Employment Outcomes of a Distance Learning System for Formerly Incarcerated Veterans With Mental Illness.

OBJECTIVE: People with previous incarceration and a mental disorder, a substance use disorder, or both are less likely to obtain employment than are those without these characteristics. Distance learning and education (DLE) systems are increasingly being integrated into clinical care and provide a pathway to disseminate vocational services. DLE systems can help reach people with barriers to accessing services, including people without transportation, experiencing homelessness, living in rural areas, or who are homebound. This study evaluated the effectiveness of one DLE system, the COMPASS program, in assisting formerly incarcerated veterans with a mental or substance use disorder to obtain employment. METHODS: The authors used a randomized controlled trial to compare employment outcomes of 39 U.S. veterans receiving the COMPASS intervention with those of 43 veterans receiving a paper self-study vocational manual. All participants had previous legal convictions and had a mental disorder, a substance use disorder, or both. The COMPASS system provided vocational services through asynchronous (online practice assignments, reading, and videos) and synchronous (video and telephone practice interviews and live chats) methods. No in-person vocational services were provided in the COMPASS intervention. RESULTS: At 6 months, participants assigned to receive the COMPASS intervention were more likely to have found employment, defined as 1 day of competitive employment, compared with those assigned to receive the self-study manual (64% vs. 35%, respectively)-and to have found employment faster. CONCLUSIONS: This study's findings provide evidence for the effectiveness of the COMPASS system in providing employment services and suggest that these services may benefit other vulnerable populations.

Development and evaluation of an online vocational program for veterans with legal convictions and psychiatric illness.

PURPOSE: We describe the development and pilot evaluation of an online vocational rehabilitation program, the About Face Online System (AFOS), for veterans with a history of felony convictions and either mental illness and/or substance use disorders. METHOD: Phase One was the development and acceptability testing of the online system. Phase Two was a small, randomized trial comparing the likelihood of obtaining employment among people using the AFOS, compared to people receiving a self-directed hardcopy manual, after 6 months. RESULTS: In Phase One, 17 veterans provided feedback as the system was being developed. The final system allows veterans to receive education on vocational reintegration skills, watch short videos describing the techniques, and communicate with a vocational staff member via chat features. Veterans found the AFOS to be as acceptable as a hardcopy manual that covered similar material. In Phase Two, 38 veterans with a history of felony convictions and either mental illness or substance use disorder were randomized to receive the AFOS or a hardcopy manual. After 6 months, people randomized to the AFOS were more likely to obtain employment than people randomized to the hardcopy manual. CONCLUSION: An online vocational program may help veterans who cannot attend traditional in-person vocational services to successfully obtain employment.

When Seeing is Believing: A Framework for Reflective Conversations in Remote and Face-to-Face Coaching Approaches.

Reflective conversations between teachers and coaches are critical to helping teachers improve their classroom instruction. Coaches who encourage teachers to "see, think, and do" are better able to facilitate meaningful reflective conversations with teachers. The "See, Think, Do" framework consists of six steps (observe, describe, process, analyze, draw conclusions, and plan) that can be used to help coaches engage in reflective conversations with teachers. The framework can be readily implemented in remote and face-to-face coaching modalities and in one-on-one and small group delivery formats. Suggestions and strategies for implementing the framework in ongoing coach-teacher conversations are provided.

"Doing What I can, but I got no Magic Wand:" A Snapshot of Early Childhood Educator Experiences and Efforts to Ensure Quality During the COVID-19 Pandemic.

The COVID-19 pandemic impacted early childhood programs serving infants, toddlers, and preschoolers in dramatic ways. After temporarily closing, many educators quickly adapted their procedures to ensure children's safety as they reopened to provide childcare for essential workers and then the community at large. This manuscript reports on statewide efforts to continue quality improvement initiatives for early childhood programs amidst the COVID-19 pandemic. We first describe the impacts of the COVID-19 pandemic for over 2000 educators-teachers, administrators, and specialists-who completed surveys in the Spring and Fall of 2020. These survey data come from a statewide system called the Texas Early Childhood Professional Development System (TECPDS), designed to track the professional development needs/progress of early childhood educators. Second, we describe an example of how a statewide professional development and quality improvement program shifted to remote delivery during the pandemic. As an increasing number of educators turn to virtual training resources, we explain lessons learned from these response efforts and how they can inform future virtual professional development efforts, even amidst crisis, to ensure that a focus on quality improvement continues while supporting teachers' individual needs.

