Through voluntary or forced migration, families enter the United States as refugees, asylum seeke... more Through voluntary or forced migration, families enter the United States as refugees, asylum seekers, documented or undocumented immigrants, students or temporary or skilled workers. They bring children or give birth to children who become citizens by virtue of having been born in the new homeland. Inevitably, some of these families will interact with public child welfare systems. Children are placed in foster care when parents die, are incarcerated, institutionalised, or abandon or neglect their children. When evaluating placement decisions for these children, child welfare workers usually overlook the resources of family members outside of the country. Grandparents and other close kin often have the ability and motivation to provide care for vulnerable relative children. Through case description and summary of domestic laws and international conventions, Dana Naughton and Kerry L Fay identify challenges to cross-border placements and make recommendations for further research and co...
Each year, thousands of children who cross international borders are destined for homes with adop... more Each year, thousands of children who cross international borders are destined for homes with adoptive families. For most, this journey from their homeland brings them to loving new homes where they will thrive and prosper. For others, the journey is hazardous and the destination uncertain.
This paper argues for a need to expand investigation of transformative learning theory to include... more This paper argues for a need to expand investigation of transformative learning theory to include consideration of transformative learning processes, practices and outcomes that do not follow a 'positive' direction but traverse a wide band of possibilities.
Opportunities to study and practice health-related professions internationally offer transformati... more Opportunities to study and practice health-related professions internationally offer transformative benefits for patients, educators, and students. Institutions and educators should model ethical behavior and set examples for global health trainees. Toward this end, it is imperative that universities engaging in international immersion experiences ensure that principles of respect, beneficence, and justice are upheld. Case A medical school in the United States has recently started advertising what it calls a "global health immersion" program to prospective applicants. The program partners with a free clinic in a South American country and is tremendously popular, often regarded by students as one of the best experiences of their medical school careers and as one of the College of Medicine's best experiential learning offerings.
This paper explores the international adoption experience of Dutch and Canadian adopters of U.S. ... more This paper explores the international adoption experience of Dutch and Canadian adopters of U.S. born children through the lens of adult learning, adult education and lifelong learning. I think also because we are more interested in background [U.S. history] and how things workhealthcare, the school system. I want to stay updated on what happens there and what’s happened in the past. I have looked over African American [literature], we did know about the slavery and the cotton fields and Uncle Tom’s story and stuff like that, but now you look through it with other eyes. You see it differently. (Dutch adoptive parent of U.S. African American child) Problem Statement and Study Purpose Renowned as a receiving country of international adoptees, the United States is, paradoxically, sought out by foreign families as a source of adoptable children. Over the last decade, approximately 1,500 children, mostly minority infants, have been placed in Canada, the Netherlands, Switzerland, and nume...
PURPOSE The current model of primary care in the United States limits physicians' ability to offe... more PURPOSE The current model of primary care in the United States limits physicians' ability to offer high-quality care. The patient-centered medical home (PCMH) shows promise in addressing provision of high-quality care, but achieving a PCMH practice model often requires comprehensive organizational change. Guided by Solberg's conceptual framework for practice improvement, which argues for shared prioritization of improvement and change, we describe strategies for obtaining organizational buy-in to and whole-staff engagement of PCMH transformation and practice improvement. METHODS Semistructured interviews with 136 individuals and 7 focus groups involving 48 individuals were conducted in 20 small-to mid-sized medical practices in Pennsylvania during the first regional rollout of a statewide PCMH initiative. For this study, we analyzed interview transcripts, monthly narrative reports, and observer notes from site visits to identify discourse pertaining to organizational buy-in and strategies for securing buy-in from personnel. Using a consensual qualitative research approach, data were reduced, synthesized, and managed using qualitative data management and analysis software. RESULTS We identified 13 distinct strategies used to obtain practice buy-in, reflecting 3 overarching lessons that facilitate practice buy-in: (1) effective communication and internal PCMH campaigns, (2) effective resource utilization, and (3) creation of a team environment. CONCLUSION Our study provides a list of strategies useful for facilitating PCMH transformation in primary care. These strategies can be investigated empirically in future research, used to guide medical practices undergoing or considering PCMH transformation, and used to inform health care policy makers. Our study findings also extend Solberg's conceptual framework for practice improvement to include buy-in as a necessary condition across all elements of the change process.
This paper argues for a need to expand investigation of transformative learning theory to include... more This paper argues for a need to expand investigation of transformative learning theory to include consideration of transformative learning processes, practices and outcomes that do not follow a ‘positive’ direction but traverse a wide band of possibilities.
