instruments and supporters of family physician authority and autonomy. A core group of people emerged to create the PCNs and, over time, to develop a long-term Quality Improvement (QI) vision and governance plan for them as organizations. The continuing willingness of both these groups to work at understanding and aligning one another’s cultures to achieve the transformation towards PHC has been central to the PCNs’ survival and success. Conclusions Generalizable lessons from the implementation history of this emerging policy experiment include: The need for flexibility within a broad commitment to improving quality. The importance of time for individuals and organizations to learn about: quality improvement; one another’s cultures; and how best to support the transformation of a system while delivering care locally.
Open Access
Assessing Subjective Probabilities of Success in Autism Research
(2013-09) Zwicker, Jennifer; Emery, J.C. Herbert
Public investment in medical science and research is considered to be a legitimate and core role for government and charitable medical research foundations. It is not clear however, whether resource allocation in medical research has been cost-effective and equitable so that limited resources maximize the health benefits for the population served. Evidence based medicine relies on evaluation and comparative assessment of research findings. Accountability is a key aspect of this evaluation to ensure that taxpayers and charitable organizations are getting value for money in their investment and healthcare delivery benefits from the findings of medical research. In medical research there are informational asymmetries present between scientists, decision makers and the public. While research evaluation is based on a peer review process with scores given by a panel of expert reviewers, the current allocation ofresearch funding and determination of priorities is also affected by lobby efforts and public opinion. This means that the uneducated consumer demand from lobbyist groups could result in research with a greater probability of success or impact in the findings receiving less funding than the research that gets the greatest hype and publicity. Autism spectrum disorder (ASD) research is particularly lacking in this type of economic evaluation. This is of increasing importance, as over the past decade the reported prevalence of ASD has been increasing. The increase in prevalence is often cited as the primary justification for the large increase in research funding for ASD that has occurred in both the public and private sectors. What is not known, however, is whether enough funding is available for ASD research or whether the allocation of ASD research funding across various research areas is appropriate or efficient. Psychiatry
Open Access
Assessing the Relationship Between Health Research and Patient Outcomes: A Case Study in Stroke Research
(2017-08-15) Finlay, Brittany; Zwicker, Jennifer
Despite the significant presence of health research in Canada, the benefits of health research and its ability to impact patient outcomes is largely debated. While some assert that health research has little impact on patient outcomes, others indicate that health research can positively impact patient outcomes through a variety of different mechanisms. To date, little empirical work has been conducted on this subject. As such, the purpose of the present study is to gain a more comprehensive understanding of the nature of the relationship between health research and patient outcomes, and the possible mechanisms linking research and outcomes in the Canadian context. We will address this question in the form of a case study focusing on stroke research, as investments and advances in stroke research have increased in Canada in recent history. There are a number of policy issues associated with the field of stroke in Canada. Stroke is one of the leading causes of death, adult disability and hospitalization in Canada. Current estimates suggest that costs of stroke to the Canadian economy surpass $3.6 billion annually in physician services, hospital costs, lost wages and decreased productivity. Particularly concerning is the higher prevalence of stroke among the population above the age of 65, as the size of this age group is expected to increase in the next twenty years as a result of the aging population. This suggests that the aging population could result in a greater impact of stroke on Canadians in the coming years. Stroke patient outcomes also vary largely between Canadian provinces, creating the need to understand the factors that contribute to these differences. Given that stroke research activity varies between provinces, it is possible that stroke research could be one of these factors contributing to differences in patient outcomes. As such, our analysis will aim to explore the relationship between stroke research and stroke patient outcomes to deduce whether or not stroke research can impact outcomes. To guide the analysis, our study first compiled a brief literature review of studies that have investigated the relationship between health research and