The association between time incarcerated and employment success: Comparing traditional vocational services with a hybrid supported employment program for veterans.

Objective : This study evaluates the effects of time incarcerated on employment outcomes between a manualized vocational program, the About Face Vocational Program (AFVP), and a hybrid program of the AFVP and Individualized Placement and Support, Supported Employment (AFVP + IPS-SE). Method : Eighty-four veterans with the histories of felony convictions and a mental illness or a substance use disorder were randomly assigned to the AFVP or AFVP + IPS-SE conditions and followed for 6 months. The associations between time to employment and months incarcerated were evaluated using nonparametric tests. Findings : The number of months incarcerated was positively associated with time to employment in the hybrid AFVP + IPS-SE condition but not the AFVP condition. In addition, significant differences were found between employment rates of the groups at lower number of months incarcerated, with higher rates of employment in the hybrid AFVP + IPS-SE condition, becoming similar as months incarcerated increased. Conclusion and Implications for Practice : Number of months incarcerated may have a deleterious effect on employment rates when using IPS-SE. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Individualized Placement and Support Supported Employment for Justice-involved Homeless and Unemployed Veterans.

BACKGROUND: Homelessness is a significant issue affecting the general US population. Two subsets of the population overrepresented in the US homeless population are justice involved individuals and Veterans. However, relatively little research has addressed alleviating homelessness in justice-involved Veterans (JIV). One direction for addressing homelessness in this population is facilitating employment. OBJECTIVE: This study examined differences in housing and employment outcomes between homeless JIV enrolled in 2 different vocational rehabilitation conditions. METHODS: This study evaluates vocational outcomes of Veterans experiencing homelessness enrolled in a larger US Department of Veterans Affairs-funded study. Participants were randomized into 2 groups: those who participated in a job search group, the About Face Vocational Program (AFVP) and those who received AFVP plus Individualized Placement and Support, Supported Employment (AFVP+IPS-SE). RESULTS: Participants who received supported employment plus group were significantly more likely to secure employment compared with group alone. This significant difference was also found in individuals who identified as chronically homeless. Furthermore, participants who secured employment were significantly more likely to exit homelessness and secure housing, suggesting group membership had an indirect effect on housing status though improved employment outcomes. CONCLUSIONS: Vocational rehabilitation groups combined with supported employment is appropriate and effective for homeless, JIV seeking employment and may also improve downstream housing outcomes.

Substance Use Rates of Veterans with Depression Leaving Incarceration: A Matched Sample Comparison with General Veterans.

Formerly incarcerated military veterans-comprising approximately 8% of the prison population-experience significant barriers to reentry including homelessness, mental illness, and mortality. One of the most consequential barriers is relapsing into substance use. Most justice-involved veterans (JIV) possess histories of substance abuse before imprisonment, and this rate continues upon release. Mental illness-depression in particular-is often comorbid with substance abuse. With high rates of depression and substance use in a JIV population, it is important to determine to what extent release from prison contributes to predicting substance use and negative clinical outcomes. This study compares rates of substance use and negative outcomes between two matched samples of JIV and general veterans, both with depression and a substance use disorder. It is hypothesized that JIV will have a higher rate of substance use and that use will be associated with higher negative outcomes in the JIV condition. Rates of use of veterans released from prison and general veterans were collected during six-year follow-up periods. Use was defined as the use of an illicit substance or alcohol, if an alcohol use disorder was present, and determined by urine drug tests or self-report recorded in medical notes. Results indicate that JIV used substances at a higher rate compared to those not recently incarcerated, and that such use is predictive of several other negative outcomes including homelessness, use of inpatient substance treatment, and reincarceration. Structured drug treatment programs and other interventions should cater to veterans recently released from prison to offer help in these areas.