I n 2008, the Commonwealth of Pennsylvania began a statewide chronic care initiative to adopt the... more I n 2008, the Commonwealth of Pennsylvania began a statewide chronic care initiative to adopt the patient-centered medical home (PCMH). The initial target disease was diabetes. Our research team, comprising experts in medicine, communication, social work, and practice facilitation, studied 25 practices in the first region of the state to begin the program. All the practices participated in a regional learning collaborative, were recognized as PCMHs by the National Committee on Quality Assurance (NCQA), 1 and received supplemental payments from six area insurers to support their transformation. Overall, practices achieved better clinical quality for diabetes care with an increase in the percentage of patients meeting evidence-based goals. 2 For example, the percentage of patients with hemoglobin A1C levels above 9 declined from 30.7 percent at the start of the initiative to 28.2 percent one year later. Cholesterolfighting efforts had the biggest impact with the percentage of patients with LDL levels under 130 rising 8.5 percent during the year.
Worldwide, there are new public health threats due to urbanization, climate change, demographic s... more Worldwide, there are new public health threats due to urbanization, climate change, demographic shifts, globalization, and political climates. At the same time, the global public health workforce may be ill-equipped to manage these threats. The current global health academic landscape in high income countries (HICs), has seen expansive growth in developing undergraduate and graduate learning opportunities aimed to provide short-term immersion in low and middle income countries [(LMICs) Jogerst et al. 2015; Panosian and Coates 2006]. There are many well-documented benefits to global health educational partnerships between the global north and global south and university linkages are a major avenue for these collaborations. For universities or host institutions in the global
Worldwide, there are new public health threats due to urbanization, climate change, demographic s... more Worldwide, there are new public health threats due to urbanization, climate change, demographic shifts, globalization, and political climates. At the same time, the global public health workforce may be ill-equipped to manage these threats. The current global health academic landscape in high income countries (HICs), has seen expansive growth in developing undergraduate and graduate learning opportunities aimed to provide short-term immersion in low and middle income countries [(LMICs) Jogerst et al. 2015; Panosian and Coates 2006]. There are many well-documented benefits to global health educational partnerships between the global north and global south and university linkages are a major avenue for these collaborations. For universities or host institutions in the global
Opportunities to study and practice health-related professions internationally offer transformati... more Opportunities to study and practice health-related professions internationally offer transformative benefits for patients, educators, and students. Institutions and educators should model ethical behavior and set examples for global health trainees. Toward this end, it is imperative that universities engaging in international immersion experiences ensure that principles of respect, beneficence, and justice are upheld. Case A medical school in the United States has recently started advertising what it calls a "global health immersion" program to prospective applicants. The program partners with a free clinic in a South American country and is tremendously popular, often regarded by students as one of the best experiences of their medical school careers and as one of the College of Medicine's best experiential learning offerings.
Through voluntary or forced migration, families enter the United States as refugees, asylum seeke... more Through voluntary or forced migration, families enter the United States as refugees, asylum seekers, documented or undocumented immigrants, students or temporary or skilled workers. They bring children or give birth to children who become citizens by virtue of having been born in the new homeland. Inevitably, some of these families will interact with public child welfare systems. Children are placed in foster care when parents die, are incarcerated, institutionalised, or abandon or neglect their children. When evaluating placement decisions for these children, child welfare workers usually overlook the resources of family members outside of the country. Grandparents and other close kin often have the ability and motivation to provide care for vulnerable relative children. Through case description and summary of domestic laws and international conventions, Dana Naughton and Kerry L Fay identify challenges to cross-border placements and make recommendations for further research and co...
Each year, thousands of children who cross international borders are destined for homes with adop... more Each year, thousands of children who cross international borders are destined for homes with adoptive families. For most, this journey from their homeland brings them to loving new homes where they will thrive and prosper. For others, the journey is hazardous and the destination uncertain.
This paper argues for a need to expand investigation of transformative learning theory to include... more This paper argues for a need to expand investigation of transformative learning theory to include consideration of transformative learning processes, practices and outcomes that do not follow a 'positive' direction but traverse a wide band of possibilities.
Opportunities to study and practice health-related professions internationally offer transformati... more Opportunities to study and practice health-related professions internationally offer transformative benefits for patients, educators, and students. Institutions and educators should model ethical behavior and set examples for global health trainees. Toward this end, it is imperative that universities engaging in international immersion experiences ensure that principles of respect, beneficence, and justice are upheld. Case A medical school in the United States has recently started advertising what it calls a "global health immersion" program to prospective applicants. The program partners with a free clinic in a South American country and is tremendously popular, often regarded by students as one of the best experiences of their medical school careers and as one of the College of Medicine's best experiential learning offerings.
This paper explores the international adoption experience of Dutch and Canadian adopters of U.S. ... more This paper explores the international adoption experience of Dutch and Canadian adopters of U.S. born children through the lens of adult learning, adult education and lifelong learning. I think also because we are more interested in background [U.S. history] and how things workhealthcare, the school system. I want to stay updated on what happens there and what’s happened in the past. I have looked over African American [literature], we did know about the slavery and the cotton fields and Uncle Tom’s story and stuff like that, but now you look through it with other eyes. You see it differently. (Dutch adoptive parent of U.S. African American child) Problem Statement and Study Purpose Renowned as a receiving country of international adoptees, the United States is, paradoxically, sought out by foreign families as a source of adoptable children. Over the last decade, approximately 1,500 children, mostly minority infants, have been placed in Canada, the Netherlands, Switzerland, and nume...