patient outcomes to date. The literature review indicated the necessity in using proxy measures for patient outcomes and research activity, given the inherent difficulties in measuring these variables directly. Additionally, most studies found that research activity had a positive impact on patient outcomes, and that a greater extent of research activity correlated with a greater improvement in patient outcomes. These results created the hypotheses for our analysis. The next part of our study involved the collection of stroke research funding and 30-day stroke in-hospital mortality rate data as proxy measures for research activity and patient outcomes. This data was collected for all Canadian provinces from the fiscal year of 2000-01 to 2014-15. Stroke research funding data were obtained from online databases from three federal funding agencies: the Canadian Institutes of Health Research, the Heart and Stroke Foundation and Natural Sciences and Engineering Research Council of Canada. A total of 1,455 projects were funded in Canada over the time period of the study, distributed among seven provinces. Mortality rate data were collected from the Canadian Institute for Health Information online indicator library. We then graphically represented compiled research funding and mortality rate data as trends over time for each Canadian province. Research funding was shown to have an overall increase over the study period, whereas mortality rates were shown to have an overall decline. The extent to which these changes occurred varied between provinces, creating difficulties in elucidating a specific relationship between research funding and mortality rates. Nonetheless, we proposed several mechanisms that may explain how research funding impacts mortality in this particular context, including the potential lack of an impact, the influence of the CSN as a research network, and attraction of specialized personnel that enhance stroke care. To add clarity to the specific nature of this relationship, we completed two regression analyses for provinces with at least one funded project per fiscal year for the duration of the study period. These provinces were Alberta, British Columbia, Ontario and Saskatchewan. We first completed a linear regression analysis for each province. Alberta and Saskatchewan exhibited a weak and non-significant positive association between research funding and mortality rate, whereas Ontario and British Columbia exhibited a strong and significant positive association. A fixedeffects linear regression including these four provinces was then completed, which allowed us to quantify the relationship between the two variables while accounting for inherent differences between provinces. This regression indicated a moderate and significant positive association between research funding and mortality rate for all four provinces. These analyses allowed us to conclude that to some extent, stroke research activity positively impacts stroke patient outcomes in Canada. Our results are an important first step in understanding the benefit to society in investing in health research. These types of analyses are important in guiding policy decisions regarding allocation of funding to research programs, as they can allow policy makers to strategically allocate research dollars towards fields of research that have a proven benefit to society. Our results also indicate research networks as a potential important tool in improving patient outcomes, creating a role for government in forming and facilitating these networks in various areas of health research. Moving forward, it is clear that the role of research should not be overlooked or undervalued in Canada anytime soon, and that additional work in this area is key to guiding policy and improving health of Canadians.
Open Access
Co-Creating the international Pediatric Oncology Exercise Guidelines (iPOEG) Toolkit with End-Users
(2021-07-16) McLaughlin, Emma; Culos-Reed, S. Nicole; Guilcher, Gregory; Zwicker, Jennifer; Laing, Catherine
The international Pediatric Oncology Exercise Guidelines (iPOEG) support movement among children and adolescents affected by cancer. Knowledge translation efforts are needed to ensure that those who will use and/or benefit from the iPOEG have access to it. This thesis used an integrated knowledge translation approach within the Knowledge to Action (KTA) Framework, to engage end-users (i.e., professionals and patients/families) to: (i) identify the types of resources needed, (ii) co-create resources and content, and (iii) co-create dissemination plans. End-users indicated requiring resources such as posters, infographics, social media posts, and videos, and co-created resource content covering quick tips to get active and movement-related education and information. End-users suggested disseminating the finalized resources (i.e., iPOEG Toolkits) using multiple modalities, including champions within each end-user group, education sessions, group discussions, emails, and social media. Co-creating the iPOEG Toolkit and dissemination plan represents an important phase within the KTA to promote the reach of the iPOEG.