Blending Traditional Vocational Services and Individualized Placement and Support for Formerly Incarcerated Veterans.

OBJECTIVE: This study compared two vocational programs: the About Face Vocational Program (AFVP), a traditional group-based vocational program created for formerly incarcerated veterans, and a hybrid program combining the AFVP with principles of individual placement and support-supported employment. METHODS: The study evaluated 111 veterans with at least one felony conviction who had a mental illness, substance use disorder, or both. Veterans were randomly assigned to either vocational condition. RESULTS: Veterans in the hybrid condition, compared with the AFVP alone, were more likely to find employment, had higher rates of full-time employment, and earned significantly more money over the course of the study. A comparison of only participants who found employment showed higher rates of full-time employment for veterans in the hybrid condition but similarities between the two groups in other measures of employment success. CONCLUSIONS: Blended models of vocational services for veterans with mental illness, substance use disorders, or both are effective at returning formerly incarcerated veterans to competitive employment.

Paternal mosaicism for a novel PBX1 mutation associated with recurrent perinatal death: Phenotypic expansion of the PBX1-related syndrome.

Autosomal dominant (de novo) mutations in PBX1 are known to cause congenital abnormalities of the kidney and urinary tract (CAKUT), with or without extra-renal abnormalities. Using trio exome sequencing, we identified a PBX1 p.(Arg107Trp) mutation in a deceased one-day-old neonate presenting with CAKUT, asplenia, and severe bilateral diaphragmatic thinning and eventration. Further investigation by droplet digital PCR revealed that the mutation had occurred post-zygotically in the father, with different variant allele frequencies of the mosaic PBX1 mutation in blood (10%) and sperm (20%). Interestingly, the father had subclinical hydronephrosis in childhood. With an expected recurrence risk of one in five, chorionic villus sampling and prenatal diagnosis for the PBX1 mutation identified recurrence in a subsequent pregnancy. The family opted to continue the pregnancy and the second affected sibling was stillborn at 35 weeks, presenting with similar severe bilateral diaphragmatic eventration, microsplenia, and complete sex reversal (46, XY female). This study highlights the importance of follow-up studies for presumed de novo and low-level mosaic variants and broadens the phenotypic spectrum of developmental abnormalities caused by PBX1 mutations.

Tracheobronchial calcification on bronchoscopy in a patient with end stage renal failure: an unusual cause of chronic cough.

Pulmonary calcification can develop as a complication of end-stage renal failure. Most patients are asymptomatic, with characteristic parenchymal changes incidentally detected on computed tomography (CT) imaging and a clinical course that is usually benign. In this report, we describe a 64-year-old female with a history of inadequate peritoneal dialysis who presented with severe chronic cough, a symptom that persisted despite treatment for respiratory tract infection. On follow-up bronchoscopic examination, white nodular tracheobronchial mucosal changes persisted. The presence of calcium deposits within these nodules was histologically confirmed, although CT imaging had not suggested the presence of calcific tracheobronchial changes. We believe that the bronchoscopic findings represent a highly unusual presentation of metastatic pulmonary calcification and an uncommon cause of chronic cough amongst patients with end-stage renal failure.

The association between time incarcerated and the search for employment in a veteran sample with substance use disorders.

OBJECTIVE: Incarceration and substance use disorders/mental illness can have a significant negative impact on finding employment. However, it is unclear in what phase of the search for employment, that is, applying for jobs, obtaining interviews, being offered employment, does time incarcerated have the most effect. This study will determine how time incarcerated in the past 10 years is associated with negative job search process outcomes. METHOD: This study evaluates 84 (81 men and 3 women) veterans with substance use disorders and histories of felony convictions. Four path analyses were conducted to evaluate models that incorporated time incarcerated at the different phases. RESULTS: The superior model incorporated time incarcerated negatively affecting the number of interviews obtained. Models that assessed the association between time incarcerated with applications submitted and likelihood of being offered employment did not demonstrate adequate goodness-of-fit. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Overall, the findings demonstrate the ex-offenders enrolled exhibited similar effort in searching for employment across time incarcerated. Also, employers are equally likely to hire those with felony histories, regardless of the time incarcerated, once the applicant has been met and interviewed. The results highlight the need for services focusing on breaking down stigma and reducing barriers that screen out ex-offenders from being interviewed by employers. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Vocational rehabilitation for veterans with felony histories and mental illness: 12-month outcomes.