PURPOSE The current model of primary care in the United States limits physicians' ability to offe... more PURPOSE The current model of primary care in the United States limits physicians' ability to offer high-quality care. The patient-centered medical home (PCMH) shows promise in addressing provision of high-quality care, but achieving a PCMH practice model often requires comprehensive organizational change. Guided by Solberg's conceptual framework for practice improvement, which argues for shared prioritization of improvement and change, we describe strategies for obtaining organizational buy-in to and whole-staff engagement of PCMH transformation and practice improvement. METHODS Semistructured interviews with 136 individuals and 7 focus groups involving 48 individuals were conducted in 20 small-to mid-sized medical practices in Pennsylvania during the first regional rollout of a statewide PCMH initiative. For this study, we analyzed interview transcripts, monthly narrative reports, and observer notes from site visits to identify discourse pertaining to organizational buy-in and strategies for securing buy-in from personnel. Using a consensual qualitative research approach, data were reduced, synthesized, and managed using qualitative data management and analysis software. RESULTS We identified 13 distinct strategies used to obtain practice buy-in, reflecting 3 overarching lessons that facilitate practice buy-in: (1) effective communication and internal PCMH campaigns, (2) effective resource utilization, and (3) creation of a team environment. CONCLUSION Our study provides a list of strategies useful for facilitating PCMH transformation in primary care. These strategies can be investigated empirically in future research, used to guide medical practices undergoing or considering PCMH transformation, and used to inform health care policy makers. Our study findings also extend Solberg's conceptual framework for practice improvement to include buy-in as a necessary condition across all elements of the change process.
This paper argues for a need to expand investigation of transformative learning theory to include... more This paper argues for a need to expand investigation of transformative learning theory to include consideration of transformative learning processes, practices and outcomes that do not follow a ‘positive’ direction but traverse a wide band of possibilities.
I n 2008, the Commonwealth of Pennsylvania began a statewide chronic care initiative to adopt the... more I n 2008, the Commonwealth of Pennsylvania began a statewide chronic care initiative to adopt the patient-centered medical home (PCMH). The initial target disease was diabetes. Our research team, comprising experts in medicine, communication, social work, and practice facilitation, studied 25 practices in the first region of the state to begin the program. All the practices participated in a regional learning collaborative, were recognized as PCMHs by the National Committee on Quality Assurance (NCQA), 1 and received supplemental payments from six area insurers to support their transformation. Overall, practices achieved better clinical quality for diabetes care with an increase in the percentage of patients meeting evidence-based goals. 2 For example, the percentage of patients with hemoglobin A1C levels above 9 declined from 30.7 percent at the start of the initiative to 28.2 percent one year later. Cholesterolfighting efforts had the biggest impact with the percentage of patients with LDL levels under 130 rising 8.5 percent during the year.
Worldwide, there are new public health threats due to urbanization, climate change, demographic s... more Worldwide, there are new public health threats due to urbanization, climate change, demographic shifts, globalization, and political climates. At the same time, the global public health workforce may be ill-equipped to manage these threats. The current global health academic landscape in high income countries (HICs), has seen expansive growth in developing undergraduate and graduate learning opportunities aimed to provide short-term immersion in low and middle income countries [(LMICs) Jogerst et al. 2015; Panosian and Coates 2006]. There are many well-documented benefits to global health educational partnerships between the global north and global south and university linkages are a major avenue for these collaborations. For universities or host institutions in the global
Worldwide, there are new public health threats due to urbanization, climate change, demographic s... more Worldwide, there are new public health threats due to urbanization, climate change, demographic shifts, globalization, and political climates. At the same time, the global public health workforce may be ill-equipped to manage these threats. The current global health academic landscape in high income countries (HICs), has seen expansive growth in developing undergraduate and graduate learning opportunities aimed to provide short-term immersion in low and middle income countries [(LMICs) Jogerst et al. 2015; Panosian and Coates 2006]. There are many well-documented benefits to global health educational partnerships between the global north and global south and university linkages are a major avenue for these collaborations. For universities or host institutions in the global
Opportunities to study and practice health-related professions internationally offer transformati... more Opportunities to study and practice health-related professions internationally offer transformative benefits for patients, educators, and students. Institutions and educators should model ethical behavior and set examples for global health trainees. Toward this end, it is imperative that universities engaging in international immersion experiences ensure that principles of respect, beneficence, and justice are upheld. Case A medical school in the United States has recently started advertising what it calls a "global health immersion" program to prospective applicants. The program partners with a free clinic in a South American country and is tremendously popular, often regarded by students as one of the best experiences of their medical school careers and as one of the College of Medicine's best experiential learning offerings.
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