Open Access
Developing Precision Health Innovation and Commercialization in Alberta: Establishing Governance Systems of Innovation
(2018-09-11) Scott, Craig; Zwicker, Jennifer
Precision health innovation and commercialization represents an opportunity for economic diversification and improved health quality for Albertans. Precision health ecosystem development requires specific governance strategies that extend beyond the field health because of the immense interdisciplinary characteristics it presents (social determinants, business development, computational technology, etc.). New technologies being developed have revolutionized the ability to provide care that is predictive, preventative, personalized and participatory. There is interest in expanding precision health as a technological subsector in this province by capitalizing on ongoing projects underway in Alberta and by creating high demand products/processes in a rapidly growing market, all while potentially improving domestic governmental concerns. The purpose of this project was to address and catalogue important aspects of governance throughout the ecosystem. Two models of innovation system governance were used as comparators to evaluate and frame discussions around this topic. Eleven interviews were conducted with leadership from three categories of ecosystem players, academia, government and industry. These interviews were semi-structured, so a breadth of questions could be asked about precision health innovation governance strengths and challenges. Thematic analysis was used to characterize certain themes that respondents indicated were important challenges to address. Key findings from the research were: • Coordination and collaboration amongst various precision health ecosystem players is suboptimal causing many downstream effects • Navigation between supporting organizations/entrepreneurs/companies is unclear and could be improved • Evaluation and data assets are a comparative strength in Alberta • Multidisciplinary collision needs to be facilitated at a larger scale • The wide variety of ecosystem organizational support is an considered an advantage • Data management and governance is unclear when considering broader health information (i.e. social determinants) • Governance around researcher autonomy divides academia and government • Procurement challenges and overall ecosystem player incentives are not always aligned • Political influence is a concern because it may distort policy decisions, long term planning and governance. Combining principles from the models of innovation governance with the respondent data from this project’s interviews generates interesting policy challenges. Governance is required in precision health to coordinate and dedicate resources to combining the wealth of organizational support within the innovation ecosystem. Presently, the Alberta precision health ecosystem has a notable deficiency in this type coordination of projects despite in some cases, strong governance structures for specific aspects such as health data governance. Based on these preliminary findings, it is recommended that a organizational entity is mandated to develop new or modify existing policy solutions relevant to the breadth of the outlined challenges of precision health for Alberta to capitalize on the upcoming opportunities in precision health. This responsibility can be assigned to an existing entity or to a new governing structure. Inaction could result in suboptimal output and no establishment of academic and industrial innovation.
Open Access
Early childhood services and outcomes for Albertan children with disabilities
(PolicyWise for Children & Families, 2019-07-19) Russell, Matthew; Zhang, Yunqi; Lamba, Navjot; Zwicker, Jennifer; Tough, Suzanne; Cui, Xinjie
Early support for children with disabilities is thought to be more impactful than later support. This report examined how preschool and kindergarten children (3 to 5 years old) with disabilities’ early service use related to their educational achievement and mental health service use outcomes. Analyses tested for differences in outcomes between children based on their special education disability type and severity and public service use patterns. This report found that (1) children with severe disability were more likely to be below educational expectations and to use mental health services as well as that these outcomes differed based on type of disability, and (2) non-educational and educational service use patterns predicted educational achievement and mental health service use. In addition, this report found that families in poorer neighbourhoods were less likely to use family disability supports when their child with a severe disability was not meeting educational expectations than families in richer neighbourhoods. These findings provide policy-relevant evidence that service providers can use to plan early services to support children with disabilities.
Open Access
Estimating costs and benefits associated with evidence-based violence prevention: Four case studies based on the Fourth R program
(The School of Public Policy, University of Calgary, 2017-05) Crooks, Claire V.; Zwicker, Jennifer; Wells, Lana; Hughes, Ray; Langlois, Amanda; Emery, J.C. Herb
Teen violence in dating and peer relationships has huge costs to society in numerous areas including health care, social services, the workforce and the justice system. Physical, psychological, and sexual abuse have long-lasting ramifications for the perpetrators as well as the victims, and for the families involved on both sides of that equation. An effective violence prevention program that is part of a school’s curriculum is beneficial not only for teaching teenagers what is appropriate behaviour in a relationship, but also for helping them break the cycle of violence which may have begun at home with their own maltreatment as children. The Fourth R program is an efficacious violence prevention program that was developed in Ontario and has been implemented in schools throughout Canada and the U.S. Covering relationship dynamics common to dating violence as well as substance abuse, peer violence and unsafe sex, the program can be adapted to different cultures and to same-sex relationships. The program, which gets its name from the traditional 3Rs — reading, ’riting and ’rithmetic — offers schools the opportunity to provide effective programming for teens to reduce the likelihood of them using relationship for violence as they move into adulthood. The federal government has estimated that the societal costs of relationship violence amount to more than $7 billion. These costs can continue to be incurred through the legal and health-care systems as the ripple effects of violence play out over the years, even after a relationship has ended. Other types of violence are also costly to society and not just in terms of dollars, but in young lives diverted into criminal activity. Up to 15 per cent of youth who become involved with the justice system grow into serious adult offenders who develop lengthy criminal careers. Yet, research shows that if prevention programs such as the Fourth R can deter just one 14-year-old high-risk juvenile from a life of crime, up to $5 million can be saved in costs to society.