Lack of employment is an important barrier to successful reintegration encountered by those released from prison with mental illnesses and/or substance use disorders. This study compares 3 different vocational reintegration modalities for a veteran population: (a) basic services; (b) self-study using the About Face Vocational Manual; and (c) the About Face Vocational Program, a standardized group program focused on the About Face Vocational Manual. One-hundred eleven veterans with a history of at least one felony conviction and a mental illness and/or substance use disorder were recruited from a large urban Veterans Affairs (VA) medical center. Veterans were assigned to 1 of the 3 conditions and followed for 12 months. At the end of the 1-year follow-up period, veterans in the group condition had superior competitive and stable employment rates, as well as faster times to employment compared with both the basic and self-study conditions. The self-study condition was generally indistinguishable from the basic services condition. Overall, new employment during the last 6 months of the follow-up period was relatively low. The findings support the use of standardized group vocational reintegration programs such as the About Face Vocational Program. Limitations and implications are discussed. (PsycINFO Database Record

Recurrent chronic histiocytic intervillositis with intrauterine growth restriction, osteopenia, and fractures.

Chronic histiocytic intervillositis (CHI) is characterized by the presence of histiocytes within the intervillous space of the placenta. The pathogenesis is unclear but available evidence supports an alloimmune mechanism on the basis of the presence in maternal blood of HLA antibodies directed against paternal HLA antigens. CHI has a high risk of recurrence and of abnormal perinatal outcomes. Little is known about the effects of CHI on the developing fetus, in particular on the growth and development of the skeleton. We have studied a woman whose third pregnancy was terminated after ultrasonography showed severe intrauterine growth restriction, raising the possibility of a lethal skeletal dysplasia. Postmortem radiographs showed multiple fractures and other signs of osteogenesis imperfecta (OI). However, bone histology was not typical of OI and no abnormalities were identified by sequencing OI genes. The subsequent pregnancy was also severely growth restricted and was terminated. The placenta showed chronic histiocytic intervillositis, which, on retrospective review, had also been present in her second and third pregnancies. Her fifth pregnancy was again associated with intrauterine growth restriction and CHI but resulted in a premature birth. CHI can be associated with radiographic features that mimic OI and should be considered when fetal fractures occur in the context of recurrent miscarriage, fetal death in utero, and intrauterine growth restriction. The correct diagnosis can be made by histopathology of the placenta, supported by bone histology and normal results of molecular studies for OI. © 2016 Wiley Periodicals, Inc.

Incorporating Individualized Placement and Support Principles Into Vocational Rehabilitation for Formerly Incarcerated Veterans.

OBJECTIVE: This study evaluated the six-month outcomes of incorporating the principles of supported employment, specifically Individual Placement and Support (IPS), into the About Face program, an existing standardized group-based vocational program for previously incarcerated veterans. METHODS: Participants (N=84) with a history of at least one felony conviction and a substance use disorder (88%) or mental illness or combination (59%) were recruited from a large urban veterans hospital. Veterans were randomly assigned to either the About Face program (AF) or to that program plus a modification of IPS (AF+IPS). Veterans were followed for six months. Employment outcomes, including time to employment, hours worked, and income earned, were evaluated with survival analyses and nonparametric tests. RESULTS: Rates of employment over the follow-up period were significantly higher for those receiving AF+IPS, with 21 of 46 (46%) finding employment, compared with only eight of 38 (21%) who received AF alone. As a group, those receiving AF+IPS worked more hours and earned more wages than those receiving AF alone. CONCLUSIONS: Incorporating many of the principles and techniques of IPS into an existing vocational program was associated with improved employment outcomes over the six-month follow-up period and should be considered a viable rehabilitation option when working with this vulnerable population.