Open Access
Exploring clinical decision-making in pediatric concussion and the impact of the COVID-19 pandemic
(2020-09-08) Grewal, Arman Singh; Zwicker, Jennifer
Concussions are a significant public health concern in Canada. The effective development and implementation of a pan-Canadian concussion strategy requires an understanding of the current state of concussion policies across the country. Given the recent COVID-19 pandemic, there is also an interest in the impact on clinicians, as well as facilitators and barriers to the remote management of concussion. This project focuses on Ontario, British Columbia, and Alberta. These three provinces have taken different approaches to concussion management. Ontario is the only province in Canada with concussion specific legislation. British Columbia’s approach to concussion policy involves the development of clinical guidelines to assist in awareness and management of concussion. Alberta’s approach involves the development of a provincial concussion strategy to support families, children, and clinicians managing concussion. At the onset of the COVID-19 pandemic, Ontario had a provincial telehealth network, while Alberta initially did not allow for virtual care. British Columbia had a hybrid model, with limited telehealth services. These initial differences impacted how clinicians’ managed concussion during the COVID-19 pandemic. The purpose of this project is to explore factors that guide how healthcare professionals manage pediatric concussion, understand perspectives of recent clinical practice guidelines and resulting changes in practice, and to explore the impact of the COVID-19 pandemic on healthcare practices, including the provision of remote telehealth/telerehab services. Eighteen interviews were conducted with physiotherapists, occupational therapists, and physicians from Ontario, Alberta, and British Columbia. Interviews were thematically analyzed and organized to identify common challenges. This study identified multiple key findings. Clinicians are playing a more active role in managing patients’ concussions, however there is a lack of harmonization in concussion management both across Canada and provincially. Although clinicians were unaware if a pan-Canadian concussion strategy current exists, the 5th Consensus Statement on Concussion in Sport, the Ontario Neurotrauma Foundation Living Guidelines, and Parachute resources, were identified as the most used resources, respectively. Concussion awareness has increased over recent years due to the Internet, media, and movies, but in some instances, this awareness is excessive and may result in hyperawareness of concussion. Waitlists and outdated or incorrect advice have been identified as challenges to effective and timely concussion care. Barriers to remote care include a lack of existing remote care infrastructure and poor technology and internet connection. Facilitators to remote care include changes to billing practices and better virtual platforms. Participants with pre-existing remote care experienced less disruption during the COVID-19 pandemic.
Open Access
Exploring Paramedic Perspectives on Emergency Medical Service (EMS) Delivery in Alberta: A Qualitative Study
(2023-11-16) Newton, Janna; Zwicker, Jennifer
This project aims to understand the factors contributing to long response times and the poor working environment but also to offer policy solutions. As Alberta is undergoing a substantial restructuring of the EMS system by Alberta Health and AHS, it is crucial that frontline paramedics are heard, and their concerns addressed regarding implemented policies. Nineteen paramedics were interviewed from across Alberta to bring attention to the frontline perspective, which can’t be captured with quantitative data. Participants were asked explicitly about response times, Emergency Department (ED) offloading and staffing. Interviews underwent thematic analysis and coded to understand issues and proposed solutions.
Open Access
Exploring paramedic perspectives on emergency medical service (EMS) delivery in Alberta: a qualitative study
(2024-04-16) Newton, Janna; Carpenter, Travis; Zwicker, Jennifer
Abstract Purpose Emergency Medical Services (EMS) in Alberta are facing critical challenges. This qualitative study aims to describe and understand the frontline perspective regarding system level issues and propose provider-informed policy recommendations. Methods 19 semi-structured one-on- one interviews were conducted with Primary or Advanced Care Paramedics (PCP/ACP) across Alberta. Participants were asked to share their perspectives, experiences and recommendations in relation to EMS response times and the working environment. Interviews were analyzed using thematic analysis to identify themes and subthemes. Results Two core themes were identified as areas of concern: poor response times and the EMS working environment, which each influence and impact the other. Within response times, paramedics highlighted specific difficulties with ED offloading, a lack of resources, low-acuity calls, and rural challenges. In terms of the EMS working environment, four subthemes were apparent including attrition, unhealthy culture, organizational barriers and the need for paramedic empowerment. Providers made many recommendations including creating and expanding emergency mobile integrated health (MIH) branches, sharing 811 and 911 responses, and enforcing ED target offload times amongst other suggestions. Conclusions While response times are a key and highly visible problem, there are many critical factors like the EMS working environment that degrade patient care and cause concern amongst frontline practitioners. Multifaceted policy changes are to be explored to reduce disfunction within EMS services, enhance the well-being of the workforce and deliver improved patient care. Specific EMS-oriented policies are important for moving forward to reduce transfers to EDs, but the broader health system which is over capacity is causing downstream effects into EMS must be addressed by government and health administrators.
Open Access
Exploring strategies on how the Government of Alberta could best engage community organizations to co-design pandemic-related policies and interventions for persons with disabilities.
(2020-09-09) Seth, Ashish; Zwicker, Jennifer
Persons with disabilities and their families are disproportionately impacted by the COVID-19 pandemic and the policy measures adopted in response. Given the increased risk for this vulnerable population group, the governments must engage stakeholders like community organizations and families of persons with disabilities to plan and co-design pandemic response plans. Harnessing experiential knowledge of and fostering collaboration with such stakeholders could aim in transforming services in crucial areas like health, where emergency policies and programs are organized around the needs of persons with disabilities. Initiatives that enhance civil society participation in designing policies and programs create a more transparent and responsive government and improve government programs' buy-in. Unfortunately, there is inadequate data collection and insufficient emergency preparedness planning and response for people with disabilities. The goal of this research was to identify the critical barriers from the government perspective while exploring best engagement strategies for co-designing rapid policy responses during the COVID-19 outbreak in Alberta. Twelve qualitative interviews with key decision-makers from provincial, municipal governments and disability advisory groups’ members were conducted. Using semi-structured interviews, the participants were asked open-ended questions on key thematic areas to address the research objective. Key findings from the research highlighted the participants’ viewpoints on barriers, aspects and preferences, which are the critical approaches through which the Government of Alberta engages with community organizations. First, health emergency policy responses need to view disability and poverty as interconnected factors to improve the overall quality of life for persons with disabilities. Findings also highlighted that top-down and tokenistic consultation approaches further limit the disability community's engagement in co-designing pandemic planning and response. Furthermore, inaccessible ways of consultation and navigation barriers exacerbate the impediments to a holistic co-design process. Findings also revealed that communication of pandemic information in accessible formats and tools is the most preferred co-design aspect to engage community organizations in developing a pandemic response. On the other hand, stakeholders' engagement in the government’s data surveillance efforts was unclear, and the overarching process of impact assessment needs to be strengthened. The research found that the COVID-19 disability group and the advisory council's presence at the federal and provincial levels is a robust mechanism that connects communities with the government. However, the process of influencing government decision making and policy actions needs to be openly communicated. The research recommends that governments transition from traditional consultative approaches to innovative engagement practices while sharing information on how public policies reflect communities’ input. Decision-makers are further recommended to make financial investments to include priorities of persons with disabilities in the pandemic planning and response. The decision-makers should also formally engage stakeholders like community organizations to co-design communication aspects of the pandemic response plan, along with the monitoring and evaluation of the plan. Medical or cultural barriers pose challenges for persons with disabilities to participate in co-designing policies. Further research is required to explore how families of persons with disabilities could be engaged to co-design public policies and interventions.