First human case of fatal Halicephalobus gingivalis meningoencephalitis in Australia.

Halicephalobus gingivalis (previously Micronema deletrix) is a free-living nematode known to cause opportunistic infections, mainly in horses. Human infections are very rare, but all cases described to date involved fatal meningoencephalitis. Here we report the first case of H. gingivalis infection in an Australian human patient, confirmed by nematode morphology and sequencing of ribosomal DNA. The implications of this case are discussed, particularly, the need to evaluate real-time PCR as a diagnostic tool.

Identification of a novel MYOC mutation, p.(Trp373), in a family with open angle glaucoma.

MYOC gene variants are associated with autosomal dominant primary open angle glaucoma (POAG). In this study, we describe a previously unreported MYOC variant segregating with a POAG phenotype in an Australian family. Two individuals affected with POAG and three unaffected individuals from the same family were recruited through the Australian and New Zealand Registry of Advanced Glaucoma (ANZRAG). Direct sequencing of all MYOC coding exons identified the novel heterozygous single nucleotide transition MYOC:c.1119G>A, p.(Trp373), predicted to encode an aberrant truncated MYOC protein in two affected siblings. Two unaffected siblings and an unaffected niece were negative for the MYOC sequence variant.

"My Baby & Me": effects of an early, comprehensive parenting intervention on at-risk mothers and their children.

This study examined the efficacy of a multimodule parenting intervention, "My Baby & Me," that began prenatally and continued until children reached 2.5 years of age. The intervention targeted specific parenting skills designed to alter trajectories of maternal and child development. Of 361 high-risk mothers (193 adolescents, 168 adults) enrolled across 4 states, half were randomly assigned to the high-intensity (HI) home visitation coaching program (55 sessions), and half to a low-intensity (LI) condition that included monthly phone calls from a coach, printed informational materials, and community resource referrals. Videotaped observations of mother-child play were coded at 5 time points for multiple maternal and child behaviors and skills. Compared to mothers in the LI group, mothers in the HI group showed higher levels of contingent responsiveness, higher quality verbal stimulation, and more verbal scaffolding by 30 months, with higher levels of warmth and greater decreases in physical intrusiveness and negativity when their children were 24 months. By 30 months, children in the HI group showed more rapid increases and higher levels of engagement with the environment, expressive language skills, and social engagement, as well as more complex toy play and fewer problem behaviors than those in the LI group. Gains in maternal responsive behaviors mediated the effects of the intervention on child outcomes. Results were comparable for adolescent and adult mothers. A strong theoretical framework, consistent focus on maternal responsiveness, high dosage, and trusting relationships with coaches are thought to explain the positive outcomes.

Enhancing early child care quality and learning for toddlers at risk: the responsive early childhood program.

Despite reports of positive effects of high-quality child care, few experimental studies have examined the process of improving low-quality center-based care for toddler-age children. In this article, we report intervention effects on child care teachers' behaviors and children's social, emotional, behavioral, early literacy, language, and math outcomes as well as the teacher-child relationship. The intervention targeted the use of a set of responsive teacher practices, derived from attachment and sociocultural theories, and a comprehensive curriculum. Sixty-five childcare classrooms serving low-income 2- and 3-year-old children were randomized into 3 conditions: business-as-usual control, Responsive Early Childhood Curriculum (RECC), and RECC plus explicit social-emotional classroom activities (RECC+). Classroom observations showed greater gains for RECC and RECC+ teachers' responsive practices including helping children manage their behavior, establishing a predictable schedule, and use of cognitively stimulating activities (e.g., shared book reading) compared with controls; however, teacher behaviors did not differ for focal areas such as sensitivity and positive discipline supports. Child assessments demonstrated that children in the interventions outperformed controls in areas of social and emotional development, although children's performance in control and intervention groups was similar for cognitive skills (language, literacy, and math). Results support the positive impact of responsive teachers and environments providing appropriate support for toddlers' social and emotional development. Possible explanations for the absence of systematic differences in children's cognitive skills are considered, including implications for practice and future research targeting low-income toddlers.