Embargo
Family Planning and Healthcare Provider Practice Patterns in Alberta: Are They Aligned With the Ready
(2017-09-14) Paul, Dhwani; Paul, Dhwani; Zwicker, Jennifer
Prenatal care is characterized by the delivery of education and services related to the health of mothers and babies. It is comprised of preconception care and family planning education that includes consultations on methods of birth control, lifestyle choices, nutrition, medical checkups as well as substance abuse (Public Health Agency of Canada, 2011). The seeking of prenatal care is not mandatory in Canada. However, regulatory bodies governed under the Health Professions Act (Government of Alberta, 2017a; 2017b) such as the Alberta College of Family Physicians (ACFP), College of Physicians and Surgeons of Alberta (CPSA), Society of Obstetricians and Gynaecologists of Canada (SOGC) and College of Midwives of Alberta (CMA) mandate the delivery of prenatal care through designated healthcare professionals, including medical doctors and registered midwives (Alberta College of Family Physicians, 2017; The College of Physicians and Surgeons of Alberta, 2017; Society of Obstetricians and Gynaecologists of Canada, 2017; College of Midwives of Alberta, 2017). The number of unplanned pregnancies in Canada remains high and the expectation of receiving prenatal care, regardless of the type of healthcare provider chosen, is unmet (Alberta Health Services, 2017a). The different focus in the scope of practice between healthcare professionals can result in differences in the prenatal education and care received. There are considerable policy implications for the differences in the delivery of health information pertaining to prenatal care in Alberta. The development of harmful behaviours as a result of a poor understanding of social determinants of health, pregnancy outcomes and child development can lead to pregnancy-related complications and an overall unhealthy population. To offer more comprehensive and consistent prenatal education to Albertans, the province launched a novel family planning and pregnancy preparedness campaign, Ready or Not, designed to provide pertinent information through an Internet-based platform (Alberta Health Services, 2017a). Funded by the Government of Alberta and delivered by Alberta Health Services (AHS), this initiative represents a diversity of partnerships involved in the service provision pertaining to prenatal health and family planning (Alberta Health Services, 2017a). Though medical doctors contributed towards the development of this campaign, their respective governing bodies may not have been directly involved (Alberta Health Services, 2017a), which can trigger discrepancies in the care provided. As such, the following capstone research study seeks to understand family planning and healthcare provider practice patterns in Alberta. Specifically, it investigates whether or not the delivery of prenatal education is consistent with the Ready or Not provincial campaign (Alberta Health Services, 2017a). This study renders important insights on the implicit and explicit decision-making process of selecting a healthcare provider for prenatal care, namely medical doctors or registered midwives, as well as the receipt of prenatal education by women in this province. Statistical analysis was conducted using the Secondary Analysis to Generate Evidence (SAGE) virtual environment analytics platform (PolicyWise for Children & Families, 2017). This studyused the All Our Babies (AOB) data (Tough et al., 2017)), which is a prospective pregnancy and birth cohort (n=3387) of Calgarian women aged 19 to 47 years (Tough et al., 2017). To better understand the connection between healthcare practitioners and the prenatal advice provided, key questions were addressed. First, the study investigated the association between the time to get pregnant and receipt of information about pregnancy planning from a healthcare provider, and the type of birth control and family planning practices used prior to becoming pregnant. Next the study examined the association between the type of healthcare provider consulted during pregnancy (medical doctor or midwife) and the prenatal education received by women in relation to the guidelines established by the Ready or Not provincial policy campaign. Third, this study explored the likelihood of receiving prenatal advice and education aligned with the Ready or Not campaign from specific types of healthcare providers (Alberta Health Services, 2017a). Demographic characteristics such as the total time spent in Canada, educational attainment, ethnicity, total income and parity impacted whether or not women received information about pregnancy planning, birth control and family planning practices prior to becoming pregnant. Nearly all the women sought care from a medical doctor as opposed to a registered midwife, and the care delivered differed between these two types of professionals. A statistically significant association was also observed between receiving information about pregnancy planning as well as the use of certain birth control and family planning practices. Women who consulted with a midwife rather than a medical doctor, on average, were more likely to receive information on nutrition, taking vitamins or mineral supplements, exercise or active living and working during pregnancy. However, those who saw a medical doctor were generally less likely to experience difficulty obtaining prenatal care (Alberta Health, 2017a). Furthermore, the differences in the scope of practice between these professionals can contribute towards variations in the delivery of prenatal care education in the province. As such, it is important to ensure that the policies in place mirror the guidelines in Ready or Not and improve the reality of prenatal care education in the province. The differences in the delivery of prenatal education requires efforts to guarantee proper preconception care in the province. Since the AOB cohort was recruited between 2008 and 2011 (Tough et al., 2013) and Ready or Not was instated in 2016 (Alberta Health Services, 2017a), the findings of this capstone project may not necessarily be representative of the current patterns in the delivery of prenatal education in Alberta. However, the recommendation for stakeholders to collaborate and develop a checklist that is to be used province-wide by relevant healthcare professionals will encourage that the guidelines in Ready or Not (Alberta Health Services, 2017a) are addressed. Furthermore, these partnerships will allow for respective licensing bodies to become more aware of the knowledge provided in this new campaign, thereby fostering the delivery of a comprehensive and consistent prenatal care education in the province.
Open Access
Going Through the Motions: Policy Considerations for Addressing Mental Health-Related Worker Presenteeism in Canada
(2022) Izegbu, Ogem; Zwicker, Jennifer
As mental illnesses in Canada have become more prevalent, a deeper examination of some key issues is required. One significant concern related to mental health is that it gives way to presenteeism – the phenomenon of employees being physically present at work but performing below capacity due to illness. This leaves workers experiencing worsened mental health outcomes and costs employers billions of dollars in lost productivity. The policy environment post COVID-19 has focused attention on mental illness as a disability and reviewing access to relevant programs that can be accessed to alleviate the financial concerns and health insecurities of people with mental illnesses. This project uses the United Nations Convention of the Rights of Persons with Disabilities (CRPD) as a guiding framework to explore alignment between rights based commitments and the current landscape of workplace disability benefit programs in Canada geared towards providing income support for people needing to take time away from work due to mental illnesses. It evaluates those programs and in doing so, isolates some potentially beneficial policy considerations that could be used in the reform of existing programs or the implementation of new ones that could address mental health-related presenteeism in Canada.
Open Access
Implementing Sexual Education for Individuals with Autism Spectrum Disorder within Alberta’s Public Education System
(2019-09-05) Lau, Ai; Zwicker, Jennifer
Sexuality and the sexual rights of individuals with Autism Spectrum Disorder (ASD) have long been discredited and ignored. However, individuals with ASD are sexual beings as made evident through advocacy, academic literature, and research. Individuals with ASD experience challenges with social interactions that often become more pronounced as their sexuality develops which could lead to potential negative consequences such as social isolation or stigmatization. Proponents of sexual education for individuals with ASD underscore the positive role sexual education has through puberty and adolescence. Sexual education could help to establish critical social skills that are transferable into adulthood and the healthy development of sexuality. Canada is a signatory to the UN Convention on the Rights of Persons with Disabilities which outlines the necessity of equal access to sexual and reproductive health care and services for people with disabilities. In Alberta’s Guide to Education, the Human Sexuality Education policy states that all students from grades 4 to 12 are to receive sexual education as part of their public education curriculum. However, many individuals with ASD continue to experience significant barriers to accessing sexual education within Alberta’s public education system. The implementation of the Human Sexuality Education policy has yet to be consistent for all individuals within Alberta’s public education system, specifically for the ASD populace. Many individuals with ASD received no sexual education throughout their schooling. The objective of this project was to review the experiences of individuals with ASD and identify present barriers to sexual education within Alberta’s public education system. A literature review was conducted to provide information and context regarding the intersectionality of sexuality and ASD and barriers to implementing sexual education. Key informant interviews were used to assess and provide feedback on key findings from the literature while providing insights from an Albertan context. These key informant interviews consisted of a sample of sexual health educators who specialize in providing sexual education curriculum to individuals with disabilities, including ASD. Findings from the literature and research support the importance of sexual education for individuals with ASD. Identified issues related to the experience of sexuality by individuals with ASD includes challenges in understanding boundaries and a lack of sexual knowledge. Individuals with ASD do express desires to find romantic partners and to develop sexuality in a healthy fashion. However, individuals with ASD are often deprived of learning opportunities to support the development of healthy sexuality. Promoting the development of healthy sexuality can lead to improvement in quality of life and self-determination in adolescence and adulthood. Barriers to sexual education for individuals with ASD continue to be persistent within Alberta’s public education system. Negative assumptions and stereotypes of the sexuality of individuals with ASD pose a significant barrier to sexual education. Additionally, educators report low levels of comfort and confidence in providing sexual education within the classroom and often lack an accountability measure to ensure the consistentdosi implementation of sexual education. However, there has been a significant increase in demand for sexual education for individuals with ASD in recent years, signifying a growing priority and shift in attitudes for sexual education for individuals with ASD. To address the implementation challenges of Alberta’s Human Sexuality Education policy, three recommendations are outlined: (1) a formal assessment of sexual knowledge of individuals with ASD; (2) increasing funding to existing organizations; and, (3) mandating specific professional development content for educators. Future considerations include adapting sexual education curriculum to meet the learning needs of the ASD population and the development of an accountability framework for educators. Ensuring consistent implementation of sexual education will help to support the healthy development of sexuality and foster inclusion for individuals with ASD.