Initial validation of the prekindergarten Classroom Observation Tool and goal setting system for data-based coaching.

Although coaching is a popular approach for enhancing the quality of Tier 1 instruction, limited research has addressed observational measures specifically designed to focus coaching on evidence-based practices. This study explains the development of the prekindergarten (pre-k) Classroom Observation Tool (COT) designed for use in a data-based coaching model. We examined psychometric characteristics of the COT and explored how coaches and teachers used the COT goal-setting system. The study included 193 coaches working with 3,909 pre-k teachers in a statewide professional development program. Classrooms served 3 and 4 year olds (n = 56,390) enrolled mostly in Title I, Head Start, and other need-based pre-k programs. Coaches used the COT during a 2-hr observation at the beginning of the academic year. Teachers collected progress-monitoring data on children's language, literacy, and math outcomes three times during the year. Results indicated a theoretically supported eight-factor structure of the COT across language, literacy, and math instructional domains. Overall interrater reliability among coaches was good (.75). Although correlations with an established teacher observation measure were small, significant positive relations between COT scores and children's literacy outcomes indicate promising predictive validity. Patterns of goal-setting behaviors indicate teachers and coaches set an average of 43.17 goals during the academic year, and coaches reported that 80.62% of goals were met. Both coaches and teachers reported the COT was a helpful measure for enhancing quality of Tier 1 instruction. Limitations of the current study and implications for research and data-based coaching efforts are discussed.

Higher prevalence of myocilin mutations in advanced glaucoma in comparison with less advanced disease in an Australasian disease registry.

OBJECTIVES: To determine the proportion of all Myocilin coding mutations responsible for advanced primary open-angle glaucoma (POAG) in early-age-at-onset individuals and to investigate the prevalence of exon 3 Myocilin mutations in advanced POAG at any age at onset in a large Australasian cohort. DESIGN: Cross-sectional study using a national disease registry. PARTICIPANTS: One thousand sixty individuals with advanced POAG (103 with age at onset of 40 years or younger) and 320 with nonadvanced POAG all recruited by the Australian and New Zealand Registry of Advanced Glaucoma. METHODS: Participants were examined and referred by their eye practitioner, and Myocilin genetic testing was performed by direct sequencing. Cascade genetic testing was made available for relatives of participants found to carry a Myocilin mutation. MAIN OUTCOME MEASURES: Advanced glaucoma diagnosis based on strict visual field entry criteria. Prevalence and spectrum of Myocilin mutations in individuals with advanced and nonadvanced POAG. RESULTS: This is the first study to report Myocilin mutations in an advanced POAG cohort. No pathogenic Myocilin mutations were identified in exons 1 and 2 in early-age-at-onset advanced POAG cases. Exon 3 Myocilin mutations were identified in 45 advanced POAG patients (4.2%), which is significantly higher (P = 0.02) compared with nonadvanced POAG patients (1.6%). A novel mutation (Trp373X) and a new variant of uncertain pathogenicity (Ala447Thr) also were reported. The prevalence of Myocilin mutations rose from 16% to 40% in selected advanced POAG subgroups based on different thresholds of maximum recorded intraocular pressure, age at diagnosis, and the presence and strength of positive family history. Twenty-six individuals with Myocilin mutations were identified through cascade genetic testing of first-degree relatives of affected mutation carriers. CONCLUSIONS: The prevalence of Myocilin mutations in glaucoma cases with severe visual field loss is significantly greater than in nonadvanced glaucoma patients. Myocilin screening in phenotypically selected cases can have a much higher yield than in previous unselected series. Identifying individuals who have Myocilin mutations provides an opportunity to screen at-risk clinically unaffected relatives and to reduce glaucoma blindness through early management and intervention. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.